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Journal of Dentistry Dec 2014To test the null hypothesis of no difference in the implant failure rates, postoperative infection, and marginal bone loss for the insertion of dental implants in... (Comparative Study)
Comparative Study Meta-Analysis Review
OBJECTIVES
To test the null hypothesis of no difference in the implant failure rates, postoperative infection, and marginal bone loss for the insertion of dental implants in periodontally compromised patients (PCPs) compared to the insertion in periodontally healthy patients (PHPs), against the alternative hypothesis of a difference.
METHODS
An electronic search without time or language restrictions was undertaken in March 2014. Eligibility criteria included clinical human studies, either randomized or not.
RESULTS
2768 studies were identified in the search strategy and 22 studies were included. The estimates of relative effect were expressed in risk ratio (RR) and mean difference (MD) in millimetres. All studies were judged to be at high risk of bias, none were randomized. A total of 10,927 dental implants were inserted in PCPs (587 failures; 5.37%), and 5881 implants in PHPs (226 failures; 3.84%). The difference between the patients significantly affected the implant failure rates (RR 1.78, 95% CI 1.50-2.11; P<0.00001), also observed when only the controlled clinical trials were pooled (RR 1.97, 95% CI 1.38-2.80; P=0.0002). There were significant effects of dental implants inserted in PCPs on the occurrence of postoperative infections (RR 3.24, 95% CI 1.69-6.21; P=0.0004) and in marginal bone loss (MD 0.60, 95% CI 0.33-0.87; P<0.0001) when compared to PHPs.
CONCLUSIONS
The present study suggests that an increased susceptibility for periodontitis may also translate to an increased susceptibility for implant loss, loss of supporting bone, and postoperative infection. The results should be interpreted with caution due to the presence of uncontrolled confounding factors in the included studies, none of them randomized.
CLINICAL SIGNIFICANCE
There is some evidence that patients treated for periodontitis may experience more implant loss and complications around implants including higher bone loss and peri-implantitis than non-periodontitis patients. As the philosophies of treatment may alter over time, a periodic review of the different concepts is necessary to refine techniques and eliminate unnecessary procedures. This would form a basis for optimum treatment.
Topics: Alveolar Bone Loss; Dental Implants; Dental Restoration Failure; Humans; Odds Ratio; Periodontal Diseases; Periodontitis; Periodontium; Surgical Wound Infection
PubMed: 25283479
DOI: 10.1016/j.jdent.2014.09.013 -
Journal of Clinical Periodontology Jun 2023To evaluate the efficacy of access flap and pocket elimination procedures in the surgical treatment of peri-implantitis. (Meta-Analysis)
Meta-Analysis Review
AIM
To evaluate the efficacy of access flap and pocket elimination procedures in the surgical treatment of peri-implantitis.
MATERIALS AND METHODS
Systematic electronic searches (Central/MEDLINE/EMBASE) up to March 2022 were conducted to identify prospective clinical studies evaluating surgical therapy (access flap or pocket elimination procedures) of peri-implantitis. Primary outcome measures were reduction of probing depth (PD) and bleeding on probing (BOP). Risk of bias was evaluated according to study design. Meta-analysis and meta-regression were performed. Results were expressed as standardized mean effect with 95% confidence interval (CI).
RESULTS
Evidence from studies directly comparing surgical with non-surgical therapy is lacking. Based on pre-post data originating from 13 prospective patient cohorts, pronounced reductions of PD (standardized mean effect: 2.2 mm; 95% CI 1.8-2.7) and BOP% (27.0; 95% CI 19.8-34.2) as well as marginal bone level gain (0.2 mm; 95% CI -0.0 to 0.5) were observed at evaluation time points ranging from 1 to 5 years. Wide prediction intervals suggested a high degree of heterogeneity. Reduction of mean PD increased by 0.7 mm (95% CI 0.5-0.9) for every millimetre in increase of mean PD at baseline. During the follow-up period ranging from 1 to 5 years, disease recurrence occurred frequently and implant loss was not uncommon.
CONCLUSIONS
Access flap and pocket elimination surgery are effective procedures in the management of peri-implantitis, although rates of disease recurrence during 5 years were high. Treatment outcomes were affected by baseline conditions.
Topics: Humans; Dental Implants; Peri-Implantitis; Prospective Studies; Surgical Flaps; Oral Surgical Procedures
PubMed: 36217689
DOI: 10.1111/jcpe.13732 -
Otolaryngology--head and Neck Surgery :... Aug 2023Primary chronic rhinosinusitis (CRS) is typically a diffuse process and the extent of endoscopic sinus surgery (ESS) performed for medically recalcitrant CRS is impacted... (Review)
Review
OBJECTIVE
Primary chronic rhinosinusitis (CRS) is typically a diffuse process and the extent of endoscopic sinus surgery (ESS) performed for medically recalcitrant CRS is impacted by many factors. However, some third-party payors have implemented policies to authorize coverage for ESS in a sinus-by-sinus manner based on a minimal measurement of millimeters of mucosal thickening or sinus opacification in the corresponding sinus that is being surgically addressed. Our objective was to determine whether such policies are based on scientific evidence that in patients with medically recalcitrant CRS, a minimum measurement of mucosal thickening or sinus opacification is a predictor of CRS in that sinus or improved outcomes after ESS on a sinus-by-sinus basis.
