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- Journal of Minimum Intervention in Dentistry
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- Volume 5, Issue 6, 2012
Journal of Minimum Intervention in Dentistry - Volume 5, Issue 6, 2012
Volume 5, Issue 6, 2012
Failure rate of atraumatic restorative treatment using high-viscosity glass-ionomer cement compared to that of conventional amalgam restorative treatment in primary and permanent teeth : a systematic review update - IIISource: Journal of Minimum Intervention in Dentistry 5, pp 273 –331 (2012)More Less
Background: This 3rd systematic review update includes evidence from further Chinese trials that were identified during reference re-check and regression analysis of the possible influence of split-mouth study design on overall results.
Review objective: This systematic review seeks to answer the question as to whether, in patients with carious cavities of any class in primary and permanent teeth, ART restorations with high-viscosity GIC have a higher failure rate than amalgam restorations placed with conventional rotary instruments after one or more years.
Search strategy: The following databases were searched for relevant trials up to January 2012: MEDLINE accessed via PubMed; CENTRAL accessed via Cochrane Library; Open access sources: Biomed Central, Database of Open Access Journals (DOAJ), OpenJ-Gate; Regional databases: Bibliografia Brasileira de Odontologia (BBO), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), IndMed, Sabinet, Scielo; Grey-Literature sources: Scirus (Medicine), OpenSIGLE, Google Scholar. Hand searching was performed for journals not indexed in the databases. References of included trials were checked.
Selection criteria: Prospective, clinical controlled trials, with focus relevant to review objective and reporting on computable data with a follow-up period of at least one year were selected without language restrictions.
Data collection and analysis: Two review authors independently screened and extracted data from, and assessed the risk of bias in, the selected trial reports. Individual datasets were extracted from the trial results and analyzed regarding in-between-dataset heterogeneity and effect size estimates. The investigated outcome was restoration failure. Meta-analysis was conducted on condition of between-dataset homogeneity. Internal trial validity was assessed in terms of selection-, performance-, detection-, attrition-, publication- and reporting bias. Research gaps in the precision and consistency of the results were evaluated.
Main results: Twenty trials were accepted for review. Of these 52 individual dichotomous datasets could be extracted and analyzed. The majority of the results show no differences between both types of intervention. High risk of selection-, performance-, detection- and attrition bias was established. Existing research gaps are mainly due to lack of trials and small sample size. Any influence of split-mouth design did not change the overall review conclusions.
Conclusion: The current evidence indicates that the failure rate of high-viscosity GIC/ART restorations is not higher than, but similar to that of conventional amalgam fillings after periods longer than one year. These results are in line with the conclusions drawn during the original systematic review. There is a high risk that these results are affected by bias, and thus confirmation by further trials with suitably high number of participants is needed.
System research note on : using formal logic for illustrating coherence of systematic review evidenceSource: Journal of Minimum Intervention in Dentistry 5, pp 332 –344 (2012)More Less
Context: Clinical knowledge, as any other type of knowledge, can be regarded as justified belief. The justification of belief follows two cognitive strategies: coherence of logic and correspondence of facts.
Problem: Coherence strategy has been traditionally favoured in the justification of beliefs concerning medical interventions throughout the centuries and is today still preferred by many clinicians as providing "logical sense" for or against the application of therapies, diagnostics or preventive measures. The use of correspondence strategy has only recently being emphasized within the medical field as evidence-based medicine (EBM). There is a risk that evidence from EBM, i.e. as appraised through systematic reviews, concerning clinical questions is ignored by clinicians, if no deeper logical integration of such evidence through coherence strategy is given.
Suggested solution: In order to explore how coherence strategy in regard to systematic review evidence may be applied, basic principles of formal logic were used on an example concerning systematic review evidence regarding the assumed active anticaries effect of xylitol. The example shows how a coherent Web-of-Beliefs (WoB) may be structured that way and how systematic review evidence may in turn serve as empirical support for such a coherent web-of-beliefs. The presented example also shows how strict logical coherence alone can be no guarantee for correctness of beliefs concerning medical interventions.
System research note on : an attempt to quantify degrees of beliefs concerning the precision and internal validity of systematic review conclusionsSource: Journal of Minimum Intervention in Dentistry 5, pp 345 –354 (2012)More Less
Context: Systematic review evidence provides best justification for specific beliefs regarding clinical interventions. The degree of such belief depends on the precision and internal validity of the evidence. While precision is often achieved on basis of quantification and statistical analysis, the (internal) validity of the evidence is appraised through judgement of the risk for several known biases. Against the background of the subsequent results, a conclusion is formulated in answer to a specific systematic review question.
Problem: Currently, systematic reviews do provide quantification of its results, e.g., by use of meta-analysis, from which conclusions are induced. However, no quantification is given concerning the degree of belief that such conclusions are coherent with the current evidence and the degree of belief that the current evidence corresponds with reality.
Suggested solution: This article presents a simple method how such degrees of beliefs may be quantified. The quantification of degrees of beliefs may be beneficial in illustrating the precision and internal validity of systematic review results. Such illustration may assist the users of systematic review evidence in gaining an intuitive first impression of its merits. However, inter-systematic review comparison based on such quantification is limited and the quantified degrees of belief reflect to a large extent the subjectivity of systematic review authors.