Int J Stomatol

Inter J Stomatol ›› 2019, Vol. 46 ›› Issue (2): 156-165.doi: 10.7518/gjkq.2019017

• Systematic Reviews • Previous Articles     Next Articles

Effect of tooth extraction for the orthodontic treatment of the upper airway: a systematic review

Tiancheng Li,Kai Xia,Shujuan Zou,Jun Liu()   

  1. State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
  • Received:2018-06-08 Revised:2018-11-08 Online:2019-03-01 Published:2019-03-15
  • Contact: Jun Liu E-mail:Jliu81@foxmail.com
  • Supported by:
    This study was supported by National Natural Science Foundation of China(81470722)

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Abstract:

Objective This study aimed to evaluate the effect of tooth extraction for the orthodontic treatment on the upper airway by systematically reviewing retrospective clinical trials. It might serve as a clinical guideline for orthodontic doctors to decide whether or not a tooth would be extracted. Methods This systematic review was performed in accor-dance with the guidelines. Relevant trials were retrieved electronically through the Cochrane Central, Medline, EMBASE (Ovid), Web of Science, China Biology Medicine disc (CBMdisc), and China National Knowledge Infrastructure (CNKI) until January 2017. Literature search, selection, data extraction, and quality assessment were independently performed by two authors. Results Twelve retrospective clinical trials were included in this systematic review. They were categorized into four groups based on their indications for extractions: Class Ⅰ bimaxillary protrusion, Class Ⅰ crowding, Class Ⅱ malocclusion, and unspecified indications. The four first premolars of patients with Class Ⅰ bimaxillary protrusion were extracted, causing a significant decrease in the upper airway dimension. An increase in the upper airway dimension was reported in patients diagnosed with Class Ⅰ crowding. No significant change was observed in patients with Class Ⅱ malocclusion and patients with unspecified indications. Conclusion The retraction of the anterior teeth and the mesial movement of posterior teeth followed by extractions could be factors affecting the upper airway of adult patients with ClassⅠ bimaxillary protrusion. Extractions as an indication to relieve denture crowding would not affect the upper airway. For patients with Class Ⅱ malocclusion, the position of the mandible could be a major factor affecting the upper airway rather than extractions. Currently, evidence-based conclusions about the effect of tooth extraction for the orthodontic treatment of the upper airway are difficult to obtain because of the heterogeneity of the included articles.

Key words: orthodontics, tooth extraction, upper airway, obstructive sleep apnea, systematic review

CLC Number: 

  • R783.5

TrendMD: 

Tab 1

General information of the included articles"

参考 研究 国家 放射方法 样本量 性别 年龄/岁 错畸形类型 拔除牙位 支抗设计 治疗时间/月
文献 类型 （男/女）
[6] 回顾性 印度 侧位片 150 - 12~18 双颌前突 4颗第一前磨牙 不明 不明
[16] 回顾性 印度 侧位片 22 9/13 22.52（17~29） 安氏Ⅰ类双颌前突 4颗第一前磨牙 最大支抗 不明
[9] 回顾性 约旦 侧位片 40 13/27 19.21±1.46 安氏Ⅰ类双颌前突 4颗第一前磨牙 不明 不明
（18~23）
[14] 回顾性 中国 侧位片 44 8/36 21.19（16~34） 安氏Ⅰ类双颌前突 4颗第一前磨牙 最大支抗 不明
[10] 回顾性 中国 MSCT 30 - 成人 安氏Ⅰ类双颌前突 4颗第一前磨牙 最大支抗 不明
[11] 回顾性 土耳其 侧位片 13 11/2 18.1±3.7 安氏Ⅰ类中度拥挤 4颗第一前磨牙 最小支抗 24.8±6.9
13 11/2 17.8±2.4 安氏Ⅰ类中度拥挤 片切 -
 17.0±4.6
13 11/2 15.5±0.9 安氏Ⅰ类双颌前突 4颗第一前磨牙 最大支抗 27.5±7.7
[15] 回顾性 中国 CBCT 18 5/13 24.1±3.8 安氏Ⅱ类高角 4颗前磨牙 最大支抗 30（18~36）
（18~33）
[5] 回顾性 美国 CBCT 拔牙组26 8/18 27.4±9.7 安氏Ⅰ类与安氏Ⅱ类 至少拔除2颗前磨牙 不明 23.5±4.5
非拔牙组48 17/31 31.9±12.0 安氏Ⅰ类与安氏Ⅱ类 18.7±5.4
[12] 回顾性 美国 CBCT 拔牙组31 16/15 12.97±1.15 混合 4颗第一前磨牙 不明 32.6±5.4
非拔牙组31 16/15 12.86±0.74 混合 不明 27.8±4.1
[13] 回顾性 美国 CBCT 拔牙组20 10/10 男13.8±1.3 安氏Ⅰ类 4颗前磨牙 不明 30.9±3.9
女13.5±1.6
非拔牙组20 10/10 男13.8±1.2 安氏Ⅰ类 25.4±4.4
女13.5±1.6
[18] 回顾性 中国 侧位片 拔牙组20 3/17 12.5±1.3 安氏Ⅱ类均角 4颗前磨牙 不明 不明
非拔牙组20 7/13 12.9±1.3
[17] 回顾性 中国 侧位片 拔牙组26 11/15 18~25 安氏Ⅰ类与安氏Ⅱ类 4颗第一前磨牙 不明 不明
非拔牙组21 8/13 不明

