Rafael Sarkis-Onofre

Epidemiology and Reporting Characteristics of Systematic Reviews of Biomedical Research: A Cross-Sectional Study.

Background Systematic reviews (SRs) can help decision makers interpret the deluge of published biomedical literature. However, a SR may be of limited use if the methods used to conduct the SR are flawed, and reporting of the SR is incomplete. To our knowledge, since 2004 there has been no cross-sectional study of the prevalence, focus, and completeness of reporting of SRs across different specialties. Therefore, the aim of our study was to investigate the epidemiological and reporting characteristics of a more recent cross-section of SRs. Methods and Findings We searched MEDLINE to identify potentially eligible SRs indexed during the month of February 2014. Citations were screened using prespecified eligibility criteria. Epidemiological and reporting characteristics of a random sample of 300 SRs were extracted by one reviewer, with a 10% sample extracted in duplicate. We compared characteristics of Cochrane versus non-Cochrane reviews, and the 2014 sample of SRs versus a 2004 sample of SRs. We identified 682 SRs, suggesting that more than 8,000 SRs are being indexed in MEDLINE annually, corresponding to a 3-fold increase over the last decade. The majority of SRs addressed a therapeutic question and were conducted by authors based in China, the UK, or the US; they included a median of 15 studies involving 2,072 participants. Meta-analysis was performed in 63% of SRs, mostly using standard pairwise methods. Study risk of bias/quality assessment was performed in 70% of SRs but was rarely incorporated into the analysis (16%). Few SRs (7%) searched sources of unpublished data, and the risk of publication bias was considered in less than half of SRs. Reporting quality was highly variable; at least a third of SRs did not report use of a SR protocol, eligibility criteria relating to publication status, years of coverage of the search, a full Boolean search logic for at least one database, methods for data extraction, methods for study risk of bias assessment, a primary outcome, an abstract conclusion that incorporated study limitations, or the funding source of the SR. Cochrane SRs, which accounted for 15% of the sample, had more complete reporting than all other types of SRs. Reporting has generally improved since 2004, but remains suboptimal for many characteristics. Conclusions An increasing number of SRs are being published, and many are poorly conducted and reported. Strategies are needed to help reduce this avoidable waste in research.

Use of guidelines to improve the quality and transparency of reporting oral health research.

OBJECTIVE The use of reporting guideline is directed at enhancing the completeness and transparency of biomedical publications. The aims of this paper are to present some of the key initiatives and guidelines providing indications and directions on the use of specific tools in oral health research. METHODS The EQUATOR Network and five established guidelines (CONSORT, STROBE, PRISMA, CARE and SPIRIT) are introduced. RESULTS Five guidelines are presented covering reporting of case reports, non-randomized studies, randomized controlled trials and systematic reviews. The importance of adherence to these guidelines by oral health researchers is emphasized. CONCLUSIONS Endorsement and robust implementation of reporting guidelines will translate into improved and more complete reporting in health research. Moreover, by ingraining the use of guidelines, it may be possible to indirectly improve the methodological quality of clinical studies. Active implementation strategies to encourage adherence to these guidelines among researchers, reviewers, editors and publishers may be an important facet in the advancement of knowledge in dentistry. CLINICAL SIGNIFICANCE Inadequate reporting of research can lead to wasted research resources and risks publication of inaccurate or misleading findings with implications on healthcare decisions. Familiarity and diligent compliance with methodological and reporting guidelines are therefore essential to maximize the yield from dental research.

Cast metal vs. glass fibre posts: A randomized controlled trial with up to 3 years of follow up

OBJECTIVE This randomized controlled trial compared the survival of glass fibre and cast metal dental posts used to restore endodontically treated teeth with no remaining coronal wall. METHODS Fifty-four participants (45 women) and 72 teeth were evaluated during a follow-up period of up to 3 years. Teeth were randomly allocated to the glass-fibre and cast-metal post groups. All teeth were restored with single metal-ceramic crowns. Survival probabilities were analyzed using Kaplan-Meier statistics (p≤0.05). RESULTS The 3-year recall rate was 92.3% and the survival rates of glass fibre and cast metal posts were similar (97.1% and 91.9%, respectively; p=0.682). Four failures were observed: two glass fibre posts in a premolar and anterior tooth debonded, one glass fibre post in a premolar debonded in association with root fracture, and one root fracture occurred in a molar with a cast metal post. CONCLUSIONS Glass fibre and cast metal posts showed similar clinical performance in teeth with no remaining coronal wall after 3 years. CLINICAL SIGNIFICANCE Posts are used to restore most endodontically treated teeth with no remaining coronal wall. This randomized controlled trial, one of few to compare glass fibre and cast metal posts in such teeth, showed that post type did not significantly influence the survival of restorations. These results can help dentists respond to the important question of how best to rehabilitate endodontically treated teeth with no remaining coronal wall.

