Evidence-based Dentistry

Published by Nature Publishing Group
Online ISSN: 1462-0049
Publications
Article
Bridging the gap between research and dental practice, EBD provides a single source of ground breaking issues in Dentistry. We filter out the best range of evidence from a wide range of sources, presenting clear, comprehensive and easily digestible summaries.
 
Main study types. 
Advantages and disadvantages of observational vs experimental designs.
Advantages and disadvantages of prospective-retrospective designs.
Article
This is the first of a series of articles that will describe the different types of study design; considerations when choosing a study design; and the advantages and disadvantages of each type of study. This first article explains the importance of choosing an appropriate design and the decisions to be made when doing so.
 
Article
Bridging the gap between research and dental practice, EBD provides a single source of ground breaking issues in Dentistry. We filter out the best range of evidence from a wide range of sources, presenting clear, comprehensive and easily digestible summaries.
 
Article
In most, if not all, studies we collect data to obtain information about an area of research in which we have an interest. For example, we might want to know the level of dental caries in our area. In order to discover this we might need to observe a number of different variables, which could include, age, sex, number of teeth, cavities, fillings, extraction, pain, sepsis and quality of life. This information or data is normally obtained from a sample of the population which can then be summarised, analysed and conclusions drawn. This collection, summarising and analysis of data are what statistics and statistical technique are all about.
 
Article
Medline, Cochrane Central Register of Controlled Trials (CENTRAL) and the reference lists of potentially relevant studies and reviews. Randomised controlled or controlled clinical trials conducted in adults (>18yr) comparing 0.12% and 0.2% CHX were included. Plaque scores, parameters of periodontal inflammation and periodontal attachment loss were selected as primary outcome parameters. Only studies written in English were accepted. Study quality (risk of bias) and heterogeneity was assessed. Where appropriate, meta-analysis was conducted using a random effect model. A narrative summary was also presented. Ten separate experiments were included in the review, and a meta-analysis of seven studies using the same plaque index found a significant difference between 0.2% and 0.12% CHX (p50.008). The Weighted Mean Difference for plaque based on the Quigley & Hein Plaque Index was 0.10 (95%CI [0.03-0.17]) (heterogeneity I2 50%, p=0.87). Three studies that compared 0.12% and 0.2% CHX mouthrinse products provided data on gingival inflammation but no difference between the two concentrations was found. No studies were found that compared the two CHX concentrations and evaluated the probing pocket depth and/or the periodontal attachment level. In comparing 0.12% and 0.2% CHX, information concerning the effect on gingival inflammation was sparse and no studies could be found that compared the two CHX concentrations and evaluated the probing pocket depth and/or the periodontal attachment level. With respect to plaque inhibition, the results showed a small but significant difference in favour of the 0.2% CHX concentration. However the clinical relevance of this difference is probably negligible.
 
Article
Data sourcesMedline, Embase and LILACS. Chief Dental Officers worldwide were contacted to request conference reports, theses, government reports and unpublished survey data.Study selectionSelection was carried out independently by two reviewers. Longitudinal or crossover studies based on random samples representing national, subnational or community populations with SP defined as; a community periodontal index of treatment needs (CPITN) score of four, a clinical attachment loss (AL) more than 6 mm, or a gingival PD more than 5 mm.Data extraction and synthesisData extraction and synthesis followed Global Burden of Disease (GBD) 2010 standards and modeled using a Bayesian meta-regression tool developed for the GBD 2010. Countries were grouped in 21 regions and seven super-regions by geographical proximity and mean age of death.ResultsSeventy two studies involving 291,170 patients were included. The majority of these (65) were prevalence studies. In 2010, SP was the sixth-most prevalent condition, affecting 10.8% (95% uncertainty interval [UI]: 10.1%-11.6%) or 743 million people worldwide. Between 1990 and 2010 the global age-standardised prevalence of SP in the entire population was static at 11.2% (95% UI: 10.4%-11.9% in 1990 and 10.5%-12.0% in 2010) a non-significant increase from the 1990 incidence of SP. The age-standardised incidence of SP in 2010 was 701 cases per 100,000 person-years (95% uncertainty interval: 599-823), a non-significant increase from the 1990 incidence of SP. Prevalence increased gradually with age, showing a steep increase between the third and fourth decades of life that was driven by a peak in incidence at around 38 years of age.Conclusions Policy makers need to be aware of a predictable increasing burden of SP due to the growing world population associated with an increasing life expectancy and a massive decrease in the prevalence of tooth loss throughout the world from 1990 to 2010. These changes underscore the enormous public health challenge posed by SP and are a microcosm of the epidemiologic transition to non-communicable diseases occurring in many countries.
 
Results for the meta-analysis (all interventions) for the outcome mean pain relief  
Results for the sensitivity analysis for the outcome mean pain relief  
Results of the meta-analysis (all interventions) for the outcome intensity of pain (proportion of patients achieving no or mild pain status) after the intervention  
Results of subgroup analysis for outcome " Mean Pain Relief " 
Results of subgroup analysis for outcome " Proportion of Patients with No or Mild Pain " 
Article
This Clinical Practice Guideline report is designed to be an up-to-date source of the best available evidence on a relevant clinical topic, developed through a systematic review, evidence synthesis and input from the community of dental practitioners. The guideline is intended to facilitate evidence-based practice.
 
Article
As in previous years we are highlighting the guidelines, questions and answers addressed by summaries in Evidence-based Dentistry. Evidence levels¹ are only given for those papers achieving level 3A and above.
 
Article
Bridging the gap between research and dental practice, EBD provides a single source of ground breaking issues in Dentistry. We filter out the best range of evidence from a wide range of sources, presenting clear, comprehensive and easily digestible summaries.
 
Journals reviewed.
Article
The purpose of this systematic literature search was to evaluate how the evidence-based approach appears in German-language dental journals. All volumes of 28 dental journals published between 1997 and 2003 were searched by hand; for 15 of these journals, an additional electronic search was made. The focus of the search was all articles, editorials or letters to the Editor dealing with topics related to evidence-based dentistry (EBD)/medicine or using its terminology. Of the 1776 journal issues that were scrutinised, 368 relevant publications were found. After a low, albeit slightly increasing, number of pertinent contributions published between 1997 and 1999, there was a sharp rise in 2000 and 2001, culminating in 2003. Our findings indicate a rising awareness of the concept of EBD in the German-language dental literature. Nonetheless, its reception within the German-speaking dental community is still modest.
 
Article
Bridging the gap between research and dental practice, EBD provides a single source of ground breaking issues in Dentistry. We filter out the best range of evidence from a wide range of sources, presenting clear, comprehensive and easily digestible summaries.
 
