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Journal of Prosthodontics : Official... Apr 2020This systematic review was undertaken to establish the most favourable protocol to treat an edentulous mandible with a single implant-retained overdenture. The... (Meta-Analysis)
Meta-Analysis
PURPOSE
This systematic review was undertaken to establish the most favourable protocol to treat an edentulous mandible with a single implant-retained overdenture. The formulated PICO question was: "Which surgical and prosthetic protocols result in the highest survival and complication rates of implants and prostheses employed in a single implant retained overdenture for the rehabilitation of a completely edentulous mandibular ridge?"
MATERIALS AND METHODS
A structured literature search was conducted using the following databases; PubMed, ScienceDirect, COCHRANE, LILACS, IndeMED, OVID, EMBASE, NIH Clinical Trials for reports related to the single implant-retained overdenture treatment. Only English articles were included. Publications with a minimum follow up time of 1 year and above were included for meta-analysis. A Poisson regression model was applied to estimate the survival rates of the implant and prosthesis employed.
RESULTS
The electronic database search yielded 2083 titles and abstracts; and a total of 17 were selected for the systematic review, of which 11 studies were subjected to meta-analysis. The implants showed high estimated five and 10-year survival rates of 91.93% and 84.62%, respectively. Implants that were delayed loaded showed the greatest survival rates, while immediately loaded implants presented with higher survival rates at five (p = 0.849) and 10 years (p = 0.464) when compared to early loaded implants. The greatest number of fractures were associated with ball abutments with an event rate of 10.8 (95% CI: 10.5-11.09) per 100 prosthesis years, while locator abutments showed a greater number of maintenance events with an event rate of 16.84(95% CI:16.01-17.66) per 100 prosthesis years.
CONCLUSION
Single implant-retained overdenture treatment is a cost-effective, minimally invasive and simple treatment that can be used to restore function and aesthetics to edentulous patients, with relatively high implant and prosthesis success rates and minimal complications.
Topics: Dental Implants; Dental Prosthesis, Implant-Supported; Denture, Overlay; Esthetics, Dental; Humans; Jaw, Edentulous; Mandible
PubMed: 31849146
DOI: 10.1111/jopr.13133 -
Oral and Maxillofacial Surgery Mar 2020This study aims to investigate rehabilitation strategies to reduce trismus, pain, and edema in patients with maxillofacial trauma. (Meta-Analysis)
Meta-Analysis
PURPOSE
This study aims to investigate rehabilitation strategies to reduce trismus, pain, and edema in patients with maxillofacial trauma.
METHODS
An electronic search in main databases was performed, including studies published until November 2017. Clinical trials aiming to investigate therapeutic techniques to improve mandibular range of motion and to reduce pain and edema compared to other treatments were included.
RESULTS
Nine studies were included in the review with different therapy modalities: photobiomodulation, kinesiologic tape, hilotherapy, jaw exercises, and TENS. Only five studies had available data to be included in a meta-analysis. There were no differences between any of the proposed strategies and its controls to prevent trismus. Individuals treated with hilotherapy presented less pain compared to controls. Kinesiologic tape or hilotherapy reduced edema when compared to controls daily until postoperative day 3.
CONCLUSIONS
There is diversity among the proposed rehabilitation techniques, and types of fractures and there are few numbers of included participants in each study. The results obtained in this review do not promote evidence to guide the use of non-drug rehabilitation techniques in patients with maxillofacial trauma after surgical intervention.
Topics: Edema; Fractures, Bone; Humans; Maxillofacial Injuries; Pain Measurement; Trismus
PubMed: 31802332
DOI: 10.1007/s10006-019-00808-8 -
Plastic and Reconstructive Surgery Dec 2019Mandibular angle fractures are common and frequently involve a tooth in the fracture line. Despite trends toward more conservative indications for tooth extraction... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Mandibular angle fractures are common and frequently involve a tooth in the fracture line. Despite trends toward more conservative indications for tooth extraction during open repair, the literature remains heterogeneous. This review aims to ascertain the effect of tooth extraction/retention on patient outcomes following mandible open reduction and internal fixation and to evaluate the evidence surrounding indications for extraction.
