Survey of systematic reviews in dentistry

Treatment Outcomes of Lip Taping in Patients with Non-syndromic Cleft Lip and/or Palate: A Systematic Review and Meta-analysis

OBJECTIVE

To conduct a systematic review of the data in peer-reviewed medical literature and evaluate the effectiveness of lip taping as a pre-surgical naso-alveolar molding (NAM) technique in infants with cleft lip and/or palate.

DESIGN

An electronic search of various databases for relevant studies, regardless of date, from inception to June 2023 was carried out and evaluated. After completing the electronic search and applying our inclusion/exclusion criteria, 6 studies-2 randomized control trials, 2 non-randomized studies, and 2 case series-were included. Data extraction of relevant articles was done independently by 2 authors. Quality assessment was done using the JBI prevalence critical appraisal tool and certainty of evidence was carried out by GRADE approach.

MAIN OUTCOME MEASURES

Nasolabial Aesthetics, Dentoalveolar Relationship.

RESULTS

A total of six studies were included in the current review. Meta-analysis was carried out, and forest plots were obtained for a single mean from the lip-taping group. 3 studies had a low risk of bias, while 3 studies displayed a serious risk of bias. Significant improvement in various outcome measures was noted with lip taping when compared with the control group although the certainty of evidence was very low.

CONCLUSION

When compared to no therapy, lip taping appears to ameliorate dentoalveolar measurements and nasolabial aesthetics. To increase our knowledge of lip taping, more research will be needed in the future, as there are not many studies to prove lip taping is better than other treatment approaches.

Reporting quality of systematic review abstracts in operative dentistry: An assessment using the PRISMA for Abstracts guidelines

OBJECTIVES

To assess and compare the reporting quality of systematic review (SR) abstracts in operative dentistry published before and after the release of Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Abstracts (PRISMA-A), and to identify factors associated with reporting quality.

METHODS

PubMed was searched for abstracts published during 2010-2012 (Pre-PRISMA period) and 2017-2019 (Post-PRISMA period). Reporting quality was assessed and scored using a modified 13-item PRSIMA-A checklist. Risk ratio (RR) was used to compare the adequate reporting rate of each item between the two periods. Univariable and multivariable linear regression analyses were performed to identify factors associated with reporting quality.

RESULTS

A total of 160 abstracts were included and assessed. Only four items ('objective', 'results of main outcomes', 'description of the effect' and 'interpretation') were adequately reported in most abstracts (>75 %). According to the multivariable analysis, greater word count (P = 0.001), being published in the Post-PRISMA period (P = 0.025) and geographic origin from Asia (P = 0.025) or South America (P = 0.015) were significantly associated with higher reporting quality.

CONCLUSIONS/CLINICAL SIGNIFICANCE

The reporting quality of SR abstracts in operative dentistry had improved significantly after the publication of PRISMA-A, but was still suboptimal. Researchers, reviewers and journal editors in operative dentistry need to be familiar with the PRISMA-A checklist, and make concerted efforts to improve the reporting of SR abstracts.

The Mass Production of Redundant, Misleading, and Conflicted Systematic Reviews and Meta-analyses

POLICY POINTS

Currently, there is massive production of unnecessary, misleading, and conflicted systematic reviews and meta-analyses. Instead of promoting evidence-based medicine and health care, these instruments often serve mostly as easily produced publishable units or marketing tools. Suboptimal systematic reviews and meta-analyses can be harmful given the major prestige and influence these types of studies have acquired. The publication of systematic reviews and meta-analyses should be realigned to remove biases and vested interests and to integrate them better with the primary production of evidence.

CONTEXT

Currently, most systematic reviews and meta-analyses are done retrospectively with fragmented published information. This article aims to explore the growth of published systematic reviews and meta-analyses and to estimate how often they are redundant, misleading, or serving conflicted interests.

METHODS

Data included information from PubMed surveys and from empirical evaluations of meta-analyses.