Article
Data sourcesMedline, Embase, Lilacs.Study selectionPublished and unpublished observational population-based studies presenting information on the prevalence, incidence, case fatality and cause-specific mortality related to untreated caries, severe periodontitis and severe tooth loss between January 1980 and December 2010. There were no language restrictions. Study quality was assessed using the STROBE checklist (http://www.strobe-statement.org/).Data extraction and synthesisPrevalence estimates were calculated on the database for all age-gender-country-year groups using a specifically developed Bayesian meta-regression tool. Disability-adjusted life-years (DALYs) and years lived with disability (YLDs) metrics were used to quantify the disease burden. Disability weights were calculated based on population-based surveys in five countries (USA, Peru, Tanzania, Bangladesh and Indonesia) and an open Internet survey. Uncertainties in estimates were examined using Monte Carlo simulation techniques with uncertainty levels presented as the 2.5th and 97.5th centiles, which can be interpreted as a 95% UI.ResultsOral diseases remain highly prevalent in 2010 affecting 3.9 billion people. Untreated caries in permanent teeth was the most prevalent condition evaluated for the entire GBD (Global Burden of Disease) 2010 Study with a global prevalence of 35% for all ages combined. Severe periodontitis and untreated caries in deciduous teeth were the 6th and 10th most prevalent conditions, affecting, respectively, 11% and 9% of the global population. Oral conditions combined accounted for 15 million DALYs globally (1.9% of all YLDs and 0.6% of all DALYs), implying an average health loss of 224 years per 100,000 people. DALYs due to oral conditions increased 20.8% between 1990 and 2010, mainly due to population growth and aging. While DALYs due to severe periodontitis and untreated caries increased, those due to severe tooth loss decreased.Conclusions The findings highlight the challenge in responding to the diversity of urgent oral health needs world-wide, particularly in developing communities.
 
Article
Randomised controlled trial. Volunteers aged 14-16 years with DMFS ≥ 5 were recruited, those with orthodontic appliances were excluded. Participants were assigned dentifrices for unsupervised toothbrushing. The test group received Duraphat 5,000 ppm F (Colgate-Palmolive AB, Danderyd, Sweden) and the control group Pepsodent Superfluor 1,450 ppm F (Lever Fabergé, Stockholm, Sweden), both as NaF. Toothbrushes and dentifrices were delivered to their home addresses by post, every third month. Patricipants and their parents were instructed to keep the 5,000 ppm dentifrice in a safe place away from small children. Evaluations were carried out at two years and a compliance questionnaire was administered. The outcome variables were caries incidence and progression of proximal and occlusal caries. 28% of participants were considered to have had poor compliance as assessed by questionnaire. Those using 5,000 ppm F toothpaste had significantly lower caries progression compared to those using 1,450 ppm F toothpaste with a prevented fraction of 40%, with those with poorer compliance showing a slightly higher prevented fraction (42%). The 5,000 ppm toothpaste therefore appears to be an important vehicle for the treatment and prevention of caries in patients with a high caries risk. The data may indicate that 5,000 ppm toothpaste has a greater impact on individuals who do not use toothpaste regularly or do not brush twice a day.
 
Article
DesignSingle-blind, multi-centre, parallel, randomised controlled trial. Intervention Adult patients (18-75 years) with 10 or more natural teeth, and one or more root caries lesion in a tooth not crowned or compromised were included. Patients were randomised to receive a high fluoride toothpaste, 1.1% sodium fluoride (5000 ppm F) or a regular toothpaste (1350 ppm F). Packaging was identical and standard brushes were also provided. Patients were strictly instructed to refrain from using toothpastes or toothbrushes other than the ones provided and restricted from using mouth rinses.Outcome measureThe primary outcome measure was changes in the surface structure of the root caries lesions after the intervention. This was graded using a surface hardness score (HS) scale: Level 1: hard; Level 2: hard to leathery; Level 3: leathery; Level 4: leathery with local softening; Level 5: soft. Scores were recorded at baseline, three and six months. Examiners were masked to the group assignment.ResultsOne hundred and thirty-five patients (test group: n = 67; control group: n = 68) with 318 identified root caries lesions were randomised. Five patients were lost to follow up, three in the test group and two in the control. The groups were similar at baseline. Overall there was no difference between the two groups for the overall HS (test group: HS = 3.4 ± 0.61; control group: HS = 3.4 ± 0.66; P = 0.8757, unpaired t-test). However the ANOVA revealed significantly better HS for the test group than for the control groups (T1: test group: HS = 2.9 ± 0.67; control group: HS = 3.1 ± 0.75; T2: test group: HS = 2.4 ± 0.81; control group: HS = 2.8 ± 0.79; P < 0.0001).Conclusions The application of a high-fluoride containing dentifrice (5000 ppm F) in adults, twice daily, significantly improves the surface hardness of otherwise untreated root caries lesions when compared with the use of regular fluoride containing (1350 ppm F) toothpastes.AcknowledgementsThe authors' institutions received per capita remunerations and the products used in this clinical trial, from Colgate - Palmolive Company. Roger P. Ellwood and Michael Warncke are employees of the Colgate - Palmolive Company.
 
Article
PubMed (1966-April 2004) provided the primary data source along with the bibliographies from identified articles and reviews. As there were no randomised controlled trials, English language prospective and retrospective cohort studies were selected if they had a mean follow-up of >/=5 years, included patients who were clinically examined at follow-up, reported details on suprastructures and described at least one-third of reconstructions as fixed partial dentures (FPDs). Two independent reviewers screened articles for inclusion. Disagreements were resolved by discussion and agreement determined by kappa. Three reviewers extracted data on the survival and success of the reconstructions and on biological and technical complications. Studies deemed sufficiently similar by design were pooled using negative binomial regression with robust standard errors. Ten-year survival risks were calculated using exp(-10 x failure rate) and 10-year failure risks using 1-S(10). 17 retrospective and two prospective cohort studies including 1764 patients with 3548 FPDs analyzed in total. Meta-analysis was undertaken and after exclusion of one outlier a 10-year FPD survival of 92% was estimated. Only four studies provided information on FPD success - pooled complication rate was 34.1/1000 FPD years (95% CI 16-74). Exclusion of one outlier resulted in an estimated 10-year success of 81.1%. Considering biological complications, the estimated 10-years risk for caries at abutments was 9.5% (95% CI 4.6-89.9) while that for FPD loss due to caries and periodontal disease were 2.6% (95% CI 1.6-4.2) and 0.5% (95% CI 0.1-2.2), respectively. Estimated 10-year risks for technical complications were: 6.4% (95% CI 3.9-10.4) for loss of retention; 2.1% (95% CI 1.4-3.2) for loss of FPD due to abutment fracture and 3.2% (95% CI 1.5-6.5) for material fractures. Estimated success and survival rates for conventional FPDs largely confirm those of previous reviews. Technical complications such as loss of retention, which have not been reviewed before, resulted in a greater risk of FPD loss than did biological complications.
 
