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Review
. 2022 Dec 28;12(1):239.
doi: 10.3390/jcm12010239.

Management of Tooth Extraction in Patients Taking Antiresorptive Drugs: An Evidence Mapping Review and Meta-Analysis

Chang Liu  1 , Yu-Tao Xiong  1 , Tao Zhu  1 , Wei Liu  1 , Wei Tang  1 , Wei Zeng  1
Affiliations
Review

Management of Tooth Extraction in Patients Taking Antiresorptive Drugs: An Evidence Mapping Review and Meta-Analysis

Chang Liu et al. J Clin Med. .

Abstract

Background: Medication-related osteonecrosis of the jaw (MRONJ) is a well-known severe adverse reaction of antiresorptive, antiangiogenic or targeted therapies, and usually occurs after tooth extraction. This review is aimed at determining the efficacy of any intervention of tooth extraction to reduce the risk of MRONJ in patients taking antiresorptive drugs, and present the distribution of evidence in these clinical questions.

Methods: Primary studies and reviews were searched from nine databases (Medline, EMBase, Cochrane Library, Scopus, WOSCC, Inspec, KCI-KJD, SciELO and GIM) and two registers (ICTRP and ClinicalTrials.gov) to 30 November 2022. The risk of bias was assessed with the ROBIS tool in reviews, and the RoB 2 tool and ROBINS-I tool in primary studies. Data were extracted and then a meta-analysis was undertaken between primary studies where appropriate.

Results: Fifteen primary studies and five reviews were included in this evidence mapping. One review was at low risk of bias, and one randomized controlled trial was at moderate risk, while the other eighteen studies were at high, serious or critical risk. Results of syntheses: (1) there was no significant risk difference found between drug holiday and drug continuation except for a subgroup in which drug continuation was supported in the reduced incidence proportion of MRONJ for over a 3-month follow-up; (2) the efficacy of the application of autologous platelet concentrates in tooth extraction was uncertain; (3) there was no significant difference found between different surgical techniques in any subgroup analysis; and (4) the risk difference with antibacterial prophylaxis versus control was -0.57, 95% CI -0.85 to -0.29.

Conclusions: There is limited evidence to demonstrate that a drug holiday is unnecessary (and may in fact be potentially harmful) in dental practice. Primary closure and antibacterial prophylaxis are recommended despite limited evidences. All evidence have been graded as either of a low or very low quality, and thus further high-quality randomized controlled trials are needed to answer this clinical question.

Keywords: evidence mapping; medication-related osteonecrosis of the jaw; meta-analysis; preventive dentistry; tooth extraction.

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Conflict of interest statement

The authors declare that they have no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
PRISMA 2020 flow diagram for this evidence mapping review.
Figure 2
Figure 2
Evidence map (temporal profile) [15,16,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40].
Figure 3
Figure 3
Evidence map of primary studies (regional profile) [27,28,29,30,31,32,33,34,35,36,37,38,39,40].
Figure 4
Figure 4
Risk of bias assessment in this evidence mapping review [15,16,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40].
Figure 5
Figure 5
Forest plot of Comparison 1 (drug holiday versus drug continuation) [29,32,33,35,36,37,38,39,40].
Figure 6
Figure 6
Forest plot of Comparison 2 (APC versus control) [27,30,32,33].
See this image and copyright information in PMC

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