18 Years of Medication-Related Osteonecrosis of the Jaw (MRONJ) Research: Where Are We Now?—An Umbrella Review

From MDPI via Jisc Publications RouterHistory: accepted 2021-09-16, pub-electronic 2021-09-23Publication status: PublishedBackground: Osteonecrosis of the jaw (ONJ) is a condition affecting patients exposed to medications used to treat benign and malignant conditions of bone tissue. Many studies have highlighted that ONJ is a severe condition, which is very challenging to manage, especially in individuals with oncologic disease. The aim of this umbrella review is to analyze all available interventional and non-interventional systematic reviews published on medication-related osteonecrosis of the jaw (MRONJ) and summarize this evidence. Material and methods: A multi-database search (PubMed, MEDLINE, EMBASE and CINAHL) was performed to identify related multi-language papers published from January 2003 until June 2021. An additional manual search was also performed in systematic review registries (PROSPERO, INPLASY, JBI and OFS) to identify possible missing reviews. Data were extracted from relevant papers and analyzed according to the outcomes selected in this review. Results: The search generated 25 systematic reviews eligible for the analysis. The total number of patients included in the analysis was 80,840. Of the reviews, 64% (n = 16) were non-interventional and 36% (n = 9) were interventional. Study designs included case series 20.50% (n = 140), retrospective cohort studies 12.30% (n = 84) and case reports 12.20% (n = 83). It was unclear what study design was used for 277 studies included in the 25 systematic reviews. Conclusions: The data reviewed confirmed that the knowledge underpinning MRONJ in the last 20 years is still based on weak evidence. This umbrella review highlighted a widespread low-level quality of studies and many poorly designed reviews

Avaliação da taxa de sucesso de implantes osseointegráveis: uma revisão sistemática de literatura

Atualmente, observamos uma maior procura pelos tratamentos através dos implantes osseointegráveis para a reabilitação dos dentes perdidos. Isto deve-se a uma crescente conscientização dos pacientes em relação ao sucesso e benefícios dos implantes. Com isso, torna-se fundamental a busca por técnicas, materiais e protocolos que forneçam uma maior segurança e previsibilidade aos tratamentos, bem como a necessidade da realização de mais estudos longitudinais. O primeiro estudo avaliando os implantes osseointegráveis foi publicado em 1981, e desde então, inúmeros outros trabalhos foram realizados. Contudo, estudos longitudinais que realizaram um acompanhamento superior a 10 anos ainda são escassos. Desta forma, o objetivo do presente estudo foi realizar através de uma revisão sistemática de literatura a análise das taxas de sucesso e sobrevida dos implantes osseointegráveis em estudos longitudinais que realizaram um acompanhamento superior a 10 anosNowadays, we observed an increased demand for treatment through dental implants for rehabilitation of missing tooth. This fact is a result of greater awareness of patients about the success and benefits of implants. With this, it is essential to search for techniques, materials and protocols that provide greater security and predictability to the treatments, as well as the need for more longitudinal studies. The first study evaluating the dental implants was published in 1981 and since then numerous other studies were performed. However, longitudinal studies performed a follow-up exceeding 10 years are scarce. Therefore, the objective of this study was through a systematic literature review to analyze the success and survival rates of dental implants in longitudinal studies performed a follow-up exceeding 10 years86f

Use of Platelet-Rich Fibrin membrane in the treatment of gingival recession: a systematic review and meta-analysis

O objetivo da presente revisão sistemática foi investigar à influência da membrana de plasma rico em fibrina (PRF) nos resultados clínicos do tratamento de recessões gengivais. Uma busca eletrônica sem restrição de datas ou idiomas em 4 banco de dados e uma busca manual em revistas regulares e na literatura cinza foram realizadas em busca de artigos até junho de 2015. Os critérios de elegibilidade foram estudos controlados randomizados (ECRs) e estudos controlados prospectivos com período de acompanhamento ≥ 6 meses que compararam o desempenho do PRF com outros biomateriais para o tratamento de recessões gengivais classe I ou II de Miller. Para a meta-análise, o método de variância inversa foi utilizado para o modelo de efeito fixo ou aleatório, dependendo da heterogeneidade. As estimativas das intervenções foram expressadas em diferenças médias em percentagem ou milímetros. Seis estudos clínicos randomizados e um estudo clínico prospectivo foram incluídos nesse estudo. Não houve diferença estatisticamente significativa para o recobrimento radicular e o nível de inserção clínica entre os subgrupos analisados (P = 0.57 e P = 0.50, respectivamente). O ganho de faixa de gengiva queratinizada foi significativamente maior (P = 0.04) no subgrupo que utilizou o enxerto de tecido conjuntivo. Os resultados da meta-análise sugerem que o uso da membrana de PRF não melhora os resultados clínicos do tratamento de recessões gengivais classe I e II de Miller em relação ao recobrimento radicular, ganho de espessura de gengiva queratinizada e nível de inserção clínica quando comparado a outras modalidades de tratamento.The aim of this systematic review was to evaluate the effects of platelet-rich fibrin (PRF) membranes on the outcomes of clinical treatments in patients with gingival recession. Articles that were published before June 2015 were electronically searched in four databases without any date or language restrictions and manually searched in regular journals and gray literature. The eligibility criteria comprised randomized controlled trials (RCTs) and prospective clinical trials with follow-up periods of 6 months or more that compared the performance of PRF with 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. Six RCTs and one prospective clinical trial were included in this study. Root coverage and clinical attachment level did not differ significantly between the analyzed subgroups (P = 0.57 and P = 0.50, respectively). The keratinized mucosa width gain was significantly greater (P = 0.04) in the subgroup that was treated with connective tissue grafts. The results of the meta-analysis suggest that the use of PRF membranes did not improve the root coverage, keratinized mucosa width, or clinical attachment level of Miller class-I and -II gingival recessions compared to the other treatment modalities.41f

Use of Enamel Matrix Derivative in Minimally Invasive/Flapless Approaches: A Systematic Review with Meta-Analysis.