Article
Medline, Embase and the Cochrane Library were searched for studies and the reference lists of the full-text articles were checked for any additional studies. Included studies were randomised clinical trials (RCT) and non-RCT, cohort studies, case-control studies, case reports, or reviews that addressed the placement of dental implants at the same time as primary oncological resection in people suffering from cancer of the head and neck (primary implant insertion); or addressed benign or malignant tumours and the placement of implants into the native maxilla, mandible and zygoma, and grafted tissue. Articles were restricted to those written in English. The title and abstracts were reviewed independently by two reviewers. Data extraction was conducted independently and a qualitative synthesis of the data presented. Three case reports, 13 reviews, and 25 clinical studies were selected. Eight of the clinical studies referred solely to the insertion of dental implants at the time of primary oncological resection, and only two were of a prospective design. Published studies concerning primary dental implants were concisely summarised, so that the collected evidence base surrounding this approach to oral rehabilitation could inform head and neck cancer teams, particularly oncological surgeons, restorative dentists, and maxillofacial prosthodontists.
 
Article
Data sourcesThe Cochrane Oral Health Groups Trials Register, Cochrane Central Register of Controlled Trials, Medline, Embase, CINAHL, OpenGrey, ZETOC Conference Proceedings World Health Organization (WHO) International Trials Registry Platform and the US National Institutes of Health Trials Registry databases were searched with no restrictions on the language or date of publication.Study selectionRandomised controlled trials of systemic antibiotics in adults with a clinical diagnosis of symptomatic apical periodontitis or acute apical abscess, with or without surgical intervention (considered in this situation to be extraction, incision and drainage or endodontic treatment) and with or without analgesics.Data extraction and synthesisStudy selection, data abstraction and risk of bias assessment were carried out independently by two reviewers.ResultsTwo trials involving 62 patients were included. They compared the effects of oral penicillin V potassium versus a matched placebo given in conjunction with a surgical intervention and analgesics to adults with an acute apical abscess or symptomatic necrotic tooth. One study was considered to have a high risk of bias and the other an unclear risk of bias. The primary outcomes were patient-reported pain and swelling. There were no statistically significant differences in participant-reported measures of pain or swelling at any of the time points assessed within the review. The body of evidence was assessed as at very low quality.Conclusions There is very low quality evidence that is insufficient to determine the effects of systemic antibiotics on adults with symptomatic apical periodontitis or acute apical abscess.
 
Article
Data sourcesOvid, Medline, EMBASE, PsycINFO, CINAHL, LILACS, CENTRAL, bibliographies of identified RCTs, Current Controlled Trials, domestic violence organisations, handsearching of a number of articles.Study selectionThis is an update of a review reported in 2004. Randomised controlled trials in any language that included adults (persons >16 years of age) presenting with facial or dental injuries to dental or healthcare settings. Eligible interventions were: referral to support services or screening for domestic violence. Eligible outcomes were: frequency of physical assault by self-report, severity of injury by self-report and proportion of victims of domestic violence detected by self-report.Data extraction and synthesisTwo reviewers screened potential reports and would have data extracted had suitable RCTs been included.ResultsNo RCTs met the inclusion criteria.Conclusions There is also no evidence from RCTs to suggest that screening for domestic violence in adults with dental or facial injury in any health setting is beneficial or harmful.
 
Article
Searches were made for studies using Applied Social Sciences Index and Abstracts, Caredata (the social work and social care knowledge base), Child Data (the National Children's Bureau Database), the Cumulative Index to Nursing and Allied Health, Embase, Medline, the System for Information on Grey Literature in Europe, the TRIP database (www.tripdatabase.com), Sciences Citation Index, and ISI Proceedings (covers conference papers in all scientific and technical fields). Authors were contacted where necessary.
 
Article
Medline, The Cochrane Library, bibliographies of identified studies and hand searching of the journals, Schweizer Monatsschrift fur Zahnmedizin (Acta Medicinae Dentium Helvetica) and Deutsche Zahnärztliche Zeitschrift and Implantologie. Randomised-controlled clinical trials, prospective and retrospective studies providing information on ceramic and metal abutments with a mean follow-up time of at least 3 years were included. Patients had to have been examined clinically at the follow-up visit. Assessment of the identified studies and data abstraction were performed independently by three reviewers. Failure rates were analysed using standard and random-effects Poisson regression models to obtain summary estimates of 5-year survival proportions. A total of 29 studies providing information on the clinical performance of the implant abutments were included in the analysis. The estimated 5-year survival rate of ceramic abutments was 99.1% [95% confidence interval (CI): 93.8-99.9%] and 97.4% (95% CI: 96-98.3%) for metal abutments. The estimated cumulative incidence of technical complications after 5 years was 6.9% (95% CI: 3.5-13.4%) for ceramic abutments and 15.9% (95% CI: 11.6-21.5%) for metal abutments. Abutment screw loosening was the most frequent technical problem, occurring at an estimated cumulative incidence after 5 years of 5.1% (95% CI: 3.3-7.7%). All-ceramic crowns supported by ceramic abutments exhibited similar annual fracture rates as metal-ceramic crowns supported by metal abutments. The cumulative incidence of biological complications after 5 years was estimated at 5.2% (95% CI: 0.4-52%) for ceramic and 7.7% (95% CI: 4.7-12.5%) for metal abutments. Aesthetic complications tended to be more frequent at metal abutments. The 5-year survival rates estimated from annual failure rates appeared to be similar for ceramic and metal abutments. The information included in this review did not provide evidence of differences for the technical and biological outcomes of ceramic and metal abutments. However, the information for ceramic abutments was limited in the number of studies and abutments analysed as well as the accrued follow-up time. Standardised methods for the analysis of abutment strength are needed.
 
Article
Returning to the two key sentences from the Abstract of Lockhart et al,1 the studies linking periodontal disease to cardiovascular disease, to date, are largely association studies. Therefore, sentence 1 is accurate: These studies ...support an association between PD and ASVD independent of known confounders." The issue with association studies is that the association may either accurately or spuriously portray a cause-effect relationship (see Figures 1 and 2). Said differently, association studies generate hypotheses that need to be tested. Sentence 2, however, might be more accurate were it so include two more words: " They do not, however, support [or refute] a causative relationship." In other words, the final word isn't in. A determination of a cause-effect relationship will require an intervention trial, as indicated in the seventh of Hill's postulates. Taken together, this suggests that the rooster(s), perhaps, might consider whether it wants to crow before or after sun up, and the clinical trials are completed, to avoid confusion.
 
