The Management of Ameloblastoma To Improve the Clinical Outcome: A Systematic Review

Abstract

Abstract: Purpose: This systematic review aims to study and assess the clinical management and outcomes of ameloblastoma. Methods: A structured search of the literature with clear inclusion and exclusion criteria was conducted in accordance with the PRISMA statement. A database search was performed using Medline/PubMed, ScienceDirect, Web of Science, Cochrane, and Google Scholar. A critical appraisal process was implemented to avoid any possible bias from the two reviewers (F.A. and C.M.) and any disagreements between the reviewers were resolved by K.H. All the extracted data from the literature were stored in a Microsoft Excel file (Version 2019). Results: A total of 1,274 studies were obtained from the database searches (Medline/PubMed: 331; ScienceDirect: 435; Web of Science: 451; Cochrane: 8; Google Scholar: 49), with 76 articles meeting the quality criteria, describing 3,927 cases of ameloblastoma. A sum of 1,669 conservative interventions was reviewed, in which 500 (29.95%) recurred; a total of 1,850 radical interventions were also reviewed, yielding a recurrence of 194 (10.48%) cases. Only four articles discussed the application of BRAF targeted therapy as a treatment approach. 12 articles primarily considered cystic ameloblastoma, referring to 456 cases (406 unicystic cases). In these, 358 conservative interventions were reviewed, with a recurrence of 69 (19.3%) and, 41 radical surgical approaches were examined, in which only one case recurred (2.4%). Conclusion: The results of the current systematic review paper are limited by the absence of a strong randomised study. Evidence in the literature favours the radical treatment approach over the conservative approach in terms of recurrence rate. The unicystic ameloblastoma, and particularly the mural type, should be treated more aggressively than the other subtypes. Targeted therapy shows a promising clinical outcome, although further research should be conducted with longer follow-up times