University of Groningen
Biodegradable versus titanium osteosynthesis in maxillofacial traumatology
Gareb, B; van Bakelen, N B; Dijkstra, P U; Vissink, A; Bos, R R M; van Minnen, B
Published in:International Journal of Oral and Maxillofacial Surgery DOI:
10.1016/j.ijom.2019.11.009
IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please check the document version below.
Document Version
Final author's version (accepted by publisher, after peer review)
Publication date: 2020
Link to publication in University of Groningen/UMCG research database
Citation for published version (APA):
Gareb, B., van Bakelen, N. B., Dijkstra, P. U., Vissink, A., Bos, R. R. M., & van Minnen, B. (2020).
Biodegradable versus titanium osteosynthesis in maxillofacial traumatology: a systematic review with meta-analysis and trial sequential meta-analysis. International Journal of Oral and Maxillofacial Surgery, 49(7), 914-931. https://doi.org/10.1016/j.ijom.2019.11.009
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RCT
Prosp. CS
Retrosp. CS
Random effects model
Random effects model
Random effects model
Heterogeneity: I2 = 0%, p = 0.89
Heterogeneity: I2 = 0%, p = 0.41 Test for effect in subgroup: p < 0.01
Test for effect in subgroup: p = 0.47
Bhatt et al. (2010) Ahmed et al. (2013) Gareb et al. (2017) Leonhardt et al. (2008) Leno et al. (2017) Wittwer et al. (2006) Park et al. (2011) Kang et al. (2014) Bhatt et al. (2015) Filinte et al. (2015) Kim et al. (2018) 0 0 0 5 2 3 3 0 0 0 0 60 51 197 18 34 8 30 21 39 56 53 24 12 13 5 4 3 4 0 2 0 5 5 1 3 58 50 167 13 35 10 30 20 15 26 56 36 19 15 0.11 1.51 0.39 0.07 0.11 0.18 1.25 4.77 0.58 3.28 0.10 0.14 0.52 0.16 [0.02; 0.57] [0.49; 4.65] [0.14; 1.11] [0.00; 1.10] [0.01; 2.04] [0.01; 2.97] [0.37; 4.21] [0.24; 93.44] [0.11; 3.12] [0.18; 61.30] [0.01; 1.69] [0.01; 2.34] [0.02; 11.79] [0.01; 2.90]
Study
Random effects model
Heterogeneity: I2 = 55%, p = 0.14 Test for overall effect: p = 0.58
Mahmoud et al. (2016) Leno et al. (2017) Total 37 14 23 Total 34 13 21 SMD -0.20 -0.61 0.13 95%-CI [-0.92; 0.52] [-1.39; 0.16] [-0.47; 0.72] -2 -1 0 1 2
Standardised Mean Difference
Retrosp. CS
Random effects model Tripathi et al. (2013) Kang et al. (2014) Filinte et al. (2015) Kim et al. (2018) 0 0 0 0 88 10 53 12 13 1 2 1 2 100 10 56 19 15 0.30 0.33 0.21 0.52 0.23 [0.07; 1.37] [0.02; 7.28] [0.01; 4.30] [0.02; 11.79] [0.01; 4.38]
Study
Test for subgroup differences: c02 = 0.00, df = 0 (p = NA) Retrosp. CS
Random effects model
Heterogeneity: I2 = 0%, p = 0.79 Test for effect in subgroup: p = 0.09
Bell et al. (2006) Wittwer et al. (2006) Kim et al. (2018) Events 1 3 1 Total 111 59 39 13 Events 0 0 0 Total 252 222 15 15 RR 4.55 11.22 2.75 3.44 95%-CI [0.78; 26.68] [0.46; 271.88] [0.15; 50.14] [0.15; 77.72] 0.01 0.1 0.5 1 2 10 100 Risk Ratio
Retrosp. CS
Random effects model
Heterogeneity: I2 = 0%, p = 0.52 Bell et al. (2006) Park et al. (2011) Kim et al. (2018) 1 1 1 128 59 56 13 0 0 1 263 222 26 15 2.37 11.22 1.41 1.15 [0.42; 13.23] [0.46; 271.88] [0.06; 33.40] [0.08; 16.67]
Study
Test for subgroup differences: c22 = 1.35, df = 2 (p = 0.51) RCT
Prosp. CS
Retrosp. CS
Random effects model