Article
Data sourcesPubmed, Embase, Google scholar beta and the Cochrane Databases.Study selectionRandomised controlled trials (RCTs) and controlled clinical trials (CCTs) reporting on results or treatment parameters related to accelerated orthodontic tooth movement were considered.Data extraction and synthesisData abstraction and quality assessment using the Cochrane risk of bias tool were carried out independently by two reviewers. A meta-analysis and narrative synthesis was presented.ResultsEighteen studies (342 patients ) were included. Eight involved low intensity laser, seven corticotomy, and interseptal bone reduction, pulsed electromagnetic fields and photobiomodulation were each investigated by a single trial. Twelve RCTs and six CCTs were included. Two RCTs were considered to be at low risk of bias, five at unclear risk and five at high risk of bias. Three CCTS were at high risk of bias and three at unclear risk. Two studies on corticotomy and two on low intensity laser were combined in a random effects model. Higher canine retraction rate was evident with corticotomy during the first month of therapy (WMD=0.73; 95% CI: 0.28, 1.19, p<0.01) and with low intensity laser (WMD=0.42mm/month; 95% CI: 0.26, 0.57, p<0.001) in a period longer than three months. The quality of evidence supporting the interventions is moderate for laser therapy and low for corticotomy intervention.Conclusions There is some evidence that low intensity laser therapy and corticotomy are effective, whereas the evidence is weak for interseptal bone reduction and very weak for photobiomodulation and pulsed electromagnetic fields. Overall, the results should be interpreted with caution given the small number of studies, allied to limited quality and heterogeneity of the included studies. Further research is required in this field with additional attention to application protocols, adverse effects and cost-benefit analysis.
 
Article
Data sources: Pubmed, Embase, Sciences Citation Index, Cochrane Central Register of Controlled Trials (CENTRAL) and grey literature database of SIGLE were searched from January 1, 1990 to August 20, 2011 with no language restrictions. Study selection: Randomised controlled trials (RCTs) or quasi-RCTs in which the participants were healthy and received additional interventions to conventional orthodontic treatment for accelerating tooth movements were included. Subjects with defects in oral and maxillofacial regions (ie, cleft lip/palate), dental pathologies and medical conditions were excluded. Data extraction and synthesis: Studies were selected by two independent reviewers and disagreements were resolved by discussion with a third reviewer. The primary outcomes included accumulative moved distance (AMD) or movement rate (MR) and time required to move the tooth to its destination. Secondary outcomes were pain improvement, anchorage loss, periodontal health, orthodontic caries, pulp vitality and root resorption. The reviewers performed statistical pooling, where possible, according to a priori criteria on the basis of comparability of patient type, treatments and outcomes measured and risk of bias. The reviewers tested for heterogeneity, publication bias and sensitivity. A quality assessment test was conducted to evaluate the method used to measure AMD. Results: The authors selected seven RCTs and two quasi-RCTs, which included a total of 101 patients with an age range of 12-26.3 years. Eight studies compared four intervention methods to no intervention group (control group). From them, four studies assessed low laser therapy (LLL), two evaluated corticotomy (CC), one assessed electrical current therapy (EC) and one evaluated pulsed electromagnetic field (PEF). Another study compared dentoalveolar distraction (DAD) vs periodontal distraction (PDD).Quality assessment scores showed that only two studies were of high quality, five studies were of medium quality, while two studies were of low quality. All studies, except one, compared left and right sides of the same participant (split mouth design), and measured the AMD.The method for measuring AMD was reliable in three studies, relatively reliable in one study and unreliable in four studies. The authors only performed pooled AMD mean meta-analysis for the LLL studies. The meta-analysis showed pooled mean AMD of 0.32 (95% confidence interval (CI), 20.04, 0.68), 0.76 (95% CI, 20.14, 1.65), and 0.73 (95% CI, 20.68, 2.14) for one month, two months and three months, respectively. Two LLL studies showed no differences regarding periodontal health and two LLL studies showed no differences in root resorption between LLL intervention and control groups. Compared to control group, one study reported that CS had significantly higher MR and another study showed that CS exhibited larger AMD for one month, two months, three months and four months. Two studies revealed that CS did not show any difference in the periodontal health status. One study reported the EC showed significantly larger AMD for one month, whereas another study reported that PEF induced larger AMD for five + 0.6 months. DAD showed faster MR and less anchorage loss compared to PDD. Teeth remained vital in both DAD and PDD interventions and one out of six cases presented root resorption in the PDD group. Conclusions: Among the five interventions corticotomy is effective and safe to accelerate orthodontic tooth movement, low-level laser therapy was unable to accelerate orthodontic tooth movement. The level of evidence does not support whether electrical current and pulsed electromagnetic fields are effective in accelerating orthodontic tooth movement and dentoalveolar or periodontal distraction is promising in accelerating orthodontic tooth movement.
 
Article
Data sources: Medline, Embase and the Chinese Biomedical Literature databases were searched with no language restrictions. Study selection: Studies evaluating the diagnostic efficacy of ultrasonography in detecting TMJ disc displacement in participants with any symptoms or clinical signs related to temporomandibular disorders (TMD), with use of MRI as the gold standard, were included. Data extraction and synthesis: Study selection, data abstraction and risk of bias assessment were carried out independently by two reviewers. A meta-analysis was conducted. Results: Fifteen studies (14 cohort studies and one case control) were included in this review; six studies had a low risk of bias, six studies an unclear risk and three studies a high risk. Meta-regression indicated that the detected results were not influenced by the types of ultrasonography, image dimensions, types of transducer and ultrasonic image of the disc (P= .05). The Q* values (the point where sensitivity equals specificity on the summary reviewer operator characteristics curve) of ultrasonography for the closed- and open-mouth positions were 0.79 and 0.91, respectively. The diagnostic efficacy of disc displacement with reduction had a sensitivity of 0.76, a specificity of 0.82, a positive likelihood ratio of 3.80, a negative likelihood ratio of 0.36, a diagnostic odds ratio of 10.95, an area under the curve of 0.83 and a Q* of 0.76. The diagnostic efficacy of disc displacement without reduction had a sensitivity of 0.79, a specificity of 0.91, a positive likelihood ratio of 80.5, a negative likelihood ratio of 0.25, diagnostic odds ratio of 36.80, an area under the curve of 0.97 and a Q* of 0.92. Conclusions: The diagnostic efficacy of ultrasonography is acceptable and can be used as a rapid preliminary diagnostic method to exclude some clinical suspicions. However, positive ultrasonographic findings should be confirmed by magnetic resonance imaging. Also, the ability of ultrasonography to detect lateral and posterior displacements is still unclear.
 
Article
Data sourcesThe databases Medline/PubMed, EMBASE, the Cochrane Library, Chinese Biomedical Literature Database and the China National Knowledge Infrastructure were searched. Additional hand searches were conducted in the journals.Study selectionRandomised controlled trials, prospective cohort studies and retrospective studies with follow-up of 36 months or longer were included.Data extraction and synthesisData were extracted independently in duplicate. The annual core and veneer fracture rates of various tooth types were estimated and compared using Poisson regression.Results37 studies were included; two RCTs, 25 prospective cohorts and 10 retrospective studies. Based on the calculated results, all-ceramic crowns had an acceptable overall five-year fracture rate of 4.4% irrespective of the materials used. Five-year fracture rates were significantly higher for molar crowns (8.1%) compared to premolar crowns (3.0%), and the difference between anterior (3.0%) and posterior crowns (5.4%) also achieved significance. Core fracture rates had a five-year incidence of 2.5%, and a significantly higher core fracture rate was found in the posterior region (3.9%). The overall five-year incidence of veneer fracture was 3.0%, and no clear difference was found between restored tooth types, with incidences of 2.0%, 2.5%, 1.0%, and 3.0% for incisor, canine, premolar, and molar crowns, respectively.Conclusions Within the limitations of this study's protocol, the current evidence suggests that dental ceramic materials demonstrated acceptable five-year core and veneer fracture incidences when used for tooth-supported single crowns in both anterior and posterior segments. Higher fracture tendency for posterior crowns was the trend for all-ceramic crowns, while molar crowns showed a significantly higher fracture rate than premolar crowns. Randomised controlled trials with large sample sizes be undertaken to obtain more definitive results.
 
