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The Kaohsiung Journal of Medical... Sep 2017The aim of this meta-analysis is to evaluate the efficacy of the 3-dimensional miniplate system in comparison with the standard miniplate system for the treatment of... (Meta-Analysis)
Meta-Analysis
The aim of this meta-analysis is to evaluate the efficacy of the 3-dimensional miniplate system in comparison with the standard miniplate system for the treatment of mandibular fractures (MFs). A systematic review was conducted according to PRISMA guidelines, examining Medline-Ovid, Embase, and PubMed databases. The primary search objective was to identify all papers reporting the results of randomized control trials (RCTs) for the treatment of adults with mandibular fractures, with the aim of comparing the different techniques. The incidence of complications was evaluated; nine studies including 283 patients with different fracture sites were enrolled in the analysis. The results showed no significant differences in overall complications (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.552-1.542; P = 0.81), postoperative infections (OR, 0.99; 95% CI, 0.40-2.48; P = 0.89), wound dehiscence (OR, 0.96; 95% CI, 0.13-7.37; P = 0.96), paresthesia (OR, 0.47; 95% CI, 0.20-1.07; P = 0.11), or malocclusion (OR, 1.8; 95% CI, 0.39-8.32; P = 0.47) between standard miniplates and 3-dimensional miniplates for treating mandibular fractures. Mandibular fractures treated with 3-dimensional miniplates and standard miniplates presented similar short-term complication rates, and the low postoperative maxillomandibular fixation rate of using standard miniplates also indicated that the standard miniplate has a promising application in the treatment of mandibular fractures.
Topics: Adult; Bone Plates; Fracture Fixation, Internal; Humans; Malocclusion; Mandibular Fractures; Odds Ratio; Paresthesia; Postoperative Complications; Randomized Controlled Trials as Topic; Surgical Wound Dehiscence; Surgical Wound Infection; Treatment Outcome
PubMed: 28865605
DOI: 10.1016/j.kjms.2017.05.001 -
Medicina Oral, Patologia Oral Y Cirugia... Jul 2015Intermaxillary fixation is used to achieve proper occlusion during and after oral and maxillofacial fracture surgery. The aim of this systematic review was to compare... (Comparative Study)
Comparative Study Review
BACKGROUND
Intermaxillary fixation is used to achieve proper occlusion during and after oral and maxillofacial fracture surgery. The aim of this systematic review was to compare Erich arch bar fixation with other intermaxillary fixation methods in terms of the operating time, safety during installation, oral health maintenance and occlusal stability.
MATERIAL AND METHODS
An electronic online search was conducted of the Scirus, PubMed, Ovid, Cochrane Library and VHL databases. A clinical trial dating from the inception of the data bases until August 2013 was selected. Studies that compared Erich arch bars with other intermaxillary fixation methods in patients older than 18 years-old were included. The studies were assessed by two independent reviewers. The methodological quality of each article was analyzed.
RESULTS
Nine hundred and twenty-five manuscripts were found. Seven relevant articles were analyzed in this review. The risk of bias was considered moderate for four studies and high for three clinical trials.
CONCLUSIONS
There is not enough evidence to conclude that the Erich arch bar is the best intermaxillary fixation method in cases of oral and maxillofacial fractures.
Topics: Bone Wires; Fracture Fixation, Intramedullary; Humans; Mandibular Fractures
PubMed: 26034929
DOI: 10.4317/medoral.20448 -
Journal of Oral & Maxillofacial Research 2015This article, the second in a two-part series, continues the discussion of inferior alveolar nerve lateralization/transposition for dental implant placement. The aim of... (Review)
Review
OBJECTIVES
This article, the second in a two-part series, continues the discussion of inferior alveolar nerve lateralization/transposition for dental implant placement. The aim of this article is to review the scientific literature and clinical reports in order to analyse the neurosensory complications, risks and disadvantages of lateralization/transposition of the inferior alveolar nerve followed by implant placement in an edentulous atrophic posterior mandible.
