低强度激光缓解正畸疼痛的系统评价

目的评价低强度激光治疗（low-level laser therapy,LLLT）缓解正畸疼痛的治疗效果及风险。方法依据Cochrane Handbook和PRISMA statement的规范化要求,检索1980-2014年2月Cochrane CENTRAL、Medline、PubMed、Embase、CNKI和CBM数据库;同时手工检索纳入文献的参考文献及中文口腔医学杂志。偏倚风险评价由2位评价者依据Cochrane系统评价者手册5.1版独立完成。在独立进行数据提取后,运用Review Manager 5.1软件进行Meta分析。结果共纳入4个随机对照试验、1个不完全随机对照试验和3个临床对照试验,共计4个国家,644例患者。偏倚风险评价显示4个随机对照试验为中度偏倚风险,1个不完全随机对照试验和3个临床对照试验均为高度偏倚风险。Meta分析结果显示：LLLT使正畸后疼痛发生率降低了19%[RR=0.81,95%CI（0.69,0.96）,P=0.01]。与空白对照组相比,LLLT缩短了正畸疼痛达峰时间[MD=-0.42,95%CI（-0.74,-0.10）,P=0.009],使正畸疼痛呈现提前消退的趋势[MD=-1.37,95%CI（-3.37,0.64）,P=0.18],LLLT使6 h内的疼痛强度显著降低[MD=-1.97,95%CI（-2.37,-1.56）,P〈0.001],24 h内疼痛视觉模拟评分值仍持续降低[MD=-2.50,95%CI（-3.67,-1.32）,P〈0.001],48 h镇疼效果仍显著（MD=-2.83,95%CI（-3.90,-1.75）,P〈0.001]。结论由于纳入文献的方法学缺陷和偏倚风险限制,LLLT缓解正畸疼痛的证据存在,但尚显薄弱,需要更多大型优质的临床随机对照试验支撑。     

牙周治疗对心血管疾病危险因素控制效果的系统评价

目的 评价牙周治疗对部分心血管疾病危险因素的控制效果。方法 对Cochrane图书馆临床随机对照试验库、PubMed数据库、荷兰医学文摘（EMBASE）数据库和中国生物医学文献数据库进行检索,检索时间为2011年10月13日;同时对纳入文献的参考文献进行进一步检索。由两位评价者分别对纳入文献进行偏倚风险评价。运用Revman 5.1软件进行Meta分析。结果共纳入6篇随机对照试验,涉及患者682例,偏倚风险评价显示1个研究为低偏倚风险,1个研究为中偏倚风险,4个研究为高偏倚风险。Meta分析的结果显示,牙周治疗并不能明显改善患者血清C-反应蛋白、总胆固醇、低密度脂蛋白、甘油三脂的水平（P>0.05）,但在改善患者血清高密度脂蛋白水平方面效果明显[MD=0.05,95%CI（0.00,0.09）,P=0.04]。结论 牙周治疗对改善患者血清高密度脂蛋白水平有较明显的效果,但还需要更多的临床随机对照试验的支持。     

加速正畸牙移动方法对根尖外吸收影响的Meta分析

目的     通过分析加速正畸牙移动方法对正畸诱导根尖外吸收的影响,以明确加速正畸牙齿移动方法的安全性和有效性。方法    检索中国知网、万方、中国生物医学文献数据库（CBM）、PubMed、Embase、Cochrane Library数据库,查找研究加速正畸牙移动方法对根尖外吸收影响的相关文章。采用Revman 5.3进行Meta分析。结果    共纳入7篇相关文献,其中4篇研究组采用皮质切开术,3篇研究组分别采用低能量激光疗法、低强度超声疗法和辅助口内振动装置;对照组均为不使用加速正畸牙移动方法进行传统正畸治疗。有5篇文献将根尖外吸收的长度作为结局指标,采用随机效应模型,Meta分析结果显示,两组根尖外吸收长度比较,差异无统计学意义（SMD = 0.17,95%CI：-0.24 ~ 0.59,P = 0.41）。有2篇文献将根尖外吸收的面积作为结局指标,采用随机效应模型,Meta分析结果显示,两组根尖外吸收面积比较,差异无统计学意义（SMD = -8.17,95%CI：-24.37 ~ 8.03,P = 0.32）。结论 本研究分析的4种加速正畸牙移动方法均不会影响正畸治疗引起的根尖外吸收,但仍需进行大样本量的长期纵向研究以获得更可靠的结果。     

