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The Cochrane Database of Systematic... Jul 2022Medication-related osteonecrosis of the jaw (MRONJ) is a severe adverse reaction experienced by some individuals to certain medicines commonly used in the treatment of... (Review)
Review
BACKGROUND
Medication-related osteonecrosis of the jaw (MRONJ) is a severe adverse reaction experienced by some individuals to certain medicines commonly used in the treatment of cancer and osteoporosis (e.g. bisphosphonates, denosumab, and antiangiogenic agents), and involves the progressive destruction of bone in the mandible or maxilla. Depending on the drug, its dosage, and the duration of exposure, this adverse drug reaction may occur rarely (e.g. following the oral administration of bisphosphonate or denosumab treatments for osteoporosis, or antiangiogenic agent-targeted cancer treatment), or commonly (e.g. following intravenous bisphosphonate for cancer treatment). MRONJ is associated with significant morbidity, adversely affects quality of life (QoL), and is challenging to treat. This is an update of our review first published in 2017.
OBJECTIVES
To assess the effects of interventions versus no treatment, placebo, or an active control for the prophylaxis of MRONJ in people exposed to antiresorptive or antiangiogenic drugs. To assess the effects of non-surgical or surgical interventions (either singly or in combination) versus no treatment, placebo, or an active control for the treatment of people with manifest MRONJ.
SEARCH METHODS
Cochrane Oral Health's Information Specialist searched four bibliographic databases up to 16 June 2021 and used additional search methods to identify published, unpublished, and ongoing studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) comparing one modality of intervention with another for the prevention or treatment of MRONJ. For 'prophylaxis of MRONJ', the primary outcome of interest was the incidence of MRONJ; secondary outcomes were QoL, time-to-event, and rate of complications and side effects of the intervention. For 'treatment of established MRONJ', the primary outcome of interest was healing of MRONJ; secondary outcomes were QoL, recurrence, and rate of complications and side effects of the intervention.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened the search results, extracted the data, and assessed the risk of bias in the included studies. For dichotomous outcomes, we reported the risk ratio (RR) (or rate ratio) and 95% confidence intervals (CIs).
MAIN RESULTS
We included 13 RCTs (1668 participants) in this updated review, of which eight were new additions. The studies were clinically diverse and examined very different interventions, so meta-analyses could not be performed. We have low or very low certainty about available evidence on interventions for the prophylaxis or treatment of MRONJ. Prophylaxis of MRONJ Five RCTs examined different interventions to prevent the occurrence of MRONJ. One RCT compared standard care with regular dental examinations at three-month intervals and preventive treatments (including antibiotics before dental extractions and the use of techniques for wound closure that avoid exposure and contamination of bone) in men with metastatic prostate cancer treated with zoledronic acid. The intervention seemed to lower the risk of MRONJ (RR 0.10, 95% CI 0.02 to 0.39, 253 participants). Secondary outcomes were not evaluated. Dentoalveolar surgery is considered a common predisposing event for developing MRONJ and five RCTs tested various preventive measures to reduce the risk of postoperative MRONJ. The studies evaluated plasma rich in growth factors inserted into the postextraction alveolus in addition to standardised medical and surgical care versus standardised medical and surgical care alone (RR 0.08, 95% CI 0.00 to 1.51, 176 participants); delicate surgery and closure by primary intention versus non-traumatic tooth avulsion and closure by secondary intention (no case of postoperative MRONJ in either group); primary closure of the extraction socket with a mucoperiosteal flap versus application of platelet-rich fibrin without primary wound closure (no case of postoperative MRONJ in either group); and subperiosteal wound closure versus epiperiosteal wound closure (RR 0.09, 95% CI 0.00 to 1.56, 132 participants). Treatment of MRONJ Eight RCTs examined different interventions for the treatment of established MRONJ; that is, the effect on MRONJ cure rates. One RCT analysed hyperbaric oxygen (HBO) treatment used in addition to standard care (antiseptic rinses, antibiotics, and surgery) compared with standard care alone (at last follow-up: RR 1.56, 95% CI 0.77 to 3.18, 46 participants). Healing rates from MRONJ were not significantly different between autofluorescence-guided bone surgery and conventional bone surgery (RR 1.08, 95% CI 0.85 to 1.37, 30 participants). Another RCT that compared autofluorescence- with tetracycline fluorescence-guided sequestrectomy for the surgical treatment of MRONJ found no significant difference (at one-year follow-up: RR 1.05, 95% CI 0.86 to 1.30, 34 participants). Three RCTs investigated the effect of growth factors and autologous platelet concentrates on healing rates of MRONJ: platelet-rich fibrin after bone surgery versus surgery alone (RR 1.05, 95% CI 0.90 to 1.22, 47 participants), bone morphogenetic protein-2 together with platelet-rich fibrin versus platelet-rich fibrin alone (RR 1.10, 95% CI 0.94 to 1.29, 55 participants), and concentrated growth factor and primary wound closure versus primary wound closure only (RR 1.38, 95% CI 0.81 to 2.34, 28 participants). Two RCTs focused on pharmacological treatment with teriparatide: teriparatide 20 μg daily versus placebo in addition to standard care (RR 0.96, 95% CI 0.31 to 2.95, 33 participants) and teriparatide 56.5 μg weekly versus teriparatide 20 μg daily in addition to standard care (RR 1.60, 95% CI 0.25 to 1.44, 12 participants).
