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Clinical Rheumatology Nov 2020SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome is a poorly known disease with cutaneous and osteo-articular manifestations requiring a...
SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome is a poorly known disease with cutaneous and osteo-articular manifestations requiring a multidisciplinary care. The aim of this study was to review the case reports that have described oral manifestations in patients suffering for this syndrome. A systematic review of case reports was performed on PubMed and Science Direct on January 2020 among all the articles dealing with the disease. In vitro, preclinical, and clinical studies have not been included to select only the case reports. Eighteen articles, published between 1999 and 2019, were included. All the patients presented mandibular osteomyelitis or sclerosis, associated with various other symptoms such as trismus, temporomandibular joint arthritis, or dysphagia. The data highlight the high variability in the disease's manifestations between people and also in the treatments applied. Knowing the orofacial signs of the SAPHO syndrome, the dental surgeon has a crucial role in the diagnosis procedure and must take place in the multidisciplinary medical team involved in the patient following. Some care adaptations are needed for oral interventions in these patients, depending on their treatments and their handicap. Key Points • Orofacial manifestations of SAPHO syndrome mainly occur on the mandible. • In cases of mandible sclerosis, decorticalization surgeries may be performed. • Oral care are encouraged, especially the preventive treatments to limit the necessity of surgeries. • The complexity in the management of patients suffering for a SAPHO syndrome concerns the oral manifestations, the patient general health and the treatments he has to take every day.
Topics: Acquired Hyperostosis Syndrome; Humans; Male; Mandible; Osteitis; Osteomyelitis; Synovitis
PubMed: 32388746
DOI: 10.1007/s10067-020-05084-6 -
Rheumatology (Oxford, England) Feb 2023Chronic nonbacterial osteomyelitis (CNO) is a rare inflammatory bone disease. The distinct CNO subtype that affects the anterior chest wall is descriptively named... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Chronic nonbacterial osteomyelitis (CNO) is a rare inflammatory bone disease. The distinct CNO subtype that affects the anterior chest wall is descriptively named sternocostoclavicular hyperostosis (SCCH) and mainly occurs in adults. Literature on CNO/SCCH is scattered and lacks diagnostic and therapeutic consensus.
METHODS
Systematic review and meta-analysis aiming to characterize clinical presentation and therapeutic modalities applied in adult CNO/SCCH patients. Untransformed numerical data and double-arcsine transformed proportional data were pooled in a random effects model in R-4.0.5; proportions were reported with 95% CI.
RESULTS
Forty studies were included, containing data on 2030 and 642 patients for aim 1 and 2, respectively. A female predisposition (67%, 95% CI 60, 73) and major diagnostic delay (5 years 95% CI 3, 7) were noted. Clinical presentation included chest pain (89%, 95% CI 79, 96) and swelling (79%, 95% CI 62, 91). Patients suffered from pustulosis palmoplantaris (53%, 95% CI 37, 68), arthritis (24%, 95% CI 11, 39) and acne (8%, 95% CI 4, 13). Inflammatory markers were inconsistently elevated. Autoantibody and HLA-B27 prevalence was normal, and histopathology unspecific. Increased isotope uptake (99%, 95% CI 96, 100) was a consistent imaging finding. Among manifold treatments, pamidronate and biologicals yielded good response in 83%, 95% CI 60, 98 and 56%, 95% CI 26, 85, respectively.
CONCLUSION
CNO/SCCH literature proves heterogeneous regarding diagnostics and treatment. Timely diagnosis is challenging and mainly follows from increased isotope uptake on nuclear examination. Biopsies, autoantibodies and HLA status are non-contributory, and biochemical inflammation only variably detected. Based on reported data, bisphosphonates and biologicals seem reasonably effective, but due to limitations in design and heterogeneity between studies the precise magnitude of their effect is uncertain. Fundamentally, international consensus seems imperative to advance clinical care for CNO/SCCH.
Topics: Adult; Humans; Female; Acquired Hyperostosis Syndrome; Delayed Diagnosis; Osteomyelitis; Psoriasis
PubMed: 35961032
DOI: 10.1093/rheumatology/keac443 -
Australian Dental Journal Jun 2021Extraction of mandibular third molars (M3M) close to the inferior alveolar nerve (IAN) has a higher risk of neurological disturbance. This review aims to evaluate the... (Review)
Review
BACKGROUND
Extraction of mandibular third molars (M3M) close to the inferior alveolar nerve (IAN) has a higher risk of neurological disturbance. This review aims to evaluate the evidence supporting the use of the coronectomy technique compared to complete extraction for such M3Ms. Case studies by a specialist oral and maxillofacial surgeon are included to illustrate clinical practice.
METHODS
Three databases (Cochrane Library, Embase, PubMed) were searched (November 2020). Additional articles were sought by hand searching the reference list of included articles. All studies published in English comparing outcomes of coronectomy with complete extraction with at least 50 subjects and 6 months follow-up were included.