自体牙本质用于牙槽嵴增量的Meta分析

目的 通过Meta分析方法系统评估在牙槽嵴缺损需要骨增量时使用自体牙本质（ATD）移植的有效性及安全性。 方法 电子检索2010年1月1日—2022年3月19日PubMed、Embase、Web of Science、Cochrane Library、CNKI、万方数据库有关牙槽嵴增量使用ATD的临床研究。使用Cochrane Tool评估随机对照试验的偏倚风险,使用Newcastle-Ottawa Scale评估队列研究。RevMan 5.4对数据进行合并分析。 结果 共纳入10项研究,其中5项研究对照组采用自体骨,另5项研究对照组采用脱蛋白牛骨基质（DBBM）。Meta分析结果显示,牙槽嵴增量术后6个月,ATD较自体骨获得更多水平向牙槽嵴增量［MD=2.01,95%可信区间（CI）（1.09,2.93）,P<0.000 1］,但在垂直向牙槽嵴增量上效果相似［MD=-0.06,95%CI（-0.21,0.08）,P=0.39］。ATD与自体骨或DBBM相比呈现更少的材料吸收［MD=-0.59,95%CI（-1.03,-0.15）,P=0.008;MD=-0.63,95%CI（-1.18,-0.07）,P=0.03］,而在种植体稳定系数和术后并发症上均无显著差异［MD=-0.76,95%CI（-3.04,1.52）,P=0.51;RR=1.01,95%CI（0.33,3.12）,P=0.98］。 结论 有限证据表明,在牙槽嵴缺损中移植ATD可取得与移植自体骨或DBBM类似或更佳的骨增量效果且材料吸收更少,可作为扩增牙槽嵴的植骨材料。但仍需要进行更大样本、更高质量、更长随访时间的临床试验评估ATD在牙槽嵴增量中的疗效。     

在后牙区应用4 mm超短种植体临床效果的Meta分析

目的 通过系统评价及Meta分析的方法评估在后牙区骨量不足植入4 mm超短种植体（ESI）的安全性和效用。方法 电子检索2010年1月1日—2022年8月31日PubMed、Embase、Cochrane Library、Web of Science、CNKI、万方数据库有关ESI与标准种植体（SI）（≥8 mm）的随机对照试验或临床对照试验，并进行引文检索。应用RevMan 5.4版软件进行Meta分析。结果 共11篇研究符合纳入标准，其中随机对照试验6篇，临床对照试验5篇。Meta分析结果：在后牙区种植时，ESI与SI的存留率差异无统计学意义[RR=1.23,95%CI(0.66,2.27),P=0.52];ESI表现出更稳定的边缘骨水平[MD=-0.16,95%CI （-0.25，-0.07）,P=0.000 7]，更少的生物并发症[RR=0.34,95%CI (0.19,0.62),P=0.000 4]，然而机械并发症更多[RR=2.89,95%CI (1.05,7.92),P=0.04]。结论 基于有限的证据，在后牙牙槽嵴高度低于5 mm时应用ESI可以获得媲美SI的临床效果...     

地塞米松冠周注射预防下颌阻生第三磨牙拔除后肿胀及张口受限的系统评价

目的 评价地塞米松（DM）冠周注射对下颌阻生第三磨牙拔除术后肿胀及张口受限的预防效果。方法 检索Cochrane图书馆临床随机对照试验库、PUBMED、荷兰医学文摘（EMBASE）和中国生物医学文献数据库;同时手检纳入文献的参考文献及中文口腔医学杂志。偏倚风险评价由2位评价者使用Cochrane系统评价者手册5.0版介绍的偏倚风险评价标准独立完成,同时独立进行数据提取。运用Revman 5.1软件进行Meta分析。结果 共纳入7篇随机对照试验,涉及患者684名,偏倚风险评价显示6个研究为中度偏倚风险,1个研究为高度偏倚风险。Meta分析的结果显示,4～5 mg DM冠周注射能够使患者术后1～2 d内最大张口度大6.77 mm（P=0.02）,同时能够减少51%的中-重度张口受限的发生率（P<0.000 01）,并且在控制面部肿胀方面效果显著（P<0.05）。注射4 mg DM与8 mg DM在各项指标中无显著差别（P>0.05）。结论 选择4～5 mg的DM冠周注射能够较好地控制下颌阻生第三磨牙拔除术后面部肿胀和张口受限,但还需要更多的临床随机对照试验的支持。     

