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Journal of Clinical Medicine May 2023There are four pairs of paranasal sinuses: maxillary, ethmoidal, frontal, and sphenoidal. It is common to see changes in size and shape throughout life, so understanding... (Review)
Review
BACKGROUND
There are four pairs of paranasal sinuses: maxillary, ethmoidal, frontal, and sphenoidal. It is common to see changes in size and shape throughout life, so understanding the effect of age on sinus volume can help in radiographic studies and in planning dental and surgical procedures in the sinus-nasal region. The aim of the present systematic review was to perform a qualitative synthesis of available studies which assess the volumetric characteristics of the sinuses and their changes according to age.
MATERIALS AND METHODS
The present review followed PRISMA 2020 guidelines. A systematic advanced electronic search was performed in five databases (Medline (via PubMed), Scopus, Embase, Cochrane, and Lilacs) in June-July 2022. Studies that assessed the volumetric changes of paranasal sinuses with age were eligible for inclusion. A qualitative synthesis of the methodology and results of the included studies was performed. Quality assessment was performed using the NIH quality assessment tool.
RESULTS
A total of 38 studies were included in the qualitative synthesis. Most authors who studied the maxillary and ethmoidal sinuses concluded that it begins its development from birth until the maximum peak of growth, from which it begins to decrease in volume with age. Results regarding the volumetric changes of the frontal and sphenoidal sinuses are mixed.
CONCLUSIONS
Based on the results of the studies included in the present review, it can be concluded that the volume of the maxillary and ethmoidal sinus appears to decrease with age. Conclusions on the volumetric changes of the sphenoidal and frontal sinuses require further evidence.
PubMed: 37240460
DOI: 10.3390/jcm12103355 -
Archives of Medical Science : AMS 2024Our goal was to systematically review the current evidence comparing the relative effectiveness of two maxillary sinus floor elevation (MSFE) approaches (internal and... (Review)
Review
Clinical evaluation of maxillary sinus floor elevation with or without bone grafts: a systematic review and meta-analysis of randomised controlled trials with trial sequential analysis.
INTRODUCTION
Our goal was to systematically review the current evidence comparing the relative effectiveness of two maxillary sinus floor elevation (MSFE) approaches (internal and external) without bone grafts with that of conventional/grafted MSFE in patients undergoing implantation in the posterior maxilla.
MATERIAL AND METHODS
Medical databases (PubMed/Medline, Embase, Web of Science, and Cochrane Library) were searched for randomised controlled trials published between January 1980 and May 2023. A manual search of implant-related journals was also performed. Studies published in English that reported the clinical outcomes of MSFE with or without bone material were included. The risk of bias was assessed using the Cochrane Handbook Risk Assessment Tool. Meta-analyses and trial sequence analyses were performed on the included trials. Meta-regression analysis was performed using pre-selected covariates to account for substantial heterogeneity. The certainty of evidence for clinical outcomes was assessed using GRADEpro GDT online (Guideline Development Tool).
RESULTS
Seventeen studies, including 547 sinuses and 696 implants, were pooled for the meta-analysis. The meta-analysis showed no statistically significant difference between MSFE without bone grafts and conventional MSFE in terms of the implant survival rate in the short term ( = 11, = 0%, risk difference (RD): 0.03, 95% confidence intervals (CI): -0.01-0.07, = 0.17, required information size (RIS) = 307). Although conventional MSFE had a higher endo-sinus bone gain ( = 13, = 89%, weighted mean difference (WMD): -1.24, 95% CI: -1.91- -0.57, = 0.0003, RIS = 461), this was not a determining factor in implant survival. No difference in perforation ( = 13, = 0%, RD = 0.03, 95% CI: -0.02-0.09, = 0.99, RIS = 223) and marginal bone loss ( = 4, = 0%, WMD = 0.05, 95% CI: -0.14-0.23, = 0.62, no RIS) was detected between the two groups using meta-analysis. The pooled results of the implant stability quotient between the two groups were not robust on sensitivity analysis. Because of the limited studies reporting on the visual analogue scale, surgical time, treatment costs, and bone density, qualitative analysis was conducted for these outcomes.
