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Post-operative pain management in dental implant surgery: a systematic review and meta-analysis of randomized clinical trials

Khouly, Ismael; Braun, Rosalie Salus; Ordway, Michelle; Alrajhi, Mashal; Fatima, Sana; Kiran, Bhupesh; Veitz-Keenan, Analia
PURPOSE/OBJECTIVE:To evaluate the clinical efficacy of various analgesic medications in mitigating orofacial pain following dental implant surgery. MATERIALS AND METHODS/METHODS:A systematic search was conducted to identify randomized controlled clinical trials (RCTs). The primary outcomes examined were post-operative pain (POP) and consumption of rescue analgesics following implant placement; secondary outcomes included adverse effects, post-operative inflammation, infection, swelling, bleeding, patient satisfaction, and quality of life. Random effects meta-analysis was conducted for risk ratios of dichotomous data. RESULTS:Nine RCTs fulfilled the eligibility criteria. Individual studies and meta-analysis of two studies indicated that nonsteroidal anti-inflammatory drugs (NSAIDs) significantly reduced POP and consumption of rescue analgesics after dental implant placement compared to placebo. Transdermal administration of NSAIDs may be superior to the oral route as it was similarly effective for POP control and resulted in fewer side effects. Glucocorticoids administered as primary analgesics or NSAID adjuvants resulted in comparable pain sensation compared to NSAIDs alone. Caffeine-containing analgesics were reported as acceptable and effective for the treatment of POP and swelling when compared to codeine adjuvants. With regard to analgesic dosing schedules, pain modulation may be most critical during the first 72 h following dental implant placement. Risk of bias assessment indicated an overall low risk of bias across the included trials. CONCLUSION/CONCLUSIONS:Within the limitations of this review, POP following implant surgery may be effectively treated with the short-term use of analgesic medications. However, given the heterogeneity in the available RCTs, there is insufficient evidence to recommend an analgesic regimen following dental implant surgery. CLINICAL RELEVANCE/CONCLUSIONS:Short-term use of analgesic medications may be sufficient for post-operative pain management in dental implant surgery. Ultimately, the clinician's analgesic prescription should be directed by a patient's medical history, in order to increase the success of pain management in a short period of time and decrease potential adverse effects. TRIAL REGISTRATION/BACKGROUND:CRD42018099324.
PMID: 33839939
ISSN: 1436-3771
CID: 4845582

What is the societal economic cost of poor oral health among older adults in the United States? A scoping review

Huang, Shulamite S; Veitz-Keenan, Analia; McGowan, Richard; Niederman, Richard
OBJECTIVE:To assess the state of the literature in the United States quantifying the societal economic cost of poor oral health among older adults. BACKGROUND:Proponents of a Medicare dental benefit have argued that addressing the growing need for dental care among the US older adult population will decrease costs from systemic disease and other economic costs due to oral disease. However, it is unclear what the current economic burden of poor oral health among older adults is in the United States. METHODS:We conducted a scoping review examining the cost of poor oral health among older adults and identified cost components that were included in relevant studies. RESULTS:Other than oral cancer, no studies were found examining the economic costs of poor oral health among older adults (untreated tooth decay, gum disease, tooth loss and chronic disease/s). Only two studies examining the costs of oral cancer were found, but these studies did not assess the full economic cost of oral cancer from patient, insurer and societal perspectives. CONCLUSIONS:Future work is needed to assess the full economic burden of poor oral health among older adults in the United States, and should leverage novel linkages between medical claims data, dental claims data and oral health outcomes data.
PMID: 33719086
ISSN: 1741-2358
CID: 4817392

Adopting an interdisciplinary clinical approach with older adults with Zoom

Chapter by: Fink, Nancy; Kaye, Jillian; Veitz-Keenan, Analia; Levine, Marci; Solvakovsky, Silvia
in: Clinical & Educational Scholarship Showcase by
[New York NY : NYU College of Dentistry. NYU Academy of Distinguished Educators], 2021
pp. ?-?
CID: 4819932

Adapting curriculum to the Integrated National Board Dental Examination

Chapter by: Levine, Marci; Veitz-Keenan, Analia
in: Clinical & Educational Scholarship Showcase by
[New York NY : NYU College of Dentistry. NYU Academy of Distinguished Educators], 2021
pp. ?-?
CID: 4819972

Adapting curriculum to the Integrated National Dental Board Examination

Chapter by: Levine, Marci; Veitz-Keenan, Analia
in: Clinical & Educational Scholarship Showcase by
[New York NY : NYU College of Dentistry. NYU Academy of Distinguished Educators], 2021
pp. -
CID: 4816362

Adhesive restorations for the treatment of dental non-carious cervical lesions [Intervention Protocol]

Veitz-Keenan, Analia; Spivakovsky, Silvia; Lo, Danny; Furnari, Winnie; ElSayed, Hend
This protocol has been withdrawn as it is now out of date and the topic has not been identified as a priority.
ISSN: 1469-493x
CID: 4248602

One phase or two phase orthodontic treatment for Class II division 1 malocclusion ?