压电骨皮质切开术在正畸中加速牙移动临床效果Meta分析

目的评价压电骨皮质切开术在正畸治疗中加速牙齿移动的临床效果。 方法根据Cochrane Handbook规范化要求，分别在中国知网（CNKI）、万方、维普、Cochrane Library、PubMed、Embase、Web of Science、ClinicalTrials.gov等数据库，以"Piezosurgery" "Orthodontics" "Tooth Movement Techniques"等主题词及其下位词，以及"加速牙齿移动" "骨皮质切开术" "超声骨刀" "正畸"为检索关键词进行检索，将检索时间限定为2009年1月至2021年6月。由3名成员进行独立标准化检索，根据预先制定标准对检索获得的文献进行筛选、偏倚风险评估和数据搜集。由于研究之间存在异质性，选择随机效应模型，选择RevMan 5.3软件对纳入文献进行Meta分析。 结果最终纳入临床随机对照试验4篇，其中共有57例受试者。Meta分析结果示，压电骨皮质切开术后第1个月和第3个月的移动速率与常规正畸治疗相比差异无统计学意义，第2个月移动速率提高0.48毫米/月，差异有统计学意义[WMD = 0.48，95%CI（0.36，0.59），P<0.001]。压电骨皮质切开术后前2个月尖牙移动速率提高0.52毫米/月，差异具有统计学意义[WMD = 0.52，95%CI（0.45，0.59），P<0.001]，研究之间异质性高（I² = 69%）。 结论压电骨皮质切开术可以在术后第2个月加快尖牙移动的速度，但是这种操作在临床上起到的效果并不显著，且术后第1个月和第3个月对牙齿移动速率可能无影响。     

A Meta-analysis of the effect of non-surgical periodontal therapy on inflammatory factors in patients with chronic kidney disease and periodontitis

目的 系统评价牙周基础治疗对慢性肾病伴牙周炎患者炎症因子的影响。方法 计算机检索中国学术期刊全文数据库（CNKI）、万方数据库、中国生物医学文献数据库 （CBM）、PubMed、EMbase以及Cochrane Library等数据库,检索时限为从建库截止到2019年12月。由2名研究者收集所有关于牙周基础治疗（牙周非手术治疗）对于慢性肾病伴牙周炎患者炎症因子[C反应蛋白（CRP）、白细胞介素（IL）-6、肿瘤坏死因子（TNF）-α]影响的文献,并且根据纳入排除标准对文献进行筛选,对研究的质量进行严格评价和资料提取,用Revman 5.3软件对符合标准的随机对照试验进行Meta分析。结果 最终纳入了6项研究分析,Meta分析结果显示,与对照组相比,牙周基础治疗能显著降低慢性肾病伴牙周炎患者CRP水平[MD=-0.58,95%CI（-1.13,-0.02）,P=0.04]和IL-6水平[MD=-2.76,95%CI（-5.15,-0.37）,P=0.02],但TNF-α水平[MD=-3.87,95%CI（-8.79,1.05）,P=0.12]没有得到明显改善。结论 慢性肾病伴牙周炎的患者在规律治疗肾病的同时行牙周基础治疗,不仅能够缓解其牙周炎症状况,还可在一定程度上改善全身的部分炎症因子的状态,有利于慢性肾病和牙周炎的控制和治疗。     

