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The Journal of Rheumatology Mar 2009In 2003, the first reports describing osteonecrosis of the jaw (ONJ) in patients receiving bisphosphonates (BP) were published. These cases occurred in patients with... (Review)
Review
In 2003, the first reports describing osteonecrosis of the jaw (ONJ) in patients receiving bisphosphonates (BP) were published. These cases occurred in patients with cancer receiving high-dose intravenous BP; however, 5% of the cases were in patients with osteoporosis receiving low-dose bisphosphonate therapy. We present the results of a systematic review of the incidence, risk factors, diagnosis, prevention, and treatment of BP associated ONJ. We conducted a comprehensive literature search for relevant studies on BP associated ONJ in oncology and osteoporosis patients published before February 2008.All selected relevant articles were sorted by area of focus. Data for each area were abstracted by 2 independent reviewers. The results showed that the diagnosis is made clinically. Prospective data evaluating the incidence and etiologic factors are very limited. In oncology patients receiving high-dose intravenous BP, ONJ appears to be dependent on the dose and duration of therapy, with an estimated incidence of 1%-12% at 36 months of exposure. In osteoporosis patients, it is rare, with an estimated incidence < 1 case per 100,000 person-years of exposure. The incidence of ONJ in the general population is not known. Currently, there is insufficient evidence to confirm a causal link between low-dose BP use in the osteoporosis patient population and ONJ. We concluded BP associated ONJ is associated with high-dose BP therapy primarily in the oncology patient population. Prevention and treatment strategies are currently based on expert opinion and focus on maintaining good oral hygiene and conservative surgical intervention.
Topics: Bone Density Conservation Agents; Diphosphonates; Dose-Response Relationship, Drug; Humans; Jaw Diseases; Neoplasms; Osteonecrosis; Osteoporosis; Risk Factors
PubMed: 19286860
DOI: 10.3899/jrheum.080759 -
Dento Maxillo Facial Radiology Sep 2008To evaluate the principal features of focal cemento-osseous dysplasia (FocCOD) by systematic review (SR) and to compare their frequencies between four global groups. (Review)
Review
OBJECTIVES
To evaluate the principal features of focal cemento-osseous dysplasia (FocCOD) by systematic review (SR) and to compare their frequencies between four global groups.
METHODS
Alternative names for FocCOD were used as search terms. The databases searched were the PubMed interface of Medline and LILACS (Literature Index for Latin-America and the Caribbean; Biblioteca Regional de Medicina (BIREME)). Only those reports of FocCODs which occurred in a series in the reporting authors' caseload were considered. All cases used radiographs and were confirmed fibro-osseous lesions histopathologically.
RESULTS
Of the 20 series considered, 10 were included in the SR. Five SR-included series were of East Asian communities. 64% of all SR-included cases were found incidentally. FocCOD predominantly affects females and the mandible. The three predominant radiological presentations varied significantly between reports.
CONCLUSIONS
The two at-risk global communities appear to be East Asians and those of black African origin. Although there appears to be little difference between East Asians and non-East Asians, the significant differences between them with regards to the predominant radiological presentation could suggest that either all communities vary in their presentation or that most, if not all, did not reflect the true frequency within their communities. Long-term follow-up of large series that would have revealed the long-term outcomes of FocCODs was lacking. This is necessary because of both FocCOD's predilection of edentulous areas, increasingly required for osseointegrated implants, and its wide differential diagnosis, which includes some lesions normally treated by surgery.
Topics: Asian People; Black People; Cementoma; Diagnosis, Differential; Humans; Jaw Neoplasms; Radiography; Sex Factors; White People
PubMed: 18757721
DOI: 10.1259/dmfr/31641295 -
Oral Oncology Sep 2018Computer-assisted surgery (CAS) for mandibular reconstruction was developed to improve conventional treatment methods. In the past years, many different software... (Review)
Review
Computer-assisted surgery (CAS) for mandibular reconstruction was developed to improve conventional treatment methods. In the past years, many different software programs have entered the market, offering numerous approaches for preoperative planning and postoperative evaluation of the CAS process of mandibular reconstruction. In this systematic review, we reviewed planning and evaluation methods in studies that quantitatively assessed accuracy of mandibular reconstruction performed with CAS. We included 42 studies describing 413 mandibular reconstructions planned and evaluated using CAS. The commonest software was Proplan/Surgicase CMF (55%). In most cases, the postoperative virtual 3-dimensional model was compared to the preoperative 3-dimensional model, revised to the virtual plan (64%). The commonest landmark for accuracy measurements was the condyle (54%). Accuracy deviations ranged between 0 mm and 12.5 mm and between 0.9° and 17.5°. Because of a lack of uniformity in planning (e.g., image acquisition, mandibular resection size) and evaluation methodologies, the ability to compare postoperative outcomes was limited; meta-analysis was not performed. A practical and simple guideline for standardizing planning and evaluation methods needs to be considered to allow valid comparisons of postoperative results and facilitate meta-analysis in the future.
