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Clinical Oral Implants Research Sep 2023The aim of this study was to review available evidence for Type 1A (immediate implant placement and immediate loading) of single tooth replacement in the maxillary... (Meta-Analysis)
Meta-Analysis Review
Selection criteria for immediate implant placement and immediate loading for single tooth replacement in the maxillary esthetic zone: A systematic review and meta-analysis.
OBJECTIVES
The aim of this study was to review available evidence for Type 1A (immediate implant placement and immediate loading) of single tooth replacement in the maxillary esthetic zone.
MATERIALS AND METHODS
An electronic search was conducted utilizing the databases of MEDLINE, Embase, and Cochrane to identify publications reporting on the outcomes of Type 1A for single tooth replacement in the maxillary esthetic zone. The success and survival rates of the included articles were reported, which were further categorized according to the clinical criteria reported in Type 1A. Mean survival rates were univariately compared between risk groups and additionally between studies published before and since 2012 using bias-corrected and study size-weighed bootstrap tests. A study time-correcting meta-analysis was then performed to obtain an overall effect for the study pool.
RESULTS
A total of 3118 publications were identified in the search, with a total of 68 articles included. A mean number of implants per study were 37.2 and mean follow-up was 2.8 years. All the included studies utilizing Type 1A report highly selective inclusion and exclusion criteria. Univariate risk group comparison determined that studies before 2012 report a significantly lower mean survival rate (difference of -1.9 percentage points [PP], 95% CI: [-0.3, -4.0], p = .02), facial gap dimension had an impact on survival rates (+3.1 PP [0.2, 5.3] for width >2 mm, p = .04), as well as presence of endodontic infection (+2.6 PP [0.9, 5.1], p = .004).
CONCLUSIONS
Type 1A has a high survival rate in studies reporting strict patient and site selection criteria. Further research is required to assess esthetic and functional success with Type 1A treatments.
Topics: Humans; Patient Selection; Dental Implants; Esthetics, Dental; Databases, Factual
PubMed: 37750515
DOI: 10.1111/clr.14109 -
Clinical Oral Implants Research Sep 2023To review the available literature on the medium- and long-term effects of soft tissue augmentation (STA) at implant sites and to explore the effects of the different... (Review)
Review
OBJECTIVES
To review the available literature on the medium- and long-term effects of soft tissue augmentation (STA) at implant sites and to explore the effects of the different approaches on clinical-, patient-reported, and health-related parameters.
MATERIALS AND METHODS
A comprehensive electronic and manual search was performed to identify prospective clinical studies that assessed the medium- and long-term (≥36 months) outcomes following STA, including number of sites maintaining peri-implant health and number of sites developing peri-implant disease, incidence of complications, stability of the clinical, volumetric, and radiographic parameters, and patient-reported outcome measures (PROMs).
RESULTS
Fifteen studies were included in the qualitative analysis. STA was performed with either a bilaminar- or an apically positioned flap (APF) approach, in combination with autogenous grafts (free gingival graft [FGG] and connective tissue graft [CTG]) or substitutes (acellular dermal matrix [ADM] and xenogeneic cross-linked collagen matrix [CCM]). An overall high survival rate was observed. Most of the augmented implant sites maintained peri-implant health in the medium and long term, with the incidence of peri-implant mucositis and peri-implantitis ranging from 0% to 50% and from 0% to 7.14%, respectively. The position of the soft tissue margin following APF + FGG and bilaminar approaches involving CTG or CCM was found to be stable over time. No substantial changes were reported for plaque score/index, bleeding on probing/bleeding index, and probing depth between early time points and following visits. CTG-based STA procedures resulted in a stable or increased dimension of keratinized mucosa width (KMW) and mucosal thickness (MT)/volumetric outcomes over time, when compared with early follow-ups. Most of the included studies described stable marginal bone levels at the grafted implant sites over time. No substantial changes for patient-reported outcomes and professionally assessed esthetic results were reported at different time points.
CONCLUSIONS
Implants that received STA showed overall high survival rate and relatively low incidence of peri-implantitis in the medium and long term. Augmented sites seem to maintain the level of soft tissue margin and marginal bone over time, while non-augmented implants may exhibit apical shift of the soft tissue margin. The overall favorable early outcomes obtained with STA are maintained in the medium and long term, with an increase in KMW and MT that may be expected over time at CTG-augmented sites.