AUTHORS CONCLUSIONS
Prophylaxis of medication-related osteonecrosis of the jaw One open-label RCT provided some evidence that dental examinations at three-month intervals and preventive treatments may be more effective than standard care for reducing the incidence of medication-related osteonecrosis of the jaw (MRONJ) in individuals taking intravenous bisphosphonates for advanced cancer. We assessed the certainty of the evidence to be very low. There is insufficient evidence to either claim or refute a benefit of the interventions tested for prophylaxis of MRONJ in patients with antiresorptive therapy undergoing dentoalveolar surgery. Although some interventions suggested a potential large effect, the studies were underpowered to show statistical significance, and replication of the results in larger studies is pending. Treatment of medication-related osteonecrosis of the jaw The available evidence is insufficient to either claim or refute a benefit, in addition to standard care, of any of the interventions studied for the treatment of MRONJ.
Topics: Anti-Bacterial Agents; Denosumab; Diphosphonates; Humans; Male; Osteonecrosis; Osteoporosis; Teriparatide
PubMed: 35866376
DOI: 10.1002/14651858.CD012432.pub3 -
Journal of Periodontology Dec 2022The use of biologics may be indicated for alveolar ridge preservation (ARP) and reconstruction (ARR), and implant site development (ISD). The present systematic review...
BACKGROUND
The use of biologics may be indicated for alveolar ridge preservation (ARP) and reconstruction (ARR), and implant site development (ISD). The present systematic review aimed to analyze the effect of autologous blood-derived products (ABPs), enamel matrix derivative (EMD), recombinant human platelet-derived growth factor-BB (rhPDGF-BB), and recombinant human bone morphogenetic protein-2 (rhBMP-2), on the outcomes of ARP/ARR and ISD therapy (i.e., alveolar ridge augmentation [ARA] and maxillary sinus floor augmentation [MSFA]).
METHODS
An electronic search for eligible articles published from January 2000 to October 2021 was conducted. Randomized clinical trials evaluating the efficacy of ABPs, EMD, rhBMP-2, and rhPDGF-BB for ARP/ARR and ISD were included according to pre-established eligibility criteria. Data on linear and volumetric dimensional changes, histomorphometric findings, and a variety of secondary outcomes (i.e., clinical, implant-related, digital imaging, safety, and patient-reported outcome measures [PROMs]) were extracted and critically analyzed. Risk of bias assessment of the selected investigations was also conducted.
RESULTS
A total of 39 articles were included and analyzed qualitatively. Due to the high level of heterogeneity across studies, quantitative analyses were not feasible. Most studies in the topic of ARP/ARR revealed that the use of biologics rendered similar results compared with conventional protocols. However, when juxtaposed to unassisted healing or socket filling using collagen sponges, the application of biologics did contribute to attenuate post-extraction alveolar ridge atrophy in most investigations. Additionally, histomorphometric outcomes were positively influenced by the application of biologics. The use of biologics in ARA interventions did not yield superior clinical or radiographic outcomes compared with control therapies. Nevertheless, ABPs enhanced new bone formation and reduced the likelihood of early wound dehiscence. The use of biologics in MSFA interventions did not translate into superior clinical or radiographic outcomes. It was observed, though, that the use of some biologics may promote bone formation during earlier stages of healing. Only four clinical investigations evaluated PROMs and reported a modest beneficial impact of the use of biologics on pain and swelling. No severe adverse events in association with the use of the biologics evaluated in this systematic review were noted.
CONCLUSIONS
Outcomes of therapy after post-extraction ARP/ARR and ARA in edentulous ridges were comparable among different therapeutic modalities evaluated in this systematic review. Nevertheless, the use of biologics (i.e., PRF, EMD, rhPDGF-BB, and rhBMP-2) in combination with a bone graft material generally results into superior histomorphometric outcomes and faster wound healing compared with control groups.
