Georgios N. Antonoglou

Non-syndromic and syndromic keratocystic odontogenic tumors: Systematic review and meta-analysis of recurrences

BACKGROUND Keratocystic odontogenic tumors (KCOTs) are locally aggressive benign tumors which occur in the bones of both jaws with a high recurrence rate. The aim of the present study was to define and evaluate the post-treatment recurrence of KCOT lesions in non-syndromic and syndromic patients. METHODS A systematic review of the literature and meta-analysis was conducted according to the PRISMA statement. Seven electronic databases were searched from their start up to August 2013 for clinical studies on human patients without limitation to year, language or publication status. RESULTS A total of five case series studies with 323 treated KCOT lesions were included in the quantitative synthesis. The recurrence rate of KCOTs for three treatment forms ranged from 7% to 28%. Comparisons among the various treatments suggest that resection or marsupialization might be associated with fewer recurrences. However, high risk of bias and effect imprecision preclude the making of clinical recommendation. Existing evidence regarding nevoid basal cell carcinoma patients was likewise scarce. CONCLUSIONS The absence of studies with low risk of bias precludes the making of safe recommendations about the optimal management of KCOTs.

Recurrence rates of intraosseous ameloblastomas of the jaws: A systematic review of conservative versus aggressive treatment approaches and meta-analysis of non-randomized studies

BACKGROUND The aim of the present study was to define and evaluate the post-treatment recurrence of unicystic and solid or multicystic ameloblastoma lesions, measured as counts of first time recurrences. METHODS A systematic review of the literature and meta-analysis was planned according to the PRISMA statement and in order to include randomized and non-randomized clinical trials and observational studies in humans. Seven electronic databases were searched from their start up to December 2013 without limitation to year, language or publication status. RESULTS A total of seven non-randomized studies with 229 cases of treated ameloblastoma lesions were included in the quantitative synthesis. The summary recurrence rate of ameloblastomas for the unicystic and solid or multicystic variants ranged from 0.2% to 12% and 0.8% to 38% respectively. The comparison of a conservative treatment approach versus radical in solid or multicystic ameloblastoma favored the radical. CONCLUSIONS The absence of studies with low risk of bias precludes the making of strong clinical recommendations while resection may be preferable in both unicystic and solid or multicystic. ameloblastomas.

Serum 1,25(OH)D level increases after elimination of periodontal inflammation in T1DM subjects.

OBJECTIVES The aim of the present study was to investigate associations between serum concentrations of vitamin D metabolites, 25-hydroxyvitamin D [25(OH)D], and its active form, 1,25-dihydroxyvitamin D [1,25(OH)D], and the severity of chronic periodontitis. SUBJECTS AND DESIGN Presence of dental plaque, probing pocket depth (PD), and attachment level in 80 type 1 diabetes mellitus subjects were recorded. The serum levels of 25(OH)D, 1,25(OH)D, ultrasensitive C-reactive protein, IL-6, TNF-α, high-density lipoprotein cholesterol, and glycosylated hemoglobin (percentage) were determined. Multivariate regression models were used to explore the associations between serum 25(OH)D (nanomoles per liter) and 1,25(OH)D (picomoles per liter) levels and periodontal health status. INTERVENTION Antiinfective periodontal therapies were delivered and the clinical examination and laboratory analyses were repeated 8 weeks after the therapies. RESULTS A statistically significant association was found between the serum level of 1,25(OH)D (odds ratio 1.06, 95% confidence interval 1.02-1.11) and periodontal health at the baseline; subjects with a high level were more likely to belong to the group of no or mild periodontitis. The serum level of 1,25(OH)D showed a statistically significant increase after antiinfective periodontal therapy in both no or mild (P = .001) and moderate or severe periodontitis (P < .001) subjects. The association between serum 25(OH)D level and periodontal health was negligible. CONCLUSION This study has shown a significant positive association between the serum 1,25(OH)D level and periodontal health status. To what extent this association is causal in nature remains to be confirmed.

Associations Between Serum 25-Hydroxyvitamin D and Periodontal Pocketing and Gingival Bleeding: Results of a Study in a Non-Smoking Population in Finland

BACKGROUND Apart from the effects of vitamin D on bone metabolism, it is also known for its immunomodulatory properties. However, so far, it is not clear whether serum 25-hydroxyvitamin D [25(OH)D] exerts any beneficial effect on the periodontium. The aim of the present study is to investigate whether the serum level of 25(OH)D is related to periodontal condition, measured by means of pocketing and gingival bleeding. METHODS This cross-sectional study is based on a non-smoking subpopulation without diabetes of the Finnish Health 2000 Survey (N = 1,262). Periodontal condition was measured as the number of teeth with deep (≥4 mm) periodontal pockets and the number of bleeding sextants per individual. Serum 25(OH)D level was determined by means of a standard laboratory measurement. Prevalence rate ratios and 95% confidence intervals were estimated using Poisson regression models. RESULTS There were practically no associations between serum 25(OH)D level and teeth with deep (≥4 mm) periodontal pockets or bleeding sextants. A somewhat lower proportion of teeth with deep periodontal pockets was found in higher serum 25(OH)D quintiles among individuals with a good oral hygiene level. CONCLUSION Serum 25(OH)D did not seem to be related to periodontal condition, measured as periodontal pocketing and gingival bleeding in this low-risk, low-25(OH)D status population.

