"Kada ku taba shakka cewa ƙaramin rukuni na masu tunani, ƴan ƙasa masu sadaukarwa na iya canza duniya.Hasali ma, ita kaɗai a wurin.”
Manufar Cureus ita ce ta canza tsarin wallafe-wallafen likita wanda ya daɗe, wanda ƙaddamar da bincike zai iya zama tsada, rikitarwa, da cin lokaci.
Cikakken kauri mucoperiosteal m, mop, piezotomy, corticotomy, lllt, prostaglandin, hanzarin motsin hakori, orthodontic, mara tiyata, tiyata
Doaa Tahsin Alfaylani, Mohammad Y. Hajir, Ahmad S. Burhan, Luai Mahahini, Khaldun Darwich, Ossama Aljabban
Rubuta wannan labarin kamar: Alfailany D, Hajeer MY, Burhan AS, et al.(Mayu 27, 2022) Yin la'akari da tasiri na aikin tiyata da marasa aikin tiyata lokacin da aka yi amfani da su tare da masu riƙewa don haɓaka motsin haƙori na orthodontic: nazari na yau da kullum.Magani 14(5): e25381.doi:10.7759/cureus.25381
Manufar wannan bita ita ce kimanta shaidar da ake da ita a halin yanzu don tasiri na hanyoyin gaggawa na tiyata da marasa tiyata da kuma illolin da ke tattare da waɗannan hanyoyin.An bincika rumbun adana bayanai tara: Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE®, Scopus®, PubMed®, Web of Science™, Google™ Scholar, Tafiya, OpenGrey da PQDT OPEN na pro-Quest®.ClinicalTrials.gov da tashar bincike na International Clinical Trials Registry Platform (ICTRP) an sake duba su don duba binciken na yanzu da wallafe-wallafen da ba a buga ba.Gwaje-gwajen da bazuwar bazuwar (RCTs) da gwajin gwaji na asibiti (CCTs) na marasa lafiya da ke yin aikin tiyata (masu ɓarna ko ƙarancin ɓarna) a hade tare da na'urori masu ƙayyadaddun al'ada kuma idan aka kwatanta da ayyukan da ba na tiyata ba.An yi amfani da kayan aikin Cochrane Risk of Bias (RoB.2) don tantance RCTs, yayin da ROBINS-I kayan aiki aka yi amfani da CCT.
RCTs hudu da CCTs guda biyu (154 marasa lafiya) an haɗa su a cikin wannan bita na yau da kullun.Gwaji guda hudu sun gano cewa aikin tiyata da marasa tiyata suna da tasiri iri ɗaya akan haɓaka motsin hakori na orthodontic (OTM).Sabanin haka, tiyata ya fi tasiri a cikin sauran karatun biyu.Matsayi mai girma na iri-iri a cikin binciken da aka haɗa ya hana ƙididdige ƙididdiga na sakamako.Abubuwan da aka ruwaito masu alaƙa da aikin tiyata da marasa tiyata sun kasance iri ɗaya.
Akwai 'ƙasa sosai' zuwa 'ƙananan' shaidar cewa ayyukan tiyata da marasa tiyata sun yi tasiri daidai a cikin hanzarin motsin haƙori na orthodontic ba tare da bambanci a cikin illa ba.Ana buƙatar ƙarin ingantattun gwaje-gwaje na asibiti don kwatanta tasirin haɓakar hanyoyin biyu a cikin nau'ikan ɓarna iri-iri.
Tsawon lokacin jiyya don kowane tsoma baki na orthodontic yana ɗaya daga cikin mahimman abubuwan da marasa lafiya ke la'akari yayin yanke shawara [1].Misali, ja da baya na manyan canines da aka danne bayan an cire premolars na sama na iya ɗaukar kimanin watanni 7, yayin da ƙimar motsin haƙoran bioorthodontic (OTM) kusan 1 mm a kowane wata, yana haifar da jimlar lokacin jiyya na kusan shekaru biyu [2, 3]. ] .Pain, rashin jin daɗi, caries, gingival koma bayan tattalin arziki da tushen resorption su ne illa masu illa waɗanda ke ƙara tsawon lokacin jiyya na orthodontic [4].Bugu da ƙari, kyawawan dalilai da dalilai na zamantakewa suna sa marasa lafiya da yawa su buƙaci gaggawar kammala maganin orthodontic [5].Saboda haka, duka likitocin kothodontists da marasa lafiya suna neman hanzarta motsin hakora da rage lokacin jiyya [6].