A systematic review of factors associated with the retention of glass fiber posts

This study aimed to identify factors that can affect the retention of glass fiber posts to intra-radicular dentin based on in vitro studies that compared the bond strength (BS) of GFPs cemented with resin cements. Searches were carried out in PubMed and Scopus until December 2013. Bond strength values and variables as type of tooth, presence of endodontic treatment, pretreatment of the post, type of bonding agent (if present), type of cement and mode of cement application were extracted from the 34 included studies. A linear regression model was used to evaluate the influence of these parameters on BS. The presence of endodontic treatment decreased the BS values in 22.7% considering the pooled data (p = 0.013). For regular cement, cleaning the post increased BS when compared to silane application without cleaning (p = 0.032), considering cleaning as ethanol, air abrasion, or phosphoric acid application. Applying the cement around the post and into root canal decreased the resistance compared to only around the post (p = 0.02) or only into root canal (p = 0.041), on the other hand, no difference was found for self-adhesive resin cement for the same comparisons (p = 0.858 and p = 0.067). Endodontic treatment, method of cement application, and post pretreatment are factors that might significantly affect the retention of glass-fiber posts into root canals mainly when cemented with regular resin cement. Self-adhesive resin cements were found to be less technique-sensitive to luting procedures as compared with regular resin cements.

Rehabilitation of severely worn teeth: A systematic review

OBJECTIVES The aim of this systematic review was to evaluate the treatment performance/longevity of dental materials/techniques indicated to restore teeth with severe wear. MATERIALS AND METHODS A systematic literature search was conducted to select retrospective studies (cohort and case series) and prospective studies that evaluated or compared techniques/materials to restore teeth with severe wear. A search was conducted in Medline (via Pubmed - June 2015) with no limits for publication year or language to identify clinical studies. Two reviewers independently selected studies, extracted data and assessed the risk of bias of randomized controlled trials included. The annual failure rate (AFR%) of restorations was calculated for each study. RESULTS A total of 511 articles were found and 23 studies were eligible for full-text analysis; hand search included 7 more papers. From the 30 studies, 12 were eligible for the review. Most of these studies presented good performance of the restorations in teeth with severe wear. AFR ranged from 0.4% (microhybrid) to 26.3% (microfilled) for direct resin composite, 0% to 14.9% for indirect resin composite and 2.7% for porcelain veneers. CONCLUSION There is no strong evidence to suggest that any material is better than another. Direct or indirect materials may be feasible options to restore severely worn teeth.

Systematic review adherence to methodological or reporting quality

BackgroundGuidelines for assessing methodological and reporting quality of systematic reviews (SRs) were developed to contribute to implementing evidence-based health care and the reduction of research waste. As SRs assessing a cohort of SRs is becoming more prevalent in the literature and with the increased uptake of SR evidence for decision-making, methodological quality and standard of reporting of SRs is of interest. The objective of this study is to evaluate SR adherence to the Quality of Reporting of Meta-analyses (QUOROM) and PRISMA reporting guidelines and the A Measurement Tool to Assess Systematic Reviews (AMSTAR) and Overview Quality Assessment Questionnaire (OQAQ) quality assessment tools as evaluated in methodological overviews.MethodsThe Cochrane Library, MEDLINE®, and EMBASE® databases were searched from January 1990 to October 2014. Title and abstract screening and full-text screening were conducted independently by two reviewers. Reports assessing the quality or reporting of a cohort of SRs of interventions using PRISMA, QUOROM, OQAQ, or AMSTAR were included. All results are reported as frequencies and percentages of reports and SRs respectively.ResultsOf the 20,765 independent records retrieved from electronic searching, 1189 reports were reviewed for eligibility at full text, of which 56 reports (5371 SRs in total) evaluating the PRISMA, QUOROM, AMSTAR, and/or OQAQ tools were included. Notable items include the following: of the SRs using PRISMA, over 85% (1532/1741) provided a rationale for the review and less than 6% (102/1741) provided protocol information. For reports using QUOROM, only 9% (40/449) of SRs provided a trial flow diagram. However, 90% (402/449) described the explicit clinical problem and review rationale in the introduction section. Of reports using AMSTAR, 30% (534/1794) used duplicate study selection and data extraction. Conversely, 80% (1439/1794) of SRs provided study characteristics of included studies. In terms of OQAQ, 37% (499/1367) of the SRs assessed risk of bias (validity) in the included studies, while 80% (1112/1387) reported the criteria for study selection.ConclusionsAlthough reporting guidelines and quality assessment tools exist, reporting and methodological quality of SRs are inconsistent. Mechanisms to improve adherence to established reporting guidelines and methodological assessment tools are needed to improve the quality of SRs.

