Steffen Mickenautsch

Publications

• 1.44

  Impact points

  Chlorhexidine for the prevention of alveolar osteitis.

  Yengopal V, Mickenautsch S

  International Journal of Oral and Maxillofacial Surgery. 05/2012;

  This systematic review assessed the efficacy of chlorhexidine for the prevention of alveolar osteitis and occurrence of adverse reactions. Databases were searched until 20 April 2011. Trial inclusion criteria were: titles/abstracts relevant to topic; prospective 2-arm (or more) clinical study design... [more] This systematic review assessed the efficacy of chlorhexidine for the prevention of alveolar osteitis and occurrence of adverse reactions. Databases were searched until 20 April 2011. Trial inclusion criteria were: titles/abstracts relevant to topic; prospective 2-arm (or more) clinical study design. Trial exclusion criteria were: not all entered subjects accounted for; subjects of both groups not followed up the same way; lack of computable data; chlorhexidine not the primary test agent; duplication of data; outcome of interest other than incidence of alveolar osteitis. Individual datasets were extracted from accepted articles. Bias risk in trials was assessed. 10 of 13 included trials were accepted. From these, 16 dichotomous datasets were extracted. Two of six application protocols favoured chlorhexidine over placebo: Single application of 0.2% chlorhexidine gel placed in the socket immediately after extraction versus placebo gel (RR 0.40; 95% CI: 0.18-0.90; p=0.03) and 0.12% chlorhexidine rinse applied on day of surgery and used twice daily for 7 days postoperatively versus placebo rinse (RR 0.50; 95% CI: 0.27-0.93; p=0.03). These results are negated due to high bias risk. Chlorhexidine did not cause higher adverse reactions than placebo. Further high-quality randomised control trials are needed.

• SYSTEM Research note on: Initial observations of diagnostic accuracy concerning quantitative testing for selection bias in RCTs

  Mickenautsch

  J Minim Interv Dent. 05/2012; 5(4):126-85.

  CONTEXT: Selection bias interferes with the internal validity of clinical trials and leads to favouring one clinical outcome over another. In order to limit the influence of selection bias on clinical trials, the methodological interventions: random sequence generation and allocation concealment of ... [more] CONTEXT: Selection bias interferes with the internal validity of clinical trials and leads to favouring one clinical outcome over another. In order to limit the influence of selection bias on clinical trials, the methodological interventions: random sequence generation and allocation concealment of such sequence have been proposed. Subsequently, authors of systematic reviews judge risk of selection bias in trials according to the reported details concerning how random sequence generation and allocation concealment of such sequence was conducted. PROBLEM: The problem with the current approach is that it only can judge bias risk on the reported attempt of adequacy of random sequence generation and allocation concealment but not whether such reported attempt (even if judged as adequate from the trial report) was indeed successful. High risk of selection bias may be prevalent and thus limit the validity of trial results even when adequate methods for bias control were reported. Without any further evidence as to whether any as adequate reported attempt was successful there is no guarantee that the reported trial results are not overestimations of the true intervention effect. SUGGESTED SOLUTION: One possible option could be based on the level of correlation (established by use of linear regression analysis) between the (i) probability values for each subject to be allocated to an intervention group with (ii) the observed dichotomous intervention outcome per subject. The probability for each subject to be allocated to an intervention group can be expressed through the reverse propensity score (RPS). Without selection bias, the RPS should not be associated with the intervention outcome of participants in a RCT beyond play of chance. Based on the RPS and by following a previously described methodology the summary measures of potential diagnostic test accuracy were established at different block sizes and subject numbers. Reasonably high evidence in support for test accuracy with values >0.80 in terms of specificity and sensitivity, >5.0 in terms of positive likelihood ratios and <0.2 in terms of negative likelihood ratios were observed. In conclusion, linear regression of the probability (RPS) values for each subject to be allocated to an intervention group and the observed intervention outcome per subject may be a valuable option to test for selection bias in RCTs. However, further investigation in the repeatability of the established test accuracy and statistical rationale of such test is needed.