MATERIAL AND METHODS
A comprehensive review of the current literature was conducted according to the PRISMA guidelines by accessing the NCBI PubMed and PMC databases, as well as academic sites and books. The articles were searched from January 1997 to July 2014. Articles in English language, which included adult patients between 18 - 80 years of age who had minimal residual bone above the mandibular canal and had undergone inferior alveolar nerve (IAN) repositioning, with minimum 6 months of follow-up, were included.
RESULTS
A total of 21 studies were included in this review. Ten were related to IAN transposition, 7 to IAN lateralization and 4 to both transposition and lateralization. The IAN neurosensory disturbance function was present in most patients (99.47% [376/378]) for 1 to 6 months. In total, 0.53% (2/378) of procedures the disturbances were permanent.
CONCLUSIONS
Inferior alveolar nerve repositioning is related to initial transient change in sensation in the majority of cases. The most popular causes of nerve damage are spatula-caused traction in the mucoperiosteal flap, pressure due to severe inflammation or retention of fluid around the nerve and subsequent development of transient ischemia, and mandibular body fracture.
PubMed: 25937874
DOI: 10.5037/jomr.2014.6103 -
Annals of Plastic Surgery Nov 2015Craniomaxillofacial (CMF) fractures are typically treated with open reduction and internal fixation. Open reduction and internal fixation can be complicated by hardware... (Review)
Review
BACKGROUND
Craniomaxillofacial (CMF) fractures are typically treated with open reduction and internal fixation. Open reduction and internal fixation can be complicated by hardware exposure or infection. The literature often does not differentiate between these 2 entities; so for this study, we have considered all hardware exposures as hardware infections. Approximately 5% of adults with CMF trauma are thought to develop hardware infections. Management consists of either removing the hardware versus leaving it in situ. The optimal approach has not been investigated. Thus, a systematic review of the literature was undertaken and a resultant evidence-based approach to the treatment and management of CMF hardware infections was devised.
MATERIALS AND METHODS
A comprehensive search of journal articles was performed in parallel using MEDLINE, Web of Science, and ScienceDirect electronic databases. Keywords and phrases used were maxillofacial injuries; facial bones; wounds and injuries; fracture fixation, internal; wound infection; and infection. Our search yielded 529 articles. To focus on CMF fractures with hardware infections, the full text of English-language articles was reviewed to identify articles focusing on the evaluation and management of infected hardware in CMF trauma. Each article's reference list was manually reviewed and citation analysis performed to identify articles missed by the search strategy. There were 259 articles that met the full inclusion criteria and form the basis of this systematic review. The articles were rated based on the level of evidence. There were 81 grade II articles included in the meta-analysis.
RESULT
Our meta-analysis revealed that 7503 patients were treated with hardware for CMF fractures in the 81 grade II articles. Hardware infection occurred in 510 (6.8%) of these patients. Of those infections, hardware removal occurred in 264 (51.8%) patients; hardware was left in place in 166 (32.6%) patients; and in 80 (15.6%) cases, there was no report as to hardware management. Finally, our review revealed that there were no reported differences in outcomes between groups.
CONCLUSIONS
Management of CMF hardware infections should be performed in a sequential and consistent manner to optimize outcome. An evidence-based algorithm for management of CMF hardware infections based on this critical review of the literature is presented and discussed.
Topics: Algorithms; Decision Support Techniques; Device Removal; Fracture Fixation, Internal; Humans; Internal Fixators; Maxillary Fractures; Maxillofacial Injuries; Skull Fractures; Treatment Outcome
PubMed: 25393499
DOI: 10.1097/SAP.0000000000000194 -
Annals of Internal Medicine Nov 2014Osteoporosis is a major contributor to the propensity to fracture among older adults, and various pharmaceuticals are available to treat it. (Review)
Review
BACKGROUND
Osteoporosis is a major contributor to the propensity to fracture among older adults, and various pharmaceuticals are available to treat it.
