A Systematic Review of Outcome Measurements and Quality of Studies Evaluating Fixed Tooth‐Supported Restorations

Abstract

PurposeThe purpose of this systematic review was to review clinical studies of fixed tooth-supported prostheses, and to assess the quality of evidence with an emphasis on the assessment of the reporting of outcome measurements. Multiple hypotheses were generated to compare the effect of study type on different outcome modifiers and to compare the quality of publications before and after January 2005.Materials and MethodsAn electronic search was conducted using specific databases (MEDLINE via Ovid, EMBASE via Ovid, Cochrane Library) through July 2012. This was complemented by hand searching the past 10 years of issues of the Journal of Oral Rehabilitation, Journal of Prosthetic Dentistry, Journal of Prosthodontics, and the International Journal of Prosthodontics. All experimental and observational clinical studies evaluating survival, success, failure, and complications of tooth-supported extracoronal fixed partial dentures, crowns, and onlays were included. No restrictions on age or follow-up time were placed.ResultsThe electronic search generated 14,869 papers, of which 206 papers were included for full-text review. Hand-searching added 23 papers. Inclusion criteria were met by 182 papers and were included for the review. The majority were retrospective studies. Only 8 (4.4%) were randomized controlled trials. The majority of the studies measured survival and failure, and few studies recorded data on success; however, more than 60% of the studies failed to define survival, success, and failure. Many studies did not use any standardized criteria for assessment of the quality of the restorations and, when standardized criteria were used, they were modified, thereby not allowing for comparisons with other studies. There was an increase of 21.8% in the number of studies evaluating outcome measurements of all-ceramic restorations in past 8 years.ConclusionsProsthodontic literature presents with a reduced percentage of RCTs compared to other disciplines in dentistry. The overall quality of recording prosthodontic outcome measurements has not improved greatly in the past 8 years.

Clinical performance of chairside monolithic lithium disilicate glass‐ceramic CAD‐CAM crowns

“…The secondary outcome was the success rate. Success was recorded for crowns that were present without core fracture, porcelain fracture, caries, periodontal inflammation, or endodontic signs and symptoms . Survival was defined as the crown having remained in situ with or without modification over the entire observation period …”

Prosthodontic Complications of Metal‐Ceramic and All‐Ceramic, Complete‐Arch Fixed Implant Prostheses with Minimum 5 Years Mean Follow‐Up Period. A Systematic Review and Meta‐Analysis

“…The data extraction and subsequent analyses highlighted, once more, the heterogeneity and lack of standardized reporting of most studies, which makes any meta-analysis very challenging. 55 A standardized method of reporting should be implemented in future studies for better clarification of complications that will allow readers to reach more meaningful conclusions relevant to their practice. 56 This heterogeneity also did not allow any meaningful analysis of the effects of other potentially significant factors, such as method of fixation, opposing dentition, and parafunctional habits.…”

“…The data extraction and subsequent analyses highlighted, once more, the heterogeneity and lack of standardized reporting of most studies, which makes any meta‐analysis very challenging . A standardized method of reporting should be implemented in future studies for better clarification of complications that will allow readers to reach more meaningful conclusions relevant to their practice .…”

Informed Consent from a Historical, Societal, Ethical, Legal, and Practical Perspective

“…Evidence‐based dental practice is a “balanced mix of science, clinical expertise and patient needs, to optimize patient care.” 22 , 23 However, dentistry lacks standardization regarding definitions of outcomes 24 . Dentistry, like medicine is not a pure science, meaning not all answers are available 23 and treatment uncertainties occur frequently.…”

“… Use a process‐based consent that is individualized to the specific conditions and patient needs. This will promote a relationship of understanding and mutual respect. “Provide the most conservative procedure possible that is in the patient's best interest.” 21 Refer patients when necessary. Use appropriate radiographic imaging to aid diagnosis, planning, and treatment, for example, full‐mouth radiographs, panoramic, CBCT (with the appropriate field of view), etc. Thoroughly document the condition of each natural tooth and use prognostic criteria to determine potential long‐term survival of natural teeth 24,26 Communicate informed consent using language patients can understand 7,51 …”