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The Cochrane Database of Systematic... Nov 2018Periodontal disease is a condition affecting tooth-supporting tissues (gingiva, alveolar bone, periodontal ligament, and cementum), with the potential of introducing... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Periodontal disease is a condition affecting tooth-supporting tissues (gingiva, alveolar bone, periodontal ligament, and cementum), with the potential of introducing severe adverse effects on oral health. It has a complex pathogenesis which involves the combination of specific micro-organisms and a predisposing host response. Infrabony defects are one of the morphological types of alveolar bone defects that can be observed during periodontitis. Recent approaches for the treatment of infrabony defects, combine advanced surgical techniques with platelet-derived growth factors. These are naturally synthesized polypeptides, acting as mediators for various cellular activities during wound healing. It is believed that the adjunctive use of autologous platelet concentrates to periodontal surgical procedures produces a better and more predictable outcome for the treatment of infrabony defects.
OBJECTIVES
To assess the effects of autologous platelet concentrates (APC) used as an adjunct to periodontal surgical therapies (open flap debridement (OFD), OFD combined with bone grafting (BG), guided tissue regeneration (GTR), OFD combined with enamel matrix derivative (EMD)) for the treatment of infrabony defects.
SEARCH METHODS
Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 27 February 2018); the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 1) in the Cochrane Library (searched 27 February 2018); MEDLINE Ovid (1946 to 27 February 2018); Embase Ovid (1980 to 27 February 2018); and LILACS BIREME Virtual Health Library (from 1982 to 27 February 2018). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials on 27 February 2018. No restrictions were placed on the language or date of publication when searching the electronic databases.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) of both parallel and split-mouth design, involving patients with infrabony defects requiring surgical treatment. Studies had to compare treatment outcomes of a specific surgical technique combined with APC, with the same technique when used alone.
DATA COLLECTION AND ANALYSIS
Two review authors independently conducted data extraction and risk of bias assessment, and analysed data following Cochrane methods. The primary outcomes assessed were: change in probing pocket depth (PD), change in clinical attachment level (CAL), and change in radiographic bone defect filling (RBF). We organised all data in four groups, each comparing a specific surgical technique when applied with the adjunct of APC or alone: 1. APC + OFD versus OFD, 2. APC + OFD + BG versus OFD + BG, 3. APC + GTR versus GTR, and 4. APC + EMD versus EMD.
MAIN RESULTS
We included 38 RCTs. Twenty-two had a split-mouth design, and 16 had a parallel design. The overall evaluated data included 1402 defects. Two studies were at unclear overall risk of bias, while the remaining 36 studies had a high overall risk of bias.1. APC + OFD versus OFD alone Twelve studies were included in this comparison, with a total of 510 infrabony defects. There is evidence of an advantage in using APC globally from split-mouth and parallel studies for all three primary outcomes: PD (mean difference (MD) 1.29 mm, 95% confidence interval (CI) 1.00 to 1.58 mm; P < 0.001; 12 studies; 510 defects; very low-quality evidence); CAL (MD 1.47 mm, 95% CI 1.11 to 1.82 mm; P < 0.001; 12 studies; 510 defects; very low-quality evidence); and RBF (MD 34.26%, 95% CI 30.07% to 38.46%; P < 0.001; 9 studies; 401 defects; very low-quality evidence).2. APC + OFD + BG versus OFD + BG Seventeen studies were included in this comparison, with a total of 569 infrabony defects. Considering all follow-ups, as well as 3 to 6 months and 9 to 12 months, there is evidence of an advantage in using APC from both split-mouth and parallel studies for all three primary outcomes: PD (MD 0.54 mm, 95% CI 0.33 to 0.75 mm; P < 0.001; 17 studies; 569 defects; very low-quality evidence); CAL (MD 0.72 