Critical analysis of methodological quality of systematic reviews and meta-analysis of antibiotics in third molar surgeries using AMSTAR 2

Methodological quality of systematic reviews in dentistry including animal studies: a cross-sectional study

BACKGROUND

The overall confidence in the results of systematic reviews including animal models can be heterogeneous. We assessed the methodological quality of systematic reviews including animal models in dentistry as well as the overall confidence in the results of those systematic reviews.

MATERIAL & METHODS

PubMed, Web of Science and Scopus were searched for systematic reviews including animal studies in dentistry published later than January 2010 until 18th of July 2022. Overall confidence in the results was assessed using a modified version of the A MeaSurement Tool to Assess systematic Reviews (AMSTAR-2) checklist. Checklist items were rated as yes, partial yes, no and not applicable. Linear regression analysis was used to investigate associations between systematic review characteristics and the overall adherence to the AMSTAR-2 checklist. The overall confidence in the results was calculated based on the number of critical and non-critical weaknesses presented in the AMSTAR-2 items and rated as high, moderate, low and critical low.

RESULTS

Of initially 951 retrieved systematic reviews, 190 were included in the study. The overall confidence in the results was low in 43 (22.6%) and critically low in 133 (70.0%) systematic reviews. While some AMSTAR-2 items were regularly reported (e.g. conflict of interest, selection in duplicate), others were not (e.g.

FUNDING

n = 1; 0.5%). Multivariable linear regression analysis showed that the adherence scores of AMSTAR-2 was significantly associated with publication year, journal impact factor (IF), topic, and the use of tools to assess risk of bias (RoB) of the systematic reviews.

CONCLUSION

Although the methodological quality of dental systematic reviews of animal models improved over the years, it is still suboptimal. The overall confidence in the results was mostly low or critically low. Systematic reviews, which were published later, published in a journal with a higher IF, focused on non-surgery topics, and used at least one tool to assess RoB correlated with greater adherence to the AMSTAR-2 guidelines.

Photobiomodulation for Pain Relief After Third Molar Extraction: A Randomized Double-Blind Split-Mouth Clinical Trial

Objective: To evaluate the local and systemic application of photobiomodulation (PBM) to reduce pain after third molar extraction. Background: PBM has been applied locally to reduce pain after third molar extraction, but there are no published studies evaluating its systemic application for this purpose. Methods: Thirty patients with two erupted third molars indicated for extraction were included in this split-mouth clinical trial. Extractions were performed 3 weeks apart in each patient, with one extraction socket being randomly assigned to local and systemic PBM (PBM group) and the other to no PBM (control group). Postoperative analgesia consisted of oral acetaminophen for 3 days. Outcomes included pain (visual analog scale), swelling, and quality of life (14-item Oral Health Impact Profile) assessed before and immediately, 24 h, 48 h, and 7 days after extraction. Results were analyzed by Kruskal-Wallis test, followed by Student-Newman-Keuls test. Results: In the control group, pain increased significantly at 24 and 48 h after extraction (p = 0.0000), decreasing after 7 days (before: 0.36; immediately after: 1.06; 24 h: 4.26; 48 h: 2.53; 7 days: 0.36). In the PBM group, patients reported no pain at all time points, indicating effectiveness of local and systemic PBM in relieving pain after third molar extraction (p = 0.2151) (before: 0.30; immediately after: 0.36; 24 h: 0.86; 48 h: 0.30; 7 days: 0.03). PBM also had a modulatory effect on the inflammatory process and improved comfort after extraction. Conclusions: Combined local and systemic PBM can be useful for pain relief, swelling control, and quality-of-life improvement in patients undergoing third molar extraction.

Quality assessment of systematic reviews with meta-analysis in undergraduate nursing education

BACKGROUND

Little attention has been given to the methodological quality of meta-analyses in nursing education. This warrants further improvements in meta-analyses in nursing education.

OBJECTIVE

This study aimed to assess the methodological quality of meta-analysis in the field of undergraduate nursing education.

DESIGN

This was a methodological study to review the methodological quality of systematic reviews (SRs) with meta-analysis.

METHODS

Exhaustive literature searches were performed using five comprehensive databases. Between 1994 and 2022, 11,827 studies were identified, and 41 full-text articles met the inclusion criteria. Two researchers extracted data using A Measurement Tool to Assess Systematic Reviews (AMSTAR)-2. The Chi-square test was conducted to make comparisons before and after 2017, the year AMSTAR-2 was released.

