Letters to EBD

Abstract

Re: Commentary: Poor quality evidence suggests that failure rates for atraumatic restorative treatment and conventional amalgam are similar.Evid Based Dent 2012; 13: 46-47. Dear SirWe would like to thank Dr Dominic Hurst for reading our systematic review update. 1 However, most of his criticism of our article seems unnecessary. 2 His objections to the appraisal of evidence regarding the question as to whether the placement of an ART (atraumatic restorative treatment) or a conventional amalgam filling would yield lesser, same or higher chance of failure appears to be underlined by the opinion that ART may not be relevant for modern dental settings. This is an unfortunate misconception. 3 Of course, other questions to the clinical merits of ART are important, too, and we look forward to learn of the findings of Dr Hurst's own two, still ongoing systematic reviews to the topic. 4,5 Dr Hurst is correct in his assumption that we did not know about the five Chinese medical databases. 6 We would like to thank him for pointing this out and will focus on it in our next systematic review update. However, the concept of language bias needs to be regarded within the context that the exclusion of non-English trials may have little effect on summary treatment effect estimates. 7,8 The results of all non-English trials (including the Chinese trials) in our review update seem to confirm this. 9 Some further points of criticism raised by Dr Hurst are: the question as to which literature source our identified Chinese trials originate from (but we made all literature sources explicit in Tables 6 and 7, as well as in the text); the question to why 'ART' [MeSH] as a search term was used (but it can be discerned from our Table 4 that this was the first and broadest search term (#1), which then got narrowed down to the final search term #6 resulting in 260 hits); his confusion regarding the randomisation status of accepted trials (but this is presented in our Table 14 on hand of all verbatim quotes extracted from the text of accepted trials that had relevance to selection-, performance-and detection bias risk); lack of summary of the included trials (but important characteristic of trials are presented in Tables 8-10); the impression that more evidence is given for primary than for permanent teeth (but our Table 13 rather indicates a higher number of evidence relevant to permanent teeth in terms of measured outcomes and number of subjects); the questioning of the 'usefulness' of grouping 'restorations evaluated according to USPHS criteria after 1 year' if type of dentition nor restoration class was specified (yes, 'usefulness' is indeed limited when important information are not reported in trials, but a pooled effect estimate -aspects of heterogeneity allowing -represent available evidence better than a number of individual ones).In addition, when reading through the PRISMA checklist 10 it is difficult to understand which section we may have missed. Indeed, our review report is rather complex but this is due to the detail...