mm, 95% CI 0.43 to 1.00 mm; P < 0.001; 17 studies; 569 defects; very low-quality evidence); and RBF (MD 8.10%, 95% CI 5.26% to 10.94%; P < 0.001; 11 studies; 420 defects; very low-quality evidence).3. APC + GTR versus GTR alone Seven studies were included in this comparison, with a total of 248 infrabony defects. Considering all follow-ups, there is probably a benefit for APC for both PD (MD 0.92 mm, 95% CI -0.02 to 1.86 mm; P = 0.05; very low-quality evidence) and CAL (MD 0.42 mm, 95% CI -0.02 to 0.86 mm; P = 0.06; very low-quality evidence). However, given the wide confidence intervals, there might be a possibility of a slight benefit for the control. When considering a 3 to 6 months and a 9 to 12 months follow-up there were no benefits evidenced, except for CAL at 3 to 6 months (MD 0.54 mm, 95% CI 0.18 to 0.89 mm; P = 0.003; 3 studies; 134 defects). No RBF data were available.4. APC + EMD versus EMDTwo studies were included in this comparison, with a total of 75 infrabony defects. There is insufficient evidence of an overall advantage of using APC for all three primary outcomes: PD (MD 0.13 mm, 95% CI -0.05 to 0.30 mm; P = 0.16; 2 studies; 75 defects; very low-quality evidence), CAL (MD 0.10 mm, 95% CI -0.13 to 0.32 mm; P = 0.40; 2 studies; 75 defects; very low-quality evidence), and RBF (MD -0.60%, 95% CI -6.21% to 5.01%; P = 0.83; 1 study; 49 defects; very low-quality evidence).All studies in all groups reported a survival rate of 100% for the treated teeth. No complete pocket closure was reported. No quantitative analysis regarding patients' quality of life was possible.
AUTHORS' CONCLUSIONS
There is very low-quality evidence that the adjunct of APC to OFD or OFD + BG when treating infrabony defects may improve probing pocket depth, clinical attachment level, and radiographic bone defect filling. For GTR or EMD, insufficient evidence of an advantage in using APC was observed.
Topics: Adolescent; Adult; Aged; Alveolar Bone Loss; Autografts; Bone Transplantation; Combined Modality Therapy; Dental Enamel Proteins; Female; Guided Tissue Regeneration, Periodontal; Humans; Male; Middle Aged; Periodontal Debridement; Periodontal Diseases; Periodontal Index; Platelet Transfusion; Randomized Controlled Trials as Topic
PubMed: 30484284
DOI: 10.1002/14651858.CD011423.pub2 -
BioMed Research International 2021Platelet-rich fibrin (PRF) is a kind of autologous platelet concentrate which is easy to obtain and cheap. In recent years, it has been studied to improve the effect of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Platelet-rich fibrin (PRF) is a kind of autologous platelet concentrate which is easy to obtain and cheap. In recent years, it has been studied to improve the effect of periodontal regeneration. However, few studies have systematically evaluated the complementary effect of PRF in the treatment of intrabony defects. The present review is aimed at systematically assessing the effects of PRF on clinical and radiological outcomes of the surgical treatment of periodontal intrabony defects.
METHODS
The protocol was registered at PROSPERO (International Prospective Register of Systematic Reviews) as CRD42020206056. An electronic search was conducted in MEDLINE, Cochrane, and EMBASE databases. Only randomized clinical trials were selected. Systematically healthy patients with two or three walls of intrabony defects were considered. Intrabony defect (IBD) depth reduction and bone fill (BF) % were set as primary outcomes while probing depth (PD) reduction, clinical attachment level (CAL) gain, and gingival margin level (GML) gain were considered as the secondary outcome. When possible, a meta-analysis was performed.
RESULTS
Eighteen articles fulfilled the inclusion criteria, and seventeen studies were quantitatively analyzed. Of 17 studies, four were rated as high risk of bias and thirteen as the moderate risk of bias. Two comparisons were set: (1) open flap debridement (OFD) combined with PRF and OFD alone and (2) bone grafting (BG) combined with PRF and BG alone. Compared to OFD alone, OFD+PRF showed significantly greater in all primary and secondary outcomes. Compared to BG alone, BG+PRF showed significantly greater in IBD depth reduction, PD reduction, CAL gain, and GML gain.