Topics: Humans; Peri-Implantitis; Prospective Studies; Dental Implants; Oral Surgical Procedures; Acellular Dermis
PubMed: 37750532
DOI: 10.1111/clr.14150 -
The Journal of Prosthetic Dentistry Apr 2024When restoring endodontically treated teeth, a post system is indicated to retain a core. Clinicians can choose from different post materials and types. However, the... (Meta-Analysis)
Meta-Analysis Review
STATEMENT OF PROBLEM
When restoring endodontically treated teeth, a post system is indicated to retain a core. Clinicians can choose from different post materials and types. However, the literature is inconclusive on the long-term clinical performance of available post systems.
PURPOSE
The purpose of this systematic review and meta-analysis was to analyze the survival and failure rates of endodontically treated teeth restored either with glass-fiber-reinforced or metal posts.
MATERIAL AND METHODS
The research question was formulated by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines by using the Population, Intervention, Comparison, Outcome, Study Type (PICOS) tool. Medline (PubMed), Embase, and Scopus searches complemented by manual search were performed for randomized controlled clinical trials with a follow-up of at least 2 years. Two independent authors performed screening and data extraction of the articles. Meta-analyses were performed with the RevMan software program. Homogeneity was checked by using chi and I tests, and random-effects meta-analyses were applied. Odds ratio and 95% confidence interval were calculated (α=.05). The publication bias was evaluated by using funnel plots and the Begg and Egger tests.
RESULTS
A total of 184 studies were retrieved through the electronic searches, and an additional 4 through the hand search. After title- and abstract-level exclusion, 23 studies remained for full-text analyses, of which 7 were selected for data extraction. Meta-analyses revealed an overall survival rate of 92.8% for endodontically treated teeth restored with glass-fiber-reinforced posts compared with 78.1% of those restored with metal posts. No statistically significant difference (P>.05) was found in the survival, success, or failure rates.
CONCLUSIONS
No statistically significant differences were found between the survival and failure rates of endodontically treated teeth restored either with glass-fiber-reinforced or metal posts. The overall survival rate was 92.8% for glass fiber posts and 78.1% for metal posts. Both are reliable materials when a significant amount of coronal tooth structure is missing and treatment with a post is indicated.
Topics: Humans; Post and Core Technique; Tooth, Nonvital; Survival Rate; Glass; Metals; Tooth Fractures; Composite Resins
PubMed: 35430048
DOI: 10.1016/j.prosdent.2022.01.003 -
Journal of Neuro-oncology Aug 2023Tumor Treating Fields (TTFields) therapy, an electric field-based cancer treatment, became FDA-approved for patients with newly diagnosed glioblastoma (GBM) in 2015... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Tumor Treating Fields (TTFields) therapy, an electric field-based cancer treatment, became FDA-approved for patients with newly diagnosed glioblastoma (GBM) in 2015 based on the randomized controlled EF-14 study. Subsequent approvals worldwide and increased adoption over time have raised the question of whether a consistent survival benefit has been observed in the real-world setting, and whether device usage has played a role.
METHODS
We conducted a literature search to identify clinical studies evaluating overall survival (OS) in TTFields-treated patients. Comparative and single-cohort studies were analyzed. Survival curves were pooled using a distribution-free random-effects method.
RESULTS
Among nine studies, seven (N = 1430 patients) compared the addition of TTFields therapy to standard of care (SOC) chemoradiotherapy versus SOC alone and were included in a pooled analysis for OS. Meta-analysis of comparative studies indicated a significant improvement in OS for patients receiving TTFields and SOC versus SOC alone (HR: 0.63; 95% CI 0.53-0.75; p < 0.001). Among real-world post-approval studies, the pooled median OS was 22.6 months (95% CI 17.6-41.2) for TTFields-treated patients, and 17.4 months (95% CI 14.4-21.6) for those not receiving TTFields. Rates of gross total resection were generally higher in the real-world setting, irrespective of TTFields use. Furthermore, for patients included in studies reporting data on device usage (N = 1015), an average usage rate of ≥ 75% was consistently associated with prolonged survival (p < 0.001).
