-
International Journal of Oral and... Mar 2011This systematic review aims to identify and review the best available evidence to answer the clinical question 'What are the incidence and the factors influencing the... (Review)
Review
This systematic review aims to identify and review the best available evidence to answer the clinical question 'What are the incidence and the factors influencing the development of osteoradionecrosis after tooth extraction in irradiated patients?'. A systematic review of published articles on post-irradiation extraction was performed via electronic search of the Medline, Ovid, Embase and Cochrane Library databases. Additional studies were identified by manual reference list search. Evaluation and critical appraisal were done in 3 stages by two independent reviewers and any disagreement was resolved by discussion with a third party. 19 articles were selected for the final analysis. The total incidence of osteoradionecrosis after tooth extraction in irradiated patients was 7%. When extractions were performed in conjunction with prophylactic hyperbaric oxygen, the incidence was 4% while extraction in conjunction with antibiotics gave an incidence of 6%. This systematic review found that while the incidence of osteoradionecrosis after post-irradiation tooth extractions is low, the extraction of mandibular teeth within the radiation field in patients who received a radiation dose higher than 60Gy represents the highest risk of developing osteoradionecrosis. Based on weak evidence, prophylactic hyperbaric oxygen is effective in reducing the risk of developing osteoradionecrosis after post-radiation extractions.
Topics: Anti-Bacterial Agents; Head and Neck Neoplasms; Humans; Hyperbaric Oxygenation; Jaw Diseases; Mandibular Diseases; Osteoradionecrosis; Radiotherapy Dosage; Risk Factors; Time Factors; Tooth Extraction; Tooth Socket
PubMed: 21115324
DOI: 10.1016/j.ijom.2010.10.005 -
Dento Maxillo Facial Radiology May 2003To evaluate the principal features of florid cemento-osseous dysplasia (FCOD) by systematic review (SR), with particular regard to comparison of Oriental with... (Comparative Study)
Comparative Study Meta-Analysis Review
OBJECTIVES
To evaluate the principal features of florid cemento-osseous dysplasia (FCOD) by systematic review (SR), with particular regard to comparison of Oriental with non-Oriental populations, and of reports derived from pathology files with those from non-pathology sources.
METHODS
All alternative names for FCOD were used as search terms for two electronic databases, namely Medline and "Web of Science". Only multiple forms of cemento-osseous dysplasia occurring in a series in the reporting authors' case load were considered.
RESULTS
Medline produced more SR-identified reports. The search terms "Cementoma" and "Osseous Dysplasia" were the most effective for both databases. One hundred and fifty-eight cases of FCOD were observed in 17 series of patients reported in 16 SR-identified reports. Fifty-nine percent of cases were found in Blacks, 37% in Orientals and 3% in Caucasians. Ninety-seven percent were females. Fifty percent of cases in the SRs were observed incidentally. Pain was most frequent in those with presenting symptoms, and was significantly more frequent in the Oriental series. In two studies on the same Chinese community, those cases found incidentally on radiographs alone were significantly younger than those with symptoms in the pathology files.
CONCLUSION
The nomenclature for FCOD is extensive, but older and more general terms were more effective in recalling SR-identified reports. Cases in a report based on pathology files appear to be older than those in a report based on radiology alone files. With the exception of a higher prevalence of pain in Orientals, mainly Chinese, there did not appear to be any differences in presentation compared with that observed in Black communities.
Topics: Asian People; Black People; Cementoma; Databases as Topic; Female; Humans; Jaw Neoplasms; MEDLINE; Male; Sex Factors; Terminology as Topic; White People
PubMed: 12917278
DOI: 10.1259/dmfr/32988764 -
Journal of Oral and Maxillofacial... Sep 2015To detect the diagnostic efficacy of emission computed tomography (ECT) in detecting mandibular invasion caused by head and neck cancers. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To detect the diagnostic efficacy of emission computed tomography (ECT) in detecting mandibular invasion caused by head and neck cancers.
MATERIALS AND METHODS
Thirteen databases were searched electronically to retrieve studies for inclusion and a manual search also was conducted. Study inclusion, data extraction, and quality assessment were completed by 2 reviewers independently. Meta-DiSc 1.4 and STATA 11.0 were used to conduct the meta-analysis.