CONCLUSIONS
The use of PRF was significantly effective in the treatment of periodontal intrabony defects. The benefit of OFD+PRF may be greater than BG+PRF. PRF can promote early wound healing in periodontal surgery. As all included studies were not at low risk of bias, well-designed RCTs having a high methodological quality are needed to clarify the additional effectiveness of PRF in the treatment of intrabony defects in the future.
Topics: Adult; Biological Products; Female; Humans; Male; Middle Aged; Periodontal Diseases; Periodontium; Platelet-Rich Fibrin; Young Adult
PubMed: 33614786
DOI: 10.1155/2021/6669168 -
International Journal of Implant... Oct 2021Information about the aesthetic effects of flapless in implant surgeries is scant. Differences of the survival rate (SR) and crestal bone loss (CBL) between the two... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Information about the aesthetic effects of flapless in implant surgeries is scant. Differences of the survival rate (SR) and crestal bone loss (CBL) between the two techniques were also controversial. Thus, this review was aimed to compare the general and aesthetic effects of flapless and flap approaches in implant surgeries.
MATERIALS AND METHODS
Following the principals of PRISMA, literature databases were searched for the eligible randomized controlled trials (RCTs) comparing the clinical performances of flap and flapless techniques. After that, relevant data of selected studies were pooled and analyzed to compare SR, bleeding on probing (BOP), probing depth (PD), visual analogue scale (VAS), papillae presentation index (PPI), keratinized mucosa (KM) width and CBL between the two techniques.
RESULTS
Fourteen RCTs were included. No significant difference was found in SR (RR = - 0.01, 95% confidence interval (CI) (- 0.05, 0.04)), BOP (OR = 0.40, 95% CI (0.15, 1.02)), KM width (WMD = - 0.42, 95% CI (- 1.02, 0.17)) between two groups. Subgroup analysis revealed that the difference of CBL was insignificant in two groups (WMD = - 0.13, 95% CI (- 0.63, 0.38)). However, flap techniques would lead more peri-implant PD (WMD = - 0.37, 95% CI (- 0.51, - 0.23)). Subgroup analysis also indicated lower VAS scores in flapless group after 1 day (WMD = - 1.66, 95% CI (- 2.16, - 1.16)) but comparable pain experience after 3 days (WMD = - 0.59, 95% CI (- 1.33, 0.16)). Mean difference of PPI (WMD = 0.32, 95% CI (0.28, 0.35)) between the two groups was significant.
CONCLUSIONS
The flapless procedure showed a superiority in preserving gingival papillae, reducing postoperative pain and peri-implant PD compared to the flap procedure, while exhibiting comparable effects on SR, BOP, KW width changes and CBL. Flapless technique is more recommended at the ideal soft and hard tissue implanting sites.
Topics: Dental Implantation; Esthetics; Gingiva; Randomized Controlled Trials as Topic; Surgical Flaps
PubMed: 34595691
DOI: 10.1186/s40729-021-00380-5 -
Journal of Stomatology, Oral and... Feb 2023To summarize published information regarding malignant tumors with metastasis to the oral cavity. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To summarize published information regarding malignant tumors with metastasis to the oral cavity.
MATERIALS AND METHODS
This was a systematic review with meta-analysis. An electronic search of Pubmed, Scopus, and Google Scholar databases from inceptions to February 2022 were performed. Only case reports or case series with histopathological results demonstrating metastasis to the oral cavity were included. The main outcomes included demographics, primary site, metastatic site, clinical manifestations, and patient survival. The quality of primary articles was assessed using the Joanna Briggs Institute - University of Adelaide scorecards for case reports and case series. Descriptive analysis and a Kaplan-Meier survival curve were performed.