Hanyar da ake haɓaka motsi na hakora ya dogara ne akan kunna halayen ƙwayoyin halitta.Dangane da matakin cin zarafi, waɗannan hanyoyin za a iya raba su zuwa ƙungiyoyi biyu: masu ra'ayin mazan jiya (hanyoyin halitta, na zahiri, da na biomechanical) da hanyoyin tiyata [7].
Hanyoyin ilimin halitta sun haɗa da amfani da magunguna don ƙara yawan motsin hakori a cikin gwaje-gwajen dabba da kuma a cikin mutane.Yawancin karatu sun nuna inganci akan yawancin waɗannan abubuwa kamar cytokines, ƙwayoyin cuta na kappa-B ligand receptor activators / kwayoyin factor-kappa-B protein receptor activators (RANKL / RANK), prostaglandins, bitamin D, hormones kamar parathyroid hormone (PTH). ).) da osteocalcin, da kuma alluran wasu abubuwa kamar relaxin, basu nuna wani ingantaccen inganci ba [8].
Hanyoyi na jiki sun dogara ne akan amfani da kayan aikin na'ura, ciki har da kai tsaye [9], filayen lantarki na lantarki [10], girgiza [11], da ƙananan ƙwayar laser [12], waɗanda suka nuna sakamako mai ban sha'awa [8].].Hanyoyin tiyata ana la'akari da mafi yawan amfani da su kuma an tabbatar da asibiti kuma suna iya rage tsawon lokacin jiyya [13,14].Duk da haka, sun dogara da "Phenomenon Acceleration Phenomenon (RAP)" tun lokacin da abin da ya faru na lalacewar tiyata ga ƙashin alveolar na iya haɓaka OTM na dan lokaci [15].Wadannan ayyukan tiyata sun haɗa da corticotomy na gargajiya [16,17], interstitial alveolar kashi tiyata [18], haɓakar orthodontics osteogenic [19], jigilar alveolar [13] da traction na periodontal [20], matsawa electrotomy [14,21], cortical resection. 19].22] da microperforation [23].
Yawancin sake dubawa na tsari (SR) na gwaje-gwajen da aka bazu (RCTs) an buga su akan tasirin aikin tiyata da marasa tiyata a cikin haɓaka OTM [24,25].Duk da haka, ba a tabbatar da fifikon tiyata akan hanyoyin da ba na tiyata ba.Sabili da haka, wannan bita na tsari (SR) yana da nufin amsa tambaya mai mahimmanci na bita: Wanne ya fi tasiri wajen hanzarta motsin haƙoran haƙora yayin amfani da ƙayyadaddun kayan aikin ƙayyadaddun kayan aiki: hanyoyin tiyata ko marasa tiyata?
Da farko, an gudanar da binciken matukin jirgi akan PubMed don tabbatar da cewa babu irin wannan SRs da kuma duba duk labaran da suka shafi kafin rubuta shawarwarin SR na ƙarshe.Daga baya, an gano gwaje-gwaje biyu masu tasiri kuma an tantance su.An kammala rajistar wannan yarjejeniya ta SR a cikin bayanan PROSPERO (lambar shaida: CRD42021274312).An haɗa wannan SR daidai da Littafin Jagora na Cochrane na Binciken Tsare-tsare na Tsare-tsare na Tsare-tsare [26] da Abubuwan da aka Fi so na Rahoto na Sharuɗɗa don Binciken Tsare-tsare da Meta-Analysis (PRISMA) [27,28].
Binciken ya haɗa da marasa lafiya maza da mata masu lafiya waɗanda ke fuskantar ƙayyadaddun magani na orthodontic, ba tare da la'akari da shekaru, nau'in ɓarna, ko ƙabila ba, bisa ga Tsarin Mahalarci, Kwatancen, Sakamako, da Tsarin Nazarin (PICOS).An yi la'akari da ƙarin tiyata (masu cin zarafi ko ƙaramin ɓarna) zuwa ƙayyadaddun magani na gargajiya.Nazarin ya haɗa da marasa lafiya waɗanda suka karɓi maganin ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙwayar cuta (OT).Waɗannan ayyukan na iya haɗawa da hanyoyin magunguna (na gida ko na tsari) da kuma hanyoyin jiki (saukar hasken laser, halin yanzu na lantarki, filayen lantarki (PEMF) da rawar jiki).
