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Insufficient evidence about the comparative effectiveness of 3 horizontal ridge augmentation techniques
JADA+ CONTENT
This review does not in any way substitute for professional advice and should not be regarded as clinical guidance. As always, any evidence should be carefully considered by clinician and patient to ensure that in their views, all potentially desirable consequences outweigh all potentially undesirable consequences.
JADA+ CLINICAL SCANS
Romina Brignardello-Petersen, DDS, MSc, PhD
INSUFFICIENT EVIDENCE ABOUT THE COMPARATIVE EFFECTIVENESS OF 3 HORIZONTAL RIDGE AUGMENTATION TECHNIQUES
Deeb GR, Tran D, Carrico CK, Block E, Laskin DM, Deeb JG. How effective is the tent screw pole technique compared to other forms of horizontal ridge augmentation [published online ahead of print June 13, 2017]? J Oral Maxillofac Surg. http://dx.doi.org/ 10.1016/j.joms.2017.05.037. Key words. Surgery, implantology; horizontal ridge augmentation; open ridge augmentation; tent screw pole technique; tunnel technique; retrospective cohort study. Clinical relevance. Patients with bone atrophy need to undergo bone augmentation surgeries when they want to replace their missing teeth with implants. With different strategies available to do this, the results of studies that compare techniques could be useful for making clinical decisions. Study summary. The researchers conducted a retrospective cohort study to compare the outcomes of screw pole technique (SPT), tunnel technique (TT), and open ridge augmentation (ORA) in patients undergoing horizontal ridge augmentation surgery (HRAS) and delayed implant placement. The researchers reviewed the charts of 35 patients who had received SPT,* 21 who had received TT,y and 31 who had received ORA.z The proportion of patients who had received implants after 6 months was not statistically different among the 3 groups.§ Patients who had received SPT had 0.22 times the risk and patients who had received TT had 0.37 times the risk of experiencing membrane exposure or wound dehiscence than patients who had received ORA.{ Patients who had received SPT had 0.22 times the risk of losing the graft than patients who had received ORA.# Patients who had received SPT and TT needed a median of 1 antibiotic course whereas those who had received ORA needed a median of 2 antibiotic courses. The median number of postoperative visits was 1 in the TT group, 2 in the SPT group, and 3 in the ORA group.
Strengths and limitations. This study provides very low-quality evidence for the comparative effectiveness of SPT, TT, and ORA for HRAS. First, the researchers used an observational study design, which is suboptimal for addressing questions about the effects of interventions. Second, this study was retrospective, and the researchers relied on patients’ records instead of measuring the outcomes for the study. The main issue is that patients may have received the different interventions on the basis of the unique characteristics of the participant and the surgeon. For example, it is likely that SPT and TT were performed in participants with less bone loss than those who received ORA. Since the researchers provided no description of the patients’ characteristics, alveolar ridges, surgeons, and surgeries, it is difficult to ascertain how balanced the groups were with respect to factors that could have affected the outcomes. Thus, there is reason to believe that patients who received SPT had a better prognosis from the start than those who received ORA, which would make the comparison biased. In addition, the lack of description of particular features listed above does not allow us to judge whether these results are applicable to other clinical settings. n http://dx.doi.org/10.1016/j.adaj.2017.07.029 Copyright ª 2017 American Dental Association. All rights reserved.
Address correspondence to Dr. Brignardello-Petersen at e-mail [email protected]. Disclosure. Dr. Brignardello-Petersen did not report any disclosures. * Residents elevated a full-thickness mucoperiostal flap and placed 2 to 4 titanium screw implants (1.5 millimeter wide Pro-fix tenting screws [Osteogenics Biomedical]). They used a 1:1 mixture of mineralized freeze-dried bone allograft (Puros, Zimmer Dental) and particulate bovine-derived hydroxyapatite (Bio-Oss, Geistlich Pharma North America) and a reabsorbable membrane (Bioguide, Geistlich Pharma North America). y Surgeons made a vertical incision inferior to the mucogingival margin and created a tunnel that was filled with the same mixture graft described above. z Surgeons elevated a full-thickness mucoperiostal flap and placed a titanium-reinforced membrane (Cytoplast, Osteogenics Biomedical) that was fixed with a titanium screw and filled with the same bone graft described above. § 97% in the screw pole technique (SPT) group, 86% in the tunnel technique (TT) group, and 71% in the open ridge augmentation (ORA) group. { Proportion of patients with membrane exposure or wound dehiscence: 11% in the SPT group, 19% in the TT group, and 52% in the ORA group. Risk ratio (RR) comparing SPT with ORA, 0.22; 95% confidence interval (CI), 0.08 to 0.59. RR comparing TT with ORA, 0.37; 95% CI, 0.14 to 0.95. # Proportion of patients with graft loss: 9% in the SPT group, 19% in the TT group, and 39% in the ORA group. RR comparing SPT with ORA, 0.22; 95% CI, 0.07 to 0.71.