RESULTS
Seventeen studies involving 668 participants were included. One study had a low risk of bias, 2 had a high risk, and the rest had unclear risk. Meta-analysis showed that for the diagnosis of mandibular invasion single-photon ECT (SPECT) had a mean sensitivity (SEN) of 0.96, a mean specificity (SPE) of 0.66, an area under the curve (AUC) of 0.8989, and a Q* (point on the summary reviewer operator characteristic curve when SEN equaled SPE) of 0.8300. Positron emission tomography combined with computed tomography (PET/CT) had a mean SEN of 0.83, a mean SPE of 0.90, an AUC of 0.9290, and a Q* of 0.8640. The comparison between the diagnostic efficacy of SPECT and PET/CT showed that SPECT was superior for SEN (P = .0014) and PET/CT had a significantly better SPE (P = .001). The summary diagnostic efficacy between these modalities did not differ significantly (P > .05).
CONCLUSIONS
The present clinical evidence showed that SPECT is an excellent tool to exclude patients with no mandibular invasion, but is not as good as PET/CT to confirm the diagnosis.
Topics: Head and Neck Neoplasms; Humans; Mandibular Neoplasms; Multimodal Imaging; Neoplasm Invasiveness; Positron-Emission Tomography; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed
PubMed: 26022068
DOI: 10.1016/j.joms.2015.04.041 -
Osteoporosis International : a Journal... Mar 2014We aimed to systematically review observational studies evaluating use of bisphosphonates (BPs) and risk of osteonecrosis of jaw (ONJ) or other sites among non-cancer... (Meta-Analysis)
Meta-Analysis Review
SUMMARY
We aimed to systematically review observational studies evaluating use of bisphosphonates (BPs) and risk of osteonecrosis of jaw (ONJ) or other sites among non-cancer patients.
INTRODUCTION
PubMed, EMBASE, and Cochrane Library were screened from database inception to Dec 2012.
METHODS
Two reviewers independently identified cohort and case-control studies evaluating the use of oral or intravenous (IV) BPs and the risk of ONJ and extracted the characteristics of the studies and risk estimates. Pooled estimates of odds ratios and 95 % confidence intervals (CI) were derived by random effects meta-analysis. Subgroup analyses were carried according to patients' characteristics and route of BP use.
RESULTS
We identified 12 studies, including 2,652 cases and 1,571,997 controls. Use of BPs was associated with a significantly increased risk of ONJ or ON of other sites [odds ratio (OR) 2.32; 95 % CI 1.38-3.91; I (2) = 91 %]. The summary OR was 2.91 (95 % CI 1.62-5.22; I (2) = 85.9 %) for adjusted studies. Use of BPs were associated with higher risk on ONJ (OR 2.57; 95 % CI 1.37-4.84; I (2) = 92.2 %) than ON of other sites (OR 1.79; 95 % CI 0.71-4.47; I (2) = 83.3 %). Meta-regression analysis did not find design characteristics or outcome definitions to be significant sources of heterogeneity.
CONCLUSION
The available evidence suggests that use of BPs in cancer patients is associated with a substantial risk for ONJ. Patients receiving IV BP are at highest risk.
Topics: Bisphosphonate-Associated Osteonecrosis of the Jaw; Bone Density Conservation Agents; Diphosphonates; Humans; Neoplasms; Osteoporosis; Publication Bias; Research Design; Risk Assessment
PubMed: 24343364
DOI: 10.1007/s00198-013-2575-3 -
European Archives of... Oct 2017Ameloblastic carcinoma is a rare locally aggressive odontogenic neoplasm. These tumors are most commonly found to arise from mandible. Because of rarity, there is... (Review)
Review
Ameloblastic carcinoma is a rare locally aggressive odontogenic neoplasm. These tumors are most commonly found to arise from mandible. Because of rarity, there is limited information about the clinical behaviour of such patients. We intended to perform this review of published literature to assess the demographic profile, pattern of care and assess survival outcomes. Two authors independently searched PubMed, Google search, and Cochrane library for eligible studies from 1950 until July 1 2016 published in English language. Data of 199 patients were retrieved from 94 publications for statistical analysis. Median age of the entire cohort was 49 years (range 7-91 years). The analysis revealed that a clear twofold higher incidence in male with male-to-female ratio was 2.4:1 (140:57). Mandible was found to be the commonest tumor location in 66.7% (n = 132) cases followed by maxilla (31.8%) (n = 64). The present analysis revealed that median PFS of 57 months (95% CI 39-120 months) with 5- and 10-year PFS was found to be 47.88 and 29.48%, respectively. Median OS for the entire cohort which was 122 months (95% CI 96-153 months) with 2- and 5-year OS for the entire cohort was 87.16 and 69.08%, respectively. In univariate analysis, patients with an R0 resection were found to have a favourable survival. In addition, patients with localized disease and younger age were found to have a better survival. Adjuvant radiation did not confer any survival advantage. The present analysis revealed excellent outcome for patients treated with an R0 resection. Older patients with high-risk factor may benefit from adjuvant radiation. Role of chemotherapy needs to be evaluated.
