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International Journal of Oral and... Apr 2016This systematic review evaluated the effect on bone formation and implant survival of combining platelet-rich plasma (PRP) with bone grafts in maxillary augmentation. A... (Meta-Analysis)
Meta-Analysis Review
This systematic review evaluated the effect on bone formation and implant survival of combining platelet-rich plasma (PRP) with bone grafts in maxillary augmentation. A comprehensive review of articles listed in the PubMed/MEDLINE, Embase, and Cochrane Library databases covering the period January 2000 to January 2015 was performed. The meta-analysis was based on bone formation for which the mean difference (MD, in millimetres) was calculated. Implant survival was assessed as a dichotomous outcome and evaluated using the risk ratio (RR) with 95% confidence interval (CI). The search identified 3303 references. After inclusion and exclusion criteria were applied, 17 studies were selected for qualitative analysis and 13 for quantitative analysis. A total of 369 patients (mean age 51.67 years) and 621 maxillary sinus augmentations were evaluated. After the data analysis, additional analyses were performed of the implant stability quotient, marginal bone loss, and alveolar bone height measured by MD. The results showed no significant difference in implant stability (P=0.32, MD 1.00, 95% CI -0.98 to 2.98), marginal bone loss (P=0.31, MD 0.06, 95% CI -0.05 to 0.16), alveolar bone height (P=0.10, MD -0.72, 95% CI -1.59 to 0.14), implant survival (P=0.22, RR 1.95, 95% CI 0.67-5.69), or bone formation (P=0.81, MD -0.63, 95% CI -5.91 to 4.65). In conclusion, the meta-analysis indicates no influence of PRP with bone graft on bone formation and implant survival in maxillary sinus augmentation.
Topics: Bone Transplantation; Graft Survival; Humans; Osteogenesis; Platelet-Rich Plasma; Sinus Floor Augmentation
PubMed: 26775635
DOI: 10.1016/j.ijom.2015.07.012 -
Cornea Mar 2016To examine the efficacy of corneal collagen cross-linking (CXL) for the treatment of keratoconus (KCN). (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To examine the efficacy of corneal collagen cross-linking (CXL) for the treatment of keratoconus (KCN).
METHODS
A systemic literature review and meta-analysis of ocular functional and structural parameters of patients with KCN undergoing cross-linking procedures were performed using PubMed and the web of science. A literature search was performed for relevant peer-reviewed publications on population-based studies. Data were analyzed with R software (Meta library), and heterogeneity was assessed with the Cochran Q and I. A random-effects model was used for high heterogeneity; otherwise a fixed model was used. Sensitivity analysis of particular tested groups was used to explain high heterogeneity. The main outcome measures extracted from the articles were corrected distance visual acuity, uncorrected distance visual acuity, and maximum K.
RESULTS
An improvement in visual acuity of 1 to 2 Snellen lines was found 3 months or more after undergoing CXL. Changes were more pronounced in uncorrected visual acuity. Some topography parameters were found to be improved (0.6-1 diopters) 12 to 24 months after CXL. The refractive cylinder improved by 0.4 to 0.7 diopters. Endothelial cell density decreased by 225 cells per square millimeter in the first 3 months and thereafter returned to normal. Corneal thickness was reduced by 10 to 20 μm in the year following CXL but not after 24 months. No changes in intraocular pressure were noted.
CONCLUSIONS
CXL is a safe and effective method for halting the deterioration of KCN, while slightly improving visual function.
Topics: Collagen; Corneal Endothelial Cell Loss; Corneal Topography; Cross-Linking Reagents; Humans; Intraocular Pressure; Keratoconus; Photochemotherapy; Photosensitizing Agents; Riboflavin; Visual Acuity
PubMed: 26751990
DOI: 10.1097/ICO.0000000000000723 -
Journal of Periodontology Mar 2016The aim of this systematic review is to evaluate the effects of platelet-rich fibrin (PRF) membranes on the outcomes of clinical treatments in patients with gingival... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The aim of this systematic review is to evaluate the effects of platelet-rich fibrin (PRF) membranes on the outcomes of clinical treatments in patients with gingival recession.
METHODS
Articles that were published before June 2015 were searched electronically in four databases without any date or language restrictions and searched manually in regular journals and unpublished studies. The eligibility criteria comprised randomized controlled trials (RCTs) and prospective controlled trials with follow-up periods of ≥ 6 months that compared the performance of PRF to other biomaterials in the treatment of Miller Class I or II gingival recessions. For the meta-analysis, the inverse variance method was used in fixed- or random-effect models, which were chosen according to heterogeneity. The estimates of the intervention effects were expressed as the mean differences in percentages or millimeters.
