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Medicina Oral, Patologia Oral Y Cirugia... Jul 2024We reviewed the literature to examine if the thickness of the sinus membrane is a risk factor for perforation during lateral sinus lift surgery. (Meta-Analysis)
Meta-Analysis
BACKGROUND
We reviewed the literature to examine if the thickness of the sinus membrane is a risk factor for perforation during lateral sinus lift surgery.
MATERIAL AND METHODS
We searched Embase, PubMed, and Web of Science databases till 4th December 2023 for studies examining the risk of perforation with different sinus membrane thicknesses. Studies reporting sinus membrane thickness in perforation and non-perforation cases were also included.
RESULTS
Eleven studies were eligible. All studies used cone beam computed tomography for measuring sinus membrane thickness. Meta-analysis showed that sinus membrane thickness was significantly lower in perforation cases as compared to non-perforation cases (MD: -0.91 95% CI: -1.48, -0.33 I2=94%). Four studies used 2mm as the cut-off to define thick and thin sinus membranes. Pooled analysis failed to demonstrate any significant difference in perforation rates (OR: 0.97 95% CI: 0.44, 2.17 I2=56%). Meta-analysis of studies using 1.5mm (OR: 0.66 95% CI: 0.29, 1.48 I2=72%) and 1mm cut-off (OR: 0.93 95% CI: 0.34, 2.56) also demonstrated similar non-significant results.
CONCLUSIONS
Our study shows that the sinus membrane is significantly thinner in cases with perforations as compared to those with no perforations. However, a meta-analysis based on different membrane thickness cut-offs failed to demonstrate a relationship between thinner sinus membranes and a higher risk of perforation. There is a need for further studies examining the role of sinus membrane thickness on perforation rates.
Topics: Humans; Cone-Beam Computed Tomography; Maxillary Sinus; Risk Factors; Sinus Floor Augmentation; Intraoperative Complications; Dental Implants
PubMed: 38794940
DOI: 10.4317/medoral.26545 -
Medicina (Kaunas, Lithuania) May 2024Despite the promise of phage therapy (PT), its efficacy in prosthetic joint infection (PJI) management is unknown. Much of the current literature is largely limited to... (Meta-Analysis)
Meta-Analysis Review
Despite the promise of phage therapy (PT), its efficacy in prosthetic joint infection (PJI) management is unknown. Much of the current literature is largely limited to case reports and series. In order to help inform power calculations for future clinical trials and comparative analyses, we performed a systematic review and proportional meta-analysis of early PT outcomes to provide a preliminary assessment of early phage therapy treatment outcomes for cases of PJI. In a search of available literature across MEDLINE (Ovid, Wolters Kluwer, Alphen aan den Rijn, The Netherlands), Embase (Elsevier, Amsterdam, The Netherlands), the Web of Science Core Collection (Clarivate, London, UK), and Cochrane Central (Wiley, Hoboken, NJ, USA) up to 23 September 2023, we identified 37 patients with PJIs receiving adjunctive PT. Patients most frequently reported species infection (95%) and intraarticular phage delivery (73%). Phage cocktail (65%) and antibiotic co-administration (97%) were common. A random-effects proportional meta-analysis suggested infection remission in 78% of patients (95% CI: 39%, 95%) ( = 55%, = 0.08) and 83% with a minimum 12-month follow-up (95% CI: 53%, 95%) ( = 26%, = 0.26). Our study provides a preliminary estimate of PT's efficacy in PJIs and informs future comparative studies.
Topics: Humans; Prosthesis-Related Infections; Phage Therapy; Treatment Outcome
PubMed: 38792972
DOI: 10.3390/medicina60050790 -
Journal of Dentistry Jul 2024The study answers the PECO question: "In adults with dental implants (P), do subjects suffering from type-2 diabetes or prediabetes (E) have worse peri-implant... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The study answers the PECO question: "In adults with dental implants (P), do subjects suffering from type-2 diabetes or prediabetes (E) have worse peri-implant conditions (O) than subjects without type-2 diabetes and prediabetes (C)?". Prediabetes (5.7-6.4 % HbA1c), and the different qualities of glycemic control in type-2 diabetes; well-controlled (>8 % HbA1c), and poorly controlled (>8 % HbA1c) individuals; were classified according to the recommendations of the American Diabetes Association.
DATA
Predefined search keys were used with search terms including: Dental implant, diabetes mellitus, glycemic control and HbA1c.
SOURCES
An electronic search in the MEDLINE, Embase, and Cochrane libraries were conducted without any filters or language restrictions. Additionally, manual search of the reference lists were carried out to identify all relevant articles.
