Randomized controlled trials in dentistry: Common pitfalls and how to avoid them

Present status and future directions - Mechanisms and management of local anaesthetic failures

Pain control during root canal treatment is of utmost importance for both the patient and the dental practitioner and many studies have investigated ways of overcoming problems with gaining adequate anaesthesia during treatment. The PubMed and Cochrane databases were searched for evidence-based studies regarding local anaesthesia for root canal treatment. Many variables, including premedication, pain during needle insertion, pain on injection, premedication with various types of drugs, volume of anaesthetic solutions, supplemental anaesthetic techniques, and additives to the anaesthetic solutions, may influence pain perception during root canal treatment. Differences between teeth with healthy pulps versus those with irreversible pulpitis should be considered when the effects of variables are interpreted. There are several concerns regarding the methodologies used in studies that have evaluated anaesthesia success rates. There are some conditions that may help to predict a patient's pain during root canal treatment and these conditions could be overcome either by employing methods such as premedication with a non-steroidal anti-inflammatory drug prior to the treatment visit or by using supplementary anaesthetic techniques before or during the treatment. However, authors need to be more careful when reporting details of their studies to reduce concerns regarding their study bias.

Autologous Platelet Concentrate of 2nd and 3rd generations efficacy in the surgical treatment of gingival recession: an overview of systematic reviews

BACKGROUND

Autologous platelet concentrate (APC)/platelet-rich fibrin (PRF) of second and third generations has increased use in periodontics to optimize wound healing. Few systematic reviews (SRs) have reported improved clinical outcomes, while other studies reported significantly better results for the connective tissue graft (CTG). There is still unclear clinical evidence about APC/PRF use to treat gingival recession (GR) defects. Then, the purpose of this SR was to evaluate the use of APC/PRF membranes (2nd and 3rd generations) in root coverage (RC) procedures and assess its efficacy as a substitute biomaterial.

MATERIALS AND METHODS

An electronic search was conducted in PubMed, Cochrane Central, Web of Science, Google Scholar, BookSC databases, and gray literature. The search strategy, without date restriction up to April 2020, included keywords as "platelet-rich fibrin," "autologous platelet concentrates," "blood," "systematic review," "periodontics," "surgery," "tissue," "gingiva," "gingival recession," "connective tissue," "graft," and "root coverage." The methodological quality was evaluated through the AMSTAR2, and a population, index test, comparator, outcome strategy was used to assess specific clinical parameters such as recession depth, clinical attachment levels, and RC outcomes.

RESULTS

Nine SRs were included. Only three articles described the technique of APC/PRF production. Three studies reported unfavorable outcomes using APC, while six reported favorable results and postoperative discomfort reduction. Articles included in this SRs that provided information about APC/PRF membranes (n = 13) showed no significant difference between APC/PRF and the control group for the parameters analyzed.

CONCLUSIONS

This implies that APC/PRF may be considered a feasible substitute biomaterial for treating GR defects, although the CTG still provides superior outcomes. Further long-term and controlled studies are needed to verify this finding.

Comparison of a full arch digital photographic assessment of caries prevalence in 5-year-old children to an established visual assessment method: a cross-sectional study

Introduction

Digital epidemiology in dental disease screening has a number of advantages which warrant further exploration.

Aim

This study aimed to test the examination accuracy of digital images to evaluate child oral health by comparing the new method to a gold standard method. It also investigated the levels of diagnostic accuracy between different examiners, including dental care professionals and a lay examiner, when quantifying dental disease using images.

Methods

A calibrated dental examiner inspected forty 5-year-olds. In addition, three sets of digital images were taken per child. These images were assessed by six examiners. Sensitivity and specificity of caries diagnosis and inter-examiner reliability were calculated to compare the caries scores derived from examination of the images to those of the gold standard examinations.

Results

The mean values for sensitivity and specificity scores were 48.0% and 99.1%, respectively. The mean value for kappa showed moderate agreement between 0.43 and 0.73 (0.57). Mean values for agreement using intra-class coefficients were excellent (0.78) and good (0.73) for dt and dmft, respectively. No statistical difference in the validity of the caries scores was shown between the different image assessors.

Conclusions

These data demonstrate the feasibility of using digital images to screen child oral health and for nondental professionals to be recruited to carry out digital epidemiology for the oral health surveillance of children.

