Evidence gaps in orthognathic surgery, a Delphi study protocol

Aim: To assess the research gaps identified in a recent mapping review of orthognathic surgery through their evaluation by clinical experts, leading to a clinically relevant list of research gaps. This will guide future investigations of the topic, focusing on the outcomes of blood loss, infection, and relapse. Methods: The Delphi technique will be used to appraise the identified research gaps. The expert panel will include maxillofacial surgeons who regularly perform orthognathic surgery. Potential participants will be identified through various methods, including contact information from articles in the mapping review, nominations from peers, and social media platforms. Two rounds of surveys will be undertaken with Likert-type and open-ended questions to assess the clinical relevance of research gaps. For the second round, participants will receive a report of the results of the first round. Questions will be modified depending on the answers obtained in the first round. A consensus of 60% will be considered valid. Conclusions: Through this Delphi study, in a collaborative effort between researchers and clinical experts, a comprehensive understanding of the clinical relevance of research gaps in orthognathic surgery will be achieved. The outcomes will guide future investigations, ultimately improving the outcomes and practices in this field.

Risk of bias in dentistry-related randomized controlled trials in spanish language journals

Objectives: To assess the risk of bias (RoB) of randomized controlled trials (RCTs) published in dental journals in the Spanish language. Methods: A systematic retrospective survey was conducted of all RCTs published from 1980 to 2019 in dentistry Spanish and Latin American journals. We extracted data and performed RoB assessments using the Cochrane Risk of Bias tool. Results: 292 RCTs published in 51 journals were included. The best-rated domains were incomplete outcome data, selective reporting, and other biases. The domains assessed with higher proportions of an unclear or high risk of bias were sequence generation, allocation concealment, and blinding of outcome assessment. There is a low proportion of RCTs published in Spanish language journals. However, the number has been increasing over the years, and the low risk of bias assessment rates across domains show an increasing trend. Conclusions: A low percentage of Spanish-language dental journals issue RCTs. Our assessment of these RCTs' RoB suggests higher difficulties in the design and conduction phase than in the posterior reporting stage.

Evaluación de estrategias para la indicación de instrucciones postoperatorias en exodoncia: Estudio clínico aleatorizado. Primera etapa / An evaluation of strategies for postoperative indications in tooth extraction: A randomised clinical trial. First Stage

Introducción: la exodoncia presenta diversos factores que influyen en el éxito del período postoperatorio. El aprendizaje de las indicaciones postoperatorias ha evidenciado influir en la morbilidad, complicaciones y calidad de vida del paciente durante sus cuidados postoperatorios. Sin embargo, la estrategia de aprendizaje convencional para entregar las instrucciones postoperatorias verbal-escrita (VE) no toma en cuenta el posible compromiso cognitivo, psicológico y emocional del individuo, realizando una entrega de instrucciones indiferente al estado del paciente. Materiales y métodos: los pacientes serán asignados aleatoriamente a grupos divididos según estrategia de aprendizaje utilizada: convencional VE y psicopedagógica visual, auditiva y kinésica (VAK). Inmediatamente posterior al procedimiento se realizará la explicación de los cuidados postoperatorios según grupo. Se realizará una encuesta inmediatamente posterior a la entrega de instrucciones, luego a las 24 horas y a los 7 días luego de la cirugía, con el objetivo de evaluar el grado de retención. Finalmente, para comparar, se contrastaron las medias de cada grupo en los tres tiempos de aplicación. Resultados: se observa una media mayor en el grupo VAK, visible en todos los tiempos de aplicación, donde observamos una tendencia a presentar mejores niveles de retención. Diferencias aun no estadísticamente significativas, ya que la muestra aún no representa el total del muestreo calculado. Discusión: los resultados preliminares nos muestran que la estrategia visual-kinésica-auditiva es superior a la convencional en cuanto a nivel de retención, lo cual podría convertirla en un método de elección al momento de entregar indicaciones post exodoncia, para tener un resultado postoperatorio óptimo.