RESULTS
Six RCTs and one prospective clinical trial are included in this review. Root coverage (RC) and clinical attachment level (CAL) did not differ significantly between the analyzed subgroups (P = 0.57 and P = 0.50, respectively). The keratinized mucosa width (KMW) gain was significantly greater (P = 0.04) in the subgroup that was treated with connective tissue grafts.
CONCLUSION
The results of the meta-analysis suggest that the use of PRF membranes did not improve the RC, KMW, or CAL of Miller Class I and II gingival recessions compared with the other treatment modalities.
Topics: Blood Platelets; Connective Tissue; Fibrin; Gingiva; Gingival Recession; Humans; Prospective Studies; Surgical Flaps; Treatment Outcome
PubMed: 26561997
DOI: 10.1902/jop.2015.150420 -
Diabetes Research and Clinical Practice Jan 2016Myopia may have protective effects against diabetic retinopathy (DR). However, the data from epidemiologic studies are inconsistent. We aimed to examine the association... (Meta-Analysis)
Meta-Analysis Review
AIMS
Myopia may have protective effects against diabetic retinopathy (DR). However, the data from epidemiologic studies are inconsistent. We aimed to examine the association between myopia and DR by conducting a meta-analysis.
METHODS
We identified studies by searching the PubMed and EMBASE databases. Study-specific odds ratios (ORs) were pooled using a fixed or random effects model. Myopic eyes were defined as having a spherical equivalent (SE)<-0.5 diopters (D). Myopic SE, each diopter decrease in SE toward myopia, and each millimeter increase in axial length (AL) were used as independent surrogate variables for myopia.
RESULTS
Data from 6 population-based and 3 clinic-based studies were included in the analyses. Myopic SE (compared with emmetropic eyes) and each millimeter increase in AL were associated with a decreased risk for DR (pooled odds ratio [OR], 0.80 and 0.79, respectively; 95% confidence interval [CI], 0.67-0.95 and 0.73-0.86, respectively; P=0.011 and 0.000, respectively). Each millimeter increase in AL was also associated with a decreased risk for vision-threatening diabetic retinopathy (VTDR) (pooled OR, 0.70; 95% CI, 0.60-0.82; P=0.000). No significant association between each diopter decrease in SE and DR was observed.
CONCLUSIONS
Our meta-analysis suggests that individuals with myopia exhibit a decreased risk of developing DR or VTDR. An increased AL plays a critical role in this protective effect.
Topics: Cohort Studies; Cross-Sectional Studies; Diabetic Retinopathy; Humans; Myopia; Odds Ratio
PubMed: 26531140
DOI: 10.1016/j.diabres.2015.10.020 -
Ophthalmology Jan 2016Primary open-angle glaucoma (POAG) is a highly prevalent condition worldwide and the most common cause of irreversible sight loss. The objective is to assess the... (Meta-Analysis)
Meta-Analysis Review
TOPIC
Primary open-angle glaucoma (POAG) is a highly prevalent condition worldwide and the most common cause of irreversible sight loss. The objective is to assess the comparative effectiveness of first-line medical treatments in patients with POAG or ocular hypertension through a systematic review and network meta-analysis, and to provide relative rankings of these treatments.
CLINICAL RELEVANCE
Treatment for POAG currently relies completely on lowering the intraocular pressure (IOP). Although topical drops, lasers, and surgeries can be considered in the initial treatment of glaucoma, most patients elect to start treatment with eye drops.
METHODS
We included randomized controlled trials (RCTs) that compared a single active topical medication with no treatment/placebo or another single topical medication. We searched CENTRAL, MEDLINE, EMBASE, and the Food and Drug Administration's website. Two individuals independently assessed trial eligibility, abstracted data, and assessed the risk of bias. We performed Bayesian network meta-analyses.
RESULTS
We included 114 RCTs with data from 20 275 participants. The overall risk of bias of the included trials is mixed. The mean reductions (95% credible intervals) in IOP in millimeters of mercury at 3 months ordered from the most to least effective drugs were as follows: bimatoprost 5.61 (4.94; 6.29), latanoprost 4.85 (4.24; 5.46), travoprost 4.83 (4.12; 5.54), levobunolol 4.51 (3.85; 5.24), tafluprost 4.37 (2.94; 5.83), timolol 3.70 (3.16; 4.24), brimonidine 3.59 (2.89; 4.29), carteolol 3.44 (2.42; 4.46), levobetaxolol 2.56 (1.52; 3.62), apraclonidine 2.52 (0.94; 4.11), dorzolamide 2.49 (1.85; 3.13), brinzolamide 2.42 (1.62; 3.23), betaxolol 2.24 (1.59; 2.88), and unoprostone 1.91 (1.15; 2.67).