DATA SOURCES
Medline, Embase, Scopus, and Web of Science databases, from inception through May 2022.
REVIEW METHODS
A systematic review was performed. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed.
RESULTS
We identified 6070 abstracts which were screened and from which 112 studies ultimately underwent a full-text review. From these studies, we found that none investigated (or provided evidence of) whether any minimal degree of radiographic mucosal thickening or sinus opacification predicted CRS or better outcomes after ESS in a sinus-specific manner.
CONCLUSION
We were unable to find evidence supporting a minimum millimeter measurement of mucosal thickening or sinus opacification as predictors of CRS or better post-ESS outcomes in a sinus-specific manner in patients with medically recalcitrant CRS. The extent of ESS for CRS should be determined through personalized medical decision-making that considers all patient-specific factors.
Topics: Humans; Rhinitis; Paranasal Sinuses; Sinusitis; Endoscopy; Chronic Disease
PubMed: 36807128
DOI: 10.1002/ohn.297 -
JSES Open Access Oct 2019There has been significant recent emphasis on the use of patient-specific instrumentation (PSI) in shoulder arthroplasty. However, clinical data are lacking to support... (Review)
Review
BACKGROUND
There has been significant recent emphasis on the use of patient-specific instrumentation (PSI) in shoulder arthroplasty. However, clinical data are lacking to support the increased time and expense associated with PSI. Our purposes were to determine whether PSI significantly improves implantation accuracy during total shoulder arthroplasty (TSA) and to analyze available techniques and correlation with clinical outcomes. We hypothesized that PSI may improve glenoid component position radiographically but without correlation with clinical outcomes.
METHODS
The MEDLINE, Scopus, Embase, and Cochrane Library databases were queried. Included articles reported use of any preoperative or intraoperative PSI techniques, models, or guides to assist with TSA prosthesis implantation. The primary outcomes were mean deviation from the preoperative plan in version (in degrees), inclination (in degrees), and entry-point offset on the glenoid (in millimeters).
RESULTS
Among the included articles, 518 TSA procedures (352 anatomic and 166 reverse) were performed. The mean postoperative errors in both version and inclination angles were 5° or less in 20 articles (90.9%) using PSI. Meta-analysis revealed no statistically significant differences in version error ( > .999, = 64.6%), inclination error ( = .702, = 82.2%), or positional offset ( = .777, = 85.7%) between PSI and standard instrumentation. No data regarding patient-reported outcome measures, range of motion, strength, or glenoid component loosening and longevity were reported.
CONCLUSIONS
Meta-analysis revealed no significant differences in accuracy between PSI and standard instrumentation. Although PSI may possess the potential to improve TSA techniques, further investigations regarding long-term clinical outcomes, impact on operating room time, and cost-effectiveness are warranted before PSI can be routinely recommended over conventional instrumentation.
PubMed: 31709351
DOI: 10.1016/j.jses.2019.07.002 -
Journal of Dental Research Sep 2015Lateral ridge augmentation procedures are aimed to reconstruct deficient alveolar ridges or to build up peri-implant dehiscence and fenestrations. The objective of this... (Meta-Analysis)
Meta-Analysis Review
Lateral ridge augmentation procedures are aimed to reconstruct deficient alveolar ridges or to build up peri-implant dehiscence and fenestrations. The objective of this systematic review was to assess the efficacy of these interventions by analyzing data from 40 clinical studies evaluating bone augmentation through either the staged or the simultaneous approach. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guideline for systematic reviews was used. The primary outcomes were the changes at reentry, in the ridge width, and in the vertical and horizontal dimensions of the peri-implant defect, measured in millimeters, in the staged and simultaneous approaches, respectively. The results of the meta-analysis showed, for the simultaneous approach, a statistically significant defect height reduction when all treatments were analyzed together (weighted mean difference [WMD] = -4.28 mm; 95% confidence interval: [CI] -4.88, -3.69; P < 0.01). The intervention combining bone replacement grafts with barrier membranes was associated with superior outcomes The most frequently used intervention was the combination of xenograft and bioabsorbable membrane. Similarly, for the staged approach, there was a statistically significant horizontal gain when all treatment groups were combined (WMD = 3.90 mm; 95% CI: 3.52, 4.28; P < 0.001). The most frequently used intervention was the use of autogenous bone blocks. Both treatment strategies led to high survival and success rates (>95%) for the implants placed on the regenerated sites. Nonexposed sites gained significantly more in the simultaneous and staged approaches (WMD = 1.1 and 3.1 mm).