Sakamakon farko na wannan ma'auni shine ƙimar motsin haƙori (RTM) ko duk wata alama mai kama da za ta iya sanar da mu game da tasirin aikin tiyata da marasa tiyata.Sakamakon na biyu ya haɗa da sakamako mara kyau kamar sakamakon da aka ba da rahoton haƙuri (zafi, rashin jin daɗi, gamsuwa, ingancin rayuwa mai alaƙa da lafiyar baki, matsalolin tauna, da sauran abubuwan gogewa), sakamakon da ke da alaƙa da nama kamar yadda aka auna ta index periodontal (PI), rikitarwa. , Gingival Index (GI), asarar abin da aka makala (AT), gingival koma bayan tattalin arziki (GR), periodontal zurfin (PD), asarar goyon baya da maras so hakora motsi (juyawa, karkatarwa, juyawa) ko iatrogenic hakori rauni irin su asarar hakori Vitality. , Tushen Resorption.Zane-zanen nazari guda biyu ne kawai aka karɓa - Randomized Sarrafa Gwaje-gwaje (RCTs) da Sarrafa Clinical Trials (CCTs), waɗanda aka rubuta cikin Ingilishi kawai, ba tare da hani kan shekarar bugawa ba.
An cire abubuwan da ke biyowa: nazari na baya-bayan nan, nazarin a cikin harsunan ban da Ingilishi, gwaje-gwajen dabba, nazarin in vitro, rahotanni ko rahotanni na shari'a, edita, labarai tare da sake dubawa da takardun farar fata, ra'ayoyin mutum, gwaji ba tare da samfurori da aka ruwaito ba, a'a. ƙungiyar kulawa, ko kasancewar ƙungiyar kulawa da ba a kula da su ba da kuma ƙungiyar gwaji tare da marasa lafiya fiye da 10 an yi nazari ta hanyar hanya mai iyaka.
An ƙirƙiri wani bincike na lantarki akan bayanan bayanai masu zuwa (Agusta 2021, ba iyaka lokaci, Turanci kawai): Cochrane Central Register of Controlled Trials, PubMed®, Scopus®, Yanar Gizo na Kimiyya™, EMBASE®, Google™ Scholar, Tafiya, OpenGrey (don gano wallafe-wallafen launin toka) da PQDT OPEN daga pro-Quest® (don gano takardu da rubuce-rubuce).An kuma bincika jerin wallafe-wallafen zaɓaɓɓun labarai don kowane gwaji mai mahimmanci wanda ƙila ba a samo shi ta hanyar binciken lantarki a Intanet ba.A lokaci guda, an gudanar da binciken hannu a cikin Journal of Angle Orthodontics, American Journal of Orthodontics da Dentofacial Orthopedics ™, European Journal of Orthodontics da Orthodontics da Craniofacial Research.Clinstttrials.gov da kuma Takaddar Lafiya na Kungiyar Kula da Kasa na Duniya (Timesungiyar Tabilar ITCP) ta shirya binciken lantarki don nemo gwaji ko a halin yanzu.Ana ba da ƙarin cikakkun bayanai kan dabarun binciken e-search a cikin Tebu 1.
RANKL: makaman nukiliya kappa-beta ligand mai kunnawa mai kunnawa;RANK: makaman nukiliya kappa-beta ligand receptor activator
Masu bita guda biyu (DTA da MYH) sun tantance cancantar binciken da kansu, kuma idan akwai rashin daidaituwa, an gayyaci marubuci na uku (LM) don yanke shawara.Mataki na farko ya ƙunshi bincika take da annotation kawai.Mataki na biyu na duk karatun shine kimanta cikakken rubutu kamar yadda ya dace da tacewa don haɗawa ko lokacin da take ko zayyanawa ba su da tabbas don taimakawa yin yanke hukunci.An cire labaran idan basu cika ɗaya ko fiye na ƙa'idodin haɗawa ba.Don ƙarin bayani ko ƙarin bayanai, da fatan za a rubuta zuwa ga marubucin.Mawallafa iri ɗaya (DTA da MYH) sun ciro bayanai da kansu daga matukin jirgi da tsararren tsararren bayanai.Lokacin da masu bitar jagororin biyu ba su yarda ba, an nemi marubuci na uku (LM) ya taimaka wajen warware su.Teburin taƙaitaccen bayani ya haɗa da abubuwa masu zuwa: cikakken bayani game da labarin (sunan marubucin, shekara ta bugawa da bayanan binciken);hanyoyin (tsarin nazari, ƙungiyar da aka tantance);mahalarta (yawan marasa lafiya da aka dauka, ma'anar shekaru da kewayon shekaru)., kasa);Tsangwama (nau'in hanya, wurin aiki, abubuwan fasaha na hanya);Halayen Orthodontic (digiri na malocclusion, nau'in motsin haƙori na orthodontic, yawan gyare-gyaren gyare-gyare, tsawon lokaci na kallo);da matakan sakamako (sakamakon farko da na biyu da aka ambata, hanyoyin aunawa, da bayar da rahoton bambance-bambance masu mahimmanci).