Collagen Matrix vs. Autogenous Connective Tissue Graft for Soft Tissue Augmentation: A Systematic Review and Meta-Analysis

Soft tissues have been shown to be critical for the maintenance of both teeth and implants. Currently, regenerative soft tissue techniques propose the use of collagen matrices, which can avoid the drawbacks derived from the obtainment of autogenous tissue graft. A systematic review and meta-analysis were conducted to ascertain the efficacy of collagen matrices (CM) compared to autogenous connective tissue graft (CTG) to improve soft tissue dimensions. An electronic and manual literature searches were performed to identify randomized clinical trials (RCT) or controlled clinical trials (CCT) that compared CTG and CM. Pooled data of width of keratinized tissue (KT) and mucosal thickness (MT) were collected and weighted means were calculated. Heterogeneity was determined using Higgins (I²). If I² > 50% a random-effects model was applied. Nineteen studies were included based on the eligibility criteria. When using CTG a higher MT gain (0.32 mm, ranging from 0.49 to 0.16 mm) was obtained than when employing CM. Similar result was obtained for the width of KT gain, that was 0.46 mm higher (ranging from 0.89 to 0.02 mm) when employing CTG. However, it can be stated that, although autogenous CTG achieves higher values, CM are an effective alternative in terms of total width of KT and MT gain.

Periodontitis As A Risk Factor For Stroke: A Systematic Review And Meta-Analysis

This systematic review and meta-analysis investigate the association between periodontitis and stroke. This review followed the methods established by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Searches were conducted in five databases and two sources of grey literature. After the selection of the articles, a risk of bias evaluation was performed. Three meta-analyzes were performed: Assessing the overall association between stroke and periodontitis in case–control studies; Ischemic stroke and periodontitis in case–control studies; The association between stroke and periodontitis in cohort studies. Heterogeneity was assessed using the I² index and the odds ratio was also calculated (p < 0.05). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was applied to evaluate the level of evidence. 2193 potentially relevant studies were identified, with 10 studies included in qualitative and quantitative analysis. All the articles were considered with low risk of bias and a low level of certainty. The results demonstrated a positive association between both disorders and increased risk for stroke among cohort studies (RR 1.88 [1.55, 2.29], p<0.00001, I²=0%) and for ischemic stroke events in case–control studies (RR 2.72 [2.00, 3.71], p<0.00001, I²= 4%). Periodontitis may represent a risk factor for stroke, especially in ischemic events. However, new studies with a robust design are necessary for a reliable conclusion.

Clinical efficacy of xenogeneic collagen matrix in the treatment of gingival recession: a systematic review and meta-analysis

Objective: The aim of this systematic review (SR) was to evaluate the effects of xenogenic collagen matrix (XCM) on the outcomes of clinical treatments of patients with Miller class-I or -II gingival recessions. Materials and methods: Articles that were published before March 2018 were electronically searched in four databases without any date or language restrictions and manually searched in regular journals and gray literature. The eligibility criteria comprised randomized controlled trials (RCTs) and prospective controlled trials with follow-up periods of 6 months or more that compared the performance of XCM in the treatment of Miller class-I or -II gingival recessions. This SR was registered in PROSPERO under number CRD42018106118. Results: Nine RCTs published between 2010 and 2018 were included in this SR. The percentage of root coverage (RC) was significantly higher (p = .0003) when gingival recessions were treated with XCM when compared to coronally advanced flap (CAF) alone. In addition, the parameters of keratinized mucosa width (KMW) (p = .006) and gingival thickness (GT) (p = .0003) were also improved when the XCM was used in comparison to the CAF alone. There was not a statistically significant difference (p = .22) between the clinical attachment level (CAL) achieved with the use of XCM and that achieved with CAF alone. RC with the use of XCM, when compared to connective tissue grafts (CTGs) (p = .09) and enamel matrix derivative (EMD) (p = .62), there was no significant difference; however, XCM yielded lower RC than CTG in the treatment of Miller class-I or -II gingival recessions. Conclusions: Based on both the individual studies' outcomes and the pooled estimates, it can be concluded that the use of XCM improves the RC, KMW and GT in the treatment of gingival recessions when compared to CAF alone and may be a viable alternative to use of CTG.

Longevity of indirect restorations cemented with self-adhesive resin luting with and without selective enamel etching. A Systematic review and meta-analysis

OBJECTIVE

To investigate the influence of the selective etching in the survival rates of indirect restorations cemented with self-adhesive resin luting.