Tab 2

Main outcomes and conclusions of the included articles"

参考
文献		 测量指标变化量 结论
切牙/磨牙 舌骨 气道
[16] 上切牙牙尖内收7.75 mm, 舌骨向后移动（4.65±3.79） mm U-MPW、TB-TPPW分别减 1）拔牙治疗后咽气道尺寸有所减小,腭
下切牙牙尖内收7.15 mm （P<0.05）。 小了（2.85±1.84）、（2.65± 咽气道和舌咽气道较显著;2）舌骨倾向
（P<0.000 1）。 1.47） mm（P<0.05）。 于向后移动;3）咽气道尺寸减小与内收
下切牙有较高的相关性。
[6]
 未测量。 H-Pg、PTM-H分别增加了（1.73±0.52）、（2.76±1.27）mm（P< 0.05）,C3H、HHp分别减小了（2.43±0.64）、（0.7±0.4）mm（P<0.05）;舌骨向后向下移动。 PNS-BP、SPP-SPPW、U- UPPW、PgT-PPPW、Bt-PBt分别减小了（1.40±0.51）、（1.23±0.43）、（2.10±0.48）、（1.47±0.32）、（1.46± 0.35）mm（P<0.05）。 1）对青年双颌前突患者采用拔除4颗第一前磨牙内收的方案会使腭后气道、舌后气道、咽下气道变窄;2）由于内收前牙后舌体位置的改变会影响舌骨舌肌,进而导致舌骨向后、向下移动。
[11]
 1）在最小支抗组,上下颌前牙分别平均内收（1.6±2.4）、（1.9±1.9） mm,磨牙平均近中移动3 mm;2）在片切组,上下颌牙平均近中移动0.7 mm;3）在最大支抗组,上下颌切牙平均内收约（12.4±3.5）、（9.6±2.9） mm。 舌骨位置无显著变化。 1）最小支抗组上段及中段口咽气道分别尺寸平均增加（1.7±2.4）、（1.0±2.2）mm （P<0.05）;2）片切组气道参数无明显变化;3）最大支抗组中段及下段口咽气道尺寸分别平均减少（2.1±1.5）、（3.8±3.3）mm（P< 0.05）。 1）在使用最小支抗的拔牙患者中,上段及中段气道尺寸有所增加;2）在使用片切的患者中,气道尺寸没有显著改变;3）在使用最大支抗的拔牙患者中,中段及下段的气道尺寸有所减小。
[12]
 未测量。 未测量。 拔牙组和非拔牙组的口咽气道容积分别增加了（1 668.87±858.57）、（1 105.38±894.43）mm3（P<0.05）。 拔牙或者非拔牙正畸治疗方案均不会影响咽气道。
[15]
 上下颌切牙分别平均内收（7.87±2.48）、（6.10±2.63）mm（P<0.05）。上下颌磨牙位置无显著变化,但均存在近中倾斜,平均角度分别为（2.75°±4.63°）、（2.17°±4.84°）（P<0.05）。 舌骨位置无显著变化。 拔牙组的 SPP-SPPW、U- MPW、PAS、V-LPW分别减小了（1.36±1.91）、（1.07±1.93）、（1.80±2.39）、（0.40± 1.53）mm（P<0.05）;其余无显著变化。 1）拔牙治疗对成人Ⅱ类高角患者的气道容积、横截面积、高度均无显著影响;2）拔牙治疗的患者中,气道中段及下段被压缩,导致矢状向宽度减小,但横截面积未发生变化;3）与未治疗组相比,拔牙组治疗后气道尺寸无明显差异。
[14] 上切牙牙尖内收6.84 mm,下切牙牙尖内收4.95 mm
