Pub Date : 2025-05-09DOI: 10.1038/s41432-025-01150-7
Lata Goyal, Komal Kaur Saroya, Shipra Gupta, Shubham Sareen
Ma X, Zhang Y, Wang J et al. Association between denture restoration for tooth loss and cognitive impairment: a systematic review and meta-analysis. J Prosthodont Res 2025; https://doi.org/10.2186/jpr.JPR_D_24_00060 . A search was conducted across five electronic databases, including PubMed, EMBASE, Cochrane Library, MEDLINE, and CNKI, from January 2000 to January 2024. The search strategy included keywords related to tooth loss, dentures, cognitive function, memory loss and dementia. Reference lists of relevant studies were also screened to identify additional articles. The search was limited to the English language only. Observational studies examining the association between denture restoration and cognitive impairment were included. Eligible studies had to report cognitive impairment or dementia as the outcome and denture restoration as the exposure factor. Six studies with a total of 24,252 participants met the inclusion criteria. Two independent reviewers extracted relevant data, including study design, participant characteristics, dental status, cognitive assessment methods, and statistical results. Meta-analysis was conducted using risk ratios (RR) with 95% confidence intervals (CI), applying a random-effects model due to clinical and methodological variations. Newcastle-Ottawa Scale and the Agency for Healthcare research and quality scale were used for quality assessment of included studies. Beg- Mazumdar and Egger regression tests were used to assess the publication bias. The meta-analysis revealed that participants with tooth loss without dentures had a 1.27-fold higher odds of having cognitive impairment, whereas those with dentures had only a 1.02-fold odds. A dose-response analysis showed that each additional missing tooth increased the cognitive impairment risk by 1.009 times in the non-denture group, while the denture group exhibited a lower risk increase of 1.003 times. Heterogeneity was influenced by follow-up duration and cognitive assessment tools. There was significant evidence of publication bias in non denture group as compared to the denture restoration group which showed nonsignificant evidence of publication bias. This study suggests denture restoration is associated with a reduced risk of cognitive impairment in individuals with tooth loss. The findings highlight the potential protective role of timely denture rehabilitation in mitigating cognitive decline. Future research should focus on longitudinal and interventional studies to establish causality.
{"title":"Association between restoration of missing teeth with dentures and cognitive function","authors":"Lata Goyal, Komal Kaur Saroya, Shipra Gupta, Shubham Sareen","doi":"10.1038/s41432-025-01150-7","DOIUrl":"10.1038/s41432-025-01150-7","url":null,"abstract":"Ma X, Zhang Y, Wang J et al. Association between denture restoration for tooth loss and cognitive impairment: a systematic review and meta-analysis. J Prosthodont Res 2025; https://doi.org/10.2186/jpr.JPR_D_24_00060 . A search was conducted across five electronic databases, including PubMed, EMBASE, Cochrane Library, MEDLINE, and CNKI, from January 2000 to January 2024. The search strategy included keywords related to tooth loss, dentures, cognitive function, memory loss and dementia. Reference lists of relevant studies were also screened to identify additional articles. The search was limited to the English language only. Observational studies examining the association between denture restoration and cognitive impairment were included. Eligible studies had to report cognitive impairment or dementia as the outcome and denture restoration as the exposure factor. Six studies with a total of 24,252 participants met the inclusion criteria. Two independent reviewers extracted relevant data, including study design, participant characteristics, dental status, cognitive assessment methods, and statistical results. Meta-analysis was conducted using risk ratios (RR) with 95% confidence intervals (CI), applying a random-effects model due to clinical and methodological variations. Newcastle-Ottawa Scale and the Agency for Healthcare research and quality scale were used for quality assessment of included studies. Beg- Mazumdar and Egger regression tests were used to assess the publication bias. The meta-analysis revealed that participants with tooth loss without dentures had a 1.27-fold higher odds of having cognitive impairment, whereas those with dentures had only a 1.02-fold odds. A dose-response analysis showed that each additional missing tooth increased the cognitive impairment risk by 1.009 times in the non-denture group, while the denture group exhibited a lower risk increase of 1.003 times. Heterogeneity was influenced by follow-up duration and cognitive assessment tools. There was significant evidence of publication bias in non denture group as compared to the denture restoration group which showed nonsignificant evidence of publication bias. This study suggests denture restoration is associated with a reduced risk of cognitive impairment in individuals with tooth loss. The findings highlight the potential protective role of timely denture rehabilitation in mitigating cognitive decline. Future research should focus on longitudinal and interventional studies to establish causality.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"26 2","pages":"85-86"},"PeriodicalIF":2.3,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-09DOI: 10.1038/s41432-025-01147-2
Paramarshi Das, Upendra Singh Bhadauria, Bharathi M. Purohit, Harsh Priya, Prasanta Majumder, Manali Deb Barma
Sugar Sweetened Beverages (SSB) can significantly influence saliva leading to a more acidic environment which makes our oral cavity prone to various oral diseases. This study investigates the influence of SSBs on salivary parameters by analyzing the existing plethora of research. To systematically review and analyze the impact of SSBs on changes in salivary pH, flow rate and bacterial proliferation. Pubmed, Embase, EBSCO, Web of Science, and Cochrane databases were searched using the PECO strategy. Risk of Bias was assessed using Newcastle Ottawa Scale and Cochrane Risk of Bias assessment tools. Meta-analysis was conducted among the eligible studies using a random effects model. A total of twenty eight studies were found eligible after a thorough PRISMA search in the databases. Many studies consistently demonstrated a rapid decline in salivary pH post-SSB consumption, creating an acidic environment conducive to enamel demineralization. Few studies also reported reduced salivary flow rate and prolonged oral clearance times. Increased proliferation of acidogenic bacteria and fungi was noted. Risk of bias was low overall, but a few studies reported limitations such as randomization bias and missing data. Consumption of sugar sweetened beverages significantly impact salivary parameters, fostering an oral environment prone to diseases such as dental caries and periodontal infections. Public health interventions and policies are essential to reduce SSB consumption and promote oral health.