RESULTS

A comprehensive literature retrieval strategy, inclusion and exclusion criteria, literature selection, and data extraction were observed in nursing education more than in other disciplines. Improvements to be made include pre-specifying the protocol, providing a list of excluded studies with their exclusion reasons, reporting the source of funding for the included studies, assessing and discussing the potential impact of risk of bias, as well as investigating and discussing publication bias and its impact.

CONCLUSIONS

The number of SRs with meta-analyses in nursing education is increasing. This warrants efforts to improve the quality of research. In addition, guidelines for reporting SRs in the field of nursing education should be constantly updated.

Association between the Risk of Preterm Birth and Low Birth Weight with Periodontal Disease in Pregnant Women: An Umbrella Review

Background: The purpose of this review is to determine the association between the risk of preterm birth and low birth weight in newborns and periodontal disease in pregnant women. Methods: A bibliographic search was carried out until November 2021 in the following biomedical databases: PubMed/Medline, Cochrane Library, Scopus, EMBASE, Web of Science, Scielo, LILACS and Google Scholar. Studies reporting the association between the risk of preterm birth and low birth weight in newborns with periodontal disease in pregnant women, which were systematic reviews, in English and without time limits were included. AMSTAR-2 was used to assess the risk of the included studies, and the GRADEPro GDT tool was used to assess the quality of the evidence and the strength of the recommendation of the results. Results: The preliminary search yielded a total of 161 articles, discarding those that did not meet the selection criteria, leaving only 15 articles. Seven articles were entered into a meta-analysis, and it was found that there is an association between the risk of preterm birth and low birth weight in newborns with periodontal disease in pregnant women. Conclusions: There is an association between the risk of preterm birth and low birth weight in newborns with periodontal disease in pregnant women.

Critical appraisal of systematic reviews of intervention in dentistry published between 2019-2020 using the AMSTAR 2 tool

Introduction The number of systematic reviews (SRs) in dentistry published each year has grown considerably, and they have been essential in clinical decision-making and health policy.Objective The objective is to critically appraise SRs of intervention in dentistry using the 'A Measurement Tool to Assess Systematic Reviews 2' (AMSTAR 2) tool published within one year.Methods A search in the Medline/PubMed database was performed. The SRs were identified in two phases. The first phase identified SRs of interventions in dentistry by title and abstract. In the second phase, the full text was read, applying the eligibility criteria. Three calibrated reviewers methodologically assessed all SRs identified using the AMSTAR 2 tool. Data were analysed descriptively, and SRs were grouped according to methodological quality as moderate/high and low/critically low. A logistic regression model was applied to explore the associations between methodological quality and the study's characteristics.Results Two hundred and twenty-two SRs were included. The methodological quality of the SRs included in this study were: critically low (56.8%), low (27.9%), moderate (14.4%) and high (0.9%), according to AMSTAR 2. There were no statistical differences between moderate/high and low/critically low methodological quality and publication year, continent, journal Impact Factor and dental speciality.Conclusion Less than 1% of recently published SRs in dentistry were classified with high methodological quality. We hope that this study will alert researchers about the need to improve the methodological quality of SRs.

Mandibular full-arch fixed prostheses supported by three-dental-implants: A protocol of an overview of reviews

INTRODUCTION

To minimize trauma and cost of treatment, oral health practitioners have successfully rehabilitated full arches by supporting the prostheses on four implants. However, there is no consensus whether less than four implants supporting full mandibular arches would provide similar clinical outcomes to other well-established all-on-four alternative.

OBJECTIVE

To identify, summarize, appraise, and compare the clinical outcomes evidence of three-implant fixed full-arch prostheses in completely edentulous mandibular patients.

MATERIALS AND METHODS

This overview of systematic reviews (OoSRs) will include secondary synthesis studies (i.e., systematic reviews with or without a meta-analysis). A three-step search strategy will be conducted in MEDLINE (Ovid), EMBASE (Ovid), Cochrane Database of Systematic Reviews, Scopus, Web of Science (WoS Core Collection), and Google Scholar. Grey literature and a manual search in 12 specialized journals will also be conducted. Three independent reviewers will screen all retrieved articles for eligibility, extract data and assess the methodological quality of the included studies. The results will be presented as tables or narrative synthesis. The studies will be evaluated for risk of bias by ROBIS and methodology quality by the AMSTAR-2 tool. If new primary studies are identified, a meta-analysis will be conducted. Certainty of the evidence will be assessed to answer the following focused research question: In edentulous mandibular patients, what are the implant and prostheses clinical outcomes of three-implant fixed full-arch prostheses compared to other all-on-x solutions?