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• SYSTEM Research note on: A simulation method to test for potential accuracy of a selection bias test for RCTs

  Steffen Mickenautsch

  Journal of Minimum Intervention in Dentistry. 05/2012; 5(3):58-62.

  CONTEXT: Selection bias interferes with the internal validity of clinical trials and leads to favoring one clinical outcome over another. Risk of selection bias is introduced when knowledge of certain patient characteristics, known to be conducive to the success of one particular intervention, is ap... [more] CONTEXT: Selection bias interferes with the internal validity of clinical trials and leads to favoring one clinical outcome over another. Risk of selection bias is introduced when knowledge of certain patient characteristics, known to be conducive to the success of one particular intervention, is applied together with foreknowledge regarding the allocation of such patients in a specific sequence of interventions. PROBLEM: Selection bias testing has been proposed and recommended on basis of the reverse propensity score (RPS). So far there are no actual clinical randomised control trials (RCTs) available from which the accuracy of such test may be studied. The challenge is therefore to find a suitable simulation method that will allow establishing the summary measures of potential diagnostic test accuracy: sensitivity, specificity, positive/negative likelihood ratios and diagnostic odds ratio (DOR). SUGGESTED SOLUTION: In order to investigate the test’s diagnostic accuracy the number of true positive (TP); true negative (TN); false positive (FP) and false negative (FN) results need to be established from a number of sufficiently relevant RCT simulations. From these, summary measures of potential diagnostic accuracy are calculated. It has to be noted that the so obtained results can only provide indication of potential (not actual) test accuracy, thus remain hypothetical and require verification through the application of the bias test in real RCTs at a later stage. This article describes one suggested simulation method in detail.

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• 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

  Steffen Mickenautsch, Veerasamy Yengopal

  Journal of Minimum Intervention in Dentistry. 05/2012; 5(3):63-124.

  BACKGROUND: Atraumatic restorative treatment (ART) is a minimally invasive procedure that involves removing markedly softened carious enamel and dentine, using only hand instruments, and then restoring the resulting cavity with an adhesive restorative material. Although developed for use in the less... [more] BACKGROUND: Atraumatic restorative treatment (ART) is a minimally invasive procedure that involves removing markedly softened carious enamel and dentine, using only hand instruments, and then restoring the resulting cavity with an adhesive restorative material. Although developed for use in the less industrialized parts of the world ART has now been accepted as part of the minimum intervention (MI) dentistry philosophy in developed countries. Currently the restorative material of choice for ART is high-viscosity glass ionomer cement (GIC). GIC is ideally suited to managing dental caries according to the principles of MI dentistry, as it can be applied in the very early stages of caries development or in the larger cavity. Additionally, it simplifies the restorative procedure and enables the dentine-pulp complex to react against the carious process. REVIEW OBJECTIVE: This systematic review update 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, in tooth cavities of the same size, type of dentition and follow-up period 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 studies 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 in-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: Eighteen trials were accepted of which 10 were currently available for review. Of these 32 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. 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 confirmation by further trials with suitably high number of participants is needed.

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• SYSTEM Research note on: Assessing attrition bias risk

  Steffen Mickenautsch

  Journal of Minimum Intervention in Dentistry. 03/2012; 5(2):23-29.