RESULTS
273 articles were selected (50 case series and 223 case reports), for a total of 950 cases. The mean age was 57.11 years. Males were more affected (57.5%). The most common primary sites in women and men was breast (29.8%), and lung (24.8%), respectively. In ∼1/3 of the cases, oral metastasis preceded tumor dissemination. Jawbones were more affected (56.7%) than soft tissues (37.9%), with the mandible being the most affected site (45.5%), followed by the gingiva (19.9%). The most common clinical manifestation was a mass or nodule. Most radiographic evidence was radiolucency of the jaw (60.6%). 3-year and 5-year survival rates were 14.2 and 10.7%. In the majority of cases, the primary tumor was the first to be diagnosed, while in 30.4%, metastasis was the first sign of the disseminated disease. This can be implied that the oral metastasis should be included in the differential diagnosis list of the oral diseases.
CONCLUSION
Clinicians should be aware of the possibility of, albeit uncommon, oral metastases. Because the extracted data in this review was relatively generalized, the investigators cannot develop the diagnostic clues of oral metastasis, which require further investigations.
Topics: Male; Humans; Female; Middle Aged; Mouth Neoplasms; Mandible; Gingiva; Diagnosis, Differential
PubMed: 36371023
DOI: 10.1016/j.jormas.2022.11.006 -
European Review For Medical and... Nov 2021The aim of the study is to investigate the efficacy of cell-based therapy in the surgical treatment of periodontal intrabony defects. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The aim of the study is to investigate the efficacy of cell-based therapy in the surgical treatment of periodontal intrabony defects.
MATERIALS AND METHODS
PRISMA guidelines were followed, and the study protocol was regis-tered in PROSPERO. Electronic and hand searches were carried out on electronic databases and major international journals of periodontology. All randomized clinical trials (RCTs) comparing cell-based therapies com-bined with surgery to surgery alone for the treatment of periodontal intrabony defects were considered. Quality assessment was performed using the Cochrane Risk of Bias Tool for randomized clinical trials (RoB 2). Quantitative evaluation of data was performed by meta-analysis.
RESULTS
Five hundred twenty-eight records were initially screened and 5 RCTs fulfilling the eligibility criteria were included. Periodontal ligament stem cells, dental pulp stem cells, periosteum-derived stem cells, gingival fibroblasts and their associated stem cells were used in combination with different surgical techniques to treat intrabony periodontal defects. Meta-analysis showed a statistically signif-icant effect in favor of cell-based groups for clinical attachment level gain (p=0.004), with a difference in means of 1.7 mm (95% CI 0.5; 2.9). This was replicated for intrabony defect depth reduction (p=0.006), with a difference in means of 1.3 (95% CI 0.4; 2.3).
CONCLUSIONS
Cell-based therapies have been positively applied for the surgical treatment of intrabony periodontal defects with promising results. However, the results obtained should be interpreted with caution due to the low number of available RCTs, the study design heterogeneity, and the limited extension of the follow-up.
Topics: Cell- and Tissue-Based Therapy; Humans; Periodontal Diseases; Randomized Controlled Trials as Topic
PubMed: 34787862
DOI: 10.26355/eurrev_202111_27102 -
Oral Health & Preventive Dentistry Oct 2020To present an update the orofacial manifestations of granulomatosis with polyangiitis (GPA) and present a clinical case with the initial signs in the oral cavity.
PURPOSE
To present an update the orofacial manifestations of granulomatosis with polyangiitis (GPA) and present a clinical case with the initial signs in the oral cavity.
MATERIALS AND METHODS
A bibliographic search was performed on Pubmed with the keywords 'Wegener's granulomatosis', 'etiology', 'oral manifestations', 'oral cavity', 'gingiva'. The inclusion criteria were papers published in English in the last 10 years that made reference to clinical cases with in which the oral cavity was affected. The quality of the results was assessed with 'The 2013 Care Checklist'.