CONCLUSIONS
All active first-line drugs are effective compared with placebo in reducing IOP at 3 months. Bimatoprost, latanoprost, and travoprost are among the most efficacious drugs, although the within-class differences were small and may not be clinically meaningful. All factors, including adverse effects, patient preferences, and cost, should be considered in selecting a drug for a given patient.
Topics: Antihypertensive Agents; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 26526633
DOI: 10.1016/j.ophtha.2015.09.005 -
Oral Surgery, Oral Medicine, Oral... Nov 2015The aim of this systematic review and meta-analysis was to assess the influence of platelet-rich plasma (PRP) on the regeneration of periodontal intrabony defects by... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The aim of this systematic review and meta-analysis was to assess the influence of platelet-rich plasma (PRP) on the regeneration of periodontal intrabony defects by means of evaluating clinical and radiographic outcomes in prospective human clinical trials.
BACKGROUND
PRP is a high concentration of platelets suspended in a small volume of plasma and has been used for periodontal tissue regeneration. However, although it has been broadly studied, there is much controversy on its efficacy when used to treat infrabony periodontal defects.
METHODS
An electronic literature search was conducted by two reviewers (AR and AM) in several databases up to February 2014. The PICO question was: Does PRP have a higher or similar efficacy of regenerating periodontal intrabony defects compared with other conventional periodontal regeneration treatments (e.g., bone grafts, barrier membranes)? Articles were included in this systematic review if they were prospective clinical trials with 10 or more human patients, reporting the radiographic and/or clinical outcomes PRP for regeneration intrabony periodontal defects. Random effects meta-analyses of the selected studies were applied to avoid any bias being caused by methodologic differences among studies.
RESULTS
Twenty-two papers were obtained and reviewed. Of these, 21 articles fulfilled the inclusion criteria and subsequently were qualitatively analyzed. Eighteen of these could be meta-analyzed. Fourteen articles were included for evaluating of probing pocket depth (PPD). The weighted mean difference (WMD) was 0.55 mm, with a 95% CI=-0.09 to 1.20 mm (P=.09). For bone level (BL), 2 articles measured BL in millimeters, and the other two articles measured BL in percentage. The WMD was 0.76 mm (95% CI=0.21-1.31 mm; P=.007) and 47.41% (95% CI=32.48%-62.33%; P<.0001), respectively. For attachment level (AL) changes, 12 articles were included. The WMD was 0.58 mm, with a 95% CI=0.24 to 0.91 mm (P=.0008). Sixteen articles were included for evaluation of marginal gingival level (MGL). The WMD -0.10 mm, with a 95% CI=-0.19 to -0.01 (P=.03).
CONCLUSIONS
High heterogeneity among studies made it difficult to draw clear conclusions. Nonetheless, within the limitations of this review, PRP might offer some beneficial effects on clinical and radiographic outcomes for regeneration of periodontal intrabony defects.
Topics: Alveolar Bone Loss; Bone Regeneration; Guided Tissue Regeneration, Periodontal; Humans; Periodontal Diseases; Platelet-Rich Plasma; Prospective Studies
PubMed: 26453383
DOI: 10.1016/j.oooo.2015.06.035 -
Critical Reviews in Oncology/hematology Jan 2016Oral cancer (OC) is known to have a multi-factorial etiology; tobacco, alcohol and betel quid being the major risk factors. Tooth loss and periodontal disease (PD) have... (Review)
Review
UNLABELLED
Oral cancer (OC) is known to have a multi-factorial etiology; tobacco, alcohol and betel quid being the major risk factors. Tooth loss and periodontal disease (PD) have been implicated to increase the risk of developing various cancers. The aim of this systematic review was to assess any possible association between PD and OC. Indexed databases were searched using different combinations of the following key words: "oral cancer", "periodontal disease", "tooth loss", "squamous cell carcinoma", "missing teeth" "alveolar bone loss", "clinical attachment loss" and "periodontitis". PRISMA criteria were followed to accrue data and databases were searched from 1984 up to and including June 2015. In total, 12 case-control studies were selected from the published literature.