MATERIALS AND METHODS

The eligibility criteria were formulated based on PICOS strategy. The search without restrictions was performed in PubMed/Medline, the Cochrane Library, Web of Science, Scopus, LILACS databases and gray literature until May 2018. Cochrane Collaboration's tool was performed for assessing the risk of bias. According to the bias risk analysis, the studies were classified as low risk of bias and high quality of evidence. The systematic review was conducted according to PRISMA and registered in PROSPERO (CRD42018091202). The meta-analysis was performed using RevMan 5.3 software (RevMan, Copenhagen, Denmark) and the risk ration and confidence interval was obtained (p < 0.05).

RESULTS

After database screening, removal of duplicates and eligibility criteria application, two studies were selected for this systematic review, with 65 participants (34 in one and 31 in the other). The pooled meta-analysis demonstrated no statistically significant difference in clinical longevity for selective etching in indirect restorations (P > .05; I² = 0%) and risk ratio of 0.46 [0.19-1.09].

CONCLUSIONS

Based on the findings, the results of this systematic review suggest that the selective enamel etching prior to application of self-adhesive luting cements systems for indirect restoration do not influence the clinical longevity of indirect restorations.

CLINICAL SIGNIFICANCE

The knowledge of the clinical steps of adhesive procedures is fundamental to the success of adhesive restorations and their longevity. Self-adhesive resin cements simplify the luting procedure of indirect restorations. However, adding a step that could significantly improve long-term survival would be of great value. Thus, the results of this systematic review will provide data so that the decision making regarding materials used for adhesive cementation is conducted based on scientific evidence.

Publication pattern, study design, authors and countries involved in orthodontic RCTs - a bibliometric MEDLINE survey over the past 50 years

OBJECTIVES

The objective of this study was to investigate the number and proportions, study design, journal publications, authors and countries involved in orthodontic randomised controlled trials (RCTs) over the past 50 years.

METHOD

A MEDLINE database search (Entrez PubMed, http://www.ncbi.nlm.nih.gov ) was performed in November 2018 for RCT publications from 1 January 1968 to 31 December 2017. All orthodontic publications, clinical trials (CTs) or RCTs were selected. For each year from 1968 to 2017, the total number of orthodontic publications and total number of CTs and RCTs were computed. Following this, study design, journal publications, authors and countries involved in orthodontic RCTs were noted.

RESULTS

The RCTs accounted for 0.1% of all orthodontic publications in the 1970s and 1980s, and, following this, the proportion of RCTs was increased and amounted to 2.7% over the past decade (2008-2017). The majority of RCTs were of single centre design (93.4%) and in 88.3% a parallel-arm design was performed. The United States and United Kingdom endorsed 16.9% and 15.5% of the RCTs, followed by Turkey (11.1%), Brazil (7.0%), Sweden (6.6%), China (5.6%), Italy (5.4%), and Germany (4.1%). Of all RCTs, 74.2% were published in 20 orthodontic journals and 25.8% in 81 non-orthodontic journals. The American Journal of Orthodontics and Dentofacial Orthopedics, Angle Orthodontist, European Journal of Orthodontics and Journal of Orthodontics contributed to 60.2% of all the RCTs.

CONCLUSION

The considerable increase in orthodontic RCTs over the past 50 years implies an increased scientific impact of orthodontic literature.

Is there an association between asthma and periodontal disease among adults? Systematic review and meta-analysis

This systematic review and meta-analysis aimed to investigate a possible association between asthma and periodontal disease in adults. This study was conducted by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the searches were performed on the following databases: PubMed, Scopus, Web of Science, Cochrane, LILACS, OpenGrey e Google Scholar. In this systematic review, observational studies with adult humans, which evaluated patients with and without asthma, were selected to verify the association between both diseases. To qualitative analysis, Fowkes and Fulton guidelines was used and for the quantitative analysis, it was used the mean and standard deviation from each group (with and without asthma), using confidence interval (CI) 95% and heterogeneity were tested using I² index. Furthermore, a summary of the overall strength of evidence was presented using Grading of recommendations, assessment, development, and evaluation (GRADE). 3395 studies were identified, 11 were included on this systematic review to qualitative analysis and 6 of them to quantitative synthesis. Six meta-analyses were performed to the following clinical parameters: plaque index (PI), gingival index (GI), bleeding on probing (BOP), papillary bleeding index (PBI), calculus index (CI), clinical attachment loss (CAL). The meta-analysis results for CI was (p < 0.00001, I2 = 0%) PBI (p < 0.00001, I2 = 0%), CAL (p = 0,03, I² = 98%) showed higher means for the asthmatic group. For BOP (p = 0.20 I2 = 83%), GI (p = 0.14 I2 = 97%) and PI (p = 0.53 I2 = 95%) non-statistical difference was found. The level of evidence analysis (GRADE) presented a low level of evidence among the clinical parameters. This systematic review and meta-analysis observed that asthmatic individuals present more periodontal disease, especially gingivitis, when compared to healthy individuals, but further studies with similar methods are necessary to evaluate interactions between both diseases.