PURPOSE
To update a review about the benefits and harms of pharmacologic treatments used to prevent fractures in adults at risk.
DATA SOURCES
Multiple computerized databases were searched between 2 January 2005 and 4 March 2014 for English-language studies.
STUDY SELECTION
Trials, observational studies, and systematic reviews.
DATA EXTRACTION
Duplicate extraction and assessment of data about study characteristics, outcomes, and quality.
DATA SYNTHESIS
From more than 52 000 titles screened, 315 articles were included in this update. There is high-strength evidence that bisphosphonates, denosumab, and teriparatide reduce fractures compared with placebo, with relative risk reductions from 0.40 to 0.60 for vertebral fractures and 0.60 to 0.80 for nonvertebral fractures. Raloxifene has been shown in placebo-controlled trials to reduce only vertebral fractures. Since 2007, there is a newly recognized adverse event of bisphosphonate use: atypical subtrochanteric femur fracture. Gastrointestinal side effects, hot flashes, thromboembolic events, and infections vary among drugs.
LIMITATIONS
Few studies have directly compared drugs used to treat osteoporosis. Data in men are very sparse. Costs were not assessed.
CONCLUSION
Good-quality evidence supports that several medications for bone density in osteoporotic range and/or preexisting hip or vertebral fracture reduce fracture risk. Side effects vary among drugs, and the comparative effectiveness of the drugs is unclear.
PRIMARY FUNDING SOURCE
Agency for Healthcare Research and Quality and RAND Corporation.
Topics: Absorptiometry, Photon; Adult; Antibodies, Monoclonal, Humanized; Bisphosphonate-Associated Osteonecrosis of the Jaw; Bone Density; Bone Density Conservation Agents; Comparative Effectiveness Research; Denosumab; Female; Fractures, Bone; Humans; Male; Neoplasms; Osteoporosis; Osteoporotic Fractures; Teriparatide
PubMed: 25199883
DOI: 10.7326/M14-0317 -
Journal of Dental Research Oct 2014The aim of this meta-analysis, based on individual participant data from several studies, was to investigate the influence of patient-, materials-, and tooth-related... (Meta-Analysis)
Meta-Analysis Review
The aim of this meta-analysis, based on individual participant data from several studies, was to investigate the influence of patient-, materials-, and tooth-related variables on the survival of posterior resin composite restorations. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a search resulting in 12 longitudinal studies of direct posterior resin composite restorations with at least 5 years' follow-up. Original datasets were still available, including placement/failure/censoring of restorations, restored surfaces, materials used, reasons for clinical failure, and caries-risk status. A database including all restorations was constructed, and a multivariate Cox regression method was used to analyze variables of interest [patient (age; gender; caries-risk status), jaw (upper; lower), number of restored surfaces, resin composite and adhesive materials, and use of glass-ionomer cement as base/liner (present or absent)]. The hazard ratios with respective 95% confidence intervals were determined, and annual failure rates were calculated for subgroups. Of all restorations, 2,816 (2,585 Class II and 231 Class I) were included in the analysis, of which 569 failed during the observation period. Main reasons for failure were caries and fracture. The regression analyses showed a significantly higher risk of failure for restorations in high-caries-risk individuals and those with a higher number of restored surfaces.
Topics: Composite Resins; Dental Caries Susceptibility; Dental Materials; Dental Restoration Failure; Dental Restoration, Permanent; Humans; Risk Factors; Survival Analysis; Time Factors
PubMed: 25048250
DOI: 10.1177/0022034514544217 -
European Urology Feb 2014Advanced prostate cancer (PCa) is associated with skeletal complications, both as a result of bone metastases and because of fractures associated with fragility due to... (Review)
Review
CONTEXT
Advanced prostate cancer (PCa) is associated with skeletal complications, both as a result of bone metastases and because of fractures associated with fragility due to androgen-deprivation therapy (ADT). Osteoclast inhibitors are commonly used to reduce skeletal complications but are associated with a number of potential adverse events.
