Methodological assessment of systematic reviews of in-vitro dental studies.

BACKGROUND Systematic reviews of in-vitro studies, like any other study, can be of heterogeneous quality. The present study aimed to evaluate the methodological quality of systematic reviews of in-vitro dental studies. METHODS We searched for systematic reviews of in-vitro dental studies in PubMed, Web of Science, and Scopus databases published up to January 2022. We assessed the methodological quality of the systematic reviews using a modified "A MeaSurement Tool to Assess systematic Reviews" (AMSTAR-2) instrument. The 16 items, in the form of questions, were answered with yes, no, or py (partial yes). Univariable and multivariable linear regression models were used to examine the association between systematic review characteristics and AMSTAR-2 percent score. Overall confidence in the results of the systematic reviews was rated, based on weaknesses identified in critical and non-critical AMSTAR-2 items. RESULTS The search retrieved 908 potential documents, and after following the eligibility criteria, 185 systematic reviews were included. The most researched topics were ceramics and dental bonding. The overall rating for the confidence in the results was critically low in 126 (68%) systematic reviews. There was high variability in the response among the AMSTAR-2 items (0% to 75% positively answered). The univariable analyses indicated dental specialty (p = 0.03), number of authors (coef: 1.87, 95% CI: 0.26, 3.47, p = 0.02), and year of publication (coef: 2.64, 95% CI: 1.90, 3.38, p < 0.01) were significantly associated with the AMSTAR-2 percent score. Whereas, in the multivariable analysis only specialty (p = 0.01) and year of publication (coef: 2.60, 95% CI: 1.84, 3.35, p < 0.001) remained significant. Among specialties, endodontics achieved the highest AMSTAR-2 percent score. CONCLUSIONS The methods of systematic reviews of in vitro dental studies were suboptimal. Year of publication and dental specialty were associated with AMSTAR-2 scores. The overall rating of the confidence in the results was low and critically low for most systematic reviews

Reporting of flow diagrams in randomised controlled trials published in periodontology and implantology: a survey.

BACKGROUND Item 13 of the CONSORT guidelines recommends documentation of the participant flow in randomised clinical trials (RCTs) using a diagram. In the medical literature, the reporting of the flow of participants in RCTs has been assessed to be inadequate. The quality of reporting flow diagrams in periodontology and implantology remains unknown. The aim of this study was to assess the reporting of flow diagrams in RCTs published in periodontology and implantology journals. MATERIALS AND METHODS RCTs published between 15th January 2018 and 15th January 2022 in twelve high-ranked periodontology and implantology journals were identified. Trial characteristics at the RCT level were extracted. The flow diagram included in each RCT was assessed for completeness of reporting in relation to published criteria and the CONSORT flow diagram template. RESULTS From the 544 eligible articles, 85% were single-centre, 82% of parallel-group design and 79% investigated surgical interventions. Three-hundred and fifteen (58%) articles were published in CONSORT endorsing journals. A flow diagram was reported in 317 (58%) trials and reporting was more common in periodontology (73.1%). Overall, 56% of publications with a flow diagram reported a complete CONSORT flow diagram, while in 44% of flow diagrams, at least one point from the CONSORT reporting template was missing. Reasons for loss to follow-up (69.7%) and exclusions from the RCT analysis (86.4%) were poorly reported. CONCLUSION The reporting of flow diagrams in periodontology and implantology RCTs was sub-optimal. Greater awareness of the importance of fully completing the participant CONSORT flow diagram is required

A case study evaluating the effect of clustering, publication bias, and heterogeneity on the meta-analysis estimates in implant dentistry.

Meta-analyses may provide imprecise estimates when important meta-analysis parameters are not considered during the synthesis. The aim of this case study was to highlight the influence of meta-analysis parameters that can affect reported estimates using as an example pre-existing meta-analyses on the association between implant survival and sinus membrane perforation. PubMed was searched on 7 July 2021 for meta-analyses comparing implant failure in perforated and non-perforated sinus membranes. Primary studies identified in these meta-analyses were combined in a new random-effects model with odds ratios (ORs), confidence intervals (CIs), and prediction intervals reported. Using this new meta-analysis, further meta-analyses were then undertaken considering the clinical, methodological, and statistical heterogeneity of the primary studies, publication bias, and clustering effects. The meta-analyses with the greatest number and more homogeneous studies provided lower odds of implant failure in non-perforated sites (OR 0.49, 95 % CI = [0.26, 0.92]). However, when considering heterogeneity, publication bias, and clustering (number of implants), the confidence in these results was reduced. Interpretation of estimates reported in systematic reviews can vary depending on the assumptions made in the meta-analysis. Users of these analyses need to carefully consider the impact of heterogeneity, publication bias, and clustering, which can affect the size, direction, and interpretation of the reported estimates

Reporting and handling of incomplete outcome data in implant dentistry: A survey of randomized clinical trials.

