Methodological quality and risk‐of‐bias assessments in systematic reviews of treatments for peri‐implantitis

Abstract

Background and Objectives The purpose of the present study was to evaluate the methodological quality and risk of bias in systematic reviews (SRs) on the effectiveness of peri‐implantitis treatments. Material and Methods We searched four electronic databases: MEDLINE, Web of Science, Cochrane Database of Systematic Reviews, and EMBASE. Previous SRs focusing on peri‐implantitis treatment published between 2010 and 2017 were identified. After literature screening, eligible SRs were qualitatively assessed using two validated instruments: Assessing the Methodological Quality of Systematic Reviews (AMSTAR2) and Risk Of Bias In Systematic reviews (ROBIS). The characteristics and findings of SRs are also reported. Results A total of 23 SRs formed the basis of this study. Of the 23, six included randomized controlled trials (RCTs) only. Overall, the AMSTAR2 assessment revealed three studies with high and six studies with low methodological quality, and all the other SRs were judged as having critically low methodological quality. ROBIS revealed only one Cochrane review with a low risk of bias and the others with a high risk of bias. In particular, the assessment of non‐randomized studies (NRSIs), appropriateness of ROB assessment, and meta‐analysis did not satisfy the criteria in AMSTAR2 assessment. Furthermore, there were a few SRs that interpreted and discussed the results of risk of bias (ROB) and heterogeneity assessment, together with the impact of treatment. Conclusions Due to the lack of head‐to‐head comparisons conducted in RCTs, review authors need to use other sources of evidence, such as clinical control trials (CCTs), cohort studies (CS), clinical research (CR), and animal studies. The end result is the presentation of low‐quality evidence, with high ROB. Several SRs conducted network meta‐analysis as an alternative to head‐to‐head conventional meta‐analysis of RCTs. We suggest that the best methods to generate, access, and assess evidence in situations where RCT evidence is lacking should be discussed on an urgent basis.

The methodological quality of systematic reviews on the treatment of adult major depression needs improvement according to AMSTAR 2: A cross-sectional study

“…A few studies have used AMSTAR 2 on topics including dentistry ( Hasuike et al., 2019 ), acupuncture ( Zhang et al., 2018 ), Tai Chi in Parkinson's Disease ( Kedzior and Kaplan, 2019 ) and surgery ( Yan et al., 2019 ). They all demonstrated that the majority or all of the included SRs had low methodological quality and in the majority the overall confidence in the results of the SR was considered to be “critically low”.…”

“…This is in line with our results. However, three of studies using AMSTAR 2 had a low sample count of 5, 10 and 23 SR respectively ( Hasuike et al., 2019 ; Kedzior and Kaplan, 2019 ; Zhang et al., 2018 ) and only one study included more than 100 meta-analyses ( Yan et al., 2019 ).…”

Clinical outcomes of peri-implantitis treated with bone substitute and resorbable membrane: a literature review with a systematic approach

“…Evidence quality assessments, including study limitations, inconsistency of results, indirectness of evidence, imprecision and reporting bias, should be discussed together with effect size obtained from synthesis such as meta-analysis. In systematic reviews on treatment of peri-implantitis, quality assessments are often performed as a simple format evaluation and scarcely presented and discussed with impact [40].…”

“…Establishing a standard treatment protocol for peri-implantitis is an urgent task for the specialists' community. Clinical trials directed to this specific condition has proven extremely challenging for researchers, as dental implants are a high-cost medical option in many countries, and peri-implantitis may be classified as an asymptomatic iatrogenic disease [40]. In the meantime, the clear lack of well-defined protocols and gold-standard approaches to tackle peri-implantitis reiterate the importance of meticulous preventative strategies in an attempt to arrest or delay the onset of the disease [56].…”

Influence of antihypertensive medications on the clinical parameters of anodized dental implants: a retrospective cohort study

“…The biological complications related to dental implants include peri-implant mucositis and peri-implantitis. There is no definitive evidence regarding the etiology and clinical countermeasures for these two biological complications [ 2 ]. Various risk indicators have been discussed, and etiological similarities between periodontal and peri-implant tissues have been of interest to clinicians and researchers [ 3 ].…”