Success rate of Hall Technique for restoring carious primary molars - systematic review and meta-analysis.

OBJECTIVES: The overall pooled success rate of the Hall Technique (HT) in various types of studies has not been investigated. The present study aims to evaluate the success rate of HT to restore carious primary molars. METHODS: A systematic search was carried out in the MEDLINE/PubMed, Excerpta Medica Database (EMBASE), Scopus, Web of Science, and LIVIVO electronic databases, as well as the ProQuest database for grey literature review. A search was carried out up to September 2023 for studies meeting the eligibility criteria: Randomised Clinical Trials (RCTs) and Non-Randomised Studies of Interventions (NRSIs); children with primary molars treated using HT; and reporting success for at least 1-month post-treatment. Single-arm meta-analysis assessed the pooled proportion (95% CI) of HT success rates. Risk of bias and certainty of evidence using the GRADE approach were assessed. RESULTS: Searching identified 665 studies, with 25 (15 RCTs and 10 NRSIs) meeting the eligibility criteria. In meta-analyses of RCTs, the pooled proportion success rate was 98% (95% CI: 97-99%) at 12-month follow-up. For NRSIs, the pooled proportion success rate was 95% (95% CI: 91-100%) up to 89 months. CONCLUSIONS: HT presents a high success rate, even though the primary studies had "low" to "high" risk of bias and demonstrated "moderate" to "low" certainty of evidence. One of the main reasons for downgrading was related to blinding, which was generally unfeasible due to visibly different restorative materials. The systematic review protocol was registered in PROSPERO (ID: CRD42021204415).

Do the clinical practice guidelines for paediatric dentistry meet the quality standards? A meta-research and quality appraisal using the AGREE II tool.

BACKGROUND: Clinical practice guidelines (CPGs) enhance health care and aid clinicians' decisions. AIM: To evaluate the quality of clinical guidelines in paediatric dentistry using the AGREE II tool. DESIGN: PubMed, EMBASE, Scopus, LIVIVO, Lilacs, international guidelines websites, scientific societies, and gray literature were searched until September 2021. We included paediatric dental clinical guidelines and excluded drafts or guidelines for patients with special needs. Two independent reviewers performed quality assessment using the APPRAISAL OF GUIDELINES FOR RESEARCH & EVALUATION II (AGREE II) instrument. We calculated the mean overall domain scores (95% confidence interval) for each guideline. We used regression analysis to correlate the score of overall assessment and the six domains of AGREE II with guideline characteristics. RESULTS: Forty-four guidelines were included in this study. Highest mean score was for Domain 4 (Clarity of Presentation; 58%, 95% CI: 50.8-64.9), whereas the lowest was for Domain 5 (Applicability; 16%, 95% CI: 10.8-21.4). The reporting quality was improved in Domains 1-5 with reporting checklists (p < .001), whereas that of Domain 6 was improved by decreasing years since publication (p = .047). CONCLUSION: Paediatric dental guidelines do not comply with the methodological quality standard, especially in Domain 5 (Applicability). The AGREE reporting checklist should be implemented with a system to evaluate the certainty of evidence for future guidelines.

A importância dos estudos clínicos randomizados e seu impacto na tomada de decisão clínica / The importance of randomized clinical trials and their impact on clinical decision making

Os ensaios clínicos randomizados (ECRs) são considerados o padrão ouro e o mais alto nível de evidência científica para estudos de intervenção, precedidos apenas pela síntese dos mesmos (revisões sistemáticas). Tanto os responsáveis pela tomada de decisões, quanto os desenvolvedores de diretrizes precisam usar tais estudos, bem como suas sínteses, para desenvolver diretrizes clínicas de alta qualidade para auxiliar os profissionais na tomada de decisões. Portanto, os ECRs precisam ser bem delineados para minimizar o risco de viés, a fim de construir evidências científicas confiáveis em relação aos benefícios e efeitos colaterais das intervenções clínicas, bem como para garantir a transparência na concepção da metodologia de estudo e na comunicação dos resultados. Ensaios clínicos mal delineados representam um risco para a prática clínica, assim como desperdício de tempo, esforço e recursos financeiros na ciência. Este comentário visa destacar e discutir questões relacionadas à qualidade dos ECRs e seu efeito na tomada de decisões clínicas, bem como enfatizar a conscientização sobre a necessidade de avaliar criteriosamente os ensaios clínicos que serão utilizados para embasar a prática clínica.

Randomized clinical trials (RCTs) are considered the gold standard and the highest level of scientific evidence, preceded only by systematic reviews with or without meta-analysis. Both policy makers and guideline developers need to use such studies, as well as systematic reviews of RCTs, to develop high-quality clinical guidelines to assist dentists in making clinical decisions. Therefore, randomized controlled trials need to be well designed and have a reduced number of systematic errors to build reliable scientific evidence regarding the benefits and side effects of clinical interventions, as well as to ensure transparency in the design of study methodology and reporting of results, all of which will reduce potential biases. Poorly designed clinical trials pose a risk to clinical practice, as well as a waste of time and effort for dentists and even a waste of resources in science. This commentary aims to highlight and discuss problems related to the quality of randomized controlled clinical trials and their effect on dental surgeons' clinical decision making, as well as emphasizing the importance of choosing high quality clinical trials as a basis for their clinical practice.