Do osteoconductive bone substitutes result in similar bone regeneration for maxillary sinus augmentation when compared to osteogenic and osteoinductive bone grafts? A systematic review and frequentist network meta-analysis

The purpose of this network meta-analysis was to identify the most effective biomaterials producing higher new bone formation (NBF) and lower residual graft (RG) and connective tissue (CT) following maxillary sinus augmentation (MSA), and to generate a ranking based on their performance. The MEDLINE, Embase, and CENTRAL databases were searched to identify randomized controlled trials (RCTs) published until March 2018, evaluating histomorphometric outcomes after MSA. Predictor variables were autogenous bone (AB), allografts (AG), xenografts (XG), alloplastic bone (AP), AB + XG, AB + AP, AG + XG, XG + AP, and grafts combined with autologous platelet concentrates/recombinant growth factors, mesenchymal stem cells (MSCs), or recombinant bone morphogenetic proteins (BMPs). Outcome variables were NBF%, RG%, and CT%. Healing time was considered. The weighted mean difference (WMD) with 95% confidence interval (CI) was calculated via frequentist network meta-analysis using Stata software. Fifty-two RCTs (1483 biopsies) were included. At a healing time <6 months, AB was superior to AP (WMD − 10.66%, 95% CI − 16.38% to −4.94%) and XG (WMD − 7.93%, 95% CI − 15.11% to −0.75%) for NBF. Regarding CT, AB was superior to XG + AP, AP, MSCs, and XG. At a healing time ≥6 months, NBF was higher for AB than AP (WMD − 7.06%, 95% CI − 12.59% to −1.52%). RG was lower in AB than AP (WMD 12.03%, 95% CI 3.04% to 21.03%), XG (WMD 14.62%, 95% CI 4.25% to 24.98%), and growth factors (WMD 12.32%, 95% CI 0.04% to 24.60%). The three highest ranked biomaterials for increasing NBF were AG + XG (95%, very low quality evidence), growth factors (69.9%, low quality evidence), and AB alone (69.8%, moderate quality evidence). The three highest ranked biomaterials for decreasing RG were BMPs (88.8%, very low quality evidence), AB alone (81.5%, moderate quality evidence), and AB + AP (58.9%, very low quality evidence). Finally, XG + AP (84.7%, low quality evidence), AP alone (77.7%, moderate quality evidence), and MSCs (76.1%, low quality evidence), were the three highest ranked biomaterials for decreasing the amount of CT. Network meta-analysis provided moderate quality evidence that AB alone is probably the best option to obtain greater NBF after MSA in the first 6 months after surgery. Additionally, the results of this network meta-analysis support the hypothesis that osteoconductive bone substitute materials should be combined with osteogenic or osteoinductive grafts for superior histomorphometric outcomes in MSA.     

Association between MAFB rs17820943 and rs6072081 polymorphism and risk of nonsyndromic cleft lip with or without cleft palate: a meta-analysis

While there have been previous studies examining the relation between the rs17820943 and rs6072081 polymorphisms in the v-maf musculoaponeurotic fibrosarcoma oncogene homolog B (MAFB) gene and rates of nonsyndromic cleft lip with or without cleft palate (NSCL/P), at present the results of these studies have been inconsistent. This meta-analysis therefore aimed to conduct a more robust assessment of the association between the MAFB rs17820943 and rs6072081 polymorphisms and NSCL/P risk. The Embase, Web of Science, PubMed, the China National Knowledge Internet (CNKI), and Wanfang databases were systematically searched to identify relevant studies. In total, five studies incorporating 2769 patients and 2885 controls were identified assessing the rs17820943 polymorphism and three studies incorporating 1242 patients and 1310 controls assessing the rs6072081 polymorphism were identified. This analysis revealed the MAFB rs17820943 and rs6072081 polymorphisms to be linked to a significantly reduced NSCL/P risk (rs17820943: C vs T: OR = 0.76, 95% CI = 0.70-0.82; CC vs CT: OR = 0.75, 95% CI = 0.67-0.85; CC vs TT: OR = 0.58, 95% CI = 0.49-0.67; CC + CT vs TT: OR = 0.67, 95% CI = 0.59-0.77; CT + TT vs CC: OR = 1.43, 95% CI = 1.28-1.60; rs6072081: A vs G: OR = 0.77, 95%CI = 0.68-0.86; AA vs AG: OR = 0.76, 95%CI = 0.64-0.90; AA vs GG: OR = 0.58, 95%CI = 0.45-0.74; AA + AG vs GG: OR = 0.68, 95%CI = 0.54-0.84; AG + GG vs AA: OR = 1.40, 95% CI = 1.19-1.65). The results of the present meta-analysis indicate that in an East Asian population, for both rs17820943 and rs6072081 were associated with NSCL/P.     