Identifying approaches for assessing methodological and reporting quality of systematic reviews: a descriptive study

BackgroundThe methodological quality and completeness of reporting of the systematic reviews (SRs) is fundamental to optimal implementation of evidence-based health care and the reduction of research waste. Methods exist to appraise SRs yet little is known about how they are used in SRs or where there are potential gaps in research best-practice guidance materials.The aims of this study are to identify reports assessing the methodological quality (MQ) and/or reporting quality (RQ) of a cohort of SRs and to assess their number, general characteristics, and approaches to ‘quality’ assessment over time.MethodsThe Cochrane Library, MEDLINE®, and EMBASE® were searched from January 1990 to October 16, 2014, for reports assessing MQ and/or RQ of SRs. Title, abstract, and full-text screening of all reports were conducted independently by two reviewers. Reports assessing the MQ and/or RQ of a cohort of ten or more SRs of interventions were included. All results are reported as frequencies and percentages of reports.ResultsOf 20,765 unique records retrieved, 1189 of them were reviewed for full-text review, of which 76 reports were included. Eight previously published approaches to assessing MQ or reporting guidelines used as proxy to assess RQ were used in 80% (61/76) of identified reports. These included two reporting guidelines (PRISMA and QUOROM) and five quality assessment tools (AMSTAR, R-AMSTAR, OQAQ, Mulrow, Sacks) and GRADE criteria. The remaining 24% (18/76) of reports developed their own criteria. PRISMA, OQAQ, and AMSTAR were the most commonly used published tools to assess MQ or RQ. In conjunction with other approaches, published tools were used in 29% (22/76) of reports, with 36% (8/22) assessing adherence to both PRISMA and AMSTAR criteria and 26% (6/22) using QUOROM and OQAQ.ConclusionsThe methods used to assess quality of SRs are diverse, and none has become universally accepted. The most commonly used quality assessment tools are AMSTAR, OQAQ, and PRISMA. As new tools and guidelines are developed to improve both the MQ and RQ of SRs, authors of methodological studies are encouraged to put thoughtful consideration into the use of appropriate tools to assess quality and reporting.

Performance of Post-retained Single Crowns: A Systematic Review of Related Risk Factors

Introduction: Numerous factors may influence the survival/success of post‐retained restorations of endodontically treated teeth (ETT). The aim of this review was to assess the influence of the number of remaining coronal walls, the use or disuse of posts, and their type on the clinical performance of these restorations. Methods: Randomized controlled trials and controlled clinical trials for ETT restored with a combination of post/crown or no post/crown were searched for in MEDLINE, Embase, and the Cochrane Library. Two authors independently reviewed all identified titles and abstracts for eligibility. Tables were generated to summarize the included studies, and reports of randomized trials were assessed for bias using the Cochrane risk of bias tool. Results: Nine articles were identified as meeting the inclusion criteria. Teeth without ferrule presented the highest values of variation of success/survival (0%–97%), whereas teeth with remaining coronal walls (1, 2, 3, or 4 walls with ferrule) presented lower variation. The use of posts with a high elastic modulus success/survival ranged between 71.8% and 100%, whereas posts with a low elastic modulus ranged between 28.5% and 100%. The survival of crowns without posts varied between 0% and 100%. The poor performance of posts with a low elastic modulus and without posts was associated with the absence of ferrule and the preservation of only 1 coronal wall. Conclusions: The restoration of ETT should focus on the maintenance of the coronal structure. Until more studies with longer follow‐up periods are available, posts with a high elastic modulus appear to present with better performance when restoring ETT with no ferrule. Highlights:Restoration of endodontically treated teeth should focus on the maintenance of coronal structure.In general, posts with high values of elastic modulus present better performance.Considering teeth with remaining coronal walls, both posts may be indicated.

Effect of triazine derivative added to denture materials on a microcosm biofilm model.

The aim of this study was to assess the effect of triazine incorporation to denture materials on biofilm formation of saliva derived from microcosms of patients who are positive for Candida albicans. Biofilms were formed on microwave-cured acrylic resin, one hard denture liner, and two soft denture liners containing 0, 2.5, 5, and 10% triazine. For experimental subset (n = 10), mechanical properties of the materials and colony-forming unit counts from the biofilms formed on the materials were assessed. Flexural strength and modulus decreased with the addition of 2.5% triazine (p < 0.01). In general, the addition of 5 and 10% triazine leaded to more soluble materials (p < 0.001). Saliva donor with candidiasis resulted in higher counts of total microorganisms (p = 0.0294) and Streptococci (p = 0.0008). Soft denture liners showed the highest counts for total microorganisms, Streptococci, and Candida species (p < 0.001). The addition of triazine directly to denture materials was not beneficial in reducing biofilm formation in a complex biofilm model.

An alternative method for the fabrication of a root-supported overdenture: A clinical report

The preservation of teeth to support an attachment-retained overdenture is an appropriate and stable alternative to extractions and complete dentures. A key to success is the strategic selection of teeth for retention. This clinical report discusses a method for fabricating an overdenture based on a combination of direct and indirect impression techniques. This technique is a simple and time-efficient alternative to traditional methods that aids in overcoming difficulties in fabricating overdentures.