Topics: Bone Transplantation; Free Tissue Flaps; Humans; Imaging, Three-Dimensional; Mandibular Neoplasms; Mandibular Reconstruction; Software; Surgery, Computer-Assisted
PubMed: 30115476
DOI: 10.1016/j.oraloncology.2018.07.004 -
Oral Surgery, Oral Medicine, Oral... Jan 2012This systematic review aimed to answer the clinical question, "What is the current risk of developing osteoradionecrosis of the jaws among irradiated head and neck... (Review)
Review
OBJECTIVE
This systematic review aimed to answer the clinical question, "What is the current risk of developing osteoradionecrosis of the jaws among irradiated head and neck cancer patients?"
STUDY DESIGN
A systematic review of published English-language randomized controlled trials on the outcome of radiation therapy was performed via Medline and Embase databases. Data on osteoradionecrosis/bone toxicity were collected and analyzed.
RESULTS
Twenty-two articles reporting on a total of 5,742 patients were selected for final review based on strict eligibility criteria. An estimated 2% of the head and neck-irradiated patients are at risk of developing osteoradionecrosis. Patients receiving adjunctive radiotherapy, accelerated fractionation without dose reduction, and chemoradiotherapy show no increase in osteoradionecrosis risk. Accelerated fractionation with dose reduction is associated with a reduced risk, whereas hyperfractionation shows elevated risk of developing osteoradionecrosis.
CONCLUSIONS
The risk of developing osteoradionecrosis among the irradiated head and neck cancer patient has significantly declined in recent years.
Topics: Adult; Chemoradiotherapy; Cranial Irradiation; Dental Care for Chronically Ill; Head and Neck Neoplasms; Humans; Jaw Diseases; Osteoradionecrosis; Radiotherapy Dosage; Randomized Controlled Trials as Topic; Risk Factors
PubMed: 22669065
DOI: 10.1016/j.tripleo.2011.07.042 -
Oral Diseases May 2018The purpose of this study was to identify the patient populations at risk of medication-related osteonecrosis of the jaw (MRONJ) and determine which medical and dental... (Review)
Review
The purpose of this study was to identify the patient populations at risk of medication-related osteonecrosis of the jaw (MRONJ) and determine which medical and dental comorbidities are significant risk factors for this disease. An electronic search of Embase, MEDLINE, Cochrane Central Register of Controlled Trials, WHO International Clinical Trials Registry Platform and ProQuest Dissertations and Theses Global was conducted to identify all human studies that reported risk factors for MRONJ. Only a qualitative analysis was performed due to significant heterogeneity in the collected data. The search strategy identified 2872 records, of which 219 studies were eligible for inclusion. A total of 4106 patients with MRONJ were identified, 39 different systemic diseases were implicated, and 14 medical and 11 dental risk factors were reported, although no statistical analysis of the significance of each of these factors was possible. The clinical reach of MRONJ may be wider than anticipated, and more data on the significance of each potential risk factor are needed to guide the identification and management of at-risk patients.
