Efficacy of alternative or adjunctive measures to conventional non-surgical and surgical treatment of peri-implant mucositis and peri-implantitis: a systematic review and meta-analysis

Abstract Purpose To evaluate the efficacy of alternative or adjunctive measures to conventional non-surgical or surgical treatment of peri-implant mucositis and peri-implantitis. Material and methods Prospective randomized and nonrandomized controlled studies comparing alternative or adjunctive measures, and reporting on changes in bleeding scores (i.e., bleed0ing index (BI) or bleeding on probing (BOP)), probing depth (PD) values or suppuration (SUPP) were searched. Results Peri-implant mucositis: adjunctive use of local antiseptics lead to greater PD reduction (weighted mean difference (WMD) = − 0.23 mm; p = 0.03, respectively), whereas changes in BOP were comparable (WMD = − 5.30%; p = 0.29). Non-surgical treatment of peri-implantitis: alternative measures for biofilm removal and systemic antibiotics yielded higher BOP reduction (WMD = − 28.09%; p = 0.01 and WMD = − 17.35%; p = 0.01, respectively). Surgical non-reconstructive peri-implantitis treatment: WMD in PD amounted to − 1.11 mm favoring adjunctive implantoplasty (p = 0.02). Adjunctive reconstructive measures lead to significantly higher radiographic bone defect fill/reduction (WMD = 56.46%; p = 0.01 and WMD = − 1.47 mm; p = 0.01), PD (− 0.51 mm; p = 0.01) and lower soft-tissue recession (WMD = − 0.63 mm; p = 0.01), while changes in BOP were not significant (WMD = − 11.11%; p = 0.11). Conclusions Alternative and adjunctive measures provided no beneficial effect in resolving peri-implant mucositis, while alternative measures were superior in reducing BOP values following non-surgical treatment of peri-implantitis. Adjunctive reconstructive measures were beneficial regarding radiographic bone-defect fill/reduction, PD reduction and lower soft-tissue recession, although they did not improve the resolution of mucosal inflammation.

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Surgical treatment is better than non-surgical treatment for primary patellar dislocation: a meta-analysis of randomized controlled trials

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-019-03308-2 ◽

2019 ◽

Vol 140 (2) ◽

pp. 219-229 ◽

Cited By ~ 1

Author(s):

Zhengdao Fu ◽

Zhiqiang Zhu ◽

Haitao Chen ◽

Shiqin Zhang

Keyword(s):

Surgical Treatment ◽

Randomized Controlled Trials ◽

Patellar Dislocation ◽

Meta Analysis ◽

Controlled Trials ◽

Randomized Controlled ◽

Non Surgical Treatment ◽

Better Than

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Comparison of Surgical versus Non-Surgical Treatment of Displaced 3- and 4-Part Fractures of the Proximal Humerus: A Meta-Analysis

Journal of Investigative Surgery ◽

10.3109/08941939.2015.1005781 ◽

2015 ◽

Vol 28 (4) ◽

pp. 215-224 ◽

Cited By ~ 7

Author(s):

Feng Mao ◽

De-Hua Zhang ◽

Xiao-Chun Peng ◽

Yi Liao

Keyword(s):

Surgical Treatment ◽

Proximal Humerus ◽

Meta Analysis ◽

Non Surgical Treatment

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Efficacy of various core decompression techniques versus non-operative treatment for osteonecrosis of the femoral head: a systemic review and network meta-analysis of randomized controlled trials

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04808-2 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Quanzhe Liu ◽

Wenlai Guo ◽

Rui Li ◽

Jae Hyup Lee

Keyword(s):

Surgical Treatment ◽

Bone Graft ◽

Statistical Difference ◽

Radiographic Progression ◽

Meta Analysis ◽

Core Decompression ◽

Systemic Review ◽

Current Evidence ◽

Cochrane Library ◽

Non Surgical Treatment

Abstract Background Various Joint-preserving therapy (JPT) methods have been performed and tried in recent decades, but their results and efficacy were inconsistent and controversial. The purpose of this study is to evaluate its effectiveness and whether there are statistical differences in treatment between different interventions based on published RCT studies. Methods Following the PRISMA-NMA checklist, Medline, EMBASE, Web of Science, and Cochrane Library databases were searched and collected related RCT studies. The sources were searched from inception up to October 30, 2020. The primary outcomes including the rate of radiographic progression and conversion to THA and the secondary outcome -Harris Hip Scores (HHS) were extracted and compared in a Network meta-analysis. Results Seventeen RCT studies involving 784 patients (918 hips) with seven interventions including CD (core decompression), CD + BG (bone graft), CD + TI (tantalum rod implantation), CD + CT (Cell therapy), CD + BG + CT, VBG (vascularized bone graft), and nonsurgical or conservative treatment for ONFH were evaluated. In the radiographic progression results, CD + CT showed a relatively better result than CD, CD + BG and non-surgical treatment, the surface under the cumulative ranking curve (SUCRA) plot displayed that CD + CT (96.4%) was the best, followed by CD (64.1%).In conversion to THA results, there were no significant differences between the JPT methods and non-surgical treatment. In HHS, there was also no significant difference, other than CD + BG showed a statistical difference than non-surgical treatment only in terms of Cis, but the SUCRA was highest in non-surgical treatment (80.5%) followed by CD + CT (72.8%). Conclusions This Net-work meta-analysis demonstrated that there was no statistical difference in the outcome of radiographic progression and conversion to THA, also in HHS, other than CD + CT showed a relatively superior result in radiographic progression than nonsurgical treatment, namely, it’s maybe an effective method for delaying disease progression or reducing disease development based on current evidence.