Topics: Adult; Aged; Ameloblastoma; Antineoplastic Protocols; Carcinoma; Child; Combined Modality Therapy; Dissection; Female; Humans; Jaw Neoplasms; Male; Prognosis; Risk Adjustment; Survival Analysis
PubMed: 28600599
DOI: 10.1007/s00405-017-4631-7 -
The Journal of Clinical Endocrinology... Oct 2023Clinical trials have investigated the role of antiresorptive agents, including bisphosphonates and denosumab, in patients with primary breast cancer receiving adjuvant... (Meta-Analysis)
Meta-Analysis
The Clinical Benefits of Antiresorptive Agents in Patients with Primary Breast Cancer Receiving Adjuvant Endocrine Therapy: A Systematic Review with Pairwise and Network Meta-analysis.
CONTEXT
Clinical trials have investigated the role of antiresorptive agents, including bisphosphonates and denosumab, in patients with primary breast cancer receiving adjuvant endocrine therapy, aiming for better bone protection and/or improving survival.
OBJECTIVE
To summarize the clinical effects of antiresorptive agents in patients with early breast cancer receiving endocrine therapy.
METHODS
We systematically reviewed and synthesized the clinical benefits and harms of antiresorptive agents in patients with early breast cancer receiving endocrine therapy by calculating the risk ratios (RRs).
RESULTS
In the pooled meta-analysis, antiresorptive agents had significant clinical benefits on disease recurrence (RR 0.78, 95% CI 0.67-0.90) and locoregional recurrence (RR 0.69, 95% CI 0.49-0.95) in patients with breast cancer receiving endocrine therapy. Early use of antiresorptive agents has a beneficial effect on secondary endocrine therapy resistance instead of primary resistance. Safety analysis revealed that potential risk for osteonecrosis of the jaw (ONJ, RR 3.29, 95% CI 1.12-9.68) with antiresorptive agents; however, there is an insignificant difference in arthralgia. The subgroup analyses revealed that intervention with bisphosphonates might have profound clinical benefits, but also increased the occurrence of ONJ. A network meta-analysis further supported the clinical effects of early antiresorptive agent use compared with delayed use or placebo.
CONCLUSION
Using antiresorptive agents early in patients with breast cancer receiving adjuvant endocrine therapy may provide additional benefits in risk reduction of recurrence, but there is a potential risk of ONJ.
Topics: Humans; Female; Bone Density Conservation Agents; Denosumab; Breast Neoplasms; Network Meta-Analysis; Neoplasm Recurrence, Local; Diphosphonates
PubMed: 37170778
DOI: 10.1210/clinem/dgad247 -
Brazilian Dental Journal 2017Here is described a case of ameloblastic fibrosarcoma (AFS) affecting the posterior mandible of a woman who was treated surgically and recovered without signs of... (Review)
Review
Here is described a case of ameloblastic fibrosarcoma (AFS) affecting the posterior mandible of a woman who was treated surgically and recovered without signs of recurrence or metastasis after 12 years of follow-up. Tumor sections were immunostained for cell cycle, epithelial and mesenchymal markers. Immunohistochemical analysis evidenced high Ki-67 positivity in stromal cells (mean of 20.9 cells/High power field). Epithelial cells displayed strong positivity for p53, p63 and cytokeratin 19. In addition to the case report, a systematic review of current knowledge is presented on the AFS's clinical-demographic features and prognostic factors. Based on the review, 88/99 cases were diagnosed as AFS, 9/99 as ameloblastic fibro-odontosarcoma and 2/99 as ameloblastic fibrodentinosarcoma. All these lesions displayed very similar clinical-demographic and prognostic features. Moreover, the review provided evidence that first treatment, regional metastasis, distant metastasis and local recurrence were significant prognostic values for malignant odontogenic mesenchymal lesions. Based on the findings, segregation among ameloblastic fibrosarcoma, ameloblastic fibrodentinosarcoma and ameloblastic fibro-odontosarcoma seems illogical, considering all these lesions have similar predilections and outcomes.