Veitz-Keenan, Analia; Liu, Nicole
Data sources Numerous online databases were searched including:, the Cochrane Central Register of Controlled Trials, the Cochrane Library, MEDLINE Ovid and Embase Ovid). The US National Institutes of Health Ongoing Trials Registry ( and the World Health Organization International Clinical Trials. No restrictions were placed on the language or date of publication when searching the electronic databases.Study selection The review included only randomised clinical trials of orthodontic treatments to correct prominent upper front teeth (Class II malocclusion) in children and adolescents. The review selected studies that compared early treatment in children (two-phase) with any type of orthodontic braces (removable, fixed, functional) or head-braces/headgear versus late (one-phase) treatment in adolescents with any type of orthodontic braces or head-braces/headgear, and studies that compared any type of orthodontic braces or head-braces/headgear versus no treatment or another type of orthodontic brace/treatment or appliance (where treatment started at a similar age in the intervention groups). The review excluded studies involving participants with craniofacial deformities/syndromes or a cleft lip or palate, and trials that recruited patients who had previously received surgical treatment for their Class II malocclusion.Data extraction and synthesis The review authors screened the search results, extracted data and assessed risk of bias independently, and used odds ratios (ORs) and 95% confidence intervals (CIs) for dichotomous outcomes (incisal trauma), and mean differences (MDs) and 95% CIs for continuous outcomes (overjet and ANB angle).Results Twenty-seven studies were included and analysed in the review. Out of the 27 trials , three trials (343 patients - low /moderate quality evidence ) compared early/ two stage orthodontic treatment with functional appliances versus late two phases orthodontic treatment assessing all changes in overjet, cephalometric changes (antero-posterior relationship of the mandible to the maxilla or ANB angle) and incisal trauma in the upper anterior teeth.Firstly the results showed a reduction in the overjet and ANB angle after phase one of early treatment in patients using functional appliances, before the other group had received any treatment; the results changed when both groups underwent treatment, resulting in a non-statistical difference between groups in final overjet (MD 0.21, 95% CI -0.10 to 0.51, P = 0.18; or ANB (MD -0.02, 95% CI -0.47 to 0.43).Incidence of new incisal trauma: the results favoured initial or early treatment with functional appliances. The odds of incisal trauma using early functional appliances were reduced compared to late treatment: OR 0.56 (95% CI 0.33 to 0.95). The incidence of front teeth trauma was 30% in the participants of the late treatment group/ one phase compared to 19% in the participants who received the early/two phase orthodontic treatment ( 332 patients - moderate quality evidence).Headgear versus late treatment: early (two-phase) treatment with headgear reduced roughly half the incidence of new front teeth trauma (OR 0.45, 95% CI 0.25 to 0.80) compared to the late treatment group . The use of headgear reduced overjet and ANB, however, when both groups finalised the treatment, there was no statistically significant difference between groups in overjet (MD -0.22, 95% CI -0.56 to 0.12; or ANB (MD -0.27°, 95% CI -0.80 to 0.26) (low quality evidence).Fixed functional appliances versus no treatment (low quality evidence): the analysis of seven trials that compared late treatment with functional appliances versus no treatment concluded that there was a reduction in final overjet with fixed functional appliances (MD -5.46 mm, 95% CI -6.63 to -4.28 ).There was no evidence of a difference in final ANB between fixed functional appliances and no treatment (MD -0.53, 95% CI -1.27 to -0.22 ).Removable functional appliances to reduce ANB compared to no treatment: the results ( low quality evidence) showing a MD of -2.37° (95% CI -3.01 to -1.74 ), favouring the functional appliances.Twin block appliance versus other appliances in adolescents: six studies found no difference in changes in overjet (0.08 mm, 95% CI -0.60 to 0.76) . The reduction in ANB favoured treatment with a twin block (-0.56°, 95% CI -0.96 to -0.16).Removable functional appliances versus fixed appliances: the data combination of three trials concluded that there is a reduction in overjet in favour of fixed appliances (0.74, 95% CI 0.15 to 1.33), and a reduction in ANB in favour of removable appliances (-1.04° , 95% CI -1.60 to -0.49).Conclusions Evidence classified as low to moderate quality suggests that providing early orthodontic treatment/two stages for children with prominent upper front teeth is more effective for reducing the incidence of upper front teeth trauma ( incisal trauma) than providing one course of orthodontic treatment in adolescence. However, it appears that there is no other benefit of providing early treatment when compared to late treatment. Low-quality evidence proposes that, compared to no treatment, late treatment in adolescence with functional appliances, is effective for reducing the prominence of upper front teeth.
PMID: 31562403
ISSN: 1476-5446
CID: 4105802