CONCLUSIONS
Meta-analysis of comparative TTFields studies suggests survival may be improved with the addition of TTFields to SOC for patients with newly diagnosed GBM.
Topics: Humans; Glioblastoma; Temozolomide; Electric Stimulation Therapy; Brain Neoplasms; Combined Modality Therapy
PubMed: 37493865
DOI: 10.1007/s11060-023-04348-w -
American Journal of Obstetrics &... Sep 2023This study aimed to review the diagnostic criteria for mirror syndrome and describe its clinical presentation. (Review)
Review
OBJECTIVE
This study aimed to review the diagnostic criteria for mirror syndrome and describe its clinical presentation.
DATA SOURCES
Databases from PubMed, Scopus, Cochrane Library, ClinicalTrials.gov, and CINAHL were inquired for case series containing ≥2 cases of mirror syndrome from inception to February 2022.
STUDY ELIGIBILITY CRITERIA
Studies were included if they reported ≥2 cases of mirror syndrome and included case reports, case series, cohort studies, and case-control studies.
STUDY APPRAISAL AND SYNTHESIS METHODS
The studies' quality and risk of bias were independently assessed. Data were tabulated using Microsoft Excel and summarized using narrative review and descriptive statistics. This systematic review was conducted according to the Preferred Reporting Item for Systematic Reviews and Meta-Analyses statement. All eligible references were assessed. Screening of records and data extraction were independently performed, and a third author resolved disagreements.
RESULTS
Of 13 citations, 12 studies (n=82) reported diagnostic criteria for mirror syndrome: maternal edema (11/12), fetal hydrops (9/12), placental edema (6/12), placentomegaly (5/12), and preeclampsia (2/12); 12 studies (n=82) described the clinical presentation of mirror syndrome as maternal edema (62.2%), hypoalbuminemia (54.9%), anemia (39.0%), and new-onset hypertension (39.0%); 4 studies (n=36) reported that hemodilution was present in all patients; 8 studies (n=36) reported the etiology of fetal hydrops, with the most common being structural cardiac malformations (19.4%), alpha thalassemia (19.4%), Rh isoimmunization (13.9%), and nonimmune hydrops fetalis (13.9%); and 6 studies (n=47) reported maternal complications, 89.4% of which were major: postpartum hemorrhage (44.7%), hemorrhage requiring blood transfusion (19.1%), intensive care unit admission (12.8%), heart failure (10.6%), pulmonary edema (8.5%), and renal dysfunction (8.5%). In 39 cases, the reported fetal outcomes were stillbirth (66.6%) and neonatal or infant death (25.6%). The overall survival rate among continued pregnancies was 7.7%.
CONCLUSION
The diagnostic criteria of mirror syndrome differed considerably among studies. Mirror syndrome clinical presentation overlapped with preeclampsia. Only 4 studies discussed hemodilution. Significant maternal morbidity and fetal mortality were associated with mirror syndrome. Further research is warranted to elucidate the pathogenesis of mirror syndrome to better guide clinicians in identifying and managing the condition.
Topics: Female; Humans; Infant, Newborn; Pregnancy; Edema; Hydrops Fetalis; Placenta; Pre-Eclampsia; Syndrome; Systematic Reviews as Topic
PubMed: 37385374
DOI: 10.1016/j.ajogmf.2023.101067 -
Updates in Surgery Oct 2023Laser-assisted resection (LAR) of pulmonary metastases offers several potential advantages compared to conventional surgical techniques. However, the technical details,... (Review)
Review
Laser-assisted resection (LAR) of pulmonary metastases offers several potential advantages compared to conventional surgical techniques. However, the technical details, indications and outcomes of LAR have not been extensively reviewed. We conducted a systematic literature search to identify all original articles reporting on LAR of pulmonary metastases. All relevant outcomes, including morbidity rate, R0 rate, pulmonary function tests, overall- (OS) and relapse-free survival (RFS) rates were collected. Additionally, a comparison between outcomes obtained by laser-assisted and conventional resection techniques was provided. Of 2629 articles found by the initial search, 12 were selected for the systematic review. Following LAR, the R0 rate ranged between 72 and 100% and the morbidity rate ranged from 0 to 27.5%. The postoperative decline in forced expiratory volume in 1 s varied between 3.4 and 11%. Median OS and RFS were 42-77.6 months and 9-34.1 months, respectively. Compared with patients treated by other resection techniques, patients treated by LAR frequently had a higher number of metastases and a higher rate of bilateral disease. Despite this, no significant differences were observed in R0 rate, morbidity rate, and median OS rate, while only 1 study found a lower RFS rate in the LAR cohort. Although selection bias limits the comparability of outcomes, the findings of this review suggest that LAR is a valid alternative to conventional procedures of lung metastasectomy. The main difficulties of this technique consist in the adoption of a video-assisted thoracoscopic approach, and in the pathologic assessment of resection margins.