METHODS
PubMed, EMBASE, the Cochrane Library, Elsevier text mining tool database, and clinicaltrials.gov were queried through March of 2018 for English language publication on adults with traumatic mandibular fractures. The review protocol was not registered online. Quality of evidence was assigned using the Grading of Recommendations Assessment, Development and Evaluation methodology. Meta-analyses were performed when definitions of outcomes were deemed similar.
RESULTS
Overall, 26 of 1212 identified studies met inclusion criteria. Indications for tooth extraction and rates of extraction varied considerably across studies. The quality of evidence was low or very low for all outcomes. Tooth retention was associated with lower overall complications (OR, 0.54; 95 percent CI, 0.37 to 0.79), major complications requiring readmission or reoperation (OR, 0.47; 95 percent CI, 0.24 to 0.92), and malocclusion (OR, 0.56; 95 percent CI, 0.32 to 0.97); there was no difference in wound issues or nonunion. Removal of asymptomatic teeth was associated with inferior alveolar nerve injury (39.4 percent versus 16.1 percent).
CONCLUSIONS
The literature is limited by retrospective study deign and poor follow-up; however, when indicated, tooth extraction is not associated with an increased risk of infection or nonunion. Removal of asymptomatic teeth was associated with a risk of inferior alveolar nerve injury. Additional high-quality studies are needed to evaluate potentially expanded indications for tooth extraction.
Topics: Fracture Fixation, Internal; Humans; Mandible; Mandibular Fractures; Molar, Third; Open Fracture Reduction; Postoperative Complications; Reoperation; Surgical Wound Infection; Tooth Extraction
PubMed: 31764658
DOI: 10.1097/PRS.0000000000006255 -
International Journal of Oral and... Apr 2020The aim of this systematic review was to verify whether the presence of a lower third molar in the mandibular angle fracture line is associated with postoperative... (Meta-Analysis)
Meta-Analysis
The aim of this systematic review was to verify whether the presence of a lower third molar in the mandibular angle fracture line is associated with postoperative complications. An electronic survey was conducted in five databases. Eligibility criteria included observational and experimental studies that evaluated the association between the presence of the lower third molar in the fracture line of mandibular angle fractures and possible postoperative complications, including infection, paresthesia, necessity of plate removal, temporomandibular joint disorders, malocclusion, dehiscence, and non-union. Thirty-four papers were included in the qualitative analysis and 26 of those in the meta-analysis. The risk of bias of observational studies was assessed by Newcastle-Ottawa scale and of the clinical trials by Cochrane Collaboration risk-of-bias tool. Absence of the third molar was associated with a lower chance of postoperative infection in angle fractures compared to presence of the tooth (odds ratio 0.55, 95% confidence interval 0.34-0.88). No statistically significant difference between the groups was found for the other outcomes evaluated. The findings of this systematic review suggest that the absence of the third molar in the mandibular angle fracture line is associated with a lower postoperative infection rate when compared to angle fractures with a third molar present.
Topics: Data Management; Humans; Mandible; Mandibular Fractures; Molar, Third; Postoperative Complications; Retrospective Studies; Tooth, Impacted
PubMed: 31653555
DOI: 10.1016/j.ijom.2019.09.017 -
Journal of Clinical Pharmacy and... Feb 2020There have been concerns about a potential link between long-term use of bisphosphonates (BPs) for the treatment of osteoporosis and rare serious adverse effects, such...
WHAT IS KNOWN AND OBJECTIVE
There have been concerns about a potential link between long-term use of bisphosphonates (BPs) for the treatment of osteoporosis and rare serious adverse effects, such as atypical femoral fractures. However, many reviews exist with conflicting conclusions about this issue. The aim of this overview of reviews was to systematically evaluate the risk of rare serious adverse effects of long-term use of BPs for the treatment of osteoporosis.