FINDINGS

Publication of systematic reviews and meta-analyses has increased rapidly. In the period January 1, 1986, to December 4, 2015, PubMed tags 266,782 items as "systematic reviews" and 58,611 as "meta-analyses." Annual publications between 1991 and 2014 increased 2,728% for systematic reviews and 2,635% for meta-analyses versus only 153% for all PubMed-indexed items. Currently, probably more systematic reviews of trials than new randomized trials are published annually. Most topics addressed by meta-analyses of randomized trials have overlapping, redundant meta-analyses; same-topic meta-analyses may exceed 20 sometimes. Some fields produce massive numbers of meta-analyses; for example, 185 meta-analyses of antidepressants for depression were published between 2007 and 2014. These meta-analyses are often produced either by industry employees or by authors with industry ties and results are aligned with sponsor interests. China has rapidly become the most prolific producer of English-language, PubMed-indexed meta-analyses. The most massive presence of Chinese meta-analyses is on genetic associations (63% of global production in 2014), where almost all results are misleading since they combine fragmented information from mostly abandoned era of candidate genes. Furthermore, many contracting companies working on evidence synthesis receive industry contracts to produce meta-analyses, many of which probably remain unpublished. Many other meta-analyses have serious flaws. Of the remaining, most have weak or insufficient evidence to inform decision making. Few systematic reviews and meta-analyses are both non-misleading and useful.

CONCLUSIONS

The production of systematic reviews and meta-analyses has reached epidemic proportions. Possibly, the large majority of produced systematic reviews and meta-analyses are unnecessary, misleading, and/or conflicted.

Dental movement acceleration: Literature review by an alternative scientific evidence method

The aim of this study was to analyze the majority of publications using effective methods to speed up orthodontic treatment and determine which publications carry high evidence-based value. The literature published in Pubmed from 1984 to 2013 was reviewed, in addition to well-known reports that were not classified under this database. To facilitate evidence-based decision making, guidelines such as the Consolidation Standards of Reporting Trials, Preferred Reporting items for systematic Reviews and Meta-analyses, and Transparent Reporting of Evaluations with Non-randomized Designs check list were used. The studies were initially divided into three groups: local application of cell mediators, physical stimuli, and techniques that took advantage of the regional acceleration phenomena. The articles were classified according to their level of evidence using an alternative method for orthodontic scientific article classification. 1a: Systematic Reviews (SR) of randomized clinical trials (RCTs), 1b: Individual RCT, 2a: SR of cohort studies, 2b: Individual cohort study, controlled clinical trials and low quality RCT, 3a: SR of case-control studies, 3b: Individual case-control study, low quality cohort study and short time following split mouth designs. 4: Case-series, low quality case-control study and non-systematic review, and 5: Expert opinion. The highest level of evidence for each group was: (1) local application of cell mediators: the highest level of evidence corresponds to a 3B level in Prostaglandins and Vitamin D; (2) physical stimuli: vibratory forces and low level laser irradiation have evidence level 2b, Electrical current is classified as 3b evidence-based level, Pulsed Electromagnetic Field is placed on the 4^th level on the evidence scale; and (3) regional acceleration phenomena related techniques: for corticotomy the majority of the reports belong to level 4. Piezocision, dentoalveolar distraction, alveocentesis, monocortical tooth dislocation and ligament distraction technique, only had case series or single report cases (4^th level of evidence). Surgery first and periodontal distraction have 1 study at level 2b and corticision one report at level 5. Multiple orthodontic acceleration reports on humans were identified by an alternative evidence level scale, which is a simple and accurate way of determining which techniques are better and have a higher rate of effectiveness. The highest level of evidence for a specific procedure to accelerate orthodontic dental movement up to October 2013 was surgery first followed by low level laser application, corticotomy and periodontal distraction located on level 2, recommendation grade b from this proposed scientific evidence-based scale.

Comparison of search strategies in systematic reviews of adverse effects to other systematic reviews

BACKGROUND

Research indicates that the methods used to identify data for systematic reviews of adverse effects may need to differ from other systematic reviews.

OBJECTIVES

To compare search methods in systematic reviews of adverse effects with other reviews.

METHODS

The search methodologies in 849 systematic reviews of adverse effects were compared with other reviews.

