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Informationen aus Orthodontie & Kieferorthopädie 2015; 47(01): 29-46
DOI: 10.1055/s-0035-1548836
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© Georg Thieme Verlag KG Stuttgart · New York

Effektivität nicht-konventioneller Verfahren zur Beschleunigung von Zahnbewegungen: Systematische Übersicht und Metaanalyse [*]

Effectiveness of Non-Conventional Methods for Accelerated Orthodontic Tooth Movement: A Systematic Review and Meta-Analysis
N. Gkantidis
1   Klinik für Kieferorthopädie, Universität Bern, Schweiz
,
I. Mistakidis
2   Department of Orthodontics, School of Health Sciences, Faculty of Dentistry, Aristotle University of Thessaloniki, Greece
,
T. Kouskoura
1   Klinik für Kieferorthopädie, Universität Bern, Schweiz
,
N. Pandis
1   Klinik für Kieferorthopädie, Universität Bern, Schweiz
› Author Affiliations
Further Information

Publication History

Publication Date:
18 May 2015 (online)

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Zusammenfassung

Zielsetzung: Untersuchung der vorliegenden Evidenz zur Wirksamkeit chirurgischer und nicht chirurgischer Verfahren zur Beschleunigung der kieferorthopädischen Bewegung von Zähnen.

Methoden: Mithilfe von elektronischer Datenbank- und Handsuche wurden randomisierte kontrollierte Studien und kontrollierte klinische Untersuchungen zum Thema zusammengestellt (Letzte Aktualisierung: März 2014). Kieferorthopädisch-chirurgische Verfahren, Distraktionsosteoneogenese und pharmakologische Verfahren wurden dabei nicht berücksichtigt. Das Biasrisiko wurde mithilfe des „Cochrane Risk of Bias Tools“ beurteilt.

Ergebnisse: Für die qualitative und die quantitative Synthese standen 18 Studien an insgesamt 354 Patienten zur Verfügung. 8 davon hatten die Laser-Phototherapie zum Thema, eine die Fotobiomodulation, eine die Magnetfeldimpulstherapie, 7 die Kortikotomieverfahren und eine die interseptale Reduktion von Knochen. 2 der Untersuchungen zu Kortikotomieverfahren und 2 Studien zur Laser-Phototherapie, die mit geringem oder unklarem Biasrisiko behaftet waren, konnten mithilfe des Random-Effect-Modells mathematisch zusammengefasst werden. Während des ersten Therapiemonats war evident, dass sich die Retraktionsrate von Eckzähnen nach einer Kortikotomie erhöht hatte (WMD=0,73; 95% CI: 0,28, 1,19; p<0,01). Unter dem Einfluss der Laser-Phototherapie war die Retraktionsrate länger als 3 Monate erhöht (WMD=0,42 mm/Monat; 95% CI: 0,26, 0,57; p<0,001). Die Qualität der Evidenz liegt bei der Laser-Phototherapie im mittleren Bereich und ist bei den Kortikotomieverfahren gering.

Es besteht eine gewisse Evidenz dafür, dass die Laser-Phototherapie und die Kortikotomieverfahren effektiv wirken. Für die interseptale Knochenreduktion ist die Evidenz dagegen schwach und für die Fotobiomodulation sowie die Magnetfeldimpulstherapie sogar sehr schwach. Unsere Ergebnisse sollten aufgrund der geringen Anzahl, der Qualität und der Heterogenität der ausgewerteten Studien generell mit der notwendigen Vorsicht interpretiert werden. Im Zusammenhang mit der Beschleunigung der kieferorthopädischen Bewegung von Zähnen sind weitere Untersuchungen notwendig, die sich für die einzelnen Arten der Intervention besonders mit Fragen der Therapieprotokolle, der gesamten Dauer einer Behandlung und der Kosten-Nutzen-Analyse beschäftigen sollten.

Praktische Bedeutung: Aufgrund der qualitativen und quantitativen Synthese der ausgewerteten Studien lässt sich schließen, dass eine gewisse Evidenz dafür vorhanden ist, dass es im Zusammenhang mit der Laser-Phototherapie und den Kortikotomieverfahren zu einer Beschleunigung der kieferorthopädischen Bewegung von Zähnen kommt. Vor dem Einsatz dieser Verfahren in der allgemeinen kieferorthopädischen Praxis sind jedoch weitere Studien notwendig.

Abstract

Objectives: To assess the available evidence on the effectiveness of accelerated orthodontic tooth movement through surgical and non-surgical approaches in orthodontic patients.

Methods: Randomized controlled trials and controlled clinical trials were identified through electronic and hand searches (last update: March 2014). Orthognathic surgery, distraction osteogenesis, and pharmacological approaches were excluded. Risk of bias was assessed using the Cochrane risk of bias tool.

Results: 18 trials involving 354 participants were included for qualitative and quantitative synthesis. 8 trials reported on low-intensity laser, 1 on photobiomodulation, 1 on pulsed electromagnetic fields, 7 on corticotomy, and 1 on interseptal bone reduction. 2 studies on corticotomy and 2 on low-intensity laser, which had low or unclear risk of bias, were mathematically combined using the random effects model. Higher canine retraction rate was evident with corticotomy during the first month of therapy (WMD=0.73; 95% CI: 0.28, 1.19, p<0.01) and with low-intensity laser (WMD=0.42 mm/month; 95% CI: 0.26, 0.57, p<0.001) in a period longer than 3 months. The quality of evidence supporting the interventions is moderate for laser therapy and low for corticotomy intervention.

Conclusions: There is some evidence that low laser therapy and corticotomy are effective, whereas the evidence is weak for interseptal bone reduction and very weak for photo-biomodulation and pulsed electromagnetic fields. Overall, the results should be interpreted with caution given the small number, quality, and heterogeneity of the included studies. Further research is required in this field with additional attention to application protocols, adverse effects, and cost-benefit analysis.

Clinical significance: From the qualitative and quantitative synthesis of the studies, it could be concluded that there is some evidence that low laser therapy and corticotomy are associated with accelerated orthodontic tooth movement, while further investigation is required before routine application.

Schlüsselwörter

Beschleunigung von Zahnbewegungen - Kortikotomie - Laser-Phototherapie - Metaanalyse

Key words

accelerated tooth movement - corticotomy - low-level laser therapy - meta-analysis

* Dieser Artikel ist im englischen Original erschienen in: Journal of Dentistry 42 (2014) 1300-1319. Der Abdruck erfolgt mit freundlicher Genehmigung.


 

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