Selective Internal Radiation Therapy Using Y-90 Resin Microspheres for Metastatic Colorectal Cancer: An Updated Systematic Review and Network Meta-Analysis.

INTRODUCTION: This literature review and exploratory network meta-analysis (NMA) aimed to compare the clinical effectiveness and tolerability of selective internal radiation therapy (SIRT) using yttrium-90 (Y-90) resin microspheres, regorafenib (REG), trifluridine-tipiracil (TFD/TPI), and best supportive care (BSC) in adult patients with chemotherapy-refractory or chemotherapy-intolerant metastatic colorectal cancer (mCRC). METHODS: In light of recently published data, the literature was searched to complement and update a review published in 2018. Studies up to December 2022 comparing two or more of the treatments and reporting overall survival (OS), progression-free survival (PFS), or incidence of adverse events (AE) were included. The NMA compared hazard ratios (HRs) for OS and PFS using Markov chain Monte Carlo techniques. RESULTS: Fifteen studies were included, with eight studies added (none addressing SIRT). All active treatments improved OS in relation to BSC. SIRT had the longest OS among all treatments, although without statistically significant differences (HR [95% credible interval] for SIRT, 0.48 [0.27, 0.87]; TFD/TPI, 0.62 [0.46, 0.83]; REG, 0.78 [0.57, 1.05]) in a fixed effects model. Information regarding SIRT was insufficient for PFS analysis, and TFD/TPI was the best intervention (HR 2.26 [1.6, 3.18]). One SIRT study reported radioembolization-induced liver disease in > 10% of the sample; this was symptomatically managed. Non-haematological AEs (hand-foot skin reaction, fatigue, diarrhoea, hypertension, rash or desquamation) were more common with REG, while haematological events (neutropoenia, leukopenia, and anaemia) were more common with TFD/TPI. CONCLUSION: Current evidence supports SIRT treatment in patients with chemotherapy-refractory or chemotherapy-intolerant mCRC compared to newer oral agents, with comparable OS and low incidence of AEs.

Short versus standard implants associated with sinus floor elevation: An umbrella review of meta-analyses of multiple outcomes.

STATEMENT OF PROBLEM: Bone loss in the edentulous posterior maxilla complicates dental implant placement. In spite of the evidence available, there is continued uncertainty about the benefit of short implants for different outcomes. PURPOSE: The purpose of this review was to evaluate the existing evidence for short and standard implants in association with sinus floor elevation regarding implant survival, marginal bone loss, and complications by using an umbrella review of the evidence across meta-analysis of interventional studies. MATERIAL AND METHODS: Medline, Scopus, and Cochrane Library were searched to identify systematic reviews and meta-analyses comparing short implants and standard implants associated with sinus floor elevation. Data extraction and methodological quality (AMSTAR-2) was assessed by 2 authors independently. Outcomes were categorized and tabulated to assess effectiveness. Qualitative data were analyzed using thematic synthesis. The certainty of the evidence was evaluated with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. RESULTS: From 2011 studies, 7 systematic reviews (66 studies) were included as per the eligibility criteria. There was no statistically significant difference between groups for implant survival (risk ratio=1.08; P=.79), and the qualitative analysis did not show differences for prosthetic outcomes. Standard implants were associated with fewer prosthetic complications in the quantitative analysis (risk ratio=3.27; P<.01), but no difference was found between the treatments in the qualitative analysis. Short implants showed reduced marginal bone loss (0.98 ±0.12 mm; mean difference=-0.22; P<.01) and better biologic outcomes (risk ratio=0.16; P<.01). Patient satisfaction was similar for both groups, whereas costs and time for the procedure favored short implants. The quality of the evidence was graded as "critically low" (57.1% of the reviews) and "low." There was a high certainty of evidence for implant survival, whereas marginal bone loss and complications had moderate certainty. CONCLUSIONS: Short implants had a better or equal performance compared with standard implants for all outcomes assessed. However, assumptions were based on reviews with low or critically low quality of the evidence, suggesting the development of high-quality systematic reviews in this field.

Treatment options for large posterior restorations: a systematic review and network meta-analysis.

BACKGROUND: The best treatment option for large caries in permanent posterior teeth is still a matter of uncertainty in dental literature. The authors conducted a network meta-analysis to address the challenges related to rehabilitation of these teeth. TYPES OF STUDIES REVIEWED: The authors selected prospective and retrospective studies that compared at least 2 different treatment alternatives for permanent teeth with a minimum of 5 years of follow-up. The authors searched databases from MEDLINE, Scopus, Cochrane Library, and Web of Science in October 2019 without language or year of publication restrictions. RESULTS: From 11,263 studies identified, 43 studies fulfilled the eligibility criteria and were included in the final review. Only 13 studies were randomized controlled trials and were classified as low risk of bias. Gold (annual failure rate of 0.29%) and metal ceramic (annual failure rate of 0.52%) crowns performed better for indirect restorations and direct resin composite performed better for direct restorations (annual failure rate of 2.19%). The most substantial comparisons were between feldspathic and glass ceramics, followed by direct resin composite and amalgam; there were no statistically significant differences between these interventions. Results of the pairwise meta-analysis showed mainly glass ionomer as significantly more prone to failure than amalgam and direct composite resin. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Reference standard direct and indirect materials except for glass ionomer can be used for restorations of large posterior caries.

Influence of different implant-abutment connection designs on the mechanical and biological behavior of single-tooth implants in the maxillary esthetic zone: A systematic review.

STATEMENT OF PROBLEM: A consensus regarding which implant-abutment connection type would perform best in the anterior maxilla is lacking. PURPOSE: The purpose of this systematic review was to determine the best implant-abutment connection type for anterior single-tooth implants considering esthetics, success, and survival rates. MATERIAL AND METHODS: An electronic search was conducted in MEDLINE, Scopus, Embase, and the Cochrane Library databases to identify clinical studies on single-tooth implants with external and internal hexagon, and/or Morse taper connections. These studies needed to describe at least one of the following outcomes: esthetic score, survival/success rate, or marginal bone loss. The included studies and reports were assessed for bias using the Cochrane risk of bias tool. RESULTS: Of the 891 articles identified, 29 were selected and analyzed. The most common technical complications were abutment screw loosening and crown-cement loosening, while dehiscence and recession were the most common biological complications. The most frequent complications were dehiscence for external hexagon, crown-cement loosening for the internal hexagon, and ceramic fracture for the Morse taper. Esthetics were favorable for all connections, but the internal hexagon performed better. However, better results for marginal bone loss, success, and survival were found for the Morse taper. The global annual failure rate was 0.90% and 0.2% for Morse taper, 0.3% for external hexagon, and 2.2% for internal hexagon. CONCLUSIONS: This review suggests that Morse taper performs better for survival, success, and marginal bone loss. Internal hexagon performed better for esthetic parameters. Additional controlled studies are needed to provide stronger evidence because the evidence generated in this study was considered low.