OBJECTIVE
To review clinical trials of osteoclast inhibitors in advanced PCa, to discuss the adverse event profile of these agents, and to discuss strategies to address specific adverse events.
EVIDENCE ACQUISITION
PubMed was searched for reports of clinical trials of osteoclast inhibitors in advanced PCa. As zoledronic acid and denosumab are used most commonly in this disease, these trials were the focus. The literature was reviewed to identify key publications addressing the prevention and management of adverse events associated with these drugs.
EVIDENCE SYNTHESIS
The major findings of the trials and the adverse events are discussed. Prevention and management of common adverse events are addressed.
CONCLUSIONS
Zoledronic acid prevents loss of bone mineral density associated with ADT and delays skeletal-related events in metastatic castration-resistant PCa (mCRPC). Denosumab reduces the incidence of fragility fractures associated with ADT, delays the onset of bone metastases in nonmetastatic castration-resistant disease, and is superior to zoledronic acid in the prevention of skeletal complications in mCRPC. Adverse events associated with both agents include osteonecrosis of the jaw and hypocalcemia. Hypocalcemia is more common with denosumab. Zoledronic acid requires dose modifications for renal insufficiency, is contraindicated in severe renal insufficiency, and has been associated with deterioration of renal function. Appropriate patient selection with close attention to dental health, supplementation with calcium and vitamin D, and monitoring of laboratory values are effective strategies to minimize the impact of adverse events associated with osteoclast inhibitors in advanced PCa.
Topics: Androgen Antagonists; Antibodies, Monoclonal, Humanized; Bisphosphonate-Associated Osteonecrosis of the Jaw; Bone Density; Bone Density Conservation Agents; Bone Neoplasms; Denosumab; Diphosphonates; Fractures, Bone; Humans; Hypocalcemia; Imidazoles; Male; Molecular Targeted Therapy; Osteoclasts; Patient Selection; Prostatic Neoplasms; RANK Ligand; Risk Factors; Treatment Outcome; Zoledronic Acid
PubMed: 23706567
DOI: 10.1016/j.eururo.2013.05.015 -
The Oncologist 2013The purpose of the study was to estimate the impact on survival and fracture rates of the use of zoledronic acid versus no use (or delayed use) in the adjuvant treatment... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The purpose of the study was to estimate the impact on survival and fracture rates of the use of zoledronic acid versus no use (or delayed use) in the adjuvant treatment of patients with early-stage (stages I-III) breast cancer.
MATERIALS AND METHODS
We performed a systematic review and meta-analysis of randomized clinical trials. Trials were located through PubMed, ISI, Cochrane Library, and major cancer scientific meeting searches. All trials that randomized patients with primary breast cancer to undergo adjuvant treatment with zoledronic acid versus nonuse, placebo, or delayed use of zoledronic acid as treatment to individuals who develop osteoporosis were considered eligible. Standard meta-analytic procedures were used to analyze the study outcomes.
RESULTS
Fifteen studies were considered eligible and were further analyzed. The use of zoledronic acid resulted in a statistically significant better overall survival outcome (five studies, 6,414 patients; hazard ratio [HR], 0.81; 95% confidence interval [CI], 0.70-0.94). No significant differences were found for the disease-free survival outcome (seven studies, 7,541 patients; HR, 0.86; 95% CI, 0.70-1.06) or incidence of bone metastases (seven studies, 7,543 patients; odds ratio [OR], 0.94; 95% CI, 0.64-1.37). Treatment with zoledronic acid led to a significantly lower overall fracture rate (OR, 0.78; 95% CI, 0.63-0.96). Finally, the rate of osteonecrosis of the jaw was 0.52%.
CONCLUSION
Zoledronic acid as adjuvant therapy in breast cancer patients appears to not only reduce the fracture risk but also offer a survival benefit over placebo or no treatment.
