国际口腔医学杂志

国际口腔医学杂志 ›› 2025, Vol. 52 ›› Issue (3): 366-379.doi: 10.7518/gjkq.2025036

• 论著 • 上一篇    

不同尺寸和材料的初始弓丝对正畸治疗中初始疼痛影响的系统评价与贝叶斯网状Meta分析

魏志(),刘畅,王艳,赖文莉()   

  1. 口腔疾病防治全国重点实验室 国家口腔医学中心 国家口腔疾病临床医学研究中心四川大学华西口腔医院口腔正畸科 成都 610041
  • 收稿日期:2024-01-05 修回日期:2024-06-24 出版日期:2025-05-01 发布日期:2025-04-30
  • 通讯作者: 赖文莉
  • 作者简介:魏志，硕士，Email：1575587389@qq.com

Effects of initial archwires of different sizes and materials on initial pain during orthodontic treatment: a systema-tic review and Bayesian network meta-analysis

Zhi Wei(),Chang Liu,Yan Wang,Wenli Lai()   

  1. State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Dept. of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
  • Received:2024-01-05 Revised:2024-06-24 Online:2025-05-01 Published:2025-04-30
  • Contact: Wenli Lai

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摘要：

目的 评价不同尺寸和材料的初始弓丝对正畸治疗初始疼痛的影响。 方法 对7个常用数据库对正畸弓丝与疼痛的文献进行电子检索，检索时间截至2023年10月1日；筛选出纳入文献并参照Cochrane推荐的偏倚风险评估表对纳入文献进行方法学质量评价和提取数据。应用R软件4.3.2（调用JAGS 4.3.1）和GeMTC 0.14.3进行网状Meta分析。 结果 最终纳入11篇文献，涉及632名患者，涉及10种干预措施。11篇文献中，3篇为低偏倚风险，1篇为高偏倚风险，7篇偏倚风险情况不清。Meta分析结果显示：1）初戴固定矫治器后1、2、7 d，10种弓丝引起患者疼痛的视觉模拟评分（VAS）两两之间的差异均无统计学意义（P>0.05）；2）森林图结果显示热激活镍钛弓丝（HANT）疼痛程度低于超弹镍钛弓丝（P<0.05）；3）排秩概率图分析表明正畸疼痛最轻的弓丝最有可能是0.012 英寸（0.305 mm）HANT。 结论 10种不同尺寸和材料的初始弓丝对正畸疼痛上的差异无统计学意义，0.012英寸HANT可能是正畸治疗初始疼痛最轻的初始弓丝。

关键词: 正畸弓丝, 疼痛, 系统评价, 视觉模拟评分

Abstract:

Objective The effects of variations in the size and materials of initial archwires on initial pain during ortho-dontic treatment were explored. Methods Seven commonly used databases were searched from inception to October 1, 2023 for publications related to orthodontic archwires and pain. Relevant literature was selected on the basis of inclusion criteria. Moreover, the methodological quality of the included studies was assessed using the risk of bias assessment tool for the nonrandomized studies of interventions recommended by Cochrane, and data were extracted accordingly. Network meta-analysis was performed using R software 4.3.2 (calling JAGS 4.3.1) and GeMTC 0.14.3 software. Results A total of 11 studies involving 632 patients and 10 intervention measures were included. Among the 11 studies, three had low risk of bias, one had high risk of bias, and seven had unclear bias risk. One, two, and seven days after the initial placement of fixed orthodontic appliances, no statistically significant difference in the visual analog scale (VAS) scores of pain was found between any two of the 10 archwires. However, forest plots results show that the pain level of heat-activated nickel-titanium archwires (HANT) is lower than that of superelastic nickel-titanium archwires (P<0.05), and rank probability plot analysis indicated that the material with the smallest VAS score was most likely the 0.012-inch (0.305 mm) HANT. Conclusion No difference in orthodontic pain intensity was found among the 10 initial archwires of different sizes and materials, and using the 0.012-inch HANT archwire as the initial archwire during fixed ortho-dontic treatment may cause the least amount of initial pain.

Key words: orthodontic archwires, pain, systematic review, visual analog scale

中图分类号: 

  • R783.5

图 1

文献筛选流程图"

表 1

纳入研究特征"