含糖饮料（SSB）可以显著影响唾液，导致更酸性的环境，使我们的口腔容易患各种口腔疾病。本研究通过分析已有的大量研究，探讨了SSBs对唾液参数的影响。目的：系统回顾和分析SSBs对唾液pH、流速和细菌增殖的影响。方法：使用PECO策略检索Pubmed， Embase， EBSCO， Web of Science和Cochrane数据库。偏倚风险采用纽卡斯尔渥太华量表和Cochrane偏倚风险评估工具进行评估。采用随机效应模型对符合条件的研究进行meta分析。结果：在数据库中进行彻底的PRISMA检索后，共有28项研究被发现符合条件。许多研究一致表明，食用ssb后唾液pH值迅速下降，形成有利于牙釉质脱矿的酸性环境。少数研究也报道了唾液流率降低和口腔清除时间延长。注意到产酸细菌和真菌的增殖增加。偏倚风险总体上较低，但少数研究报告了随机偏倚和缺失数据等局限性。结论：饮用含糖饮料会显著影响唾液参数，形成易患龋齿和牙周感染等疾病的口腔环境。公共卫生干预措施和政策对于减少SSB消费和促进口腔健康至关重要。
{"title":"Impact of sugar-sweetened beverages on salivary parameters: A systematic review & meta-analysis","authors":"Paramarshi Das, Upendra Singh Bhadauria, Bharathi M. Purohit, Harsh Priya, Prasanta Majumder, Manali Deb Barma","doi":"10.1038/s41432-025-01147-2","DOIUrl":"10.1038/s41432-025-01147-2","url":null,"abstract":"Sugar Sweetened Beverages (SSB) can significantly influence saliva leading to a more acidic environment which makes our oral cavity prone to various oral diseases. This study investigates the influence of SSBs on salivary parameters by analyzing the existing plethora of research. To systematically review and analyze the impact of SSBs on changes in salivary pH, flow rate and bacterial proliferation. Pubmed, Embase, EBSCO, Web of Science, and Cochrane databases were searched using the PECO strategy. Risk of Bias was assessed using Newcastle Ottawa Scale and Cochrane Risk of Bias assessment tools. Meta-analysis was conducted among the eligible studies using a random effects model. A total of twenty eight studies were found eligible after a thorough PRISMA search in the databases. Many studies consistently demonstrated a rapid decline in salivary pH post-SSB consumption, creating an acidic environment conducive to enamel demineralization. Few studies also reported reduced salivary flow rate and prolonged oral clearance times. Increased proliferation of acidogenic bacteria and fungi was noted. Risk of bias was low overall, but a few studies reported limitations such as randomization bias and missing data. Consumption of sugar sweetened beverages significantly impact salivary parameters, fostering an oral environment prone to diseases such as dental caries and periodontal infections. Public health interventions and policies are essential to reduce SSB consumption and promote oral health.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"26 3","pages":"152-153"},"PeriodicalIF":2.3,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-07DOI: 10.1038/s41432-025-01137-4
Kelvin I. Afrashtehfar
Malhotra T, Kumar Yadav B, Singh Phukela S et al. A comparative evaluation of prosthetic and biologic outcomes as influenced by two different implant restorative materials: a prospective, split-mouth study. Int J Prosthodont. 2025; https://doi.org/10.11607/ijp.8729 . This was a prospective split-mouth study, where each patient received monolithic zirconia and metal-ceramic implant-supported crowns on contralateral sides in the same arch. This design guaranteed direct intra-patient comparison, reducing inter-individual variability. Twenty partially edentulous patients (14 males, 6 females) were selected based on strict inclusion criteria, ensuring bilateral posterior implant placement with opposing natural dentition. Patients with parafunctional habits, active periodontal disease, or systemic conditions affecting bone metabolism were excluded. Implant placement and prosthetic restoration were performed per standard clinical protocols. The study assessed outcomes at baseline, 1-year, and 2-year follow-ups, measuring prosthetic integrity, periodontal health, and inflammatory markers. Clinical indices (plaque index, bleeding on probing, probing depth), peri-implant crevicular fluid biomarkers (MMP-8 levels), and prosthetic performance (USPHS criteria) were statistically analysed using chi-square tests, ANOVA, and Student t-tests, with significance set at P < 0.05. Both materials showed 100% implant and prosthetic survival rate over 2 years. Metal-ceramic crowns exhibited higher incidences of ceramic chipping and screw loosening, while monolithic zirconia crowns demonstrated greater mechanical stability but poorer aesthetic match. No significant differences in marginal bone loss (MBL) or MMP-8 inflammatory marker levels were observed between groups. However, higher plaque index (PI) and probing depth (PD) were recorded for metal-ceramic crowns. Monolithic zirconia crowns demonstrate superior mechanical reliability and fewer technical complications but have aesthetic limitations compared to metal-ceramic crowns. Biologic outcomes were comparable between both materials. Clinicians should weigh mechanical durability versus aesthetic demands when selecting implant-supported restorations. Further long-term studies are recommended to validate these findings.