Random effects model
Random effects model
Heterogeneity: I2 = 0%, p = 0.83
Heterogeneity: I2 = 0%, p = 0.55
Heterogeneity: I2 = 0%, p = 0.96 Test for effect in subgroup: p = 0.22
Test for effect in subgroup: p = 0.49
Test for effect in subgroup: p = 0.82
Bhatt et al. (2010) Ahmed et al. (2013) Leonhardt et al. (2008) Qiu et al. (2015) Leno et al. (2017) Bell et al. (2006) Wittwer et al. (2006) Lee et al. (2010) Lim et al. (2014) Kang et al. (2014) Burlini et al. (2015) Filinte et al. (2015) Kim et al. (2018) Events 0 0 1 1 1 1 3 2 1 0 5 0 1 Total 51 98 447 17 34 30 45 23 59 39 48 13 53 210 12 13 Events 1 2 3 2 0 7 0 1 1 1 23 2 1 Total 52 96 1298 17 35 30 45 21 222 15 43 16 56 912 19 15 RR 0.26 0.60 0.92 0.33 0.21 0.33 0.50 2.74 0.54 2.75 1.79 1.23 0.35 0.94 0.31 1.15 95%-CI [0.03; 2.26] [0.14; 2.52] [0.46; 1.83] [0.01; 7.63] [0.01; 4.13] [0.04; 3.03] [0.05; 5.32] [0.12; 63.84] [0.07; 4.28] [0.15; 50.14] [0.17; 19.07] [0.08; 17.83] [0.01; 8.45] [0.36; 2.45] [0.02; 5.97] [0.08; 16.67] 0.01 0.1 0.5 1 2 10 100 Risk Ratio
RCT
Random effects model Bhatt et al. (2010) Buijs et al. (2012) Ahmed et al. (2013) 2 0 1 60 18 8 34 1 2 0 57 13 9 35 1.01 1.44 0.22 3.09 [0.21; 4.81] [0.15; 14.29] [0.01; 4.03] [0.13; 73.21]
Study
Test for subgroup differences: c02 = 0.00, df = 0 (p = NA) Retrosp. CS
Random effects model
Heterogeneity: I2 = 0%, p = 0.98 Test for effect in subgroup: p = 0.55
Bhatt et al. (2015) Filinte et al. (2015) Events 0 0 Total 36 24 12 Events 1 1 Total 55 36 19 RR 0.51 0.50 0.52 95%-CI [0.06; 4.68] [0.02; 11.70] [0.02; 11.79] 0.01 0.1 0.5 1 2 10 100 Risk Ratio
RCT
Random effects model Bhatt et al. (2010) Ahmed et al. (2013) 1 2 52 18 34 0 1 48 13 35 2.11 2.19 2.06 [0.32; 13.79] [0.10; 49.71] [0.20; 21.67]
Study
Test for subgroup differences: c02 = 0.00, df = 0 (p = NA) Retrosp. CS
Random effects model
Heterogeneity: I2 = 0%, p = 0.65 Test for effect in subgroup: p = 0.94
Bell et al. (2006) Filinte et al. (2015) Events 1 0 Total 71 59 12 Events 3 1 Total 241 222 19 RR 0.93 1.25 0.52 95%-CI [0.15; 5.75] [0.13; 11.84] [0.02; 11.79] 0.01 0.1 0.5 1 2 10 100 Risk Ratio
PubMed (n = 2257) EMBASE (n = 2269) CENTRAL (n = 475) Sc re en in g In cl u d e d El ig ib ili ty Id en ti fi ca ti o
n Reference lists, screening of
leading OMFS journals, and questioning experts for relevant
articles (n = 0)
Records after duplicates removed
(n = 3542)
Records screened by title and abstract
(n = 3542)
Records excluded
(n = 3462)
Full-text articles assessed for eligibility
(n = 80)
Full-text articles excluded
(n = 56)
- n = 47: did not fulfill inclusion criteria - n = 6 did fulfill exclusion criteria - n = 2 insufficient details - n = 1 included the same study population and endpoints with shorter follow-up
Studies included in qualitative synthesis
20 trauma and 4 trauma and orthognathic population(s)
(n = 24)
Studies included in the quantitative synthesis (meta-analysis)
(n = 21) EMBASE (n = 182)
CENTRAL (n = 132)
Excluded for quantitative synthesis (n = 3) - n = 1: single cost-effectiveness study - n = 1: total zero-event study - n = 1: included the same study population with shorter follow-up