Masu bita guda biyu (DTA da MYH) sun tantance haɗarin rashin son zuciya ta amfani da kayan aikin RoB-2 don RCTs da aka samo [29] da ROBINS-I na CCTs [30].Idan akwai rashin jituwa, da fatan za a tuntuɓi ɗaya daga cikin mawallafa (ASB) don samun mafita.Don gwaje-gwajen da bazuwar, mun ƙididdige waɗannan yankuna a matsayin "ƙananan haɗari", "haɗari mai girma" ko "wasu matsala na son zuciya": nuna son zuciya da ke tasowa daga tsarin bazuwar, son rai saboda sabawa daga sa hannun da ake sa ran (sakamakon da aka danganta ga sa baki; sakamakon riko da shisshigi), son zuciya saboda batan bayanan sakamako, auna ma'auni, zaɓin zaɓi a cikin sakamakon rahoton.An ƙididdige haɗarin gaba ɗaya na nuna bambanci ga binciken da aka zaɓa kamar haka: "Ƙarancin haɗari na son rai" idan an ƙididdige duk yankuna "ƙananan haɗarin rashin son zuciya";"Wasu Damuwa" idan aƙalla yanki ɗaya aka ƙididdige shi azaman "Wasu Damuwa" amma ba "Haɗarin Bias a kowane yanki ba, Babban Haɗarin Bias: idan an ƙididdige aƙalla ɗaya ko fiye yanki azaman Babban Haɗarin Bias" ko wasu damuwa a kan yankuna da yawa, wanda ke rage amincewa da sakamakon.Ganin cewa, don gwaje-gwajen da ba na bazuwar ba, mun ƙididdige waɗannan yankuna a matsayin ƙananan, matsakaici, da haɗari mai girma: yayin sa baki (bangancin rarraba tsaka-tsakin);bayan shiga tsakani (rashin son rai saboda sabawa daga sa hannun da ake sa ran; son zuciya saboda rashin bayanai; sakamakon) nuna son zuciya;bayar da rahoton son zuciya a cikin zaɓin sakamako).An ƙididdige haɗarin gaba ɗaya na nuna bambanci ga binciken da aka zaɓa kamar haka: "Ƙarancin haɗari na son rai" idan an ƙididdige duk yankuna "ƙananan haɗarin rashin son zuciya";"matsakaicin haɗari na son zuciya" idan an ƙididdige duk yankuna a matsayin "ƙananan haɗari ko matsakaicin haɗari na son zuciya".son zuciya" "Mummunan kasadar son zuciya";"Mai Girma Haɗari na Bias" idan aƙalla yanki ɗaya aka ƙididdige "Haɗarin Bias" amma babu Mummunan Haɗarin Bias a kowane yanki, "Haɗarin Bias mai tsanani" idan an ƙididdige aƙalla yanki ɗaya "Haɗari mai tsanani na kuskuren tsari";an yi la'akari da binciken "bacewar bayanai" idan babu wata alamar da ke nuna cewa binciken yana da "mahimmanci ko kuma yana da haɗari mai mahimmanci" kuma ya ɓace bayanai a cikin ɗaya ko fiye da mahimman wurare na nuna bambanci.An ƙididdige amincin shaidar bisa ga tsarin Ƙididdigar Jagora, Ƙaddamarwa da Ƙaddamarwa (GRADE), tare da sakamakon da aka rarraba a matsayin babba, matsakaici, ƙananan, ko ƙananan [31].
Bayan bincike na lantarki, an gano jimillar labaran 1972 kuma ambato ɗaya kawai daga wasu kafofin.Bayan cire kwafin kwafin, an sake duba rubuce-rubucen 873.An bincika lakabi da taƙaitaccen bayani don cancanta kuma an ƙi duk wani binciken da bai cika ka'idojin cancanta ba.A sakamakon haka, an gudanar da bincike mai zurfi na takardu 11 masu yuwuwa.Gwaje-gwaje biyar da aka kammala da kuma binciken da ke gudana guda biyar ba su cika ka'idojin haɗawa ba.An ba da taƙaitaccen labarin abubuwan da aka cire bayan cikakken kima na rubutu da dalilan cirewa a cikin tebur a cikin kari.A ƙarshe, nazarin shida (RCT hudu da CCTs guda biyu) an haɗa su a cikin SR [23,32-36].An nuna zanen toshe na PRISMA a Hoto 1.
Ana nuna halayen gwaje-gwaje na shida da aka haɗa a cikin Tables 2 da 3 [23,32-36].An gano gwaji ɗaya kawai na yarjejeniya;duba Tables 4 da 5 don ƙarin bayani kan wannan aikin bincike mai gudana.