Variation between natural head orientation and Frankfort horizontal planes in orthognathic surgery patients: 187 consecutive cases

The purpose of this study was to assess the relationship between the Frankfort horizontal (FH) and natural head orientation (NHO), their correlation between patients’ malocclusion, and the impact of counterclockwise rotation (CCW) on the FH-NHO angle variation after orthognathic surgery. An evaluation of 187 consecutive patients was performed at the Maxillofacial Institute (Teknon Medical Center, Barcelona). FH-NHO° was measured pre- and postoperatively at 1 and 12 months, after three-dimensional (3D) superimposition using a software (Dolphin®). Patients were classified as follows: 3.2%, 48.7% and 48.1%, class I, II and III, respectively. Baseline FH-NHO° was significantly positive for patients with dentofacial deformities (2.73° ± 4.19 (2.12–3.33°, P < 0.001). The impact of orthognathic surgery in FH-NHO° was greater in class II when compared with class III patients, with a variation of 2.04° ± 4.79 (P < 0.001) and −1.20° ± 3.03 (P < 0.001), respectively. FH-NHO° increased when CCW rotational movements were performed (P = 0.006). The results of this study suggest that pre- and postoperative NHO differs from FH in orthognathic patients. The angle between FH and NHO is significantly larger in class III than in class II patients at baseline, which converges after orthognathic surgery when CCW rotation is performed. Therefore, NHO should be used as the real horizontal plane when planning for orthognathic surgery.     

Clinical efficacy of acellular dermal matrix for plastic periodontal and implant surgery: a systematic review

This review was performed to validate the clinical efficacy of acellular dermal matrix (ADM) for plastic periodontal and implant surgery. Four electronic databases and a manual search were utilized to select randomized clinical trials (RCTs) published until March 2019. Overall, 28 RCTs were included: 25 on teeth and three on implants. For plastic periodontal surgery, ADM exhibited a comparable gingival recession reduction (RecRed) and soft tissue thickness (STT) gain to connective tissue graft (CTG). Subgroup analyses revealed that ADM obtained a similar keratinized tissue width (KTW) gain to CTG within 3–6 months postoperative, but significantly less KTW gain at 1–5 years postoperative (P = 0.01, mean difference (MD) −0.86 mm). Analyses comparing ADM with free gingival graft (FGG) demonstrated similar RecRed but significantly more KTW/STT gain favouring FGG (KTW: P = 0.01, MD −1.78 mm; STT: P = 0.01, MD −0.77 mm). Significantly more RecRed and KTW/STT gain were verified in ADM + coronally advanced flap/laterally positioned flap compared with these flaps alone (RecRed: P < 0.00001, MD 0.65 mm; KTW: P = 0.001, MD 0.66 mm; STT: P < 0.00001, MD 0.59 mm). Limited data for implant surgery indicated a similar trend as for periodontal surgery. Concerning patient-reported outcomes, ADM achieved favourable aesthetic appearance, alleviation of dentinal hypersensitivity, and less surgical morbidity. In conclusion, ADM exerted comparable clinical efficacy to autogenous tissue for root coverage procedures, with good long-term stability. However, for soft tissue augmentation, ADM exhibited inferior 3–6-month postoperative outcomes compared with FGG and less long-term stability of KTW gain compared with CTG.     