  CONTEXT: Systematic reviews of clinical trials need to assess the risk of attrition bias as part of its appraisal of the currently available evidence to a particular review question. PROBLEM: Notwithstanding the possible merits of different approaches to estimate the potential intervention outcomes... [more] CONTEXT: Systematic reviews of clinical trials need to assess the risk of attrition bias as part of its appraisal of the currently available evidence to a particular review question. PROBLEM: Notwithstanding the possible merits of different approaches to estimate the potential intervention outcomes of lost trial participants as the main reason for attrition bias, most remain arbitrary. SUGGESTED SOLUTION: Assuming a worst- and best-case scenario of intervention outcomes provides the certainty that neither lower nor higher values beyond these scenarios, respectively, are possible. Thus, worst- and best-case scenarios provide extreme outcome values that have the same probability to correspond with the true intervention outcome as any other possible scenario in between these extremes. Worst- and best-case scenarios can be calculated for dichotomous and continuous data, if the number of lost trial participants per intervention group is known. The results may then be compared to the intervention outcomes computed for participants available to follow-up and on this basis conclusions concerning attrition bias risk been drawn: i.e. risk of attrition bias may be assumed if the computed outcomes between worst- and best-case scenario and the intervention outcomes computed for participants available to follow-up differ significantly. Care needs to be taken not to accept the results of either worst- or best case-scenario as evidence for clinical considerations. They only provide evidence, if they differ significantly, for reasonable doubt concerning the validity of trial results in light of potential attrition bias risk.

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• 0.63

  Impact points

  Effect of xylitol versus sorbitol: a quantitative systematic review of clinical trials

  Steffen Mickenautsch, Veerasamy Yengopal

  International Dental Journal. 03/2012;

  Objectives: This study aimed to appraise, within the context of tooth caries, the current clinical evidence and its risk for bias regarding the effects of xylitol in comparison with sorbitol. Methods:: Databases were searched for clinical trials to 19 March 2011. Inclusion criteria required studies ... [more] Objectives: This study aimed to appraise, within the context of tooth caries, the current clinical evidence and its risk for bias regarding the effects of xylitol in comparison with sorbitol. Methods:: Databases were searched for clinical trials to 19 March 2011. Inclusion criteria required studies to: test a caries-related primary outcome; compare the effects of xylitol with those of sorbitol; describe a clinical trial with two or more arms, and utilise a prospective study design. Articles were excluded if they did not report computable data or did not follow up test and control groups in the same way. Individual dichotomous and continuous datasets were extracted from accepted articles. Selection and performance/detection bias were assessed. Sensitivity analysis was used to investigate attrition bias. Egger’s regression and funnel plotting were used to investigate risk for publication bias. Results:: Nine articles were identified. Of these, eight were accepted and one was excluded. Ten continuous and eight dichotomous datasets were extracted. Because of high clinical heterogeneity, no meta-analysis was performed. Most of the datasets favoured xylitol, but this was not consistent. The accepted trials may be limited by selection bias. Results of the sensitivity analysis indicate a high risk for attrition bias. The funnel plot and Egger’s regression results suggest a low publication bias risk. External fluoride exposure and stimulated saliva flow may have confounded the measured anticariogenic effect of xylitol. Conclusions:: The evidence identified in support of xylitol over sorbitol is contradictory, is at high risk for selection and attrition bias and may be limited by confounder effects. Future high-quality randomised controlled trials are needed to show whether xylitol has a greater anticariogenic effect than sorbitol.
• 0.63

  Impact points

  Anticariogenic effect of xylitol versus fluoride - a quantitative systematic review of clinical trials.

  Steffen Mickenautsch, Veerasamy Yengopal

  International dental journal. 02/2012; 62(1):6-20.