DISCUSSION

There are some systematic reviews about the use of fixed complete dental prostheses supported by three implants; however, their clinical outcomes related to the other all-on-four plus solutions are conflicting. So, an overview on this topic is required to provide recommendations.

REVIEW REGISTRATION NUMBER

International prospective register of systematic reviews (PROSPERO) ID#: CRD42021262175. National Institute for Health Research (NIHR) and Centre for Reviews and Dissemination, University of York, York, United Kingdom.

Use of antibiotics after lower third molar surgery - useful or harmful procedure? A randomized, double-blind, placebo-controlled trial

Introduction/Objective. The aim of the present study was to investigate the effects of moxifloxacin and cefixime in preventing postoperative infection following mandibular third molar surgery. Methods. Double-blind study was completed by 157 patients undergoing surgical removal of mandibular third molars. Patients were randomly assigned to three groups: moxifloxacin (M), cefixime (C) and placebo (P). Patients in each group were classified into two subgroups: subgroup (a) without previous history of pericoronitis and subgroup (b) with previous history of pericoronitis. All patients were evaluated at the postoperative follow-ups on the first, second and seventh postoperative day. Results. Postoperative infections were registered only in patients with history of pericoronitis. Antibiotic prophylaxis with cefixime, and moxifloxacin, reduced the occurrence of postoperative infection. Overall incidence of postoperative infections was 6.4%. All postoperative infections were registered in placebo-group, where the incidence of postoperative infection was 19.2%. Microbiological tests verified the clinically obtained results. Isolated microflora was resistant to penicillin-derived antibiotics in 50% of cases. Conclusion. Prophylactic use of antibiotics after third molar surgery should be weighted against potential risks and benefits and could be considered in cases with previous history of pericoronitis, when complicated surgical extraction is performed.

Current thinking in lower third molar surgery

The removal of lower third molar teeth is one of the most common surgical procedures performed worldwide, but many concepts in this surgery have been unclear and have engendered different opinions. This paper aims to review current thinking in certain pertinent aspects of this surgery to update the reader on the most current research and synthesise it to make clinical recommendations. Topics covered include preoperative imaging, timing of removal, flap design, lingual retraction, coronectomy, lingual split, closure techniques, and use of antibiotics, steroids, and drains.

Use of quality assessment tools within systematic reviews in orthodontics during the last decade: looking for a threshold?

OBJECTIVE

To record the prevalence and extent of use of quality assessment/ risk of bias tools in orthodontic systematic reviews and to identify whether systematic reviews authors stipulated a threshold during the evaluation process of the primary studies included in systematic reviews, published across the previous decade and until now. Associations with publication characteristics including the journal of publication, year, the inclusion of a meta-analysis, design of primary studies and others, were sought.

MATERIALS AND METHODS

Electronic search within 6 orthodontic journals and the Cochrane Database of Systematic Reviews was conducted to identify relevant systematic reviews from 1 January 2010 and 31 December 2020. The outcomes of interest pertained to the use, type and extent of quality appraisal/ risk of bias tools utilized as a standard process within the systematic reviews, and also whether a threshold had been stipulated by the systematic reviews authors. Predictor variables included journal, year of publication, geographic region, number of authors, involvement of a methodologist, type of systematic reviews, inclusion of meta-analysis, type/design of primary studies.

RESULTS

A total of 262 systematic reviews were eligible for inclusion, with 41 quality appraisal/ risk of bias sets of tools being described either jointly or in isolation. One-third of the systematic reviews of the present sample (88/262; 33.6%) included a threshold, while this was mostly represented by the stipulation of sensitivity analyses in this respect (64/88; 72.8%). Journal of publication (non-Cochrane systematic reviews versus Cochrane systematic reviews: adjusted odds ratio, OR: 0.04, 95%CI: 0.01, 0.16; P < 0.001) and inclusion of a meta-analysis (adjusted OR: 8.76; 95%CI: 4.18, 18.37; P < 0.001), were identified as significant predictors for preplanning of thresholds.

CONCLUSIONS AND IMPLICATIONS

Quality assessment tools for primary studies are largely used and varied in orthodontic systematic reviews, while a threshold-level has been stipulated in only one third. Additional efforts should be endorsed by the scientific community, to embrace more straightforward adoption of the most rigorous reporting guidelines in this respect.