Saudi Cultural Missions Theses & Dissertations
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Item Restricted Osteoradionecrosis Prophylaxis by Pentoxifylline and Tocopherol Prior to Dental Extractions: A Systematic Review(Saudi Digital Library, 2022) Alleft, Abdullah; Leeson, RachelBackground and Objectives: Osteoradionecrosis (ORN) remains one of the most abysmal complications of head and neck radiotherapy (XRT). The advantageous and welcoming news of increased survivability for head and neck cancer patients came at the expense of increased risks of complications in general, including ORN. Consequently, this positive survival outcome provides plentiful of time for dental deterioration to occur, which may lead to more dental extractions, the main propagator for ORN. Therefore, preventing ORN became a pivotal matter for head and neck cancer patients. From the numerous preventative measures for ORN, prophylactic administration of Pentoxifylline and Tocopherol (PVe) appears promising, especially since many publications have demonstrated its success in treating ORN. However, recently multiple studies investigating PVe prophylactic use to prevent ORN came to fruition. This study aims to assess reported publications by employing a systematic review to investigate whether the prophylactic administration of PVe can prevents or reduces the incidence of ORN. Methods: The systematic review was done according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. An electronic database search on Medline (Ovid), Embase (Ovid), Cochrane Library, Web of Science and Google Scholar focusing on the prophylactic use of PVe to prevent ORN was conducted. Results: Out of two thousand five hundred and thirty-six (2536) publications, five (5) were included based on the patient/population, intervention, comparison, outcomes and studies type (PICOS) design for the prophylactic use of PVe before extraction and/or oral surgical procedure. This systematic review revealed out of 440 individuals, 19 developed ORN representing an incidence rate of 4.3%. However, when control groups and studies that were deemed high risk of bias or poor design were excluded, the incidence of ORN dropped to 2.5 % (9 out of 359 individuals). Both outcomes reveal a lower incidence of ORN compared to the established benchmark without any preventive measures of 7% and lower than the controlled group incidence of 11.5 % in one of the reviewed studies. Conclusion: This systematic review shows that current literature supports the prophylactic use of PVe to prevent ORN prior to dental extraction and other oral surgical intervention. Nevertheless, additional well-designed and prospective randomised controlled trial studies are needed to further validate the efficacy of PVe prophylaxis to prevent ORN before any oral surgical intervention.21 0