RCT: gwaji na asibiti bazuwar;NAC: sarrafawa mara hanzari;SMD: tsaga bakin zane;MOPs: perforation microosseous;LLLT: ƙananan maganin laser mai ƙarfi;CFO: orthodontics tare da corticotomy;FTMPF: cikakken kauri mucoperiosteal m;Exp: gwaji;namiji: namiji;F: mace;U3: canine na sama;ED: yawan makamashi;RTM: saurin motsin hakori;TTM: lokacin motsi hakori;CTM: jimlar motsin haƙori;PICOS: mahalarta, shisshigi, kwatancen, sakamako da ƙirar nazari
TADs: na'urar anga ta wucin gadi;RTM: saurin motsin hakori;TTM: lokacin motsi hakori;CTM: jimlar motsin haƙori;EXP: gwaji;NR: ba a ruwaito ba;U3: canine na sama;U6: babba na farko;SS: bakin karfe;NiTi: nickel-titanium;MOPs: lalatawar ƙasusuwan ƙananan ƙwayoyin cuta;LLLT: ƙananan maganin laser mai ƙarfi;CFO: orthodontics tare da corticotomy;FTMPF: Cikakken kauri na mucoperiosteal
NR: Ba a ruwaito ba;WHO ICTRP: Tashar Bincike na Platform Rajista na Gwajin gwaji na Duniya na WHO
Wannan bita ya haɗa da RCTs23,32-34 guda huɗu da aka kammala da CCTs35,36 guda biyu waɗanda suka haɗa da marasa lafiya 154.Tsawon shekaru daga 15 zuwa 29 shekaru.Ɗaya daga cikin binciken ya haɗa da marasa lafiya mata kawai [32], yayin da wani binciken ya ƙunshi mata kaɗan fiye da maza [35].Akwai mata fiye da maza a cikin binciken uku [33,34,36].Nazarin daya kawai bai samar da rarraba jinsi ba [23].
Hudu daga cikin karatun da aka haɗa sune zane-zane na tashar tashar jiragen ruwa (SMD) [33-36] kuma biyu sun kasance nau'i-nau'i (COMP) ƙira (daidai da tashar jiragen ruwa) [23,32].A cikin nazarin ƙirar ƙira, an kwatanta sashin aiki na ƙungiyar gwaji tare da bangaren marasa aiki na sauran ƙungiyoyin gwaji, kamar yadda ɓangaren ɓangaren waɗannan ƙungiyoyin ba su sami wani hanzari ba (kawai jiyya na orthodontic na al'ada) [23,32].A cikin sauran karatun guda huɗu, an yi wannan kwatancen kai tsaye ba tare da wani rukunin kulawa mara hanzari ba [33-36].
Nazarin guda biyar idan aka kwatanta aikin tiyata tare da sa baki na jiki (watau ƙananan maganin laser mai ƙarfi {LILT}), da bincike na shida idan aka kwatanta aikin tiyata tare da taimakon likita (watau prostaglandin E1).Ayyukan tiyata sun fito ne daga ɓarna a fili (na al'ada corticotomy [33-35], FTMPF cikakken kauri na mucoperiosteal flap [32]) zuwa ƙananan ɓangarorin ɓarna (ƙananan hanyoyin ɓarna {MOPs} [23] da hanyoyin piezotomy mara kyau [36]).
Duk binciken da aka samu sun haɗa da marasa lafiya da ke buƙatar ja da baya na canine bayan cirewar premolar [23,32-36].Duk waɗanda suka haɗa da marasa lafiya sun sami maganin cirewa.An cire canines bayan an cire farkon premolars na muƙamuƙi na sama.An yi hakar a farkon jiyya har sai an kammala matakin daidaitawa da daidaitawa a cikin binciken uku [23, 35, 36] da wasu uku [32-34].Binciken da aka biyo baya ya fito ne daga makonni biyu [34], watanni uku [23,36], da watanni hudu [33] don kammala ƙaddamar da canine [32,35].A cikin binciken hudu [23, 33, 35, 36], an bayyana ma'aunin motsin hakori a matsayin "Matsayin motsin hakori" (RTM), kuma a cikin binciken daya, "lokacin motsin hakori" (CTM) an bayyana shi a matsayin "motsin hakori" ."Lokaci" (TTM).) na karatu guda biyu [32,35], daya yayi nazarin ƙididdigar sRANKL [34].Nazarin biyar sun yi amfani da na'urar anka ta TAD na wucin gadi [23,32-34,36], yayin da bincike na shida yayi amfani da jujjuya tip don gyarawa [35].Dangane da hanyoyin da ake amfani da su don auna saurin haƙori, binciken ɗaya ya yi amfani da calipers na intraoral na dijital [23], binciken ɗaya ya yi amfani da fasahar ELISA don gano samfuran gingival sulcus fluid (GCF) [34], kuma binciken biyu sun kimanta amfani da simintin dijital na lantarki..ya jefa caliper [33,35], yayin da bincike biyu suka yi amfani da samfuran binciken 3D don samun ma'auni [32,36].
