Article

A Bayesian network meta-analysis on comparisons of enamel matrix derivatives, guided tissue regeneration and their combination therapies.

Department of Periodontology, Leeds Dental Institute, University of Leeds, UK.
Journal Of Clinical Periodontology (Impact Factor: 3.61). 03/2012; 39(3):303-14. DOI: 10.1111/j.1600-051X.2011.01844.x
Source: PubMed

ABSTRACT Guided tissue regeneration (GTR) and enamel matrix derivatives (EMD) are two popular regenerative treatments for periodontal infrabony lesions. Both have been used in conjunction with other regenerative materials. We conducted a Bayesian network meta-analysis of randomized controlled trials on treatment effects of GTR, EMD and their combination therapies.
A systematic literature search was conducted using the Medline, EMBASE, LILACS and CENTRAL databases up to and including June 2011. Treatment outcomes were changes in probing pocket depth (PPD), clinical attachment level (CAL) and infrabony defect depth. Different types of bone grafts were treated as one group and so were barrier membranes.
A total of 53 studies were included in this review, and we found small differences between regenerative therapies which were non-significant statistically and clinically. GTR and GTR-related combination therapies achieved greater PPD reduction than EMD and EMD-related combination therapies. Combination therapies achieved slightly greater CAL gain than the use of EMD or GTR alone. GTR with BG achieved greatest defect fill.
Combination therapies performed better than single therapies, but the additional benefits were small. Bayesian network meta-analysis is a promising technique to compare multiple treatments. Further analysis of methodological characteristics will be required prior to clinical recommendations.

Download full-text

Full-text

Available from: Leandro Chambrone, May 27, 2015
3 Followers
 · 
153 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective Pulpotomy is a common procedure to treat asymptomatic reversible pulpitis in primary molars. The aim of this study is to undertake a systematic review and a network meta-analysis to compare the clinical and radiographic outcomes of different pulpotomy procedures in primary molars. Data: Three authors performed data extraction independently and in duplicate using data collection forms. Disagreements were resolved by discussion. Sources: An electronic literature search was performed within MEDLINE (via PubMed), ScienceDirect, Web of Science, Cochrane, and ClinicalKey databases until December 2012. Medications for pulpotomy including formocresol, ferric sulfate, calcium hydroxide, and mineral trioxide aggregate (MTA), and laser pulpotomy are compared using Bayesian network meta-analyses. The outcome is the odds ratio for clinical and radiographic failure including premature tooth loss at 12 and 24 months after treatments amongst different treatment procedures. >37 studies were included in the systematic review, and 22 of them in the final network meta-analyses. After 18-24 months, in terms of treatment failure, the odds ratio for calcium hydroxide vs formocresol was 1.94 [95% credible interval (CI): 1.11, 3.25]; 3.88 (95% CI: 1.37, 8.61) for lasers vs formocresol; 2.16 (95% CI: 1.12, 4.31) for calcium hydroxide vs ferric sulfate; 3.73 (95% CI: 1.27, 11.67) for lasers vs ferric sulfate; 0.47 (95% CI: 0.26, 0.83) for MTA vs calcium hydroxide; 3.76 (95% CI: 1.39, 10.08) for lasers vs MTA. Conclusions After 18-24 months, formocresol, ferric sulfate, and MTA showed significantly better clinical and radiographic outcomes than calcium hydroxide and laser therapies in primary molar pulpotomies. Clinical significance: The network meta-analyses showed that MTA is the first choice for primary molar pulpotomies. However, if treatment cost is an issue, especially when the treated primary molars are going to be replaced by permanent teeth, ferric sulfate may be the choice.
    Journal of dentistry 09/2014; 42(9). DOI:10.1016/j.jdent.2014.02.001 · 2.84 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: AIM: Dentin hypersensitivity, caused by the exposure and patency of dentinal tubules, can affect patients' quality of life. The aim of this study was to undertake a systematic review and a network meta-analysis, comparing the effectiveness in resolving dentin hypersensitivity among different in-office desensitizing treatments. MATERIALS AND METHODS: A literature search was performed with electronic databases and by hand until December 2011. The included trials were divided into six treatment groups as placebo, physical occlusion, chemical occlusion, nerve desensitization, laser therapy and combined treatments. The treatment effects between groups were estimated with standardized mean differences by using a Bayesian network meta-analysis. RESULTS: Forty studies were included. The standardized mean difference between placebo and physical occlusion was -2.57 [95% credible interval (CI): -4.24 to -0.94]; placebo versus chemical occlusion was -2.33 (95% CI: -3.65 to -1.04); placebo versus nerve desensitization was -1.72 (95% CI: -4.00 to 0.52); placebo versus laser therapy was -2.81 (95% CI: -4.41 to -1.24); placebo versus combined treatment was -3.47 (95% CI: -5.99 to -0.96). The comparisons of the five active treatments showed no significant differences. CONCLUSIONS: The results from network meta-analysis showed that most active treatment options had significantly better treatment outcome than placebo.
    Journal Of Clinical Periodontology 08/2012; 40(1). DOI:10.1111/jcpe.12011 · 3.61 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: In the last decade, a new statistical methodology, namely, network meta-analysis, has been developed to address limitations in traditional pairwise meta-analysis. Network meta-analysis incorporates all available evidence into a general statistical framework for comparisons of all available treatments. A further development in the network meta-analysis is to use a Bayesian statistical approach, which provides a more flexible modelling framework to take into account heterogeneity in the evidence and complexity in the data structure. The aim of this paper is therefore to provide a nontechnical introduction to network meta-analysis for dental research community and raise the awareness of it. An example was used to demonstrate how to conduct a network meta-analysis and the differences between it and traditional meta-analysis. The statistical theory behind network meta-analysis is nevertheless complex, so we strongly encourage close collaboration between dental researchers and experienced statisticians when planning and conducting a network meta-analysis. The use of more sophisticated statistical approaches such as network meta-analysis will improve the efficiency in comparing the effectiveness between multiple treatments across a set of trials.
    06/2012; 2012:276520. DOI:10.5402/2012/276520