RESULTS
Of the six included studies, five reported a lower rate of IAN disturbance after coronectomy compared with complete extraction. There were no reported cases of lingual nerve disturbance. Other outcomes of coronectomy such as pain, infection, alveolar osteitis were either similar or lower compared to complete extraction. There were high rates of root migration but low rates of exposure and reoperation. Follow-up protocols varied considerably.
CONCLUSIONS
There is medium quality evidence to support the option of coronectomy for high risk M3M cases. Further studies to develop follow-up protocols to assist general dental practice is warranted.
Topics: Humans; Mandible; Mandibular Nerve; Molar, Third; Tooth Crown; Tooth Extraction; Tooth, Impacted; Trigeminal Nerve Injuries
PubMed: 33486775
DOI: 10.1111/adj.12825 -
Hua Xi Kou Qiang Yi Xue Za Zhi = Huaxi... Oct 2021This study aims to analyze the effectiveness of platelet-rich fibrin (PRF) in mandibular third molar extraction and provide suggestions for alleviating postoperative... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
This study aims to analyze the effectiveness of platelet-rich fibrin (PRF) in mandibular third molar extraction and provide suggestions for alleviating postoperative complications.
METHODS
Pubmed, EMBASE, Web of Science, and SinoMed were searched electronically on February 2020. Randomized controlled trials focusing on PRF usage in mandibular third molar extraction were included. Reviewers assessed the risk of bias in the included literature and extracted data independently using the criteria recommended by the Cochrane Collaboration. Meta-analysis was performed using RevMan 5.3 and STATA 13.0.
RESULTS
Twenty-one studies were included, comprising 991 patients who had mandibular third molar extraction. The topical application of PRF effectively reduced pain after extraction [MD=-12.06, 95%CI (-21.42, -2.71), =0.01], attenuated post-extraction swelling [MD=-1.42, 95%CI (-2.41, -0.44), =0.005], and promoted soft tissue hea-ling [MD=0.66, 95%CI (0.34, 0.99), <0.000 1]. PRF significantly reduced trismus and alveolar osteitis (<0.05). However, data could not prove whether PRF has any significant positive effect on bone healing compared with the control group (>0.05).
CONCLUSIONS
Limited clinical evidence indicates that applying PRF after mandibular third molar extraction could reduce pain, swelling, trismus and the occurrence of dry socket and promote soft tissue healing. However, the effect of PRF on bone healing requires further large-scale randomized controlled trials and unified measurement criteria.
Topics: Humans; Mandible; Molar, Third; Platelet-Rich Fibrin; Tooth Extraction; Tooth, Impacted
PubMed: 34636211
DOI: 10.7518/hxkq.2021.05.017 -
Journal of Cranio-maxillo-facial... Sep 2020A systematic review and network meta-analysis was carried out to assess the efficacy of different intrasocket interventions immediately after mandibular third molar... (Meta-Analysis)
Meta-Analysis
A systematic review and network meta-analysis was carried out to assess the efficacy of different intrasocket interventions immediately after mandibular third molar surgery to prevent alveolar osteitis (AO). An electronic search was undertaken using EMBASE, Cochrane Library, MEDLINE/PubMed, Web of Science, Scopus, LILACS, and grey literature. We reviewed studies published up to September 2019 and included 37 randomized controlled trials (6175 mandibular third molar surgeries in 4716 patients). The pairwise meta-analysis showed that the incidence of AO decreased significantly when an intrasocket intervention was performed (risk ratio 0.39 [0.30, 0.52]; p < 0.0001). Platelet-rich fibrin (odds ratio 0.28; 95% CI [0.10, 0.71]), chlorhexidine gel 0.2% (0.52 [0.32, 0.95]), eugenol paste (0.06 [0.00, 0.77]), recombinant bovine growth factor (0.07 [0.00, 0.97]), colloidal silver gelatin sponge (0.05 [0.00, 0.74]), and acellular dermal matrix (0.04 [0.00, 0.74]) were significantly more effective than the placebo. Platelet-rich fibrin and chlorhexidine 0.2% gel had a large number of included studies and patients per comparison. Overall, there was moderate evidence to support the use of platelet-rich fibrin or chlorhexidine 0.2% gel in the socket for the prevention of AO after mandibular third molar surgery.
