Outcomes reporting in systematic reviews on revitalization: A scoping review for the development of a core outcome set.

BACKGROUND: Revitalization is a type of regenerative endodontic treatment (RET) that offers the exciting prospect of revitalizing damaged tissue, therefore improving outcomes for non-vital immature teeth. To evaluate its potential, there needs to be consistency in outcome reporting of clinical studies investigating revitalization to allow for evidence synthesis and inform clinical decision making. OBJECTIVES: The aim of this scoping review was to identify outcomes that are reported in systematic reviews on revitalization including how and when these outcomes are measured. Additionally, evidence of selective reporting bias in the reviews was assessed. METHODS: A comprehensive electronic search of healthcare databases and grey literature was conducted to identify systematic reviews published in the English language reporting outcomes of revitalization in permanent immature teeth. There was no restriction on the date of publication. Outcome data was extracted by four reviewers independently and mapped with a healthcare taxonomy into five core areas: survival, clinical/physiological changes, life impact, resource use and adverse events. Selective reporting bias and how it was measured was assessed independently by two reviewers. RESULTS: Twenty-six systematic reviews were included in this scoping review. There was lack of standardization in reporting and significant heterogeneity across reviews in outcome endpoints. The outcomes reported could be aligned within the five core areas of the taxonomy including tooth survival which was reported in nine reviews. Patient-reported outcomes were generally limited and no review reported on Oral Health Related Quality of Life. Many of the reviews reporting on randomized control trials were at low risk of selective reporting bias whilst other study designs were at higher risk. DISCUSSION: Consistency in outcome reporting is necessary to realize the benefits of old but particularly novel therapies. Data from this review confirmed heterogeneity in reporting outcomes of revitalization and the need for development of a core outcome set (COS). CONCLUSIONS: Several important outcomes including survival, root development, tooth discolouration and periapical healing have been identified in this review which could inform the development of a COS in this area. REGISTRATION: Core Outcome Measures in Effectiveness Trials (COMET) database (registration no. 1879).

Appropriateness of tooth replacement strategies for adult patients in the United Kingdom with reduced dentitions - a modified Delphi analysis.

OBJECTIVE: To develop consensus from experts in Restorative Dentistry based in the United Kingdom (UK) on the most appropriate tooth replacement strategies in adult patients with reduced dentitions using a modified Delphi analysis. METHODS: An expert panel of UK specialists (n=20) in Restorative Dentistry or Prosthodontics were asked to answer the following question: using available evidence and your clinical experience, how appropriate is each tooth replacement strategy for each clinical scenario of tooth loss in the mandible presented? Five specific clinical patterns of tooth loss were presented to panellists using clinical photographs, and using a 9-point Likert scale, they were asked to rate the appropriateness of listed tooth replacement strategies during two Delphi rounds. The target level of consensus for each statement was 70%. RESULTS: Consensus was reached on the appropriateness of thirty-seven tooth replacement strategies (37%) across ten clinical scenarios. Of these, thirteen were considered appropriate (13%) and twenty-four were considered inappropriate (24%). CONCLUSION: The results from this Delphi process represent the consensus professional views of an expert panel of UK specialists in Restorative Dentistry and Prosthodontics. CLINICAL SIGNIFICANCE: Tooth replacement for partially dentate patients is a common clinical consideration. This study provides evidence from a Delphi process to help clinicians and patients make informed choices about appropriate and inappropriate treatment options.

Tooth replacement options for partially dentate older adults: a survival analysis.

