Assessment of the quality of reporting in abstracts of systematic reviews with meta-analyses in periodontology and implant dentistry.

BACKGROUND: Proper scientific reporting is necessary to ensure the correct interpretation of study results by readers. The main objective of this study was to assess the quality of reporting in abstracts of systematic reviews (SRs) with meta-analyses in periodontology and implant dentistry. Differences in reporting of abstracts in Cochrane and paper-based reviews were also assessed. METHODS: The PubMed electronic database and the Cochrane database for SRs were searched on November 11, 2012, independently and in duplicate, for SRs with meta-analyses related to interventions in periodontology and implant dentistry. Assessment of the quality of reporting was performed independently and in duplicate, taking into account items related to the effect direction, numerical estimates of effect size, measures of precision, probability and consistency. RESULTS: We initially screened 433 papers and included 146 (127 paper-based and 19 Cochrane reviews, respectively). The direction of evidence was reported in two-thirds of the abstracts while strength of evidence and measure of precision (i.e., confidence interval) were reported in less than half the selected abstracts. Measures of consistency such as I(2) statistics were reported in only 5% of the selected sample of abstracts. Cochrane abstracts reported the limitations of evidence and precision better than paper-based ones. Two items ("meta-analysis" in title and abstract, respectively), were nevertheless better reported in paper-based abstracts. CONCLUSION: Abstracts of SRs with meta-analyses in periodontology and implant dentistry currently have no uniform standard of reporting, which may hinder readers' understanding of study outcomes.

Use of methodological tools for assessing the quality of studies in periodontology and implant dentistry: a systematic review.

OBJECTIVE: To evaluate the methodological approaches used to assess the quality of studies included in systematic reviews (SRs) in periodontology and implant dentistry. MATERIALS & METHODS: Two electronic databases (PubMed and Cochrane Database of Systematic Reviews) were searched independently to identify SRs examining interventions published through 2 September 2013. The reference lists of included SRs and records of 10 specialty dental journals were searched manually. Methodological approaches were assessed using seven criteria based on the Cochrane Handbook for Systematic Reviews of Interventions. Temporal trends in methodological quality were also explored. RESULTS: Of the 159 SRs with meta-analyses included in the analysis, 44 (28%) reported the use of domain-based tools, 15 (9%) reported the use of checklists and 7 (4%) reported the use of scales. Forty-two (26%) SRs reported use of more than one tool. Criteria were met heterogeneously; authors of 15 (9%) publications incorporated the quality of evidence of primary studies into SRs, whereas 69% of SRs reported methodological approaches in the Materials/Methods section. Reporting of four criteria was significantly better in recent (2010-2013) than in previous publications. CONCLUSION: The analysis identified several methodological limitations of approaches used to assess evidence in studies included in SRs in periodontology and implant dentistry.

The reporting quality of meta-analysis results of systematic review abstracts in periodontology and implant dentistry is suboptimal.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Assessment of the quality of reporting in abstracts of systematic reviews with meta-analyses in periodontology and implant dentistry. Faggion CM Jr., Liu J, Huda F, Atieh M. J Periodontal Res 2014; 49(2):137-42. REVIEWER: Argy Polychronopoulou, DDS, MS, ScM, ScD PURPOSE/QUESTION: What is the reporting quality of meta-analysis results of abstracts of systematic reviews in periodontology and implant dentistry journals? SOURCE OF FUNDING: The authors received no funding for this study TYPE OF STUDY/DESIGN: Meta-epidemiological study LEVEL OF EVIDENCE: Level 3: Other evidence STRENGTH OF RECOMMENDATION GRADE: Not applicable.

BSP Implementation of prevention and treatment of peri-implant diseases - The EFP S3 level clinical practice guideline.