Limited Evidence Suggests Metformin Might Be Beneficial to Reduce Head and Neck Cancer Risk and Increase Overall Survival, While Any Benefit With Antiinflammatory Drugs Is Inconsistent

Veitz-Keenan, Analia; Silvestre Calle, Thamar Delia; Bergamini, Marco
ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION/BACKGROUND:Protective effects of metformin, statins, and antiinflammatory drugs on head and neck cancer: A systematic review. Saka Herrán C, Jané-Salas E, Devesa AE, López-López J. Oral Oncol 2018;85:68-81. SOURCE OF FUNDING/BACKGROUND:None. TYPE OF DESIGN/UNASSIGNED:Systematic review with meta-analysis.
PMID: 31732106
ISSN: 1532-3390
CID: 4208312

Quality Appraisal of Child Oral Health-Related Quality of Life Measures: A Scoping Review

Yang, C; Crystal, Y O; Ruff, R R; Veitz-Keenan, A; McGowan, R C; Niederman, R
BACKGROUND/UNASSIGNED:Children's oral health-related quality of life (COHQoL) measures are well known and widely used. However, rigorous systematic reviews of these measures and analyses of their quality are in absence. OBJECTIVES/UNASSIGNED:To systematically review and quantitatively assess the quality of COHQoL measures through a scoping review. DATA SOURCES/UNASSIGNED:Systematic literature search of PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), EMBASE (Excerpta Medica database), HaPI (Health and Psychosocial Instruments), and DOSS (Dentistry and Oral Sciences Source). STUDY ELIGIBILITY/UNASSIGNED:The measure's focus was COHQoL; the child age ranged from 5 to 14 years; the publication was either a research article or a systematic review and related to caries; and it was written in English or had an English abstract. Two authors independently selected the studies. Disagreements were reconciled by group discussions with a third author. APPRAISAL/UNASSIGNED:The International Society for Quality of Life Research minimum standards for patient-reported outcome measures were used for quality appraisal. SYNTHESIS/UNASSIGNED:Descriptive analysis. RESULTS/UNASSIGNED:We identified 18 measures. Their quality scores ranged from 9.5 to 15.0 on a scale of 16. The quality appeared to bear no relationship to the citation and use of these measures. However, elements of these measures might be more useful than others, depending on the age-specific use and primary quality concerns. LIMITATIONS/UNASSIGNED:Some of the information on the minimum standards of the 18 measures cannot be found in the existing literature. Measures published without English abstract were not searched. CONCLUSIONS/UNASSIGNED:The quality of these measures is suboptimal. Researchers and practitioners in this field should exercise caution when choosing and using these measures. Efforts at improving the quality of the COHQoL measures, such as refining existing ones or developing new measures, are warranted. KNOWLEDGE TRANSFER STATEMENT/UNASSIGNED:Researchers, clinician scientists, and clinicians can use the results of this study when deciding which oral health-related quality of life measure they wish to use in children.
PMID: 31238010
ISSN: 2380-0852
CID: 3962742

A systematic review on incidental findings in cone-beam computed tomography (CBCT) Scans

Dief, Sandy; Veitz-Keenan, Analia; Amintavakoli, Niloufar; McGowan, Richard
OBJECTIVES/UNASSIGNED:Cone-beam computed tomography's use (CBCT) in dentistry is increasing. Incidental findings (IFs: discoveries unrelated to the original purpose of the scan), are frequently found as a result of a large field of view. The aim of the systematic review is to analyze present literature on IFs using CBCT. METHODS AND MATERIALS/UNASSIGNED:The authors searched online databases of studies and assessed the prevalence of IFs among patients undergoing head and neck CBCT scans. STROBE criteria was used to evaluate the quality of the studies. RESULTS/UNASSIGNED:The original search retrieved 509 abstracts of which only 10 articles met the inclusion criteria. The sample size varied between 90 - 1000 participants. The frequency of IFs of the selected articles were 24.6 - 94.3 %. The most common non-threatening IFs were found in the airway, such as mucous retention cyst (55.1%) and sinusitis (41.7%). Other non-threatening IFs were soft tissue calcifications such as calcified stylohyloid ligament (26.7%), calcified pineal gland (19.2%), and tonsillolith (14.3%). Threatening IFs were rare findings (1.4%). Three articles reported incidental carotid artery calcifications with a prevalence of 5.7 - 11.6 %. Pathological findings were not common between the articles, but still relevant (2.6%). The studies had a risk of bias varying from moderate to low. CONCLUSIONS/UNASSIGNED:There is a high frequency of IFs, yet not all of them require immediate medical attention. The low prevalence of threatening IFs emphasizes that CBCT should not be considered a substitution for conventional radiographs, but when used, the scans should be evaluated by a maxillofacial radiologist.
PMID: 31216179
ISSN: 0250-832x
CID: 3938762