{"title":"Monolithic zirconia outperforms metal-ceramic in mechanical reliability for single implant crowns but lacks long-term validation","authors":"Kelvin I. Afrashtehfar","doi":"10.1038/s41432-025-01137-4","DOIUrl":"10.1038/s41432-025-01137-4","url":null,"abstract":"Malhotra T, Kumar Yadav B, Singh Phukela S et al. A comparative evaluation of prosthetic and biologic outcomes as influenced by two different implant restorative materials: a prospective, split-mouth study. Int J Prosthodont. 2025; https://doi.org/10.11607/ijp.8729 . This was a prospective split-mouth study, where each patient received monolithic zirconia and metal-ceramic implant-supported crowns on contralateral sides in the same arch. This design guaranteed direct intra-patient comparison, reducing inter-individual variability. Twenty partially edentulous patients (14 males, 6 females) were selected based on strict inclusion criteria, ensuring bilateral posterior implant placement with opposing natural dentition. Patients with parafunctional habits, active periodontal disease, or systemic conditions affecting bone metabolism were excluded. Implant placement and prosthetic restoration were performed per standard clinical protocols. The study assessed outcomes at baseline, 1-year, and 2-year follow-ups, measuring prosthetic integrity, periodontal health, and inflammatory markers. Clinical indices (plaque index, bleeding on probing, probing depth), peri-implant crevicular fluid biomarkers (MMP-8 levels), and prosthetic performance (USPHS criteria) were statistically analysed using chi-square tests, ANOVA, and Student t-tests, with significance set at P < 0.05. Both materials showed 100% implant and prosthetic survival rate over 2 years. Metal-ceramic crowns exhibited higher incidences of ceramic chipping and screw loosening, while monolithic zirconia crowns demonstrated greater mechanical stability but poorer aesthetic match. No significant differences in marginal bone loss (MBL) or MMP-8 inflammatory marker levels were observed between groups. However, higher plaque index (PI) and probing depth (PD) were recorded for metal-ceramic crowns. Monolithic zirconia crowns demonstrate superior mechanical reliability and fewer technical complications but have aesthetic limitations compared to metal-ceramic crowns. Biologic outcomes were comparable between both materials. Clinicians should weigh mechanical durability versus aesthetic demands when selecting implant-supported restorations. Further long-term studies are recommended to validate these findings.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"26 2","pages":"76-77"},"PeriodicalIF":2.3,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12204853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-06DOI: 10.1038/s41432-025-01155-2
Omer Waleed Majid
Gaspar J, Botelho J, Proença L et al. Osseodensification versus lateral window technique for sinus floor elevation with simultaneous implant placement: a randomized clinical trial on patient-reported outcome measures. Clin Implant Dent Relat Res 2024; 26: 113–126. A randomized, controlled, parallel-arm clinical trial. To compare patient-reported and surgical outcomes between osseodensification (OD) and lateral window (LW) techniques for sinus floor elevation (SFE) with concurrent implant placement. The study received approval from the local Ethics Committee, followed the Helsinki Declaration and CONSORT guidelines, and obtained written informed consent from all participants. Eligibility criteria included adults aged 18 or older, in good systemic health, with a missing posterior maxillary tooth, residual bone height (RBH) ≤ 4 mm, and crestal bone width >6 mm. Patients were randomly assigned to either the OD group or the LW group. Both techniques involved simultaneous single implant placement, and all surgical and prosthetic procedures were performed by one experienced clinician. Primary outcomes were pain (measured on a visual analogue scale), and quality of life (QoL) using a modified Oral Health Impact Profile-14 (OHIP-14) questionnaire, assessed daily for the first week postoperatively. Patients also self-reported symptoms like edema, hematoma, and epistaxis using a 5-point Likert scale. Secondary outcomes included implant stability (ISQ), surgery duration, complications, and analgesic use. Follow up extended for 1 year. A total of 20 participants (8 males, 12 females; mean age 47.9 years) were included in the study. Up to Day 3, pain levels were significantly lower (p < 0.05) in OD group, which also had a significantly reduced average analgesic intake throughout the first postoperative week (p < 0.001) compared to LW group. The OHIP-14 total scores were significantly lower in OD group on all days except Day 5 (p < 0.05). The mean surgical time was significantly shorter in the OD group (33 vs. 71 min; p < 0.001). Additionally, postoperative symptoms and complications were significantly fewer (p < 0.001), and the ISQ at 6 months was higher in the OD group (p < 0.05). All implants were restored using screw-retained zirconia crowns, with a 100% success rate. Both OD and LW techniques were effective for SFE with simultaneous implant placement in cases with RBH ≤ 4 mm. However, OD showed superior short-term outcomes, including less pain and swelling, faster surgery, lower analgesic use, and improved QoL measures.