PURPOSE The aim of the present systematic review with meta-analysis was to investigate the clinical effectiveness of EMD (enamel matrix derivative) using a minimally invasive surgical technique (MIST) or flapless approach for the treatment of severe periodontal probing depths. MATERIALS AND METHODS A systematic review of the literature including searches in PubMed/Medline, Cochrane Library, Google Scholar, and Grey Literature databases as well as manual searches was performed on September 1st, 2021. Studies utilising EMD in a non-surgical or minimally invasive approach were included. The eligibility criteria comprised randomised controlled trials (RCTs) comparing minimally-invasive/flapless approaches with/without EMD for the treatment of probing depths >5 mm. RESULTS From 1525 initial articles, 7 RCTs were included and 12 case series discussed. Three studies investigated a MIST approach, whereas 3 studies utilised a flapless approach. One study compared EMD with either a MIST or a flapless approach. The RCTs included ranged from 19-49 patients with at least 6 months of follow-up. While 5 of the studies included smokers, patients smoking >20 cigarettes/day were excluded from the study. The meta-analysis revealed that EMD with MIST improved recession coverage (REC) and bone fill (BF) when compared to MIST without EMD. However, no difference in CAL or PD was observed between MIST + EMD vs MIST without EMD. No statistically significant advantage was found for employing the EMD via the flapless approach. CONCLUSIONS Implementing EMD in MIST procedures displayed statistically significant improvement in REC and BF when compared to MIST alone. These findings suggest that MIST in combination with EMD led to improved clinical outcomes while EMD employed in nonsurgical flapless therapy yielded no clinical benefits when compared to nonsurgical therapy alone without EMD. More research is needed to substantiate these findings

Clinical efficacy of single and multiple applications of antimicrobial photodynamic therapy in periodontal maintenance: A systematic review and network meta-analysis.

BACKGROUND At present the clinical efficacy of single (S) versus multiple (M) applications of antimicrobial photodynamic therapy (aPDT) is controversially discussed. AIM To systematically evaluate the clinical efficacy of adjunctive S and M applications of aPDT to subgingival debridement (SD) in the treatment of residual periodontal pockets. METHODS An electronic search was carried out for randomized controlled clinical trials (RCTs) reporting on SD with the adjunctive use of S- or M-aPDT applications. RESULTS Statistically significantly higher improvement in bleeding on probing (BOP) and probing depth (PD) reduction was found for SD + S-aPDT versus SD, with Mean difference (MD) = -16.8 (95% CI: -30.7 to -2.91; p = 0.02) and 0.4, (95% CI: 0.02 to 0.78, p = 0.04), respectively. Regarding BOP, there was also a statistically significant difference when SD + M-aPDT was compared with SD alone, with a MD of -5.13 (95% CI: -7.20 to -3.07; p < 0.00001). For all parameters, SD + S-aPDT demonstrated the best treatment ranking of probability results, followed by SD + M-aPDT and SD alone. CONCLUSIONS Within their limits, the present data indicate that in periodontal patients enrolled in maintenance: a) single and multiple adjunctive applications of aPDT following SD resulted in statistically significant BOP reduction compared to SD alone, and b) repeated applications of aPDT did not seem to result in superior outcomes compared to single applications

Dental implants in Sjögren’s syndrome patients: A systematic review

<div><p>Objectives</p><p>The Sjögren’s syndrome (SS) is a chronic autoimmune disease that affects salivation and consequently the health of oral tissues. The aim of this systematic review was to investigate the implant survival rate, marginal bone loss (MBL) and biological complications of dental implants in SS patients.</p><p>Materials and methods</p><p>Eligibility criteria included prospective and retrospective cohort studies, controlled clinical trials, and randomized clinical trials (RCTs). An electronic search without date or language restrictions was carried out in MEDLINE, Cochrane, Web of Science, and LILACS until June 2017. In addition, manual search and in the grey literature were also conducted. The search process, data analysis, and quality assessment were performed by two independent reviewing authors. The protocol of this systematic review was registered in PROSPERO under number CRD42016053277.</p><p>Results</p><p>The search and selection process yielded 6 studies, published between 1997 and 2016. An average of 93.7% survival in a mean period of 3.97 years of follow-up was observed. A low number of MBL and biological complications were reported by the studies. All the studies analyzed observed an improvement in life quality of subjects with SS and rehabilitated through dental implants.</p><p>Conclusions</p><p>With the limitations of this review and based on the available data, the dental implant therapy in SS patients seems to present high implant survival rate, low MBL and low biological complications. In addition, all included studies observed an increase in the quality of life of SS patients who were rehabilitated through dental implants.</p></div

Main characteristics of selected studies.

<p>Main characteristics of selected studies.</p

Excluded studies.

<p>Excluded studies.</p

Assessment of quality and the risk of bias (NOS Scale).

<p>Assessment of quality and the risk of bias (NOS Scale).</p

Systematic search strategy (PICOS strategy).

<p>Systematic search strategy (PICOS strategy).</p