Topics: Animals; Cattle; Chlorhexidine; Dry Socket; Humans; Molar; Molar, Third; Tooth Extraction; Tooth, Impacted
PubMed: 32718882
DOI: 10.1016/j.jcms.2020.06.012 -
National Journal of Maxillofacial... 2024To compare the effectiveness of pre-operative and post-operative administration of amoxicillin in patients undergoing third molar extraction surgery. A systematic search... (Review)
Review
To compare the effectiveness of pre-operative and post-operative administration of amoxicillin in patients undergoing third molar extraction surgery. A systematic search was executed according to PRISMA guidelines for studies published till December 2021. Studies were included based on the pre-eligibility criteria. The risk of bias was assessed using the Cochrane risk of bias tool. The heterogeneity was evaluated, and a random effect model was used for meta-analysis. A total of five studies were included from an initial search of 96 studies. The included studies were randomized controlled trials and comparative studies assessing pre-operative and post-operative administration of antibiotics among patients undergoing third molar extraction surgery. For comparison between pre-operative and post-operative groups, interincisal distance, complications, pain, and swelling were systematically reviewed and meta-analysis was done for interincisal distance and complications. The mean change in interincisal distance ranged from 5.5 to 47.9 and from 4.56 to 46.1 in the pre-operative and post-operative amoxicillin groups, respectively. Complications reported were infections, alveolar osteitis, nausea, diarrhea, gastric pain, rash, and headache with a pooled incidence of 4.3-33% in the pre-operative amoxicillin group and 0-22.7% in the post-operative amoxicillin group. Quantitative synthesis of data carried out from meta-analysis shows a significant difference in the pre-operative and post-operative amoxicillin groups in improving the interincisal distance and incidence of complications post surgery. The qualitative synthesis of data derived from systematic review for pain provides favoring results for post-operative amoxicillin administration. In case of swelling, a non-conclusive result was obtained.
PubMed: 38690250
DOI: 10.4103/njms.njms_163_22 -
World Neurosurgery Aug 2022Spinal vertebral hemangiomas (SVHs) are the most common benign tumors of the spine. We performed a systematic review and meta-analysis of radiosurgery (RS) for SVHs. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Spinal vertebral hemangiomas (SVHs) are the most common benign tumors of the spine. We performed a systematic review and meta-analysis of radiosurgery (RS) for SVHs.
METHODS
We reviewed articles published between January 1990 and December 2020 on PubMed. Tumor control, pain relief, and damage to surrounding tissues were evaluated with separate meta-analyses. This study was performed in accordance with the published Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 23 patients with 24 SVHs were reported in 3 studies.
RESULTS
Follow-up time was 7.3-84 months. The vast majority of lesions were located at dorsal level (n = 18; 75%). In 20 (83.3%) patients, pain was the initial clinical presentation. Complete, partial, and stable responses after radiation were reported in 45.7% (P < 0.001), 23.6% (P = 0.02), and 37.2% (P = 0.7) of cases. Overall response was reported in 94.1% (P = 0.7). No progressive disease was reported. Pain relief was achieved in 87.5% of patients (P = 0.2). Damage to surrounding tissue caused by irradiation was reported in 22.3% (P = 0.02) of cases in 1 study, in which higher doses of radiation were delivered.
CONCLUSIONS
Radiosurgery is safe and effective for SVHs. Pain relief after RS in symptomatic patients was extremely high, while no progressive disease was reported. Damage to surrounding tissues was reported in only 1 series and included osteitis, osteonecrosis, or soft tissue injury after higher radiation doses.
Topics: Hemangioma; Humans; Pain; Radiosurgery; Spinal Neoplasms; Treatment Outcome; Vertebral Body
PubMed: 35378316
DOI: 10.1016/j.wneu.2022.03.120 -
The Journal of Nursing Research : JNR Sep 2020Alveolar osteitis (AO) may occur after molar extraction. Chlorhexidine (CHX) rinse and CHX gel are widely used to prevent AO. Although previous meta-analyses support the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Alveolar osteitis (AO) may occur after molar extraction. Chlorhexidine (CHX) rinse and CHX gel are widely used to prevent AO. Although previous meta-analyses support the effectiveness of both CHX rinse and CHX gel in preventing AO, important issues regarding these two formulations have not been addressed adequately in the literature.
PURPOSE
A systematic review and meta-analysis of randomized controlled trials was conducted to determine the effectiveness of CHX rinse and CHX gel in preventing AO.
METHODS
PubMed, EMBASE, SCOPUS, and Cochrane databases were searched for randomized controlled trials published before June 2018. The risk ratio (RR) was used to estimate the pooled effect of AO incidence using a random-effect model.
RESULTS
The RRs of AO in patients treated with 0.12% CHX rinse (RR = 0.54, 95% CI [0.41, 0.72]) and 0.2% CHX rinse (RR = 0.84, 95% CI [0.52, 1.35]) were significantly lower than in those treated with the control. Moreover, a significantly lower RR was identified in patients treated with 0.2% CHX gel (RR = 0.47, 95% CI [0.34, 0.64]) than in those treated with the control. When CHX products of different concentrations were grouped together, patients treated with CHX rinse showed an RR of AO of 0.61 (95% CI [0.48, 0.78]) and those treated with CHX gel showed an RR of AO of 0.44 (95% CI [0.43, 0.65]). On the other hand, a meta-analysis of three trials that compared CHX rinse and CHX gel directly showed a significantly lower RR of AO in patients treated with CHX rinse than in those treated with CHX gel (RR = 0.56, 95% CI [0.34, 0.96]).