STUDY SELECTION
Eligibility criteria were cohort, case-control and cross-sectional studies that answerd our PECO question with at least 1 year of follow-up. From a total of 2660 records, 35 articles (1761 individuals) were included in the analysis. Meta-analytic difference in means for crestal bone loss was 1.2 mm [95 % CI=0.4; 2.1] in patients with prediabetes, 1.8 mm [CI=1.0; 2.7] in poorly controlled patients, whereas 0.4 mm [CI=-0.3; 1.1] in well-controlled individuals. Meta-regression showed that 1 % increase in HbA1c increased crestal bone loss by 0.24 mm.
CONCLUSIONS
Within the limitations of the study, patients with poorly controlled type-2 diabetes or prediabetes may have worse peri-implant conditions compared to patients without diabetes and well-controlled type-2 diabetes. Well-controlled type-2 diabetes is not a risk indicator for peri-implant diseases.
CLINICAL SIGNIFICANCE
Clinicians should measure blood HbA1c levels when planning implant-supported restorations, thus patients with undiagnosed or poorly controlled type-2 diabetes can be identified, that allows for glycemic level adjustment prior to dental implant surgery, ensuring peri-implant health. PROTOCOL REGISTRATION NUMBER: (CRD42022375263).
Topics: Humans; Diabetes Mellitus, Type 2; Prediabetic State; Dental Implants; Glycated Hemoglobin; Risk Factors; Peri-Implantitis; Glycemic Control
PubMed: 38788918
DOI: 10.1016/j.jdent.2024.105094 -
Journal of Prosthodontic Research May 2024This study aimed to provide the latest updates on the therapeutic effectiveness of keratinized mucosa (KM) augmentation using autogenous soft tissue grafts for dental...
PURPOSE
This study aimed to provide the latest updates on the therapeutic effectiveness of keratinized mucosa (KM) augmentation using autogenous soft tissue grafts for dental implants retaining prostheses.
STUDY SELECTION
A systematic search of electronic databases was conducted on autogenous soft tissue grafts to create and/or augment KM for functioning dental implants. Two investigators independently extracted data from the selected 11 clinical studies, including 290 participants, from the initially retrieved 573 publications.
RESULTS
A lack of KM surrounding dental implants was associated with greater mucosal inflammation. A free gingival graft (FGG) was used to increase the KM width, and a connective tissue graft (CTG) was used to manage peri-implant mucosal recession (MR). The weighted mean gain in KM was 2.6 mm from the selected FGG studies, with a significant reduction in mucosal inflammation and no changes in crestal bone levels for up to 4 years. The weighted mean reduction in MR was 2 mm in selected CTG studies.
CONCLUSIONS
A lack of KM negatively affects soft tissue health around dental implants. FGG was effective in increasing KM and reducing mucosal inflammation, whereas CTG was effective in decreasing MR.
PubMed: 38777752
DOI: 10.2186/jpr.JPR_D_24_00002 -
Heliyon May 2024The objective of the systematic review is to find an answer to a question: "What is the influence of the building direction of titanium implants produced by additive... (Review)
Review
The objective of the systematic review is to find an answer to a question: "What is the influence of the building direction of titanium implants produced by additive manufacturing on their physical and mechanical properties?" This review followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA 2020) and was registered in the Open Science Framework (OSF) (osf.io/rdc84). Searches were performed in PubMed, Scopus, Science Direct, Embase, and Google Scholar databases on February 17th, 2024. Articles were chosen in 2 steps by 2 blinded reviewers based on previously selected inclusion criteria: In vitro studies that evaluated the influence of the impression direction of titanium implants produced by additive manufacturing on their physical and mechanical properties were selected. Articles were excluded that (1) did not use additive technology to obtain the implants, 2) used surfaces other than titanium, 3) did not evaluate the direction of impression, 4) Studies with only in vivo analyses, clinical studies, systematic reviews, book chapters, short communications, conference abstracts, case reports, and personal opinions.). In the initial search, 581 results were found. Of this total, 108 were excluded for duplication and, after applying the eligibility criteria, 16 articles were included in the present review. The risk of bias was analyzed using the RoBDEMAT. The risk of bias was analyzed using the RoBDEMAT. In addition, the coefficient of interagreement of the reviewers (Cohen's Kappa) and the certainty of evidence by GRADE were analyzed. In general, different impression angles showed variations in the physical and mechanical characteristics of the groups evaluated, including roughness, tensile strength, hardness, and modulus of elasticity. While some impression orientations resulted in greater strength or hardness, others showed greater elasticity or lower surface roughness. These findings suggest that print orientation plays a significant role in determining material properties. It can be concluded that printing directions influence the physical and mechanical properties of titanium implants and the studies included showed that the 0°, 45°, and 90° directions are the most evaluated as they present lower probabilities of structural anisotropies and provide better results in their roughness, hardness, tensile and compressive strength.