OBJECTIVES: To compare the success of two different tooth replacement strategies for partially dentate older adults; namely resin bonded bridgework (RBB) provided to restore patients according to the principles of the shortened dental arch concept (SDA) and conventional full-arch rehabilitation with removable dental prostheses (RDPs). METHODS: A randomised controlled clinical trial (RCT) was conducted with partially dentate adults aged 65 years or older. Each patient from the RDP group had all missing natural teeth replaced with cobalt-chromium framework RDPs. Each patient from the SDA group was restored to 10 occluding pairs of natural and replacement teeth using RBB. Patients were followed-up at 6, 12, 24, 36 months. Success rates were generated according to defined success criteria. Log-rank tests and Cox's proportional hazard models were used to compare the success of the two treatment strategies. RESULTS: After 36 months, 89 patients completed the RCT; n = 45 in the RDP group and n = 44 in the SDA group. The overall success rate of the SDA treatment was 90.4% compared to 73.0% for RDPs (p = 0.005). In the upper arch SDA treatment was 100% successful compared to 86.4% for RDPs (p = 0.019). In the lower arch, lower success rates were reported for both the SDA treatment (80.0%) and RDPs (60.0%) (p = 0.054). Further analyses with cox's proportional hazard models demonstrated that SDA treatment was significantly more successful than RDPs (Hazard Ratio: 2.47, p = 0.04). CONCLUSIONS: After 36 months SDA treatment using RBB was significantly more successful than RDPs used for conventional full-arch rehabilitation in partially dentate older adults. CLINICAL SIGNIFICANCE: Functionally orientated treatment according to the principles of the SDA is a feasible alternative to RDPs for partially dentate older patients. SDA treatment using RBB can achieve higher success rates compared to RDPs in this patient group.

Pre-radiotherapy dental extractions in patients with head and neck cancer: a Delphi study.

OBJECTIVES: To gain a consensus from consultants in restorative dentistry about the types of teeth that should be extracted from head and neck cancer patients (HNC) pre-radiotherapy. MATERIALS: Literature- and clinician-informed questionnaires were emailed to an 'expert panel' of consultants (n = 24/28; 86%) in the United Kingdom (UK) and Ireland on three consecutive occasions (Delphi rounds). The results of Round 1 were used to revise the questionnaire that was distributed in Round 2, and this procedure was repeated for Round 3. During Rounds 2 and 3, participants were asked to indicate, on a 5-point Likert scale, their level of agreement with a series of statements on the types of teeth that should be extracted pre-radiotherapy. The target level of consensus for each statement was 70%. RESULTS: In Round 2, there was consensus-agreement for 69 of 102 statements (i.e. ≥ 70% of participants rated 'agree' or 'strongly agree' to the relevant statement). Consensus agreement was also achieved for 20 of 28 statements in Round 3. Therefore, a total of 89 consensus statements are presented that illuminate the decision-making process for the pre-radiotherapy extraction of molar, premolar, and anterior teeth with periodontal pocketing, furcation disease, mobility, caries, tooth-wear, apical disease, or other pathology. CONCLUSION: The statements represent the consensus professional views of participated consultants in restorative dentistry in the UK and Ireland regarding the types of teeth that should be extracted from HNC patients pre-radiotherapy. The results provide a platform for the development of future guidelines. CLINICAL SIGNIFICANCE: Pre-radiotherapy dental assessments for head and neck cancer patients are considered mandatory. This study presents different criteria that should be considered for the treatment planning of these patients in relation to pre-radiotherapy extractions, according to the collective consensus opinion of participated consultants in restorative dentistry in the UK and Ireland.

Dental caries following radiotherapy for head and neck cancer: A systematic review.

Post-radiotherapy head and neck cancer patients are at increased risk of dental caries due to radiotherapy-induced salivary gland hypofunction and radiation-damage to tooth structure. Dental caries may cause pain and discomfort, and is likely to have a detrimental impact on patients' quality of life. This systematic review appraised and synthesised best available evidence regarding the incidence and severity of post-radiotherapy dental caries in head and neck cancer patients. Six databases and two trial registries were searched from their inception to May 2019. A total of 22 papers met the inclusion criteria. The pooled percentage of patients that developed dental caries post-radiotherapy was 29% (n = 15 studies; 95% CI 21%, 39%; I2 = 88.0%). Excluding studies with longer than two years follow-up, the pooled percentage was 37% (n = 9 studies; 95% CI 25%, 51%; I2 = 88.6%). Meta-regression analysis revealed that studies with a higher mean/median radiotherapy dose exposure, had an increased incidence of dental caries (p = 0.02). Furthermore, studies with a higher proportion of patients treated with chemotherapy in addition to radiotherapy, had an increased incidence of dental caries (p = 0.02) after the exclusion of an outlier. It is important to be mindful of the high degree of observed heterogeneity and the inclusion of a large number of non-randomised studies. Data regarding the number of carious teeth, the number of carious tooth surfaces, and the number of carious lesions developed post-radiotherapy was unsuitable for meta-analysis. There is a need for well-designed research studies to improve understanding of dental caries-risk in post-radiotherapy head and neck cancer patients.

