Evidence‐based dentistry for planning restorative treatments: barriers and potential solutions

Afrashtehfar, Kelvin I.; Eimar, Hazem; Yassine, R.; Abi-Nader, Samer; Tamimi, Faleh

doi:10.1111/eje.12208

Cited by 30 publications

(38 citation statements)

References 87 publications

(121 reference statements)

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“…Examples of these may be host-dependant (age, gender, health status, parafunction, presence of antagonists, number of canals), operator-dependant factors (level of experience, training, dexterity, knowledge), other root canal treatmentfactors (type of intracanal medicaments when used, irrigation solution and technique, single-and multiplevisit endodontics, condensation technique) and clinical setting. 15 The electronic and hand search strategies yielded 1155 references of studies after removal of duplicates ( Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

In Vivo and In Vitro Effectiveness of Rotary Nickel-Titanium vs Manual Stainless Steel Instruments for Root Canal Therapy: Systematic Review and Meta-analysis

Fabbro

Afrashtehfar

Corbella

et al. 2018

Journal of Evidence Based Dental Practice

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The results of this systematic review suggested that NiTi rotary instruments were associated with lower canal transportation and apical extrusion when compared to SST hand files, whereas both groups had similar outcomes in terms of success of therapy, amount of residual bacteria, and cleansing ability after treatment. However, due to the limited evidence available, these results should be interpreted with caution. Consequently, more randomized control trials using standardized protocols are needed in order to provide more solid recommendations.

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Section: Resultsmentioning

confidence: 99%

In Vivo and In Vitro Effectiveness of Rotary Nickel-Titanium vs Manual Stainless Steel Instruments for Root Canal Therapy: Systematic Review and Meta-analysis

Fabbro

Afrashtehfar

Corbella

et al. 2018

Journal of Evidence Based Dental Practice

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“…However, the overall results were combined to provide a pooled average value for each clinical scenario (Afrashtehfar et al . ). Five‐year survival rates are useful values for comparing the effectiveness of treatments (Cosetti et al .…”

Section: Methodsmentioning

confidence: 97%

“…Based on the moderate amount of information available from the systematic review (small number of studies), an inferential statistical analysis was not possible. However, the overall results were combined to provide a pooled average value for each clinical scenario (Afrashtehfar et al 2016b). Five-year survival rates are useful values for comparing the effectiveness of treatments (Cosetti et al 2008), especially for dental restorations as most treatments perform well in the short term (<3-year follow-up; Demarco et al 2012) and difference is only clear at longer follow-up periods (Manhart et al 2004).…”

Section: Data Synthesismentioning

confidence: 99%

Failure of single‐unit restorations on root filled posterior teeth: a systematic review

et al. 2017

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Afrashtehfar KI, Ahmadi M, Emami E, Abi-Nader S, Tamimi F. Failure of single-unit restorations on root filled posterior teeth: a systematic review. International Endodontic Journal, 50, 951-966, 2017. This systematic review investigated the failure rate of conventional single-unit restorations in root filled posterior permanent teeth. Two reviewers independently applied eligibility criteria, extracted data and assessed the quality of the evidence of each included study according to the Cochrane Collaboration's procedures for randomized control trials (RCTs) and the STROBE criteria for observational studies. The MEDLINE (via Ovid), EMBASE (via Ovid), Cochrane Oral Health Group Trials Register and CENTRAL (via Cochrane Library) databases were searched electronically (January 1993 to week 1, February 2015). This was complemented by an additional hand search of selected journals and the references of relevant studies. Clinical studies published on root filled single-unit restorative treatments with a mean follow-up period of at least 3 years were selected. The outcome measured was clinical or radiological failure. Overall, the four RCTs and the single observational study included were of low and high quality, respectively. Therefore, a meta-analysis was not possible. The pooled mean failure rates were reported according to the type of treatment and remaining coronal tooth structure. The current evidence suggested that the failure rates of the treatments may depend on the amount of remaining tooth structure and type of treatment. Postretained crowns were associated with the most favourable outcome in teeth with one to two remaining coronal tooth wall(s), whereas post-free crowns were superior when greater tooth structure was available. Restorations in teeth without ferrules had such a high rate of failure that other treatment options should be considered.

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“…2,9,10 In addition, keeping up to date with the most recent evidence is increasingly challenging for clinicians. 11,12 Therefore, the objective of the study of Papageorgiou et al was to compare the effects of lingual and labial appliances from clinical trials in orthodontic patients using an evidence-based approach.…”

Section: Commentarymentioning

confidence: 99%

Evidence regarding lingual fixed orthodontic appliances' therapeutic and adverse effects is insufficient

Afrashtehfar

2016

Evid Based Dent

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Data sourcesMedline, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Virtual Health Library and Web of Science were systematically searched up to July 2015 without limitations. Scopus, Google Scholar, ClinicalTrials.gov, the ISRCTN registry as well as reference lists of the trials included and relevant reviews were manually searched.Study selectionRandomised (RCTs) and prospective non-randomised clinical trials (non-RCTs) on human patients that compared therapeutic and adverse effects of lingual and labial appliances were considered. One reviewer initially screened titles and subsequently two reviewers independently screened the selected abstracts and full texts.Data extraction and synthesisThe data were extracted independently by the reviewers. Missing or unclear information, ongoing trials and raw data from split-mouth trials were requested from the authors of the trials. The quality of the included trials and potential bias across studies were assessed using Cochrane's risk of bias tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. For parallel trials, mean difference (MD) and the relative risk (RR) were used for continuous (objective speech performance, subjective speech performance, intercanine width, intermolar width and sagittal anchorage loss) and binary outcomes (eating difficulty), respectively. The standardised mean difference (SMD) was chosen to pool, after conversion, the outcome (oral discomfort) that assessed both binary and continuous. Random-effects meta-analyses were conducted, followed by subgroup and sensitivity analyses.ResultsThirteen papers pertaining to 11 clinical trials (three parallel RCTs, one split-mouth RCT and seven parallel prospective non-RCTs) were included with a total of 407 (34% male/66% female) patients. All trials had at least one bias domain at high risk of bias. Compared with labial appliances, lingual appliances were associated with increased overall oral discomfort, increased speech impediment (measured using auditory analysis), worse speech performance assessed by laypersons, increased eating difficulty and decreased intermolar width. On the other hand, lingual appliances were associated with increased intercanine width and significantly decreased anchorage loss of the maxillary first molar during space closure. However, the quality of all analyses included was judged as very low because of the high risk of bias of the included trials, inconsistency and imprecision.ConclusionsBased on existing trials there is insufficient evidence to make robust recommendations for lingual fixed orthodontic appliances regarding their therapeutic or adverse effects, as the quality of evidence was low.

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Evidence‐based dentistry for planning restorative treatments: barriers and potential solutions

Abstract: Even though dental students are aware of the importance of EBD in restorative dentistry they rarely apply the concept, mainly due to time constraints. For this reason, implementation of EBD would probably require faster access to evidence-based knowledge.

Cited by 30 publications

References 87 publications

In Vivo and In Vitro Effectiveness of Rotary Nickel-Titanium vs Manual Stainless Steel Instruments for Root Canal Therapy: Systematic Review and Meta-analysis

In Vivo and In Vitro Effectiveness of Rotary Nickel-Titanium vs Manual Stainless Steel Instruments for Root Canal Therapy: Systematic Review and Meta-analysis

Failure of single‐unit restorations on root filled posterior teeth: a systematic review

Evidence regarding lingual fixed orthodontic appliances' therapeutic and adverse effects is insufficient

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