Shah Darshana Nilesh, Chauhan Chirag Jasubhai, Solanki Jenish Sureshbhai
Department of Prosthodontics, Crown and Bridge and Oral Implantology, Ahmedabad Dental College and Hospital, Gandhinagar, Gujarat, India.
J Indian Prosthodont Soc. 2017 Apr-Jun;17(2):109-119. doi: 10.4103/0972-4052.203193.
The significantly higher implant failure rates in maxillofacial patients, undergoing radiotherapy, might be caused by the long-term effects of reduced vascularization compromising the implantation site. An extensive preclinical animal literature and a multitude of clinical reports suggest the use of hyperbaric oxygen (HBO) therapy as it can improve the tissue vascularity. Hence, it may increase the implant survival rate by enhancing osseointegration process in such patients. The objective of this systematic review was to investigate the effectiveness of HBO therapy on dental implant survival rate in irradiated maxillofacial patients who require prosthodontic rehabilitation. An electronic search without time restrictions was undertaken in April 2016 using databases: PubMed, Google Scholar, and the Cochrane Oral Health Group Trials Register. We also tried to contact the manufacturers and researchers in the field for necessary details. Clinical human studies, on irradiated maxillofacial dental implant patients, including randomized controlled trials (RCTs), prospective controlled trials, retrospective studies, and preliminary reports were included in the study. Data collection was carried out by two of the authors' independently. The titles and abstracts of all reports were screened for the study design and type of reported intervention; all the duplicates were removed. The data search yielded 62 titles, out of which 14 articles were selected for the study by the article filtration criteria: Title/abstract/full text. Data which were extracted by two authors with any disagreement were resolved by the third author, and a meta-analysis was done using binary random-effect model. The results show decreased implant failure rate in HBO group (9.21%) compared to non-HBO group (22.44%). The potential limitations of this study are amount of radiation doses used, period lasting from radiotherapy to the placement of the implants, and follow-up period which varies for every subject of the included study, which can affect the treatment outcome. Although there are many sensitive articles published about HBO, including a number of review papers, RCTs are still lacking. According to the statistical analysis, it can be concluded that preventive HBO therapy can reduce the risk of implant failures in irradiated patients by 1.21 (relative risk) with 95% confidence interval ( < 0.001). Hence, HBO can be the effective treatment protocol for the implant treatment in irradiated maxillofacial patients.
接受放疗的颌面部患者种植体失败率显著更高,这可能是由于血管化减少的长期影响损害了种植部位。大量的临床前动物文献和众多临床报告表明可使用高压氧(HBO)疗法,因为它可以改善组织血管化。因此,它可能通过增强此类患者的骨整合过程来提高种植体存活率。本系统评价的目的是研究HBO疗法对需要修复治疗的接受过放疗的颌面部患者牙种植体存活率的有效性。2016年4月使用PubMed、谷歌学术和Cochrane口腔健康组试验注册库等数据库进行了无时间限制的电子检索。我们还试图联系该领域的制造商和研究人员以获取必要的详细信息。纳入研究的是关于接受过放疗的颌面部牙种植体患者的临床人体研究,包括随机对照试验(RCT)、前瞻性对照试验、回顾性研究和初步报告。数据收集由两位作者独立进行。对所有报告的标题和摘要进行筛选,以确定研究设计和报告干预的类型;去除所有重复项。数据检索产生了62个标题,其中14篇文章根据标题/摘要/全文的文章筛选标准被选入研究。由两位作者提取的数据如有分歧则由第三位作者解决,并使用二元随机效应模型进行荟萃分析。结果显示,与非HBO组(22.44%)相比,HBO组的种植体失败率降低(9.21%)。本研究的潜在局限性在于所使用的辐射剂量、从放疗到种植体植入的持续时间以及纳入研究的每个受试者的随访期各不相同,这可能会影响治疗结果。尽管已经发表了许多关于HBO的敏感性文章,包括一些综述论文,但仍然缺乏RCT。根据统计分析,可以得出结论,预防性HBO疗法可将放疗患者种植体失败的风险降低1.21(相对风险),95%置信区间(<0.001)。因此,HBO可以成为接受过放疗的颌面部患者种植治疗的有效治疗方案。