  The objective of this study was to appraise the clinical evidence and its bias risk regarding the anticariogenic effect of xylitol in comparison with that of fluoride. Databases were searched for clinical trials up to 18 March 2011. Article inclusion criteria were as follows: caries-related primary ... [more] The objective of this study was to appraise the clinical evidence and its bias risk regarding the anticariogenic effect of xylitol in comparison with that of fluoride. Databases were searched for clinical trials up to 18 March 2011. Article inclusion criteria were as follows: caries-related primary outcomes were tested; xylitol was compared with topical fluoride in some form; two-arm (or more) clinical trial including test/control group(s); prospective study design. Article exclusion criteria were as follows: no computable data were reported; test and control groups were not followed up in the same way; chewing gum was the main form of clinical application in either group. Individual continuous datasets were extracted from accepted articles. Selection and performance/detection bias were assessed. Sensitivity analysis was used to investigate attrition bias risk. Egger's regression and funnel plot was used to investigate publication bias risk. Twelve articles were included. Of these, six were accepted and six excluded, and 21 continuous datasets were extracted. Owing to the high clinical heterogeneity, no meta-analysis was performed. The addition of xylitol to existing fluoride regimes may be beneficial in the prevention of caries. However, all identified trials were limited by potential risk of selection, performance/detection and attrition bias. The funnel plot and Egger's regression results (-2.80; 95% confidence interval -4.01, -1.58; P = 0.0001) indicated possible publication bias risk. External fluoride access may have confounded the measured anticariogenic effect of xylitol. The evidence found contains a high risk of bias and may be limited by confounder effects. Future high-quality randomised controlled trials are needed in order to provide conclusive evidence on this topic.
• 2.23

  Impact points

  Retention of orthodontic brackets bonded with resin-modified GIC versus composite resin adhesives--a quantitative systematic review of clinical trials.

  Steffen Mickenautsch, Veerasamy Yengopal, Avijit Banerjee

  Clinical oral investigations. 02/2012; 16(1):1-14.

  The aim of this systematic review was to establish whether the clinical debonding (failure) rates of orthodontic brackets bonded either with resin-modified glass ionomer (RM-GIC) or with composite resin adhesive are the same. Five databases were searched for articles up to 18 November 2010. Inclusio... [more] The aim of this systematic review was to establish whether the clinical debonding (failure) rates of orthodontic brackets bonded either with resin-modified glass ionomer (RM-GIC) or with composite resin adhesive are the same. Five databases were searched for articles up to 18 November 2010. Inclusion criteria were titles/abstracts relevant to the review question and two or more arm clinical trial. Exclusion criteria were the following: no computable data recorded and subjects of both groups not followed up in the same way. From the accepted trials, datasets were analysed concerning clinical precision and internal validity. Eleven trials were accepted. From these, 15 dichotomous datasets were extracted. Relative risk with 95% confidence interval of nine datasets showed no statistically significant differences in outcome between the treatment and control group after 6 months-1.32 years. Five showed a statistically significant difference (p < 0.05), favouring resin composite bonding after 12 and 18 months. One favoured RM-GIC after 10 months. Meta-analysis found no difference in the failure rate between the two treatment groups after 12 months (RR, 1.11; 95% CI, 0.87-1.42; p = 0.40) and found in favour of composite resin adhesive after >14 months (RR, 2.25; 95% CI, 1.60-3.17; p < 0.00001). All trials had poor internal validity due to selection and detection/performance bias risk. The current evidence suggests no difference between the types of materials after 12 months but favours composite resin adhesives after a >14-month period. However, its risk of selection and detection/performance bias are high, and all results need to be regarded with caution. Further high quality randomised control trials addressing this topic are needed. The clinical relevance of this study is that RM-GIC may have the same clinical debonding (failure) rate as composite resin adhesives after 1 year when used for bonding of orthodontic brackets.

• Coherence of evidence from systematic reviews as a basis for evidence strength - a case study in support of an epistemological proposition.

  Steffen Mickenautsch

  BMC research notes. 01/2012; 5:26.

  ABSTRACT: This article aims to offer, on the basis of Coherence theory, the epistemological proposition that mutually supportive evidence from multiple systematic reviews may successfully refute radical, philosophical scepticism. A case study including seven systematic reviews is presented with the ... [more] ABSTRACT: This article aims to offer, on the basis of Coherence theory, the epistemological proposition that mutually supportive evidence from multiple systematic reviews may successfully refute radical, philosophical scepticism. A case study including seven systematic reviews is presented with the objective of refuting radical philosophical scepticism towards the belief that glass-ionomer cements (GIC) are beneficial in tooth caries therapy. The case study illustrates how principles of logical and empirical coherence may be applied as evidence in support of specific beliefs in healthcare. The results show that radical scepticism may epistemologically be refuted on the basis of logical and empirical coherence. For success, several systematic reviews covering interconnected beliefs are needed. In praxis, these systematic reviews would also need to be of high quality and its conclusions based on reviewed high quality trials. A refutation of radical philosophical scepticism to clinical evidence may be achieved, if and only if such evidence is based on the logical and empirical coherence of multiple systematic review results. Practical application also requires focus on the quality of the systematic reviews and reviewed trials.