OBJECTIVES: to adapt the supranational European Federation of Periodontology (EFP) Prevention and Treatment of Peri-implant Diseases - The EFP S3 Level Clinical Practice Guideline for UK healthcare environment, taking into account a broad range of views from stakeholders and patients. SOURCES: This UK version, based on the supranational EFP guideline [1] published in the Journal of Clinical Periodontology, was developed using S3-level methodology, combining assessment of formal evidence from 13 systematic reviews with a moderated consensus process of a representative group of stakeholders, and accounts for health equality, environmental factors and clinical effectiveness. It encompasses 55 clinical recommendations for the Prevention and Treatment of Peri-implant Diseases, based on the classification for periodontal and peri­implant diseases and conditions [2]. METHODOLOGY: The UK version was developed from the source guideline using a formal process called the GRADE ADOLOPMENT framework. This framework allows for adoption (unmodified acceptance), adaptation (acceptance with modifications) and the de novo development of clinical recommendations. Using this framework, following the S3-process, the underlying evidence was updated and a representative guideline group of 111 delegates from 26 stakeholder organisations was assembled into four working groups. Following the formal S3-process, all clinical recommendations were formally assessed for their applicability to the UK and adoloped accordingly. RESULTS AND CONCLUSION: Using the ADOLOPMENT protocol, a UK version of the EFP S3-level clinical practice guideline for the Prevention and Treatment of Peri-implant Diseases was developed. This guideline delivers evidence- and consensus-based clinical recommendations of direct relevance to the UK healthcare community including the public. CLINICAL SIGNIFICANCE: The S3-level-guidelines combine evaluation of formal evidence, grading of recommendations and synthesis with clinical expertise of a broad range of stakeholders. The international S3-level-guideline was implemented for direct clinical applicability in the UK healthcare system, facilitating a consistent, interdisciplinary, evidence-based approach with public involvement for the prevention and treatment of peri­implant diseases.

Examiner alignment and assessment in clinical periodontal research.

Periodontal research typically relies on clinical examiners to assess variables such as gingival inflammation, plaque scores or probing depths as a means of determining treatment outcomes or for performing group comparisons. The quality of the gathered information is dependent, to a large extent, on the skills of the examiner(s) and on the validity of the assessment methods that are used. Attempts have been made to increase the objectivity of periodontal assessments, for example by introducing scoring systems for gingival inflammation, but within these systems there is often considerable scope for variation when interpreting the scoring criteria, leading to subjectivity when assigning scores to individual periodontal sites. This has led to an awareness of the importance of examiner alignment and assessment to improve the data quality by standardizing techniques and improving examiner reliability. Examiner alignment and assessment is used in preference to the term 'examiner calibration' because calibration implies comparison with an accurate or 'gold' standard, which is not available in periodontal research. In this review, we consider the historical perspective that led to the development of clinical scoring systems for periodontal research using gingival inflammation as an example. A clinical protocol for undertaking examiner alignment and assessment is presented, and we review the common sources of error and bias that can lead to difficulties in aligning examiners, and consider how they can be eliminated. It is particularly important that subjects who are recruited to the examiner alignment and assessment study present with a comparable level of disease to the subjects who will ultimately be recruited to the planned clinical trial. Another challenge in examiner alignment and assessment is applying appropriate statistical tests to assess the outcome of the alignment exercise. In the periodontal literature, the statistic kappa is frequently used to confirm an adequate degree of examiner agreement, but kappa is bound to significant restrictions when applied for this purpose. Through the use of case studies, we present different approaches to data analysis from calibration studies, focusing on continuous variables (such as probing depths and attachment levels) or ordinal data (such as gingival or plaque indices), to enable a correct, although frequently conservative, interpretation of data generated during examiner alignment and assessment studies.

Influence of bony defects on implant stability.

INTRODUCTION: The purpose of this study was to analyze the evolution of implant mechanical stability in different types/sizes of bony defects using both Periotest and Osstell devices as "objective tools." MATERIALS AND METHODS: Thirty-two implants were randomly allocated to one of the four types of bone defects: marginal bone loss, peri-apical bone defect, constant width dehiscence and constant length dehiscences. Periotest/Osstell measurements were completed before and during staged bone removal (to enlarge defect size). RESULTS: Significant differences (P<0.05) with initial values were found after a 2 mm marginal bone removal (Osstell/Periotest); for a peri-apical bone lesion, after removal of 5 mm (Osstell) or 8 mm (Periotest); for a 6-mm-long dehiscence, after removal up to 180 degrees of the implant perimeter (Osstell/Periotest); for a 3-mm-wide dehiscence, after removal of 10 mm (Osstell) or 6 mm (Periotest). CONCLUSION: Periotest and Osstell are in general not very sensitive in the identification of peri-implant bone destruction, except for marginal bone loss.

