Although a range of pharmacological interventions is available, it remains uncertain which treatment for osteoporosis is more effective. This network meta-analysis study aimed to compare different drug efficacy and safety in randomized controlled trials (RCTs) for the treatment of postmenopausal osteoporosis. PubMed, EMBASE, MEDLINE, Clinicaltrial.gov, Cochrane library, Google scholar were searched up to 31 October 2020. Randomized placebo-controlled trials that reported measures of bone mineral density (BMD) percentage change and/or numbers of adverse events of postmenopausal osteoporosis patients were included. Network meta-analysis was conducted using frequentist approach. Ninety-four RCTs comprising 15,776 postmenopausal osteoporosis females were included in the network meta-analysis. Compared with placebo, most interventions showed increase in BMD change. According to surfaces under the cumulative ranking curves (SUCRAs), strontium ranelate, fluoride, and hormone replacement therapy were most effective in increasing total hip, lumbar spine, and distal radius BMD, respectively. Parathyroid hormone (PTH) was most effective in preventing new hip fracture. When taking into account all anatomic sites, bisphosphonate (BP), monoclonal antibody (mAb), and fluoride have a balanced efficacy in increasing BMD at all sites. Considering both the effectiveness of increasing BMD and preventing hip fracture, mAb, BP, and PTH are more favorable among all interventions. The treatment effects of different medications on BMD percentage change are anatomic site-dependent. After weighing anti-osteoporosis treatment efficacy against risk of complications, BP and mAb are the more favorable interventions to increase BMD at all sites and reduce the risks of hip fracture and death.
The treatment effects of Invisalign® are still obscure due to methodological limitations of previous studies. We introduced a method to comprehensively evaluate the dental and skeletal changes of Class II malocclusion treated non-extraction with Invisalign® and compare with the virtual simulation of ClinCheck® using digital models integrated into maxillofacial cone-beam computed tomography (CBCT). The pretreatment (T1) and posttreatment (T2) scanned digital images of actual dentitions were integrated into maxillofacial CBCT images. To evaluate three-dimensional movement of maxillary teeth and change of mandible position, T1 and T2 digital model-integrated maxillofacial CBCT images were superimposed using voxel-based registrations of stable cranial base structures. To evaluate movement of mandibular teeth, model-integrated mandibular CBCT superimposition was registered on mandibular basal bone. To compare achieved and predicted tooth movements, the actual dental images and the virtual digital models created by ClinCheck® were registered on the T1 dentitions. For simulated upper first molar (U6) distalization of more than 1 mm, treatment accuracy ranged from 31.1% to 40.1%, which was significantly less than virtual planning and previous reports. In unilateral Class II subjects, the amount of U6 distalization on the Class II side was not significantly different from contralateral side, indicating efficacy of sequential distalization was questionable. Those with favorable overjet correction showed evidence of condylar distraction. Digital model-integrated CBCT superimpositions reflected the actual treatment changes in comparison with the virtual simulation, and showed that ideal occlusion was not achieved in mild to moderate Class II adult patients treated non-extraction with Invisalign®.
This study evaluates the effectiveness of adjunctive therapies combined with non-surgical periodontal treatment for Stage III/IV Grade C periodontitis, focusing on pocket depth (PD) reduction, clinical attachment level (CAL) gain, and adverse events. A systematic review and network meta-analysis were conducted, including randomized controlled trials up to September 2024. Inconsistencies and publication bias were detected, prompting sensitivity analyses and effectiveness rankings of adjunctive therapies. Data from 50 studies were included, with 45 entered into network meta-analysis, covering 24 interventions and 1431 patients. Compared to scaling and root planing (SRP) alone, adjunctive systemic lincosamides with nitroimidazole (Mac/Linc+Nitro-S) demonstrated the greatest PD reduction, followed by local statins (Statins-L) in the short term (≤3 months). Statins-L also provided the highest CAL gain. In the medium term (4-6 months), Statins-L remained the most effective, followed by bisphosphonates. For long-term (>6 months) follow-up, where fewer treatment approaches were available, Nitro-S achieved the most significant PD reduction and CAL gain, followed by Mac/Linc-S. Adverse effects were mild and self-limiting. Despite promising findings, inconsistencies in CAL outcomes and potential publication bias highlight the need for further research to confirm long-term safety and efficacy.
Background/purpose: The use of computed tomography (CT) for craniofacial measurements is common in medical imaging, but concerns about accuracy and reliability persist, especially with different CT technologies. This study assessed the accuracy of twenty-six common measurements on consecutive CT images from the same patients, using multidetector CT (MDCT) and cone-beam CT (CBCT) with two software programs (Amira and Dolphin). Materials and methods: Ten adult subjects with consecutive CBCT scans within one year were randomly selected. Another ten subjects with consecutive MDCT scans were paired with the CBCT group based on age, gender, race, occlusion, and craniofacial pattern. All digital imaging and communications in medicine (DICOM) files were randomly coded and analyzed using the two software programs. Intra-examiner reliability was assessed using the intraclass correlation coefficient. Successive measurement errors from consecutive scans for both imaging modalities and software programs were compared. Results: For most skeletal linear and angular measurements, Dolphin showed greater successive measurement errors compared to Amira. Eight of the 26 common measurements had errors greater than one unit (millimeter or degree). Despite almost perfect intra-examiner reliability for upper airway analysis, average successive measurement errors were notably high, particularly for intraoral and oropharyngeal airway volumes. The successive Dolphin measurement error for oropharyngeal airway volume on CBCT images was over three times that on MDCT images. Conclusion: Given the substantial successive measurement errors observed during consecutive CT scanning for the upper airway, this study does not support the quantitative use of CT for analyzing changes in airway dimensions for research purposes. (c) 2024 Association for Dental Sciences of the Republic of China. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
1 January 2022 in Australasian Orthodontic Journal
Post-extraction alveolar ridge resorption is a common sequela when missing mandibular molar spaces are not managed in a timely fashion. The situation becomes more complicated in patients who seek orthodontic treatment if closure of the edentulous space is the major objective in order to avoid prosthetic rehabilitation. In the present article, two cases are reported, in which different bone augmentation graft materials were used and treatment duration and post-orthodontic alveolar ridge characteristics were compared. A regional acceleratory phenomenon after the grafting procedure facilitated uneventful orthodontic space closure. The status of the investing alveolar bone was compared using post-treatment cone-beam computed tomography. Both autogenous bone graft and allograft ridge augmentation procedures aided in successful molar protraction through the resorbed mandibular alveolar ridge, as well as preventing periodontal attachment loss.