{"title":"Minimally invasive advantage? Patient feedback supports osseodensification in sinus lift surgery","authors":"Omer Waleed Majid","doi":"10.1038/s41432-025-01155-2","DOIUrl":"10.1038/s41432-025-01155-2","url":null,"abstract":"Gaspar J, Botelho J, Proença L et al. Osseodensification versus lateral window technique for sinus floor elevation with simultaneous implant placement: a randomized clinical trial on patient-reported outcome measures. Clin Implant Dent Relat Res 2024; 26: 113–126. A randomized, controlled, parallel-arm clinical trial. To compare patient-reported and surgical outcomes between osseodensification (OD) and lateral window (LW) techniques for sinus floor elevation (SFE) with concurrent implant placement. The study received approval from the local Ethics Committee, followed the Helsinki Declaration and CONSORT guidelines, and obtained written informed consent from all participants. Eligibility criteria included adults aged 18 or older, in good systemic health, with a missing posterior maxillary tooth, residual bone height (RBH) ≤ 4 mm, and crestal bone width >6 mm. Patients were randomly assigned to either the OD group or the LW group. Both techniques involved simultaneous single implant placement, and all surgical and prosthetic procedures were performed by one experienced clinician. Primary outcomes were pain (measured on a visual analogue scale), and quality of life (QoL) using a modified Oral Health Impact Profile-14 (OHIP-14) questionnaire, assessed daily for the first week postoperatively. Patients also self-reported symptoms like edema, hematoma, and epistaxis using a 5-point Likert scale. Secondary outcomes included implant stability (ISQ), surgery duration, complications, and analgesic use. Follow up extended for 1 year. A total of 20 participants (8 males, 12 females; mean age 47.9 years) were included in the study. Up to Day 3, pain levels were significantly lower (p < 0.05) in OD group, which also had a significantly reduced average analgesic intake throughout the first postoperative week (p < 0.001) compared to LW group. The OHIP-14 total scores were significantly lower in OD group on all days except Day 5 (p < 0.05). The mean surgical time was significantly shorter in the OD group (33 vs. 71 min; p < 0.001). Additionally, postoperative symptoms and complications were significantly fewer (p < 0.001), and the ISQ at 6 months was higher in the OD group (p < 0.05). All implants were restored using screw-retained zirconia crowns, with a 100% success rate. Both OD and LW techniques were effective for SFE with simultaneous implant placement in cases with RBH ≤ 4 mm. However, OD showed superior short-term outcomes, including less pain and swelling, faster surgery, lower analgesic use, and improved QoL measures.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"26 3","pages":"123-124"},"PeriodicalIF":2.3,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-06DOI: 10.1038/s41432-025-01153-4
Omer Waleed Majid
Saatchi M, Mohammadi G, Iranmanesh P et al. Articaine buccal infiltration for mandibular first molars with symptomatic irreversible pulpitis: is it as effective as inferior alveolar nerve block with lidocaine? A systematic review and meta-analysis. Clin Oral Investig 2025; 29: 146. A systematic review and meta-analysis. To compare the anesthetic success rate of 4% articaine buccal infiltration (BI) with 2% lidocaine inferior alveolar nerve block (IANB) for lower first molars (LM1) presenting with symptomatic irreversible pulpitis. This systematic review, registered in PROSPERO and conducted per PRISMA guidelines, included randomized clinical trials (RCTs) on adults (≥18 years) with symptomatic irreversible pulpitis in LM1, using a single cartridge (1.7–1.8 ml) of either articaine BI or lidocaine IANB as the primary injection. Studies were excluded if they were non-RCTs, used other anesthetics or techniques, included supplemental injections, used articaine BI as a secondary method, or did not report results specific to LM1. Anesthetic success was defined as patient-reported pain <4 on a visual analog scale (VAS) during cavity access or canal instrumentation. A comprehensive English-language search was conducted across five databases and gray literature sources, with manual searches of key journals and textbooks. Two independent reviewers handled screening and data extraction. Risk of bias was assessed with the Cochrane RoB2 tool. A fixed-effect meta-analysis estimated pooled risk ratios, with tests for heterogeneity and publication bias. Trial Sequential Analysis (TSA) was utilized to evaluate the robustness of the evidence, and the GRADE approach assessed certainty. From 780 initial records, five RCTs met the inclusion criteria after full screening. These trials included 405 patients aged 18–65, each comparing 4% articaine BI (1:100,000 epinephrine) against 2% lidocaine IANB (three with 1:100,000 and two with 1:200,000 epinephrine). No adverse effects were reported in three studies; the remaining two did not address safety. Risk of bias was low in three trials, with two showing some concerns due to unclear randomization and blinding. No publication bias was detected. Of the 405 first molars with irreversible pulpitis, 284 cases (70%) demonstrated successful pulpal anesthesia. The meta-analysis showed similar anesthetic success rates between articaine BI (72.2%) and lidocaine IANB (68.1%) [RR = 1.06, 95% CI: 0.93–1.20, I2 = 24.51%]. However, TSA indicated that current evidence is inconclusive due to insufficient sample size. According to GRADE, the overall certainty of evidence was rated as moderate, with concerns primarily related to imprecision. Moderate evidence indicates that 4% articaine BI offers anesthetic efficacy comparable to 2% lidocaine IANB for LM1 with symptomatic irreversible pulpitis. Although additional high-quality clinical trials are needed to validate these results, articaine BI may present a promising alternative to the tra
{"title":"Articaine buccal infiltration for mandibular first molars with irreversible pulpitis: is the evidence enough?","authors":"Omer Waleed Majid","doi":"10.1038/s41432-025-01153-4","DOIUrl":"10.1038/s41432-025-01153-4","url":null,"abstract":"Saatchi M, Mohammadi G, Iranmanesh P et al. Articaine buccal infiltration for mandibular first molars with symptomatic irreversible pulpitis: is it as effective as inferior alveolar nerve block with lidocaine? A systematic review and meta-analysis. Clin Oral Investig 2025; 29: 146. A systematic review and meta-analysis. To compare the anesthetic success rate of 4% articaine buccal infiltration (BI) with 2% lidocaine inferior alveolar nerve block (IANB) for lower first molars (LM1) presenting with symptomatic irreversible pulpitis. This systematic review, registered in PROSPERO and conducted per PRISMA guidelines, included randomized clinical trials (RCTs) on adults (≥18 years) with symptomatic irreversible pulpitis in LM1, using a single cartridge (1.7–1.8 ml) of either articaine BI or lidocaine IANB as the primary injection. Studies were excluded if they were non-RCTs, used other anesthetics or techniques, included