TMD before and after correction of dentofacial deformities by orthodontic and orthognathic treatment

The aims of the study were to investigate the alteration of temporomandibular disorders (TMD) after correction of dentofacial deformities by orthodontic treatment in conjunction with orthognathic surgery; and to compare the frequency of TMD in patients with dentofacial deformities with an age and gender matched control group. TMD were evaluated in 121 consecutive patients (treatment group), referred for orthognathic surgery, by a questionnaire and a clinical examination. 18 months after treatment, 81% of the patients completed a follow-up examination. The control group comprised 56 age and gender matched subjects, of whom 68% presented for follow-up examination. TMD were diagnosed according to research diagnostic criteria for TMD. At baseline examination, the treatment group had a higher frequency of myofascial pain (P = .035) and arthralgia (P = .040) than the control group. At follow-up, the frequencies of myofascial pain, arthralgia and disc displacement had decreased in the treatment group (P = .050, P = .004, P = .041, respectively). The frequency of TMD was comparable in the two groups at follow-up. Patients with dentofacial deformities, corrected by orthodontic treatment in conjunction with orthognathic surgery, seem to have a positive treatment outcome in respect of TMD pain.     

Comparison between computer-guided and freehand dental implant placement surgery: A systematic review and meta-analysis

The purpose of this systematic review was to compare computer-guided (fully guided) and freehand implant placement surgery in terms of marginal bone loss, complications, and implant survival. This review followed the PRISMA guidelines and was registered in the PROSPERO database (CRD42019135893). Two independent investigators performed the search of the PubMed/MEDLINE, Scopus, and Cochrane Library databases for studies published up to April 2020 and identified 1508 references. After a detailed review, only four studies were considered eligible. These studies involved a total of 154 patients with 597 dental implants and a mean follow-up period of 2.25 years. There was no difference between computer-guided surgery and freehand surgery in terms of the marginal bone loss (mean difference ?0.11 mm, 95% confidence interval (CI) ?0.27 to 0.04 mm; P = 0.16), mechanical complications (risk ratio (RR) 0.85, 95% CI 0.36–2.04; P = 0.72), biological complications (RR 1.56, 95% CI 0.42–5.74; P = 0.51), and implant survival rate (RR 0.53, 95% CI 0.11–2.43; P = 0.41). This meta-analysis demonstrated that both computer-guided and freehand surgeries yielded similar results for marginal bone loss, mechanical and biological complications, and implant survival rate.     

Quality assessment of clinical practice guidelines used in oral and maxillofacial surgery

An assessment of the quality of oral and maxillofacial surgery clinical practice guidelines is lacking. The aim of this investigation was to assess the quality of guidelines using the RIGHT (Reporting Items for practice Guidelines in HealThcare) checklist. The primary outcome was to assess the score (quality) of guidelines based on the RIGHT checklist and to identify predictors (region, type, single or multi-centre, and speciality/non-speciality) influencing the quality score. In this review, following a search of electronic databases and national society websites, a total of 25 guidelines were independently assessed by two assessors against the 22-item RIGHT checklist. Inter-assessor reliability was assessed. Deficiencies in the reporting of items relating to limitations, funding, declaration and management of interests, healthcare questions, and quality assurance were evident. The median overall score for the guidelines was 28 (range 14–66). Guidelines produced by multiple centres (β = 57.15, 95% confidence interval −26.62 to 87.68, P =  0.001, multivariate analysis) and non-speciality societies (β = 20, 95% confidence interval −0.03 to 40.03, P = 0.05, univariate analysis) tended to have higher quality scores. Overall, the quality of clinical practice guidelines used in oral and maxillofacial surgery was deemed suboptimal. If clinical practice guidelines are to be used in making treatment decisions for patients, clinicians should be aware of their possible limitations.     