Topics: Alveolar Process; Alveolar Ridge Augmentation; Bone Transplantation; Dental Implantation, Endosseous; Guided Tissue Regeneration, Periodontal; Humans; Membranes, Artificial; Treatment Outcome
PubMed: 26215467
DOI: 10.1177/0022034515594780 -
Journal of the American Dental... May 2017Through a systematic literature review, the authors evaluated the use of chlorhexidine (CHX) mouthwash as an adjunct to mechanical periodontal therapy for chronic... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Through a systematic literature review, the authors evaluated the use of chlorhexidine (CHX) mouthwash as an adjunct to mechanical periodontal therapy for chronic periodontitis.
TYPES OF STUDIES REVIEWED
The authors performed a systematic search by using PubMed (MEDLINE), Scopus, Scientific Electronic Library Online, and Cochrane Central Register of Controlled Trials. The authors selected randomized controlled clinical trials in which the investigators evaluated the probing depth (PD) and clinical attachment level (CAL) in test groups by using CHX as an adjuvant and in control groups and subject to mechanical periodontal therapy (scaling and root planing [SRP] 4-6 visits or 24 hours).
RESULTS
The literature search resulted in 8 articles, which the authors then assessed for quality. After testing for heterogeneity, the authors performed a meta-analysis only in the SRP group with 4 to 6 visits. Results were positive for both PD and CAL with use of CHX. However, the summary measure was significant (P < .05) only for PD at 40 to 60 days (0.33 millimeters; 95% confidence interval, 0.08 to 0.58 mm) and 180 days (0.24 mm; 95% confidence interval, 0.02 to 0.47 mm) of follow-up, showing positive results for the use of CHX at those times. Although those differences were statistically significant, they could be interpreted as clinically slight.
CONCLUSIONS AND PRACTICAL IMPLICATIONS
Adjunctive use of CHX mouthrinse with mechanical SRP resulted in slightly greater PD reduction than did SRP alone. Clinicians must consider the small additional gain in PD reduction, negligible effect on CAL, and potential for tooth staining when using CHX as an adjunct to SRP in treating chronic periodontitis.
Topics: Chlorhexidine; Chronic Periodontitis; Combined Modality Therapy; Dental Scaling; Humans; Mouthwashes; Root Planing
PubMed: 28284417
DOI: 10.1016/j.adaj.2017.01.021 -
Journal of the American Dental... Jun 2022In this systematic review, the authors aimed to answer the following question: Do vital teeth differ in the level of external root resorption induced by means of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
In this systematic review, the authors aimed to answer the following question: Do vital teeth differ in the level of external root resorption induced by means of orthodontic treatment compared with root-filled teeth?
TYPES OF STUDIES REVIEWED
The search strategy was performed in 6 electronic databases and in gray literature for articles published until July 29, 2021. Two reviewers independently assessed potentially eligible studies according to the following criteria: studies that evaluated patients undergoing fixed orthodontic therapy and compared the mean difference in millimeters of orthodontically induced external root resorption in endodontically treated teeth with the vital contralateral tooth. Only randomized, quasi-randomized, nonrandomized, cohort, case-control, or cross-sectional studies were considered eligible. There were no restrictions on language or publication time. Two reviewers also independently extracted data on the characteristics of the included studies, methods, and results, and performed risk-of-bias analysis using the Meta-Analysis of Statistics Assessment and Review instrument. Estimates of interest were calculated using random-effects meta-analyses. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation tool.
RESULTS
Eleven studies were included in the quantitative synthesis. Endodontically treated teeth had a lower level of root resorption (mean difference, 0.45 mm; 95% CI, -0.69 to -0.21 mm). However, the level of certainty of the evidence was considered very low owing to confounding factors.
CONCLUSIONS AND PRACTICAL IMPLICATIONS
Endodontically treated teeth may have a lower level of orthodontically induced root resorption than vital teeth, but the evidence is still uncertain about this outcome. Furthermore, owing to the small effect size, this difference might not be clinically significant (up to 1 mm).
