ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Root Surface Application of Bisphosphonates Reduces Root Resorption of Implanted Teeth
Clinical Question For patients who undergo tooth replantation, does root surface application of bisphosphonates compared to adding nothing reduce root resorption?
Clinical Bottom Line Surface application of bisphosphonates reduces root resorption of implanted teeth. This statement is supported by a systematic review consisting of 10 animal studies in which bisphosphonates like zoledronate and alendronate reduced root resorption in animal teeth after replantation. The application of bisphosphonates is a simple procedure that can be done during any replantation procedure.
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) 27960049Ansari /2016 n = 378 molars; n = 41 premolars; n = 108 incisorsSystematic review of randomized trials
Key resultsIn 8 out of the 10 studies, surface application of alendronate prevented root resorption. The remaining two studies showed surface application of bisphosphonates had no significant effect on root resorption, and intracanal application of bisphosphonates actually increased root resorption. In one of the studies, surface application of zoledronate was more effective than alendronate, and etidronate was not effective in preventing root resorption. In this same study, zoledronate at a concentration of 20 μM had a higher efficacy than at concentrations of 1, 5, 10, and 40 μM. For all the studies, the prereplantation dry times ranged from 0-75 minutes. Aside from the two studies that also applied the bisphosphonates inside the canal, all of the studies applied bisphosphonates on the root surface by immersion in their respective liquid bisphosphonate for either 5, 10, or 20 minutes. Concentrations of the bisphosphonates ranged from .01 mM to 1mM. The control groups were stored in either HBSS (Hank’s Balanced Salt Solution), NaCl, NaOCl, NaF, or Ca(OH)2 for either 5, 10, or 20 minutes. Measure of root resorption was collected 21 days to 4 months after application of the bisphosphonate. Root resorption was measured as compared to the control.
Evidence Search replantation and bisphosphonates
Comments on
The Evidence
Validity: The systematic review of animal studies has some limitations. Six studies were given a quality grade of ‘low’ and four studies were given a grade of medium or high. These studies did not include a statistically calculated sample size, and 7 of the 10 studies did not blind their investigators. The biggest limitation is that all the studies were animal studies, whose results may or may not translate to positive clinical outcomes. On the other hand, strengths of this systematic review include: clearly stated research question; extensive search for articles; and multiple authors selecting articles for inclusion and grading the articles for quality. All of these reduce possible bias in the selection of the 10 articles. Perspective: Although the results are positive in terms of preventing root resorption, these experiments were done on animals. For these results to be clinically significant, these studies need to be conducted in humans.
Applicability These results are readily applicable to any patient needing replantation procedures. It would be relatively simple for a clinician to place bisphosphonates on the root of the teeth before replanting the tooth. However, clinical studies on humans need to be done for these results to be highly applicable to a patient.
Specialty/Discipline (Endodontics)
Keywords Bisphosphonates, Replantation
ID# 3174
Date of submission: 04/03/2017spacer
E-mail nguyent24@livemail.uthscsa.edu
Author Thomas Nguyen
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Nikita Ruparel, DDS, MS, PhD
Faculty mentor/Co-author e-mail ruparel@uthscsa.edu
Basic Science Rationale
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