RESULTS

Poor reporting of search strategies is apparent in both systematic reviews of adverse effects and other types of systematic reviews. Systematic reviews of adverse effects are less likely to restrict their searches to MEDLINE or include only randomised controlled trials (RCTs). The use of other databases is largely dependent on the topic area and the year the review was conducted, with more databases searched in more recent reviews. Adverse effects search terms are used by 72% of reviews and despite recommendations only two reviews report using floating subheadings.

CONCLUSIONS

The poor reporting of search strategies in systematic reviews is universal, as is the dominance of searching MEDLINE. However, reviews of adverse effects are more likely to include a range of study designs (not just RCTs) and search beyond MEDLINE.

A descriptive analysis of oral health systematic reviews published 1991-2012: cross sectional study

Objectives

To identify all systematic reviews (SRs) published in the domain of oral health research and describe them in terms of their epidemiological and descriptive characteristics.

Design

Cross sectional, descriptive study.

Methods

An electronic search of seven databases was performed from inception through May 2012; bibliographies of relevant publications were also reviewed. Studies were considered for inclusion if they were oral health SRs defined as therapeutic or non-therapeutic investigations that studied a topic or an intervention related to dental, oral or craniofacial diseases/disorders. Data were extracted from all the SRs based on a number of epidemiological and descriptive characteristics. Data were analysed descriptively for all the SRs, within each of the nine dental specialities, and for Cochrane and non-Cochrane SRs separately.

Results

1,188 oral health (126 Cochrane and 1062 non-Cochrane) SRs published from 1991 through May 2012 were identified, encompassing the nine dental specialties. Over half (n = 676; 56.9%) of the SRs were published in specialty oral health journals, with almost all (n = 1,178; 99.2%) of the SRs published in English and almost none of the non-Cochrane SRs (n = 11; 0.9%) consisting of updates of previously published SRs. 75.3% of the SRs were categorized as therapeutic, with 64.5% examining non-drug interventions, while approximately half (n = 150/294; 51%) of the non-therapeutic SRs were classified as epidemiological SRs. The SRs included a median of 15 studies, with a meta-analysis conducted in 43.6%, in which a median of 9 studies/1 randomized trial were included in the largest meta-analysis conducted. Funding was received for 25.1% of the SRs, including nearly three-quarters (n = 96; 76.2%) of the Cochrane SRs.

Conclusion

Epidemiological and descriptive characteristics of the 1,188 oral health SRs varied across the nine dental specialties and by SR category (Cochrane vs. non-Cochrane). There is a clear need for more updates of SRs in all the dental specialties.

Fluoride varnishes for preventing dental caries in children and adolescents

BACKGROUND

Topically-applied fluoride varnishes have been used extensively as an operator-applied caries-preventive intervention for over three decades. This review updates the first Cochrane review of fluoride varnishes for preventing dental caries in children and adolescents, which was first published in 2002.

OBJECTIVES

To determine the effectiveness and safety of fluoride varnishes in preventing dental caries in children and adolescents, and to examine factors potentially modifying their effect.

SEARCH METHODS

We searched the Cochrane Oral Health Group's Trials Register (to 13 May 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 4), MEDLINE via OVID (1946 to 13 May 2013), EMBASE via OVID (1980 to 13 May 2013), CINAHL via EBSCO (1980 to 13 May 2013), LILACS and BBO via the BIREME Virtual Health Library (1980 to 13 May 2013), ProQuest Dissertations and Theses (1861 to 13 May 2013), and Web of Science Conference Proceedings (1945 to 13 May 2013). A search for ongoing trials was undertaken on ClinicalTrials.gov on 13 May 2013. There were no restrictions on language or date of publication in the search of the electronic databases.

SELECTION CRITERIA

Randomised or quasi-randomised controlled trials with blind outcome assessment used or indicated, comparing topically-applied fluoride varnish with placebo or no treatment in children up to 16 years during at least one year. The main outcome was caries increment measured by the change in decayed, missing and filled tooth surfaces in both permanent (D(M)FS) and primary (d(e/m)fs) teeth.