PubMed: 37347356
DOI: 10.1007/s13304-023-01564-x -
The International Journal of Oral &... Oct 2023To assess the survival rate (SR) and probability of postoperative complications at both the implant and patient level for each of the four surgical techniques for... (Meta-Analysis)
Meta-Analysis
PURPOSE
To assess the survival rate (SR) and probability of postoperative complications at both the implant and patient level for each of the four surgical techniques for zygomatic implant (ZI) placement: Brånemark, sinus slot, extrasinus, and extramaxillary.
MATERIALS AND METHODS
A systematic literature review and meta-analysis of clinical studies that reported the survival rate and postoperative ZI complications for the rehabilitation of atrophic edentulous maxillae was conducted based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations. Two independent reviewers consulted four databases during the literature search: MEDLINE (PubMed), Google Scholar, Clinicaltrials.gov, and LILACS. Duplicate articles were eliminated.
RESULTS
A total of 35 studies were included in the meta-analysis. Subgroup analysis showed that study design (prospective vs retrospective) had no significant impact (P = .10) on the outcomes. The SR was highest for the Brånemark and extrasinus techniques (100%) and lowest for the sinus slot technique (94%; 95% CI = 86% to 102%). The extramaxillary (38%; 95% CI = 1% to 3%) and the Brånemark (29%; 95% CI = 15% to 44%) techniques resulted in the highest occurrence of patient-level complications. Moreover, the extramaxillary technique showed the highest percentage of prothesis-related complications (44%; 95% CI = 27% to 62%).
CONCLUSIONS
ZI placement was demonstrated to be a reliable technique for the rehabilitation of severely atrophic maxillae, irrespective of the surgical technique evaluated. Accurate case and surgical protocol selection is of paramount importance to reduce technique-related postoperative complications.
Topics: Humans; Dental Implants; Retrospective Studies; Prospective Studies; Survival Rate; Dental Implantation, Endosseous; Postoperative Complications; Zygoma; Maxilla; Dental Prosthesis, Implant-Supported; Jaw, Edentulous; Follow-Up Studies
PubMed: 37847828
DOI: 10.11607/jomi.10330 -
Clinical Oral Investigations Nov 2023This systematic review assessed the available evidence on the survival and success rate of zirconia and titanium implants. As secondary outcomes, aesthetic, radiographic... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This systematic review assessed the available evidence on the survival and success rate of zirconia and titanium implants. As secondary outcomes, aesthetic, radiographic and clinical parameters, as well as biological and mechanical complications, were considered.
MATERIALS AND METHODS
A systematic search was performed up to March 2022 to identify CCTs/RCTs comparing zirconia and titanium implants with a minimum of 12 months of follow-up. Meta-analysis was performed when ≥ 2 articles with similar characteristics were retrieved.
RESULTS
Four published articles with two RCTs (2 different patient populations) with 100 zirconia and 99 titanium implants that were followed up over 12-80 months were selected out of the 6040 articles. A non-statistically significant difference between zirconia and titanium implant survival at 12 months was suggested (P = 0.0938). The success rates were 57.5-93.3% and 57.1-100% for zirconia and titanium implants, respectively. The pink aesthetic score (PES) was higher for zirconia (10.33 ± 2.06 to 11.38 ± 0.92) compared to titanium implants (8.14 ± 3.58 to 11.56 ± 1.0).
CONCLUSION
Based on the 2 RCTs retrieved in the literature, similar survival rates were reported for zirconia and titanium implants in the short term (12 months of follow-up). Future RCTs are warranted to evaluate the long-term outcomes of zirconia implants.
