Efficacy of pre- and postirradiation hyperbaric oxygen therapy in the prevention of postextraction osteoradionecrosis: a systematic review.
OBJECTIVE
There is still considerable controversy regarding whether hyperbaric oxygen (HBO) therapy used preoperatively and postoperatively will prevent osteoradionecrosis in previously irradiated patients undergoing tooth extraction. The purpose of this systematic review was to evaluate the best evidence available in an attempt to find an answer to this question.


METHODS
The literature search on Medline covered the period from January 1948 to March 2008. Included were randomized clinical trials, prospective studies without randomization, case-control studies, retrospective studies, and observational studies with and without control groups. This search retrieved 696 citations, which was reduced to 14 acceptable publications based on an assessment of methodologic quality. They included 1 randomized clinical trial, 8 cohort-controlled studies, and 5 observational studies. These were analyzed for radiation dose, type of radiation, use of adjunctive cancer treatments, number and location of extractions, method of extraction, HBO protocol, and use of adjunctive therapy besides HBO.


RESULTS
Most of the studies had a small sample size, lacked specific inclusion and exclusion criteria, did not report the interval between radiation and extraction, and provided limited information on the method of extraction. There was also variation in HBO protocols, radiation dosage, the use of antibiotics, and the use of adjunctive cancer therapy.


CONCLUSIONS
On the basis of the best available evidence, there is currently insufficient information to show that the use of HBO reduces the incidence of osteoradionecrosis in irradiated patients requiring tooth extraction.
Fritz
Gabriel W
GW
Department of Oral and Maxillofacial Surgery, School of Dentistry, Virginia Commonwealth University, Richmond, VA 23298-0566, USA.
Gunsolley
John C
JC
Abubaker
Omar
O
Laskin
Daniel M
DM
D016022:Case-Control Studies; D015331:Cohort Studies; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000379:methods*; D007571:Jaw Diseases / Q000517:prevention & control*; D020360:Neoadjuvant Therapy; D010025:Osteoradionecrosis / Q000517:prevention & control*; D011182:Postoperative Care; D011300:Preoperative Care; D011878:Radiotherapy / Q000009:adverse effects*; D011879:Radiotherapy Dosage; D016032:Randomized Controlled Trials as Topic; D014081:Tooth Extraction; D016896:Treatment Outcome