Topics: Breast Neoplasms; Chemotherapy, Adjuvant; Diphosphonates; Disease-Free Survival; Female; Fractures, Bone; Humans; Imidazoles; Neoplasm Staging; Osteoporosis; Randomized Controlled Trials as Topic; Treatment Outcome; Zoledronic Acid
PubMed: 23404816
DOI: 10.1634/theoncologist.2012-0261 -
Journal of Digital Imaging Aug 2013The objective of this study was to make a systematic review on the impact of voxel size in cone beam computed tomography (CBCT)-based image acquisition, retrieving... (Review)
Review
The objective of this study was to make a systematic review on the impact of voxel size in cone beam computed tomography (CBCT)-based image acquisition, retrieving evidence regarding the diagnostic outcome of those images. The MEDLINE bibliographic database was searched from 1950 to June 2012 for reports comparing diverse CBCT voxel sizes. The search strategy was limited to English-language publications using the following combined terms in the search strategy: (voxel or FOV or field of view or resolution) and (CBCT or cone beam CT). The results from the review identified 20 publications that qualitatively or quantitatively assessed the influence of voxel size on CBCT-based diagnostic outcome, and in which the methodology/results comprised at least one of the expected parameters (image acquisition, reconstruction protocols, type of diagnostic task, and presence of a gold standard). The diagnostic task assessed in the studies was diverse, including the detection of root fractures, the detection of caries lesions, and accuracy of 3D surface reconstruction and of bony measurements, among others. From the studies assessed, it is clear that no general protocol can be yet defined for CBCT examination of specific diagnostic tasks in dentistry. Rationale in this direction is an important step to define the utility of CBCT imaging.
Topics: Animals; Cadaver; Cone-Beam Computed Tomography; Dentistry; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Jaw; Swine; Temporomandibular Joint; Tooth
PubMed: 23254628
DOI: 10.1007/s10278-012-9562-7 -
Medicina Oral, Patologia Oral Y Cirugia... Nov 2011Osteoporosis is a systemic bone disease that is characterized by a generalized reduction of the bone mass. It is the main cause of fractures in elderly women. Bone... (Review)
Review
UNLABELLED
Osteoporosis is a systemic bone disease that is characterized by a generalized reduction of the bone mass. It is the main cause of fractures in elderly women. Bone densitometry is used in the lumbar spine and hip in order to detect osteoporosis in its early stages. Different studies have observed a correlation between the bone mineral density of the jaw (BMD) and that of the lumbar spine and/or hip. On the other hand, there are studies that evaluate the findings in the orthopantomograms and perapical X-rays, correlating them with the early diagnosis of osteoporosis and highlighting the role of the dentist in the early diagnosis of this disease.
MATERIALS AND METHODS
A search was carried out in the Medline-Pubmed database in order to identify those articles that deal with the association between the X-ray findings observed in the orthopantomograms and the diagnosis of the osteoporosis, as well as those that deal with the bone mineral density of the jaw.
RESULTS
There were 406 articles, and with the limits established, this number was reduced to 21. Almost all of the articles indicate that when examining oral X-rays, it is possible to detect signs indicative of osteoporosis.
DISCUSSION
The radiomorphometric indices use measurements in orthopantomograms and evaluate possible loss of bone mineral density. They can be analyzed alone or along with the visual indices. In the periapical X-rays, the photodensimetric analyses and the trabecular pattern appear to be the most useful. There are seven studies that analyze the densitometry of the jaw, but only three do so independently of the photodensitometric analysis.
CONCLUSIONS
The combination of mandibular indices, along with surveys on the risk of fracture, can be useful as indicators of early diagnosis of osteoporosis. Visual and morphometric indices appear to be especially important in the orthopantomograms. Photodensitometry indices and the trabecular pattern are used in periapical X-rays. Studies on mandibular dual-energy X-ray absorptiometry are inconclusive.
Topics: Early Diagnosis; Humans; Mandibular Diseases; Osteoporosis; Radiography, Panoramic
PubMed: 21743400
DOI: 10.4317/medoral.17304