Topics: Bisphosphonate-Associated Osteonecrosis of the Jaw; Humans; Neoplasms; Osteoporosis; Risk Factors
PubMed: 28656643
DOI: 10.1111/odi.12708 -
Toxins Dec 2023This systematic review investigates the effect of botulinum neurotoxin (BoNT) therapy on cancer-related disorders. A major bulk of the literature is focused on BoNT's... (Review)
Review
This systematic review investigates the effect of botulinum neurotoxin (BoNT) therapy on cancer-related disorders. A major bulk of the literature is focused on BoNT's effect on pain at the site of surgery or radiation. All 13 published studies on this issue indicated reduction or cessation of pain at these sites after local injection of BoNTs. Twelve studies addressed the effect of BoNT injection into the pylorus (sphincter between the stomach and the first part of the gut) for the prevention of gastroparesis after local resection of esophageal cancer. In eight studies, BoNT injection was superior to no intervention; three studies found no difference between the two approaches. One study compared the result of intra-pyloric BoNT injection with preventive pyloromyotomy (resection of pyloric muscle fibers). Both approaches reduced gastroparesis, but the surgical approach had more serious side effects. BoNT injection was superior to saline injection in the prevention of esophageal stricture after surgery (34% versus 6%, respectively, = 0.02) and produced better results (30% versus 40% stricture) compared to steroid (triamcinolone) injection close to the surgical region. All 12 reported studies on the effect of BoNT injection into the parotid region for the reduction in facial sweating during eating (gustatory hyperhidrosis) found that BoNT injections stopped or significantly reduced facial sweating that developed after parotid gland surgery. Six studies showed that BoNT injection into the parotid region prevented the development of or healed the fistulas that developed after parotid gland resection-parotidectomy gustatory hyperhidrosis (Frey syndrome), post-surgical parotid fistula, and sialocele. Eight studies suggested that BoNT injection into masseter muscle reduced or stopped severe jaw pain after the first bite (first bite syndrome) that may develop as a complication of parotidectomy.
Topics: Humans; Botulinum Toxins, Type A; Sweating, Gustatory; Gastroparesis; Pain; Neoplasms
PubMed: 38133193
DOI: 10.3390/toxins15120689 -
International Journal of Oral and... Nov 2016The purpose of this systematic review was to answer the clinical question "When should elective neck dissection be performed in maxillary gingival and alveolar squamous... (Review)
Review
The purpose of this systematic review was to answer the clinical question "When should elective neck dissection be performed in maxillary gingival and alveolar squamous cell carcinoma with a cN0 neck?" A systematic review, designed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, was conducted by two independent reviewers with three rounds of search and evaluation. Ten studies with 506 patients were included in the final review. The overall risk of cervical metastasis was 23.2% for those who did not receive an elective neck dissection (END), which was 3.4 times higher than that in the END group (6.8%). The 5-year survival rate was higher in those who had an END (80.3%) when compared to those who did not receive an END (67.4%). Overall, 14.1% of the cases with cN0 maxillary squamous cell carcinoma (SCC) presented with positive node(s) in pathological specimens after END. The risk of occult cervical metastasis in a cN0 maxillary SCC case with pathological stage pT1, pT2, pT3, and pT4 was 11.1%, 12.1%, 20%, and 36.1%, respectively. It is therefore concluded that END is recommended in patients with cN0 maxillary SCC, especially in stage T3 or T4 cases.
Topics: Alveolar Process; Carcinoma, Squamous Cell; Elective Surgical Procedures; Gingival Neoplasms; Humans; Lymphatic Metastasis; Maxillary Neoplasms; Neck Dissection; Neoplasm Staging; Retrospective Studies; Survival Rate; Time Factors; Treatment Outcome
PubMed: 27289248
DOI: 10.1016/j.ijom.2016.05.021 -
PloS One 2018In advanced prostate cancer, osteoclast inhibitors prevent and palliate skeletal related events associated with bone metastases. However, it is uncertain whether they... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
In advanced prostate cancer, osteoclast inhibitors prevent and palliate skeletal related events associated with bone metastases. However, it is uncertain whether they play a disease-modifying role earlier in the course of the disease.
METHODS
Medline, EMBASE, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews and ASCO conference proceedings were searched for randomized controlled trials that compared osteoclast inhibitors with placebo and/or standard of care (SOC) in patients with high-risk, non-metastatic prostate cancer. The primary outcome measure was incidence of new bone metastases; secondary outcomes included overall survival (OS), prostate cancer specific survival, mortality unrelated to prostate cancer, toxicity and health related quality of life outcomes. Results are presented as relative risk (RR) with 95% confidence intervals (CI).
RESULTS
Six randomized controlled trials (5947 participants) were included, five evaluating bisphosphonates and one denosumab. Overall, there was no difference in incidence of bone metastases between participants treated with osteoclast inhibitors versus placebo/SOC (RR 1.09, 95%CI 0.84-1.41, p = 0.51) however significant heterogeneity was observed between studies. The denosumab trial was the largest and only positive trial amongst the included studies (RR 0.83, 95%CI 0.73-0.95, p = 0.007). No significant difference was observed in OS (RR 0.99 95% CI 0.89-1.10, p = 0.84) nor prostate cancer specific survival (RR 1.12 95%CI 0.93-1.36, p = 0.24). Most studies reported increased rates of osteonecrosis of the jaw (5% or less) and hypocalcemia (2% or less) with osteoclast inhibitors.