PubMed: 38774089
DOI: 10.1016/j.heliyon.2024.e30108 -
The Journal of Prosthetic Dentistry May 2024Additive (3-dimensional printing) and subtractive (milling) methods are digital approaches to fabricating zirconia restorations. Comparisons of their resultant... (Review)
Review
STATEMENT OF PROBLEM
Additive (3-dimensional printing) and subtractive (milling) methods are digital approaches to fabricating zirconia restorations. Comparisons of their resultant fabrication accuracy and restoration fit are lacking.
PURPOSE
The purpose of this systematic review and meta-analysis was to evaluate the accuracy and fit of monolithic zirconia crowns fabricated by 3-dimensional printing and milling.
MATERIAL AND METHODS
The PubMed (Medline), Scopus, Embase, Web of Science, Cochrane Library, and Google Scholar databases were searched up to August 2023. Eligible records were included, and the standardized mean difference (SMD) analyzed 4 outcomes: marginal fit, intaglio fit, trueness, and precision. Publication bias was analyzed with Trim-and-fill, the Egger regression test, and Begg funnel plot. Methodological quality was rated using the QUIN tool.
RESULTS
A total of 15 publications were found eligible out of the initial 6539 records. The 3-dimensional printing group demonstrated a lower marginal fit (SMD=1.46, 95% CI=[0.67, 2.26], P<.001; I=83%, P<.001) and trueness (SMD=0.69, 95% CI=[0.20, 1.18], P=.006; I=88%, P<.001) and a significantly higher precision (SMD=-2.19, 95% CI=[-2.90, -1.48], P<.001; I=56%, P=.045). The intaglio fit did not differ significantly across the study groups (SMD=0.77, 95% CI=[-0.22, 1.77], P=.127; I=87%, P<.001).
CONCLUSIONS
Given the high degree of heterogeneity, it can be cautiously concluded that while 3-dimensional printing led to greater precision, the outcomes of the 2 accuracy and adaptation parameters most crucial to the longevity of the restorations-trueness and marginal fit-showed the superiority of the milling technique.
PubMed: 38772783
DOI: 10.1016/j.prosdent.2024.04.010 -
Clinical Neurology and Neurosurgery Jul 2024Basilar artery stenting is a rescue therapy in the management of hyperacute stroke. Published data on efficacy and safety are limited.
BACKGROUND AND PURPOSE
Basilar artery stenting is a rescue therapy in the management of hyperacute stroke. Published data on efficacy and safety are limited.
METHODS
A systematic review of published studies was performed in accordance with PRISMA guidelines. Inclusion criteria were adult patients with ischemic stroke with permanent basilar artery stent placement within 48 h of onset. Data were extracted by two independent reviewers. Additional cases from our institution were identified via a local stroke registry.
RESULTS
Of 212 screened articles, patient-level data was reported in 35 studies (87 individuals) and six additional patients were included from our registry. Patients (n = 93, 63 % male; median age 64) most often presented with mid-basilar occlusion (52 %) and 76 % received treatment within 12 hours of onset. Favorable angiographic results occurred in 67 %. The final modified Rankin Scale score (mRS) was 0-3 for 56 % of patients; mortality was 29 %. Those with complete flow post-procedure were more likely to have a final mRS of 0-3 (p = 0.05).
CONCLUSIONS
In 93 cases of basilar stenting in hyperacute stroke, favourable angiographic and functional outcomes were reported in 67 % and 56 % of patients, respectively. International multicenter registries are required to establish benefit and identify patient and technical factors that predict favorable outcomes.
Topics: Humans; Stents; Basilar Artery; Stroke; Endovascular Procedures; Treatment Outcome; Ischemic Stroke; Male; Female; Middle Aged
PubMed: 38761504
DOI: 10.1016/j.clineuro.2024.108327 -
The British Journal of Oral &... Jun 2024This systematic review aimed to evaluate results reported in the literature regarding the success rate of the titanium mesh technique for the placement of dental... (Review)
Review
This systematic review aimed to evaluate results reported in the literature regarding the success rate of the titanium mesh technique for the placement of dental implants. The topic focused on titanium mesh used as a physical barrier for ridge reconstruction in cases of partial or total edentulism. The authors conducted an electronic search of four databases up to October 2023. Six articles fulfilled the inclusion criteria and were analysed. A total of 100 titanium meshes with a minimum of 4.6 months follow up after surgery were studied, and 241 implants were placed. The review shows that the use of titanium mesh is a predictable method for the rehabilitation of complex atrophic sites. Further investigation generating long-term data is needed to confirm these findings.