Choice of effect measure for meta-analyses of dichotomous outcomes influenced the identified heterogeneity and direction of small-study effects.

OBJECTIVES The aim of this study was to compare the use of odds ratio (OR), risk ratio (RR), and risk difference (RD) in meta-analyses of dichotomous outcomes and assess their influence on their results. STUDY DESIGN AND SETTING Initially, we included meta-analyses from a meta-epidemiologic database and reanalyzed them with OR, RR, and RD as summary metric. The primary outcomes were the effects of metric choice on the (1) statistical significance, (2) heterogeneity, and (3) Eggers test for publication bias. Additionally, meta-analyses that originally used OR were reanalyzed using RR to assess the differences in their results. RESULTS In the 235 meta-analyses (147 reviews) that were included, the conclusions in terms of significance rarely changed. On the other hand, use of OR displayed the lowest I(2) values (median 42%), followed by RR (+5.1%) and RD (+15.0%). The Eggers test was most often significant with RR (32%), followed by RD (29%) and OR (24%). Substitution of RR for OR led to a change of the observed effects in 3%, change of between-study heterogeneity in 6% to 24%, and change in Eggers test results in 7% of the cases, respectively. CONCLUSION The choice of metric for meta-analyses of dichotomous outcomes might influence the identified between-study heterogeneity and the results of Eggers test.

Randomized clinical trials in orthodontics are rarely registered a priori and often published late or not at all

A priori registration of randomized clinical trials is crucial to the transparency and credibility of their findings. Aim of this study was to assess the frequency with which registered and completed randomized trials in orthodontics are published. We searched ClinicalTrials.gov and ISRCTN for registered randomized clinical trials in orthodontics that had been completed up to January 2017 and judged the publication status and date of registered trials using a systematic protocol. Statistical analysis included descriptive statistics, chi-square or Fisher exact tests, and Kaplan-Meier survival estimates. From the 266 orthodontic trials registered up to January 2017, 80 trials had been completed and included in the present study. Among these 80 included trials, the majority (76%) were registered retrospectively, while only 33 (41%) were published at the time. The median time from completion to publication was 20.1 months (interquartile range: 9.1 to 31.6 months), while survival analysis indicated that less than 10% of the trials were published after 5 years from their completion. Finally, 22 (28%) of completed trials remain unpublished even after 5 years from their completion. Publication rates of registered randomized trials in orthodontics remained low, even 5 years after their completion date.

Clinical Performance of Dental Implants Following Sinus Floor Augmentation: A Systematic Review and Meta-Analysis of Clinical Trials with at Least 3 Years of Follow-up

PURPOSE The purpose of this systematic review was to assess the survival of implants placed in augmented sinuses on a medium- to long-term basis, and identify factors affecting implant survival such as surgical technique, bone grafts, and timing of implant placement. MATERIALS AND METHODS A literature search up to July 2016 was performed to identify prospective clinical studies on sinus floor augmentation in conjunction with implant placement with a minimum follow-up of 3 years. Meta-analytic methods were implemented to calculate implant survival rates and relative risks (RR) for failure and the effect of surgical technique, use of bone graft, graft type, use of membrane, mean residual bone height, and timing of implant insertion. RESULTS A total of 17 clinical trials (1 randomized and 16 prospective nonrandomized) were included, which pertained to 637 patients (at least 48% male) and 1,610 implants placed after sinus floor augmentation with the osteotome (transalveolar) or lateral window approach. The pooled implant survival rate at 3 to 6 years of follow-up was 97.7% (17 studies; 95% CI = 94.4% to 99.7%) with high heterogeneity. Smoking was associated with significantly worse implant survival (2 studies; RR = 4.8; 95% CI = 1.2 to 19.4; P < .05). However, evidence of influencing factors varied from very low to moderate after adopting the GRADE approach, due to risk of bias, imprecision, inconsistency, and small-study effects. CONCLUSION Current evidence suggests that implants in augmented sinuses have high survival rates, with smoking playing a potentially important negative role in their prognosis. Both indirect and direct maxillary sinus floor augmentation seem to have a low frequency of manageable complications.