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Intervention Review

Interventions for replacing missing teeth: hyperbaric oxygen therapy for irradiated patients who require dental implants

  1. Marco Esposito1,*,
  2. Maria Gabriella Grusovin1,
  3. Satya Patel1,
  4. Helen V Worthington2,
  5. Paul Coulthard1

Editorial Group: Cochrane Oral Health Group

Published Online: 23 JAN 2008

Assessed as up-to-date: 31 OCT 2007

DOI: 10.1002/14651858.CD003603.pub2


How to Cite

Esposito M, Grusovin MG, Patel S, Worthington HV, Coulthard P. Interventions for replacing missing teeth: hyperbaric oxygen therapy for irradiated patients who require dental implants. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD003603. DOI: 10.1002/14651858.CD003603.pub2.

Author Information

  1. 1

    School of Dentistry, The University of Manchester, Department of Oral and Maxillofacial Surgery, Manchester, UK

  2. 2

    School of Dentistry, The University of Manchester, Cochrane Oral Health Group, MANDEC, Manchester, UK

*Marco Esposito, Department of Oral and Maxillofacial Surgery, School of Dentistry, The University of Manchester, Higher Cambridge Street, Manchester, M15 6FH, UK. espositomarco@hotmail.com. marco.esposito@manchester.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 23 JAN 2008

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Dental implants offer one way to replace missing teeth. Patients who have undergone radiotherapy and those that have also undergone surgery for cancer in the head and neck region may benefit particularly from reconstruction with implants. Hyperbaric oxygen therapy (HBO) has been advocated to improve the success of implant treatment in patients who have undergone radiotherapy but this remains a controversial issue.

Objectives

To compare success, morbidity, patient satisfaction and cost effectiveness of dental implant treatment carried out with and without HBO in irradiated patients.

Search methods

We searched the Cochrane Oral Health Group's Trials Register, The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. Handsearching included several dental journals. We checked the bibliographies of relevant clinical trials and review articles for studies outside the handsearched journals. We wrote to authors of the identified randomised controlled trials (RCTs), to more than 55 oral implant manufacturers; we used personal contacts and we asked on an internet discussion group in an attempt to identify unpublished or ongoing RCTs. No language restriction was applied. The last electronic search was conducted on 13 June 2007.

Selection criteria

Randomised controlled trials of HBO therapy for irradiated patients requiring dental implants.

Data collection and analysis

Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two review authors. Results were expressed as random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals.

Main results

Only one RCT was identified and included. Thirteen patients received HBO therapy while other 13 did not. Two to six implants were placed in fully edentulous mandibles to be rehabilitated with bar-retained overdentures. One year after implant loading four patients died from each group. One patient, treated with HBO, developed an osteoradionecrosis and lost all implants so the prosthesis could not be provided. Five patients in the HBO group had at least one implant failure versus two in the control group. There were no statistically significant differences for prosthesis and implant failures, postoperative complications and patient satisfaction between the two groups.

Authors' conclusions

Despite the limited amount of clinical research available, it appears that HBO therapy in irradiated patients requiring dental implants may not offer any appreciable clinical benefits. There is a definite need for more RCTs to ascertain the effectiveness of HBO in irradiated patients requiring dental implants. These trials ought to be of a high quality and reported as recommended by the CONSORT statement (www.consort-statement.org/). Each clinical centre may have limited numbers of patients and it is likely that trials will need to be multicentred.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Interventions for replacing missing teeth: hyperbaric oxygen therapy for irradiated patients who require dental implants

We could only identify one study including a limited number of patients. This study suggested that the use of hyperbaric oxygen (HBO) therapy for patients who require dental implants after radiotherapy is of no apparent clinical benefit. HBO requires patients to breath pure oxygen under pressure in a specially designed chamber on several occasions. It has been suggested that HBO therapy will improve the healing of bone and tissues around dental implants, however the scarce scientific evidence available does not support this hypothesis. More reliable studies are needed to provide the final answer to this question.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

重建缺牙的治療方式: 利用高壓氧治療接受過放射線治療且需要植牙的病患

植牙是一種重建缺牙的方式。 接受過放射線治療及因頭頸部癌症而接受手術的病人可經由植牙重建而獲益。 高壓氧治療(HBO)被認為是會對接受過放射線治療的病人用以改善植牙治療成功率的方式,但這仍然是有爭議性的課題。

目標

比較接受過放射線治療並有或無HBO治療的植牙病患的植牙成功率,罹病率,病人滿意度及成本效益。

搜尋策略

我們搜尋了the Cochrane Oral Health Group's Trials Register, The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE等資料庫。 人工搜尋包含了多項的牙科期刊。 並查看在人工搜尋期刊之外的相關臨床試驗及回顧文獻的目錄。我們寫信去詢問找出的隨機對照試驗(RCTs)的作者及超過55個植牙製造商;我們利用私下聯絡及詢問網路討論小組以便找出尚未發表或正在進行的RCTs。 並沒有語言上的限制。 最後的電子搜尋是在2007年6月13日完成的。

選擇標準

高壓氧治療對於接受過放射線治療且需要植牙病患的隨機對照試驗。

資料收集與分析

由兩位回顧作者重複並獨立的篩選合用的研究,評估試驗中方法學上的品質及取得資料。結果以隨機效果模式及95% CI來呈現,針對連續性資料,使用平均差,而二分類的資料則以風險比(risk ratio)。

主要結論

只有一個RCT被找到並被收錄在此研究。有13個病人接受HBO治療而另外13個病人則無。在完全無牙的下顎骨放置2至6個植體而利用桿固定(barretained)的覆蓋義齒(overdenture)來重建。在放置植牙承受力量一年後,在各組都有4位病人過世。一位以HBO治療的病人產生放射線骨壞死而喪失所有的植體,因而無法提供義齒。5位以HBO治療組的病人至少有一支植體失敗,相較於對照組病人的兩支。在義齒,植體失敗,術後副作用,病人滿意度上,此兩組中並沒有統計學上顯著的差異。

作者結論

雖然只能獲得有限的臨床研究,HBO治療對於接受過放射線治療的植牙病人並沒有提供明顯的臨床益處。為了得到更確定HBO對於接受過放射線治療的植牙病人的效果,必須有更多的RCTs。這些試驗必須是高品質且被CONSORT聲明(http://www.consortstatement.org/)所建議的。由於各個臨床機構可能只有少數病患,故此類試驗未來可能必須以多中心方式來進行。

翻譯人

本摘要由臺灣大學附設醫院張玉芳翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

重建缺牙的治療方式: 利用高壓氧治療接受過放射線治療且需要植牙的病患。我們只找到一個包含少數病人研究。這個研究表示在接受過放射線治療的植牙病人使用HBO治療並沒有顯著臨床的益處。HBO需要讓病人數次在特殊設計的艙內有壓力下呼吸純氧。HBO被認為會改善植體周圍骨頭及組織癒合,但是這稀有的科學性證據並不支持這樣的假設。還需要更多值得信賴的研究來回答這個問題。