METHODS
We identified systematic reviews with meta-analyses of randomized controlled trials (RCTs) and (or) observational studies published in English or Chinese that evaluated the safety of BPs through to December 2018. The Cochrane library, PubMed, Web of Science and hand-searching of reference lists and clinical practice guidelines were electronically searched for data sources. Carcinogenicity, atypical fracture, osteonecrosis of jaw (ONJ) and fracture union time were specified as the primary outcomes. The methodological quality of each systematic review was assessed by two reviewers using the Assessment of Multiple Systematic Reviews (AMSTAR) tool, and the quality of evidence for key outcomes was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.
RESULTS AND DISCUSSION
In total, 1376 potentially relevant citations were identified, of which only 8 systematic reviews with meta-analyses met the eligibility criteria. All the included reviews were published between 2012 and 2015 and documented the pooled estimates of effect size (relative risk [RR], odds ratio [OR] or hazard ratio [HR] and their 95% confidence intervals [95% CI]) for the incidence of adverse events. All included systematic reviews were of moderate or high quality. The median AMSTAR score was 7.5 (interquartile range, 5-10). However, evidence of the key outcomes was mainly of very low or moderate quality. BP treatment only increased the risk of atypical fracture and ONJ, and prolonged union time compared with placebo or other anti-osteoporosis drugs (P < .05).
WHAT IS NEW AND CONCLUSION
This study indicated that long-term use of BPs could increase the risk of rare serious adverse effects, but the relationship between long-term use of BPs and carcinogenicity was often uncertain. Therefore, high-quality research and more complete inclusion criteria are needed.
Topics: Bone Density Conservation Agents; Diphosphonates; Humans; Osteoporosis; Randomized Controlled Trials as Topic; Time Factors
PubMed: 31608489
DOI: 10.1111/jcpt.13056 -
The Journal of Craniofacial Surgery Oct 2019Despite there being several clinical studies reporting promising outcomes of resorbable plates for fixation of pediatric mandible fractures, the literature is devoid of...
INTRODUCTION
Despite there being several clinical studies reporting promising outcomes of resorbable plates for fixation of pediatric mandible fractures, the literature is devoid of large studies or comprehensive reviews assessing safety rates, complications and long-term outcomes. The purpose of the current review is to obtain a global consensus, shed light on efficacy and complications, and provide the reader with evidence-based data to help guide clinical management.
METHODS
A systematic review of clinical studies assessing outcomes for resorbable plates in pediatric mandibular fractures was carried out. The main outcomes included infection, hardware failure, hardware exposure, malocclusion, reoperation and nonunion. Overall rates were pooled and stratified by fracture and implant type.
RESULTS
Ten studies were included yielding 232 patients with 269 fractures. The mean age at surgery was 8.24 years with a mean follow up of 1.03 years. The overall complication rate was 5.2% (n = 12). Complications included infection (n = 4, 1.7%), hardware exposure (n = 3, 1.29%), wound dehiscence (n = 2, .86%) and intra-oral fistula formation (n = 2, .86%). One patient (0.43%) had malocclusion and none (0%) had hardware failure, nonunion or revision surgery. Patients with multiple fractures (≥ 2) had higher complication rates compared to isolated fractures (12.5% versus 1.7%).
CONCLUSION
The use of resorbable plates for pediatric mandibular fractures is a viable option with similar rates of post-operative complications and outcomes compared to standard metallic counterparts. In the absence of large studies or systematic reviews, this study provides craniofacial surgeons with an evidence-based reference to guide decision making and improve informed consent.
Topics: Adolescent; Bone Plates; Child; Child, Preschool; Humans; Infant; Malocclusion; Mandibular Fractures; Postoperative Complications; Reoperation; Treatment Outcome
PubMed: 31568159
DOI: 10.1097/SCS.0000000000006002 -
Journal of Oral and Maxillofacial... Dec 2019Mandibular condylar fractures are relatively common fractures, accounting for 29 to 52% of all mandibular fractures. Recently, the debate between closed versus open... (Meta-Analysis)
Meta-Analysis
PURPOSE
Mandibular condylar fractures are relatively common fractures, accounting for 29 to 52% of all mandibular fractures. Recently, the debate between closed versus open treatment of the condylar fracture has shifted toward more specific surgical questions concerning the number and pattern of the fixation method for the condylar region. We have attempted to resolve the controversy with the systematic review and meta-analysis. The purpose of the present study was to compare the outcomes of different methods of fixation for mandibular condylar fractures.
