| objective:The aim of this systematic review is to analyze the stability of seriously skeletal Class ? malocclusion patients treated with orthodontic combined surgical treatments,Compare with the changes of hard tissue,soft tissue and tooth position after surgery and 3 years after surgery,to investigate the long-term stability of seriously skeletal Class ?malocclusion patients treated with orthodontic and surgical treatments,in order to prove the effect of combined orthodontic with surgical treatment to get more scientific guidelines for clinical treatment programs.Methods:1.In accordance with the inclusion and exclusion criteria searched Cochrane Central Register of Controlled Trials,Cochrane Library,Medline via pubmed(1950-2013),EMBASE(1980-2013)and other foreign databases,and Chinese Biomedical Literature Database(CBM),China National Knowledge Infrastructure Database(CNKI),VIP Database for Chinese Technical Periodicals(VIP),digital journal of Wanfang Data and so on,other more manually retrieved unpublished conference papers and gray literatures.Preliminary selected the literatures with the criteria,which consist of randomized controlled trials(RCT),quasi-randomized controlled trials and clinical case-control trial(CCT)literatures.2.Two professional training of reviewers evaluated the quality of the screened literatures,scored literatures with the NOS evaluation tool,and collectd data and information of the medium and higher quality literatures.3.Analyze the heterogeneity of the included literatures,and selected the homogeneous literature.Then meta-analysis was performed by using Revman5.2 software which combined the amount of the same effect and described the different index.Results:Ultimately,there were 4 references met the requirements,including 1 Chinese article and 3 foreign articles.They were all clinical case-control test(CCT)and with a total of 180 patients,but the literature overall quality was not high.Proceed the heterogeneity test before extracting the literature data and analysing,finding the value of I2 was 96%and the heterogeneity was too large.The sensitivity analysis of the literature found that 1 Chinese literature data variation was big,after removing the article the value of I2 was 0%,so the literature maybe greatly influenced the results and decided to remove it.Eventually,we obtained 3 foreign literatures and merged the same index to do Meta analysis to analyze the stability from three aspects:1.The stability of the hard tissue:SNA?SNB?ANB?MP-SN?A and B.Meta analysis showed that the difference of SNA(WMD=-0.16,95%CI[-0.93,0.61])?SNB(WMD=0.36,95%CI[-0.53,1.25])?ANB(WMD=-0.28,95%CI[-0.72,0.17])at post-operation and 3 years after operation had no statistical significance,and maintained a good skeletal class I facial types;The comparison results of MP-SN(WMD=0.38,95%CI[-0.81,1.56])showed that there was no significant statistical difference and the mandibular plane angle maintained the relative stability;Meta analysis didn't take because of the different measurement methods of A and B point position.The qualitative description as follows:point A remained relatively stable position and point B had some replace compared with post-operative.2.The teeth stability analysis:the forest figure showed that the angle of Ul-SN(WMD=3.5,95%CI[1.69,5.31])increased at 3 years after surgery,upper anterior teeth had recurrence and lip dip;The position of L1-MP(WMD=-0.12,95%CI[-1.82,1.57])and the mandibular anterior teeth remained stable and the labial inclination kept normal;The heterogeneity of Overjet(OJ)was huge in 2 literatures so that we choosed the random effect model to analyze and found no statistical significance,proved that OJ(WMD=-0.41,95%CI[-1.19,0.36])was relatively stable;Meta analysis of overbite(OB)WMD=0,95%CI[-0.09,0.08]had no difference and maintaind the long-term stability.3.The stability analysis of soft tissue:only one paper reported the stability of the soft tissue,so we couldn't do Meta analysis,just adopted the qualitative description.Ana found the soft tissue angles such as G'-Sn-Pog'?Nasolabial?Mentolabial?UpperlipeNperp had no statistical significance at post operation and 3 years after surgery,only LowerlipeNperp had some recurrence at 3 years after surgery.Generally,the healing effect of the soft tissue was stable.Conclusion:The orthodontic and surgical treatment for skeletal class III malocclusion could keep the hard tissue relative stability except a little replace of the mandibular.The position of the lower anterior teeth could keep stable as well as the over bite and the over jet of the anterior teeth except the recurrence of maxillary anterior teeth which were tilted to the lip.The protrusion of the upper lip,the angle of the face type,nose-lip.chin-lip all stayed stability while the protrusion of the lower lip recurred.In the mass,The orthodontic and surgical treatment for skeletal class ? malocclusion kept stability in the long term.The overall quality of the studies included in this research was not high as well as the reliability of the conclusions.The clinicians should strictly finish the clinical case-control study,design scientifically rigorous test,write thesis accurately to provide evidence of high quality for the systematic review. |
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