[Dissertations 25 years after date 24. Barriers to effective periodontal care]. / Proefschriften 25 jaar na dato 24. Belemmeringen bij effectieve parodontale behandeling.

In the thesis 'Barriers to effective periodontal care, published in 1984, an investigation was described on professional periodontal care lagging behind the development of periodontology. The objectives of the investigation were to assess whether dentists were treating periodontal disease as a behavioural problem using effective communication techniques, and whether serious periodontal disease had such low frequency that dentists had not the opportunity to become experienced in recognizing the disease. It was concluded that serious periodontal disease had a low frequency and was not influenced by communication on periodontal care. After 25 years, these conclusions are still valid: the percentage of risk patients is still 5-10% and the correlation between seriousness of periodontal disease and periodontal care provided is still limited. Not all dentists do have affinity to periodontal care, but they do have affinity to practical aspects, such as removing dental calculus deposits. A classification of obvious recognizable diseases and treatments would make periodontal care more manageable for dentists.

Dental hygienists in Europe: trends towards harmonization of education and practice since 2003.

AIM: The aim of this study was to investigate the trends in dental hygienists' education and regulation in the European Union (EU) and European Economic Area (EEA) to examine whether, since 2003, there has been harmonization in dental hygiene education. METHODS: Information and data were obtained via piloted questionnaires and structured interviews with delegates from the International and European Dental Hygienists' Federations and representatives of the Council of European Chief Dental Officers and by literature review. RESULTS: In the EU/EEA, dental hygienists are legally recognized in 22 countries. Since 2003, there has been an increase in the number of Bachelor degree programmes and in autonomous practice. Entry to the profession is now exclusively via a Bachelor degree in five EU/EEA Member States and pending in two more. Ten Member States have adapted their degree programmes to the European Credit Transfer System. Two Member States combine education for dental hygienists and dental therapists. However, dental hygienists are not recognized by EU law and in five Members States, the introduction of the profession has been opposed by dental associations. CONCLUSIONS: For the reasons of wide variations in the standards of preventive care and periodontal therapies, the formal recognition of the dental hygiene profession by EU legislation and agreement on a pan-European curriculum for dental hygiene education leading to defined professional competencies and learning outcomes is required. To achieve this, there is a need for a better collaboration between competent authorities including governments, universities and dental and dental hygienists' associations.

Influence of Self-Assessment on Dental Students' Performance on Technical Assessments in Periodontics.

Self-assessments were introduced into a third-year clinical periodontics course to enable dental students to self-assess and receive faculty feedback prior to technical assessment. The aims of this study were to determine if there was an improvement in the pass rate and average grade on the technical assessments following implementation of self-assessments and to analyze the accuracy of the student self-assessments by comparing them with faculty assessments. Scores from 106 third-year dental students for four periodontal procedures were included in the analysis. Faculty and student self-assessment scores, along with self-assessment and final technical assessments scores, were compared, as were the average number of self-assessment attempts for the various procedures and the pass rates. The average number of self-assessments per student was 6.5 compared to 4.2 for the technical assessments. There was no significant difference between students' self-assessment scores and faculty scores (average difference=0.005; p=0.7894). However, there was a significant increase in overall scores between students' self-assessments and technical assessments (average difference: 0.30 out of 5; p=0.0001). There was also a significant difference in pass rate between self-assessments and technical assessments (92.3% and 99.7%, respectively). The individual technical assessment with the greatest improvement was for scaling and root planing (average difference=0.47; p=0.0001), which also had significantly more self-assessments (2.3 vs. 1.2-1.7, p=0.0001). These results suggest that self-assessment and the subsequent faculty feedback provided students with information that enabled them to improve their performance on technical assessments.

[Post-academic dental specialties 18. The graduate programme in periodontology]. / Beroepsdifferentiatie in de tandheelkunde 18. De opleiding tot tandarts-parodontoloog.

In 1987, the Dutch Society of Periodontology (NVvP) made it possible for dentists to be recognized as specialists in periodontology. This recognition lasts for 5 years after which, on the basis of an evaluation of the Consilium Parodontologicum of the NVvP, continuation of the recognition for another period of 5 years is possible. The Academic Centre for Dentistry at the University of Amsterdam and the University Medical Centre St Radboud at Nijmegen University provide a 3 year full time specialisation programme in periodontology. These programmes are approved by the European Federation of Periodontology. After successful completion of one of these programmes, recognition as periodontist by the Dutch Society of Periodontology can be requested. Possible recognition is based on an extensive evaluation during a one day site visit in the practice by the Consilium Parodontologicum.