Effectiveness of different psychological interventions in reducing fixed orthodontic pain: A systematic review and meta-analysis

Background/Objective

Pain induced by tooth movement is a common experience for orthodontic patients. The effectiveness of psychological intervention, as a new approach to control pain, has not been fully explored. Hence, this systematic review and meta-analysis is intended to evaluate the analgesic effect of psychological intervention within the week after fixed orthodontic initial arch wire placement.

Methods

A computerised literature search was conducted in the Medline (1966-2019), Embase (1984-2019), Cochrane Library (Issue 1 of 2019), CBMdisk (1978-2019) and CNKI (1994-2019) databases to identify randomised clinical trials (RCTs), which used psychological interventions to relieve pain during fixed orthodontic treatment. Specific inclusion and exclusion criteria were applied to identify relevant articles. The data were extracted independently by two reviewers and a quality assessment was carried out by using the Cochrane Collaboration ‘risk of bias’ tool. Meta-analyses were conducted with fixed or random effects models as appropriate. Statistical heterogeneity was also examined. The RevMan 5.3 software was used for data analysis.

Results

A total of 472 articles were identified, from which nine RCTs were finally included. A meta-analysis revealed that after initial arch wire placement, cognitive behaviour therapy (CBT) and music therapy could significantly reduce pain within three days compared with a control group. In addition, there were no differences in pain reduction between CBT and music therapy within one week. Furthermore, a structured phone and text follow-up could significantly reduce and control pain and had the same effectiveness in pain reduction.

Conclusions

In the short term after initial arch wire placement, all psychological interventions could significantly reduce the intensity of pain without adverse effects. In the current study, there was no significant difference in pain relief between the different psychological interventions. In the future, more high-quality research with consistency in research design is needed for further evaluation.

Patients' self-report on post-retained restoration is more valuable than expected! Explorative analysis of an 11-year follow-up

Objective: Assessment of long-term clinical data regarding post-endodontic restorations is essential for the evaluation of different post-and-core concepts. The aim of the present study was to assess the diagnostic accuracy of patient self-reporting on post-endodontic restorations after 11 years of clinical service.Materials and methods: Twenty-nine patients (61 ± 15 years old) with endodontic glass-fibre and titanium post-endodontic restorations were examined within the 11-year follow-up of a randomized controlled trial. Restorations were assessed by self-reports during a telephone interview (one item), the completion of a four-item questionnaire and clinical and radiographic examination. A gold standard for restoration in situ or 'failure' was defined by clinical and radiographic examination. Diagnostic accuracy of patients' self-reports was evaluated by calculating the sensitivity, specificity, and positive (PPV) and negative predictive values (NPV).Results: After a mean observation time of 137 months (min/max: 125/154 months), 25 (86.2%) restorations were in situ and 4 (13.8%) failures were detected. Self-report during a telephone interview and the four-item questionnaire correctly identified all in situ restorations (specificity = both 100%, NPV = 92.6%/96.2%). Self-report during a telephone interview identified two out of four failures (sensitivity = 50%, PPV = 100%), and self-report on the four-item questionnaire identified three out of four failures (sensitivity = 75%, PPV = 100%).Conclusions: When the clinical examination is not feasible, patients' self-report shows valuable diagnostic potential in the identification of the post-endodontic failure.

Cariology Clinical Trials: What Are We-and What Should We Be-Looking At?