DATA COLLECTION AND ANALYSIS

At least two review authors assessed all search results, extracted data and undertook risk of bias independently. Study authors were contacted for additional information. The primary measure of effect was the prevented fraction, that is the difference in mean caries increments between the treatment and control groups expressed as a percentage of the mean increment in the control group. The caries increments nearest to three years were used from each included study. Random-effects meta-analyses were performed where data could be pooled. Potential sources of heterogeneity were examined in random-effects meta-regression analyses. Adverse effects information was collected from the included trials.

MAIN RESULTS

Twenty-two trials with 12,455 participants randomised (9595 used in analyses) were included. For the 13 that contributed data for the permanent tooth surfaces meta-analysis, the pooled D(M)FS prevented fraction estimate comparing fluoride varnish with placebo or no treatment was 43% (95% confidence interval (CI) 30% to 57%; P < 0.0001). There was substantial heterogeneity, confirmed statistically (P < 0.0001; I(2) = 75%), however this body of evidence was assessed as of moderate quality. The pooled d(e/m)fs prevented fraction estimate was 37% (95% CI 24% to 51%; P < 0.0001) for the 10 trials that contributed data for the primary tooth surfaces meta-analysis, also with some heterogeneity (P = 0.009; I(2) = 59%). Once again this body of evidence was assessed as of moderate quality. No significant association between estimates of D(M)FS or d(e/m)fs prevented fractions and the pre-specified factors of baseline caries severity, background exposure to fluorides, application features such as prior prophylaxis, concentration of fluoride, frequency of application were found. There was also no significant association between estimates of D(M)FS or d(e/m)fs prevented fractions and the post hoc factors: whether a placebo or no treatment control was used, length of follow-up, or whether individual or cluster randomisation was used, in the meta-regression models. A funnel plot of the trials in the main meta-analyses indicated no clear relationship between prevented fraction and study precision. In both methods, power is limited when few trials are included. There was little information concerning possible adverse effects or acceptability of treatment.

AUTHORS' CONCLUSIONS

The conclusions of this updated review remain the same as those when it was first published. The review suggests a substantial caries-inhibiting effect of fluoride varnish in both permanent and primary teeth, however the quality of the evidence was assessed as moderate, as it included mainly high risk of bias studies, with considerable heterogeneity.

Systematic Reviews Informing Occupational Therapy

OBJECTIVE. We sought to identify and describe the number, topics, and publishing trends of systematic reviews relevant to occupational therapy indexed in the OTseeker database.

METHOD. We performed a cross-sectional survey of the systematic reviews contained in OTseeker in December 2011.

RESULTS. Of the 1,940 systematic reviews indexed in OTseeker, only 53 (2.7%) were published in occupational therapy journals. The most common diagnostic categories were stroke (n = 195, 10.1%) and affective disorders (n = 204, 10.5%). The most common intervention categories were consumer education (n = 644, 33.2%) and psychosocial techniques (n = 571, 29.4%). Only 390 (20.1%) of the 1,940 systematic reviews specifically involved occupational therapy.

CONCLUSION. Occupational therapists need to search broadly to locate relevant systematic reviews or, alternatively, to use databases such as OTseeker. Clarity about the involvement of occupational therapy in reports of future research will improve the ability to identify occupational therapy research for all stakeholders. Finally, occupational therapy practitioners need to read systematic reviews critically to determine whether review conclusions are justified.

Cochrane and non-Cochrane systematic reviews in leading orthodontic journals: a quality paradigm?

The aims of this study were to assess and compare the methodological quality of Cochrane and non-Cochrane systematic reviews (SRs) published in leading orthodontic journals and the Cochrane Database of Systematic Reviews (CDSR) using AMSTAR and to compare the prevalence of meta-analysis in both review types. A literature search was undertaken to identify SRs that consisted of hand-searching five major orthodontic journals [American Journal of Orthodontics and Dentofacial Orthopedics, Angle Orthodontist, European Journal of Orthodontics, Journal of Orthodontics and Orthodontics and Craniofacial Research (February 2002 to July 2011)] and the Cochrane Database of Systematic Reviews from January 2000 to July 2011. Methodological quality of the included reviews was gauged using the AMSTAR tool involving 11 key methodological criteria with a score of 0 or 1 given for each criterion. A cumulative grade was given for the paper overall (0-11); an overall score of 4 or less represented poor methodological quality, 5-8 was considered fair and 9 or greater was deemed to be good. In total, 109 SRs were identified in the five major journals and on the CDSR. Of these, 26 (23.9%) were in the CDSR. The mean overall AMSTAR score was 6.2 with 21.1% of reviews satisfying 9 or more of the 11 criteria; a similar prevalence of poor reviews (22%) was also noted. Multiple linear regression indicated that reviews published in the CDSR (P < 0.01); and involving meta-analysis (β = 0.50, 95% confidence interval 0.72, 2.07, P < 0.001) showed greater concordance with AMSTAR.