Do antibiotics decrease implant failure and postoperative infections? A systematic review and meta-analysis

The purpose of this study was to systematically review and perform a comprehensive meta-analysis of the current literature to answer the following question: among patients receiving dental implants, does the use of antibiotics, when compared with a control group, reduce the frequency of implant failure and postoperative infection? A manual and electronic PubMed search of the literature was made to identify randomized controlled trials (RCTs) on the efficacy of antibiotics compared with a control group (not receiving antibiotics or receiving placebo). Four RCTs were included in the final review. These four RCTs grouped a total of 2063 implants and a total of 1002 patients. Antibiotic use significantly lowered the implant failure rate (P = 0.003), with an odds ratio of 0.331, implying that antibiotic treatment reduced the odds of failure by 66.9%. The number needed to treat (NNT) to prevent one patient from having an implant failure was 48 (95% confidence interval 31–109). In contrast, antibiotic use did not significantly reduce the incidence of postoperative infection (P = 0.754). Based on the results of this meta-analysis, and pending further research in the field, it can be concluded that there is evidence in favour of systematic antibiotic use in patients receiving dental implants, since such treatment significantly reduces implant failure. In contrast, antibiotic use does not exert a significant preventive effect against postoperative infection. Our recommendations for future research focus on the performance of large-scale RCTs to identify the best choice of antibiotic, timing of administration, and dose. Increased effort is also required to reach consensus and define the most effective antibiotic treatment protocol for patients who are allergic to beta-lactams and for those who are not.     

Effect of platelet-rich fibrin on the control of alveolar osteitis,pain, trismus,soft tissue healing,and swelling following mandibular third molar surgery: an updated systematic review and meta-analysis

The purpose of this study was to estimate the effect of platelet-rich fibrin (PRF) on the control of alveolar osteitis (AO), pain, trismus, soft tissue healing, and swelling following mandibular third molar surgery. A comprehensive search of the literature was conducted through PubMed, Embase, Web of Science, and Cochrane Library up to May 2019. Randomized controlled studies conforming to the inclusion criteria were included. The record screening and data extraction were conducted by two authors independently. The risk of bias assessment was performed according to the guidelines recommended by the Cochrane Collaboration. The quantitative analysis was performed using RevMan version 5.3. Nineteen studies were included in the systematic review and 17 studies were eligible for the meta-analysis. The use of PRF significantly reduced the incidence of AO and postoperative pain when compared to the controls (AO: relative risk 0.43, 95% confidence interval (CI) 0.28 to 0.65, Z = 3.90, P < 0.0001 (I² = 0%); pain: day 1, standardized mean difference (SMD) ?1.12, 95% CI ?1.87 to ?0.37, Z = 2.93, P = 0.003 (I² = 95%); day 3, SMD ?0.93, 95% CI ?1.48 to ?0.38, Z = 3.30, P = 0.001 (I² = 92%); day 7, SMD ?1.84, 95% CI ?2.98 to ?0.71, Z = 3.19, P = 0.001 (I² = 97%)). Additionally, the result showed a better soft tissue healing when PRF was used (mean difference ?0.63, 95% CI ?1.08 to ?0.18, Z = 2.76, P = 0.006 (I² = 90%)). The use of PRF reduced the incidence of AO and postoperative pain following third molar surgery. Furthermore, PRF may also improve the postoperative soft tissue healing.     