• Coherence of evidence from systematic reviews as a basis for evidence strength - a case study in support of an epistemological proposition.

  Mickenautsch S.

  BMC Res Notes. 01/2012; 5:26.

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• SYSTEM Research note on: Assessing publication bias

  Steffen Mickenautsch

  Journal of Minimum Intervention in Dentistry. 01/2012; 5(1):4-6.

  CONTEXT: Systematic reviews aim to assess precision and internal validity of the current clinical evidence. The precision and internal validity of clinical evidence is limited by the risk of biases, one of which is publication bias. Publication bias is created when trials, often with small sample si... [more] CONTEXT: Systematic reviews aim to assess precision and internal validity of the current clinical evidence. The precision and internal validity of clinical evidence is limited by the risk of biases, one of which is publication bias. Publication bias is created when trials, often with small sample size that have found negative or non-significant results are not being published and thus are not identified during systematic reviews as part of the of current clinical evidence. In that way, publication bias distorts precision and internal validity of clinical evidence. The extent of such distortion thus requires the assessment of publication bias risk as part of the systematic review methodology. Funnel plots and Egger’s regression form one of the best currently available methods when assessing for publication bias risk. PROBLEM: However, funnel plot and Egger’s regression have weak statistical power and its results may even be misleading when the number of included trials/datasets is small. They do not measure risk of publication bias directly but statistical in-between-trials heterogeneity in terms of their relation of sample size (SE) to effect size (lnRR). In that regard, the lack of published small trials is only one possible reason for any observed asymmetry. Other reasons are: (i) General in-between-trial heterogeneity and (ii) Methodological artifacts. Both will give positive results even in complete absence of publication bias risk. SUGGESTED SOLUTION: Therefore, funnel plot and Egger’s regression need to be applied together with other considerations, which are presented in this research note, in order to obtain meaningful results.

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• SYSTEM Research note on: Recognizing statistical in-between-trials heterogeneity

  Steffen Mickenautsch

  Journal of Minimum Intervention in Dentistry. 01/2012; 5(1):1-4.

  CONTEXT: Quantitative systematic reviews need to consider clinical, methodological and statistical heterogeneity of trials or datasets from trials before combining their results in meta-analyses, as combining results from heterogeneous datasets and/or trials will lead to meaningless results and thus... [more] CONTEXT: Quantitative systematic reviews need to consider clinical, methodological and statistical heterogeneity of trials or datasets from trials before combining their results in meta-analyses, as combining results from heterogeneous datasets and/or trials will lead to meaningless results and thus should be avoided. Potential statistical heterogeneity between trials/datasets that have been considered as being clinically/methodologically homogeneous is usually investigated using I2 – test and Cochrane Q statistics. PROBLEM: However, both, I2 – test and Cochrane Q statistics are tests with low statistical power, which gives even weaker results the smaller the number of trials/datasets is (n < 15). SUGGESTED SOLUTION: Therefore, statistical in-between-trial heterogeneity should be assessed using the point estimate together with its 95% Confidence interval of the I2 – test. Galbraith plots are to be used to identify outlying datasets/trials, which then should be further investigated for potential effect modifiers using regression analysis.

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• Failure rate of atraumatic restorative treatment using high-viscosity glass-ionomer cement compared to conventional amalgam restorative treatment in primary and permanent teeth: a systematic review update [protocol]

  S. Mickenautsch, V. Yengopal

  Journal of Minimum Intervention in Dentistry. 01/2012; 5(2):29-42.

