2020 Jul-Sep; Vol 11, No 3
Harvesting of Autogenous Bone Graft from the Ascending Mandibular Ramus Compared with the Chin Region: a Systematic Review and Meta-Analysis Focusing on Complications and Donor Site Morbidity
J Oral Maxillofac Res 2020;11(3):e1
Objectives: The aim of this systematic review was to test the hypothesis of no difference in complications and donor site morbidity following harvesting of autogenous bone graft from the ascending mandibular ramus compared with the chin region.
Material and Methods: MEDLINE (PubMed), Embase and Cochrane Library search in combination with a hand-search of relevant journals was conducted including human studies published in English through June 26, 2020. Randomized and controlled trials were included. Outcome measures included pain, infection, mucosal dehiscence, altered sensation or vitality of adjacent tooth/teeth, neurosensory disturbances and patient-reported outcome measures. Risk of bias was assessed by Cochrane risk of bias tool and Newcastle-Ottawa Scale.
Results: Ten controlled trials of high-quality fulfilled inclusion criteria. Risk of infection and mucosal dehiscence seems to be comparable with the two treatment modalities. However, harvesting from the chin seems to be associated with increased risk of pain, altered sensation or loss of tooth vitality, and neurosensory disturbances. Willingness to undergo the same treatment again was reported with both treatment modalities, but significant higher satisfaction, lower discomfort and acceptance of the surgical procedure was reported following harvesting from the ascending mandibular ramus.
Conclusions: The hypothesis was rejected due to higher prevalence and severity of complications and donor site morbidity following harvesting of autogenous bone graft from the chin region. Dissimilar evaluation methods and various methodological confounding factors posed serious restrictions for literature review in a quantitative systematic manner. Conclusions drawn from results of this systematic review should therefore be interpreted with caution.
Keywords: alveolar bone grafting; alveolar ridge augmentation; dental implants; oral surgical procedures; review.
Maxillary Sinus Floor Augmentation with Autogenous Bone Graft Alone Compared with Alternate Grafting Materials: a Systematic Review and Meta-Analysis Focusing on Histomorphometric Outcome
J Oral Maxillofac Res 2020;11(3):e2
Objectives: The objective of present systematic review was to test the hypothesis of no difference in histomorphometric outcome after maxillary sinus floor augmentation with autogenous bone graft alone compared with alternate grafting materials applying the lateral window technique.
Material and Methods: MEDLINE (PubMed), Embase and Cochrane library search in combination with hand-search of relevant journals were conducted. Human studies published in English until the 25th of March, 2020 were included. Histomorphometric outcomes were evaluated by descriptive statistics and meta-analysis including 95% confidence interval (CI).
Results: Electronic search and hand-searching resulted in 1902 entries. Sixteen randomized controlled trials with unclear risk of bias fulfilled the inclusion criteria. Descriptive statistics showed comparable or improved histomorphometric outcomes with autogenous bone graft. Meta-analysis revealed a mean difference of -7.1% (CI = -11.0 to -3.2) indicating a significant higher amount of bone after maxillary sinus floor augmentation with autogenous bone graft compared with alternate grafting materials. Subgroup analysis demonstrated a non-significantly differences of -3.7% (CI = -10.9 to 3.4), -11.5% (CI = -25.9 to 2.8), 2.2% (CI = -16.9 to 21.3), and -4.6% (CI = -14.4 to 5.2), when autogenous bone graft was compared with allogeneic bone graft, xenograft, composite grafting materials involving xenograft or synthetic biomaterial mixed with autogenous bone graft, respectively.
Conclusions: Maxillary sinus floor augmentation with autogenous bone graft seems to facilitate improved histomorphometric outcomes compared with alternate grafting materials. However, the included studies were characterised by an unclear risk of bias and various methodological confounding factors. Hence, the conclusions drawn from the results of present study should be interpreted with caution.
Keywords: alveolar ridge augmentation; dental implants; oral surgical procedures; review; sinus floor augmentation.
Late Oral Complications Caused by Head and Neck Radiotherapy: Clinical and Laboratory Study
J Oral Maxillofac Res 2020;11(3):e3
Objectives: The aim of presented cross-sectional and observational study was to determine the prevalence of late oral complications of patients with head and neck cancer who underwent radiotherapy, by clinical and laboratory analyses.