Article
Bridging the gap between research and dental practice, EBD provides a single source of ground breaking issues in Dentistry. We filter out the best range of evidence from a wide range of sources, presenting clear, comprehensive and easily digestible summaries.
 
Article
Data sources: Medline, CINAHL, PsycINFO, SCI, SSCI, Cochrane Database of Systematic Reviews, Business Source Premier, Google scholar. Study selection: Primary or secondary reports and studies, published in English, after 1993, likely to include data relevant to direct access, report on empirical data relating to the operation of that system. Data extraction and synthesis: After initial screening, titles and abstracts were assessed by two reviewers, and disagreements resolved by the third. Full texts of these eligible ones were then assessed by the team until consensus reached. Data extraction by one reviewer was checked by a second and disagreements resolved by discussion with the third. Study quality was assessed through reference to CASP or SIGN checklists. Descriptive analyses and synthesis of findings were given. Results: From the 1,733 studies yielded from the search, over 100 research dental and other health-related papers were identified as relevant. Thirty-five studies were eligible for inclusion under dental health care direct access and 57 under non-dental health care direct access literature. The quality of the evidence was varied but on the whole assessed as moderately good quality.There was no evidence of increased risk to patient safety in any of the included seven studies. Four studies on appropriateness of DCP referrals reported a high proportion of over-referral, one study found under-referral and one good agreement regarding referral decisions.Six of the seven studies looking at DCPs' knowledge or support to patients for smoking cessation, diabetes, child abuse and domestic violence found deficiencies in DCPs' knowledge or support to patients, but these studies didn't have evidence to suggest how this compared to dentists.Increasing access to dental therapists and hygienists (whether indirect, general or without supervision of a dentist) according to ten studies, resulted in greater access to and use of dental services by underserved populations. Three studies suggested variable and, at most, modest cost savings to patients and service providers. High levels of patient satisfaction were found in all eight studies reporting this, and DCP job satisfaction was reported to be higher with direct access. Conclusions: Although over-referral of patients to dentists was suggested and a need for training on assessment and referral skills, there was no evidence of significant issues of patient safety from the clinical activities of DCPs. There was strong evidence of improved access to dental care with direct access arrangements, cost benefits to patients/service providers and high levels of patient satisfaction.
 
Article
Medline, Embase, CENTRAL and the reference lists of identified studies. Studies had to describe diagnostic accuracy efficacy, diagnostic thinking efficacy, therapeutic efficacy or any combination for CBCT in the diagnosis of impacted teeth or of important features associated with impactions. Criteria for the diagnosis had to be described in detail or referenced. For studies elucidating only observer performance, the analysis had to be based on a minimum of two observers. Data were extracted with the aid of protocol based on critical appraisal of diagnostic studies. Two authors independently assessed the quality and internal validity of studies using the QUADAS tool,(1) with disagreements being resolved by discussion. The results were described narratively as meta-analyses could not be conducted. The search yielded 96 titles, of which seven were included. There was only limited evidence for diagnostic efficacy expressed as sensitivity, specificity and predictive values. Only two studies compared CBCT and panoramic radiographs with a valid reference method and presented the results in terms of percentage of correct diagnoses. There is a need for diagnostic accuracy studies on CBCT where accepted methodological criteria for diagnostic thinking, efficacy and therapeutic efficacy are incorporated.
 
Article
Data sourcesThe Cochrane Central register of controlled trials, Medline and Embase databases were searched.Study selectionClinical studies that compared methods against a reference standard were included. Studies also needed to have sensitivity, specificity, likelihood ratio, odds ratio or receiver operator curve (ROC) data or data reported so this could be calculated.Data extraction and synthesisTwo reviewers independently assessed abstracts and full text articles. Study quality was assessed using the GRADE criteria (www.gradeworkinggroup.org/). A qualitative summary was conducted.ResultsTwenty-six studies were included, none was considered to be of high quality, 11 were of moderate quality. There was insufficient evidence that the digital intraoral radiographic technique is diagnostically as accurate as the conventional film technique. The same applies to Cone beam computed tomography (CBCT).Conclusions No conclusions can be drawn regarding the accuracy of radiological examination in identifying various forms of periapical bone tissue changes or about the pulpal condition.
 
Article
Data sourcesThe Cochrane CENTRAL and Medline databases and reference lists of identified were searched.Study selectionProspective longitudinal cohorts or randomised controlled trials were included.Data extraction and synthesisStudy assessment and data extraction were carried out independently by at least two reviewers. The quality of studies was assessed using the QUADAS and AMSTAR tools. The overall quality of evidence was assessed using the GRADE approach.Results90 studies were included, seven were of high quality, 35 of moderate quality and the rest poor. The accuracy of multivariate models was higher for pre-school children than for schoolchildren/adolescents. As the models had rarely been tested in independent populations their accuracy is uncertain. The single predictor baseline caries experience had moderate/good accuracy in pre-school children and limited accuracy in schoolchildren/adolescents. In general, the quality of evidence was limited.Conclusions Multivariate models and baseline caries prevalence performed better in pre-school children than in school-children/adolescents. Baseline caries prevalence was the most accurate single predictor in all age groups. The heterogeneity of populations, models, outcome criteria, measures and reporting hampered the synthesis of results. There is a great need to standardise study design, outcome measures and reporting of data in studies on caries risk assessment. The accuracy of prediction models should be validated in at least one independent population.
 
Article
DesignRandomised controlled trialInterventionPatients with a clinical diagnosis of a symptomatic tooth with a pulpal diagnosis of necrosis and moderate to severe pain at the time of treatment were randomised to either 80 capsules of 150mg ibuprofen or 80 capsules of 150mg ibuprofen/250mg acetaminophen. Patients were to take four capsules every six hours. Escape medication (hydrocodone/acetaminophen) was also available; if patients had significant swelling or fever, they were seen clinically. Patients' preoperative pain was assessed on the/a visual analogue scale (VAS). Patients also received a six-day diary to be completed after anaesthesia wore off and every morning for five days, to record pain, symptoms and the number of capsules taken.Outcome measureThe main outcome measures were pain and medication use.ResultsNo significant differences were found between the two groups.Conclusions There were decreases in pain levels and analgesic use over time for the ibuprofen and ibuprofen/acetaminophen groups. There was no statistically significant difference between the two groups for analgesic use or escape medication use. Approximately 20% of patients in both groups required escape medication to control pain.
 
