Oral and Maxillofacial Surgery, Faculty of Dentistry, the University of Hong Kong, Hong Kong.
Int J Oral Maxillofac Surg. 2011 Mar;40(3):229-43. doi: 10.1016/j.ijom.2010.10.005. Epub 2010 Nov 5.
This systematic review aims to identify and review the best available evidence to answer the clinical question 'What are the incidence and the factors influencing the development of osteoradionecrosis after tooth extraction in irradiated patients?'. A systematic review of published articles on post-irradiation extraction was performed via electronic search of the Medline, Ovid, Embase and Cochrane Library databases. Additional studies were identified by manual reference list search. Evaluation and critical appraisal were done in 3 stages by two independent reviewers and any disagreement was resolved by discussion with a third party. 19 articles were selected for the final analysis. The total incidence of osteoradionecrosis after tooth extraction in irradiated patients was 7%. When extractions were performed in conjunction with prophylactic hyperbaric oxygen, the incidence was 4% while extraction in conjunction with antibiotics gave an incidence of 6%. This systematic review found that while the incidence of osteoradionecrosis after post-irradiation tooth extractions is low, the extraction of mandibular teeth within the radiation field in patients who received a radiation dose higher than 60Gy represents the highest risk of developing osteoradionecrosis. Based on weak evidence, prophylactic hyperbaric oxygen is effective in reducing the risk of developing osteoradionecrosis after post-radiation extractions.
本系统评价旨在确定和回顾最佳现有证据，以回答临床问题“在接受放射治疗的患者中，拔牙后发生放射性骨坏死的发生率和影响因素有哪些？”。通过电子检索 Medline、Ovid、Embase 和 Cochrane Library 数据库，对放射治疗后拔牙的已发表文章进行了系统评价。通过手动参考文献搜索，还确定了其他研究。由两名独立评审员分 3 个阶段进行评估和批判性评价，任何分歧均通过与第三方讨论解决。最终有 19 篇文章被选入进行分析。在接受放射治疗的患者中，拔牙后放射性骨坏死的总发生率为 7%。如果在预防性高压氧治疗的同时进行拔牙，发生率为 4%，而在使用抗生素的同时进行拔牙，发生率为 6%。本系统评价发现，尽管放射治疗后拔牙后发生放射性骨坏死的发生率较低，但对于接受剂量超过 60Gy 的放射治疗的患者，在放射野内拔牙下颌牙齿的风险最高。基于较弱的证据，预防性高压氧治疗可有效降低放射治疗后拔牙后发生放射性骨坏死的风险。
