Envelope or triangular flap for surgical removal of third molars? A systematic review and meta-analysis

The aim of this systematic review was to compare the triangular and envelope flaps in mandibular third molar surgery with regard to pain, oedema, and trismus. Secondary outcomes assessed were dehiscence, ecchymosis, alveolar osteitis, periodontal condition, and surgical time. The PRISMA guidelines and recommendations in the Cochrane Handbook were followed, and the review was registered before commencement (PROSPERO; CRD42018112373). The literature search was conducted in the Web of Science, PubMed, Virtual Health Library, Cochrane Library, and Scopus databases and in the grey literature; randomized clinical trials, indexed through November 2018 were included. Three reviewers independently examined the studies. Twenty studies were included in the qualitative analysis, of which 18 were included in the meta-analyses. The flap design did not influence pain, oedema, trismus, dehiscence, or osteitis. The triangular flap was associated with a greater occurrence of postoperative ecchymosis (odds ratio 4.58, 95% confidence interval 1.34 to 15.91, I² = 0) and lower periodontal probing depth on day 7 postoperative (standardized mean difference −1.36, 95% confidence interval −2.68 to −0.03, I² = 88%) when compared to the envelope flap in mandibular third molar surgeries.     

Are dairy products containing probiotics beneficial for oral health? A systematic review and meta-analysis

Clinical Oral Investigations - To evaluate the effect of probiotic containing in dairy products on oral and salivary parameters. Electronic searches were performed based on the PICO criteria....     

How frequent does peri-implantitis occur? A systematic review and meta-analysis

Clinical Oral Investigations - The objective of this study is to estimate the overall prevalence of peri-implantitis (PI) and the effect of different study designs, function times, and implant...     

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.     

Anterolateral thigh flap for the reconstruction of head and neck defects: alternative or replacement of the radial forearm flap?

This paper presents our clinical experience with head and neck reconstruction using radial forearm flap and our preliminary experience with anterolateral thigh (ALT) flap. We analyze the advantages and disadvantages of these 2 flaps from the complications we have encountered. From 1993 to 2006, the radial forearm flap has been used in 75 patients, whereas we began using the ALT flap in 2006. Since this time, we have used the ALT flap in 10 patients. One flap partial loss was observed in a patient who underwent reconstruction of the ethmoid region and nasal bones with an osteofasciocutaneous radial flap. In one patient who underwent reconstruction with ALT flap, inadequate venous outflow was discovered, and the flap was salvaged with reexploration, removing of the cutaneous component of the flap and using antithrombotic agents. Donor-site complications were experienced in 8 of 75 patients who underwent reconstruction with radial forearm flap, whereas all donor thighs healed uneventfully. Anterolateral thigh flap gives optimal results either at the donor site or at the accepting site, being easy to harvest and providing an ideal reconstructive option. Nevertheless, radial forearm flap remains a valuable alternative in case of a thin soft tissue reconstruction because of its thinness and versatility; furthermore, it can provide a long and constant pedicle of large caliber. However, since we began using the ALT flap, we had only performed this flap with respect to radial forearm flap because of its lower donor-site morbidity.     

Does HIV infection affect the survival of dental implants? A systematic review and meta-analysis

Statement of problemImmunosuppression and coinfections associated with human immunodeficiency virus (HIV) infection pose a relative contraindication for dental implant therapy. However, although implants have been placed in patients with HIV with reasonable success, how HIV infection affects their survival is unclear.PurposeThe purpose of this systematic review of the literature and meta-analysis was to analyze the data on the survival of dental implants in patients with HIV.Material and methodsA search for relevant articles published up to November 2019 was performed in PubMed/Medline and Cochrane databases, Clinicaltrials.gov, and Google Scholar. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were adopted for the conduct of the systematic review. The most pertinent data were extracted and pooled for qualitative and quantitative analyses with 95% confidence intervals. Heterogeneity was analyzed by using I-squared statistics.ResultsA total of 8 studies involving 411 individuals with HIV and 1109 implants were included in the meta-analysis. The mean follow-up period was 2.8 years. A pooled estimate of 95% of implant survival rate with 95% confidence interval(92% to 96%) was noted. Heterogeneity across the 8 studies was found to be 41% with moderate true variability.ConclusionsThis systematic review demonstrated that HIV infection does not pose a serious threat to implant survival on short-term evaluation, but the evidence is of low quality.     

