Are prophylactic antibiotics effective in preventing osteoradionecrosis after high-risk dental extractions?

Q3 Dentistry
Omer Waleed Majid
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引用次数: 0

Abstract

A systematic review and meta-analysis. To assess and compare the effectiveness of different adjunctive treatments during tooth extraction in post-radiotherapy head and neck patients for preventing osteoradionecrosis (ORN). Two independent reviewers conducted an electronic search through PubMed, Embase, Cochrane Libraries, Scopus and Web of Science databases using relevant search terms. Additionally, references of relevant articles were manually searched for eligible studies. Included were full-length articles (randomized controlled trials (RCTs), clinical trials, or observational studies) published in English, reporting on ORN occurrence after dental extraction, with or without adjunctive interventions, in patients who had previous radiotherapy. Data extraction was similarly performed by two independent researchers. For quality assessment, bias in observational studies was evaluated using the ROBINS-I tool, while the RoB 2 tool was used for RCTs. One-arm meta-analyses estimated pooled ORN prevalence rates for different adjunctive treatments based on patient-level outcomes. For studies with direct comparisons between two modalities, pooled odds ratios for ORN were calculated using pairwise meta-analyses. This systematic review followed PRISMA guidelines and was registered in the PROSPERO database. A total of 29 studies with 1520 patients were included, comprising 4 RCTs, 4 prospective studies, and 21 retrospective observational studies. Five adjunctive treatment modalities around the time of dental extractions were identified: hyperbaric oxygen (HBO), pentoxifylline-tocopherol (PENTO), antibiotics (ABX), platelet-rich fibrin and photobiomodulation. Of the 25 observational studies included, 11 had a serious risk of bias, while all RCTs but 1 had low risk of bias. Egger’s test showed no publication bias for the HBO and ABX groups (p > 0.05). Antibiotics were used in 17 studies, with significant variations in preoperative and postoperative protocols. Most studies utilized penicillin or clindamycin. The pooled prevalence of ORN was significantly lower in the HBO (4.6%), PENTO (3.4%), and ABX (3.8%) groups compared to the Control (17.6%), as indicated by the non-overlapping 95% CIs between the Control and any of the intervention groups. In studies with direct comparisons, HBO exhibited lower odds of developing ORN than the Control (odds ratio [OR] = 0.27) and ABX (OR = 0.57), although these differences were not statistically significant. HBO, PENTO, and ABX show similar reduction in ORN rates compared to no intervention. Given its cost-effectiveness and accessibility, ABX may be the most practical prophylactic modality at present.
预防性抗生素是否能有效预防高风险拔牙后的骨坏死?
研究设计系统综述和荟萃分析:评估和比较头颈部放疗后患者拔牙期间不同辅助治疗对预防骨坏死(ORN)的有效性:两名独立审稿人使用相关检索词对 PubMed、Embase、Cochrane Libraries、Scopus 和 Web of Science 数据库进行了电子检索。此外,还人工检索了相关文章的参考文献,以寻找符合条件的研究。纳入的研究均为用英语发表的长篇文章(随机对照试验 (RCT)、临床试验或观察性研究),这些文章报道了曾接受过放疗的患者在拔牙后发生 ORN 的情况,无论是否采取了辅助干预措施。数据提取同样由两名独立研究人员进行。在质量评估方面,采用 ROBINS-I 工具对观察性研究的偏倚进行评估,RoB 2 工具则用于研究性试验。单臂荟萃分析根据患者层面的结果,估算出不同辅助治疗方法的ORN患病率。对于两种方式直接比较的研究,则使用成对荟萃分析计算ORN的集合几率比。该系统性综述遵循PRISMA指南,并在PROSPERO数据库中注册:结果:共纳入 29 项研究,1520 名患者,其中包括 4 项研究性临床试验、4 项前瞻性研究和 21 项回顾性观察研究。研究确定了拔牙前后的五种辅助治疗方式:高压氧(HBO)、五氧代甲烷-生育酚(PENTO)、抗生素(ABX)、富血小板纤维蛋白和光生物调节。在纳入的 25 项观察性研究中,有 11 项研究存在严重的偏倚风险,而除一项研究外,其他所有研究的偏倚风险均较低。Egger检验显示,HBO组和ABX组没有发表偏倚(P>0.05)。有 17 项研究使用了抗生素,术前和术后方案差异很大。大多数研究使用了青霉素或克林霉素。与对照组(17.6%)相比,HBO 组(4.6%)、PENTO 组(3.4%)和 ABX 组(3.8%)的 ORN 总发病率明显较低,对照组与任何干预组之间的 95% CI 均无重叠。在直接比较的研究中,HBO发生ORN的几率低于对照组(几率比[OR] = 0.27)和ABX组(OR = 0.57),但这些差异在统计学上并不显著:结论:与不采取干预措施相比,HBO、PENTO 和 ABX 能相似地降低 ORN 发生率。鉴于其成本效益和可及性,ABX 可能是目前最实用的预防方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Evidence-based dentistry
Evidence-based dentistry Dentistry-Dentistry (all)
CiteScore
2.50
自引率
0.00%
发文量
77
期刊介绍: Evidence-Based Dentistry delivers the best available evidence on the latest developments in oral health. We evaluate the evidence and provide guidance concerning the value of the author''s conclusions. We keep dentistry up to date with new approaches, exploring a wide range of the latest developments through an accessible expert commentary. Original papers and relevant publications are condensed into digestible summaries, drawing attention to the current methods and findings. We are a central resource for the most cutting edge and relevant issues concerning the evidence-based approach in dentistry today. Evidence-Based Dentistry is published by Springer Nature on behalf of the British Dental Association.
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