Introduction: Tooth extractions present several factors that affect the success of the postoperative period. The correct learning of the postoperative instructions has shown to affect the morbidity, complications, and quality of life of the patient after the surgery. Neverthe-less, the conventional verbal-written (VW) learning strategy to give the postoperative indications doesn't consider the possible cognitive, psychological and emotional compromise of the patient. Methods: The patients were assigned randomly into two groups, according to the learning strategy used: conventional (VW) and a psycho-pedagogical visual, auditive, and kinesic learning strategy (VAK). After extraction, the patients were explained about the postoperative care, according to the group they belonged to. A survey was conducted immediately, one day, and seven days after the procedure to record the grade of retention of the information. The means of each group were compared. Results: A higher mean was observed in the VAK group, which is visible in all the application times, determining a tendency to present better levels of retention of the information. The differences are not yet statistically significant, as the sample does not represent the total of patients previously considered. Discussion: The preliminary results show that the VAK strategy is superior to the conventional one regarding the level of retention of the information, becoming the method of choice when giving postoperative indications after dental extractions to develop a more optimal postoperative result

Toxina Botulínica tipo A para el bruxismo del sueño en adultos / Botulinum toxin type A for sleep bruxism in adults

RESUMEN: Introducción: El bruxismo del sueño es un comportamiento que se caracteriza por la actividad repetitiva de los músculos masticadores. Varias terapias para el manejo del bruxismo del sueño se centran en la relajación de los músculos involucrados, incluyendo la inyección intramuscular de Toxina Botulínica tipo A (BoNTA). A pesar de que se ha comprobado la efectividad de esta terapia frente al dolor subjetivo, cuando se asocia a bruxismo del sueño, es necesario determinarla frente a desenlaces objetivos, tanto a nivel craneofacial como sistémico. Además, se debe evaluar también la seguridad de esta intervención frente a eventos adversos tales como afecciones estéticas, debilidad masticatoria y pérdida ósea mandibular, entre otros. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un meta-análisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Identificamos 11 revisiones sistemáticas que en conjunto incluyeron 9 estudios primarios, de los cuales, 8 corresponden a ensayos aleatorizados. Concluimos que la inyección intramuscular de toxina botulínica tipo A podría disminuir el dolor en reposo, presentar poca o nula diferencia en dolor durante la masticación y mejorar la autoevaluación del bruxismo, pero la certeza de la evidencia es baja. Por otra parte, no es posible establecer con claridad si el uso de Toxina Botulínica Tipo A disminuye el número de eventos de bruxismo, ya que la certeza de la evidencia ha sido evaluada como muy baja. Finalmente y a pesar de la evidencia existente respecto de los potenciales eventos adversos producto de la intervención con Toxina Botulínica Tipo A en los músculos masticatorios, los ensayos clínicos fallan en evaluarlos y reportarlos.

ABSTRACT: Introduction: The sleep bruxism is a behavior that impacts the craniofacial musculoskeletal system characterized by repetitive activity of the masticatory muscles. Several management strategies for sleep bruxism are focused of the relaxation of the involved masticatory muscles, including the intramuscular injection of botulinum toxin type A (BoNTA). Although the effectiveness of BoNTA for myofascial pain, when related with the sleep bruxism in adult patients, it is necessary to determine its effectiveness using objective outcomes at both craniofacial and systemic levels. In addition, it is necessary to determine the safety of this intervention in the context of adverse events such as aesthetic alterations, reduced masticatory function, mandibular bone loss among others. Methods: A search was performed using Epistemonikos, the biggest database for systematic reviews in health, with is maintained by screening of multiple sources of information, including MEDLINE, EMBASE, Cochrane, among others. Data from systematic reviews were extracted, and analysis of the primary studies was performed, including a meta-analysis and a summary of findings table using GRADE assessment. Results and conclusions: 11 systematic reviews were identified, and 9 primary studies were included. 8 out of these 9 studies corresponded to randomized clinical trials. We conclude that the intramuscular injection of BoNTA may reduce the pain during rest and results in either little or none difference in pain during mastication, when pain is associated with sleep bruxism in adult patients. Also, low evidence is determined for auto-report and subjective evaluation of sleep bruxism among adult patients. Additionally, it is not possible to determine if the BoNTA intervention is effective to reduce the bruxism events due to the low evidence. Finally, although evidence regarding adverse events such as mandibular bone loss after BoNTA intervention in masticatory muscles has been published at preclinical and clinical levels, the clinical trials fail to consider and to report these outcomes.