  This protocol has been registered with the International Prospective Register for Systematic Reviews (PROSPERO) on the 05 January 2012 under registration number CRD42012001887 (Available online from http://www.crd.york.ac.uk/PROSPERO/full_doc.asp?ID=CRD42012001887). This protocol comprises an update... [more] This protocol has been registered with the International Prospective Register for Systematic Reviews (PROSPERO) on the 05 January 2012 under registration number CRD42012001887 (Available online from http://www.crd.york.ac.uk/PROSPERO/full_doc.asp?ID=CRD42012001887). This protocol comprises an update of an existing systematic review report by the authors as part of the SYSTEM initiative: Mickenautsch S, Yengopal V, Banerjee A. Atraumatic restorative treatment versus amalgam restoration longevity: a systematic review. Clin Oral Investig 2010; 14: 233-40. The protocol of this original review was not registered. This update will differ from the original review by changing and adding the following: PICO question: while the original review focused on the comparative success rate, this update will focus on the comparative failure rate between ART and amalgam restorations; Systematic literature search: extended to the databases for open access journals (OpenJ-Gate); regional databases (LILACS, BBO, IndMed, SABINET, Scielo); grey literature sources (Scirus/Medicine, OpenSIGLE, GoogleScholar); hand-searching of additional journals that were identified as not been indexed in above databases; searching of reference lists of included articles; Search term development: a detailed search strategy will be added; the search cut-off date will be extended beyond the date of the original systematic review; Article inclusion criteria: while the original review focused on articles published in English, only, this update will have no restriction on the publication language type; Article exclusion criteria: while the original review used lack of randomisation/quasi-randomisation as criteria for exclusion, this update will include all clinical controlled trials for data extraction; Data extraction: The information extracted from trials will be more extensive in terms of general trial information, intervention integrity, methodological quality and bias risk; Data analysis and reporting: in addition to a computed relative point estimate (RR = Risk ratio), the results will also be converted into an absolute outcome measure (RD = Risk difference), as well as an illustrative comparative risk for both, test- and control intervention, and reported accordingly; a summary of findings table will be added; statistical heterogeneity will be investigated using regression analysis; sensitivity analysis will be added in order to establish whether all findings are robust to the type of data analysis used; The original quality assessment of studies, including its criteria, will be replaced by a more stricter assessment of selection-, detection-, performance-, attrition bias risk; the assessment of publication- and reporting bias risk in the accepted trials will be added; Research gaps within accepted trials in terms of imprecision, inconsistency, lack of right information and shortcomings in bias risk control will be identified using a designated worksheet and subsequently more detailed recommendations for further research will be added to the this systematic review update.

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• How well are GIC product labels related to current systematic review evidence?

  Steffen Mickenautsch

  Dental update. 11/2011; 38(9):634-8, 641-2, 644.

  Systematic reviews have been recommended as providing the best source of evidence to guide clinical decisions in dentistry. They appraise evidence from trials focused on investigating clinical effects of dental material categories, such as conventional glass-ionomer cements (GIC) or resin-modified G... [more] Systematic reviews have been recommended as providing the best source of evidence to guide clinical decisions in dentistry. They appraise evidence from trials focused on investigating clinical effects of dental material categories, such as conventional glass-ionomer cements (GIC) or resin-modified GIC. In contrast, the general dental practitioner is introduced to these categories of materials in the form of branded or private product labels that are marketed during dental conventions or through advertisements. Difficulties may arise in recognizing material categories that have been subjected to systematic reviews, because of the multitude of product labels on the current market. Thus, the value and relevance of published systematic review evidence concerning the material categories represented by these labels may remain obscure. Based on a systematic literature search, this article identifies glass-ionomer cement product labels used during clinical trials which, in turn, were subsequently reviewed in systematic review articles (published between 15 April 2009 and 14 April 2011). This article further clarifies how these product labels relate to the systematic review conclusions. The results show that the conventional and resin-modified glass-ionomer cements that were used in most trials were marketed by GC and 3M ESPE, respectively. The conventional GICs used in most of the reviewed trials were Fuji III and Fuji IX, while Vitremer was the most commonly used resin-modified GIC. Evidence from the reviewed trials suggests that GIC provides beneficial effects for preventive and restorative dentistry. However, more trials of higher internal validity are needed in order to confirm (or disprove) these findings. Only GIC products of branded labels and none of private labels were identified, suggesting that private label GIC products have little or no research back-up. CLINICAL RELEVANCE: Dental products, such as glass-ionomers cements (GIC), can only be judged as effective when they are based on sufficient research back-up. Systematic reviews of clinical trials provide such back-up at the highest level. Thus clinicians must be able to identify GIC products for which reliable evidence from systematic reviews of clinical studies is available and know about what such evidence contains.
• 0.63