Article
DesignRandomised controlled trialInterventionPatients with coronary artery disease who were receiving 100 mg/day of ASA for the prevention of thromboembolic events, and requiring at least one molar tooth extracted were randomised to either having their ASA therapy suspended for seven days before tooth extraction and restarted the day following the surgical procedure or not having their ASA therapy suspended at any point before or after the procedure. A single dentist who was unaware of the patients' ASA therapy status performed all the extractions.Outcome measureOutcomes were a platelet aggregation test carried out on the day of the operation and the amount of bleeding measured during the intra-operative period.ResultsBleeding was controlled with local haemostatic methods and there were no reported episodes of haemorrhaging during the intra- and post-operative periods. The mean (±SD) volume of bleeding was 12.10 ±9.37 mL for patients who underwent ASA therapy suspension and 16.38±13.54 mL for those patients whose treatments were unaltered (P= .151). The platelet reactivity index values exhibited statistically significant differences between the two investigated groups (P= .004). The platelet reactivity index values for the group with ASA therapy suspended was 242.58 ± 71.26 compared with 192.09 ± 60.54 in the group that continued with ASA.Conclusions There was no difference in the amount of bleeding that occurred during tooth extraction between patients who continued ASA therapy and patients who suspended their ASA therapy. The platelet reactivity test demonstrated a reduction in platelet aggregation in the ASA therapy group, but this was without clinical consequence.
 
Article
The Cochrane Oral Health Group's Trials Register; Cochrane Central Register of Controlled Trials, Medline and Embase were used to search for studies. There were no language restrictions. Randomised controlled trials (RCT) were eligible if they compared aciclovir to placebo in children and young adults (<25 years of age) who had been diagnosed with primary herpetic gingivostomatitis with or without herpes labialis. Two review authors independently and in duplicate screened and extracted information from, and assessed the risk of bias, in the included clinical trials. The Cochrane Collaboration statistical guidelines were followed for data synthesis. Only two clinical trials, one with 72 participants and the other with 20, were included in this review. The second study failed to report details of its methods and was inconsistent in its reporting of the outcomes measured. The first trial, which had a moderate risk of bias, showed that aciclovir was better than placebo at reducing, in children of <6 years, the number with oral lesions [risk ratio (RR), 0.10; 95% confidence interval (CI), 0.02-0.38)], with new extra-oral lesions (RR; 0.04; 95% CI, 0.00-0.65), and difficulty in eating (RR, 0.14; 95% CI, 0.03-0.58) and drinking (RR, 0.11; 95% CI, 0.01-0.83) after 8 days of treatment. Following onset of treatment, three patients from the placebo group were admitted to hospital for rehydration (P 0.11 ). Four children (two from the aciclovir group and two taking placebo) suffered mild gastrointestinal symptoms that resolved spontaneously after 24-48 h without a change in the study regimen. Two relevant trials were found for this systematic review. Only one was able to provide weak evidence that aciclovir is an effective treatment in children under 6 years of age with primary herpetic gingivostomatitis, in reducing the number of oral lesions, preventing the development of new extra-oral lesions, decreasing the number of individuals experiencing difficulties eating and drinking and reducing hospital admission.
 
Article
Medline, Medline In-Process and other non-indexed citations, Lilacs, PubMed, Embase, Web of Science and all evidence-based medicine reviews were searched. The reference lists of the retrieved articles were also searched by hand for possible missing articles. Authors were contacted to obtain additional information if necessary. For inclusion, an article had to satisfy the following criteria: they should be clinical trials with a comparable untreated control group; facial soft tissue changes were evaluated through lateral cephalograms; Activator and/or Bionator functional appliances were used to correct Class II division 1 malocclusions; no syndromic or medically compromised patients were included; none were individual case-reports or series of cases; there was no surgical intervention; and only a removable functional appliance was used. Screening of eligible studies was independently made by both authors and their results were compared: discrepancies were settled through discussion. In the case of the Lilacs database, evaluation was by one author alone because of language limitation. Eligible studies were independently evaluated by both authors using a methodological scoring process which was developed to identify which selected studies would be most valuable. The search identified 30 articles, of which 11 met the inclusion criteria. Only one of these was a randomised controlled trial. Five studies evaluated the soft tissue changes after use of an Activator appliance. No changes in the naso-labial and labio-mental angles were observed, but a mild protrusion of menton was reported. Neither the tip nor the base of the nose underwent any change. Contradictory results were found regarding the position of the upper lip, the lower lip and menton. Contradictory changes in upper lip thickness and length were also reported, but no changes in the lower lip or soft tissue menton were noted. Six studies evaluated the soft tissue changes using a Bionator. Contradictory results were reported for the facial angles. No studies reported a significant naso-labial angle change. Total face height and lower face thirds were augmented. Contradictory results were found for the antero-posterior position of the upper lip, lower lip and soft-tissue pogonion. A vertical increase was reported for upper lip, lower lip and soft tissue menton measurements. Based on the available evidence, a significant amount of controversy regarding the soft tissue changes produced by the Activator and the Bionator exists. Soft tissue changes that were reported as being statistically significant were of questionable clinical significance.
 
Article
Data sourcesThe Cochrane Library, Medline and Embase databases were searched as well as the references of identified articles and reviews.Study selectionStudies were selected independently by two authors with disagreements being resolved by discussion. Only English language papers were included.Data extraction and synthesisData abstraction was conducted independently and meta-analysis conducted where appropriate.ResultsTwelve studies were included; seven on toothbrushing, one on dental flossing and four on chewing were included. Plaque and gingival indices were found to have a significant effect on the prevalence of bacteraemia following toothbrushing, with pooled odds ratios of 2.61 [95% confidence interval (CI) = 1.45-4.69] and 2.77 (95% CI = 1.50-5.11) respectively. None of five studies on bacteraemia following dental flossing and chewing revealed a statistically significant association between oral hygiene, gingival or periodontal status and the development of bacteraemia.Conclusions Meta-analysis showed that plaque accumulation and gingival inflammation scores significantly increased the prevalence of bacteraemia following toothbrushing. However, systematic review showed no relationship between oral hygiene, gingival and periodontal status and the development of B-chewing, and there is no evidence that gingival and periodontal health status affects B-flossing.
 
Article
DesignThis study was a randomised controlled trial (RCT).InterventionEdentulous subjects were randomly assigned to receive mandibular over-dentures retained by implants (test group) or conventional mandibular dentures (control group). All subjects also received new complete maxillary dentures. Participants completed a social impact questionnaire (SIQ) at baseline and 2 months after treatment; oral health-related quality of life was measured using the oral health impact profile (OHIP).Outcome measureBetween- and within-group changes were recorded in impact categories and the correlation between post-treatment OHIP and impact items assessed.ResultsIn total, 102 edentulous subjects (age range, 35–65 years) were recruited and randomised to the test group (number with implant retained dentures, 54; mean age, 50.8 years) or control group (number with conventional dentures, 48; mean age, 51.2 years). Following treatment, significant effects of the treatment were found on scores of the OHIP and most of the items of the SIQ. Subjects given implant retained dentures had lower impacts on all OHIP scores than people with conventional dentures; the mean score was 34 points lower post-treatment for implant retained dentures, versus 9 points lower for conventional dentures. Treatment had a significant impact on all but three of the social and sexual impact items.Conclusions Implant-supported mandibular over-dentures provide greater relief from problems associated with denture-wearing in social and sexual activities than conventional dentures.
 