Ana nuna haɗarin rashin daidaituwa don haɗawa a cikin RCTs a cikin Hoto na 2, kuma ana nuna babban haɗari ga kowane yanki a cikin Hoto 3. Dukkan RCTs an ƙididdige su a matsayin suna da "wasu damuwa don nuna bambanci" [23,32-35]."Wasu damuwa game da son zuciya" shine mahimmin fasalin RCTs.Rashin son zuciya saboda sabawa daga abubuwan da ake tsammani (sakamakon shiga tsakani, tasirin shiga tsakani) sune wuraren da ake zargi (watau "wasu damuwa" sun kasance a cikin 100% na binciken hudu).Ana nuna haɗarin ƙimar ƙima don binciken CCT a cikin Hoto na 4. Waɗannan karatun suna da "ƙananan haɗarin rashin son zuciya".
Hoto dangane da bayanai daga Abdelhameed da Refai, 2018 [23], El-Ashmawi et al., 2018 [33], Sedky et al., 2019 [34], da Abdarazik et al., 2020 [32].
Yin tiyata tare da tsoma baki na jiki: Nazarin biyar idan aka kwatanta nau'ikan tiyata daban-daban tare da ƙarancin laser mai ƙarfi (LILT) don haɓaka haɓakar canine [23,32-34].El-Ashmawy et al.An kimanta tasirin "corticotomy na gargajiya" da "LLT" a cikin ɓarke ​​​​RCT [33].Game da saurin janyewar canine, babu wani bambanci mai mahimmanci tsakanin corticotomy da LILI a kowane matsayi a cikin kimantawa (ma'anar 0.23 mm, 95% CI: -0.7 zuwa 1.2, p = 0.64).
Turker et al.kimanta tasirin piezocision da LILT akan RTM a cikin tsagewar TBI [36].A cikin wata na farko, yawan jujjuyawar canine na sama a gefen LILI ya kasance a kididdiga fiye da na gefen piezocision (p = 0.002).Duk da haka, ba a sami bambanci mai mahimmanci tsakanin bangarorin biyu ba a watanni na biyu da na uku na farfadowa na canine na sama, bi da bi (p = 0.377, p = 0.667).Yin la'akari da jimlar lokacin kimantawa, tasirin LILI da Piezocisia akan OTM sun kasance daidai (p = 0.124), kodayake LILI ya fi tasiri fiye da hanyar Piezocisia a cikin watan farko.
Abdelhameed da Refai sun yi nazarin tasirin "MOPs" idan aka kwatanta da "LLLT" da "MOPs + LLLT" akan RTM a cikin ƙirar RCT [23]. Sun sami karuwa a cikin ƙimar haɓakar canine na sama a cikin ɓangarorin haɓaka ("MOPs" da "LLLT") idan aka kwatanta da bangarorin da ba a haɓaka ba, tare da bambance-bambance masu mahimmanci a duk lokutan kima (p<0.05). Sun sami karuwa a cikin ƙimar haɓakar canine na sama a cikin ɓangarorin haɓaka ("MOPs" da "LLLT") idan aka kwatanta da bangarorin da ba a haɓaka ba, tare da bambance-bambance masu mahimmanci a duk lokutan kima (p<0.05). Они обнаружили ускоренное увеличение скорости ретракции верхних клыков в боковых сторонах («MOPs», а также «LLLT») по сравнению с неускоренными боковыми ретракциями со статистически значимыми различиями во все времена оценки (p<0,05). Sun sami haɓakar haɓakawa a cikin saurin jujjuyawar gefe na canines na sama ("MOPs" da "LLLT") idan aka kwatanta da ja da baya mara sauri tare da bambance-bambance masu mahimmanci a duk lokutan kima (p<0.05).他们发现，与非加速侧相比，加速侧（“MOPs”和“LLLT Sun gano cewa, idan aka kwatanta da gefen da ba a hanzarta ba, hakoran canine na sama na gefen haɓaka ("MOPs" da "LLLT") sun karu da raguwar raguwa, kuma akwai bambanci mai mahimmanci (p <0.05) a duk lokacin kimantawa. . Они обнаружили, что ретракция верхнего клыка была выше на стороне акселерации («MOPs» и «LLLT») по сравнению со стороной без акселерации со статистически значимой разницей (p<0,05) во все оцениваемые моменты времени. Ya gano cewa raguwa na babba ya kasance mafi girma a gefe tare da hanzari ("MOPs" da "LLLT") idan