Awareness, knowledge and practice of evidence-based dentistry amongst dentists in Kuwait

This study assessed the awareness, knowledge and practice of evidence-based dentistry (EBD) amongst dentists working in the public sector in Kuwait. Of the 150 randomly selected dentists from all five health districts in Kuwait who had originally been approached, 120 participated by completing a pre-tested, self-administered questionnaire (80% response rate). Whereas 60.9% of the group stated that they practice EBD most of the time, fewer (40.8%) had a reasonable understanding of EBD based upon tested knowledge scores of EBD-related topics. Clinical decisions appeared to be mostly based on the clinician's own judgment (73.3%) rather than on evidence-based sources such as PubMed (28.3%) or the Cochrane Library (6.7%). A number of within-group differences were noted, with women (P<0.05), those working in a particular district (P<0.05), those with <10years' experience (P=0.05), those whose first dental qualification had been obtained in Kuwait (P<0.05), and those who had had any EBD training (P<0.05) showing greater knowledge of EBD. Training in EBD was felt necessary by a majority of the group, and this may be facilitated if dental centres have access to evidence-based sources to remove some of the possible barriers to implementation of EBD.

Long-Term Effects of Presurgical Infant Orthopedics in Patients with Cleft Lip and Palate: A Systematic Review

Objective

This study aimed to assess the scientific evidence on the efficiency of presurgical infant orthopedic appliances in patients with cleft lip and palate to shed light on a specific, contemporary discussion of whether the appliances have long-term advantages with respect to treatment outcomes.

Design

A systematic review.

Method

Two literature surveys from the five electronic databases were performed with a 1-month interval. Randomized controlled trials and controlled clinical trials (controls had no presurgical infant orthopedics) that had follow-up periods of a minimum of 6 years were included in the study. The exceptions to the follow-up limit were studies related to feeding and parent satisfaction.

Results

Of the 319 articles retrieved in the literature surveys, 12 were qualified for the final analysis. The level of evidence of these articles ranged from 1b to 4. Eight randomized controlled trials and four controlled clinical trials were available on eight treatment outcomes. The longest follow-up period of the randomized controlled trials was 6 years. No randomized controlled trials were found on active presurgical infant orthopedic appliances and on nasoalveolar molding appliances.

Conclusions

Based on the results, presurgical infant orthopedic appliances have no long-term positive effects on seven of the eight studied treatment outcomes in patients with cleft lip and palate. More randomized controlled trials need to be done to have evidence regarding the effects of presurgical infant orthopedics in different surgical protocols. Also, the encouraging results about the effect of nasolaveolar molding appliances on nasal symmetry have to be supported by future randomized controlled trials.

Why be an evidence-based dentistry champion?

Evidence-based dentistry champions are committed to improving the quality, effectiveness, and appropriateness of dental care through the application of evidence-based principles and tools. They share knowledge and skills to promote evidence-based dentistry (EBD) in practice, guiding colleagues, patients and policy makers in the application of critical thinking skills and evidence-based decision-making. Being an evidence-based champion requires furthering an understanding of the full process and the challenges of evidence based dentistry, including the development of an evidence base, evidence synthesis and summary, the creation of best practice guidelines, as well as evidence implementation. Efforts to improve the quality, effectiveness, and appropriateness of dental care need to occur at, and be coordinated across, multiple levels of dentistry, including the patient, clinician, team, organization, and policy.

Effect of lip bumpers on mandibular arch dimensions

INTRODUCTION

The aim of this systematic review was to examine the effects of lip bumper therapy on mandibular arch dimensions.