Topics: Humans; Titanium; Surgical Mesh; Bone Regeneration; Dental Implantation, Endosseous; Dental Implants; Alveolar Ridge Augmentation; Guided Tissue Regeneration, Periodontal
PubMed: 38760261
DOI: 10.1016/j.bjoms.2024.04.005 -
PloS One 2024The recommendation on whether to bury or expose the Kirschner wire (K-wire) for the management of fractures has still been controversial with inconsistent results in the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The recommendation on whether to bury or expose the Kirschner wire (K-wire) for the management of fractures has still been controversial with inconsistent results in the published studies due to the potential issue associated with exposed K-wire is the heightened risk of infection, as it comes into direct contact with the external environment and air. This study aims to summarize the specific outcomes between buried and exposed K-wire for the management of hand and forearm fractures.
METHODS
We conducted relevant literature searches on Europe PMC, Medline, Scopus, and Cochrane Library databases using specific keywords. This investigation focuses on individuals of any age diagnosed with hand or forearm fractures who underwent surgery involving Kirschner wire (K-wire) fixation. It examines the comparison between buried and exposed K-wire fixation, emphasizing primary outcome pin infection, along with secondary outcomes such as early pin removal, days to pin removal, and surgical duration. The study includes observational studies (cohort/case-control) or randomized clinical trials (RCTs). The results of continuous variables were pooled into the standardized mean difference (SMD), while dichotomous variables were pooled into odds ratio (OR) along with 95% confidence intervals using random-effect models. The quality of included studies was assessed with Cochrane Collaborations, Risk of Bias version 2 (RoB v2).
RESULTS
A total of 11 studies were included. Our pooled analysis revealed that buried K-wire was associated with a lower risk of pin site infection [RR 0.49 (95% CI 0.36-0.67), p < 0.00001, I2 = 0%] and 33.85 days longer duration until pin removal [MD 33.85 days (95% CI 18.68-49.02), p < 0.0001, I2 = 99%] when compared with exposed K-wire. However, the duration of surgery was 9.98 minutes significantly longer in the buried K-wire [MD 6.98 minutes (95% CI 2.19-11.76), p = 0.004, I2 = 42%] with no significant difference in the early pin removal rate [RR 0.73 (95% CI 0.36-1.45), p = 0.37, I2 = 0%]. Further regression analysis revealed that sample size, age, sex, and duration of follow-up did not affect those relationships.
CONCLUSION
Buried K-wire may offer benefits in reducing the infection rate with a longer duration until pin removal. However, further RCTs with larger sample sizes are still needed to confirm the results of our study.
Topics: Bone Wires; Humans; Fracture Fixation, Internal; Fractures, Bone; Hand Bones; Forearm Injuries
PubMed: 38748687
DOI: 10.1371/journal.pone.0296149 -
Plastic and Reconstructive Surgery.... May 2024Implant-based breast reconstruction after nipple-sparing mastectomy (NSM) presents unique benefits and challenges. The literature has compared outcomes among total...
BACKGROUND
Implant-based breast reconstruction after nipple-sparing mastectomy (NSM) presents unique benefits and challenges. The literature has compared outcomes among total submuscular (TSM), dual-plane (DP), and prepectoral (PP) planes; however, a dedicated meta-analysis relevant to NSM is lacking.
METHODS
We conducted a systematic review of studies on immediate breast reconstruction after NSM using TSM, DP, or PP prosthesis placement in PubMed, Embase, and Cochrane databases. In total, 1317 unique articles were identified, of which 49 were included in the systematic review and six met inclusion criteria for meta-analysis. Pooled descriptive outcomes were analyzed for each cohort for all 49 studies. Fixed-effects meta-analytic methods were used to compare PP with subpectoral (TSM and DP) reconstructions.
RESULTS
A total of 1432 TSM, 1546 DP, and 1668 PP reconstructions were identified for descriptive analysis. Demographics were similar between cohorts. Pooled descriptive outcomes demonstrated overall similar rates of reconstructive failure (3.3%-5.1%) as well as capsular contracture (0%-3.9%) among cohorts. Fixed-effects meta-analysis of six comparative studies demonstrated a significantly lower rate of mastectomy flap necrosis in the PP cohort compared with the subpectoral cohort (relative risk 0.24, 95% confidence interval [0.08-0.74]). All other consistently reported outcomes, including, hematoma, seroma, infection, mastectomy flap necrosis, nipple -areola complex necrosis, and explantation were comparable.
CONCLUSIONS
A systematic review of the literature and meta-analysis demonstrated the safety of immediate prepectoral breast reconstruction after NSM, compared with submuscular techniques. Submuscular reconstruction had a higher risk of mastectomy flap necrosis, though potentially influenced by selection bias.
PubMed: 38746948
DOI: 10.1097/GOX.0000000000005808