Randomized control trial (RCT) methodology has compared interventions for the prevention and management of dental caries since the late 1960s. Despite almost 50 years and evidence of significant wastage within the wider biomedical research field, there has been little investigation into what works well and where weaknesses lie. This paper aims to draw attention to areas for improvement within cariology clinical trial methodology by summarizing systematic reviews on interventions and outcomes, and using examples to illustrate some challenges with intervention delivery fidelity, outcome analyses, and intervention co-production. Trial design stage choices are critical to ensure that optimum information is obtained when testing interventions. Intervention choice, outcome choice, and analyses are particularly important, and cariology trials have specific issues associated with them. A systematic search and review of cariology RCTs found 650 RCT reports. Social Network Analysis of interventions revealed a high degree of separation between prevention and management trials, gaps in clinically important comparisons, and a tendency for there to be comparisons within groups; e.g., comparison of interventions within the same, rather than different, levels of invasiveness. Outcomes measured for the same trial reports show: a focus on restoration performance and individual/population caries burden; the growing use of carious lesion activity and economic-related outcomes; and sparse, although an increase in the use of, patient-reported/patient-centered outcomes. Fidelity of adherence to complex interventions can be challenging to measure but is important in interpreting trial findings. Involving target populations in intervention design, delivery, and relating it to the planned rollout, are opportunities to ensure intervention relevance and improved uptake. Outcomes analyses should consider the minimum clinically important differences and outcome relevance measures for the target population. Factors underlying trialists' comparator and outcome choices need to be identified, and there is a need to ensure that a minimum dataset of outcomes allow for combination and comparisons of trial data for systematic review.

Efficacy of Adjunctive Bioactive Materials in the Treatment of Periodontal Intrabony Defects: A Systematic Review and Meta-Analysis

Objectives

Lots of bioactive materials have been additionally applied for the treatment of periodontal intrabony defect. However, there is dearth of studies to systematically evaluate the supplementary role of them in periodontal regeneration. The goal of this meta-analysis is to evaluate the adjunctive effects of bioactive materials such as platelet-rich plasma (PRP), platelet-rich fibrin (PRF), enamel matrix derivative (EMD), and amnion membrane (AM) on the outcomes of bone grafting treatment for periodontal intrabony defects.

Methods

Articles published before December 2017 were searched electronically in three databases (PubMed, Embase, and Cochrane Central), with no date or language limits. Randomized controlled trials (RCTs) on the assessment of effectiveness of the four biomaterials in conjunction with demineralized freeze-dried bone allografts (DFDBA) in the treatment of periodontal intrabony defects were enrolled in this meta-analysis. Data were analyzed with STATA 12.

Results

Nine studies were included. PRF and PRP significantly improved pocket depth (PD) reduction and clinical attachment loss (CAL) gain. Only PRF exhibited a positive result in recession reduction (RecRed). Only PRP showed a statistically significant increase in bone fill. AM merely gained more CAL. EMD did not improve any clinical outcome.

Conclusion

Our data suggest that PRF/PRP could be taken as a preferred adjunct to facilitate periodontal regeneration of intrabony defects.

Dental implants in Sjögren's syndrome patients: A systematic review

Objectives

The Sjögren’s syndrome (SS) is a chronic autoimmune disease that affects salivation and consequently the health of oral tissues. The aim of this systematic review was to investigate the implant survival rate, marginal bone loss (MBL) and biological complications of dental implants in SS patients.

Materials and methods

Eligibility criteria included prospective and retrospective cohort studies, controlled clinical trials, and randomized clinical trials (RCTs). An electronic search without date or language restrictions was carried out in MEDLINE, Cochrane, Web of Science, and LILACS until June 2017. In addition, manual search and in the grey literature were also conducted. The search process, data analysis, and quality assessment were performed by two independent reviewing authors. The protocol of this systematic review was registered in PROSPERO under number CRD42016053277.

Results

The search and selection process yielded 6 studies, published between 1997 and 2016. An average of 93.7% survival in a mean period of 3.97 years of follow-up was observed. A low number of MBL and biological complications were reported by the studies. All the studies analyzed observed an improvement in life quality of subjects with SS and rehabilitated through dental implants.

Conclusions

With the limitations of this review and based on the available data, the dental implant therapy in SS patients seems to present high implant survival rate, low MBL and low biological complications. In addition, all included studies observed an increase in the quality of life of SS patients who were rehabilitated through dental implants.