aka kwatanta da gefe ba tare da haɓaka ba tare da bambancin ƙididdiga (p <0.05) a duk lokacin da aka kimanta.Idan aka kwatanta da gefen da ba a hanzari ba, an sake mayar da clavicle ta hanyar 1.6 da 1.3 sau a kan sassan "SS" da "NILT", bi da bi.Bugu da ƙari, sun kuma nuna cewa tsarin MOPs ya fi tasiri fiye da tsarin LLLT a cikin hanzari na janyewar clavicles na sama, kodayake bambancin ba shi da mahimmanci.Babban bambanci da bambance-bambance a cikin ayyukan da aka yi amfani da su tsakanin karatun da suka gabata ya hana ƙididdiga na ƙididdiga na bayanai [23,33,36].Abdalazik et al.RCI mai hannu biyu tare da ƙira mai haɗe-haɗe [32] ta kimanta tasirin babban kauri na mucoperiosteal (tsayin FMPF kawai tare da LLLT) akan motsin haƙori mai tarawa (CTM) da lokacin motsin haƙori (TTM)."Lokacin motsin hakori" lokacin da aka kwatanta sassan da aka haɓaka da kuma wadanda ba su da sauri ba, an sami raguwa mai yawa a cikin jimlar lokacin janyewar hakori.A cikin duka binciken, babu wani bambanci mai mahimmanci tsakanin "FTMPF" da "LLLT" dangane da "motsi na haƙori" (p = 0.728) da "lokacin motsi hakori" (p = 0.298).Bugu da kari, "FTMPF" da "LLLT" za su iya cimma 25% da 20% acceleration OTM bi da bi.
Seki et al.An kimanta tasirin "corticotomy na gargajiya" da "LLT" akan sakin RANKL yayin OTM a cikin RCT tare da orotomy kuma an kwatanta shi [34].Binciken ya ruwaito cewa duka corticotomy da LILI sun karu da sakin RANKL yayin OTM, wanda ya shafi gyaran kashi kai tsaye da kuma adadin OTM.Bambanci tsakanin bangarorin biyu ba shi da mahimmanci a cikin 3 da 15 kwanaki bayan shiga tsakani (p = 0.685 da p = 0.400, bi da bi).Bambance-bambance a cikin lokaci ko hanyar kimanta sakamako sun hana haɗawa da binciken biyu da suka gabata a cikin meta-bincike [32,34].
Ayyukan tiyata da magunguna: Rajasekaran da Nayak sun kimanta tasirin corticotomy tare da allurar prostaglandin E1 akan RTM da lokacin motsi na hakori (TTM) a cikin tsaga-baki CCT [35].Sun nuna cewa corticotomy ya inganta RTM fiye da prostaglandins, tare da bambanci mai mahimmanci (p = 0.003), tun da ma'anar RTM a gefen prostaglandin shine 0.36 ± 0.05 mm / mako, yayin da corticotomy ya kasance 0.40 ± 0 .04mm / kewaye.Haka kuma an sami bambance-bambance a lokacin motsin haƙori tsakanin ayyukan biyu.Ƙungiyar corticotomy (makonni 13) tana da gajeren "lokacin motsin haƙori" fiye da ƙungiyar prostaglandin (makonni 15).Don ƙarin cikakkun bayanai, an gabatar da taƙaitaccen binciken ƙididdigewa daga babban binciken kowane bincike a cikin Table 6.
RTM: saurin motsin hakori;TTM: lokacin motsi hakori;CTM: jimlar motsin haƙori;NAC: sarrafawa mara hanzari;MOPs: lalatawar ƙasusuwan ƙananan ƙwayoyin cuta;LLLT: ƙananan maganin laser mai ƙarfi;CFO: orthodontics tare da corticotomy;FTMPF: cikakken kauri mucoperiosteal m;NR: ba a ruwaito ba
Nazarin hudu sun tantance sakamakon sakandare [32,33,35,36].Nazarin guda uku sun tantance asarar tallafin molar [32,33,35].Rajasekaran da Nayak ba su sami wani bambanci mai mahimmanci tsakanin corticotomy da ƙungiyoyin prostaglandin (p = 0.67) [35].El-Ashmawi et al.Babu wani bambanci mai mahimmanci da aka samo tsakanin corticotomy da LLLT a kowane lokaci na kimantawa (MD 0.33 mm, 95% CI: -1.22-0.55, p = 0.45) [33].Maimakon haka, Abdarazik et al.An ba da rahoton babban bambanci tsakanin ƙungiyoyin FTMPF da LLLT, tare da ƙungiyar LLLT ta fi girma [32].