supplemental injections, used articaine BI as a secondary method, or did not report results specific to LM1. Anesthetic success was defined as patient-reported pain <4 on a visual analog scale (VAS) during cavity access or canal instrumentation. A comprehensive English-language search was conducted across five databases and gray literature sources, with manual searches of key journals and textbooks. Two independent reviewers handled screening and data extraction. Risk of bias was assessed with the Cochrane RoB2 tool. A fixed-effect meta-analysis estimated pooled risk ratios, with tests for heterogeneity and publication bias. Trial Sequential Analysis (TSA) was utilized to evaluate the robustness of the evidence, and the GRADE approach assessed certainty. From 780 initial records, five RCTs met the inclusion criteria after full screening. These trials included 405 patients aged 18–65, each comparing 4% articaine BI (1:100,000 epinephrine) against 2% lidocaine IANB (three with 1:100,000 and two with 1:200,000 epinephrine). No adverse effects were reported in three studies; the remaining two did not address safety. Risk of bias was low in three trials, with two showing some concerns due to unclear randomization and blinding. No publication bias was detected. Of the 405 first molars with irreversible pulpitis, 284 cases (70%) demonstrated successful pulpal anesthesia. The meta-analysis showed similar anesthetic success rates between articaine BI (72.2%) and lidocaine IANB (68.1%) [RR = 1.06, 95% CI: 0.93–1.20, I2 = 24.51%]. However, TSA indicated that current evidence is inconclusive due to insufficient sample size. According to GRADE, the overall certainty of evidence was rated as moderate, with concerns primarily related to imprecision. Moderate evidence indicates that 4% articaine BI offers anesthetic efficacy comparable to 2% lidocaine IANB for LM1 with symptomatic irreversible pulpitis. Although additional high-quality clinical trials are needed to validate these results, articaine BI may present a promising alternative to the tra","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"26 2","pages":"89-90"},"PeriodicalIF":2.3,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-01DOI: 10.1038/s41432-025-01136-5
Viviane Oliveira Prado, Carlos Flores-Mir, Magda Feres, Luciana Faria Sanglard, Rafaela Manente, Paulo Nelson-Filho, Murilo Fernando Neuppmann Feres
Numerous instruments have been suggested to analyze the essential Evidence-Based Dentistry (EBD) dimensions, but it is unclear whether they were comprehensive and validated appropriately. To investigate instruments that assess EBD-related dimensions. We included primary studies involving dentists, faculty members, or dental students at any level of professional career that described validation or translation/transcultural adaptation processes of EBD instruments or reported the application of such instruments. Searches were conducted at PubMed, Embase, Web of Science, and Scopus, along with manual searches in EBD journals, Google Scholar and reference lists. Descriptive data were collected and standardized in tables, and summarized. Fifty studies were included. The KACE (Knowledge, Attitudes, Access, and Confidence Evaluation) instrument demonstrated clarity, internal consistency, face validity, discriminant validity, and responsiveness, but neglected important dimensions such as EBD-related practices, patient benefits, barriers/facilitators, and willingness to learn and disseminate EBD practices. The modified Berlin questionnaire designed to measure perceived/actual knowledge, showed clarity, internal consistency, content validity, and discriminant validity, but lacked data on reproducibility, face validity, construct validity, and responsiveness. Other questionnaires, while broader, had significant limitations in reported reliability and validation. Although the KACE instrument and the modified Berlin questionnaire underwent relatively rigorous reliability and validation testing, they were considered insufficiently comprehensive. When analyzed together, other questionnaires were found to be relatively more comprehensive, but they exhibited more significant limitations regarding reported reliability and validation assessments. This suggests the need for a novel instrument that fulfills a more significant number of validation phases and EBD-related dimensions.
背景：许多工具已被建议用于分析基本的循证牙科（EBD）维度，但尚不清楚它们是否全面和适当验证。目的：研究评估ebd相关维度的工具。方法：我们纳入了涉及牙医、教职员工或任何专业水平的牙科学生的初步研究，这些研究描述了EBD仪器的验证或翻译/跨文化适应过程，或报告了此类仪器的应用。检索在PubMed， Embase， Web of Science和Scopus上进行，同时在EBD期刊，谷歌Scholar和参考文献列表中进行手动检索。描述性数据被收集并以表格形式标准化，并进行汇总。结果：纳入50项研究。KACE （Knowledge, Attitudes, Access, and Confidence Evaluation，知识、态度、获取和信心评估）工具显示了清晰度、内部一致性、面孔效度、区别效度和响应性，但忽略了重要的维度，如EBD相关实践、患者利益、障碍/促进因素以及学习和传播EBD实践的意愿。改进后的柏林问卷旨在测量感知/实际知识，显示出清晰性、内部一致性、内容效度和区别效度，但缺乏再现性、面孔效度、结构效度和反应性的数据。其他问卷虽然范围更广，但在报告的信度和有效性方面存在显著的局限性。结论：虽然KACE量表和修改后的柏林问卷经过了相对严格的信度和验证检验，但被认为不够全面。当一起分析时，发现其他问卷相对更全面，但它们在报告的可靠性和有效性评估方面表现出更大的局限性。这表明需要一种新的仪器来满足更多的验证阶段和ebd相关的维度。
{"title":"Questionnaires related to Evidence-Based Practice applied to dentists, faculty members or dental students: a scoping review","authors":"Viviane Oliveira Prado, Carlos Flores-Mir, Magda Feres, Luciana Faria Sanglard, Rafaela Manente, Paulo Nelson-Filho, Murilo Fernando Neuppmann Feres","doi":"10.1038/s41432-025-01136-5","DOIUrl":"10.1038/s41432-025-01136-5","url":null,"abstract":"Numerous instruments have been suggested to analyze the essential Evidence-Based Dentistry (EBD) dimensions, but it is unclear whether they were comprehensive and validated appropriately. To investigate instruments that assess EBD-related dimensions. We included primary studies involving dentists, faculty members, or dental students at any level of professional career that described validation or translation/transcultural adaptation processes of EBD instruments or reported the application of such instruments. Searches were conducted at PubMed, Embase, Web of Science, and Scopus, along with manual searches in EBD journals, Google Scholar and reference lists. Descriptive data were collected and standardized in tables, and summarized. Fifty studies were included. The KACE (Knowledge, Attitudes, Access, and Confidence Evaluation) instrument