Mineral trioxide aggregate and other bioactive endodontic cements: an updated overview - part II: other clinical applications and complications

Mineral trioxide aggregate (MTA) is a dental material used extensively for vital pulp therapies (VPT), protecting scaffolds during regenerative endodontic procedures, apical barriers in teeth with necrotic pulps and open apices, perforation repairs as well as root canal filling and root-end filling during surgical endodontics. A number of bioactive endodontic cements (BECs) have recently been introduced to the market. Most of these materials have calcium and silicate in their compositions; however, bioactivity is a common property of these cements. These materials include the following: BioAggregate, Biodentine, BioRoot RCS, calcium-enriched mixture cement, Endo-CPM, Endocem, EndoSequence, EndoBinder, EndoSeal MTA, iRoot, MicroMega MTA, MTA Bio, MTA Fillapex, MTA Plus, Neo MTA Plus, Ortho MTA, Quick-Set, Retro MTA, Tech Biosealer, and TheraCal LC. It has been claimed that these materials have properties similar to those of MTA but without the drawbacks. In Part I of this review, the available information on the chemical composition of the materials listed above was reviewed and their applications for VPT was discussed. In this article, the clinical applications of MTA and other BECs will be reviewed for apexification, regenerative endodontics, perforation repair, root canal filling, root-end filling, restorative procedures, periodontal defects and treatment of vertical and horizontal root fractures. In addition, the literature regarding the possible drawbacks of these materials following their clinical applications is reviewed. These drawbacks include their discolouration potential, systemic effects and retreatability following use as a root filling material. Based on selected keywords, all publications were searched regarding the use of MTA as well as BECs for the relevant clinical applications. Numerous publications were found regarding the use of BECs for various endodontic applications. The majority of these investigations compared BECs with MTA. Despite promising results for some materials, the number of publications using BECs for various clinical applications was limited. Furthermore, most studies had several methodological shortcomings and low levels of evidence.

Mineral trioxide aggregate and other bioactive endodontic cements: an updated overview - part I: vital pulp therapy

Mineral trioxide aggregate (MTA) is a bioactive endodontic cement (BEC) mainly comprised of calcium and silicate elements. The cement was introduced by Torabinejad in the 1990s and has been approved by the Food and Drug Administration to be used in the United States in 1997. A number of new BECs have also been introduced to the market, including BioAggregate, Biodentine, BioRoot RCS, calcium-enriched mixture cement, Endo-CPM, Endocem, EndoSequence, EndoBinder, EndoSeal MTA, iRoot, MicroMega MTA, MTA Bio, MTA Fillapex, MTA Plus, NeoMTA Plus, OrthoMTA, Quick-Set, RetroMTA, Tech Biosealer and TheraCal LC. It has been claimed that these materials have properties similar to those of MTA without its drawbacks. In this article, the chemical composition and the application of MTA and other BECs for vital pulp therapy (VPT), including indirect pulp cap, direct pulp cap, partial pulpotomy, pulpotomy and partial pulpectomy, have been reviewed and compared. Based on selected keywords, all papers regarding chemical composition and VPT applications of BECs had been reviewed. Most of the materials had calcium and silicate in their composition. Instead of referring to the cements based on their chemical compositions, we suggest the term 'bioactive endodontic cements (BECs)', which seems more appropriate for these materials because, in spite of differences in their chemical compositions, bioactivity is a common property for all of them. Numerous articles were found regarding use of BECs as VPT agents for indirect and direct pulp capping, partial pulpotomy and cervical pulpotomy. Most of these investigations used MTA for VPT. In most studies, newly introduced materials have been compared to MTA. Some of the BECs have shown promising results; however, the number of their studies compared to investigations on MTA is limited. Most studies had several methodological shortcomings. Future investigations with rigorous methods and materials are needed.

Can rapid maxillary expansion cause auditory improvement in children and adolescents with hearing loss? A systematic review

OBJECTIVE

To evaluate whether the use of palatal expansion techniques can influence hearing loss in children and adolescents with previous hearing impairment.

MATERIALS AND METHODS

Electronic searches in PubMed, Scopus, Web of Science, The Cochrane Library, Lilacs, OpenGrey, and Google Scholar were performed with a controlled vocabulary and free-text terms relating to palatal expansion and hearing loss. No language or time restrictions were imposed. Clinical trials that focused on human patients treated with rapid or semirapid maxillary expansion in children and teenagers with hearing loss were included. Data extraction was undertaken by two authors, with conflict resolution by a third author. Risk of bias assessment and data extraction were performed on the selected studies.

RESULTS

Seventy-four citations were retrieved by the search. Initially, 12 studies were selected according to the eligibility criteria, but three studies were excluded because of the presence of adults, absence of hearing level evaluation, and oversampling, resulting in nine studies. The mean improvement in hearing levels varied from 2 to 19 dB among the studies. The risk of bias varied from low to moderate risk.