Effectiveness of prosthodontic interventions and survival of remaining teeth in adult patients with shortened dental arches-A systematic review.

OBJECTIVES: A systematic review of randomised and non-randomised controlled trials was conducted to evaluate studies of the effectiveness of different tooth replacement strategies in adult patients with shortened dental arches. The objectives of the review were to determine the survival rates of different prosthodontic interventions, the risk of tooth loss with and without prosthodontic interventions, and the impact of different tooth replacement strategies on oral-health related quality of life (OHRQoL). METHODS: The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO CRD42017064851), and the review was conducted in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). RESULTS: The search strategy identified 112 potentially relevant publications; 22 from Medline (OVID), 54 from EMBASE (OVID), 35 from CENTRAL, one from the authors' knowledge of the subject area, and none from OpenSIGLE. Ten articles were included in this systematic review. Of these, four were analyses of different outcomes from a multicentre randomized controlled trial in Germany, whilst one study was the pilot phase for this trial. Two further randomized controlled trials were included from the United Kingdom and Republic of Ireland. The remaining articles were reports of prospective cohort studies from Denmark and the Netherlands. CONCLUSIONS: there is currently insufficient evidence to recommend one tooth replacement strategy over another in adult patients with reduced dentitions. CLINICAL SIGNIFICANCE: There is a need for further research as there are insufficient numbers of good quality randomised controlled trials currently available. Authors should be encouraged to adhere to CONSORT guidelines for randomized controlled trials, and report findings in such a way that facilitates future meta-analysis.

Effectiveness of prosthodontic interventions and survival of remaining teeth in adult patients with shortened dental arches-Protocol for a systematic review and meta-analysis.

AIMS/OBJECTIVES: To evaluate studies of the effectiveness of different tooth replacement strategies in adult patients with shortened dental arches (SDA). Specifically, the objectives of the proposed review are to determine the survival rates of different prosthodontic interventions; the risk of tooth loss with and without different prosthodontic interventions; and the impact of different tooth replacement strategies on oral-health related quality of life (OHRQoL). MATERIALS AND METHODS: The protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO), and was developed in accordance with the guidelines of the Preferred Reporting Items for Systematic Review and Meta-analyses Protocols (PRISMA-P). Studies will be selected according to outlined eligibility criteria including types of studies, participants, interventions, comparators and outcomes. Specific search strategies will be created and data collection and analysis will be undertaken by two independent reviewers. DISCUSSION: The review will assess the body of evidence for clinical decision making in patients with SDA and reduced dentitions, by comparing the effectiveness of different tooth replacement strategies. In addition, it will assess the influence of patients in this decision making, help to inform subsequent cost-effectiveness analyses, identify areas of further research and hopefully inform future healthcare policy.

Impact of Referral Protocols on the Dental Management of Patients Undergoing Treatment for Head and Neck Oncology in Northern Ireland.

Management of head and neck oncology necessitates an extensive multidisciplinary approach. Throughout Northern Ireland all oral care for Head and Neck Oncology patients is overseen within the Centre for Dentistry, Queens University Belfast via referral from the Head and Neck Multidisciplinary Team. The aim of this study was to develop and introduce a referral pro-forma to improve communication between members of the multidisciplinary team and ultimately expedite provision of oral care prior to patients undergoing treatment for Head and Neck Oncology. The study period ran from June 2013 until November 2014. All patients undergoing treatment for Head and Neck Oncology in Northern Ireland were included in the study. A referral pro-forma was introduced in June 2014 in an attempt to streamline the referral process. Data was gathered on patient waiting times, extraction protocols with comparisons made between the period before and after introduction of the pro-forma. In total 137 patients were included in the study: 96 patients were referred to the service using referral letters, confidential emails and via telephone; 41 patients were referred using the pro-forma. The introduction of the referral pro-forma resulted in a significant decrease in the mean number of days from referral to assessment (12 to 7 days) (p < 0.05) and significantly increased mean interval time between extractions and patients beginning radiotherapy (13 to 17 days) (p < 0.05). Significant improvements have been made with the introduction of the referral pro-forma where patients are waiting significantly less time for dental assessment and having extractions completed in a more timely manner therefore expediting the commencement of their oncology treatment.