Review
Introduction
Material and methods
Protocol and registration
Eligibility criteria
Information sources
Focus question
Search strategy
Study selection
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The study explored the COX pathway and its role in osseointegration.
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The effects of NSAIDs on osteoblasts attached to titanium are investigated (in vitro studies).
Data collection process
Data items
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Author (year)—reveals the author/s and year of publication
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Sample (size)—describes the sample and sample size used in the study
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Treatment group (size)—describes the treatments used in study
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Methodology—describes the method of drug delivery
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Parameter—describes the parameter/s that are measured
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Outcome—describes the outcome/s of the experiments
Quality and risk of bias in individual studies
Study | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | Summary assessment |
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Arpornmaeklong et al. [19] | + | ? | + | + | – | – | – | – | n/a | + | + | – | + | – | High |
Boyan et al. [20] | + | + | + | + | – | – | – | – | n/a | + | + | – | + | – | High |
Item | Domain |
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1 | Abstract: structured summary of trial design, methods, results, and conclusions |
Introduction | |
2 | Scientific background and explanation of rationale with specific objectives and/or hypotheses |
Methods | |
3 | Intervention: the intervention for each group, including how and when it was administered, with sufficient detail to enable replication |
4 | Outcomes: completely defined, pre-specified primary and secondary measures of outcome, including how and when they were assessed |
5 | Sample size: how sample size was determined |
6 | Randomisation: method used to generate the random allocation sequence |
7 | Allocation: mechanism used to implement the random allocation sequence, describing any steps taken to conceal the sequence until intervention was assigned |
8 | Implementation: who generated the random allocation sequence, who enrolled teeth, and who assigned teeth to intervention |
9 | Blinding: if done, who was blinded after assignment to intervention and how |
10 | Statistics: statistical methods used to compare groups for primary and secondary outcomes |
Results | |
11 | For each primary and secondary outcome, results for each group, and the estimated size of the effect and its precision |
Discussion | |
12 | Trial limitations, addressing sources of potential bias, imprecision, and, if relevant, multiplicity of analyses |
Other information | |
13 | Sources of funding and other support role of funders |
14 | Where the full trial protocol can be accessed, if available |
Study | Random sequence generation | Allocation concealment | Blinding of participants/personnel | Blinding of outcome assessment | Incomplete outcome data | Selective reporting | Summary assessment |
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Alissa et al. [21] | + | + | + | ? | + | + | Unclear |
Sakka et al. [24] | – | – | – | + | + | + | High |
Winnett et al. [25] | n/a | – | – | – | ? | + | High |
Study | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | Summary assessment |
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Cai et al. [22] | + | ? | + | + | ? | ? | ? | + | + | Unclear |
Chikazu et al. [30] | + | – | + | + | – | – | ? | + | + | High |
Goodman et al. [29] | ? | + | + | + | – | ? | – | + | + | High |
Goodman et al. [26] | ? | + | + | + | – | ? | – | + | + | High |
Pablos et al. [31] | + | ? | + | + | – | – | ? | + | + | High |
Ribeiro et al. [27] | + | ? | + | + | – | – | ? | + | + | High |
Ribeiro et al. [28] | + | ? | + | + | – | – | ? | + | + | High |
Salduz et al. [32] | – | + | + | + | ? | – | + | + | + | High |
Item | Domain |
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5 | Ethical statement |
6 | Study design |
7 | Experimental procedures |
8 | Experimental animals |
9 | Housing and husbandry |
10 | Sample size |
11 | Allocating animals to experimental groups |
12 | Experimental outcomes |
13 | Statistical analysis |