demonstrated clarity, internal consistency, face validity, discriminant validity, and responsiveness, but neglected important dimensions such as EBD-related practices, patient benefits, barriers/facilitators, and willingness to learn and disseminate EBD practices. The modified Berlin questionnaire designed to measure perceived/actual knowledge, showed clarity, internal consistency, content validity, and discriminant validity, but lacked data on reproducibility, face validity, construct validity, and responsiveness. Other questionnaires, while broader, had significant limitations in reported reliability and validation. Although the KACE instrument and the modified Berlin questionnaire underwent relatively rigorous reliability and validation testing, they were considered insufficiently comprehensive. When analyzed together, other questionnaires were found to be relatively more comprehensive, but they exhibited more significant limitations regarding reported reliability and validation assessments. This suggests the need for a novel instrument that fulfills a more significant number of validation phases and EBD-related dimensions.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"26 3","pages":"148-149"},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-25DOI: 10.1038/s41432-025-01143-6
A. Selva Arockiam, P. Nithya Nandhini, Praveen Chandrashekaraiah, Reshma Benzigar, Ramya Shivananjan
Adam R, Grender J, Timm H, Qaqish J, Goyal C R. A randomized controlled trial evaluating a novel oscillating-rotating electric toothbrush versus a sonic toothbrush for plaque and gingivitis. Am J Dent 2025; 38: 3–8. The study was a rigorously designed, single-center, examiner-blinded, randomized controlled trial. It included adult participants presenting with clinical signs of gingivitis and visible plaque. Subjects were randomly assigned to use either an oscillating-rotating electric toothbrush or a high-end sonic electric toothbrush. Both groups brushed twice daily for four weeks using a standard sodium fluoride toothpaste. Gingival inflammation was evaluated using the Modified Gingival Index and the Gingival Bleeding Index. Plaque accumulation was assessed via the Rustogi Modification of the Navy Plaque Index. Data were collected at baseline, immediately after a single brushing session and after four weeks of consistent use. Participants were adults diagnosed with plaque-induced gingivitis. They were randomized into two arms: one group used the Oral-B iO2 toothbrush with the Ultimate Clean brush head in Daily Clean mode while the other group used the usmile Marble-Art toothbrush with the Advanced Whitening brush head in high-intensity clean mode. All participants followed a standardized brushing regimen. Examiner blinding was implemented to reduce observational bias and enhance objectivity. Gingival inflammation and plaque levels were assessed at three distinct intervals. The percentage of participants achieving gingival health defined as fewer than ten percent of bleeding sites was also measured. Comparisons were performed within and between groups. The threshold for statistical significance was set at a probability value less than 0.05. Both devices led to statistically significant reductions in plaque accumulation and gingival inflammation. However, the oscillating-rotating toothbrush demonstrated superior performance across all parameters. Participants using this toothbrush exhibited a significantly greater reduction in Modified Gingival Index scores and a marked decrease in the number of bleeding sites. A higher proportion of users in this group attained gingival health status. Plaque removal was more effective following a single brushing session with notable improvements observed throughout the entire mouth, interproximal surfaces and along the gingival margins. These benefits were maintained at the four-week follow-up. The oscillating-rotating toothbrush achieved superior clinical outcomes in the reduction of plaque and gingival inflammation when compared to the sonic toothbrush. Its efficacy was observed both immediately and after consistent use over a four-week period.
Adam R, Grender J, Timm H, Qaqish J, Goyal C R.一项随机对照试验评估新型振荡旋转电动牙刷与声波牙刷治疗牙菌斑和牙龈炎的疗效。Am J Dent 2025；38: 3 - 8。资料来源：该研究是一项严格设计的单中心、检查者盲法、随机对照试验。它包括有牙龈炎临床症状和可见菌斑的成年参与者。受试者被随机分配使用振荡旋转电动牙刷或高端声波电动牙刷。两组人每天刷牙两次，持续四周，使用标准的氟化钠牙膏。采用改良牙龈指数和牙龈出血指数评估牙龈炎症。通过海军斑块指数的Rustogi修正来评估斑块积累。数据在基线、单次刷牙后立即和连续使用四周后收集。研究选择：参与者为诊断为菌斑性牙龈炎的成年人。他们被随机分为两组：一组在日常清洁模式下使用带有终极清洁刷头的Oral-B iO2牙刷，另一组在高强度清洁模式下使用带有高级美白刷头的usmile Marble-Art牙刷。所有参与者都遵循标准化的刷牙方案。采用检查者盲法以减少观察偏倚，提高客观性。数据提取和合成：在三个不同的间隔评估牙龈炎症和菌斑水平。达到牙龈健康的参与者的百分比定义为出血部位少于10%，也进行了测量。在组内和组间进行比较。统计学显著性阈值设置为概率值小于0.05。结果：两种器械均能显著减少菌斑积累和牙龈炎症。然而，振荡旋转牙刷在所有参数上都表现出优越的性能。使用这种牙刷的参与者在改良牙龈指数得分上表现出明显更大的下降，出血部位的数量也明显减少。该组中较高比例的使用者达到了牙龈健康状况。单次刷牙后菌斑清除更有效，在整个口腔、近端间表面和牙龈边缘观察到明显的改善。这些益处在四周的随访中保持不变。结论：与声波牙刷相比，摆动旋转牙刷在减少牙菌斑和牙龈炎症方面取得了更好的临床效果。它的功效被观察到立即和持续使用后超过四周的时间。
{"title":"Should clinicians recommend oscillating-rotating toothbrushes over sonic models for superior plaque and gingivitis control?","authors":"A. Selva Arockiam, P. Nithya Nandhini, Praveen Chandrashekaraiah, Reshma Benzigar, Ramya Shivananjan","doi":"10.1038/s41432-025-01143-6","DOIUrl":"10.1038/s41432-025-01143-6","url":null,"abstract":"Adam R, Grender J, Timm H, Qaqish J, Goyal C R. A randomized controlled trial evaluating a novel oscillating-rotating electric toothbrush versus a sonic toothbrush for plaque and gingivitis. Am J Dent 2025; 38: 3–8. The study was a rigorously designed, single-center, examiner-blinded, randomized controlled trial. It included adult participants presenting with clinical signs of gingivitis and visible plaque. Subjects were randomly assigned to use either an oscillating-rotating electric toothbrush or a high-end sonic electric toothbrush. Both groups brushed twice daily for four weeks using a standard sodium fluoride toothpaste. Gingival inflammation was evaluated using the Modified Gingival Index and the Gingival Bleeding Index. Plaque accumulation was assessed via the Rustogi Modification of the Navy Plaque Index. Data were collected at baseline, immediately after a single brushing session and after four weeks of consistent use. Participants were adults diagnosed with plaque-induced gingivitis. They were