CONCLUSIONS
This systematic review revealed that both non-graft and grafted MSFE had high implant survival rates. Owing to the moderate strength of the evidence and short-term follow-up, the results should be interpreted with caution.
PubMed: 38757030
DOI: 10.5114/aoms/174648 -
Clinical Implant Dentistry and Related... Dec 2022The lateral maxillary sinus augmentation (MSA) procedure has good predictability in terms of the success of bone regeneration with a low incidence of postoperative... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The lateral maxillary sinus augmentation (MSA) procedure has good predictability in terms of the success of bone regeneration with a low incidence of postoperative infections, estimated between 2% and 5.6%. Although the use of antibiotics is an established and standardized prophylactic measure for MSA procedures, the addition of corticosteroids still varies among clinician preference and clinical judgment.
PURPOSE
The aim of this systematic review was to identify whether the administration of corticosteroids during the MSA surgical procedure affects postoperative symptoms including swelling, pain, and infection rate.
MATERIALS AND METHODS
A literature search through PubMed, EMBASE, Ovid MEDLINE, and Web of Science indices, according to PICO criteria, was conducted to identify whether MSA peri-operative use of corticosteroids reduces the incidence of complications and patient morbidity. A single arm meta-analysis was performed due to the lack of randomized controlled trials (RCTs) comparing groups treated with or without peri-operative corticosteroids. The intracluster correlation co-efficient (ICC) and design effect were calculated to adjust for the clustering design.
RESULTS
In the 37 studies included, a total of 1599 patients (378 Cort, 1221 No-Cort) were analyzed. Before and after taking account of clustering, there was statistically significant effect of corticosteroids on swelling, pain, wound dehiscence, trismus, and hematoma. The complication rates postoperatively were comparable between the two study groups, however slight differences existed in the incidence of active suppuration (1.7% [95% CI 0.7-3.9] Cort vs. 3.2% [2.2-4.5] No-Cort), wound dehiscence (3.9% [1.3-11.2] Cort vs. 2.1% [1.0-4.1] No-Cort) and trismus (2.7% [0.8-8.4] Cort vs. 1.4% [0.8-2.5] No-Cort).
CONCLUSIONS
Although the event rate of the 1-to-2-week postoperative complications did not differ between the two groups, the lack of conclusive data and research comparing peri-operative corticosteroid use makes it impossible to draw definitive conclusions and more evidence and studies designed for this specific purpose are needed.
Topics: Humans; Transverse Sinuses; Postoperative Complications; Pain
PubMed: 36068078
DOI: 10.1111/cid.13126 -
International Journal of Environmental... Feb 2023This systematic review aimed to investigate the scientific literature on volumetric studies concerning the diagnosis and treatment of apical periodontitis using CBCT. A... (Review)
Review
This systematic review aimed to investigate the scientific literature on volumetric studies concerning the diagnosis and treatment of apical periodontitis using CBCT. A systematic review protocol was written following the preferred reporting items for the systematic reviews and meta-analyses (PRISMA) checklist. Four electronic databases were searched for relevant publications in English, which were published up to 21 January 2023. The inclusion criteria and corresponding search keys were applied. The risk of bias was assessed using the Joanna Briggs Institute Meta-Analysis of Statistic Assessment and Review Instrument. The search strategy identified 202 studies, with 123 studies excluded during the title and abstract screening and 47 studies left for full text screening. A total of 17 studies met the inclusion criteria. The lesion volume was measured and classified according to different indices which compared the effectiveness of their diagnostics. Moreover, the volume of AP lesions increased with the thickness of the maxillary sinus mucosa in primary and secondary infections and decreased due to endodontic treatment. Volumetric measurements using CBCT are useful in the correct definition of periapical tissue pathosis using a CBCT periapical volume index and assessment of the dynamics of the treatment of apical lesions.
