Cochrane · intervention · CD011559

Interventions for preventing osteoradionecrosis of the jaws in adults receiving head and neck radiotherapy

El‐Rabbany, M, Duchnay, M, Raziee, HR, et al. · Cochrane Database of Systematic Reviews · 2019 · Cochrane Library

Oral Health Oral and maxillofacial surgery2 versionsAMSTAR 2: not assessed

Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.

Questions

current version

GRADE rated

No studies

Included studies

as reported

No studies 0 · 0%Ungraded 0 · 0%Very low 8 · 100%Low 0 · 0%Moderate 0 · 0%High 0 · 0%

Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.

Review question

Element	Planned (methods)	Found (results)
Population	All adult head and neck cancer patients who underwent radiotherapy, either curative or adjuvant, having received radiation to the mandible or maxilla or both. Excluded: patients treated with palliative intent; re-irradiated patients; child and adolescent populations.	342 adults with head and neck cancer treated with radiotherapy across 4 trials (Horiot 1983 randomised 220, 190 evaluated; Marx 1985 74; Schoen 2007 26; Batstone 2012 22)
Intervention	Any form of prophylactic intervention (local, systemic, or behavioural, or combinations). Excluded: interventions directly related to cancer therapy (modified radiotherapy or chemotherapy regimens). Examples: prophylactic/symptomatic extraction with intra-operative surgical technique; endodontic/periodontal therapy; caries prevention measures; stents/radiation guards; topical antibiotics; ultrasound; hyperbaric oxygen therapy; systemic prophylactic antibiotics; NSAIDs; corticosteroids; pentoxifylline; tocopherol; platelet-rich plasma; patient education.	PRP in cellulose foam placed in extraction socket (n=22); Fluoride gel 450 ppm (n=99); Hyperbaric oxygen therapy following extractions (n=37); Combined hyperbaric oxygen therapy and perioperative antibiotics prior to implant therapy (n=13)
Comparison	No limitations on control interventions were defined.	Cellulose foam only/placebo (n=22); High-content fluoride toothpaste 1350 ppm (n=91); Perioperative antibiotic prophylaxis penicillin G (n=37); Antibiotics alone (n=13)
Outcomes	Primary: Incidence of ORN (an area of devitalized and exposed bone that fails to heal over three to six months in the absence of local neoplastic disease). Secondary: Adverse effects of interventions (hospitalization, morbidity e.g. pain, loss of sensation, effects on taste, and mortality).	Incidence of ORN (n=4); Adverse effects (n=4)
Study designs	Randomised controlled trials (RCTs) or quasi-RCTs of any intervention for the prevention of ORN, as long as incidence of ORN was reported as a primary or secondary outcome. Excluded: cluster trials; cross-over trials.	Randomised controlled trials, including one split-mouth trial (n=4)
Timing	Not restricted with regard to time points but those with more sufficient follow-up (preferably greater than three years) given greater weight.	Follow-up: 5 years (Batstone 2012); 14 to 36 months (Horiot 1983); 6 months (Marx 1985); 1 year (Schoen 2007)

Search date: 2019-11. Databases: Cochrane Oral Health's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE Ovid; Embase Ovid; AMED (Allied and Complementary Medicine) Ovid; Scopus; Proquest Dissertations and Theses International; Web of Science Conference Proceedings; US National Institutes of…

Questions and results

Show all 2 versions

PRP (platelet-rich plasma) in cellulose foam placed in extraction socket vs No treatment/placebo (cellulose foam only) placed in extraction socket

Population: Adults with head and neck cancer undergoing curative or adjuvant radiotherapy (at risk of osteoradionecrosis of the jaws)

2 questions

Outcome	Effect	Evidence	Status / GRADE
Incidence of ORN 5-year follow-up same question in other reviews	OR 3.32 [0.58, 19.09]	1 study · 44 participants	Very low Downgraded: risk of bias, imprecision
Adverse effects (wound pain) 2 weeks to 12 months same question in other reviews	This comparison was only made in 1 study: mean pain scores at 2 weeks, 2, 6, 9, and 12 months showed no 'significant' differences between the 2 groups (self-reported Likert scale 1 to 10; difference at 2 weeks P =…	1 study · 44 participants	Very low Downgraded: risk of bias, imprecision

Fluoride gel (450 ppm) vs High-content fluoride toothpaste (1350 ppm)

Population: Adults with head and neck cancer undergoing curative or adjuvant radiotherapy (at risk of osteoradionecrosis of the jaws)

2 questions

Outcome	Effect	Evidence	Status / GRADE
Adverse effects 14 to 36 months same question in other reviews	Adverse effects were an outcome of interest in the study conducting this comparison, however no mention was made of the presence or absence of any adverse events	1 study · 220 participants	Very low Downgraded: risk of bias, imprecision
Incidence of ORN 14 to 36 months same question in other reviews	This comparison was only made in 1 study, which showed no difference between the 2 interventions: no patients in either group developed ORN (12- to 36-month follow-up) (0/99 in the fluoride gel group and 0/91 in the…	1 study · 220 participants	Very low Downgraded: risk of bias, imprecision

Hyperbaric oxygen therapy (HBO) following extractions vs Perioperative antibiotic prophylaxis (penicillin G) following extractions

Population: Adults with head and neck cancer undergoing curative or adjuvant radiotherapy (at risk of osteoradionecrosis of the jaws)

2 questions

Outcome	Effect	Evidence	Status / GRADE
Adverse effects 6 months same question in other reviews	Adverse effects were an outcome of interest in the study conducting this comparison, however no mention was made of the presence or absence of any adverse events	1 study · 74 participants	Very low Downgraded: risk of bias, imprecision
Incidence of ORN 6 months same question in other reviews	RR 0.18 [0.43, 0.76]	1 study · 74 participants	Very low Downgraded: risk of bias, imprecision

Combined HBO and perioperative antibiotics prior to dental implant therapy vs Antibiotics alone prior to dental implant therapy

Population: Adults with head and neck cancer undergoing curative or adjuvant radiotherapy (at risk of osteoradionecrosis of the jaws)

2 questions

Outcome	Effect	Evidence	Status / GRADE
Adverse effects (including quality of life) 1 year same question in other reviews	This comparison was only made in 1 study which reported no serious adverse events associated with HBO therapy. Quality of life measures (oral status, functioning, satisfaction) showed emotional functioning and pain…	1 study · 26 participants	Very low Downgraded: risk of bias, imprecision
Incidence of ORN 1 year same question in other reviews	RR 3.00 [0.14, 65.16]	1 study · 26 participants	Very low Downgraded: risk of bias, imprecision