randomized into two arms: one group used the Oral-B iO2 toothbrush with the Ultimate Clean brush head in Daily Clean mode while the other group used the usmile Marble-Art toothbrush with the Advanced Whitening brush head in high-intensity clean mode. All participants followed a standardized brushing regimen. Examiner blinding was implemented to reduce observational bias and enhance objectivity. Gingival inflammation and plaque levels were assessed at three distinct intervals. The percentage of participants achieving gingival health defined as fewer than ten percent of bleeding sites was also measured. Comparisons were performed within and between groups. The threshold for statistical significance was set at a probability value less than 0.05. Both devices led to statistically significant reductions in plaque accumulation and gingival inflammation. However, the oscillating-rotating toothbrush demonstrated superior performance across all parameters. Participants using this toothbrush exhibited a significantly greater reduction in Modified Gingival Index scores and a marked decrease in the number of bleeding sites. A higher proportion of users in this group attained gingival health status. Plaque removal was more effective following a single brushing session with notable improvements observed throughout the entire mouth, interproximal surfaces and along the gingival margins. These benefits were maintained at the four-week follow-up. The oscillating-rotating toothbrush achieved superior clinical outcomes in the reduction of plaque and gingival inflammation when compared to the sonic toothbrush. Its efficacy was observed both immediately and after consistent use over a four-week period.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"26 2","pages":"99-100"},"PeriodicalIF":2.3,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-24DOI: 10.1038/s41432-025-01140-9
Nidhi Parmar
Benzaquen S I, Ardakani M T, Tsigarida A et al. Biologic complications with removable partial dentures assisted by short implants: A 34-month pilot randomized controlled clinical trial. J Prosthet Dent 2025; https://doi.org/10.1016/j.prosdent.2025.01.026 . This single-centre, parallel-arm, pilot randomised controlled clinical trial (RCT) was conducted in accordance with CONSORT guidelines. The primary objective was to compare the incidence of biologic complications between conventional removable partial dentures (CRPDs) and short implant-assisted removable partial dentures (IARPDs) in patients with Kennedy Class I bilateral distal-extension edentulism. A secondary objective was to evaluate implant survival and peri-implant outcomes over a mean follow-up period of 34 months. Thirty-three partially edentulous adult participants (aged 36–87 years) were recruited. Included participants had sufficient bone height to accommodate 6 mm implants without the need for bone augmentation. A strict exclusion criteria included current smoking, uncontrolled diabetes, pregnancy or lactation, and use of immunosuppressive or antiresorptive medications. Random allocation to receive either CRPDs (n = 19) or IARPDs supported by two short implants (n = 14) was conducted after initial CRPD fabrication. Both implant- and non-implant-related biologic complications were recorded at baseline and annual follow-up visits up to four years. Parameters included caries, gingival inflammation, abutment tooth loss, peri-implant mucositis, peri-implantitis, and marginal bone level (MBL) changes. Statistical analyses were performed using chi-square tests, Fisher’s exact test and paired and unpaired t-tests, with significance set at p = 0.05. Non-implant biologic complications affected 44.7% of abutment teeth in the CRPD group and 21.4% in the IARPD group; however, this difference was not statistically significant (p > 0.05). The most common complications were gingival inflammation and caries. One abutment tooth was lost in the CRPD group versus none in the IARPD group. Peri-implant mucositis and peri-implantitis were observed in 42.9% and 10.7% of implants, respectively. Implant survival was 81.2%. Most MBL occurred prior to prosthetic loading, with minimal loss thereafter. Both CRPDs and IARPDs are viable treatment options for patients with Kennedy Class I edentulism, with no significant difference in the incidence of biologic complications between groups.
{"title":"Biologic complications in short implant-assisted versus conventional partial dentures","authors":"Nidhi Parmar","doi":"10.1038/s41432-025-01140-9","DOIUrl":"10.1038/s41432-025-01140-9","url":null,"abstract":"Benzaquen S I, Ardakani M T, Tsigarida A et al. Biologic complications with removable partial dentures assisted by short implants: A 34-month pilot randomized controlled clinical trial. J Prosthet Dent 2025; https://doi.org/10.1016/j.prosdent.2025.01.026 . This single-centre, parallel-arm, pilot randomised controlled clinical trial (RCT) was conducted in accordance with CONSORT guidelines. The primary objective was to compare the incidence of biologic complications between conventional removable partial dentures (CRPDs) and short implant-assisted removable partial dentures (IARPDs) in patients with Kennedy Class I bilateral distal-extension edentulism. A secondary objective was to evaluate implant survival and peri-implant outcomes over a mean follow-up period of 34 months. Thirty-three partially edentulous adult participants (aged 36–87 years) were recruited. Included participants had sufficient bone height to accommodate 6 mm implants without the need for bone augmentation. A strict exclusion criteria included current smoking, uncontrolled diabetes, pregnancy or lactation, and use of immunosuppressive or antiresorptive medications. Random allocation to receive either CRPDs (n = 19) or IARPDs supported by two short implants (n = 14) was conducted after initial CRPD fabrication. Both implant- and non-implant-related biologic complications were recorded at baseline and annual follow-up visits up to four years. Parameters included caries, gingival inflammation, abutment tooth loss, peri-implant mucositis, peri-implantitis, and marginal bone level (MBL) changes. Statistical analyses were performed using chi-square tests, Fisher’s exact test and paired and unpaired t-tests, with significance set at p = 0.05. Non-implant biologic complications affected 44.7% of abutment teeth in the CRPD group and 21.4% in the IARPD group; however, this difference was not statistically significant (p > 0.05). The most common complications were gingival inflammation and caries. One abutment tooth was lost in the CRPD group versus none in the IARPD group. Peri-implant mucositis and peri-implantitis were observed in 42.9% and 10.7% of implants, respectively. Implant survival was 81.2%. Most MBL occurred prior to prosthetic loading, with minimal loss thereafter. Both CRPDs and IARPDs are viable treatment options for patients with Kennedy Class I edentulism, with no significant difference in the incidence of biologic complications between groups.