Topics: Adult; Female; Fibrosarcoma; Humans; Immunohistochemistry; Mandibular Neoplasms; Odontogenic Tumors
PubMed: 28492759
DOI: 10.1590/0103-6440201701050 -
Oral Oncology Aug 2015Trismus is characterized by a reduced ability to open the mouth, directly affecting many aspects of daily life, such as chewing, swallowing, speaking and maintaining... (Review)
Review
Trismus is characterized by a reduced ability to open the mouth, directly affecting many aspects of daily life, such as chewing, swallowing, speaking and maintaining oral hygiene. Several studies have shown that trismus affects health related quality of life. Radiotherapy in the head and neck area is identified as one of the most frequent causes of trismus in head and neck cancer (HNC) patients. Currently, there is no standard treatment for trismus. Several stretching techniques and jaw mobilizing devices are available, but their effect in radiotherapy-induced trismus is still largely unknown. With this review we give an overview of the present relevant literature and compare the effect of exercise therapy versus no exercise therapy on jaw mobility, expressed in millimeters mouth opening, in HNC patients with radiotherapy-induced trismus. A systematic literature search in four electronic bibliographic databases was conducted in July 2014. Selected articles were critically appraised on relevance and validity. Best available evidence was analyzed and compared. Three of the four selected articles show a significant increase (p-value<0.05) in maximal interincisal opening (MIO) after exercise therapy using a jaw-mobilizing device. One article reports a significant decrease in MIO. However, this decrease is less in the intervention group, which implies a positive effect of exercise therapy. Based on this current best clinical evidence, it can be assumed that exercise therapy with a jaw-mobilizing device yields better results than no exercise, with regards to opening of the mouth in HNC patients with radiotherapy-induced trismus.
Topics: Exercise Therapy; Head and Neck Neoplasms; Humans; Jaw; Radiation Injuries; Recovery of Function; Treatment Outcome; Trismus
PubMed: 26058916
DOI: 10.1016/j.oraloncology.2015.05.001 -
European Review For Medical and... Dec 2019Medication-related osteonecrosis of the jaw (ONJ) is an adverse, severe and debilitating effect, which although infrequent, affects patients with osteoporosis or...
OBJECTIVE
Medication-related osteonecrosis of the jaw (ONJ) is an adverse, severe and debilitating effect, which although infrequent, affects patients with osteoporosis or neoplasm who take bisphosphonates, antiresorptive drugs, and/or antiangiogenic drugs. Its etiopathogenesis is unknown, although genetic causes have been postulated.
MATERIALS AND METHODS
This review analyzed articles published to date that have studied genetic factors associated with ONJ. Fifteen case-control studies were included, published between 2008 and 2018.
RESULTS
Five set out to determine genetic causes by means of genome-centered techniques, while ten do so by investigating gene-centered variants. Nine works found statistically significant associations between one or various single nucleotide polymorphisms (SNPs) and the appearance of ONJ. None of the studies coincided as to which genes present some association.
CONCLUSIONS
The review observed the moderate impact of genetic factors on the appearance of ONJ. It also showed the heterogeneity of the studies that have investigated ONJ to date. In future studies, involving international and interhospital collaboration will be necessary to recruit sample sizes of sufficient size, elaborate adequate study designs, obtain clear results, and advance our understanding of ONJ and make it possible to single out individual patients at risk.
Topics: Angiogenesis Inhibitors; Bisphosphonate-Associated Osteonecrosis of the Jaw; Bone Density Conservation Agents; Diphosphonates; Humans
PubMed: 31841171
DOI: 10.26355/eurrev_201912_19652 -
Journal of Oral and Maxillofacial... Oct 2015Melanotic neuroectodermal tumor of infancy (MNTI) is a rare tumor, usually diagnosed within the first year of age, with a predilection for the maxilla. Although the... (Review)
Review
Melanotic neuroectodermal tumor of infancy (MNTI) is a rare tumor, usually diagnosed within the first year of age, with a predilection for the maxilla. Although the tumor is usually benign, its rapidly growing nature and ability to cause major deformities in surrounding structures necessitate early diagnosis and intervention. It is important that medical and dental specialists are prepared to make the diagnosis and proceed with appropriate intervention. The authors performed a systematic review of the 472 reported cases from 1918 through 2013 and provided a comprehensive update on this rare entity that can have devastating effects on young patients. This investigation uncovered age at diagnosis as an important prognostic indicator, because younger age correlated with a higher recurrence rate. The authors also present a case report of a 5-month-old girl diagnosed with MNTI and review her clinical presentation and imaging and histopathologic findings.
Topics: Diagnosis, Differential; Female; Humans; Infant; Maxillary Neoplasms; Neuroectodermal Tumor, Melanotic; Tomography, X-Ray Computed
PubMed: 25936939
DOI: 10.1016/j.joms.2015.03.061