RESULTS
Nineteen clinical cases were analysed. The average quality was 7.68/13 (range 5-10/13). 73.7% of patients were women, the most frequent area for the lesions was the gingiva and the most prevalent lesion was gingival hyperplasia. 68.4% of the patients had this lesion as a first sign, 21.1% as a progression and 10.5% as a recurrence. 68.4% of the lesions resolved once medical treatment was established.
CONCLUSION
GPA is a multisystem disorder associated with considerable morbidity and mortality if not treated. Early diagnosis improves the prognosis. The first manifestation of the disease can be seen in the oral cavity. It is important that dentists recognise the oral manifestation in order to improve the prognosis. Key words: granulomatosis, polyangiiitis, Wegener's granulomatosis.
Topics: Female; Gingiva; Gingival Hyperplasia; Granulomatosis with Polyangiitis; Humans; Prognosis
PubMed: 33215484
DOI: 10.3290/j.ohpd.a45433 -
Clinical Oral Implants Research May 2024Pigs are emerging as a preferred experimental in vivo model for bone regeneration. The study objective was to answer the focused PEO question: in the pig model (P),... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Pigs are emerging as a preferred experimental in vivo model for bone regeneration. The study objective was to answer the focused PEO question: in the pig model (P), what is the capacity of experimental alveolar bone defects (E) for spontaneous regeneration in terms of new bone formation (O)?
METHODS
Following PRISMA guidelines, electronic databases were searched for studies reporting experimental bone defects or extraction socket healing in the maxillae or mandibles of pigs. The main inclusion criteria were the presence of a control group of untreated defects/sockets and the assessment of regeneration via 3D tomography [radiographic defect fill (RDF)] or 2D histomorphometry [new bone formation (NBF)]. Random effects meta-analyses were performed for the outcomes RDF and NBF.
RESULTS
Overall, 45 studies were included reporting on alveolar bone defects or extraction sockets, most frequently in the mandibles of minipigs. Based on morphology, defects were broadly classified as 'box-defects' (BD) or 'cylinder-defects' (CD) with a wide range of healing times (10 days to 52 weeks). Meta-analyses revealed pooled estimates (with 95% confidence intervals) of 50% RDF (36.87%-63.15%) and 43.74% NBF (30.47%-57%) in BD, and 44% RDF (16.48%-71.61%) and 39.67% NBF (31.53%-47.81%) in CD, which were similar to estimates of socket-healing [48.74% RDF (40.35%-57.13%) and 38.73% NBF (28.57%-48.89%)]. Heterogeneity in the meta-analysis was high (I > 90%).
CONCLUSION
A substantial body of literature revealed a high capacity for spontaneous regeneration in experimental alveolar bone defects of (mini)pigs, which should be considered in future studies of bone regeneration in this animal model.
