不同尺寸和材料的初始弓絲對正畸治療中初始疼痛影響的系統評價與貝葉斯網狀Meta分析

[中圖分類號]R783.5[文獻標志碼]A [doi] 10.7518/gjkq.2025036

Effectsof initialarchwiresofdifferent sizesand materialsoninitialpainduringorthodontic treatment：asystematicreviewandBayesiannetworkmeta-analysis

WeiZhi，LiuChang，WangYan，LaiWenli

StateKeyLaboratoryofOralDiseasesamp;NationalCenterforStomatologyamp;NationalClinicalResearchCenterforOral Diseaseamp;ept.frthdontics，WestnaHospitalofomatologyichuanUiversityengdu6 Correspondence：LaiWenli，Email：wenlilai@scu.edu.cn

[Abstract]ObjectiveTheeffectsofvariationsinthesizeandmaterialsofinitialarchwiresoninitialpainduringorthodontic treatment were explored.Methods Seven commonly used databases were searched from inception to October1， 2023 for publications related toorthodontic archwires and pain.Relevantliterature was selected on the basis of inclusion criteria.Moreover，the methodologicalqualityof the included studies wasassessedusing theriskofbiasassssmenttool forthe nonrandomized studiesof interventionsrecommended by Cochrane，and data were extracted accordingly.Network meta-analysis was performed using R software 4.3.2（caling JAGS4.3.1）and GeMTC0.14.3 software.ResultsA total of1l studies involving 632 patients and10 intervention measures were included.Among the1 studies，three had lowrisk ofbias，one hadhighriskofbias，andseven hadunclear bias risk.One，two，andseven daysafterthe initial placementoffixedorthodonticappliances，nostatisticallsignificant difference inthevisualanalogscale （VAS）scoresofpain was foundbetweenanytwoofthe10archwires.However，forestplotsresultsshow thatthepainlevelofheat-activated nickel-titaniumarchwires （HANT） is lower than that of superelastic nickel-titanium archwires （ Plt;0 . 0 5 ） ，and rankprobability plotanalysis indicated thatthe material with thesmallest VASscore Wasmost likelythe O.O12-inch （ （ 0 . 3 0 5 m m 0

HANT.ConclusionNo difference in orthodontic pain intensitywas found amongthe1O initial archwiresof different sizesand materials，and using the O.ol2-inch HANTarchwireas theinitial archwire during fixed orthodontictreatment maycause the leastamountof initial pain

Key words] orthodontic archwires； pain； systematic review； visual analog scale

近年來，正畸治療的需求不斷增加，固定矯治器作為正畸治療中最常用的矯治器，引起的正畸疼痛一直是口腔正畸學的研究熱點之一。正畸治療過程中，由固定矯治器產生的矯治力往往會導致患者疼痛、焦慮和煩躁，其機制是牙齒的移動會導致局部牙周膜壓力和張力增大，進而釋放白細胞介素6（interleukin-6，IL-6）等炎性因子引起三叉神經節的神經炎癥，最終導致正畸疼痛2]。正畸疼痛對患者的健康和生活產生負面影響，尤其是在正畸治療的初期，正畸疼痛在患者初戴矯治時廣泛發生。其疼痛在初始弓絲放入后1d達到峰值，最終在3＼～7d后消失4。

初始弓絲是固定矯治中置入托槽中的第一根正畸弓絲5，理想的初始弓絲不僅要更快地排齊牙齒，還應該盡可能地減輕患者的疼痛。1972年，Andreasen將鎳鈦弓絲引人臨床應用以來，鎳鈦弓絲發展至今主要有以下3種：普通鎳鈦弓絲（con-ventionalnickel-titaniumarchwires，CNT）、超彈鎳鈦弓絲（superelasticnickel-titaniumarchwires，SENT）、熱激活鎳鈦弓絲（heat-activatednickel-ti-taniumarchwires，HANT）。隨著材料學的發展，越來越多種類的弓絲相繼出現，但哪種初始弓絲對正畸疼痛最輕尚未明確。

目前，有許多高質量臨床隨機對照試驗（ran-domizedcontrolledtrial，RCT）探究不同尺寸和材料的初始弓絲對正畸治療初期疼痛的影響。Azizi等在一項前瞻性RCT中采用視覺模擬評分（visualanaloguescale，VAS）評估初戴o.012英寸0 （ 0 . 3 0 5 m m） ）SENT和0.014英寸（ 0 . 3 5 6 m m ）HANT初始弓絲在1、2、3、4d的疼痛，發現2種材料之間的差異無統計學意義。然而，初可嘉等的前瞻性RCT中采用VAS評估初戴3種（0.012英寸SENT、0.012英寸HANT和0.014英寸HANT）初始弓絲放入后1＼～5d的疼痛，發現0.012英寸HANT的疼痛強度顯著低于其他2組。……