Topics: Humans; Cone-Beam Computed Tomography; Maxillary Sinus; Periapical Periodontitis
PubMed: 36833634
DOI: 10.3390/ijerph20042940 -
Dentistry Journal May 2024The aim of this work was to systematically review and carry out a statistical metanalysis to identify the best treatment for close oroantral communications and fistulas... (Review)
Review
OBJECTIVES
The aim of this work was to systematically review and carry out a statistical metanalysis to identify the best treatment for close oroantral communications and fistulas and to avoid the risk of recurrence.
MATERIALS AND METHODS
An electronic search was conducted on the MEDLINE database (Pubmed), Scopus, and Google scholar using the following keywords: "oro antral communication (OAC)" OR "oro antral fistula (OAF)" OR "antro-oral communication" OR "communication between maxillary sinus and oral cavity" OR "oro-sinusal communication" OR "oro-sinusal fistula" OR "sinus communication" OR "sinus fistula" OR "antral communication" AND "treatment" OR "management" OR "surgical treatment" OR "surgical interventions". This work was performed in accordance with the guidelines of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses). After article screening, 9 RCTs (randomized controlled trials), comparing two or more techniques, were included in this review.
RESULTS
A statistically significant difference was detected in favor of the buccal fat pad compared to the buccal advancement flap and palatal rotational flap.
CONCLUSIONS
With the limitations of this study, the buccal fat pad showed the best results in terms of communication closure and reducing the risk of relapse.
PubMed: 38786545
DOI: 10.3390/dj12050147 -
Journal of Oral & Maxillofacial Research 2019Test the hypothesis of no difference in implant treatment outcomes after maxillary sinus floor augmentation with or without barrier membrane coverage of the lateral... (Review)
Review
OBJECTIVES
Test the hypothesis of no difference in implant treatment outcomes after maxillary sinus floor augmentation with or without barrier membrane coverage of the lateral window.
MATERIAL AND METHODS
A MEDLINE (PubMed), Embase and Cochrane library search in combination with a hand-search of relevant journals was conducted. Human studies published in English until the 5th of July, 2019 were included. Randomised controlled trials and controlled trials with an observation period of minimum six months were included. Primary outcomes included survival of suprastructures and implants. Secondary outcomes included implant stability quotient, peri-implant marginal bone loss, bone regeneration, patient-reported outcome measures, biologic and mechanical complications.
RESULTS
The electronic search and hand-searching resulted in 1068 entries. Six randomised controlled trials characterised by low to high risk of bias and one controlled trial with high risk of bias fulfilled the inclusion criteria. High implant survival rate was reported with both treatment modalities. Meta-analyses disclosed a mean difference of newly formed bone of 6.4% (confidence interval = 0 to 12.9) and non-mineralised tissue of -1.1% (confidence interval = -2.7 to 0.5), indicating more newly formed bone and diminished non-mineralised with barrier membrane coverage.
CONCLUSIONS
There seem to be no statistically significant differences in implant treatment outcomes after maxillary sinus floor augmentation with or without barrier membrane coverage of the lateral window. However, barrier membrane coverage increases percentage of newly formed bone and diminishes proliferation of non-mineralised tissue. Thus, barrier membrane coverage seems to be beneficial and also preventing displacement of the grafting material.
PubMed: 32158525
DOI: 10.5037/jomr.2019.10401 -
Medicine Sep 2023The objective of this review is to investigate and analyze the anatomical variations present in the maxillary sinus (MS), through the examination of the prevalence of... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The objective of this review is to investigate and analyze the anatomical variations present in the maxillary sinus (MS), through the examination of the prevalence of these variations, as well as the corresponding prevalence of clinically significant pathologies and complications associated with them.