CONCLUSIONS

The evidence indicated that there was a hearing improvement after maxillary expansion in patients with hearing loss in the evaluated studies, although more controlled and randomized studies are necessary to investigate this issue further.

Fixed functional appliances with multibracket appliances have no skeletal effect on the mandible: A systematic review and meta-analysis

INTRODUCTION

Our aim was to assess the skeletal mandibular changes (anteroposterior and vertical) in circumpubertal patients with fixed functional appliances installed on multibracket appliances compared with untreated patients.

METHODS

An open-ended electronic search of 4 databases (PubMed, Embase, Cochrane Library, and Web of Science) up to April 2014 was performed. Additional searches of relevant journals, reference lists of the retrieved articles, systematic reviews, and gray literature were performed. Specific inclusion and exclusion criteria were applied to identify relevant articles. Quality was evaluated using the Cochrane Collaboration risk of bias tool and the Newcastle-Ottawa scale for prospective controlled clinical trials. Meta-analyses were conducted with fixed and random effects models as appropriate. Statistical heterogeneity was also examined.

RESULTS

Seven articles were included in the qualitative synthesis and 5 in the meta-analysis. The included randomized controlled trials were at high risk of bias, and the methodologic quality of the prospective controlled clinical trials was high. Based on assessment of the fixed functional appliance phase in isolation, no difference in mandibular anteroposterior positional changes (SNB angle) (standard mean difference, 0.11°; 95% CI, -0.28, 0.50) was found between the treated and control groups. The vertical dimension was not influenced by the fixed functional appliance treatment.

CONCLUSIONS

There is little high-quality evidence concerning the relative influence of fixed functional appliances on skeletal and dentoalveolar changes. However, based on the limited evidence, it appears that they have little effect on the skeletal mandibular parameters.

Maxillary sinus floor elevation with simultaneous implant placement without grafting materials: a systematic review and meta-analysis

The present study aimed to conduct a systematic review and meta-analysis on the effectiveness of maxillary sinus floor elevation and immediate implant installation without the use of grafting material. An electronic search without date or language restriction ​​was performed in PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, Embase, and the grey literature, to May 2016. Eligibility criteria encompassed prospective and retrospective cohort studies, controlled clinical trials, and randomized clinical trials. The search and selection process yielded 18 studies, published between 2005 and 2016. A meta-analysis was conducted only for experimental studies comparing sinus floor elevation with and without grafting material; results were expressed as the standardized mean difference (SMD) or risk ratio (RR) with the 95% confidence interval (CI). An average gain in bone height of 4.7mm over an average 39.4 month period was observed in the sinus elevated without grafting material. Regarding implants, there was a cumulative average survival rate of 97%. On meta-analysis, bone gain (P=0.98) and implant survival (P=0.13) did not differ significantly between sinuses lifted with or without grafting material, with a SMD of 0.01 (95% CI -0.42 to 0.44) and with a RR of 0.55 (95% CI 0.26 to 1.19), respectively.

Should oral anticoagulant therapy be continued during dental extraction? A meta-analysis

Background

Oral anticoagulation therapy is widely used to reduce the risks of thromboembolism. However, the therapy increases the risk of hemorrhage during the surgical procedures. The aim of this meta-analysis was to evaluate the bleeding risk of patients continuing or discontinuing oral anticoagulant therapy while undergoing dental extractions.

Methods

Six electronic databases, including PubMed, Embase, Cochrane library, Web of Science, China Biology Medicine disc (CBM), and China National Knowledge Infrastructure (CNKI), were searched in March, 2016. Relevant articles were screened by two independent reviewers under our inclusion criteria. Quality was evaluated using the Cochrane Collaboration risk of bias tool. Meta-analyses were conducted with fixed and random effects models as appropriate.

Results

Six studies (with a total of 591 patients) were included in our meta-analysis. Our results showed that there was no significant difference in the bleeding risk between patients continuing or discontinuing oral anticoagulant therapy while undergoing dental extractions (risk ratio, 1.31; 95 % CI, 0.79, 2.14; P > 0.05). There was also no significant difference in bleeding risk 1 day (risk ratio, 0.91; 95 % CI, 0.35, 2.37; P > 0.05) and 7 days (risk ratio, 1.47; 95 % CI, 0.83, 2.59; P > 0.05) after the dental extraction.