MATERIALS AND METHODS
We conducted an electronic database search for clinical studies evaluating the stability of internal fixation of condylar fractures. The search was restricted to studies reported in the English language from January 2000 to July 2018. The review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement guidelines.
RESULTS
The initial search returned 285 studies reported from January 2000 through July 2018. After reviewing the full-text reports, only 16 studies were deemed eligible for the review. The total sample size was 831 patients with mandibular subcondylar fractures. The patients were classified into 25 groups according to the fixation method, follow-up period, use of intermaxillary fixation, and the presence of associated fractures.
CONCLUSIONS
The results of our systematic review and meta-analysis showed that single plate fixation has been associated with more complications with poor outcomes, including hardware failure, screw loosening, and postoperative malocclusion.
Topics: Bone Plates; Bone Screws; Fracture Fixation; Fracture Fixation, Internal; Humans; Mandibular Condyle; Mandibular Fractures; Treatment Outcome
PubMed: 31472103
DOI: 10.1016/j.joms.2019.07.012 -
Journal of Oral Rehabilitation Jan 2020To evaluate the biological and mechanical complications of angulated abutments on full-arch and partial jaw rehabilitations with a follow-up for at least 1 year. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To evaluate the biological and mechanical complications of angulated abutments on full-arch and partial jaw rehabilitations with a follow-up for at least 1 year.
METHODS
Electronic search was carried out in MEDLINE, EMBASE and Web of Science. Studies published between January 2000 and January 2019 were included. The quality of the included studies was assessed. The data extraction was focused on implant loss, marginal bone loss and mechanical complications, and meta-analyses were performed for marginal bone loss, mechanical complications and implant failure.
RESULTS
Nine studies, three prospective and six retrospective cohort studies were included. They reported on 797 patients that received 4127 implants. The total number of abutments was 4079 of which 1673 were angulated, and 2406 were straight. All abutments were prefabricated. Angulated abutments were associated with increased implant failure rates (two studies; RR = 7.30; 95% CI = 2.79-19.08) and an effect that was both statistically significant (P < .001) and clinically relevant. Three studies reported differentiated data for mechanical and technical complications at 1 year of follow-up, being mostly related to the retention screw while screw fracture. Angulated abutments were associated with a statistically significant increase in MBL 1 year after insertion compared to straight abutments (three studies; MD = 0.08 mm; 95% CI = 0.01-0.14 mm; P = .02), which might be, however, clinically negligible.
CONCLUSIONS
The prosthetic complications such as screw loosening and abutment loosening were frequent. After 1 year of follow-up, implants supporting angulated abutments yielded significantly more marginal bone loss than those supporting straight abutments.
Topics: Bone Screws; Dental Abutments; Dental Implants; Dental Prosthesis, Implant-Supported; Dental Restoration Failure; Humans; Prospective Studies; Retrospective Studies
PubMed: 31441527
DOI: 10.1111/joor.12877 -
Journal of Cranio-maxillo-facial... Oct 2019The zygomaticomaxillary complex (ZMC) functions as the main buttress for the lateral portion of the middle third of the facial skeleton and because of its prominent... (Comparative Study)
Comparative Study
BACKGROUND
The zygomaticomaxillary complex (ZMC) functions as the main buttress for the lateral portion of the middle third of the facial skeleton and because of its prominent position & convex shape, it is frequently fractured, alone or along with other bones of the midface. The management of the ZMC fractures is debatable as the literature is saturated with various theories. A number of techniques, from closed reduction to open reduction and internal fixation can be effectively used to manage these fractures. Controversies lie right from the amount of fixation (1-, 2-, 3- or 4- point fixation) required to the ideal approach, and there is no conclusive view on its ideal line of management.
OBJECTIVE
To compare Malar asymmetry after 2-point vs 3-point fixation in the treatment of zygomaticomaxillary complex fractures.
DATA SOURCE
Electronic search of Pub Med, Google Scholar, Institutional Library, Email to authors and manual search of various journals.
