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.

Histological Evaluation of the Effect of Alendronate on the Maxillary Bone of Wistar Rats Combined with Orthodontic Movement of Intense Force / Evaluación Histológica del Efecto del Alendronate en el Hueso Maxilar de Ratas Wistar Combinado con Movimiento de Ortodoncia de Fuerzas Intensas

SUMMARY: To evaluate the histological adverse effects of alendronate administered systemically and topically in combination with orthodontic movement by intense force. Thirty-six 24-week-old female Wistar rats, ovariectomized, were used and divided into three groups (n = 12/group): control, locally treated with saline (0.07 ml/kg/week) (group 1) and experimental, treated with alendronic acid systemically (0.07 mg/kg/week) (group 2) and locally (7 mg/kg/week) (group 3). At 14 days, an orthodontic anchor was installed in the right first molar, and a force of 144 cN was applied for 28 days. The samples were processed for histological evaluation. Descriptive statistics, Shapiro-Wilk tests, one-way ANOVA with Bonferroni correction, one-way repeated measures ANOVA and chi-square tests were performed. All tests were statistically significant at p <0.05. The adverse events found in all groups were inflammation and osteoclastic activity. In the bisphosphonate-treated groups, there were statistically significant differences (p = 0.005) in the osteoclastic activity between the two hemiarcates. All rats in group 2 presented paralytic ileus. Compared to local administration, systemic treatment with alendronic acid produces more adverse effects, such as inflammation, fibrinoid necrosis, and osteoclastic activity. During the application of intense forces, it was not possible to show that there is necrosis associated with bisphosphonates.

Evaluar los efectos adversos histológicos del alendronato administrado sistémica y tópicamente en combinación con movimientos ortodóncicos de fuerza intensa. Treinta y seis ratas Wistar hembras de 24 semanas de edad, ovariectomizadas, fueron utilizadas y divididas en tres grupos (n = 12/grupo): control, tratado localmente con solución salina (0,07 ml/kg/semana) (grupo 1) y experimental, tratados con ácido alendrónico por vía sistémica (0,07 mg/kg/semana) (grupo 2) y local (7 mg/kg/semana) (grupo 3). A los 14 días se instaló un anclaje de ortodoncia en el primer molar derecho y se aplicó una fuerza de 144 cN durante 28 días. Las muestras fueron procesadas para evaluación histológica. Se realizó estadística descriptiva, pruebas de Shapiro-Wilk, ANOVA de una vía con corrección de Bonferroni, ANOVA de medidas repetidas de una vía y pruebas de chi-cuadrado. Todas las pruebas fueron estadísticamente significativas con un p <0,05. Los eventos adversos encontrados en todos los grupos fueron inflamación y actividad osteoclástica. En los grupos tratados con bisfosfonatos hubo diferencias estadísticamente significativas (p = 0,005) en la actividad osteoclástica entre los dos hemiarcados. Todas las ratas del grupo 2 presentaron íleo paralítico. En comparación con la administración local, el tratamiento sistémico con ácido alendrónico produce más efectos adversos, como inflamación, necrosis fibrinoide y actividad osteoclástica. Durante la aplicación de fuerzas intensas, no fue posible demostrar que existe necrosis asociada con los bisfosfonatos.

Riesgo de hemorragia postquirúrgica en pacientes bajo tratamiento antitrombótico sometidos a cirugía oral: Revisión Sistemática y Metaanálisis / Risk of postsurgical hemorrhage in patients with antitrombotic treatment undergoing oral surgery: A systematic review and Metanalysis

RESUMEN: Introducción: el objetivo de esta revisión fue determinar el riesgo de hemorragia postoperatoria en pacientes con tratamiento anticoagulante oral (TACO) sometidos a cirugía oral que no suspenden su tratamiento comparado con quienes lo modifican o suspenden. Materiales y métodos: se realizó una búsqueda en CENTRAL, Medline y EMBASE, junto con una revisión manual de revistas especializadas y resúmenes de la IADR. Dos revisores realizaron la selección de estudios, evaluación de riesgo de sesgo y extracción de datos de forma independiente. Se seleccionaron los ensayos clínicos aleatorizados que miden la aparición de hemorragias en pacientes sometidos a procedimientos quirúrgicos orales con TACO en comparación con un grupo que interrumpió o modificó su terapia. Resultados: Solo 5 estudios cumplieron los criterios de inclusión (549 pacientes). El metanálisis mostró que el mantenimiento de la TACO no aumenta el riesgo de hemorragia postoperatoria (riesgo relativo: 1,41 [0,93 - 2,16], IC del 95% p = 0,11) en comparación con la interrupción del tratamiento. Conclusión: Aunque se encontró una mayor cantidad de hemorragia postoperatoria en pacientes con TACO comparado con quienes lo interrumpieron o modificaron, esta diferencia no fue estadística ni clínicamente significativa. Por lo tanto, TACO no debe suspenderse en pacientes sometidos a cirugía oral.

ABSTRACT: Introduction: This systematic review aims to determine the postoperative bleeding risk in patients on oral anticoagulant therapy (OAT) undergoing oral surgical procedures when continuing with the treatment, compared with those modifying or discontinuing the treatment. Materials and methods: A search was performed using CENTRAL, Medline and EMBASE, in conjunction with a manual review of indexes of specialized journals and abstracts of the IADR. Study selection, assessments of risk of bias and data extraction were performed independently by 2 reviewers. Randomized clinical trials measuring the occurrence of bleeding in patients on OAT undergoing oral surgical procedures compared with a group discontinuing or modifying their therapy were selected. Results: A total of 5 studies were included based on inclusion criteria (549 patients). The meta-analysis showed that the maintenance of OAT does not increases the risk of postoperative bleeding (relative risk [RR] 1.41 [0.93 - 2.16]; 95% CI p= 0,11) compared with the discontinuation of therapy. Conclusion: Although a larger quantity of oral postoperative bleeding episodes were found in patients continuing with OAT compared with patients discontinuing or modifying their therapy, this difference was neither statistically nor clinically significant. Therefore, OAT should not be discontinued in patients undergoing oral surgery.