研究地区研究类型患者数量（男/女）年龄/岁干预措施结局指标
Alhaija等[12]约旦双臂双盲RCT40（13/27）19.50±1.39*0.014、0.016英寸SENTVAS
Azizi等[7]伊朗双臂三盲RCT88（44/44）18.6±4.4*0.014英寸SENT、0.014英寸HANTVAS
初可嘉等[8]中国三臂RCT45（21/24）24.20±3.44*0.014英寸SENT，0.012、0.014英寸HANTVAS
Cioffi等[13]意大利双臂双盲RCT30（11/19）14.7±3.7*0.016英寸SENT、0.016英寸HANTVAS
Erdin?等[14]土耳其双臂单盲109（52/57）14.20±1.52*0.014英寸CNT、0.016英寸CNTVAS
Fernandes等[15]挪威双臂RCT128（72/56）12.6#0.014英寸SENT、0.014英寸CNTVAS
Jain等[16]印度双臂双盲RCT20（6/14）18.9±3.6*0.016英寸HANT、0.016英寸SENTVAS
Jones等[17]英国双臂RCT43（23/20）9.4~16.8&0.014英寸SENT、0.015英寸MSSVAS
Kishore等[18]印度双臂RCT14—0.016英寸SENT、0.016英寸CNTVAS
任庆源[19]中国双臂双盲RCT44（11/33）14.4±2.6*0.014英寸SENT、0.014英寸HANTVAS
Sandhu等[20]印度双臂双盲RCT85（42/43）14.1±2.0*0.016英寸SENT、0.017 5英寸MSSVAS

图2

偏倚风险图"

图3

偏倚风险总结图"

表 2

各研究VAS数据提取汇总表"

研究干预措施1 d VAS2 d VAS7 d VAS
平均值标准差n平均值标准差n平均值标准差n
Alhaija等[12]0. 014英寸SENT44.032.41432.029.5148.912.214
0.016英寸SENT28.224.91415.116.81412.325.714
Azizi等[7]0.014英寸SENT58.420.444——————
0.014英寸HANT61.622.343——————
初可嘉等[8]0.012英寸SENT38.78.31548.07.5152.04.115
0.012英寸HANT30.75.91539.39.6150.72.615
0.014英寸HANT37.38.01548.69.9151.33.515
Cioffi等[13]0.016英寸SENT36.028.71550.725.01520.317.415
0.016英寸HANT29.025.91539.721.61518.022.515
Erdin?等[14]0.014英寸CNT4928.3513921.849136.323
0.016英寸CNT4828.1484020.94695.314
Fernandes等[15]0.014英寸SENT36.732.44037.232.5657.112.965
0.014英寸CNT37.831.13936.030.0636.711.059
Jain等[16]0.016英寸HANT35.57.2910———4.11.6610
0.016英寸SENT42.95.8410———5.81.3210
Jones等[17]0.014英寸SENT29.022.42119.621.2211.22.521
0.015英寸MSS23.720.72125.024.4210.51.621
Kishore等[18]0.016英寸SENT27.14.8728.66.97———
0.016英寸CNT24.39.8734.39.87———
任庆源[19]0.014英寸SENT43.927.12431.725.0248.314.024
0.014英寸HANT39.018.92027.617.9202.96.420
Sandhu等[20]0.016英寸SENT28.811.04224.610.4423.51.542
0.0175英寸MSS26.49.04323.05.8433.21.343

图 4

戴入弓丝后1、2、7 d的网状关系图"

表 3

各组VAS的MD及95%CI"

两两比较1 d2 d7 d
0.014英寸HANT与0.012英寸SENT1.45（-14.89，17.85）-0.67（-20.62，19.41）0.71（-6.15，7.60）
0.014英寸HANT与0.012英寸HANT-6.54（-22.67，9.63）-9.26（-29.52，11.04）-0.60（-7.34，6.21）
0.014英寸SENT与0.014英寸HANT0（-13.39，412.77）-4.09（-26.33，18.16）-5.37（-14.00，3.30）
0.014英寸SENT与0.014英寸CNT-2.26（-19.22，14.70）-3.74（-22.45，14.79）-0.37（-7.91，7.04）
0.014英寸SENT与0.015英寸MSS-5.18（-24.83，14.64）5.28（-17.29，27.98）-0.71（-7.27，5.87）
0.014英寸SENT与0.016英寸HANT-11.04（-28.74，6.17）-11.00（-35.47，13.36）-0.25（-12.03，11.48）
0.014英寸SENT与0.016英寸SENT-4.99（-22.26，10.45）-12.73（-34.06，7.26）1.69（-10.15，13.49）
0.014英寸CNT与0.016英寸CNT-3.51（-19.94，12.49）-1.24（-19.82，16.86）-3.98（-11.21，3.37）
0.016英寸SENT与0.0175英寸MSS-2.39（-18.58，13.59）-1.51（-20.98，18.21）-0.31（-6.82，6.20）

图5

戴入后1、2和7 d VAS收敛诊断图A：1 d；B：2 d；C：7 d。"

图6

戴入后1、2和7 d VAS的轨迹密度图A：1 d；B：2 d；C：7 d。"

图7

戴入后1 d VAS的森林图"

图 8

戴入后2 d VAS的森林图"

图9

戴入后7 d VAS的森林图"

图 10

戴入后1、2、7 d VAS排秩概率图Rank 1~10：疼痛程度排第1~10位的概率。"

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