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Arthroscopic meniscectomy versus non-surgical or sham treatment in patients with MRI confirmed degenerative meniscus lesions: a protocol for an individual participant data meta-analysis

BMJ Open ◽

10.1136/bmjopen-2019-031864 ◽

2020 ◽

Vol 10 (3) ◽

pp. e031864

Author(s):

Stan R W Wijn ◽

Maroeska M Rovers ◽

Jan J Rongen ◽

Håvard Østerås ◽

May A Risberg ◽

...

Keyword(s):

Surgical Treatment ◽

Meta Analysis ◽

Trial Data ◽

Individual Participant Data ◽

Sham Treatment ◽

Meniscus Tears ◽

Meniscus Lesions ◽

Individual Participant ◽

The Difference ◽

Non Surgical Treatment

IntroductionArthroscopic partial meniscectomy (APM) after degenerative meniscus tears is one of the most frequently performed surgeries in orthopaedics. Although several randomised controlled trials (RCTs) have been published that showed no clear benefit compared with sham treatment or non-surgical treatment, the incidence of APM remains high. The common perception by most orthopaedic surgeons is that there are subgroups of patients thatdoneed APM to improve, and they argue that each study sample of the existing trials is not representative for the day-to-day patients in the clinic. Therefore, the objective of this individual participant data meta-analysis (IPDMA) is to assess whether there are subgroups of patients with degenerative meniscus lesions who benefit from APM in comparison with non-surgical or sham treatment.Methods and analysisAn existing systematic review will be updated to identify all RCTs worldwide that evaluated APM compared with sham treatment or non-surgical treatment in patients with knee symptoms and degenerative meniscus tears. Time and effort will be spent in contacting principal investigators of the original trials and encourage them to collaborate in this project by sharing their trial data. All individual participant data will be validated for missing data, internal data consistency, randomisation integrity and censoring patterns. After validation, all datasets will be combined and analysed using a one-staged and two-staged approach. The RCTs’ characteristics will be used for the assessment of clinical homogeneity and generalisability of the findings. The most important outcome will be the difference between APM and control groups in knee pain, function and quality of life 2 years after the intervention. Other outcomes of interest will include the difference in adverse events and mental health.Ethics and disseminationAll trial data will be anonymised before it is shared with the authors. The data will be encrypted and stored on a secure server located in the Netherlands. No major ethical concerns remain. This IPDMA will provide the evidence base to update and tailor diagnostic and treatment protocols as well as (international) guidelines for patients for whom orthopaedic surgeons consider APM. The results will be submitted for publication in a peer-reviewed journal.PROSPERO registration numberCRD42017067240.

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Surgical versus non-surgical treatment for acute Achilles’ tendon rupture. A systematic review of literature and meta-analysis

Foot and Ankle Surgery ◽

10.1016/j.fas.2019.03.010 ◽

2020 ◽

Vol 26 (3) ◽

pp. 280-288 ◽

Cited By ~ 10

Author(s):

Yasser Reda ◽

Amr Farouk ◽

Ibrahim Abdelmonem ◽

Ossama A. El Shazly

Keyword(s):

Systematic Review ◽

Surgical Treatment ◽

Achilles Tendon ◽

Tendon Rupture ◽

Meta Analysis ◽

Achilles Tendon Rupture ◽

Review Of Literature ◽

Non Surgical Treatment

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Usefulness of surgical treatment for asymptomatic patients with extra-peritoneal desmoid-type fibromatosis: a systematic review and meta-analysis

Japanese Journal of Clinical Oncology ◽

10.1093/jjco/hyaa009 ◽

2020 ◽

Vol 50 (5) ◽

pp. 574-580

Author(s):

Munehisa Kito ◽

Akira Ogose ◽

Masahiro Yoshida ◽

Yoshihiro Nishida

Keyword(s):

Surgical Treatment ◽

Treatment Group ◽

Progressive Disease ◽

Meta Analysis ◽

Case Series ◽

Case Control ◽

Case Control Studies ◽

Exacerbation Rate ◽

Asymptomatic Patients ◽

Non Surgical Treatment

Abstract Objective The purpose of this systematic review is to assess and compare the efficacy of surgical treatment for patients with asymptomatic extra-peritoneal desmoid-type fibromatosis to the wait-and-see policy by evaluating (1) the exacerbation rate (exacerbation; recurrence after surgery or progressive disease following non-surgical treatment) and (2) treatment-associated complications in extra-peritoneal desmoid-type fibromatosis. Methods We evaluated documents published between 1 January 1990 and 31 August 2017. The risk of bias in the selected literature was analyzed using the Cochrane Collaboration Risk of Bias Tool. Quality of evidence was evaluated using Grading of Recommendation, Assessment, Development and Evaluation approach. Results One prospective cohort study, four case–control studies and five case series studies were identified. Meta-analysis was performed to evaluate the exacerbation rate after treatment on one prospective cohort study and four case–control studies. In comparing surgical and non-surgical treatments, the exacerbation rate was significantly higher in the surgical treatment group (odds ratio: 1.32, 95% confidence interval 1.01–1.73, P = 0.05). However, in the case series study, the recurrence rate was 23.4% for the surgical treatment group, while the progressive disease rate was 28.1% for the non-surgical treatment group. The postoperative complication rates associated with surgical treatment in the two studies were 20.8 and 17.2%, respectively. Conclusions When considering the exacerbation rate, non-surgical treatment might be appropriate for asymptomatic patients with extra-peritoneal desmoid-type fibromatosis. However, if patients with tumor-related symptoms opt for surgery, including those who face difficulties due to the presence of tumors, it is important to fully explain to them the possibility that the recurrence rate and treatment-associated functional failures may increase depending on the site of occurrence.

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