ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Hyperbaric Oxygen (HBO) Therapy Does Not Improve Implant Survival for Irradiated Patients
Clinical Question Does hyperbaric oxygen therapy reduce the risk of implant failure in irradiated patients requiring dental implants?
Clinical Bottom Line There is no evidence supporting that Hyperbaric Oxygen therapy improves implant survival for irradiated patients.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 24158336Chambrone/201315 studies were chosen from 1,051 publications. Among them 1,689 implants were placed on irradiated jaws. But only 3 studies were on HBO therapy. Meta-Analysis
Key resultsThere was only one RCT study among the 3 selected studies on HBO therapy; based on the result of that single RCT study, HBO did not affect implant loss (Schoen et al..2007). In conclusion, there is not enough evidence to support the theory that HBO therapy provides any clinical benefits in implant success in irradiated patients. Risk ratio: 1.28; 95% confidence interval: 0.19, 8.82; p = .80, I2- 91%   
#2) 24085641Esposito/2013Patient Group One RCT was identified. There were 13 patients who received HBO therapy and 13 controls. Systematic review of randomized trials
Key resultsOnly 9 patients from each group completed the study. A total of 8 patients passed away prior to the completion of the study. In conclusion, prosthetic failure rate is as follows: 8 implants failed from 5 patients who received HBO therapy compared to 3 implant failure from 2 control patients. HBO therapy does not improve the osseointegration of implants in irradiated patients. Risk Ratio: 3; 95% Confidence Interval :0.13, 67.06; p= <0.1
Evidence Search PubMed Search; "Hyperbaric Oxygenation"[Mesh] AND "Dental Implants"[Mesh] AND (systematic[sb] OR Randomized Controlled Trial[ptyp])
Comments on
The Evidence
The first article, which was written by Chambrone was a Systemic Review of RCT. The search yielded 1,051 eligible publications. Among them, 15 publications were selected based on the inclusion criteria. 3 studies used HBO therapy on irradiated patients. A total of 10,150 implants were placed, and among them 1,689 implants were placed on irradiated patients. Meta-analysis was conducted. Esposito wrote the second article. It was a systematic review of one identified RCT. But the RCT identified was very low quality. The study included a total of 26 patients; among them 13 patients received HBO therapy and 13 patients were controls. Meta Analysis was not conducted. Both articles conducted a comprehensive, detailed search for the publications and two independent reviewers screened each article for their validity. The CI ranges from the Esposito article was 0.13 to 67.06. The wide discrepancy in the CI was due to poor quality/grade of the RCT study. A high quality or moderate quality research can have an important impact and may even change the confidence interval. According to the article, “ The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI)”.
Applicability These findings apply to a very specific patient population who may have dramatic gains in function through successful implant therapy making the use of HBO therapy a reasonable consideration. The use of machined implants in most of the studies, “which is no longer used because of its higher failure rate, particularly in the maxilla,” reduces the applicability of the findings to cases with rough surfaces.
Specialty/Discipline (Oral Medicine/Pathology/Radiology) (General Dentistry) (Oral Surgery) (Periodontics) (Prosthodontics) (Restorative Dentistry)
Keywords Dental Implants, Irradiated patients, Hyperbaric oxygen therapy
ID# 2968
Date of submission: 02/27/2016spacer
E-mail pathiyil@livemail.uthscsa.edu
Author Nessa Pathiyil
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Thomas Oates, DDS
Faculty mentor/Co-author e-mail oates@uthscsa.edu
Basic Science Rationale
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Comments on the CAT
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