METHODS

A literature survey of PubMed, EMBASE, Cochrane Central, and Cochrane Database of Systematic Reviews (www.cochrane.org) was conducted from December 1968 to January 2007. Human studies, randomized clinical trials, prospective and retrospective studies, and studies discussing the effect of lip bumpers on the arch and teeth were included. Two reviewers independently selected and extracted the data.

RESULTS

Of the 52 studies found in the search, only 1 met the inclusion criteria.

CONCLUSIONS

The results showed increases in arch dimensions that included an increase in arch length. This was attributed to incisor proclination, distalization, and distal tipping of the molars. There was also an increase in the arch width seen in the intercanine and deciduous intermolar and premolar distances. The long-term stability of the effects of the lip bumper need to be elucidated.

Stumbling into the age of evidence

This article presents personal observations on how the concept of evidence-based dentistry is faring in the profession. It considers how the dental profession's concept of evidence has matured, how evidence-based dentistry was originally envisioned, how it is currently embodied, and what its prospects might be for the immediate future. Evidence-based dentistry began in the profession approximately 2 decades ago, initiated by the appearance of the first systematic reviews on dental topics in the late 1980s. The emergence of the concept of evidence-based dentistry--and its fundamental construct, the systematic review--marks what can be considered a fundamental shift in how the dental knowledge base has grown and developed over time.

The methodological quality of systematic reviews comparing temporomandibular joint disorder surgical and non-surgical treatment

BACKGROUND

Temporomandibular joint disorders (TMJD) are multifactor, complex clinical problems affecting approximately 60-70% of the general population, with considerable controversy about the most effective treatment. For example, reports claim success rates of 70% and 83% for non-surgical and surgical treatment, whereas other reports claim success rates of 40% to 70% for self-improvement without treatment. Therefore, the purpose of this study was to (1) identify systematic reviews comparing temporomandibular joint disorder surgical and non-surgical treatment, (2) evaluate their methodological quality, and (3) evaluate the evidence grade within the systematic reviews.

METHODS

A search strategy was developed and implemented for MEDLINE, Cochrane Library, LILACS, and Brazilian Dentistry Bibliography databases. Inclusion criteria were: systematic reviews (+/- meta-analysis) comparing surgical and non-surgical TMJD treatment, published in English, Spanish, Portuguese, Italian, or German between the years 1966 and 2007(up to July). Exclusion criteria were: in vitro or animal studies; narrative reviews or editorials or editorial letters; and articles published in other languages. Two investigators independently selected and evaluated systematic reviews. Three different instruments (AMSTAR, OQAQ and CASP) were used to evaluate methodological quality, and the results averaged. The GRADE instrument was used to evaluate the evidence grade within the reviews.

RESULTS

The search strategy identified 211 reports; of which 2 were systematic reviews meeting inclusion criteria. The first review met 23.5 +/- 6.0% and the second met 77.5 +/- 12.8% of the methodological quality criteria (mean +/- sd). In these systematic reviews between 9 and 15% of the trials were graded as high quality, and 2 and 8% of the total number of patients were involved in these studies.

CONCLUSION

The results indicate that in spite of the widespread impact of TMJD, and the multitude of potential interventions, clinicians have expended sparse attention to systematically implementing clinical trial methodology that would improve validity and reliability of outcome measures. With some 20 years of knowledge of evidence-based healthcare, the meager attention to these issues begins to raise ethical issues about TMJD trial conduct and clinical care.

Meta-analysis: an introduction into a research process

Various methods for statistical analysis of data are available to clinicians and researchers. Meta-analysis is a tool by which small, related studies are identified and, through systematic review, are combined into a common data pool for a single, larger population analysis. As with all statistical methods, there are indications and contraindications for the use of meta-analysis. Additionally, meta-analysis is dependent upon the quality of data applied, the bias of the test itself, and the interpretation of the results. This article will discuss these aspects of meta-analysis, including the history of its development and usage in the scientific community, basic terminology, and a relevant literature review.

