激光辅助金属托槽瓷面粘接效果的Meta分析

目的 采用Meta分析的方法评价激光辅助金属托槽瓷面粘接的效果。方法 检索PubMed、The Cochrane Library、CBM、CNKI、万方数据库，搜集关于激光辅助金属托槽瓷面粘接时剪切粘接强度或瓷面粘接剂残余指数的文献，检索年限均为自建库至2021年5月。根据Cochrane系统评价者手册实施文献筛选，以Stata 16.0进行异质性检验、发表偏倚检验及敏感性分析，并使用RevMan 5.4进行亚组分析。结果 最终纳入12篇文献。以剪切粘接强度为结局指标的文献12篇，包含16组研究数据；以瓷面粘接剂残余指数为结局指标的文献4篇，包含5组研究数据。Meta分析的结果显示：与氢氟酸处理瓷面相比较，在粘接金属托槽前使用激光处理瓷面，可以使瓷面粘接剂残余指数降低[MD=-1.44，95％ CI（-2.37，-0.51），P=0.001]。而对于剪切粘接强度，激光处理瓷面后相较于氢氟酸并未显示出更强的效果[MD=-0.63，95％CI（-1.19，-0.07），P=0.000]。结论 与氢氟酸处理瓷面的传统方法相比，激光辅助金属托槽瓷面粘接可降低瓷面粘接剂残余指数，不能增强剪切粘接强度。激光处理瓷面后，大部分研究结果能够满足正畸临床所需求的粘接强度，并能在一定程度上降低托槽去粘接后瓷面损伤而带来的重新修复的风险。

A Meta-analysis of the effect on laser-assisted metal brackets bonding to porcelain surface

Objective The aim of this study was to evaluate the effect that laser-assisted porcelain surface bonding of metal brackets by meta-analysis. Methods PubMed, the Cochrane Library, CBM, CNKI and Wanfang databases were searched from the date of establishment to 2021-05, and the literatures on laserassisted porcelain surface bonding of metal brackets including shear bond strength or adhesive remnant index were collected. According to the Cochrane systematic review manual, we screened the literature. Stata 16.0 was used for heterogeneity test, publication bias test and sensitivity analysis. Revman 5.4 was used for subgroup analysis. Results Finally, 12 articles were included. There were 12 literatures with shear bond strength (SBS) as the outcome index, including 16 groups of research data. There were 4 articles with adhesive remnant index (ARI) of porcelain surface as the outcome index, including 5 groups of data. The results of Meta-analysis showed that:compared with the hydrofluoric acid treatment of porcelain surface, laser treatment of porcelain surface before bonding metal brackets could reduce the ARI[MD=-1.44, 95% CI (-2.37, -0.51), P=0.001]. For the shear bond strength, laser treatment did not show a stronger effect than hydrofluoric acid treatment[MD=-0.63,95% CI (-1.19, -0.07), P=0.000]. Conclusion Compared with the traditional method of hydrofluoric acid treatment, laser-assisted porcelain surface bonding of metal brackets can reduce the ARI, but can not enhance the SBS. After laser treatment of porcelain surface, most of the research results can meet the orthodontic clinical needs of 6-8 MPa bonding strength, and can reduce the risk of the repair caused by porcelain surface damage after bracket debonding.