CONCLUSIONS/IMPLICATIONS FOR PRACTICE
The results support the effectiveness of both CHX rinse and gel in reducing the risk of AO after molar extraction. Each formulation provides unique benefits in terms of ease of application and cost. On the basis of the results of this study, the authors recommend that CHX gel be used immediately after molar extraction because of the convenience and cost-effectiveness of this treatment and that CHX rinse be used by the patient after discharge at home in combination with appropriate health education and case management.
Topics: Chlorhexidine; Dental Care; Dry Socket; Humans; Randomized Controlled Trials as Topic
PubMed: 32956135
DOI: 10.1097/jnr.0000000000000401 -
Dermatology (Basel, Switzerland) 2021There is growing evidence that (certain) hidradenitis suppurativa (HS) comorbidities comprise syndromes including HS as a key cutaneous manifestation. These apparently... (Meta-Analysis)
Meta-Analysis
BACKGROUND
There is growing evidence that (certain) hidradenitis suppurativa (HS) comorbidities comprise syndromes including HS as a key cutaneous manifestation. These apparently autoinflammatory syndromes and their diagnostic delay might have detrimental effects on affected patients.
METHODS
A systematic review was performed on the databases MEDLINE, EMBASE, and CENTRAL utilizing a standardized extraction form according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
RESULTS
Sixty-four eligible articles on syndromic HS were retrieved. The identified syndromes included already described ones (pyoderma gangrenosum-acne-suppurative hidradenitis, pyogenic arthritis-pyoderma gangrenosum-acne-suppurative hidradenitis, psoriatic arthritis-pyoderma gangrenosum-acne-suppurative hidradenitis, pyoderma gangrenosum-acne vulgaris-hidradenitis suppurativa-ankylosing spondylitis, synovitis-acne-pustulosis-hyperostosis-osteitis) and further novel symptom constellations. Cutaneous signs, including HS lesions, usually precede signs from other organs. The cutaneous signs of a considerable proportion of patients appear refractory to conventional treatment, and monotherapy with biologics does not suffice to sustain remission.
CONCLUSION
The results are subsequently discussed with focus on the pathophysiology and treatment of the detected syndromes. The dermatologist's role in the precise diagnosis and early treatment administration of HS is pivotal. The purpose of the treatment should be the effective prevention or delay of the autoinflammatory march and its irreversible consequences.
Topics: Hidradenitis Suppurativa; Humans
PubMed: 32942279
DOI: 10.1159/000509873 -
BMC Oral Health Jul 2019The present study investigated and evaluated the efficacy and safety of platelet-rich fibrin (PRF) in patients during bilateral mandibular third molars extraction by... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The present study investigated and evaluated the efficacy and safety of platelet-rich fibrin (PRF) in patients during bilateral mandibular third molars extraction by systematic review and meta-analysis.
METHODS
The PubMed, Embase, and Cochrane library databases were retrieved, and the effect of PRF on the healing process of the alveolar socket after surgical extraction of the mandibular third molars was evaluated by meta-analysis. The postoperative pain, swelling, trismus, osteoblastic activity, and soft tissue healing were assessed, and the incidence of alveolar osteitis, weighted mean difference (WMD)/standard mean difference (SMD), the risk ratio (RR), and the 95% confidence interval (CI) were calculated.
RESULTS
The current results showed that the local application of PRF during lower third molar extraction prevented postoperative complications. Subsequently, the pain (SMD = - 0.53, 95% CI: - 1.02--0.05, P = 0.001, I = 75.7%) and swelling (WMD = - 0.55, 95% CI: - 1.08--0.01, P = 0.573, I = 0) were relieved and the incidence of alveolar osteitis was reduced (RR = 0.35, 95% CI: 0.16-0.75, P = 0.597, I = 0%). However, no significant difference was observed in trismus, osteoblastic activity, and soft tissue healing between the PRF and non-PRF groups.
CONCLUSION
The current study confirms that PRF only reduces some of the postoperative complications but does not prevent all the postoperative complications. PRF significantly relieved the pain and swelling and reduced the incidence of alveolar osteitis after the extraction of an impacted lower third molar.
Topics: Dry Socket; Female; Humans; Male; Molar, Third; Platelet-Rich Fibrin; Postoperative Complications; Tooth Extraction; Tooth Socket; Tooth, Impacted; Treatment Outcome; Wound Healing
PubMed: 31345203
DOI: 10.1186/s12903-019-0824-3