Benchmarking of reported search and selection methods of systematic reviews by dental speciality

BACKGROUND

Previous evaluations showed that literature-search and selection methods reported in dental systematic reviews (SR) have improved since 2000. It is not known, however, whether these differences are consistent between the SR of the different dental specialities.

METHODS

SR in dentistry published in the English language between 1 January 2000 and 14 June 2006 were located and then categorised by American Dental Association (ADA) recognised specialities. Search and selection methods were evaluated following an adaptation of the Cochrane Handbook for Systematic Reviews. Search and selection methods between dental specialities were compared using Pearson's chi-squared analysis and ranked.

RESULTS

There were significant differences between specialities in the following criteria: documentation of search dates (P 0.003); inclusion-exclusion documentation (P 0.017); article selection by two or more reviewers (P 0.001); and inclusion of all languages (P 0.014). Periodontics SR met the most criteria followed by oral and maxillofacial surgery (OMS) and then dental public heath (DPH). Prosthodontics along with the area of oral and maxillofacial radiology (OMR) met the fewest. All dental SR had low compliance with four criteria, only 65.7% searched more than Medline, 50.4% had a search strategy documented with Boolean operators, 51.5% had article selection carried out by two or more reviewers and only 25.7% included all languages.

CONCLUSIONS

Some dental specialities are better at reporting search and selection methods than others but all dental SR need some improvement in their reporting.

The challenges of transferring evidence-based dentistry into practice

The goal of evidence-based dentistry is to help practitioners provide their patients with optimal care. This is achieved by integrating sound research evidence with personal clinical expertise and patient values to determine the best course of treatment. Although clinicians embrace this concept, its implementation in clinical practice has been slow. In this article, barriers against the implementation of evidence-based care are examined and possible solutions are offered. The dental profession is committed to providing the best possible dental care for patients. This is proving to be more complex due to a virtual "information explosion" on new therapies, techniques, and materials; increased consumer understanding of treatment possibilities and therapeutic outcomes; and changing sociodemographic patterns. Although the profession advocates the importance of evidence-based dental disease prevention and treatment, practitioners have been slow to implement this concept. In 2003, the California Dental Association (CDA) formulated an evidence-based dentistry (EBD) action plan that included the formation of a task force to monitor EBD efforts and implement programs to educate CDA members on this methodology. The challenges of transferring EBD into clinical practice were key issues addressed by the task force, and much of their deliberations and perspectives are reflected in this article. Possible solutions for eliminating barriers against evidence-based care will also be explored.

Evaluation of the methodologies used in clinical trials and effectiveness of chemo-mechanical caries removal with CarisolvTM

This investigation aims to discuss the methodologies applied in clinical trials published about CarisolvTM, in order to assess the best scientific evidence concerning chemo-mechanical caries removal. Papers concerning the use of CarisolvTM were sought using a search strategy. The titles and abstracts of all the reports identified through the search were analyzed by a single reviewer. The inclusion criterion involved: clinical trials having CarisolvTM in one of the study groups. Then, those that fulfilled the inclusion criterion underwent methodology assessment and data extraction. Only 12 papers met the inclusion criterion. It was observed that none of these studies complied with all the evaluated research methodological principles required in order to have power of evidence generation. CarisolvTM proved to be effective in caries removal. Appointment mean time was greater, but the perceived time was shorter than that using conventional techniques due to patients' perception of more comfort and a reduction of anesthesia needs. There were no adverse effect in long-term assessments. In studies with microbiological evaluation of the remaining dentine, it was observed that both the conventional and chemo-mechanical methods produced statistically significant reduction on counts of viable microorganisms.

True molar intrusion attained during orthodontic treatment: A systematic review

INTRODUCTION

The aim of this systematic review was to quantify the amount of true molar intrusion attainable during orthodontic treatment.

METHODS

A literature search was conducted to identify clinical trials that assessed true molar intrusion through superimposition of lateral cephalogram tracings. Craniofacial growth had to be factored out when appropriate. Electronic databases (Pubmed, Medline, Medline In-Process & Other Non-Indexed Citations, all EBM reviews, Embase, Web of Science, and Lilacs) were searched with the help of a senior health-sciences librarian. Abstracts that appeared to fulfill the initial selection criteria were selected, and the full-text original articles were then retrieved and analyzed. Only articles that fulfilled the final selection criteria were finally considered. Their references were also hand-searched for possible missing articles from the database searches.