CONCLUSIONS
While there is limited evidence that bisphosphonates alter the natural history of high-risk, non-metastatic prostate cancer, denosumab delays onset of bone metastases in this patient population. Neither class of osteoclast inhibitor demonstrated an impact on survival outcomes. Future trials with better defined patient selection and a robust definition for high risk disease is critical.
Topics: Bone Density Conservation Agents; Bone Neoplasms; Denosumab; Diphosphonates; Humans; Male; Osteoclasts; Outcome Assessment, Health Care; Prostatic Neoplasms; Quality of Life; Randomized Controlled Trials as Topic; Risk Factors
PubMed: 29370211
DOI: 10.1371/journal.pone.0191455 -
The British Journal of Oral &... Sep 2021Carnoy's solution (CS) is routinely used as adjuvant therapy in the management of odontogenic keratocyst (OKC) and a few other benign lesions. The purpose of this study... (Review)
Review
Carnoy's solution (CS) is routinely used as adjuvant therapy in the management of odontogenic keratocyst (OKC) and a few other benign lesions. The purpose of this study was to explore the evidence of its application and efficacy in benign lesions other than OKC. We have systematically reviewed published articles to identify the evidence of CS in benign jaw lesions other than OKC following the PRISMA guidelines. The search was conducted in PubMed, Google Scholar, Semantic Scholar, and Cochrane Library database, to find relevant articles from 1980 to March 2020. Finally, 39 studies were analysed in this review. It included studies where CS was used as an adjunct for the benign lesion of the jaw and followed for a minimum of 6 months. Thirty-nine studies with 11 different types of lesion were reported where CS was used as an adjuvant and application time was restricted to 3-5minutes. Recurrence were reported only in ameloblastoma cases [unicystic=10.98% (10/91), mixed=18.18% (26/143)]. Meta-analysis was not possible as all studies were non-controlled in nature. Based on the available data, there was no strong evidence for the use of CS as an adjuvant in the benign lesion of the jaw. Prospective and randomised control studies are recommended for the best stratification for the use of CS.
Topics: Acetic Acid; Chloroform; Ethanol; Humans; Neoplasm Recurrence, Local; Odontogenic Cysts; Prospective Studies
PubMed: 34272109
DOI: 10.1016/j.bjoms.2020.12.019 -
PloS One 2015Ameloblastoma is the second most common odontogenic tumor, known to be slow-growing, persistent, and locally aggressive. Recent data suggests that ameloblastoma is best... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Ameloblastoma is the second most common odontogenic tumor, known to be slow-growing, persistent, and locally aggressive. Recent data suggests that ameloblastoma is best treated with wide resection and adequate margins. Following primary excision, bony reconstruction is often necessary for a functional and aesthetically satisfactory outcome, making early diagnosis paramount. Despite earlier diagnosis potentially limiting the extent of resection and reconstruction, an understanding of the growth rate and natural history of ameloblastoma has been notably lacking from the literature.
METHOD
A systematic review of the literature was conducted by reviewing relevant articles from PubMed and Web of Science databases. Each article's level of evidence was formally appraised according to the Centre of Evidence Based Medicine (CEBM), with data from each utilized in a meta-analysis of growth rates for ameloblastoma.
RESULTS
Literature regarding the natural history of ameloblastoma is limited since the tumor is immediately acted upon at its initial detection, unless the patient voluntarily refuses a surgical intervention. From the limited data, it is derived that the highest estimated growth rate is associated with solid, multicystic type and the lowest rate with peripheral ameloblastomas. After meta-analysis, the calculated mean specific grow rate is 87.84% per year.
CONCLUSION
The growth rate of ameloblastoma has been demonstrated, offering prognostic and management information, particularly in cases where a delay in management is envisaged.
Topics: Adult; Aged; Ameloblastoma; Female; Humans; Jaw Neoplasms; Male; Middle Aged; Young Adult
PubMed: 25706407
DOI: 10.1371/journal.pone.0117241