  Impact points

  Extent and quality of systematic review evidence related to minimum intervention in dentistry: essential oils, powered toothbrushes, triclosan, xylitol.

  Steffen Mickenautsch, Veerasamy Yengopal

  International dental journal. 08/2011; 61(4):179-92.

  To investigate extent and quality of current systematic review evidence regarding: powered toothbrushes, triclosan toothpaste, essential oil mouthwashes, xylitol chewing gum. Five databases were searched for systematic reviews until 13 November 2010. Inclusion criteria: relevant to topic, systematic... [more] To investigate extent and quality of current systematic review evidence regarding: powered toothbrushes, triclosan toothpaste, essential oil mouthwashes, xylitol chewing gum. Five databases were searched for systematic reviews until 13 November 2010. Inclusion criteria: relevant to topic, systematic review according to title and/or abstract, published in English. Article exclusion criteria were based on QUOROM recommendations for the reporting of systematic review methods. Systematic review quality was judged using the AMSTAR tool. All trials included by reviews were assessed for selection bias. 119 articles were found, of which 11 systematic reviews were included. Of these, six were excluded and five accepted: one for triclosan toothpaste; one for xylitol chewing gum; two for powered toothbrushes; one for essential oil mouthwashes. AMSTAR scores: triclosan toothpaste 7; powered toothbrushes 9 and 11; xylitol chewing gum 9; essential oil mouthwashes 8. In total, 75 (out of 76) reviewed trials were identified. In-depth assessment showed a high risk of selection bias for all trials. The extent of available systematic review evidence is low. Although the few identified systematic reviews could be rated as of medium and high quality, the validity of their conclusions needs to be treated with caution, owing to high risk of selection bias in the reviewed trials. High quality randomised control trials are needed in order to provide convincing evidence regarding true clinical efficacy.

• Absence of carious lesions at margins of glass-ionomer cement and amalgam restorations: An update of systematic review evidence.

  Steffen Mickenautsch, Veerasamy Yengopal

  BMC research notes. 03/2011; 4:58.

  This article aims to update the existing systematic review evidence elicited by Mickenautsch et al. up to 18 January 2008 (published in the European Journal of Paediatric Dentistry in 2009) and addressing the review question of whether, in the same dentition and same cavity class, glass-ionomer ceme... [more] This article aims to update the existing systematic review evidence elicited by Mickenautsch et al. up to 18 January 2008 (published in the European Journal of Paediatric Dentistry in 2009) and addressing the review question of whether, in the same dentition and same cavity class, glass-ionomer cement (GIC) restored cavities show less recurrent carious lesions on cavity margins than cavities restored with amalgam. The systematic literature search was extended beyond the original search date and a further hand-search and reference check was done. The quality of accepted trials was assessed, using updated quality criteria, and the risk of bias was investigated in more depth than previously reported. In addition, the focus of quantitative synthesis was shifted to single datasets extracted from the accepted trials. The database search (up to 10 August 2010) identified 1 new trial, in addition to the 9 included in the original systematic review, and 11 further trials were included after a hand-search and reference check. Of these 21 trials, 11 were excluded and 10 were accepted for data extraction and quality assessment. Thirteen dichotomous datasets of primary outcomes and 4 datasets with secondary outcomes were extracted. Meta-analysis and cumulative meta-analysis were used in combining clinically homogenous datasets. The overall results of the computed datasets suggest that GIC has a higher caries-preventive effect than amalgam for restorations in permanent teeth. No difference was found for restorations in the primary dentition. This outcome is in agreement with the conclusions of the original systematic review. Although the findings of the trials identified in this update may be considered to be less affected by attrition- and publication bias, their risk of selection- and detection/performance bias is high. Thus, verification of the currently available results requires further high-quality randomised control trials.