引流在下颌阻生第三磨牙拔除后应用效果的系统评价

目的评价各种引流方法控制下颌阻生第三磨牙拔除术后并发症的有效性与安全性。方法明确评价各种引流方法控制下颌阻生第三磨牙拔除术后并发症的有效性与安全性的研究问题后,电子检索MEDLINE、Cochrane 图书馆临床随机对照试验库、荷兰医学文摘、欧洲灰色文献数据库和中国生物医学文献数据库,检索时间截至2011 年8月23日,同时对中文口腔医学杂志进行手工检索,对纳入文献的参考文献进行追索。使用Cochrane协作网推荐的标准对纳入文献进行偏倚风险评价并提取数据。采用Revman 5.1软件进行统计分析。结果最终纳入研究的文献为 9篇,其中7篇为随机对照试验,2篇为半随机对照试验。偏倚风险评价显示,7篇为中度风险,2篇为高度风险。Meta 分析结果显示,引流能够增加患者术后最大张口度4.44 mm（P=0.003）,明显改善患者术后面部肿胀（P<0.05）,减少术后干槽症的发生率（P=0.008）。但是引流并不能够显著降低患者术后疼痛（P=0.09）。结论引流对缓解下颌阻生第三磨牙拔除术后并发症有一定的疗效和安全性,但还需要更多的临床随机对照试验的支持。     

盐酸米诺环素联合翻瓣术辅助治疗慢性牙周炎疗效的Meta分析

目的 系统评价牙周翻瓣术中使用2%盐酸米诺环素处理根面的疗效,为其治疗慢性牙周炎提供循证医学证据。方法 检索中国期刊全文数据库、维普、万方、中国生物医学文献数据库、PubMed、ScienceDirect和Embase等数据库,检索时限为从建库到2017年7月。由2名评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3对数据进行Meta分析。结果 最终纳入7个随机对照实验,共217例受试者。Meta分析结果显示,与单纯翻瓣术（FO）组比较,盐酸米诺环素联合翻瓣术（FM）组患者随访3个月时的探诊深度减少[MD=-0.55,95%CI（-0.84,-0.26）,P=0.000 2],菌斑指数降低[MD=-0.08,95%CI（-0.15,-0.01）,P=0.03],随访6个月时探诊深度减少[MD=-0.62,95%CI（-1.04,-0.21）,P=0.003]方面更加明显,组间比较差异有统计学意义（P<0.05）。FM组患者随访3个月时在临床附着丧失获得[MD=-0.21,95%CI（-0.47,0.04）,P=0.10]方面改变的差异无统计学意义（P>0.05）。结论 在翻瓣下机械清创治疗慢性牙周炎中,使用2%盐酸米诺环素处理根面减少探诊深度和炎症控制方面有明显的效果。     

低水平激光用于加速正畸牙齿移动的研究进展

以往研究表明,低水平激光治疗(low-level laser therapy, LLLT)可能具有加速牙齿移动的效果。笔者通过查阅文献,总结归纳了LLLT在加速牙齿移动方面的临床效果及其生物学机制。大多数研究认为,LLLT可加速牙齿移动。但也有一些研究认为LLLT不具有加速正畸牙齿移动的效果。LLLT具有小剂量刺激,大剂量抑制的特点。因此,结果差异可能与激光应用时的参数设置有关。LLLT通过光生物调节作用,促进牙齿周围骨组织的改建。研究表明,接受LLLT的患者,牙周组织中的骨细胞数、局部胶原蛋白量、炎症因子的表达情况等均出现差异,但具体的机制尚不明确,有待更深入的研究。     

低水平激光治疗促进正畸牙齿移动的研究进展

低水平激光治疗（low-level laser therapy ,LLLT）是被FDA批准应用于临床的一种安全、无创的治疗方法,可通过使用600-1000nm的单色可见红光或近红外光对细胞和组织产生光生物刺激作用。目前,LLLT广泛应用于促进伤口愈合,缓解疼痛,减少炎症,再生医学等领域。现有研究认为,LLLT的分子和细胞机制主要与线粒体电子呼吸链有关,通过促进ATP的生成,调节细胞新陈代谢。大量研究表明,LLLT可通过促进牙周膜和牙槽骨的生理性改建,加速牙齿移动,进而缩短正畸治疗时间。由于LLLT的光生物刺激作用、非侵入性方式等特点使其在加速正畸牙齿移动方面有广泛的应用前景。本文就LLLT的作用机制,生物学效应及对正畸治疗中牙齿移动的促进作用进行探讨。     

A systematic review and meta‐analysis of experimental clinical evidence on initial aligning archwires and archwire sequences