Topics: Humans; Tooth Socket; Sinus Floor Augmentation; Biological Products; Becaplermin; Alveolar Ridge Augmentation; Alveolar Process; Tooth Extraction
PubMed: 35841608
DOI: 10.1002/JPER.22-0069 -
Maxillofacial Plastic and... Jul 2022After tooth extraction, dimensional changes affect the alveolar socket, leading to loss in alveolar bone height and width. Histological modifications also occur, with... (Review)
Review
After tooth extraction, dimensional changes affect the alveolar socket, leading to loss in alveolar bone height and width. Histological modifications also occur, with initial formation of a blood clot that is replaced with granulation tissue and subsequently with a provisional connective tissue matrix. Spontaneous healing ends with socket filling with woven bone, which is gradually replaced with lamellar bone and bone marrow. Adequate alveolar ridge dimensions and bone quality are required to assure optimal stability and osseointegration following dental implant placement. When a tooth is extracted, alveolar ridge preservation (ARP) procedures are an effective method to prevent collapse of the post-extraction socket. Heterologous bone is widely chosen by clinicians for ARP, and anorganic bone xenografts (ABXs) made bioinert by heat treatment represents the most used biomaterial in clinical applications. Collagen-preserving bone xenografts (CBXs) made of porcine or equine bone are fabricated by less invasive chemical or enzymatic treatments to remove xenogenic antigens, and these are also effective in preserving post-extraction sites. Clinical differences between anorganic bone substitutes and collagen-preserving materials are not well documented in the literature but understanding these differences could clarify how processing protocols influence biomaterial behavior in situ. This systematic review of the literature compares the dimensional changes and histological features of ABXs versus CBXs in ridge preservation procedures to promote awareness of different bone xenograft efficacies in stimulating the healing of post-extraction sockets.
PubMed: 35821286
DOI: 10.1186/s40902-022-00349-3 -
Clinical Oral Implants Research Sep 2022Alveolar ridge preservation (ARP) procedures can limit bone changes following tooth extraction. However, the role of ARP in periodontally compromised socket lacks strong... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Alveolar ridge preservation (ARP) procedures can limit bone changes following tooth extraction. However, the role of ARP in periodontally compromised socket lacks strong scientific evidence. The aim of this systematic review and meta-analysis was to evaluate the outcomes of ARP following extraction of periodontally compromised teeth in comparison with extraction alone in terms of hard tissue changes, need for additional augmentation at the time of implant placement, and patient-reported outcomes.
MATERIAL AND METHODS
Electronic databases were searched to identify randomized controlled trials (RCTs) that compared ARP in periodontally compromised sockets with spontaneous socket healing. The risk of bias was assessed using the Cochrane Collaboration's risk of bias tool.
RESULTS
Five studies with 134 extraction sockets in 126 participants were included. Of these, ARP was performed in 77 sites, while the remaining sites were intentionally left to heal without any ARP treatment. The follow-up time varied between 6 and 12 months. Overall meta-analysis showed significant differences in changes in ridge height (mean difference (MD) -0.95; 95% confidence interval (CI) -1.43 to -0.47; p = .0001) and bone volume (MD -38.70; 95% CI -52.17 to -25.24; p < .0001) in favor of ARP. The use of ARP following extraction of periodontally compromised tooth was also associated with significantly less need for additional bone grafting at the time of implant placement.
CONCLUSIONS
Within the limitation of this review, ARP following extraction of periodontally compromised teeth may have short-term positive effects on alveolar ridge height and bone volume and minimize the need for additional augmentation procedures. However, the evidence is of very low to low certainty.
Topics: Alveolar Bone Loss; Alveolar Process; Alveolar Ridge Augmentation; Bone Transplantation; Humans; Tooth Extraction; Tooth Socket
PubMed: 35818637
DOI: 10.1111/clr.13975 -
The Journal of Contemporary Dental... Feb 2022The present systematic review and meta-analysis (SR/MA) aimed to test the null hypothesis that there is no difference between socket-shield technique (SST) and... (Meta-Analysis)
Meta-Analysis
AIM
The present systematic review and meta-analysis (SR/MA) aimed to test the null hypothesis that there is no difference between socket-shield technique (SST) and conventional immediate implant placement (CIIP) as an esthetic rehabilitation option for permanent human anterior teeth, against the alternative one of a difference.
BACKGROUND
Socket-shield technique is considered as a highly promising procedure that has the potential to prevent resorption of anterior alveolar ridges, maintains white and pink esthetics, and provides a solution for esthetically critical cases. Controlled randomized clinical trials (RCT) and nonrandomized ones had been identified by searching the following databases: Google Scholar, Scopus, and PubMed. Literature search was determined from January 2010 up to June 2020. Hand searches were also accomplished for relevant abstracts, books, and reference lists. The eligibility criteria included prospective observational controlled RCTs and non-RCTs.