Topics: Case-Control Studies; Cross-Sectional Studies; Humans; Root Resorption; Tooth Root; Tooth, Nonvital
PubMed: 35287942
DOI: 10.1016/j.adaj.2021.11.012 -
International Journal of Oral and... Aug 2023The aim of this study was to determine whether arthrocentesis is superior to conservative treatment in the management of painful temporomandibular joint disorders with... (Meta-Analysis)
Meta-Analysis Review
The aim of this study was to determine whether arthrocentesis is superior to conservative treatment in the management of painful temporomandibular joint disorders with restricted opening. A systematic review was undertaken of prospective randomized controlled trials (RCT) comparing arthrocentesis to conservative management, identified in the MEDLINE and PubMed databases. Inclusion criteria included a 6-month follow-up, with clinical assessment of the patients and painful restricted mouth opening. Data extracted included pain measured on a visual analogue scale and maximum mouth opening measured in millimetres. Risk of bias was assessed using the Cochrane Risk of Bias Tool 2 for RCTs, and a meta-analysis with the random-effects model was undertaken. Of 879 records retrieved, seven met the inclusion criteria; these RCTs reported the results at 6 months for 448 patients. One study had a low risk of bias, four studies had an uncertain risk, and two had a high risk of bias. In the meta-analysis, arthrocentesis was statistically superior to conservative management at 6 months for an increase in maximum mouth opening (1.12 mm, 95% confidence interval 0.45-1.78 mm; P = 0.001; I = 87%) and borderline superior for pain reduction (-1.09 cm, 95% confidence interval -2.19 to 0.01 cm; P = 0.05; I = 100%). However, these differences are unlikely to be clinically relevant.
Topics: Humans; Arthrocentesis; Conservative Treatment; Treatment Outcome; Randomized Controlled Trials as Topic; Temporomandibular Joint Disorders; Pain; Temporomandibular Joint; Range of Motion, Articular
PubMed: 36732095
DOI: 10.1016/j.ijom.2022.12.005 -
Journal of Maxillofacial and Oral... Sep 2023The aim of this systematic review was to systematically assess the papers comparing the surgical techniques of Alveolar Distraction Osteogenesis(ADO) and Autogenous Bone... (Review)
Review
AIM
The aim of this systematic review was to systematically assess the papers comparing the surgical techniques of Alveolar Distraction Osteogenesis(ADO) and Autogenous Bone grafting (ABG) for Vertical Ridge Augmentation in terms of bone gain, bone resorption and incidences of complications.
METHOLODOLOGY
The review was registered on PROSPERO with the ID : CRD42021237671. A broad electronic survey was conducted in the PubMed, Scopus, Web of Science, Cochrane Library, and Virtual Health Library databases of all studies published till 08/03/2022. Four studies fulfilled the criteria to carry out a meta-analysis a in which a total of 58 patients underwent ADO and 43 patients for ABG. A total of 133 implants were placed in the ABG group and 124 in the ADO group.
STATISTICAL ANALYSIS
DerSimonian-Laird estimator of variance was used for Random effect meta-analysis. The estimates of an intervention were expressed as the odds ratio (OR) and standard mean difference (SMD) in millimeters.
RESULTS
There was statistically significant difference in terms of bone height gain with SMD of - 0.78 (95% 0.04-1.55) in ABG. Bone resorption and complications were statistically insignificant with SMD of 0.52 (95% - 1.59 to 0.56) and OR 0.55 (95% 0.18-1.70), respectively.: CRD42021237671.
PubMed: 37534356
DOI: 10.1007/s12663-023-01943-2 -
Cornea Mar 2016To examine the efficacy of corneal collagen cross-linking (CXL) for the treatment of keratoconus (KCN). (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To examine the efficacy of corneal collagen cross-linking (CXL) for the treatment of keratoconus (KCN).
METHODS
A systemic literature review and meta-analysis of ocular functional and structural parameters of patients with KCN undergoing cross-linking procedures were performed using PubMed and the web of science. A literature search was performed for relevant peer-reviewed publications on population-based studies. Data were analyzed with R software (Meta library), and heterogeneity was assessed with the Cochran Q and I. A random-effects model was used for high heterogeneity; otherwise a fixed model was used. Sensitivity analysis of particular tested groups was used to explain high heterogeneity. The main outcome measures extracted from the articles were corrected distance visual acuity, uncorrected distance visual acuity, and maximum K.
RESULTS
An improvement in visual acuity of 1 to 2 Snellen lines was found 3 months or more after undergoing CXL. Changes were more pronounced in uncorrected visual acuity. Some topography parameters were found to be improved (0.6-1 diopters) 12 to 24 months after CXL. The refractive cylinder improved by 0.4 to 0.7 diopters. Endothelial cell density decreased by 225 cells per square millimeter in the first 3 months and thereafter returned to normal. Corneal thickness was reduced by 10 to 20 μm in the year following CXL but not after 24 months. No changes in intraocular pressure were noted.
CONCLUSIONS
CXL is a safe and effective method for halting the deterioration of KCN, while slightly improving visual function.
Topics: Collagen; Corneal Endothelial Cell Loss; Corneal Topography; Cross-Linking Reagents; Humans; Intraocular Pressure; Keratoconus; Photochemotherapy; Photosensitizing Agents; Riboflavin; Visual Acuity
PubMed: 26751990
DOI: 10.1097/ICO.0000000000000723