Topics: Animals; Alveolar Bone Loss; Bone Regeneration; Disease Models, Animal; Swine; Tooth Socket; Wound Healing
PubMed: 38450852
DOI: 10.1111/clr.14253 -
Pathology Oncology Research : POR Apr 2019Whole saliva is mainly composed of fluid produced by major and minor salivary glands. Major salivary glands including parotid, submandibular, and sublingual glands, are... (Meta-Analysis)
Meta-Analysis
Whole saliva is mainly composed of fluid produced by major and minor salivary glands. Major salivary glands including parotid, submandibular, and sublingual glands, are known to secrete fluid transported from serum as well as surrounding glandular tissues [1]. Beside the secretions from salivary glands, oral mucosa, periodontium, as well as oral microflora also contribute to the final content of whole saliva [1]. Whole saliva therefore represents a complex balance among local and systemic sources [2]. This allows for the application of saliva in the diagnosis not only for salivary gland disorders but also for oral diseases and systemic conditions [2]. The role of saliva as a diagnostic tool in detecting Oral Squamous Cell Carcinoma. Articles published in PUBMED, EMBASE, COCHRANE, GOOGLE, manual search and back references of the articles for last 5 years extracted 77 articles. Studies which considered saliva as a diagnostic tool were included. Statistical analysis with Receivers Operating Curve to establish sensitivity and specificity of the salivary biomarkers as a diagnostic tool to detect Oral Squamous Cell Carcinoma were included for meta analysis. The measure of effect with 95% confidence interval were meta analysed for 9 articles in which 308 healthy individuals compared with 340 patients with Oral Squamous Cell Carcinoma. Highly sensitive salivary biomarkers for detecting Oral Squamous Cell Carcinoma were MMP-9, Chemerin, Choline + Betaine + Pipecolinic Acid + I - Carnitine(confidence interval ranges from 0.83-1.0). The narrow confidence interval of 0.95 + (0.88-1.00) was seen for MMP-9 followed by 1.00 + (0.78-1.00) for chemerin. Highly specific biomarkers for Oral Squamous Cell Carcinoma were MMP-9 (specificity -100%,), Chemerin(specificity-100%), over expressed mi RNA 136 with specificity of 0.88(0.69-0.97), under expressed mi RNA 27B with specificity of 1.0(0.66-1.00). Saliva can be used as a diagnostic tool with highly sensitive and specific markers namely MMP-9, Chemerin for early detection of Oral Squamous Cell Carcinoma.
Topics: Biomarkers, Tumor; Chemokines; Early Detection of Cancer; Humans; Intercellular Signaling Peptides and Proteins; Matrix Metalloproteinase 9; Mouth Neoplasms; Saliva; Sensitivity and Specificity; Squamous Cell Carcinoma of Head and Neck
PubMed: 30712193
DOI: 10.1007/s12253-019-00588-2 -
Archives of Oral Biology Jul 2020The aim of this review was to appraise the existing evidence from pre- clinical research on tooth movement under the condition of hyperglycemic status. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The aim of this review was to appraise the existing evidence from pre- clinical research on tooth movement under the condition of hyperglycemic status.
DESIGN
Electronic search was conducted in 8 databases in October 13, 2019, to identify related pre- clinical animal research with keywords being: "diabetes mellitus", "tooth movement". Eligibility criteria involved controlled animal studies, entailing tooth movement under diabetic status compared to control healthy animals. Primary endpoints involved all outcomes related to tooth movement. Risk of bias (RoB) was assessed through the SYstematic Review Centre for Laboratory animal Experimentation tool (SYRCLE), while quantitative synthesis was planned after exploration of heterogeneity, through random effects meta-analyses of standardized mean differences (SMDs) with 95 % confidence intervals (CIs).
RESULTS
Of an initial number of 290 articles retrieved, 14 papers were eligible for inclusion in the qualitative synthesis, while 9 contributed to meta-analyses. Heterogeneity of experimental conditions in individual studies was evident. The risk of bias overall was rated as unclear to high. There was no evidence of a significant effect of diabetes mellitus when tooth movement was assessed macroscopically (6 studies, SMD: 1.47; 95 % CI: -0.60, 3.53; p = 0.16). However, attenuation of osteoblastic differentiation within the periodontal ligament was detected, as there was evidence of reduction of osteopontin expression (2 studies, SMD: -3.77; 95 %CI: -4.89, -2.66; p < 0.001).
CONCLUSIONS
There is currently a paucity of solid evidence with regard to alterations of the equilibrium of the implicated structures under the status of diabetes mellitus, when mechanical stimulation of teeth is attempted, with sporadic inferences from animal research. Significant research insights in how the disease impacts on orthodontic tooth movement are invaluable, at present.
Topics: Animals; Diabetes Mellitus; Hyperglycemia; Periodontal Ligament; Tooth Movement Techniques; Treatment Outcome
PubMed: 32422362
DOI: 10.1016/j.archoralbio.2020.104739