POPULATIONS
patients with endodontically treated/nonrestorable permanent mature anterior teeth indicated for extraction.
INTERVENTIONS
the sockets were subjected to immediate implant placement using SST.
CONTROLS
implants placed with SST compared with those of CIIP.
OUTCOME
the pink esthetic score measured for esthetic rehabilitation. To assess article quality, the Cochrane risk-of-bias tool was used by two independent authors. The data across quantitative studies were analyzed using comprehensive MA software.
REVIEW RESULTS
The initial search found out 172 references through the search strategy and three additional ones were recognized through hand searching. After being filtered, 101 references were screened and recorded. After the inclusion and exclusion criteria were applied, only seven unduplicated prospective controlled RCTs and non-RCTs were involved in the quantitative MA. At the 6-month evaluation period, the total standard difference in mean was 1.07 and test value measuring heterogeneity was 77.182, whereas at the 12-month period, the total standard difference in mean was 1.43 and test value measuring heterogeneity was 64.914.
CONCLUSION
SST had a positive effect on the esthetic rehabilitation for anterior teeth better than CIIP. However, this conclusion was dependent on a very few well-conducted prospective RCT and non-RCT. Further RCTs with longer observational time, proper methodology, and of larger sample size are still required to adequately answer the question of the present SR.
CLINICAL SIGNIFICANCE
There is limited knowledge about the appropriateness of SST in the field of implant dentistry, specifically for esthetic consideration. This SR/MA confirmed the positive effect of the SST over CIIP for esthetic rehabilitation for anterior teeth.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, identifier CRD42020194086.
Topics: Dental Implantation, Endosseous; Dental Implants, Single-Tooth; Esthetics, Dental; Humans; Immediate Dental Implant Loading; Observational Studies as Topic; Tooth Extraction; Tooth Socket; Treatment Outcome
PubMed: 35748456
DOI: No ID Found -
The Journal of Evidence-based Dental... Jun 2022Alveolar osteitis (commonly known as dry socket) is a very common painful complication of dental extraction with no definitive cure. This systematic review assessed the... (Review)
Review
OBJECTIVE
Alveolar osteitis (commonly known as dry socket) is a very common painful complication of dental extraction with no definitive cure. This systematic review assessed the efficacy of laser therapy in the management of alveolar osteitis.
METHODS
PubMed, Scopus, Web of Science, Embase, Cochrane Central, and China National Knowledge Infrastructure (CNKI) were searched for all studies published till July 2021 using relevant keywords. All clinical trials that assessed the efficacy of laser in the management of alveolar osteitis were included. Due to missing some numerical data and the substantial heterogeneity across the studies, no meta-analysis was performed.
RESULTS
Out of the 296 identified articles, 14 clinical trials comprising 981 patients were included. The laser wavelengths, power output, and energy fluence showed a great variability across the included studies: 632.8 - 2940 nm, 16 mW - 10 W, and 0.2 - 85.7 J/cm, respectively. All included studies found laser to be efficacious in alleviating pain and accelerating healing in patients with alveolar osteitis. Of the 14 included studies, 13 studies reported superior outcomes in favor of laser therapy as compared to conventional therapies.
CONCLUSION
The available evidence suggests a good efficacy of laser therapy in reducing signs and symptoms of alveolar osteitis. However, owing to the marked methodological heterogeneity and the substantial variations in laser parameters among the included studies, more well-designed clinical trials with adequate sample sizes and standardized laser parameters are highly recommended.
CLINICAL SIGNIFICANCE
Laser therapy can be applied for the management of dry socket.
Topics: China; Dry Socket; Humans; Low-Level Light Therapy; Tooth Extraction; Wound Healing
PubMed: 35718430
DOI: 10.1016/j.jebdp.2022.101711 -
International Journal of Oral and... Jan 2023This systematic review was conducted to evaluate the available literature on the clinical outcomes of the use of autogenous tooth bone graft prepared chairside, and its... (Review)
Review
This systematic review was conducted to evaluate the available literature on the clinical outcomes of the use of autogenous tooth bone graft prepared chairside, and its current applications. A literature search was done to answer the focused questions "In partially edentulous patients, what are the alveolar ridge volumetric changes, histological findings, and implant survival rates in sites augmented with autogenous tooth bone graft prepared chairside?" Twenty articles were included at the end of the database search. Reported alveolar bone dimension changes after ridge preservation ranged between - 0.64 mm and + 2.26 mm for height, and between - 1.21 mm and + 0.41 mm for width. Augmented sites showed a significant increase in their dimensions in all investigations. The implant survival rate was 98.8% for delayed placement and 97.4% for immediate placement. Additional reports were found on the percentage bone formation following the use of this graft at different postoperative time points, which showed a higher bone volume with time. Currently available studies have included small samples, with short follow-up periods, and most have lacked a control group. Within the limitations of this review, the available evidence suggests that the autogenous tooth bone graft prepared chairside is as effective as other bone grafting materials.
