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Previous issue date: 2018-03-26 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / (Artigo ?Overview? de revis?es sistem?ticas em cirurgia ortogn?tica ?
hierarquia da estabilidade cir?rgica)
O objetivo do presente estudo ? avaliar por meio de uma ?overview? de
revis?es sistem?ticas a estabilidade da cirurgia ortogn?tica em diferentes t?cnicas e
movimentos cir?rgicos, a fim de estabelecer uma escala hier?rquica com o aux?lio do
mais alto n?vel de evid?ncia cient?fica. A busca sistem?tica na literatura foi efetuada
nas bases de dados PubMed, EMBASE e Biblioteca Cochrane. A literatura cinza foi
investigada no Google Acad?mico e a busca manual foi realizada nas refer?ncias
dos estudos inclu?dos. Quarenta e cinco estudos foram selecionados para leitura na
?ntegra e, desses, 15 foram inclu?dos na amostra final, sendo 8 revis?es sistem?ticas
e 7 meta-an?lises. O n?vel de concord?ncia entre os autores para a sele??o e
elegibilidade dos estudos foi considerado excelente, com os respectivos valores de
kappa: k=0,827 e k=0,857. A escala hier?rquica da estabilidade em cirurgia
ortogn?tica foi estabelecida com dois procedimentos cir?rgicos considerados muito
inst?veis: a expans?o maxilar com fixa??o interna semi-r?gida avaliada a n?vel
dent?rio na regi?o posterior e a rota??o hor?ria da mand?bula com fixa??o interna
r?gida de parafuso bicortical no sentido sagital. Os estudos secund?rios foram
considerados com qualidade metodol?gica de m?dia a alta pelos pesquisadores com
base na ferramenta AMSTAR 2, e os estudos prim?rios inclu?dos nos estudos
secund?rios foram classificados por esses, na sua grande maioria, com potencial
para risco de vi?s moderado a alto. Sugere-se a produ??o de ensaios cl?nicos bem
delineados para elevar a qualidade dos estudos prim?ros e de revis?es sistem?ticas
que incluam an?lises tridimensionais para a estabilidade cir?rgica. / (Artigo Stability and surgical complications in segmental Le Fort I osteotomy : a systematic review)
The aim of this study was to conduct a systematic review to evaluate the stability and surgical complications of segmental Le Fort I osteotomy. The search was divided in Main search (PubMed, EMBASE and Cochrane Library), Gray literature (Scholar Google) and Manual search. Twenty-three studies were included, 14 studies evaluated stability outcome and 9 studies surgical complications outcome. The level of agreement between the authors was considered excellent (k=0.893 ?
study selection and k=0.853 ? study elegibility). Segmental Le Fort I osteotomy provides stable outcomes in the sagittal plane, is less stable dentally than skeletally in the transverse plane, and provides little stability in the posterior segment after downward movement. The most recurrent complications are oral fistula (6 studies) and damage to adjacent teeth (5 studies), but the most prevalent complication is postoperative infection (32.62%). Four studies evaluating stability outcome showed a medium potential risk of bias, whereas all studies addressing surgical complications
showed a high potential risk of bias. Segmental Le Fort I osteotomy should not be proscribed from the technical armamentarium in orthognathic surgery. On the contrary, the consulted literature suggests it is a useful tool for the three-dimensional surgical correction of maxillary malposition. / (Artigo ?Overview? de revis?es sistem?ticas em cirurgia ortogn?tica ? hierarquia da
estabilidade cir?rgica)
The objective of the present study is to evaluate the stability of orthognathic
surgery in different surgical techniques and movements by means of an overview of
systematic reviews in order to establish a hierarchical scale with the aid of the
highest level of scientific evidence. The systematic search in the literature was
carried out in PubMed, EMBASE and Cochrane Library databases. The gray
literature was investigated in Google Scholar and a manual search was made in the
references of included studies. Forty-five studies were selected for reading the full
text, and of these, 15 were included in the final sample, of which 8 were systematic
reviews and 7 were meta-analyzes. The level of agreement between the authors for
the selection and eligibility of the studies was considered excellent, with the
respective kappa values: k = 0.827 and k = 0.857. The hierarchical scale of stability
in orthognathic surgery was established with two surgical procedures considered
very unstable, the maxillary expansion with semi-rigid internal fixation evaluated at
the dental level in the posterior region and the mandible clockwise rotation with rigid
internal fixation of bicorticals screws in the sagittal direction. The hierarchical scale of
stability in orthognathic surgery was established with two surgical procedures
considered very unstable, the maxillary expansion with semi-rigid internal fixation
evaluated at the dental level in the posterior region and the mandible clockwise
rotation with rigid internal fixation of bicorticals screws in the sagittal direction.
Secondary studies were considered to be of medium to high methodological quality
by the researchers based on the AMSTAR 2 tool and the primary studies included in
the secondary studies were classified by them with the potential for risk of bias as
moderate to high. The authors suggest the production of well-designed clinical trials
to raise the quality of primary studies and systematic reviews that include threedimensional
analyzes for surgical stability.
| Identifer | oai:union.ndltd.org:IBICT/oai:tede2.pucrs.br:tede/8185 |
| Date | 26 March 2018 |
| Creators | Haas Junior, Orion Luiz |
| Contributors | Oliveira, Rog?rio Belle de |
| Publisher | Pontif?cia Universidade Cat?lica do Rio Grande do Sul, Programa de P?s-Gradua??o em Odontologia, PUCRS, Brasil, Escola de Ci?ncias da Sa?de |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/doctoralThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da PUC_RS, instname:Pontifícia Universidade Católica do Rio Grande do Sul, instacron:PUC_RS |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | -8096554818733665164, 500, 500, 600, -2070498469879244349, 2075167498588264571 |
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