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Preventive Treatments for Osteonecrosis of the Jaw: A Systematic Review and Network Meta-Analysis
Lucas Nascimento Ribeiro1,2, Raisa Severino-Lazo1,2, Belmiro Cavalcanti do Egito Vasconcelos3
1Department of Oral and Maxillofacial Pathology, School of Dentistry, University of Pernambuco (UPE), Recife, Brazil.
Objectives:
A systematic review and network meta-analysis were conducted to address the following research question: "What is the most effective preventive treatment for reducing the risk of jaw osteonecrosis after tooth extraction in patients receiving medications associated with osteonecrosis?"
Material And Methods:
Only randomized clinical trials conducted in adults with a history of medication use associated with osteonecrosis of the jaw, who were treated with a preventive method to reduce the risk of osteonecrosis after tooth extraction, were included. Risk of bias and quality of evidence were assessed using the Cochrane Collaboration tool. Bayesian random-effects mixed treatment comparison model was employed to compare all evaluated strategies: regenerative therapy, primary closure, secondary closure, epiperiosteal flap, and ozone infiltration. The network meta-analysis results were presented as point estimates with 95% credible intervals.
Results:
Five randomized clinical trials conducted between 2012 and 2024 were included after applying the predetermined criteria. These studies evaluated various interventions, including platelet-rich fibrin, platelet-rich plasma, oxygen-ozone therapy, and different surgical closure techniques. Bayesian network meta-analysis demonstrated no conclusive evidence of superiority for any intervention over primary closure.
Conclusion:
No preventive strategy demonstrated superiority in reducing the risk of medication-related osteonecrosis of the jaw in patients undergoing tooth extraction.
Trial Registration:
International Prospective Register of Systematic Reviews: CRD42024619828.
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