Vertical bone augmentation and regular implants versus short implants in the vertically deficient posterior mandible: a systematic review and meta-analysis of randomized studies

The aim of this study was to perform a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing the outcomes of short dental implants (≤7 mm) versus vertical bone augmentation followed by regular dental implants (>7 mm) in the deficient posterior mandible. In total, eight RCTs (six using interpositional sandwich grafting and two using a guided bone regeneration technique) were reported in 17 articles at different time points. In the meta-analysis of the sandwich group, the relative risk (RR) for implant loss at 1 year was in favour of short implants (RR 0.41, P = 0.02), while no significant difference was found at 3 years (RR 0.65, P = 0.43), 5 years (RR 1.08, P = 0.86), or 8 years (RR 1.53, P = 0.52). The risk of complications was in favour of short implants (RR 0.34, P = 0.0002), as was the mean difference in marginal bone resorption after 1 year (−0.09 mm, P = 0.17), 3 years (−0.32 mm, P < 0.00001), 5 years (−0.65 mm, P < 0.00001), and 8 years (−0.88, P < 0.00001). The mean residual osseointegration length of the implants was between 2.94 mm and 4.44 mm in the short implants group and between 7.97 mm and 8.62 mm in the regular implants group after 5 years. In conclusion, in the deficient atrophic posterior mandible, short implants and regular implants demonstrate comparable outcomes within the first 5 years. Patients who are fit for surgery should be informed about the risks and benefits of both options.     

Comparison between flapless and open-flap implant placement: a systematic review and meta-analysis

No consensus has been reached regarding the influence of the flapless and open-flap surgical techniques on the placement of dental implants. This systematic review compared the effects of flapless implant placement and implant placement with elevation of the mucoperiosteal flap in terms of marginal bone loss, implant survival rate and complications rates. This review followed PRISMA guidelines and was registered in PROSPERO with the registration number CRD42017071475. Two independent reviewers performed a comprehensive search of the PubMed/MEDLINE, Scopus, and Cochrane Library databases for studies published until December 2017. The search identified 559 references. After a detailed review, 24 studies were assessed for eligibility. A total of 1025 patients who had received a total of 1873 dental implants were included. There were no significant differences between the flapless and open-flap surgical techniques in terms of implant survival rates (P = 0.34; risk ratio (RR): 1.36; confidence interval (CI): 0.72–2.56), marginal bone loss (P = 0.23; MD: −0.20; CI: −0.52–0.13), or complication rates (P = 0.67; RR: 1.10; CI: 0.70–1.73). The current meta-analysis showed that the implant survival rate, marginal bone levels, and complications of flapless surgery were similar to those of open-flap surgery over a mean follow-up period of 21.62 months.     

Does a learning curve exist for accuracy in three-dimensional planning for maxillary positioning in bimaxillary orthognathic surgery?

The purpose of this study was to investigate the influence of time, and experience, on the accuracy of maxillary repositioning in bimaxillary orthognathic surgery performed using virtual surgical planning (VSP). Patients who had undergone bimaxillary orthognathic surgery were reviewed. Maxillary position on pre- and postoperative computed tomography scans was compared. The patients were divided into groups according to the year in which VSP was performed and surgery completed. Linear distances between upper jaw reference landmarks were measured in all three planes of space to determine accuracy between the preoperative VSP and the surgical outcome at various time points. One hundred subjects met the eligibility criteria for assessment and were allocated to groups: 2013 (n = 10), 2014 (n = 17), 2015 (n = 39), 2016 (n = 20), and 2017 (n = 14). Overall, the results demonstrated improved precision in maxillary position over the years, with more accurate results in patients who underwent surgery in 2015, 2016, and 2017. Mean linear differences between planned and obtained results demonstrated more accurate results in the horizontal direction, followed by transverse and vertical directions. An overall average difference within 1 mm was observed for 51.3% of the measurements included in the sample group. Time, and surgeon experience, can influence the accuracy of maxillary positioning in bimaxillary orthognathic surgery.     