Synthesis of results
Study (year) | Sample | Treatment group | Methodology | Parameter | Outcome |
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Arpornmaeklong et al. (2009) [19] | Mouse calvaria cell line (MC3T3-E1) | Indomethacin 0.1 μM Celecoxib 1.5 μM Celecoxib 3.0 μM Celecoxib 9.0 μM Control | Incubation in treatment medium for 5 days. Investigations were performed in three experimental phases: static, log, and plateau | The following parameters were assessed at 1, 3, and 5 days: cell attachment, cell growth, cell differentiation, secretion of PGE2 | Cells were able to grow and attach to titanium surface for all treatment groups. Indomethacin and celecoxib cell growth on days 3 and 5 in static phase and on day 3 in log phase. Indomethacin and celecoxib caused a significant decrease PGE2 concentration in static and plateau but not log phases. |
Boyan et al. (2001) [20] | Human osteosarcoma cell line (MG63) | Indomethacin 0.1 μM Resveratrol 1 μM Resveratrol 10 μM NS-398 1 μM NS-398 10 μM | Incubation in treatment medium for 5 days. Cells were cultured on tissue culture plastic, smooth titanium, and two rough titanium surfaces: grit-blasted/acid-etched and titanium-plasma sprayed | The following parameters were assessed after 5 days: osteocalcin content, PGE2 content, and TGF-β1 content. | Indomethacin, resveratrol, and NS-398 had no effect on osteocalcin content. Indomethacin and resveratrol blocked PGE2 production. NS-398 had no effect on PGE2 production on smooth surfaces but caused a reduction on rough surfaces. Indomethacin blocked TGF-β1 production on rough surfaces. Resveratrol blocked TGF-β1 on TPS. NS-398 did not cause TGF-β1 inhibition. |
Study (year) | Sample (size) | Treatment group (size) | Methodology | Parameter | Outcome |
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Alissa et al. (2009) [21] | Eligible human patients (n = 61). Implants inserted (n = 132). | Ibuprofen (n = 31), implants (n = 67). Placebo (n = 30), implants (n = 65). | Ibuprofen, 600 mg q.i.d. for 7 days orally | Post-operative radiographic marginal bone height at 3 and 6 months | No statistically significant differences in mean marginal bone level changes at 3 or 6 months. |
Sakka et al. (2013) [24] | Eligible human patients (n = 28). Implants inserted (n = 57). | Ibuprofen (n = 14), implants (n = 31). Non-Ibuprofen (n = 14), implants (n = 26). | Ibuprofen, 600 mg q.i.d. for 7 days orally | Post-operative radiographic marginal bone height at 3 and 6 months | No statistically significant differences in mean marginal bone level changes at 3 or 6 months. |
Winnett et al. (2014) [25] | Patients treated between 1979 and 2012 with failed and surgically removed dental implants | Cohort that used post-operative NSAIDs (n = 60, with 119 failed implants). Cohort that did not use post-operative NSAIDs (n = 44, with 78 failed implants). | Ibuprofen was the most commonly prescribed, 600 mg q.i.d. Other prescribed analgesics were ketorolac, vioxx, celebrex, diflunisal, meloxicam, paracetamol, and naproxen. | Radiographic bone loss. Vertical bone height of remaining implants. | NSAID cohort experienced more implant failures than the non-NSAID cohort. The NSAID cohort experienced more cases of radiographic bone loss greater than 30% of the vertical height of their remaining implants. |
Study (year) | Sample (size) | Treatment group (size) | Methodology | Parameter | Outcome |
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Cai et al. (2015) [22] | New Zealand white rabbits (n = 18). Implant inserted into calvaria (n = 18). | Control (n = 6) Diclofenac (n = 6) Parecoxib (n = 6) | Treatments were administered for 7 days: Diclofenac, 2 mg/kg/day orally Parecoxib, 1.5 mg/kg/day subcutaneous injection | Parameters observed at week 4 and 12 after implantation: Micro-CT: bone volume ratio, mean trabecular thickness, and mean trabecular separation. Histomorphometric: bone-to-implant contact. | No statistically significant differences between the three separate groups, nor between the different time points. |
Chikazu et al. (2007) [30] | 9-week old male mice (n = 72). Implant inserted in femur (n = 72). | Mice with the original C57BL6/129S7 hybrid background were generated and maintained: Wild-type (n = 36) COX-2-knockout (n = 36) | No drug was administered | mRNA levels were observed at days 0, 1, 2, 4, 7, and 56 after implant insertion: expression of COX-2 and osteocalcin mRNA. Histomorphometric analysis at weeks 4 and 8: bone-to-implant contact. | Expression of COX-2 and osteocalcin mRNA was induced in bone surrounding implants in wild-type mice, but not in knockout mice. Bone-to-implant contact was minimal in knockout mice. |