Conclusion

Under current studies and evidence, it appears that patients continuing oral anticoagulant therapy do not have an increased risk of bleeding after dental extractions compared to patients who discontinue oral anticoagulant therapy.

Selective enamel etching in cervical lesions for self-etch adhesives: A systematic review and meta-analysis

OBJECTIVES

To identify if selective etching of enamel (SEE) margins improves the retention rates and marginal discoloration of cervical composite restorations in non-carious cervical lesions (NCCLs) of adult patients.

SOURCE

MEDLINE, Scopus, Web of Science, LILACS, BBO Library, Cochrane Library and SIGLE were searched without restrictions, as well as IADR abstracts and gray literature via trial registries. Dissertations and theses were searched using the ProQuest Dissertations and Periódicos Capes Theses databases.

STUDY SELECTION

We included randomized clinical trials that compared the clinical effectiveness of SEE using the self-etch adhesive for direct composite resin restorations in NCCLs in the permanent dentition.

DATA

After removal of duplicates, 2689 articles were identified. Following screening of abstracts, 10 studies remained in the qualitative synthesis. Seven were considered to be at "low" risk of bias. The report of the studies varied from 1 to 5 years. Except for one-year follow-up, there was a significantly lower marginal discoloration and marginal adaptation during all follow-up periods. Significantly less loss of retention of restorations at the 3-year follow-up was observed with the selective enamel etching technique.

CONCLUSIONS

Selective enamel prior to application of self-etch adhesive systems in NCCLs might improve clinical performance of resin-composite cervical restorations, although further long-term research is required to confirm this.

CLINICAL SIGNIFICANCE

Selective enamel etching prior to application of self-etch adhesive systems in NCCLs can produce composite restorations with higher longevity.

Use of Platelet-Rich Fibrin Membrane in the Treatment of Gingival Recession: A Systematic Review and Meta-Analysis

BACKGROUND

The aim of this systematic review is to evaluate the effects of platelet-rich fibrin (PRF) membranes on the outcomes of clinical treatments in patients with gingival recession.

METHODS

Articles that were published before June 2015 were searched electronically in four databases without any date or language restrictions and searched manually in regular journals and unpublished studies. The eligibility criteria comprised randomized controlled trials (RCTs) and prospective controlled trials with follow-up periods of ≥ 6 months that compared the performance of PRF to other biomaterials in the treatment of Miller Class I or II gingival recessions. For the meta-analysis, the inverse variance method was used in fixed- or random-effect models, which were chosen according to heterogeneity. The estimates of the intervention effects were expressed as the mean differences in percentages or millimeters.

RESULTS

Six RCTs and one prospective clinical trial are included in this review. Root coverage (RC) and clinical attachment level (CAL) did not differ significantly between the analyzed subgroups (P = 0.57 and P = 0.50, respectively). The keratinized mucosa width (KMW) gain was significantly greater (P = 0.04) in the subgroup that was treated with connective tissue grafts.

CONCLUSION

The results of the meta-analysis suggest that the use of PRF membranes did not improve the RC, KMW, or CAL of Miller Class I and II gingival recessions compared with the other treatment modalities.

Use of guidelines to improve the quality and transparency of reporting oral health research

OBJECTIVE

The use of reporting guideline is directed at enhancing the completeness and transparency of biomedical publications. The aims of this paper are to present some of the key initiatives and guidelines providing indications and directions on the use of specific tools in oral health research.

METHODS

The EQUATOR Network and five established guidelines (CONSORT, STROBE, PRISMA, CARE and SPIRIT) are introduced.

RESULTS

Five guidelines are presented covering reporting of case reports, non-randomized studies, randomized controlled trials and systematic reviews. The importance of adherence to these guidelines by oral health researchers is emphasized.

CONCLUSIONS

Endorsement and robust implementation of reporting guidelines will translate into improved and more complete reporting in health research. Moreover, by ingraining the use of guidelines, it may be possible to indirectly improve the methodological quality of clinical studies. Active implementation strategies to encourage adherence to these guidelines among researchers, reviewers, editors and publishers may be an important facet in the advancement of knowledge in dentistry.

CLINICAL SIGNIFICANCE

Inadequate reporting of research can lead to wasted research resources and risks publication of inaccurate or misleading findings with implications on healthcare decisions. Familiarity and diligent compliance with methodological and reporting guidelines are therefore essential to maximize the yield from dental research.