Article
Medline, PubMed, The Cochrane Library 2010, CINAHL, Embase, seven Korean Medical Databases and a Chinese Medical Database (China Academic Journal, www.cnki.co.kr). Parallel or cross-over RCTs that assessed the efficacy of acupuncture regardless of blinding, language and type of reporting published in English, Chinese and Korean were included. Dissertations and abstracts were included provided they contained sufficient detail. Complex interventions in which acupuncture was not a sole treatment and studies with no reported clinical data were excluded. All RCTs were obtained and read in full by two independent reviewers and data extracted according to pre-defined criteria. Quality was assessed using the Cochrane risk of bias criteria. Meta-analysis was conducted using random effect models if excessive statistical heterogeneity did not exist. Additional subgroup analysis or sensitivity analysis additionally was conducted to explore heterogeneity. Publication bias was assessed by funnel plot using the Cochrane software. Seven RCTs (including 141 patients) met our inclusion criteria. Six studies comparatively tested needle acupuncture against penetrating sham acupuncture, non-penetrating sham acupuncture or sham laser acupuncture, whilst the remaining study tested laser acupuncture against sham laser acupuncture. Five studies were considered to be at low risk of bias. Outcomes were reported for pain intensity, facial pain, muscle tenderness and mouth opening. This systematic review produced limited evidence that acupuncture is more effective than sham acupuncture in alleviating pain and masseter muscle tenderness in TMD. Further rigorous studies are, however, required to establish beyond doubt whether acupuncture has therapeutic value for this indication.
 
Article
Data sources Cochrane Oral Health Group's Trials Register (May 2000), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2000), MEDLINE (1966 to January 2000), plus several other databases. We handsearched journals, reference lists of articles and contacted selected authors and manufacturers.Study selection Randomized or quasi-randomized controlled trials with blind outcome assessment, comparing fluoride varnish, gel, mouthrinse, or toothpaste in combination with each other in children up to 16 years during at least 1 year. The main outcome was caries increment measured by the change in decayed, missing and filled tooth surfaces (D(M)FS).Data extraction and synthesis Inclusion decisions, quality assessment and data extraction were duplicated in a random sample of one third of studies, and consensus achieved by discussion or a third party. Authors were contacted for missing data. The primary measure of effect was the prevented fraction (PF) 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. Random effects meta-analyses were performed where data could be pooled.Results Eleven of the 12 included studies contributed data for meta-analyses. Nine trials (4026 children) provided data for the main meta-analysis on the effect of fluoride mouthrinses, gels or varnishes used in combination with toothpaste. The D(M)FS pooled PF was 10% (95% CI, 2–17%; p=0.01) in favour of the combined regimens. There was no substantial heterogeneity. The estimated benefit equates to a number needed to treat (NNT) of 4 to avoid one decayed, filled or missing tooth surface (DMFS) per year in a child population with a caries increment of 2.5 D(M)FS per year, or an NNT of 13 for children from a population with a caries increment of 0.8 D(M)FS per year.Meta-analyses of fluoride gel or mouthrinse combined with toothpaste versus toothpaste alone favour the combined regimens, but differences were not statistically significant; the significant difference in favour of the combined use of fluoride varnish and toothpaste accrues from a very small trial and appears likely to be a spurious result. Not all other combinations of possible practical value were tested in the included studies. The only other statistically significant result was in favour of the combined use of fluoride gel and mouthrinse in comparison to gel alone (pooled DMFS PF 23%; 95% CI, 4–43%; p=0.02), based on two trials. No other combinations of TFT were consistently superior to a single TFT.Conclusions Topical fluorides (mouthrinses, gels, or varnishes) used in addition to fluoride toothpaste achieve a modest reduction in caries compared to toothpaste used alone. No conclusions about any adverse effects could be reached, because data were scarcely reported in the trials.
 
Article
Data sourcesPubMed and seven other databases.Study selectionEnglish-language articles evaluating the association between the frequency of tooth brushing and periodontitis were considered. Two reviewers independently conducted study selection with study quality being assessed using the Health Evidence Bulletin (HEB) Wales checklist.Data extraction and synthesisRelevant study characteristics were extracted and where necessary, effect measures and corresponding confidence intervals (CIs) were recalculated from the reported papers. Random and fixed effects meta-analyses were conducted.ResultsFourteen studies were included (12 cross-sectional, two case-controlled). Sample sizes ranged from 44 - 9203. A fixed effects meta-analysis (12 cross sectional studies) found a significant overall odds ratio (OR) 1.41 (95%CI: 1.25-1.58, P <0.0001). A random effects meta-analysis (all 14 studies) found OR =1.44 (95%CI: 1.21-1.71, P < <0.0001) a slight indication for heterogeneity (I(2) = 48%, P = 0.02).Conclusions There are relatively few studies evaluating the association between tooth brushing frequency and periodontitis. A clear effect was observed, indicating that infrequent tooth brushing was associated with severe forms of periodontal disease. Further epidemiological studies are needed to precisely estimate the effect of key risk factors for periodontitis and their interaction effects.
 
Article
Medline, Embase, the Cochrane Library, the Wiley online database, four journals (Journal of Endodontics, International Endodontic Journal, Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology and Endodontics and Dental Traumatology) and the references of identified articles were searched manually. There was no language restriction. Clinical studies that provided sample size, and where success was based on radiographic and/or clinical criteria that evaluated quality of root filling, the quality of coronal restoration and periapical status at least one year after root canal treatment that provided an overall success rate or sufficient data to allow it to be calculated from the raw data were included. Data were collected based on predetermined criteria. Percentages of teeth without apical periodontitis were recorded for each category: adequate root canal treatment (AE); inadequate root canal treatment (IE); adequate restoration (AR); and inadequate restoration (IR). Data were analysed using meta-analysis for odds ratios (ORs). Nine article were included . After adjusting for significant covariates to reduce heterogeneity, the results were combined to obtain pooled estimates of the common OR for the comparison of AR/AE versus AR/IE:-AR/AE versus AR/IE (OR = 2.734; 95%CI, 2.61-2.88; P < .001)AR/AE versus IR/AE (OR = 2.808; 95% CI, 2.64-2.97; P < .001). On the basis of the current best available evidence, the odds for healing of apical periodontitis increase with both adequate root canal treatment and adequate restorative treatment. Although poorer clinical outcomes may be expected with adequate root filling-inadequate coronal restoration and inadequate root filling-adequate coronal restoration, there is no significant difference in the odds of healing between these two combinations.
 