JADA
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http://jada.ada.org
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2017 e1
This review does not in any way substitute for professional advice and should not be regarded as clinical guidance. As always, any evidence should be carefully considered by clinician and patient to ensure that in their views, all potentially desirable consequences outweigh all potentially undesirable consequences.
JADA+ CLINICAL SCANS
Romina Brignardello-Petersen, DDS, MSc, PhD
INSUFFICIENT EVIDENCE ABOUT THE COMPARATIVE EFFECTIVENESS OF 3 HORIZONTAL RIDGE AUGMENTATION TECHNIQUES
Deeb GR, Tran D, Carrico CK, Block E, Laskin DM, Deeb JG. How effective is the tent screw pole technique compared to other forms of horizontal ridge augmentation [published online ahead of print June 13, 2017]? J Oral Maxillofac Surg. http://dx.doi.org/ 10.1016/j.joms.2017.05.037. Key words. Surgery, implantology; horizontal ridge augmentation; open ridge augmentation; tent screw pole technique; tunnel technique; retrospective cohort study. Clinical relevance. Patients with bone atrophy need to undergo bone augmentation surgeries when they want to replace their missing teeth with implants. With different strategies available to do this, the results of studies that compare techniques could be useful for making clinical decisions. Study summary. The researchers conducted a retrospective cohort study to compare the outcomes of screw pole technique (SPT), tunnel technique (TT), and open ridge augmentation (ORA) in patients undergoing horizontal ridge augmentation surgery (HRAS) and delayed implant placement. The researchers reviewed the charts of 35 patients who had received SPT,* 21 who had received TT,y and 31 who had received ORA.z The proportion of patients who had received implants after 6 months was not statistically different among the 3 groups.§ Patients who had received SPT had 0.22 times the risk and patients who had received TT had 0.37 times the risk of experiencing membrane exposure or wound dehiscence than patients who had received ORA.{ Patients who had received SPT had 0.22 times the risk of losing the graft than patients who had received ORA.# Patients who had received SPT and TT needed a median of 1 antibiotic course whereas those who had received ORA needed a median of 2 antibiotic courses. The median number of postoperative visits was 1 in the TT group, 2 in the SPT group, and 3 in the ORA group.
Strengths and limitations. This study provides very low-quality evidence for the comparative effectiveness of SPT, TT, and ORA for HRAS. First, the researchers used an observational study design, which is suboptimal for addressing questions about the effects of interventions. Second, this study was retrospective, and the researchers relied on patients’ records instead of measuring the outcomes for the study. The main issue is that patients may have received the different interventions on the basis of the unique characteristics of the participant and the surgeon. For example, it is likely that SPT and TT were performed in participants with less bone loss than those who received ORA. Since the researchers provided no description of the patients’ characteristics, alveolar ridges, surgeons, and surgeries, it is difficult to ascertain how balanced the groups were with respect to factors that could have affected the outcomes. Thus, there is reason to believe that patients who received SPT had a better prognosis from the start than those who received ORA, which would make the comparison biased. In addition, the lack of description of particular features listed above does not allow us to judge whether these results are applicable to other clinical settings. n http://dx.doi.org/10.1016/j.adaj.2017.07.029 Copyright ª 2017 American Dental Association. All rights reserved.
Address correspondence to Dr. Brignardello-Petersen at e-mail [email protected]. Disclosure. Dr. Brignardello-Petersen did not report any disclosures. * Residents elevated a full-thickness mucoperiostal flap and placed 2 to 4 titanium screw implants (1.5 millimeter wide Pro-fix tenting screws [Osteogenics Biomedical]). They used a 1:1 mixture of mineralized freeze-dried bone allograft (Puros, Zimmer Dental) and particulate bovine-derived hydroxyapatite (Bio-Oss, Geistlich Pharma North America) and a reabsorbable membrane (Bioguide, Geistlich Pharma North America). y Surgeons made a vertical incision inferior to the mucogingival margin and created a tunnel that was filled with the same mixture graft described above. z Surgeons elevated a full-thickness mucoperiostal flap and placed a titanium-reinforced membrane (Cytoplast, Osteogenics Biomedical) that was fixed with a titanium screw and filled with the same bone graft described above. § 97% in the screw pole technique (SPT) group, 86% in the tunnel technique (TT) group, and 71% in the open ridge augmentation (ORA) group. { Proportion of patients with membrane exposure or wound dehiscence: 11% in the SPT group, 19% in the TT group, and 52% in the ORA group. Risk ratio (RR) comparing SPT with ORA, 0.22; 95% confidence interval (CI), 0.08 to 0.59. RR comparing TT with ORA, 0.37; 95% CI, 0.14 to 0.95. # Proportion of patients with graft loss: 9% in the SPT group, 19% in the TT group, and 39% in the ORA group. RR comparing SPT with ORA, 0.22; 95% CI, 0.07 to 0.71.
JADA
( )
- -
http://jada.ada.org
-
2017 e1