Clinician assessment of guidelines that support common dental procedures.

Many common clinical dental procedures do not have high-quality clinical guidelines available. Clinical guidelines are considered an important tool for applying the evidence-based concept to dental practice. The main objective of this study was to assess if current clinical guidelines that are easily available to dental practitioners in electronic databases support common dental procedures. In addition, a useful model for the assessment of the quality of the guidelines is presented. The results of a literature search demonstrated a lack in both the number and quality of clinical dental guidelines that support common dental procedures. Nine selected guidelines were assessed using the Appraisal of Guidelines, Research, and Evaluation instrument (AGREE). Following the AGREE recommendation, only one guideline could be considered for use in dental practice. Four guidelines were also considered for use in practice, but they would need some alteration in their contents. The last four guidelines did not achieve a good score and therefore could not be considered for use in dental practice. In conclusion, more high-quality dental guidelines should be developed to support common dental procedures using standardized quality criteria in order to appropriately implement the evidence-based process into dental practice. Furthermore, the AGREE instrument may help dental practitioners objectively assess the quality of clinical guidelines.

[Post-academic dental specialties 19. The effect of periodontal treatment on the degree of de novo plaque formation]. / Beroepsdifferentiatie in de tandheelkunde 19. Het effect van parodontale behandeling op de mate van de novo plaquevorming.

In order to determine whether the quantity of bacteria in saliva and the degree of periodontal infection influence the speed of de novo plaque formation in periodontitis patients, 23 patients rinsed with 10 ml sterile saline. All teeth were then supragingivally and professionally cleaned, after which the patients were not allowed to undertake any form of oral hygiene for 24 hours. After this period, the rinsing procedure was repeated and the amount of de novo plaque was assessed. Three months after the initial periodontal therapy was completed the experiment was repeated. Both before and after treatment, the periodontal parameters were evaluated. The results showed that the quantity of the de novo plaque in healthy areas was less than in infected areas. In order to determine the influence of the quantity of bacteria in the saliva, only the areas which were already healthy before the treatment and the same areas after treatment were inspected. It was concluded that the degree of periodontal infection was the most important parameter for the degree of de novo plaque formation, but that the number of bacteria in the saliva also played a role.

Evidence-based dentistry: a model for clinical practice.

Making decisions in dentistry should be based on the best evidence available. The objective of this study was to demonstrate a practical procedure and model that clinicians can use to apply the results of well-conducted studies to patient care by critically appraising the evidence with checklists and letter grade scales. To demonstrate application of this model for critically appraising the quality of research evidence, a hypothetical case involving an adult male with chronic periodontitis is used as an example. To determine the best clinical approach for this patient, a four-step, evidence-based model is demonstrated, consisting of the following: definition of a research question using the PICO format, search and selection of relevant literature, critical appraisal of identified research reports using checklists, and the application of evidence. In this model, the quality of research evidence was assessed quantitatively based on different levels of quality that are assigned letter grades of A, B, and C by evaluating the studies against the QUOROM (Quality of Reporting Meta-Analyses) and CONSORT (Consolidated Standards of Reporting Trials) checklists in a tabular format. For this hypothetical periodontics case, application of the model identified the best available evidence for clinical decision making, i.e., one randomized controlled trial and one systematic review of randomized controlled trials. Both studies showed similar answers for the research question. The use of a letter grade scale allowed an objective analysis of the quality of evidence. A checklist-driven model that assesses and applies evidence to dental practice may substantially improve dentists' decision making skill.

The gold standard of veterinary oral health care.

Veterinary dentistry has evolved to the point that consumers now demand and expect the best oral health care possible for their pets. The gold standard is an attainable goal for all veterinary practices that provide oral health care. If the practice chooses to improve its delivery system, the changes should be rewarding.

Reliability of standardized narrow strips in the Periotron.