Article
This was a cluster-randomised clinical trial (RCT) of incomplete block design. The interventions comprised an online 'patient-simulated clinical case' assessment, guideline dissemination, an interactive educational meeting, and flow chart reminders. All participants received feedback on individual as well as group scores for the patient-simulated clinical case assessment. Reminders with particular information and guideline-algorithm flow diagrams were provided 2 months before post-intervention measurements. The primary outcome measure was guideline-adherent recall interval assignment, and the secondary outcome measure was guideline-adherent bitewing frequency prescription. For low-risk patients, guideline-adherent recall increased in the intervention group (+8%), which differed from the control group (-6.1%; P 0.01). Guideline-adherent bitewings showed mixed results. Multifaceted intervention had a moderate but relevant effect on the performance of general dental practitioners, which is consistent with other findings in primary care.
 
Article
The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline and Embase were used and a search of the internet also undertaken. There was no restriction with regard to publication status or language of publication. Randomised controlled trials (RCT) and controlled clinical trials (CCT), including split-mouth studies, of adhesives used to attach orthodontic bands to molar teeth were selected. All review authors were involved in study selection, validity assessment and data extraction without blinding to the authors, adhesives used or results obtained. All disagreements were resolved by discussion. Five RCT and three CCT were identified as meeting the review's inclusion criteria. All the included trials were of split-mouth design. Four trials compared chemically cured zinc phosphate and chemically cured glass ionomer; three trials compared chemically cured glass ionomer cement with light-cured compomer; one trial compared chemically cured glass ionomer with a chemically cured glass phosphonate. Data analysis was often inappropriate within the studies that did meet the inclusion criteria. There is insufficient evidence to determine the most effective adhesive for attaching orthodontic bands to molar teeth in patients with full-arch fixed orthodontic appliances.
 
Article
DesignRandomised controlled trial.InterventionChildren with at least two sound permanent first molars and the presence of at least one sound distal surface of adjacent second primary molar were eligible. Children were randomised into three groups. In group one first permanent molars were sealed with a high-viscosity glass ionomer cement (GIC group; n = 926), group two received a resin-based fluoride containing sealant (RBF group; n = 923) and group three a resin-based sealant without fluoride (RB group; n = 927). Two examiners blind to group allocation conducted examinations at 30 months. Sealant retention and caries at D1-D3 levels was assessed. Bitewing radiographs were taken.Outcome measureCaries prevalence and incidence rate ratios were calculated.ResultsTwo thousand seven hundred and seventy-six children were enrolled; the number of dropouts were similar in each group (GIC group; n = 75), (RBF group; n = 67), (RB group; n = 77). The prevalence of affected surfaces was significantly lower in the GIC (p = .03) and FRB groups (p = .04). Fewer new caries developed on the distal surfaces of the second primary molars in the GIC group than in the other two groups. Incidence rate ratios (IRRs) were: 0.70 (95% CI: 0.50, 0.68; p < .01) for GIC vs. RB; 0.89 (95% CI: 0.89, 1.28; p = .10) for GIC vs. FRB and 0.79 (95% CI: 0.53, 1.04; p = .005) for FRB vs RB. Partial sealant loss was higher in the GIC group (76 molars; 2.95%), compared with FRB (52 molars; 1.41%), RB group (50 molars;1.35%).Conclusions Fluoride-releasing sealants (high-viscosity GIC and fluoride RB) were demonstrated to provide protection against caries on the distal surface of second primary molars. This preventive strategy might contribute to maintaining the integrity of the mesial surfaces of the first permanent molars.
 
Article
Data sourcesMedline, PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL) and Embase databases.Study selectionRandomised controlled trials (RCTs) using thermal diode lasers as an adjunct to non-surgical conventional periodontal initial therapy conducted in patients ≥18 years old written in English or Dutch were considered.Data extraction and synthesisStudy assessment data extraction and quality assessment was carried out independently by two reviewers. The main outcome variables were probing pocket depth (PPD) and clinical attachment loss (CAL), but plaque scores (PS), bleeding scores (BS) and the Gingival Index (GI) were also considered. Meta-analysis was carried out using a random effects model.ResultsNine studies involving 247 patients were included. Seven studies were of split mouth design and two were parallel group studies. The study designs showed considerable heterogeneity and follow up ranged from six weeks to six months. Meta-analysis found no significant effect on PPD, CAL and PS. There was however a significant effect for GI and BS favouring adjunctive use of the diode laserConclusions The collective evidence regarding adjunctive use of the diode laser with SRP indicates that the combined treatment provides an effect comparable to that of SRP alone. With respect to BS the results showed a small but significant effect favouring the diode laser, however, the clinical relevance of this difference remains uncertainStandard . This systematic review questions the adjunctive use of diode laser with traditional mechanical modalities of periodontal therapy in patients with periodontitis. The strength of the recommendation for the adjunctive use of the diode laser is considered to be 'moderate' for changes in PPD and CAL.
 
Article
Data sources Medline provided the primary data source and references lists from the identified papers were reviewed to source additional studies.Study selection Studies published in English prior to December 2001 were included if they were primary randomised controlled trials; were conducted in human subjects; examined the effects of local tetracycline in various forms in reducing probing depth (PD) and/or improving attachment level (AL); and they reported mean and measures of variance of PD and AL.Data extraction and synthesis The methods and results section of each article were read and scored by two independent readers. Meta-analyses were performed on the basis of baseline PD, type of antibiotic used, and experimental and control regimens. A random-effects model was used to combine data.Results A total of 29 studies met the inclusion criteria and were included in the meta-analyses. The quality assessment showed the studies to be of variable quality, with many failing to report relevant information. A significant mean reduction in PD was observed when tetracycline was used as an adjunct to scaling and root planing (SRP; mean difference at 12 weeks, 0.69 mm; 95% confidence interval, 0.57–0.81; P6 mm after 4 (P
 
Article
PubMed, Embase and the Cochrane Library were searched for relevant studies. Only controlled human trials of chlorhexidine varnish using clinical outcomes were included: other chlorhexidine preparations (mouth rinses/ gels) were excluded, as were studies with concomitant preventive measures, eg, fluoride varnishes. Details of data extraction methods are not provided and a qualitative summary is presented. Ten studies were identified. Comparisons were difficult because of considerable variation in the study parameters, such as varnishes with different chlorhexidine concentrations, different ages of participants, number of applications and clinical indices employed. Eight of the 10 studies found improvements in clinical parameters. The application of chlorhexidine varnish seems to have beneficial effects in people who have chronic gingivitis, improving their plaque accumulation and bleeding levels and reducing their gingival index. It is possible to maintain this beneficial effect for prolonged periods of time, although this requires re-applications of the varnish.
 
Top-cited authors
Kate A Levin
  • NHS Greater Glasgow and Clyde
Derek Richards
  • University of Dundee
Analia Veitz Keenan
  • New York University
John Mew
  • WWF United Kingdom
Brett Duane
  • Trinity College Dublin