The aim of the study was to assess treatment effects and potential side effects of different archwires used on patients receiving orthodontic therapy. Electronic and manual unrestricted searches were conducted in 19 databases including MEDLINE, Cochrane Library, and Google Scholar until April 2012 to identify randomized controlled trials (RCTs) and quasi‐RCTs. After duplicate study selection, data extraction, risk of bias assessment with the Cochrane risk of bias tool, and narrative analysis, mean differences (MDs) with confidence intervals (CIs) of similar studies were pooled using a random‐effects model and evaluated with GRADE. A total of 16 RCTs were included assessing different archwire characteristics on 1108 patients. Regarding initial archwires, meta‐analysis of two trials found slightly greater irregularity correction with an austenitic‐active nickel‐titanium (NiTi) compared with an martensitic‐stabilized NiTi archwire (corresponding to MD: 1.11 mm, 95% CI: ?0.38 to 2.61). Regarding archwire sequences, meta‐analysis of two trials found it took patient treated with a sequence of martensitic‐active copper‐nickel‐titanium (CuNiTi) slightly longer to reach the working archwire (MD: 0.54 months, 95% CI: ?0.87 to 1.95) compared with a martensitic‐stabilized NiTi sequence. However, patients treated with a sequence of martensitic‐active CuNiTi archwires reported general greater pain intensity on the Likert scale 4 h and 1 day after placement of each archwire, compared with a martensitic‐stabilized NiTi sequence. Although confidence in effect estimates ranged from moderate to high, meta‐analyses could be performed only for limited comparisons, while inconsistency might pose a threat to some of them. At this point, there is insufficient data to make recommendations about the majority of initial archwires or for a specific archwire sequence.     

Effects of low-level laser therapy on the rate of orthodontic tooth movement

OBJECTIVES: To test the hypothesis that mechanical forces combined with low-level laser therapy stimulate the rate of orthodontic tooth movement. STUDY DESIGN: This study was a double blind, randomized placebo/control matched pairs clinical trial to test the efficacy of GaAlAs low-level laser therapy (LLLT) on 12 young adult patients who required retraction of maxillary canines into first premolar extraction spaces using tension coil springs with fixed edgewise appliance. LLLT was applied on the mucosa buccally, distally and palatally to the canine on the test side and using a pseudo-application on the placebo side. Dental impressions and casts were made at the commencement of the trial and at the end of the first, second and third months after starting the trial. Measurement of tooth movements was made on each stage model using a stereo microscope. RESULTS: There was no significant difference of means of the canine distal movement between the LLLT side and the placebo side for any time periods (p-value = 0.77). CONCLUSION: The energy density of LLLT (GaAlAs) at the surface level in this study (25 J/cm(2)) was probably too low to express either stimulatory effect or inhibitory effect on the rate of orthodontic tooth movement.     

Soft tissue changes following extraction vs. nonextraction orthodontic fixed appliance treatment: a systematic review and meta‐analysis

The aim of this systematic review was to assess the effect of systematic extraction protocols during orthodontic fixed appliance treatment on the soft tissue profile of human patients. Nine databases were searched until December 2016 for controlled clinical studies including premolar extraction or nonextraction treatment. After elimination of duplicate studies, data extraction, and risk‐of‐bias assessment according to the Cochrane guidelines, random‐effects meta‐analyses of mean differences (MD) or standardized mean differences (SMD) and their 95% CIs were performed, followed by subgroup, meta‐regression, and sensitivity analyses. Extraction treatment was associated with increased lower lip retraction (24 studies; 1,456 patients; MD = 1.96 mm), upper lip retraction (21 studies; 1,149 patients; MD = 1.26 mm), nasolabial angle (21 studies; 1,089 patients; MD = 4.21°), soft‐tissue profile convexity (six studies; 408 patients; MD = 1.24°), and profile pleasantness (three studies; 249 patients; SMD = 0.41). Patient age, extraction protocol, and amount of upper incisor retraction during treatment were significantly associated with the observed extraction effects, while the quality of evidence was very low in all cases due to risk of bias, baseline confounding, inconsistency, and imprecision. Although tooth extractions seem to affect patient profile, existing studies are heterogenous and no consistent predictions of profile response can be made.     

