Ana Gabriela Costa Normando1, Maria Eduarda Pérez-de-Oliveira1, Eliete Neves Silva Guerra2, Márcio Ajudarte Lopes1, André Caroli Rocha3,4, Thaís Bianca Brandão5, Ana Carolina Prado-Ribeiro1,5, Luiz Alcino Monteiro Gueiros6, Joel B Epstein7,8, César Augusto Migliorati9, Alan Roger Santos-Silva10. 1. Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, SP, Brazil. 2. Laboratory of Oral Histopathology, Health Sciences Faculty, University of Brasilia, Brasilia, DF, Brazil. 3. Oral Medicine Department, AC Camargo Cancer Center, São Paulo, SP, Brazil. 4. Clinics Hospital of the Medical School of the University of São Paulo, São Paulo, Brazil. 5. Dental Oncology Service, Instituto Do Câncer Do Estado de São Paulo (ICESP-FMUSP), São Paulo, Brazil. 6. Departamento de Clínica E Odontologia Preventiva, Oral Medicine Unit, Universidade Federal de Pernambuco, Recife, PE, Brazil. 7. Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA, USA. 8. City of Hope Comprehensive Cancer Center, Duarte, CA, USA. 9. College of Dentistry, University of Florida, Gainesville, FL, USA. 10. Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, SP, Brazil. alan@unicamp.br.
Abstract
PURPOSE: Teeth with poor prognosis are generally recommended to be extracted prior to head and neck radiotherapy (RT) to reduce the risk of developing osteoradionecrosis (ORN), although controversies have been reported. The present systematic review aimed to determine whether tooth extraction prior to head and neck RT may be associated with a reduced risk of developing ORN compared to dental extraction during or after RT. METHODS: The review protocol was registered in PROSPERO (CRD42021241631). The review was reported according to the PRISMA checklist and involved a comprehensive search of PubMed, Scopus, Embase, Cochrane Library, LILACS, and Web of Science, in addition to the gray literature. The selection of studies was performed in two phases by two reviewers independently. The risk of bias of individual studies was analyzed using the Joanna Briggs Institute checklist for cross-sectional studies, and the certainty of evidence was assessed using the GRADE tool. RESULTS: Twenty-eight observational studies were included in the qualitative synthesis, which showed substantial heterogeneity regarding the association between the timing of tooth extraction and ORN development. Twenty-seven of 28 studies were pooled in a meta-analysis that demonstrated a significant association between an increased risk of ORN and post-RT tooth extraction (odds ratio: 1.98; 95% CI: 1.17-3.35; p = 0.01). CONCLUSION: It was confirmed with moderate certainty that dental extractions should be performed prior to the start of head and neck RT to reduce the risk of ORN.
PURPOSE: Teeth with poor prognosis are generally recommended to be extracted prior to head and neck radiotherapy (RT) to reduce the risk of developing osteoradionecrosis (ORN), although controversies have been reported. The present systematic review aimed to determine whether tooth extraction prior to head and neck RT may be associated with a reduced risk of developing ORN compared to dental extraction during or after RT. METHODS: The review protocol was registered in PROSPERO (CRD42021241631). The review was reported according to the PRISMA checklist and involved a comprehensive search of PubMed, Scopus, Embase, Cochrane Library, LILACS, and Web of Science, in addition to the gray literature. The selection of studies was performed in two phases by two reviewers independently. The risk of bias of individual studies was analyzed using the Joanna Briggs Institute checklist for cross-sectional studies, and the certainty of evidence was assessed using the GRADE tool. RESULTS: Twenty-eight observational studies were included in the qualitative synthesis, which showed substantial heterogeneity regarding the association between the timing of tooth extraction and ORN development. Twenty-seven of 28 studies were pooled in a meta-analysis that demonstrated a significant association between an increased risk of ORN and post-RT tooth extraction (odds ratio: 1.98; 95% CI: 1.17-3.35; p = 0.01). CONCLUSION: It was confirmed with moderate certainty that dental extractions should be performed prior to the start of head and neck RT to reduce the risk of ORN.
Authors: Francesca Caparrotti; Shao Hui Huang; Lin Lu; Scott V Bratman; Jolie Ringash; Andrew Bayley; John Cho; Meredith Giuliani; John Kim; John Waldron; Aaron Hansen; Li Tong; Wei Xu; Brian O'Sullivan; Robert Wood; David Goldstein; Andrew Hope Journal: Cancer Date: 2017-06-13 Impact factor: 6.860
Authors: Daniel T Chang; Pamela R Sandow; Christopher G Morris; Rachel Hollander; Lauren Scarborough; Robert J Amdur; William M Mendenhall Journal: Head Neck Date: 2007-06 Impact factor: 3.147