医学
随机对照试验
荟萃分析
证据质量
相对风险
置信区间
牙科
分级(工程)
梅德林
不利影响
外科
内科学
政治学
工程类
土木工程
法学
作者
Spyridon N. Papageorgiou,Despina Koletsi,Anna Iliadi,Timo Peltomäki,Theodore Eliades
出处
期刊:European Journal of Orthodontics
[Oxford University Press]
日期:2019-11-23
卷期号:42 (3): 331-343
被引量:99
摘要
The use of orthodontic aligners to treat a variety of malocclusions has seen considerable increase in the last years, yet evidence about their efficacy and adverse effects relative to conventional fixed orthodontic appliances remains unclear.This systematic review assesses the efficacy of aligners and fixed appliances for comprehensive orthodontic treatment.Eight databases were searched without limitations in April 2019.Randomized or matched non-randomized studies.Study selection, data extraction, and risk of bias assessment was done independently in triplicate. 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 11 studies (4 randomized/7 non-randomized) were included comparing aligners with braces (887 patients; mean age 28.0 years; 33% male). Moderate quality evidence indicated that treatment with orthodontic aligners is associated with worse occlusal outcome with the American Board of Orthodontics Objective Grading System (3 studies; MD = 9.9; 95% CI = 3.6-16.2) and more patients with unacceptable results (3 studies; RR = 1.6; 95% CI = 1.2-2.0). No significant differences were seen for treatment duration. The main limitations of existing evidence pertained to risk of bias, inconsistency, and imprecision of included studies.Orthodontic treatment with aligners is associated with worse treatment outcome compared to fixed appliances in adult patients. Current evidence does not support the clinical use of aligners as a treatment modality that is equally effective to the gold standard of braces.PROSPERO (CRD42019131589).
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