METHODS
The search process was carried out in the following databases; MEDLINE, SCIELO, WOS, CINHAL, SCOPUS, and GOOGLE SCHOLAR, using as search terms; "Maxillary bone," "Maxillary sinus," "Paranasal sinus," "Anatomical variations," "Sinusitis" and "Clinical anatomy."
RESULTS
A total of 26 articles and 12969 samples were included, from which 12,594 subjects had their sex recorded giving a total of 5802 males and 6792 females. The variants reported by the included were Haller cells, Concha Bullosa, Number of septa, Hypoplastic sinus, Agger Nasi, Thickening of the MS mucosa, Deviation of the nasal septum, Accessory ostium, and Onodi cells. Among the mentioned, the ones that presented the greatest number of studies (between 8 and 10 studies included) were: the Haller Cells, the Concha Bullosa, and the Number of septa, where prevalence was 0.30, 0.36, 0.39 respectively. These variations can lead to sinusitis, cause some types of tumors, or affect neighboring structures that could be compromised by this variation.
CONCLUSION
As a result, it is certainly complex to distinguish the presence of anatomical variations from pathological abnormalities. Therefore, knowledge of the different variations and their clinical relationships could be a useful asset for clinicians dedicated to this region.
Topics: Female; Male; Humans; Nose Diseases; Databases, Factual; Knowledge; MEDLINE; Maxillary Sinus
PubMed: 37747000
DOI: 10.1097/MD.0000000000034510 -
Journal of Oral & Maxillofacial Research 2020The objective of present systematic review was to test the hypothesis of no difference in histomorphometric outcome after maxillary sinus floor augmentation with... (Review)
Review
Maxillary Sinus Floor Augmentation with Autogenous Bone Graft Alone Compared with Alternate Grafting Materials: a Systematic Review and Meta-Analysis Focusing on Histomorphometric Outcome.
OBJECTIVES
The objective of present systematic review was to test the hypothesis of no difference in histomorphometric outcome after maxillary sinus floor augmentation with autogenous bone graft alone compared with alternate grafting materials applying the lateral window technique.
MATERIAL AND METHODS
MEDLINE (PubMed), Embase and Cochrane library search in combination with hand-search of relevant journals were conducted. Human studies published in English until the 25 of March, 2020 were included. Histomorphometric outcomes were evaluated by descriptive statistics and meta-analysis including 95% confidence interval (CI).
RESULTS
Electronic search and hand-searching resulted in 1902 entries. Sixteen randomized controlled trials with unclear risk of bias fulfilled the inclusion criteria. Descriptive statistics showed comparable or improved histomorphometric outcomes with autogenous bone graft. Meta-analysis revealed a mean difference of -7.1% (CI = -11.0 to -3.2) indicating a significant higher amount of bone after maxillary sinus floor augmentation with autogenous bone graft compared with alternate grafting materials. Subgroup analysis demonstrated a non-significantly differences of -3.7% (CI = -10.9 to 3.4), -11.5% (CI = -25.9 to 2.8), 2.2% (CI = -16.9 to 21.3), and -4.6% (CI = -14.4 to 5.2), when autogenous bone graft was compared with allogeneic bone graft, xenograft, composite grafting materials involving xenograft or synthetic biomaterial mixed with autogenous bone graft, respectively.
CONCLUSIONS
Maxillary sinus floor augmentation with autogenous bone graft seems to facilitate improved histomorphometric outcomes compared with alternate grafting materials. However, the included studies were characterised by an unclear risk of bias and various methodological confounding factors. Hence, the conclusions drawn from the results of present study should be interpreted with caution.