RESULTS

Thirty abstracts met the initial inclusion criteria, and these articles were retrieved. From these, 29 were later rejected because they did not either quantify true molar intrusion or factor out normal craniofacial growth when required. Only 1 article remained, and it showed a mean maxillary molar intrusion of 0.96 mm (SD, 0.54) in 12 subjects.

CONCLUSIONS

True molar intrusion appears to be achievable in the maxillary arch, although the amount of evidence is minimal. The clinical significance of the magnitude of the true intrusion reported is questionable as the sole treatment option to correct open-bite malocclusions. Better quantification method of the true intrusion attained has to be utilized.

Search and selection methodology of systematic reviews in orthodontics (2000-2004)

INTRODUCTION

More systematic reviews related to orthodontic topics are published each year, although little has been done to evaluate their search and selection methodologies.

METHODS

Systematic reviews related to orthodontics published between January 1, 2000, and December 31, 2004, were searched for their use of multiple electronic databases and secondary searches. The search and selection methods of identified systematic reviews were evaluated against the Cochrane Handbook's guidelines.

RESULTS

Sixteen orthodontic systematic reviews were identified in this period. The percentage of reviews documenting and using each criterion of article searching has changed over the last 5 years, with no recognizable directional trend. On average, most systematic reviews documented their electronic search terms (88%) and inclusion-exclusion criteria (100%), and used secondary searching (75%). Many still failed to search more than MEDLINE (56%), failed to document the database names and search dates (37%), failed to document the search strategy (62%), did not use several reviewers for selecting studies (75%), and did not include all languages (81%).

CONCLUSIONS

The methodology of systematic reviews in orthodontics is still limited, with key methodological components frequently absent or not appropriately described.

The ADA Perspective

BACKGROUND

The American Dental Association (ADA) has long relied on available scientific evidence in its commitment to use credible scientific data and analyses in policy-making, and its communications with the dental profession and the public.

OVERVIEW

The evidence-based dentistry (EBD) process is a systematic approach that reviews and publishes the evidence relevant to specific clinical questions. The goal of this process is to help practitioners provide patients with quality oral health care. The ADA has developed a strategic plan of EBD initiatives and activities in order to increase the knowledge base and improve educational programs; to encourage significant collaboration on EBD-related issues from interested organizations, specialty groups, and various outside agencies; and to increasingly derive the best scientific evidence for use in clinical practice in concert with professional judgment and patient treatment preferences.

CONCLUSION

The ADA endeavors to provide relevant information that can assist dentists in translating systematic-review findings and implementing an evidence-based approach in everyday clinical practice. This supports the Association's goal to continue supporting the best available evidence to assist health care teams in the provision of quality patient care and preventive techniques that improve oral health care outcomes.

Evidence-based decision making: Guide to reading the dental materials literature

Although potential links between materials data and clinical behavior are often implied, the status of such linkage is often left obscure. This paper provides clinicians a context within which to view materials information as evidence for clinical indications and to broaden readers' appreciation for the subject. Hierarchies of both clinical and nonclinical data are presented and discussed from the point of view of their predictive potential regarding clinical performance. Excellent sources of information are identified for the clinician making treatment decisions, and perspectives are offered on the value of other published materials data.

Research in general dental practice

Spurred by an initiative by the National Institute of Dental and Craniofacial Research in the USA, this article presents the need for a change in clinical dental research towards practice-based research. It outlines the shortcomings of past and present-day research in dentistry, with emphasis on the lack of clinical relevance of much of the research performed. The slow transfer of sound research findings to clinical practice is also a major problem. The article reviews some problems related to restorative dentistry and how they have adversely affected general dental practice. Practice-based research places emphasis on the problems experienced by clinicians in the routine care of patients. Clinicians should be linked together in research networks. The problems they face in dental practice and the clinical experience they have will form the basis for studies by the network. Experienced clinical researchers will provide guidance and statistical support for the studies initiated by the clinicians.