Topics: Humans; Alveolar Ridge Augmentation; Dental Implantation, Endosseous; Bone Substitutes; Bone Transplantation; Tooth Extraction; Tooth Socket
PubMed: 35618639
DOI: 10.1016/j.ijom.2022.04.018 -
Journal of Medicine and Life Mar 2022The aim of this study was to evaluate the clinical need and impact of socket preservation to protect the bone for future dental implant placement. Moreover, we aimed to... (Review)
Review
The aim of this study was to evaluate the clinical need and impact of socket preservation to protect the bone for future dental implant placement. Moreover, we aimed to list down various methods of socket preservation by going through randomized clinical trials. We searched PubMed, Google Scholar, and Cochrane databases for all relevant publications, where researchers compared various methods and tools for socket preservation. All eight randomized controlled trials mentioned several methods that are helpful in preserving bone levels both horizontally and vertically. The studies included in this systematic review demonstrate that each material has certain efficacy in preserving the socket after tooth extraction for future implant placement. Socket preservation methods and materials are effective in preparing patients for future prostheses.
Topics: Humans; Tooth Extraction; Tooth Socket
PubMed: 35450006
DOI: 10.25122/jml-2021-0308 -
Cureus Mar 2022An alveolar cleft is the most common congenital bone defect. This systematic review aimed to investigate the use of stem cells for alveolar cleft repair and summarize... (Review)
Review
An alveolar cleft is the most common congenital bone defect. This systematic review aimed to investigate the use of stem cells for alveolar cleft repair and summarize the outcomes of clinical research studies. The electronic databases PubMed, Scopus, Web of Sciences, and Google Scholar were utilized to search the literature for relevant studies after administering specific inclusion and exclusion criteria. The search included articles that were published from 2011 to 2021 and specific keywords were used in the databases. The search was completed by two independent reviewers following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.Only four studies satisfied both the inclusion and exclusion criteria and were included in this systematic review. These studies investigated different aspects of bone reconstruction in the maxillary alveolar bone by stem cells, including cell types, clinical applications, biomaterial scaffolds, and follow-up period. The accumulated evidence in this systematic review is limited and insufficient to support the role of stem cell use in bone regeneration of maxillary alveolar bone defects. The outcome of using stem cells was studied only in 57 subjects from the four included studies. Although the noninvasive methods of isolating stem cells make them attractive resources for bone regeneration, more research is required in order to standardize and investigate stem cell therapy. This should be done beforehand in adults in less invasive procedures such as bone defect repair in dentistry prior to considering this type of therapy in this vulnerable patient population.
PubMed: 35425680
DOI: 10.7759/cureus.23111 -
Tissue Engineering and Regenerative... Jun 2022Platelet rich fibrin (PRF) has shown great potential in osteogenesis; however, some studies still question utilizing it as a grafting material. Thus, the aim of this... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Platelet rich fibrin (PRF) has shown great potential in osteogenesis; however, some studies still question utilizing it as a grafting material. Thus, the aim of this review is to evaluate the effect of PRF when used in socket and ridge preservation procedures.
METHODS
Electronic searches through MEDLINE, EMBASE, and Cochrane, Science Citation Index Expanded databases and manual searches of unpublished data, academic theses, and journals were conducted up until July 2021. The outcomes were to assess the ability of PRF as a graft material to preserve bone width, height, and density after tooth extraction.
RESULTS
Twelve studies were included in the review, using PRF showed significant results in all three outcomes when compared to no grafting at all, however when compared to other commonly used grafting materials it showed a lesser effect. On the other hand, most studies included reported mixing PRF with a graft material showed the best result. The meta-analysis also revealed the significant results in using PRF on the three outcomes.
CONCLUSION
The meta-analysis of the studies included proved the beneficial effect of PRF in socket preservation surgeries alone or in combination with other graft materials, but further individual multi-centre randomized controlled studies with appropriate sample size are still needed to further confirm our findings.
Topics: Osteogenesis; Platelet-Rich Fibrin; Tooth Extraction; Tooth Socket
PubMed: 35334092
DOI: 10.1007/s13770-021-00428-y