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"26 2","pages":"83-84"},"PeriodicalIF":2.3,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12204855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Odontogenic keratocyst (OKC) is aggressive cyst with high recurrence rates, traditionally treated using Carnoy’s solution (CS) as an adjunct to surgical enucleation. However, the toxicity and potential complications of CS, including neurotoxicity and tissue damage, necessitate the exploration of safer alternatives. The aim of systematic review was to evaluate potential alternatives to CS for preventing recurrence and minimizing postoperative complications in OKC. Studies were searched and retrieved from PubMed, Scopus, and Web of Science using relevant keywords. Inclusion criteria focused on studies evaluating alternatives to CS for OKC treatment, while reviews, case reports, and non-clinical studies were excluded. Quality assessment was performed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias 2 Tool. Data extraction included study design, intervention, recurrence rates, and complications. Findings were summarized descriptively. Meta-analysis (random-effect model) was performed for recurrence in OKC. Six studies met the inclusion criteria after examining 280 studies. These studies examined recurrence and post-operative complications in CS, modified CS (MCS), and 5- Fluorouracil (5-FU) treated OKC cases. The recurrence events were 15/153 with CS and 37/200 with MCS; however, no recurrence was recorded for 5-FU. Paresthesia was seen in 17/74 of OKC-treated CS/MCS cases and 12/72 of OKC-treated 5-FU cases after surgery. The random-effects model estimated a pooled risk ratio of 0.13 (95% CI: 0.02 to 0.68, p = 0.015), suggesting that the 5-FU treated OKC patients was significantly less likely to experience recurrence than the CS/MCS treated OKC patients. 5-FU is found to be a better alternative to CS or MCS in terms of recurrence and postoperative complications in OKC. While 5-FU and/or CS remain effective, its side effects highlight the need for safer, equally effective alternatives. Future research should focus on long-term outcomes and the efficacy of novel treatments, including herbal therapies.
目的：牙源性角化囊肿（OKC）是一种高复发率的侵袭性囊肿，传统上使用卡诺伊溶液（CS）作为手术摘除的辅助治疗。然而，CS的毒性和潜在并发症，包括神经毒性和组织损伤，需要探索更安全的替代品。系统回顾的目的是评估在OKC中预防复发和减少术后并发症的潜在替代CS。方法：使用相关关键词从PubMed、Scopus和Web of Science中检索和检索研究。纳入标准侧重于评估CS替代OKC治疗的研究，而综述、病例报告和非临床研究被排除在外。使用纽卡斯尔-渥太华量表和Cochrane风险偏倚2工具进行质量评估。资料提取包括研究设计、干预、复发率和并发症。对研究结果进行描述性总结。对OKC复发率进行meta分析（随机效应模型）。结果：在280项研究中，有6项研究符合纳入标准。这些研究检查了CS、改良CS （MCS）和5-氟尿嘧啶（5- fu）治疗OKC病例的复发和术后并发症。CS的复发率为15/153，MCS的复发率为37/200；5-FU无复发记录。术后17/74的okc治疗CS/MCS病例和12/72的okc治疗5-FU病例出现感觉异常。随机效应模型估计的合并风险比为0.13 (95% CI: 0.02 ~ 0.68, p = 0.015)，表明5-FU治疗的OKC患者复发的可能性明显低于CS/MCS治疗的OKC患者。结论：在OKC的复发率和术后并发症方面，5-FU优于CS或MCS。虽然5-FU和/或CS仍然有效，但其副作用表明需要更安全、同样有效的替代品。未来的研究应该关注长期结果和新疗法的疗效，包括草药疗法。
{"title":"Efficacy of alternative agents to Carnoy’s solution in the prevention of recurrence in odontogenic keratocyst: a systematic review and meta-analysis","authors":"Samyuktha Aarthi, Monal Yuwanati, Pratibha Ramani, Gheena Sukumaran","doi":"10.1038/s41432-025-01138-3","DOIUrl":"10.1038/s41432-025-01138-3","url":null,"abstract":"Odontogenic keratocyst (OKC) is aggressive cyst with high recurrence rates, traditionally treated using Carnoy’s solution (CS) as an adjunct to surgical enucleation. However, the toxicity and potential complications of CS, including neurotoxicity and tissue damage, necessitate the exploration of safer alternatives. The aim of systematic review was to evaluate potential alternatives to CS for preventing recurrence and minimizing postoperative complications in OKC. Studies were searched and retrieved from PubMed, Scopus, and Web of Science using relevant keywords. Inclusion criteria focused on studies evaluating alternatives to CS for OKC treatment, while reviews, case reports, and non-clinical studies were excluded. Quality assessment was performed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias 2 Tool. Data extraction included study design, intervention, recurrence rates, and complications. Findings were summarized descriptively. Meta-analysis (random-effect model) was performed for recurrence in OKC. Six studies met the inclusion criteria after examining 280 studies. These studies examined recurrence and post-operative complications in CS, modified CS (MCS), and 5- Fluorouracil (5-FU) treated OKC cases. The recurrence events were 15/153 with CS and 37/200 with MCS; however, no recurrence was recorded for 5-FU. Paresthesia was seen in 17/74 of OKC-treated CS/MCS cases and 12/72 of OKC-treated 5-FU cases after surgery. The random-effects model estimated a pooled risk ratio of 0.13 (95% CI: 0.02 to 0.68, p = 0.015), suggesting that the 5-FU treated OKC patients was significantly less likely to experience recurrence than the CS/MCS treated OKC patients. 5-FU is found to be a better alternative to CS or MCS in terms of recurrence and postoperative complications in OKC. While 5-FU and/or CS remain effective, its side effects highlight the need for safer, equally effective alternatives. Future research should focus on long-term outcomes and the efficacy of novel treatments, including herbal therapies.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"26 3","pages":"151-151"},"PeriodicalIF":2.3,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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