Goodman et al. (2002) [29] | New Zealand white rabbits (n = 8). Titanium bone harvest chamber inserted in tibia (n = 8). | Control Naproxen Rofecoxib | Treatments administered: Control: weeks 0–4 and 9–12. Naproxen, 110 mg/kg: weeks 5–8 orally. Rofecoxib, 12.5 mg/kg: week 13–16 orally. | Immunohistochemistry observed: total tissue area, total bone area, ratio of bone area, and total number of osteoblasts and osteoclast-like cells per section area | Naproxen and rofecoxib decreased bone ingrowth significantly. Rofecoxib decreased the area of osteoblasts per area compared with controls, and naproxen sodium did not reach statistical significance. |
Goodman et al. (2005) [26] | New Zealand white rabbits (n = 8). Titanium bone harvest chamber implanted bilaterally in tibia (n = 16). | Control Rofecoxib | Treatments were administered for 6 weeks each: control-no drug; rofecoxib (12.5 mg/day) for the first 2 weeks of a 6-week trial, or the last 2 weeks or given continuously for all 6 weeks washout periods | Immunohistochemistry observed: total tissue area, total bone area, ratio of bone area, and the total number of osteoblasts and osteoclast-like cells per section area. | Rofecoxib given continuously for 6 weeks had less bone ingrowth, osteoclast-like cells and osteoblasts per area compared to the control treatment. Rofecoxib given for 2 of a 6-weeks cycle did not interfere with the parameters. |
Pablos et al. (2008) [31] | Male Sprague-Dawley rats, 3-month-old, weighing 250-300 g (n = 30). Implant inserted in tibia (n = 30). | Control (n = 10) Diclofenac (n = 10) Meloxicam (n = 10) | Diclofenac, 1.07 mg/kg b.i.d. for 5 days. Meloxicam, 0.2 mg/kg daily for 5 days. | Histomorphometric analysis at 28 days after implant insertion: bone-to-implant contact, cortical bone area, and trabecular bone area within the implant threads | The bone-to-implant contact was lower in diclofenac compared with the meloxicam and control. The trabecular bone area was greater in diclofenac compared with meloxicam and control. |
Ribeiro et al. (2006) [27] | Male Wistar rats, aged 10 weeks (n = 31). Implant inserted in tibia (n = 31). | Control (n = 14) Meloxicam (n = 17) | Daily subcutaneous injections for 60 days: control, 1 mL/kg of saline Meloxicam, 3 mg/kg | Histomorphometric analysis at 60 days after implant insertion: bone-to-implant contact, bone area, and bone density in the cortical and cancellous bone areas | Meloxicam reduced bone-to-implant contact, bone area, and bone density in both the cortical and cancellous bone areas. |
Ribeiro et al. (2009) [28] | Male Wistar rats, aged 10 weeks (n = 30). Implant inserted in tibia (n = 30). | Control (n = 14) Meloxicam (n = 16) | Daily subcutaneous injections for 60 days: control, 1 mL/kg of saline Meloxicam, 3 mg/kg | Histomorphometric analysis at 60 days after implant insertion: bone-to-implant contact, bone area, and bone density in the cortical and cancellous bone areas | Blasting implant surface with aluminium oxide can increase bone-to-implant contact; however, it does not reverse the negative effects caused by a selective COX-2 inhibitor on bone healing around implants. |
Salduz et al. (2017) [32] | New Zealand white rabbits, skeletally mature weighing 3.5–4 kg (n = 40). Titanium rods implanted bilaterally in femur (n = 80). | Control Diclofenac Celecoxib | Treatments were administered for 8 weeks: control, regular food Diclofenac, 5 mg/kg/day intramuscularly Celecoxib, 3 mg/kg/day orally | Biomechanical and histomorphometric analysis at 8 weeks after implant insertion: interface failure load, bone quality, bone implant interface, host reaction, total bone area, and bone-to-implant contact rate | No significant difference in the biomechanical and histological results between the groups. |
Statistical analysis
Results
Study selection
Exclusion of studies
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The study did not explore the role of COX pathway in osseointegration (n = 26).
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The effects of NSAIDs on osteoblasts were not investigated on titanium (n = 24).
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The study was a systematic review (n = 16).