In clinical practice the authors have found the 2-mm wide Periopaper slightly too large for insertion into the gingival crevice. This study investigated the reliability of Periotron readings for quantitation of gingival fluid when using filter paper strips which are narrower than the Periopaper. The round-ended strips were cut to a standard size 1 mm wide and 15 mm long using a conchotome. A microsyringe was used to deposit 0.1 microliter of four different fluids (distilled water, undiluted horse serum, diluted horse (1:2) and human (1:2) sera) onto Periopaper and the narrow S-690 strips. The moistened end of each strip was placed between the jaws of both the Periotron 600 and the Periotron 6000, and the maximum digital reading was recorded in two series of 20 measurements for each of the four fluids and two strips, giving a total of 640 assessments. A comparison between the two series confirmed the excellent reproducibility of Periotron readings. The comparison between strips revealed from 10% (Periotron 600) to 20% (Periotron 6000) lower readings for the S-690 than for the Periopaper strips for all fluids. The SD of the readings for both the S-690 and the Periopaper strip was low enough to make the difference between strips statistically significant. The slightly lower readings obtained with the narrow S-690 strip were found as reliable as those recorded when using Periopaper.

Systemic antibiotics in periodontics.

This position paper addresses the role of systemic antibiotics in the treatment of periodontal disease. Topical antibiotic therapy is not discussed here. The paper was prepared by the Research, Science and Therapy Committee of the American Academy of Periodontology. The document consists of three sections: 1) concept of antibiotic periodontal therapy; 2) efficacy of antibiotic periodontal therapy; and 3) practical aspects of antibiotic periodontal therapy. The conclusions drawn in this paper represent the position of the American Academy of Periodontology and are intended for the information of the dental profession.

Concepts of quality and the provision of periodontal care: a survey.

This is a survey of various concepts of quality of care in the health care field and their application to periodontics. Definitions of quality care, measuring and improving quality, third party payment and quality of care, and the role of periodontists in managing quality are presented. The definitions of quality care include the following dimensions: access, appropriateness, technical quality, and the art of care. Examples of each of these dimensions are presented, and their implications for quality assessment are discussed. Emphasis is placed on appropriateness of care and the strengths and weaknesses of mechanisms for deriving evidence-based decision making. The use of randomized clinical trials (RCT), employing expert opinion such as consensus panels, and meta-analysis are discussed as they apply to appropriateness of periodontal treatment. Work in the area of technical quality of care (i.e., the third dimension of quality care) has resulted in the development of quality assurance guidelines. Examples of guidelines and practice parameters such as those developed by the U.S. Food and Drug Administration and by various dental specialties are presented. The fourth dimension of quality deals with the art of care. It focuses on the patient's participation in the process of care and the input of the provider in this interaction. The description of outcomes of care includes the concept of measuring clinical outcomes of treatment as well as efforts to measure the health and well-being of a patient. It deals with quality of life measures. Patient satisfaction is another outcome that is presented. Examples of these aspects of quality measurement are discussed. These concepts and measures are presented within the context of a quality assurance program. The steps used to assess and assure quality are outlined. Examples of provider and patient profiles are presented, along with a discussion on how they are used in a quality assurance system. Lastly, the role of the periodontist in quality of care is presented, emphasizing the efforts that have already been made as well as the leadership role that the periodontist has in influencing the profession of dentistry. The advent of managed care and its implications for the quality of periodontal treatment and patient management are discussed using situations obtained from dental plans.

Millimeter marks and probe tip diameter standardisation from commercially available periodontal probes. A comparative study.

The periodontal probe is still the most important tool for a correct and reproducible periodontal diagnosis. The aim of this study was to verify the standardisation from millimeter marks and tip diameter of four currently marketed periodontal probes. 129 new probes were randomly acquired in the market: 9 Williams-Hu Friedy (group A), 50 Williams-Golgran (group B), 35 Williams-Neumar (group C) and 35 WHO-Hu Friedy (group D). Mark calibration was assessed by digital images that were analysed by an image analysis system. A digital caliper assessed the tip diameter. Blind duplicate measurements were undertaken. The calibration of mark measurements demonstrated that all probes used in this study were not precise, although groups A and D were more accurate than groups B and C (P < 0.05). The tip diameter analysis did not reveal significant differences among the groups (P > 0.05). It can be concluded that some concern should arise regarding the standardisation of periodontal probes since they are relevant to minimise probing errors and consequently enhance the accuracy and reproducibility of periodontal probe-dependant measurements in clinical and epidemiological studies.