Marx2
A peri-operative regime of hyperbaric oxygenation significantly reduced the incidence of osteoradionecrosis in tooth sockets following dental extractions in a previously irradiated field.
Clinical Bottom Line: The number of patients developing osteoradionecrosis in at least one socket was significantly reduced by the application of hyperbaric oxygenation. Appraised by: Mike Bennett, Dept of Diving and Hyperbaric Medicine, Prince of Wales Hospital, Sydney, Sunday, 15 November, 1998
Clinical Scenario: A patient with a history of therapeutic irradiation to the head and neck and requiring dental extractions. Three-part Question: In irradiated patients requiring dental extractions, does the prophylactic application of hyperbaric oxygenation as opposed to standard care, result in any reduction in the rate of osteoradionecrosis in the teeth sockets? Search Terms: hyperbaric oxygenation, osteoradionecrosis.
The Study: Non-blinded randomised controlled trial with intention-to-treat. Patients requiring at least one tooth extraction in a section of mandible previously irradiated with at least 6,000 rads of absorbed radiation, 6 or more months previously and who showed no evidence of tumour persistence or recurrence. Control group (N = 37; 37 analysed): General or local anaesthesia as indicated, standard method of tooth extraction and penicillin 1 gram pre-op and 500mg sixth hourly for 10 days post-op. Experimental group (N = 37; 37 analysed): As above but no penicillin and received 20 sessions of hyperbaric oxygen at 2.4 ATA for 90 minutes pre-op and 10 further sessions post-op.
The Evidence:
Outcome |
Time to Outcome |
Penicillin rate |
HBO rate |
Relative risk reduction |
Absolute risk reduction |
NNT |
|
ORN in at least one socket |
6 months |
0.297 |
0.054 |
82% |
0.243 |
4 |
|
95% CI |
27% to 100% |
.41 to 0.08 |
2 to 13 |
Comments:
1. Not blinded, but a hard endpoint after six months.
2. In terms of sockets, 23% in penicillin arm versus 3% in HBO arm, developed ORN.
3. May have implications for the prevention of spontaneous ORN.
4. Suggests that penicillin may not have a role in prevention of ORN.
Expiry date: December 2019
References: 1. Marx RE, Johnson RP, Kline SN. Prevention of osteoradionecrosis: a randomised prospective clinical trial of hyperbaric oxygen versus penicillin. Journal of American Dental Association 1985; 111: 49-54.
