Maxillary sinus augmentation – relative performance of available biomaterials and the challenge of small studies

Sinus Lift

Mark Steven Howe takes a detailed look at this Bayesian network meta-analysis (NMA) assessing the relative performance of diffferent biomaterials used for maxillary sinus augmentation. 34 RCTs with 28 different treatment options providing a large number of potential pairwise comparisons although only a small number used direct data. The findings suggest little difference beween the various biomaterials but the available studies are small with only 5 being at low risk of bias.

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Platelet-rich fibrin to reduce post-operative complications of lower third molar removal

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This review of platelet-rich fibrin (PRF) to reducedpostoperative complications following lower third molar surgery included 6 RCTs.
The findings are consistent to other reviews finding that PRF derivative may lead to improvements in postoperative outcomes from third molar surgery but the amount of evidence is limited.

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Osteonecrosis in bisphosphonate users having dental procedures

osteonecrosis

This review of the the frequency of osteonecrosis of the jaw in bisphosphonate users undergoing dental interventions included 27 studies. having dental procedures of 2.7% (95%CI: 0.9 to 5.2%) being higher in those having dental extractions 4.1% (95%CI: 1.5 to 7.7%).

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Dental implants – post-operative pain management

The authors sought to review available literature relating to SSRI withdrawal syndromes

This review evaluating clinical efficacy of analgesics in mitigating orofacial pain following dental implant surgery included 9 RCTs. While the findings suggest analgesics may be beneficial the number of studies is small an additional infromation is required on which medication,, dosage, dosing schedule, administration route and adverse effects.

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Alveolar osteitis: Are warm saline mouthwashes effective for prevention?

Unequal measures

This review of the effectiveness of warm saltwater mouthwashes in preventing incidence of dry socket following tooth extraction included 8 RCTs. Only one of the included studies was considered to be at low risk of bias with the findings indicting that saltwater was more effective than no moutwash but less effective than chlorhexidine.

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Third molar extraction– effect of preoperative oral corticosteroids on pain, swelling and trismus

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Four RCTs involving a total of 212 patients were included in this review of a single pre-operative dose of oral corticosteroids in reducing pain,swelling & trismus after surgical removal of lower third molars. While the findings suggested there was little benefit to the patients none of the studies were small and none of them were at low risk of bias.

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Sinus lift for implants in maxilla – graft or not?

Sinus_lift

This review of the efficacy of graftless maxillary sinus membrane elevation using the lateral window approach for implantation in the atrophic maxilla included 9 RCTs. While some difference between grafted and graftless sinus lifts were shown at 6 months only a limited number of small short term trials were available.

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Third molar surgery – Lingual or buccal-based flaps?

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This review of postoperative discomfort, operative time, and wound healing in the short-term follow-up following surgical extraction of lower third molars with lingual- or buccal-based flaps included 7 RCTs. The quality of the included studies was limited and few differences were seen between the type of flaps.

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Orofacial trauma in wheeled non-motorsports

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This review of the prevalence of orofacial trauma in wheeled non-motor sports athletes included 5 cross-sectional studies involving 132,132 participants. Analyses showed the overall prevalence of orofacial trauma = 21.7% (95%CI; 8.7 to 34.7%) however the evidence was of very low certainty.

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Alveolar ridge preservation techniques

tooth Socket_preservation_complete

16 RCTs were included in this Cochrane review update of the effectiveness of techniques for alveolar ridge preservation (ARP) following dental extractions prior to implant placement. The findings suggest that ARP techniques may minimise the overall changes in residual ridge height and width six months after extraction, but the evidence is very uncertain

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