CLINICAL RELEVANCE
Zirconia implants may be the procedure of choice, particularly in the aesthetic zone, since they show a similar survival and success rate as titanium implants on a short-term follow-up.
TRIAL REGISTRATION
Systematic review registration number-CRD42021288704 (PROSPERO).
Topics: Humans; Dental Implants; Titanium; Dental Restoration Failure; Esthetics, Dental; Zirconium; Dental Prosthesis Design
PubMed: 37740825
DOI: 10.1007/s00784-023-05242-5 -
The Journal of Evidence-based Dental... Dec 2023The aim of this systematic review was to evaluate the survival and complication rates of resin composite laminate veneers. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
The aim of this systematic review was to evaluate the survival and complication rates of resin composite laminate veneers.
METHODS
Randomized controlled trials and cohort studies with a minimum 2-year follow-up assessing survival and complication rates of resin composite laminate veneers on permanent dentition from 1998 to May 2022. Literature searches were conducted in MEDLINE (PubMed), Scopus, and the Cochrane Central Register of Controlled Trials electronic databases. References cited in the related reviews and included full-text articles were also hand-searched to further identify potentially relevant studies.
RESULTS
A total of 827 articles were identified. Twenty-two studies were considered for full-text review after the title and abstract screening stage. After exclusion, 7 studies (3 randomized controlled trials and 4 cohort studies) were included in the systematic review. Three published scales were adopted for the quality and risk of bias assessment. At the survival rate threshold, the overall heterogeneity (I) for randomized controlled trials was 50.5% (P = .108). The overall pooled survival rate of the randomized controlled trials was 88% (95% CI: 81%-94%), with the mean follow-up time ranging from 24 to 97 months. Surface roughness, color mismatch, and marginal discoloration were the most reported complications.
CONCLUSION
Resin composite laminate veneers demonstrated moderately high survival rates for the entire sample and the direct laminate veneer group demonstrated higher survival rates than the indirect approach. Most of the complications were regarded as clinically acceptable with or without reintervention.
Topics: Humans; Dental Porcelain; Composite Resins; Dental Restoration Failure
PubMed: 38035903
DOI: 10.1016/j.jebdp.2023.101911 -
International Journal of Dermatology Aug 2023Biologic agents (also termed biologics) have become an important adjuvant-targeted treatment option in autoimmune blistering disease. We evaluated the efficacy and... (Meta-Analysis)
Meta-Analysis Review
Biologic agents (also termed biologics) have become an important adjuvant-targeted treatment option in autoimmune blistering disease. We evaluated the efficacy and safety of newly licensed biologics for the management of pemphigoid using a meta-analysis. PubMed, EMBASE, Web of Science, and the Cochrane Library for studies involving pemphigoid patients treated with biological agents (rituximab, dupilumab, omalizumab, or mepolizumab) were searched. The pooled risk ratio (RR) with a 95% confidence interval (CI) was used to assess the short-term efficacy, adverse event (AE), relapse, and long-term survival. A total of seven studies involving 296 patients were identified. The pooled RRs for short-term effectiveness, AE, relapse, and long-term survival rate in patients treated with biological agents versus systemic corticosteroids were 1.37 (95% CI 0.95-1.97; I = 82%; P = 0.09), 0.54 (95% CI 0.39-0.73; I = 13%; P = 0.005), 1.36 (95% CI 0.95-1.96; I = 16.8%; P = 0.19), and 1.08 (95% CI 0.95-1.21; I = 48.1%; P = 0.53), respectively. Meta-regression and subgroup analysis revealed that the RRs of efficacy were 2.10 (95% CI 1.61-2.75; I = 0%; P < 0.00001) for rituximab and 2.07 (95% CI 1.61-2.67; I = 0%; P < 0.00001) for sample size greater than 30. Compared with conventional therapy, biologics treatment was significantly associated with fewer adverse events (P < 0.05), but no significant differences were found for efficacy and relapse (P > 0.05). The findings demonstrate that a biologics-containing regimen could minimize the occurrence of AEs and might display a comparable efficacy and recurrence to that of receiving systemic corticosteroids.
Topics: Humans; Rituximab; Biological Factors; Pemphigoid, Bullous; Adrenal Cortex Hormones; Chronic Disease; Biological Products; Recurrence
PubMed: 37212599
DOI: 10.1111/ijd.16678