RESULTS
Nine studies reported a 2-5 fold increase in the risk of OC among patients with PD as compared to those without PD. Three studies reported no association between PD and OC. In one study, an increased risk of tongue cancer was associated with each millimeter of alveolar bone loss and in two studies clinical attachment loss of more than 1.5mm was associated with an increased risk of OC. In studies reporting significant findings these associations persisted after adjusting for major risk factors. PD is associated with a small but significant increase in risk for OC. In several reported studies this association was attenuated following adjustment for tobacco and alcohol use.
Topics: Humans; Mouth Neoplasms; Periodontal Diseases; Risk Factors
PubMed: 26343577
DOI: 10.1016/j.critrevonc.2015.08.018 -
The Cochrane Database of Systematic... Aug 2015Drugs with combined alpha and beta blocking activity are commonly prescribed to treat hypertension. However, the blood pressure (BP) lowering efficacy of this class of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Drugs with combined alpha and beta blocking activity are commonly prescribed to treat hypertension. However, the blood pressure (BP) lowering efficacy of this class of beta blockers has not been systematically reviewed and quantified.
OBJECTIVES
To quantify the dose-related effects of various types of dual alpha and beta adrenergic receptor blockers (dual receptor blockers) on systolic and diastolic blood pressure versus placebo in patients with primary hypertension.
SEARCH METHODS
We searched the Cochrane Hypertension Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and ClinicalTrials.gov for randomized controlled trials up to October 2014. The WHO International Clinical Trials Registry Platform (ICTRP) is searched for inclusion in the Group's Specialised Register.
SELECTION CRITERIA
Randomized double blind placebo controlled parallel or cross-over trials. Studies contained a beta blocker monotherapy arm with a fixed dose. Patients enrolled in the studies had primary hypertension at baseline. Duration of the studies was from three to 12 weeks. Drugs in this class of beta blockers are carvedilol, dilevalol and labetalol.
DATA COLLECTION AND ANALYSIS
Two review authors (GW and AL) confirmed the inclusion of studies and extracted the data independently. RevMan 5.3 was used to synthesize data.
MAIN RESULTS
We included eight studies examining the blood pressure lowering efficacy of carvedilol and labetalol in 1493 hypertensive patients. Five of the included studies were parallel design; three were cross-over design. The two largest included studies were unpublished carvedilol studies. The estimates of BP lowering effect (systolic BP/diastolic BP millimeters of mercury; SPB/DBP mm Hg) were -4 mm Hg (95% confidence intervals (CI) -6 to -2)/-3 mm Hg (95% CI -4 to -2) for carvedilol (>1000 subjects) and -10 mm Hg (95% CI -14 to -7)/-7 mm Hg (95% CI -9 to -5) for labetalol (110 subjects). The effect of labetalol is likely to be exaggerated due to high risk of bias. Carvedilol, within the recommended dose range, did not show a significant dose response effect for SBP or DBP. Carvedilol had little or no effect on pulse pressure (-1 mm Hg) and did not change BP variability. Overall, once and twice the starting dose of carvedilol and labetalol lowered BP by -6 mm Hg (95% CI -7 to -4) /-4 mm Hg (95% CI -4 to -3) (low quality evidence) and lowered heart rate by five beats per minute (95% CI -6 to -4) (low quality evidence). Five studies (N = 1412) reported withdrawal due to adverse effects; the risk ratio was 0.88 (95% CI 0.54 to 1.42) (moderate quality evidence).
AUTHORS' CONCLUSIONS
This review provides low quality evidence that in patients with mild to moderate hypertension, dual receptor blockers lowered trough BP by an average of -6/-4 mm Hg and reduced heart rate by five beats per minute. Due to the larger sample size from the two unpublished studies, carvedilol provided a better estimate of BP lowering effect than labetalol. The BP lowering estimate from combining carvedilol once and twice the starting doses is -4/-3 mm Hg. Doses higher than the recommended starting dose did not provide additional BP reduction. Higher doses of dual receptor blockers caused more bradycardia than lower doses. Based on indirect comparison with other classes of drugs, the blood pressure lowering effect of dual alpha- and beta-receptor blockers is less than non-selective, beta1 selective and partial agonist beta blockers, as well as thiazides and drugs inhibiting the renin angiotensin system. Dual blockers also had little or no effect on reducing pulse pressure, which is similar to the other beta-blocker classes, but less than the average reduction of pulse pressure seen with thiazides and drugs inhibiting the renin angiotensin system. Patients taking dual receptor blockers were not more likely to withdraw from the study compared to patients taking placebo.