AIM To assess the reporting and handling of incomplete outcome data in randomized clinical trials (RCTs) published in implant dentistry. MATERIALS AND METHODS We included RCTs on interventions related to the treatment with dental implants and presented any form of missing data. PubMed, SCOPUS and Cochrane databases were searched for studies published between May 2015 and May 2018. Reporting and handling of missing data at the study level was evaluated using a series of relevant questions. Descriptive data was reported, and univariable analyses were performed to evaluate the association of study variables with quality of reporting and data handling. RESULTS One-hundred and thirty-seven RCT reports were included from the 7,116 initially retrieved publications. The reporting of incomplete outcome data varied greatly among the trials and for the different questions. The range of adequately reported questions was between 3.64% (question: comparison of baseline characteristics of all randomised participants) and 100% (question: explicit reporting of missing data). The complete case analysis was the most used (45.3%) approach for incomplete outcome data handling. CONCLUSIONS Randomized studies in implant dentistry have room for improvement in both the reporting and the handling of incomplete outcome data

Prediction intervals should be included in meta-analyses published in dentistry.

This focus article aims to highlight the value of reporting prediction intervals (PIs) in random effects meta-analysis and to assess the prevalence of PI-reporting in periodontology and implant dentistry meta-analyses. We searched in the PubMed database for meta-analyses published in the fields of periodontology and implant dentistry. We selected meta-analyses related to primary outcomes with at least three trials. Additionally, we extracted information on the type of the meta-analysis model (fixed or random) and whether the random effects meta-analyses included PIs in addition to the 95% confidence intervals. Three-hundred and forty-nine meta-analyses were found in 94 systematic reviews. Two-hundred and sixty-three (75.4%) subgroup and full meta-analyses used the random-effects model, 81 (23.2%) used fixed-effect methods, and 5 (1.4%) did not specify the model used. In 75 systematic reviews, we found 231 meta-analyses with three or more trials (173 full meta-analyses and 58 subgroup meta-analyses). Only one systematic review reported PIs. Interpretation of the results of random effects meta-analyses which ignore heterogeneity can be misleading. Heterogeneity should be explored, and two common approaches include subgroup analyses and meta-regression. Random effects meta-analyses should include PIs because they convey the extent of heterogeneity in treatment effects across studies in a clinically relevant context

PRESUMED PREDATORY JOURNALS ARE ABUNDANT IN ORAL HEALTH

Objective to identify characteristics of presumed predatory (PP) journals, presumed legitimate open access (PLOA) journals, and presumed legitimate subscription (PLS) journals published in dentistry. Methods We assessed presumed predatory (PP), presumed legitimate open access (PLOA) and presumed legitimate subscription (PLS) using indicators reported in the literature consisting of 29 items in the form of questions in a cross-sectional setting. The indicators formed the basis for the 13 salient characteristics of PP journals that were used to generate scores. Greater scores would imply that the journal was more likely to be predatory compared to lower score journals. Associations between predatory score and journal type were examined using the nonparametric Kruskal-Wallis test, and classification to the 3 groups based on the article characteristics was implemented using the random forest approach. Results From the 580 potentially eligible journals, 431 dental journals were included: 226 PP (52%), 111 (26%) PLOA, and 94 (22%) PLS. There were significant differences in the predatory score among the three groups; PP journals had the highest mean score and PLS journals the lowest mean score. Mention or reporting to be indexed in the Directory of Open Access Journals (DOAJ) database and journals´website with distorted or blurry images were the most influential variables for accurate classification into a predatory category or not. Conclusions The present study found that some specific characteristics such as distorted images and grammatical errors are more prominent in PP dental journals

ASSESSMENT OF THE FREQUENCY OF REPORTING DENTAL PATIENT-REPORTED OUTCOMES (dPROs) IN A SAMPLE OF RANDOMIZED CONTROLLED TRIALS ON ROOT COVERAGE PROCEDURES

Objective: Dental patient-reported outcomes (dPROs) are important for understanding the impact of proposed therapies on patients’ oral health. The aims of the present study were to investigate the frequency of the reporting of dPROs in randomized controlled trials (RCTs) of root coverage procedures and to assess associations between the study/article characteristics and the reporting level of the dPROs. Methods: The PubMed database was searched for RCTs of root coverage procedures in March 16, 2022 and articles published up to March 2022 were included. Information on the types of outcomes and the characteristics of the studies/articles were extracted and reported as frequencies and percentages. Univariate and multivariate binary logistic regression analyses were performed to investigate the associations between the study/article characteristics and the reporting level of dPROs. Results: The search initially identified 387 articles, and after applying the eligibility criteria, 135 articles reporting 135 RCTs were included. A combination of dPROs and non-dPROs was reported in 61.5% of the selected trials, while 37.8% of the trials reported only non-dPROs. Pain or discomfort was the most frequently reported dPRO (n = 58, 43% of the RCTs). More recently published RCTs reported more dPROs. The country of the first author (odds ratio [OR]: 4.39; 95% CI: 1.76-10.95; P <.01), protocol registration (OR: 0.36; 95% CI: 0.16-0.83; P =.02), and RCT type (OR: 0.38; 95% CI: 0.17-0.83; P =.02) were significantly associated with the reporting level of the dPROs. Conclusions: Researchers in recent years seem to be paying more attention to the importance of dPROs. RCTs in which the first authors were from developed countries, registered trials, and RCTs with a parallel design were more likely to report dPROs than RCTs with first authors from developing countries, unregistered trials, and RCTs with a split-mouth design