Cervical spine changes with functional appliance treatment: A systematic review and meta-analysis

Q1 Medicine Journal of oral biology and craniofacial research Pub Date : 2024-05-29 DOI:10.1016/j.jobcr.2024.05.015

Sandhya Murali, Annapurna Kannan, Vignesh Kailasam

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Abstract

Objective

Cervical spine posture is related to craniofacial morphology, airway, gait and body posture. This posture may be influenced by the changes in the mandibular position brought about by functional appliance therapy. Therefore, this systematic review aimed to assess the changes in the cervical spine posture with functional appliance treatment in Skeletal Class II subjects.

Methods

A search of studies in six electronic databases - Medline (via Pubmed), the Cochrane Library, OVID, LILACS, Scopus and Web of Science were performed until January 18, 2024 without any restriction in date or language of publication. Eligibility screening, study selection, and data extraction were performed by two reviewers independently. The risk of bias assessment of the included studies was performed with the Newcastle Ottawa scale and Cochrane RoB 2.0. Meta-analysis was performed using random effects model for assessment of changes in the cervical spine with removable and fixed functional appliances.

Results

Twelve articles that satisfied the eligibility criteria were included for systematic review and nine articles for meta-analysis. Five studies showed a low risk of bias, one as moderate and six as high risk of bias. GRADE assessment revealed a low quality evidence. Meta-analysis revealed a decrease of the upper cervical inclination by 1.16° (95 % CI of −2.68 to 0.35, I² = 6 %), an increase of the middle cervical inclination by 2.20° (95 % CI of 0.46–3.94, I² = 49 %), an increase in cervical curvature angle by 1.60° (95 % CI of 0.12–3.09, I² = 89 %) and a decrease in cervical lordosis angle by 1.54° (95 % CI of −4.16 to 1.08, I² = 0 %).

Conclusions

Minimal uprighting of the cervical spine was noted with functional appliances. Fixed functional appliances exerted a greater effect than removable functional appliances. Cervical hyperlordosis was reduced with removable functional appliance treatment. Though these changes are minimal, the clinical orthodontist should be aware that functional therapy also influences cervical spine posture. Due to the heterogeneity and low quality of evidence, the results are to be considered critically.

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功能性矫治器治疗带来的颈椎变化：系统回顾与荟萃分析

目的颈椎姿势与颅面形态、气道、步态和体态有关。这种姿势可能会受到功能矫治器治疗带来的下颌位置变化的影响。因此，本系统性综述旨在评估功能性矫治器治疗对骨骼II类受试者颈椎姿势的改变。方法截至2024年1月18日，在Medline（通过Pubmed）、Cochrane图书馆、OVID、LILACS、Scopus和Web of Science等六个电子数据库中进行了研究检索，对发表日期和语言没有任何限制。资格筛选、研究选择和数据提取由两名审稿人独立完成。采用纽卡斯尔-渥太华量表和 Cochrane RoB 2.0 对纳入研究进行偏倚风险评估。采用随机效应模型对使用活动和固定功能矫治器评估颈椎变化的情况进行了荟萃分析。五项研究显示存在低偏倚风险，一项为中度偏倚风险，六项为高度偏倚风险。GRADE 评估显示证据质量较低。元分析显示，上颈椎倾斜度减少了 1.16°（95 % CI 为 -2.68 至 0.35，I2 = 6 %），中颈椎倾斜度增加了 2.20°（95 % CI 为 0.46 至 3.94，I2 = 49 %），颈椎弯曲角度增加了 1.结论使用功能性矫治器后，颈椎的直立程度最小。固定式功能矫治器比活动式功能矫治器的效果更好。使用可摘功能矫治器治疗后，颈椎过度伸展的情况有所减轻。虽然这些变化微乎其微，但临床正畸医生应该意识到，功能矫治器也会影响颈椎姿势。由于证据的异质性和低质量，应严格考虑这些结果。

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来源期刊

Journal of oral biology and craniofacial research Medicine-Otorhinolaryngology

CiteScore

4.90

自引率

0.00%

发文量

133

审稿时长

167 days

期刊介绍： Journal of Oral Biology and Craniofacial Research (JOBCR)is the official journal of the Craniofacial Research Foundation (CRF). The journal aims to provide a common platform for both clinical and translational research and to promote interdisciplinary sciences in craniofacial region. JOBCR publishes content that includes diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the mouth and jaws and face region; diagnosis and medical management of diseases specific to the orofacial tissues and of oral manifestations of systemic diseases; studies on identifying populations at risk of oral disease or in need of specific care, and comparing regional, environmental, social, and access similarities and differences in dental care between populations; diseases of the mouth and related structures like salivary glands, temporomandibular joints, facial muscles and perioral skin; biomedical engineering, tissue engineering and stem cells. The journal publishes reviews, commentaries, peer-reviewed original research articles, short communication, and case reports.