活动保持器与固定保持器对牙周健康的影响及保持效果Meta分析

摘要

Objective To investigate the effect of removable retainers (Hawley and Vacuum-formed retainer) and fixed retainers on periodontal status and the retention effect.Methods Seven databases were searched including Pubmed,Cochrane Library and CNKI,which were updated until March 1st,2017.Two researchers finished the screenings,data extraction and bias risk evaluation separately.RevMan 5.2 software was utilized to finish the data processing and statistical analysis.Results Totally 20 researches were included in the study and 18 was used in Meta-analysis.For periodontal status Hawley demonstrated better results when compared with vacuum-formed retainer [gingival index (GI):MD =0.11,95％ CI 0.05 ～ 0.16,P ＜ 0.05;plaque index (PLI):MD =0.11,95％ CI 0.07 ～0.16,P ＜ 0.05],and Hawley also showed advantages over fixed retainer (GI:MD =0.23,95％ CI 0.14～0.32,P ＜ 0.05;PLI:MD =0.37,95％ CI 0.25 ～ 0.48,P ＜ 0.05;calculus index (CI):MD =0.52,95％CI 0.21 ～ 0.83,P =0.001);whereas no differences were found between fixed and vacumm-formed retainer.For retention effect,vacuum-formed retainer displayed more benefits than Hawley retainers (Little index:MD =-0.41,95％CI-0.51 ～-0.30,P ＜ 0.05).Conclusion Hawley shows benefits in periodontal status in a short term when compared to vacuum-formed and fixed retainers,while vacuum-formed retainer shows advantages in retaining the treatment result over Hawley retainers.Larger-sample and randomized long-term studies are needed to acchieve more reliable results.%目的 研究活动保持器(Hawley保持器、压膜保持器)与固定保持器(舌侧固定保持器)对牙周健康的影响及保持效果.方法 检索PubMed、Cochrane Library和CNKI等7个数据库,时间截止于2017年3月,2位作者独立完成文献筛选、数据提取和偏倚风险评估.使用RevMan5.2软件进行资料的提取和统计学分析.结果 共纳入20项研究,其中18篇可进行Meta分析.Meta分析结果显示:牙周健康方面,Hawley保持器优于压膜保持器[牙龈指数(GI):均数差(MD)=0.11,95％可信区间(CI)为0.05～0.16,P＜0.05;菌斑指数(PLI):MD=0.11,95％CI为0.07～0.16,P＜0.05];Hawley保持器优于舌侧固定保持器[GI:MD=0.23,95％CI为0.14～0.32,P＜0.05;PLI:MD=0.37,95％CI为0.25 ～ 0.48,P＜0.05;牙石指数(CI):MD=0.52,95％CI为0.21～0.83,P=0.001];舌侧固定保持器与压膜保持器无显著差异.保持效果方面,压膜保持器优于Hawley保持器(Little指数:MD=-0.41,95％CI为-0.51 ～-0.30,P＜0.05).结论 短时期内,Hawley保持器比压膜及舌侧固定保持器更利于牙周健康;而压膜保持器在保持效果方面优于Hawley保持器;需要更大样本更长观察时间的随机对照实验以获得更可靠的结果.