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• 1.22

  Impact points

  Therapeutic effect of glass-ionomers: an overview of evidence.

  S Mickenautsch, G Mount, V Yengopal

  Australian dental journal. 03/2011; 56(1):10-5; quiz 103.

  The requirements for an ideal restorative material include adhesion to tooth structure (enamel and dentine) and an ability to withstand the traumas of occlusion. However, some level of an anticaries effect is also desirable. After a long history of glass-ionomer cement (GIC) development, an evidence... [more] The requirements for an ideal restorative material include adhesion to tooth structure (enamel and dentine) and an ability to withstand the traumas of occlusion. However, some level of an anticaries effect is also desirable. After a long history of glass-ionomer cement (GIC) development, an evidence base in support of the therapeutic effect of GIC, particularly with regard to its anticaries effect, is emerging. This evidence is increasingly presented through systematic reviews of clinical GIC application and, to a certain extent, relates to a caries-preventive effect of the material itself. However, the strength of evidence supporting other aspects of GIC, such as a higher remineralizing effect, fluoride uptake in hard tooth tissue and fluoride release of GIC, is limited. Nevertheless, the results of these in situ and laboratory trials provide valuable insights into factors that facilitate understanding of the clinical efficacy of GIC.

• Caries-preventive effect of resin-modified glass-ionomer cement (RM-GIC) versus composite resin: a quantitative systematic review.

  V Yengopal, S Mickenautsch

  European archives of paediatric dentistry : official journal of the European Academy of Paediatric Dentistry. 02/2011; 12(1):5-14.

  To determine whether resin-modified glass-ionomer cement (RM-GIC), when compared with composite resins (CR), offers a significant caries-preventive effect. Quantitative systematic review. Five databases were searched until 29 July 2010. Inclusion criteria were: relevant to review question related to... [more] To determine whether resin-modified glass-ionomer cement (RM-GIC), when compared with composite resins (CR), offers a significant caries-preventive effect. Quantitative systematic review. Five databases were searched until 29 July 2010. Inclusion criteria were: relevant to review question related to orthodontic or restorative treatment; published in English; prospective clinical 2-arm study. Exclusion criteria were: no computable data reported; study groups not followed up in the same way. References of included articles were checked. The outcome measure was absence of carious lesions. Dichotomous datasets for both groups were extracted from accepted trials. Trials were assessed for selection-, detection/performance, attrition and publication bias. Of the 11 trials included, 6 were accepted and 24 datasets extracted; 17 datasets showed no difference after 4 weeks to >25 months. There were 7 datasets that favoured (p < 0.05) RM-GIC after 12 - 24 months. The results are limited by risk of selection-, detection-/performance bias and attrition bias. Risk of publication bias was identified. The overall results showed either no difference between the materials, or indicated that RM-GIC has a superior caries-preventive effect. The clinical meaning of this result remains uncertain due to risk of bias. High-quality randomised control trials are needed in order to answer the review question conclusively.

• How well are GIC product labels related to current systematic review evidence?

  Mickenautsch S.

  Dent Update. 01/2011; 38:634-8.

• Retention of orthodontic brackets bonded with resin-modified GIC versus composite resin adhesives-a quantitative systematic review of clinical trials.

  Mickenautsch S, Yengopal V, Banerjee A.

  Clin Oral Investig. 01/2011;