STUDY ELIGIBILITY CRITERIA
The following criteria were used to select the studies on 2- point and 3-point fixation methods in Zygomaticomaxillary complex fractures. Inclusion criteria had articles that included clinical studies published in the English language or those having sufficient data in English on 2-point or 3-point fixation in the treatment of zygomaticomaxillary complex fractures between the period of 1st January 2008 to 30th September 2018. While exclusion criteria were articles not published in the English language before 1st January 2008 and after 30th September 2018, any reviews, abstracts, letters to editors, editorials and in vitro studies were excluded. Studies that included patients with craniofacial and secondary deformities were also excluded.
INTERVENTION
Open reduction and internal fixation using 2-point and 3-point fixation methods in the treatment of Zygomaticomaxillary complex fractures.
RESULTS
Preliminary screening consisted of 757 studies and additional records identified through other sources of 272 studies. Amongst these 1029 studies, 837 studies were excluded after reviewing the titles. A review of abstract further excluded 71 studies, so 34 studies that remained were evaluated to fit the eligibility criteria. On the basis of information on fixation methods and parameters of evaluation of fixation method, 26 studies were further excluded. Thus 8 studies with a total of 823 estimates were included in qualitative synthesis.
LIMITATIONS
Parameters assessed by all the authors varied and hence a standardisation for comparison could not be done.
CONCLUSION
Five out of eight studies showed that the use of 3-point fixation in the treatment of zygomaticomaxillary complex fractures was superior than 2-point fixation for the same. Hence it can be concluded that 3-point fixation is superior than 2-point fixation in reducing malar asymmetry in zygomaticomaxillary complex fractures.
FUTURE IMPLICATIONS
Future studies with uniform parameters being assessed can be done. 3-point fixation can be used as a standard treatment modality in the effective management of Zygomaticomaxillary complex fractures.
Topics: Fracture Fixation, Internal; Humans; Maxillary Fractures; Open Fracture Reduction; Zygoma; Zygomatic Fractures
PubMed: 31395419
DOI: 10.1016/j.jcms.2019.07.009 -
Osteoporosis International : a Journal... Sep 2019Given the widespread practice of recommending drug holidays, we reviewed the impact of medication discontinuation of two common anti-osteoporosis therapies...
UNLABELLED
Given the widespread practice of recommending drug holidays, we reviewed the impact of medication discontinuation of two common anti-osteoporosis therapies (bisphosphonates and denosumab). Trial evidence suggests the risk of new clinical fractures, and vertebral fracture increases when osteoporosis treatment with bisphosphonates or denosumab is stopped.
INTRODUCTION
The aim of this paper was to review the available literature to assess what evidence exists to inform clinical decision-making with regard to drug holidays following treatment with bisphosphonates (BiP) or denosumab.
METHODS
Systematic review.
RESULTS
Differing pharmacokinetics lead to varying outcomes on stopping therapy. Prospective and retrospective analyses report that the risk of new clinical fractures was 20-40% higher in subjects who stopped BiP treatment, and vertebral fracture risk was approximately doubled. Rapid bone loss has been well described following denosumab discontinuation with an incidence of multiple vertebral fractures around 5%. Studies have not identified risk factors for fracture after stopping treatment other than those that provide an indication for treatment (e.g. prior fracture and low BMD). Studies that considered long-term continuation did not identify increased fracture risk, and reported only very low rates of adverse skeletal events such as atypical femoral fracture.
CONCLUSIONS
The view that patients on long-term treatment with bisphosphonates or denosumab should always be offered a drug holiday is not supported by the existing evidence. Different pharmacokinetic properties for different therapies require different strategies to manage drug intermission. In contrast, long-term treatment with anti-resorptives is not associated with increased risk of fragility fractures and skeletal adverse events remain rare.
Topics: Age Factors; Bisphosphonate-Associated Osteonecrosis of the Jaw; Bone Density; Bone Density Conservation Agents; Clinical Decision-Making; Denosumab; Diphosphonates; Drug Administration Schedule; Humans; Osteoporosis, Postmenopausal; Osteoporotic Fractures; Risk Assessment; Risk Factors; Withholding Treatment
PubMed: 31175404
DOI: 10.1007/s00198-019-05002-w