Clinical viability of single implant-retained mandibular overdentures: a systematic review and meta-analysis

The aim of this meta-analysis was to verify the clinical viability of single implant-retained mandibular overdentures (SIMO). An electronic search of the PubMed and Cochrane databases was performed (end date July 2017); this was supplemented by a manual search of the literature. Only prospective clinical trials and randomized controlled trials (RCTs) that evaluated SIMO with a minimum follow-up of 12 months were included. The meta-analysis was based on the Mantel–Haenszel method. Dental implant and prosthetic failure were the dichotomous outcome measures; these were evaluated through the risk ratio (RR) and odds ratio (OR), with corresponding 95% confidence intervals (CI). Of 499 articles identified, nine fulfilled the inclusion criteria. A total of 205 implants were placed in patients with a mean age of 64.1 years; the cumulative survival rate was 96.6% over a mean follow-up period of 37.3 months. The procedure used (SIMO vs. two implant-retained mandibular overdenture) did not affect dental implant failure (P = 0.45) or prosthetic failure (P = 0.65): RR 1.06 (95% CI 0.91–1.23) and RR 0.88 (95% CI 0.51–1.51), respectively; OR 2.56 (95% CI 0.27–24.39; P = 0.41) and OR 0.44 (95% CI 0.15–1.26; P = 0.13), respectively. Within the limitations of this systematic review and meta-analysis, SIMO with a complete denture as the opposing arch may be considered an alternative treatment for completely edentulous patients. However, this study also confirmed the need for more RCTs on this topic.     

BMP2 and BMP4 variations and risk of non-syndromic cleft lip and palate

ObjectiveNon-syndromic cleft lip with or without cleft palate (CL/P) is one of the most common congenital anomalies and arises from the interaction of environmental and genetic factors. The objective of this study was to investigate the association between the BMP2 (bone morphogenetic protein 2) and BMP4 (bone morphogenetic protein 4) polymorphisms with non-syndromic CL/P to clarify the potential role of these genes in the etiology of CL/P in Iranian population.DesignThe allelic and genotypic frequencies of BMP2 rs235768 A > T and BMP4 rs17563 T > C polymorphisms were determined in 107 unrelated Iranian subjects with non-syndromic CL/P and 186 control subjects using PCR and RFLP methods, and the results were compared with healthy controls. A p-value of <0.05 was considered statistically significant.ResultsThe BMP2 rs235768 AT genotype was significantly higher (P = 0.009, OR = 3, 95% CI = 1.3–7.0) in the CL/P (59.8%) than the control group (33.3%). Similarly, the BMP4 rs17563 TC genotype were significantly higher (P = 0.008, OR = 3.7, 95% CI = 1.4–9.9) in the CL/P (70.0%) than the control group (44.6%).ConclusionThe BMP2 rs235768 A > T and BMP4 rs17563 T > C polymorphisms could be considered as the risk factor for non-syndromic CL/P in Iranian population.     

The impact of smoking on surgical complications after head and neck reconstructive surgery with a free vascularised tissue flap: a systematic review and meta-analysis

Reconstructive surgery with a free vascularised tissue flap is indicated in large defects in the head and neck region, which arise mostly because of head and neck cancer. Tobacco smoking is a major risk factor for head and neck cancer, and many patients undergoing reconstructive surgery in the head and neck have a history of smoking. The objective of this meta-analysis was to determine the impact of smoking on surgical complications after head and neck reconstructive surgery with a free vascularised tissue flap. A systematic review was undertaken for articles reporting and comparing the incidence of overall surgical complications after reconstructive surgery with a free vascularised tissue flap between smokers and nonsmokers. Relevant articles were searched using PubMed, Cochrane, and Embase databases, and screened for eligibility according to the PRISMA guidelines. The risk of bias analysis was conducted using the Newcastle-Ottawa quality assessment scale. A meta-analysis was performed to quantitatively compare the incidence rate of overall surgical complications, flap failure, surgical site infection, fistula, and haematoma between smokers and nonsmokers using OpenMetaAnalyst (open source) software. Only qualitative analysis was performed for wound dehiscence, bleeding, nerve injury, and impaired wound healing. Forty-six articles were screened for eligibility; 30 full texts were reviewed, and 19 studies were included in the quantitative meta-analysis. From the 19 studies, 18 were retrospective and 1 was a prospective study. In total, 2155 smokers and 3124 nonsmokers were included in the meta-analysis. Smoking was associated with a significantly increased risk of 19.12% for haematoma (95% Confidence Interval (CI): 4.75–33.49; p < 0.01), and of 4.57% for overall surgical complications (95% CI: 1.97–7.15; p < 0.01). No significant difference in risk was found for flap failure (95% CI: ?4.33–9.90; p = 0.44), surgical site infection (95% CI: ?0.88–2.60; p = 0.33) and fistula formation (95% CI: ?3.81–3.71; p = 0.98) between smokers and nonsmokers. Only for flap failure was a significant heterogeneity found (I² = 63.02%; p = 0.03). Smoking tobacco was significantly associated with an increased risk of overall surgical complications and haematoma, but did not seem to affect other postoperative complications. Encouraging smoking cessation in patients who need reconstructive head and neck surgery remains important, but delaying surgery to create a non-smoking interval is not needed to prevent the investigated complications. More high-quality retrospective or prospective studies with a standardised protocol are needed to allow for definitive conclusions.     