Does early repair of trigeminal nerve injuries influence neurosensory recovery? A systematic review and meta-analysis

This systematic review and exploratory meta-analysis of the available evidence was performed to examine whether early nerve repair of lingual nerve (LN) and inferior alveolar nerve (IAN) injuries has an effect on neurosensory recovery. A literature search was conducted to identify relevant studies meeting the inclusion criteria. Two reviewers independently evaluated the methodological quality of the included studies and the risk of bias using the ROBINS-I quality assessment tool. For the quantitative analysis, data were pooled using the Mantel–Haenszel random-effects method due to the clinical heterogeneity across the studies. Sensitivity and subgroup analyses were performed based upon the group definition of timing from injury to nerve repair, with breakpoints of 2, 3, and 6 months. A total 1236 citations were identified, with a final 13 studies included in the systematic review. A clear definition of ‘early’ versus ‘late’ repair was not reported in six studies, allowing only seven to be included in the meta-analysis. The effect of early repair on functional sensory recovery was found not to be significant in nine studies, while four studies found a significant effect of early intervention. The meta-analysis showed a combined success rate of 93.0% for the early group and 78.5% for the late group. The odds of improvement were 5.49 (95% confidence interval 1.40–21.45) in the 3-month breakpoint studies and 2.28 (95% confidence interval 1.05–4.98) in the 6-month studies. A trend towards early repair achieving better functional sensory recovery outcomes was observed, but the specific time period is unknown.     

Does methylprednisolone improve postoperative outcomes after mandibular third molar surgery? A systematic review and meta-analysis

This systematic review and meta-analysis was performed to investigate whether methylprednisolone (MP) administered via any route improves postoperative outcomes (pain, trismus, and oedema) following mandibular third molar surgery. An electronic search of the PubMed, Scopus, Cochrane CENTRAL, and Google Scholar databases was performed to identify studies published in English up until January 2018. A total of 28 studies were included in the review: 25 randomized clinical trials (RCTs) and three controlled clinical trials. Studies were grouped according to the route of administration of MP for qualitative and quantitative analysis. Three studies were of ‘high’ quality and 22 were of ‘medium’ quality; three studies had a high risk of bias. Within the purview of the limitations of this review, the results showed that MP administered via any route significantly improves oedema in the early postoperative period, but has no effect on late postoperative oedema. Oral and intra-masseteric MP also seems to reduce pain and trismus in the early postoperative period. The results also indicate that oral MP may reduce late postoperative pain, while intra-masseteric MP may improve the late trismus outcome. More high quality RCTs are required to provide stronger evidence on the use of MP in third molar surgery.     

Does oral lichen planus aggravate the state of periodontal disease? A systematic review and meta-analysis

Clinical Oral Investigations - The objective of this systematic review and meta-analysis (SRM) was to assess the evidence between the association of oral lichen planus and periodontal disease,...     

Does cortical thickness influence the primary stability of miniscrews?: A systematic review and meta-analysis

Objective:To investigate whether there is evidence to support the association between cortical thickness (CtTh) and the primary stability of mini-implants (MI).Materials and Methods:A search was performed including articles published until September 2013. The inclusion criteria comprised observational clinical studies conducted in patients who received monocortical MI for orthodontic anchorage and in vivo or ex vivo experimental studies performed to evaluate the primary stability of MI, studies that evaluated the association between CtTh and MI primary stability, CtTh measurement performed numerically, and MI primary stability evaluated by implant stability quotient value, Periotest value , pull-out strength, or insertion torque. Studies conducted exclusively in artificial bone or finite elements were excluded.Results:Abstract and title reading identified 15 possible articles to be included. After reading the complete text, three were excluded. One article was found by hand searching and another excluded for an overlapping sample. Finally, 12 articles were selected. A positive correlation was found between primary stability and CtTh when studies that evaluated primary stability through PS were grouped (r  =  .409) and when studies that evaluated stability in humans were grouped (r  =  .338).Conclusions:There is a positive association between MI primary stability and CtTh of the receptor site. However, there is still a lack of well-designed clinical trials.     

Is there an association between overweight/obesity and dental implant complications? A systematic review and meta-analysis

The aim of this systematic review was to test the following hypotheses: (1) that there is no difference in implant survival rate between individuals with overweight or obesity and those who are within the ideal weight range; (2) that there are no differences between these groups regarding indicators of peri-implant health. Two independent reviewers performed a literature search of the PubMed/MEDLINE, Scopus, and Cochrane Library databases for studies published up to April 1, 2018. A meta-analysis was performed to determine the risk difference for implant failure and mean difference for marginal bone loss, probing depth, and bleeding on probing. Six studies were selected for review, involving a total of 746 patients with 986 implants: 609 in overweight or obese individuals and 377 in individuals within the ideal weight range. The findings of this systematic review indicate that the first hypothesis should be accepted, since no statistically significant difference in implant survival rate was found between individuals with overweight/obesity and those within the ideal weight range (P = 0.64). The second hypothesis was rejected, as the review indicated a difference in marginal bone loss (P < 0.00001), probing depth (P < 0.00001), and bleeding around dental implants (P < 0.00001).