Effects of Low-Level Laser Therapy and Orthodontic Tooth Movement on Dental Pulps in Rats

Objectives:To describe the microscopic pulpal reactions resulting from orthodontically induced tooth movement associated with low-level laser therapy (LLLT) in rats.Materials and Methods:Forty-five young male Wistar rats were randomly assigned to three groups. In group I (n = 20), the maxillary right first molars were submitted to orthodontic movement with placement of a coil spring. In group II (n = 20), the teeth were submitted to orthodontic movement plus LLLT at 4 seconds per point (buccal, palatal, and mesial) with a GaAlAs diode laser source (830 nm, 100 mW, 18 J/cm²). Group III (n = 5) served as a control (no orthodontic movement or LLLT). Groups I and II were divided into four subgroups according to the time elapsed between the start of tooth movement and sacrifice (12 hours, 24 hours, 3 days, and 7 days).Results:Up until the 3-day period, the specimens in group I presented a thicker odontoblastic layer, no cell-free zone of Weil, pulp core with differentiated mesenchymal and defense cells, and a high concentration of blood vessels. In group II, at the 12- and 24-hour time points, the odontoblastic layer was disorganized and the cell-free zone of Weil was absent, presenting undifferentiated cells, intensive vascularization with congested capillaries, and scarce defense cells in the cell-rich zone. In groups I and II, pulpal responses to the stimuli were more intense in the area underneath the region of application of the force or force/laser.Conclusions:The orthodontic-induced tooth movement and LLLT association showed reversible hyperemia as a tissue response to the stimulus. LLLT leads to a faster repair of the pulpal tissue due to orthodontic movement.     

Prevention of orthodontic enamel demineralization: A systematic review with meta‐analyses

Aim of this systematic review was to assess the efficacy of preventive interventions against the development of white spot lesions (WSLs) during fixed appliance orthodontic treatment. Nine databases were searched without limitations in September 2018 for randomized trials. Study selection, data extraction and risk of bias assessment were done independently in duplicate. Random‐effects meta‐analyses of mean differences (MDs) or relative risks (RRs) with their 95% confidence intervals (CIs) were conducted, followed by sensitivity analyses, and the GRADE analysis of the evidence quality. A total of 24 papers (23 trials) were included, assessing preventive measures applied either around orthodontic brackets (21 trials; 1427 patients; mean age 14.4 years) or molar bands (2 trials; 46 patients; age/sex not reported). Active patient reminders were associated with reduced WSL incidence on patient level compared to no reminder (3 trials; 190 patients; RR: 0.4; 95% CI: 0.31‐0.64; Number Needed to Treat [NNT]: 3 patients), flat surface sealants were associated with reduced WSL incidence on tooth level than no sealant (5 trials; 2784 teeth; RR: 0.8; 95% CI: 0.63‐0.95; NNT: 33 teeth), and fluoride varnish was associated with reduced WSL severity on tooth level (2 trials; 1160 teeth; MD: ?0.32 points; 95% CI: ?0.44 to ?0.21 points). However, the quality of evidence was low according to GRADE, due to risk of bias. Some evidence indicates that active patient reminders and flat surface sealants or fluoride varnish around orthodontic brackets might be associated with reduced WSL burden, but further research is needed.     

Effectiveness of different protocols to reduce postoperative pain following orthognathic surgery: A systematic review and meta-analysis

Pain management in orthognathic surgery is essential to enhance recovery, reduce hospital stay, and improve the whole experience of the patient. The aim of this systematic review was to evaluate current evidence on pain management in orthognathic surgery.A systematic review of the literature was performed following PRISMA guidelines, and PubMed, EMBASE, and the Cochrane Controlled Trials Registry were searched to retrieve randomised clinical trials (RCTs) published until July 2020. RCTs that compared different pre-emptive analgesia and low-level laser therapy (LLLT) with placebo after orthognathic surgery were included. Outcome variables were pain scores and duration of surgery. The quality of evidence was rated according to Cochrane’s tool for assessing risk of bias. Standardised mean difference (SMD) or mean difference (MD) was used to analyse continuous data. There was significant pain reduction within the first 48 hours after pre-emptive analgesia (very low quality evidence, SMD: ?1.329; confidence interval (CI): ?2.030 to ?0.628; p = 0.001) and LLLT (very low quality evidence, SMD: ?0.690; CI: ?1.172 to ?0.207; p = 0.005) versus placebo. Evidence to support pre-emptive analgesia or LLLT effectively reducing pain scores within the first postoperative 48 hours after orthognathic surgery when compared with placebo, was of low quality.