An kiyasta zafi da kumburi a cikin gwaji guda biyu da aka haɗa [33,35].A cewar Rajasekaran da Nayak, marasa lafiya sun ba da rahoton kumburi mai laushi da zafi a cikin makon farko a gefen corticotomy [35].A cikin yanayin prostaglandins, duk marasa lafiya sun sami ciwo mai tsanani akan allura.A yawancin marasa lafiya, ƙarfin yana da yawa kuma yana ɗaukar har zuwa kwanaki uku daga ranar allura.Duk da haka, El-Ashmawi et al.[33] ya ruwaito cewa 70% na marasa lafiya sun koka da kumburi a gefen corticotomy, yayin da 10% yana da kumburi a gefen corticotomy da kuma gefen LILI.An lura da ciwon bayan tiyata ta 85% na marasa lafiya.Gefen corticotomy ya fi tsanani.
Rajasekaran da Nayak sun kimanta canjin tsayin tsayi da tsayin tushe kuma basu sami wani bambanci mai mahimmanci tsakanin corticotomy da ƙungiyoyin prostaglandin (p = 0.08) [35].An kimanta zurfin gwajin lokaci a cikin bincike ɗaya kawai kuma ba a sami wani bambanci mai mahimmanci tsakanin FTMPF da LLLT [32].
Türker et al yayi nazarin canje-canje a cikin kusurwoyi na canine da na farko na molar kuma ba su sami wani bambanci mai mahimmanci a cikin canine da kusurwoyin molar na farko tsakanin gefen piezotomy da gefen LLLT a lokacin watanni uku na biyan kuɗi [36].
Ƙarfin shaida don rashin daidaituwa na orthodontic da sakamako masu illa sun kasance daga "ƙananan" zuwa "ƙananan" bisa ga jagororin GRADE (Table 7).Rage ƙarfin shaida yana da alaƙa da haɗarin son zuciya [23,32,33,35,36], kaikaice [23,32] da rashin fahimta [23,32,33,35,36].
a, g Rage haɗarin son zuciya ta mataki ɗaya (bangaranci saboda sabawa daga ayyukan da ake tsammani, babban hasara don bin diddigin) da rage rashin daidaituwa ta matakin ɗaya* [33].
c, f, i, j Haɗarin son zuciya ya ragu da matakin ɗaya (nazarin da ba a kayyade ba) kuma gefen kuskure ya ragu da matakin ɗaya* [35].
d Rage haɗarin son zuciya (saboda kaucewa daga ayyukan da ake tsammani) ta mataki ɗaya, kaikaice ta mataki ɗaya**, da rashin fahimta ta mataki ɗaya* [23].
e, h, k Rage haɗarin rashin son rai (rashin son rai da ke tattare da tsarin bazuwar, son rai saboda karkata daga shiga tsakani) ta matakin ɗaya, kaikaice ta mataki ɗaya **, da rashin fahimta ta matakin ɗaya* [32].
CI: tazarar amincewa;SMD: tsaga tashar tashar jiragen ruwa;COMP: ƙirar ƙira;MD: bambanci ma'ana;LLLT: ƙananan maganin laser mai ƙarfi;FTMPF: Cikakken kauri na mucoperiosteal
An sami ƙaruwa mai yawa a cikin bincike game da haɓaka motsi na orthodontic ta amfani da hanyoyi daban-daban na hanzari.Ko da yake an yi nazarin hanyoyin gaggawar fiɗa, hanyoyin da ba na tiyata ba kuma sun sami hanyar yin bincike mai zurfi.Bayanai da shaidar cewa hanyar haɓaka ɗaya ta fi wani ta kasance gauraye.
Bisa ga wannan SR, babu wata yarjejeniya tsakanin binciken kan fifikon hanyoyin tiyata ko marasa tiyata a cikin hanzarin OTM.Abdelhameed da Refai, Rajasekaran da Nayak sun gano cewa a cikin OTM, tiyata ya fi tasiri fiye da sa baki [23,35].Maimakon haka, Türker et al.Ba tare da tiyata ba ya tabbatar da ya fi tasiri fiye da aikin tiyata a cikin watan farko na ja da baya na canine [36].Duk da haka, idan aka yi la'akari da dukan lokacin gwaji, sun gano cewa tasirin aikin tiyata da marasa aikin tiyata akan OTM ya kasance iri ɗaya.Bugu da kari, Abdarazik et al., El-Ashmawi et al., da Sedki et al.ya lura cewa babu bambanci tsakanin aikin tiyata da marasa aikin tiyata dangane da haɓakar OTM [32-34].