Efficacy of bone‐substitute materials use in immediate dental implant placement: A systematic review and meta‐analysis

OBJECTIVE: To assess the efficacy of using a bone substitute material (BSM) in the fixture–socket gap in patients undergoing tooth extraction and immediate implant placement. MATERIALS AND METHODS: MEDLINE, EMBASE, and CENTRAL databases were searched for randomized controlled trials (RCTs). RCTs were screened for eligibility, and data were extracted by two authors independently. Risk of bias (ROB) was assessed using Cochrane's ROB tool 2.0. Primary outcomes were implant failure, overall complications, and soft‐tissue esthetics. Secondary outcomes were vertical buccal bone resorption, vertical interproximal bone resorption, horizontal buccal bone resorption, and mid‐buccal mucosal recession. Meta‐analysis was performed using random‐effects model with generic inverse variance weighing. GRADE was used to grade the certainty of the evidence. RESULTS: After screening 19 544 potentially eligible references, 20 RCTs were included in this review, with a total of 848 patients (916 sites). Most included RCTs were deemed of some concerns (53%) or at low (38%) risk of bias, except for overall complications (high ROB). Implant failure did not differ significantly RR = 0.92 (confidence intervals [CI] 0.34 to 2.46) between using a BSM compared with not using a BSM (NoBSM). BSM use resulted in less horizontal buccal bone resorption (MD = −0.52 mm [95% CI −0.74 to −0.30]), a higher esthetic score (MD = 1.49 [95% CI 0.46 to 2.53]), but also more complications (RR = 3.50 [95% CI 1.11 to 11.1] compared with NoBSM. Too few trials compared types of BSMs against each other to allow for pooled analyses. The certainty of the evidence was considered moderate for all outcomes except implant failure (low), overall complications (very low), and vertical interproximal bone resorption (very low). CONCLUSION: BSM use during immediate implant placement reduces horizontal buccal bone resorption and improves the periimplant soft‐tissue esthetics. Although BSM use increases the risk of predominantly minor complications

A systematic review and meta-analysis of the risk of increasing adiposity on Barrett's Esophagus

OBJECTIVES: Esophageal adenocarcinoma and its precursor lesion, Barrett's esophagus, are increasing in incidence in western populations. Gastroesophageal reflux disease (GERD) and high body mass index (BMI) are known risk factors, but it is unclear whether BMI mediates its risk on Barrett's esophagus independently. This systematic review and meta-analysis investigated whether increasing BMI is associated with Barrett's esophagus as compared to general population and GERD controls. METHODS: Search strategies were conducted in MEDLINE (U.S. National Library of Medicine, Bethesda, MD) (1966-2005) and EMBASE (Reed Elsevier PLC, Amsterdam, The Netherlands) (1980-2005). Studies to be included were required to present "current" BMI data for consecutively recruited Barrett's esophagus patients and appropriate comparison arms with a minimum number of 30 subjects in each. RESULTS: The literature search produced 5,501 hits from which 295 papers were extracted. Only :10 studies met the criteria for inclusion. The Statistics/Data Analysis (STATA) program was used to conduct random effects meta-analyses. Nine studies comparing the BMI of the Barrett's esophagus and GERD groups produced a pooled odds ratio (OR) of 0.99 per kg/m(2) (95% confidence interval [CI] 0.97-1.01, I-2 = 52%), while the pooled estimate of three studies comparing Barrett's esophagus with general population controls was 1.02 per kg/m(2) (95% CI 1.01-1.04, I-2 = 0%). CONCLUSIONS: Increasing adiposity is only an indirect risk factor of Barrett's esophagus through the precursor lesion of GERD. Hence, BMI status has no predictive value with respect to GERD patients and their risk of progression to Barrett's esophagus