（P<0.05）。		 舌骨水平向后移（0.88±2.32） mm,垂直向下降（1.24±3.42）mm（P<
0.05）。		 SPP-SPPW、U-MPW、TB- TPPW、V-LPW分别减少（0.56±1.48）、（0.85±1.77）、（1.63±1.80）、（1.54±2.90）mm（P<0.05）。 1）随着切牙内收,咽气道变得狭窄;2）治疗前后高角组和非高角组气道体积变化无差异;3）治疗过程中舌骨有向下向后移动趋势;4）切牙内收量和舌体、软腭及悬雍垂后的气道体积相关。
[10] 上切牙切缘内收（7.64±1.68）mm,牙尖内收（3.90±2.10）mm（P<0.05）。 舌骨水平向后移（2.96±0.54） mm,垂直向下降（9.87±2.92）mm（P< 0.05）。 腭咽、舌咽、喉咽的平均截面面积分别减少了（21.02%±7.89%）、（25.18%±13.51%）、（38.19%±5.51%）（P<0.05）。 1）成人双颌前突患者,大量内收切牙导致上气道狭窄;2）上切牙内收量和舌骨水平向内收量及喉咽体积的减小量相关。
参考
文献		 测量指标变化量 结论
切牙/磨牙 舌骨 气道
[5] 未测量。 未测量。 拔牙组和非拔牙组治疗前后气道总体积及各部分体积变化无显著差异。 拔牙治疗和非拔牙治疗对鼻咽、口咽气道体积影响无差异。
[13] 拔牙组上切牙切缘内收（3.1±1.4）mm,下切牙切缘内收（2.2±1.3）mm（P< 0.05）。 舌骨位置无显著改变。 拔牙组和非拔牙组各自治疗前后口咽气道体积变化无显著差异;组间口咽气道变化
量也无差异。		 切牙的位置及倾斜度发生变化;拔牙组和非拔牙治疗前后口咽气道变化无显著差异。
[9] 上下切牙唇倾度及下切牙到A-Pog线的距离显著减小。 舌骨位置无显著改变。 上气道体积无显著改变。 双颌前突病人拔除4颗第一前磨牙不影响上气道体积。
[18] 拔牙组上切牙内收4.27 mm,下切牙内收1.86 mm（P< 0.01）。 未测量。 非拔牙组矫治后鼻咽气道（PNS-Ba）平均增加（1.21± 2.44）mm（P<0.05）。 颌骨的变化尤其下颌骨的大小和位置较牙齿的位移对上气道口咽部矢状径的变化影响大。
[17] 拔牙组上下切牙切缘分别内收8.34、5.91 mm（P<0.05）,上下磨牙分别近中移动4.11、3.77 mm（P<0.05）。 未测量。 气道相关参数SPAS、 MAS、IAS治疗前后均无显著性变
化 （P>0.05）。		 拔牙矫治未引起上气道大小的明显改变, 但切牙位置改变与上气道大小改变有显著相关性。

Tab 3

Quality assessment of the included articles"

参考文献 年份 对象选择 可比性 结局 总计
[6] 2014 ☆☆☆☆ - ☆☆ 6
[16] 2016 ☆☆☆ - ☆☆ 5
[9] 2012 ☆☆☆☆ - ☆☆ 6
[14] 2012 ☆☆☆☆ - ☆☆☆ 7
[10] 2010 ☆☆☆☆ - ☆☆☆ 7
[11] 2010 ☆☆☆☆ ☆ ☆☆☆ 8
[15] 2015 ☆☆☆ ☆☆ ☆☆ 7
[5] 2016 ☆☆☆☆ - ☆☆ 6
[12] 2012 ☆☆☆☆ ☆ ☆☆ 7
[13] 2010 ☆☆☆☆ ☆☆ ☆☆ 8
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