Superficial versus deep system single venous anastomosis in the radial forearm free flap: a meta-analysis

The selection of the superficial or deep drainage system for use with the radial forearm free flap (RFFF) remains controversial. The aim of this study was to identify the optimal drainage system for single venous anastomosis. A systematic review and cumulative meta-analysis was performed to assess superficial and deep system single venous anastomosis for use with the RFFF in postoperative reconstruction of the head and neck. This study included 1073 flaps (495 superficial system-based flaps, 578 deep system-based flaps) reported in six studies. The outcomes assessed in the studies selected for this meta-analysis included venous compromise, flap failure, and the salvage success rate. Venous compromise was more common in the superficial system group (odds ratio (OR) 2.29, 95% confidence interval (CI) 1.36–3.86, P = 0.002). The rate of successful salvage was higher with the superficial system (OR 8.19, 95% CI 1.75–38.3, P = 0.008). The rate of flap failure was lower in the superficial system group (OR 0.30, 95% CI 0.04–2.48, P = 0.27). Although the deep system showed a lower risk of venous compromise, the evidence provided by the meta-analysis was insufficient to determine which type of drainage system is more suitable for single venous anastomosis in RFFF. All included studies were cohort studies; therefore, findings must be interpreted with caution.     

The effects of melatonin prophylaxis on sensory recovery and postoperative pain following orthognathic surgery: a triple-blind randomized controlled trial and biochemical analysis

Post-surgical neuropathy is a known complication of many surgical procedures for which few remedies are effective. This study used neurosensory assessments and biochemical assays to evaluate the efficacy of melatonin on nerve healing following orthognathic surgery. Thirty randomly allocated orthognathic patients were prophylactically administered either oral melatonin or identical placebo for 21 consecutive days. Pre- and post-surgical clinical parameters included subjective pain, numbness, and objective neurosensory function. Pre- and post-surgical biochemical parameters were serum hydrogen peroxide and antioxidant enzyme levels. Melatonin was found to significantly reduce subjective pain perception by 50% in the early postoperative days. A 30% reduction in subjective numbness perception was observed at 1-week postoperative, increasing to an over 80% reduction by 3 months postoperative (P < 0.00001). Objective neurosensory testing showed a significant improvement in healing profile in the melatonin group. Postoperatively, the hydrogen peroxide concentration was lower in the melatonin group (P < 0.00001), and the levels of antioxidant enzymes were higher (P < 0.00001). The strong correlations between clinical outcomes and biochemical changes suggest a link between antioxidant effects and reduced postsurgical pain and sensory recovery. The study findings suggest that the prophylactic administration of melatonin confers significant clinical benefits in terms of reduced postoperative pain and opioid use and improved sensory recovery following surgery.     