Material and Methods: Fifty-five patients, 43 (78.2%) men and 12 (21.8%) women, mean age 60; range 38 to 87 years, who have completed radiotherapy for head and neck cancer for at least 6 months were enrolled. The presence of xerostomia, hyposalivation, oral candidiasis, and type of oral yeasts were correlated with post-radiotherapy period. A control group, age and gender matched, was used for comparisons. The Pearson's Chi-square or Fischer's exact test was used at a significance level of 5%.
Results: The mean post-radiotherapy period was 32 months. The oral complications found were xerostomia (45/55, [81.8%]), hyposalivation (44/55 [80%]) and oral candidiasis (15/55 [27.2%]). Xerostomia and hyposalivation was statistically higher in the study group when compared to the control group (P < 0.05). The presence of yeast occurred in 39 (70.9%) of the patients in the study group, and Candida albicans was the most prevalent etiological agent in 25 (64.1%) of those patients (P < 0.05).
Conclusions: Xerostomia and hyposalivation were the more prevalent late oral complications related to radiotherapy. Oral candidiasis was also observed, although its prevalence was lower. The need for long-term dental follow-up of patients who underwent radiotherapy of the head and neck cancer is mandatory.
Keywords: candida albicans; postoperative complications; radiotherapy; xerostomia.
Evaluation of Collagen Membranes Coated with Testosterone and Alendronate to Improve Guided Bone Regeneration in Mandibular Bone Defects in Minipigs
J Oral Maxillofac Res 2020;11(3):e4
Objectives: The purpose of the present in vivo study was to evaluate whether pericard collagen membranes coated with ancillary amounts of testosterone and alendronate in a poly-lactic glycolic acid (PLGA) carrier as compared to uncoated membranes will improve early bone regeneration.
Material and Methods: In each of 16 minipigs, four standardized mandibular intraosseous defects were made bilaterally. The defects were filled with Bio-Oss® granules and covered with a non-coated or coated membrane. Membranes were spray-coated with 4 layers of PLGA containing testosterone and alendronate resulting in 20, 50 or 125 μg/cm2 of testosterone and 20 µg/cm2 alendronate (F20, F50, F125). Non-coated membranes served as controls (F0). Animals were sacrificed at 6 and 12 weeks after treatment. Qualitative and quantitative histological evaluations of bone regeneration were performed. Differences between groups were assessed by paired Student's t‐test.
Results: Light microscopical analysis showed new bone formation that was in close contact with the Bio-Oss® surface without an intervening non-mineralized tissue layer. Histomorphometric analysis of newly formed bone showed a significant 20% increase in area in the F125 coated membrane treated defects (40 [SD 10]%) compared to the F0 treated defects after 6 weeks (33 [SD 10]%, P = 0.013). At week 12, the total percentage of new bone was increased compared to week 6, but no increase in newly formed bone compared to F0 was observed.
Conclusions: The data from this in vivo study indicate that F125 collagen membranes coated with testosterone and alendronate resulted in superior bone formation (+24%) when normalized to control sites using uncoated membranes.
Keywords: bone regeneration; bone substitutes; mandible; surgery; membranes; minipig.
Peculiarities of Dental Treatment among Paediatric Oncological Patients: a Case Report
J Oral Maxillofac Res 2020;11(3):e5
Objectives: According to the National Cancer Institute of Lithuania, cancer is diagnosed for almost 100 children each year. Oncological patients suffer from complications during and after treatment. Radiation therapy also affects dental hard tissues. Many oncological patients lose motivation to take care of their oral hygiene because they are focused on cancer diagnosis. This case report discusses prevention and dental treatment severity after radiation therapy treatment.
Material and Methods: A 9-year-old boy with cancer diagnosis visited a dentist in 2017. The patient was complaining about poor aesthetic quality of the teeth, but there were no complaints about teeth sensitivity or pain. Different stages of active caries, poor oral hygiene, visible abundant plaque, swollen, red and bleeding gums were observed during appointment. A motivational interview explaining the importance of oral hygiene was conducted. Non-surgical caries treatment was prescribed during the first visit. Restorative treatment was performed after 1 month.
Results: The motivational interview explaining the importance of oral hygiene was conducted during every appointment per 3-year period. Unfortunately, oral hygiene is still poor due to the lack of motivation. Active-cavitated caries lesions were restored with glass ionomer cement and composite resin. The aesthetics of teeth was improved.
Conclusions: Oncological and recovered patients after radiation therapy should be assigned to a high risk of caries. These patients should be treated individually by the algorithm. Psychological or psychotherapeutic assistance is necessary for patients due to motivation for treatment and oral care.
Keywords: cancer of head and neck; dental atraumatic restorative treatment; dental caries; pediatric dentistry; radiation; radiotherapy.