PubMed: 33262881
DOI: 10.5037/jomr.2020.11302 -
Journal of Clinical Medicine Oct 2022Background: To assess the diagnostic utility of middle meatal culture (MMC) in patients with acute and chronic sinusitis; Methods: Six databases were thoroughly reviewed... (Review)
Review
Background: To assess the diagnostic utility of middle meatal culture (MMC) in patients with acute and chronic sinusitis; Methods: Six databases were thoroughly reviewed up to March 2022. Sensitivity, specificity, and negative and positive predictive values were extracted. Methodological quality was evaluated using the QUADAS-2 instrument; Results: Fifteen reports were analyzed. MMC results exhibited a significant correlation (r = 0.7590, 95% confidence interval [CI] [0.6855; 0.8172], p < 0.0001) with those of maxillary sinus puncture. The diagnostic odds ratio (DOR) of MMC (reference = maxillary sinus culture) was 8.5475 [3.9238; 18.6199]. The area under the summary receiver operating characteristic curve was 0.761. The sensitivity and specificity of MMC were 0.7759 [0.6744; 0.8526] and 0.7514 [0.6110; 0.8534], respectively. We performed subgroup analysis based on age (children vs. adults), duration of disease (acute vs. chronic), and specimen collection method (biopsy, swabs, suction tips). The DORs, specificities, and negative and positive predictive values varied significantly. Diagnostic accuracy was highest for children and individuals with chronic disease, and when samples were collected via suction.; Conclusions: MMC provided fair diagnostic accuracy in patients with acute or chronic sinusitis. Although some institutional differences were evident, the middle meatal and maxillary sinus culture results were similar.
PubMed: 36294389
DOI: 10.3390/jcm11206069 -
Biology Jun 2021The aim of this systematic review and meta-analysis was to analyze and compare the survival rate and prosthetic and sinus complications of zygomatic dental implants for... (Review)
Review
Survival Rate and Prosthetic and Sinus Complications of Zygomatic Dental Implants for the Rehabilitation of the Atrophic Edentulous Maxilla: A Systematic Review and Meta-Analysis.
UNLABELLED
The aim of this systematic review and meta-analysis was to analyze and compare the survival rate and prosthetic and sinus complications of zygomatic dental implants for the rehabilitation of the atrophic edentulous maxilla.
MATERIALS AND METHODS
We conducted a systematic literature review and meta-analysis, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, of clinical studies that evaluated the survival rate and prosthetic and sinus complications of zygomatic dental implants for the rehabilitation of the atrophic edentulous maxilla. Four databases were consulted during the literature search: Pubmed-Medline, Scopus, Embase, and Web of Science. After eliminating duplicate articles and applying the inclusion criteria, 46 articles were selected for the qualitative analysis and 32 for the quantitative analysis.
RESULTS
Four randomized controlled trials, 19 prospective clinical studies, 20 retrospective studies, and 3 case series were included in the meta-analysis. Conventional dental implants failure ( = 3549) were seen in 2.89% (IC-95% 1.83-3.96%), while zygomatic dental implants failure ( = 1895) were seen in 0.69% (IC-95% 0.21-1.16%). The measure of the effect size used was the Odds Ratio, which was estimated at 2.05 with a confidence interval of 95% between 1.22 and 3.44 (z test = 2.73; -value = 0.006). The failure risk of conventional dental implants is 2.1 times higher than that of zygomatic dental implants. Slight heterogeneity was determined in the meta-analysis between 23 combined studies (Q test = 32.4; -value = 0.070; I = 32.1%). Prosthetic complications were recorded in 4.9% (IC-95% 2.7-7.3%) and mild heterogeneity was observed in a meta-analysis of 28 combined studies (Q test = 88.2; -value = 0.001; I = 69.4%). Sinus complications were seen in 4.7% (IC-95% 2.8-6.5%) and mild heterogeneity was observed in a meta-analysis of 32 combined studies (Q test = 75.3; -value = 0.001; I = 58.8%).
CONCLUSIONS
The high survival rate and low prosthetic and sinus complications related to zygomatic dental implants suggest the use of zygomatic dental implants for the rehabilitation of the atrophic edentulous maxilla.
PubMed: 34209770
DOI: 10.3390/biology10070601