Evaluation of the efficacy of celecoxib and ibuprofen on postoperative pain,swelling, and mouth opening after surgical removal of impacted third molars: a randomized,controlled clinical trial

The objective of this study was to compare the efficacy of celecoxib and ibuprofen in reducing postoperative sequelae following the surgical removal of impacted mandibular third molars. Ninety-eight subjects who needed surgical extraction of an impacted mandibular third molar were selected for the study. All subjects were randomly allocated to receive one of the following treatments twice a day for 5 days after surgery: placebo (n = 32), ibuprofen (n = 33), or celecoxib (n = 33). The primary outcome chosen was postoperative pain, which was evaluated using the visual analogue scale (VAS) score recorded by each patient. The secondary outcomes chosen were changes in postoperative swelling and maximum mouth opening values compared to preoperative ones. Compared to placebo, treatment with celecoxib and ibuprofen resulted in improvements in the primary outcome. Furthermore, when compared to the other groups, patients in the celecoxib group showed a significant reduction in postoperative pain scores at 6 h (P < 0.001), 12 h (P = 0.011), and 24 h (P = 0.041) after surgery. Regarding swelling and maximum mouth opening values, there were no significant differences between the groups at each follow-up session. This study demonstrated that treatment with celecoxib decreased the incidence and severity of postoperative pain following third molar surgery compared to ibuprofen and placebo.     

Narrow-diameter implants versus regular-diameter implants for rehabilitation of the anterior region: a systematic review and meta-analysis

The aim of this systematic review and meta-analysis was to evaluate studies comparing implant survival rates, marginal bone loss (MBL), and mechanical and biological complication rates between narrow-diameter implants (NDIs) and regular-diameter implants (RDIs) used for oral rehabilitation in the anterior region. The review was conducted according to the PRISMA checklist. Two independent reviewers performed a comprehensive search of the PubMed/MEDLINE, Embase, Scopus, and Cochrane Library databases for studies published until May 2020. A total of 843 implants (484 NDIs and 359 RDIs) were included. No significant difference in implant survival rate (risk difference (RD) 0.01, 95% confidence interval (CI) ?0.01 to 0.03; P = 0.34), MBL (standardised mean difference ?0.51 mm, 95% CI ?1.29 to 0.26 mm; P = 0.19), mechanical complications (RD 0.01, 95% CI ?0.02 to 0.04; P = 0.40), or biological complications (RD 0.01, 95% CI ?0.09 to 0.11; P = 0.85) was found between the implant groups. Within the limitations of this study, it is concluded that NDIs are an effective alternative to RDIs due to similar survival rates, MBL, and mechanical and biological complication rates. However, future studies are highly encouraged due to the small number of interventional studies on this topic.     

Surgical morbidities of sagittal split ramus osteotomy versus intraoral vertical ramus osteotomy for the correction of mandibular prognathism: a randomized clinical trial

The sagittal split ramus osteotomy (SSRO) and intraoral vertical ramus osteotomy (IVRO) are two common orthognathic procedures for the treatment of mandibular prognathism. This randomized clinical trial compared the surgical morbidities between SSRO and IVRO for patients with mandibular prognathism over the first 2 years postoperative. Ninety-eight patients (40 male, 58 female) with a mean age of 24.4 ± 3.5 years underwent bilateral SSRO (98 sides) or IVRO (98 sides) as part or all of their orthognathic surgery. IVRO presented less short-term and long-term surgical morbidity in general. The SSRO group had a greater incidence of inferior alveolar nerve deficit at all follow-up time points (P <  0.01). There was more TMJ pain at 6 weeks (P =  0.047) and 3 months (P =  0.001) postoperative in the SSRO group. The SSRO group also presented more minor complications, which were related to titanium plate exposure and infection. There were no major complications for either technique in this study. Despite the need for intermaxillary fixation, IVRO appears to be associated with less surgical morbidity than SSRO when performed as a mandibular setback procedure to treat mandibular prognathism.