Topics: Adrenergic alpha-1 Receptor Antagonists; Adrenergic beta-Antagonists; Antihypertensive Agents; Blood Pressure; Carbazoles; Carvedilol; Essential Hypertension; Heart Rate; Humans; Hypertension; Labetalol; Propanolamines; Randomized Controlled Trials as Topic; Withholding Treatment
PubMed: 26306578
DOI: 10.1002/14651858.CD007449.pub2 -
Journal of Dental Research Sep 2015Lateral ridge augmentation procedures are aimed to reconstruct deficient alveolar ridges or to build up peri-implant dehiscence and fenestrations. The objective of this... (Meta-Analysis)
Meta-Analysis Review
Lateral ridge augmentation procedures are aimed to reconstruct deficient alveolar ridges or to build up peri-implant dehiscence and fenestrations. The objective of this systematic review was to assess the efficacy of these interventions by analyzing data from 40 clinical studies evaluating bone augmentation through either the staged or the simultaneous approach. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guideline for systematic reviews was used. The primary outcomes were the changes at reentry, in the ridge width, and in the vertical and horizontal dimensions of the peri-implant defect, measured in millimeters, in the staged and simultaneous approaches, respectively. The results of the meta-analysis showed, for the simultaneous approach, a statistically significant defect height reduction when all treatments were analyzed together (weighted mean difference [WMD] = -4.28 mm; 95% confidence interval: [CI] -4.88, -3.69; P < 0.01). The intervention combining bone replacement grafts with barrier membranes was associated with superior outcomes The most frequently used intervention was the combination of xenograft and bioabsorbable membrane. Similarly, for the staged approach, there was a statistically significant horizontal gain when all treatment groups were combined (WMD = 3.90 mm; 95% CI: 3.52, 4.28; P < 0.001). The most frequently used intervention was the use of autogenous bone blocks. Both treatment strategies led to high survival and success rates (>95%) for the implants placed on the regenerated sites. Nonexposed sites gained significantly more in the simultaneous and staged approaches (WMD = 1.1 and 3.1 mm).
Topics: Alveolar Process; Alveolar Ridge Augmentation; Bone Transplantation; Dental Implantation, Endosseous; Guided Tissue Regeneration, Periodontal; Humans; Membranes, Artificial; Treatment Outcome
PubMed: 26215467
DOI: 10.1177/0022034515594780 -
Journal of the American Dental... Jul 2015Conduct a systematic review and meta-analysis on nonsurgical treatment of patients with chronic periodontitis by means of scaling and root planing (SRP) with or without... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Conduct a systematic review and meta-analysis on nonsurgical treatment of patients with chronic periodontitis by means of scaling and root planing (SRP) with or without adjuncts.
METHODS
A panel of experts convened by the American Dental Association Council on Scientific Affairs conducted a search of PubMed (MEDLINE) and Embase for randomized controlled trials of SRP with or without the use of adjuncts with clinical attachment level (CAL) outcomes in trials at least 6 months in duration and published in English through July 2014. The authors assessed individual study bias by using the Cochrane Risk of Bias Tool and conducted meta-analyses to obtain the summary effect estimates and their precision and to assess heterogeneity. The authors used funnel plots and Egger tests to assess publication bias when there were more than 10 studies. The authors used a modified version of the US Preventive Services Task Force methods to assess the overall level of certainty in the evidence.
RESULTS
The panel included 72 articles on the effectiveness of SRP with or without the following: systemic antimicrobials, a systemic host modulator (subantimicrobial-dose doxycycline), locally delivered antimicrobials (chlorhexidine chips, doxycycline hyclate gel, and minocycline microspheres), and a variety of nonsurgical lasers (photodynamic therapy with a diode laser, a diode laser, neodymium:yttrium-aluminum-garnet lasers, and erbium lasers).
CONCLUSIONS AND PRACTICAL IMPLICATIONS
With a moderate level of certainty, the panel found approximately a 0.5-millimeter average improvement in CAL with SRP. Combinations of SRP with assorted adjuncts resulted in a range of average CAL improvements between 0.2 and 0.6 mm over SRP alone. The panel judged the following 4 adjunctive therapies as beneficial with a moderate level of certainty: systemic subantimicrobial-dose doxycycline, systemic antimicrobials, chlorhexidine chips, and photodynamic therapy with a diode laser. There was a low level of certainty in the benefits of the other included adjunctive therapies. The panel provides clinical recommendations in the associated clinical practice guideline.
Topics: Chronic Periodontitis; Dental Scaling; Humans; Root Planing; Treatment Outcome
PubMed: 26113099
DOI: 10.1016/j.adaj.2015.01.028