Multivariable prediction models of caries increment: a systematic review and critical appraisal.

BACKGROUND: Multivariable prediction models are used in oral health care to identify individuals with an increased likelihood of caries increment. The outcomes of the models should help to manage individualized interventions and to determine the periodicity of service. The objective was to review and critically appraise studies of multivariable prediction models of caries increment. METHODS: Longitudinal studies that developed or validated prediction models of caries and expressed caries increment as a function of at least three predictors were included. PubMed, Cochrane Library, and Web of Science supplemented with reference lists of included studies were searched. Two reviewers independently extracted data using CHARMS (Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies) and assessed risk of bias and concern regarding applicability using PROBAST (Prediction model Risk Of Bias ASessment Tool). Predictors were analysed and model performance was recalculated as estimated positive (LR +) and negative likelihood ratios (LR -) based on sensitivity and specificity presented in the studies included. RESULTS: Among the 765 reports identified, 21 studies providing 66 prediction models fulfilled the inclusion criteria. Over 150 candidate predictors were considered, and 31 predictors remained in studies of final developmental models: caries experience, mutans streptococci in saliva, fluoride supplements, and visible dental plaque being the most common predictors. Predictive performances varied, providing LR + and LR - ranges of 0.78-10.3 and 0.0-1.1, respectively. Only four models of coronal caries and one root caries model scored LR + values of at least 5. All studies were assessed as having high risk of bias, generally due to insufficient number of outcomes in relation to candidate predictors and considerable uncertainty regarding predictor thresholds and measurements. Concern regarding applicability was low overall. CONCLUSIONS: The review calls attention to several methodological deficiencies and the significant heterogeneity observed across the studies ruled out meta-analyses. Flawed or distorted study estimates lead to uncertainty about the prediction, which limits the models' usefulness in clinical decision-making. The modest performance of most models implies that alternative predictors should be considered, such as bacteria with acid tolerant properties. TRIAL REGISTRATION: PROSPERO CRD#152,467 April 28, 2020.

Assessment model blending formative and summative assessments using the SOLO taxonomy.

INTRODUCTION: Formative assessment with emphasis on feedback has been linked to developmental purposes of assessment, whilst summative assessment is assumed to focus on judgemental and quality assurance purposes. This dichotomy is questioned but designs to blend formative and summative assessments in constructive ways are rare in health care education. MATERIALS AND METHODS: We have designed an assessment model blending formative and summative assessments. In the formative assessment at the end of a course, students' responses to real-life scenarios with questions demanding responses at the relational level of understanding were assessed at three levels of understanding (incorrect, descriptive and relational) modified after the SOLO taxonomy. Students were presented with individual feedback for each response. At the summative assessment of a subsequent course, the students' new responses were assessed underpinning a final judgement of students' performance. The assessment model was justified across three student cohorts. RESULTS: Both formative and summative assessment events of the model provided information about the levels of understanding, unique to each student. A comparison of results from the assessments demonstrated that most responses developed to a higher level of understanding. With the summative assessment, it was possible to make judgements about whether or not individual students passed the pre-set standards. CONCLUSIONS: We argue that the current assessment model presents real interdependence between formative and summative assessments and can provide information that meets the needs of students as learners, education institutes and health care organisations. The SOLO taxonomy can be used to emphasise the importance of developing and assessing cognitive complexity.

A meta-review of effective doses in dental and maxillofacial cone beam CT using the ROBIS tool.

OBJECTIVES: To apply the ROBIS tool for assessment of risk of bias (RoB) in systematic reviews (SRs) in a meta-review on effective doses (EDs) in dental and maxillofacial cone beam CT. METHODS: Three electronic databases and reference lists of included SRs were searched. Eligible SRs were classified as having low, high or unclear RoB. Findings of SRs were synthesised and data from primary studies combined to relate ED to field of view (FOV) and operating potential (kV). RESULTS: Seven SRs were included: three displayed low RoB, three high and one had unclear RoB. Only one SR related ED to image quality. Deficiencies in reporting of eligibility criteria, study selection and synthesis of results in SRs were identified. FOV height had a significant relationship with ED, explaining 27.2% of its variability. Median ED for three FOV categories differed significantly. Operating potential had a weak relationship with ED, with no significant difference in median ED between three operating potential groups. CONCLUSION: The ROBIS tool should have a role for meta-reviews of different aspects of radiology. The disappointing results for RoB might be remedied by developing standards to improve the quality of reporting of primary dosimetry studies and of SRs. Future dosimetry studies should always relate ED to image quality or diagnostic accuracy. ADVANCES IN KNOWLEDGE: This meta-review is the first to implement ROBIS for SRs of ED and identified that trustworthiness of some SRs is questionable. The percentage change in average ED per cm increase in FOV height could be calculated, emphasizing the importance of FOV as a determinant of ED in CBCT.

There is a paucity of economic evaluations of prediction methods of caries and periodontitis-A systematic review.

OBJECTIVES: Direct cost for methods of prediction also named risk assessment in dentistry may be negligible compared with the cost of extensive constructions. On the other hand, as risk assessment is performed daily and for several patients in general dental practice, the costs may be considerable. The objective was to summarize evidence in studies of economic evaluation of prognostic prediction multivariable models and methods of caries and periodontitis and to identify knowledge gaps (PROSPERO registration number: CRD42020149763). MATERIAL AND METHODS: Four electronic databases (PubMed, Web of Science, The Cochrane Library, NHS Economic Evaluation Database) and reference lists of included studies were searched. Titles and abstracts were screened by two reviewers in parallel. Full-text studies reporting resources used, costs and cost-effectiveness of prediction models and methods were selected and critically appraised using a protocol based on items from the CHEERS checklist for economic evaluations and the CHARMS checklist for evaluation of prediction studies. RESULTS: From 38 selected studies, six studies on prediction fulfilled the eligibility criteria, four on caries and two on periodontitis. As the economic evaluations differed in method and perspective among the studies, the results could not be generalized. Our systematic review revealed methodological shortcomings regarding the description of predictive models and methods, and particularly of the economic evaluation. CONCLUSIONS: The systematic review highlighted a paucity of economic evaluations regarding methods or multivariable models for prediction of caries and periodontitis. Our results indicate that what we currently practice using models and methods to predict caries and periodontitis lacks evidence regarding cost-effectiveness.

A tool for assessment of risk of bias in studies of adverse effects of orthodontic treatment applied in a systematic review on external root resorption.

BACKGROUND AND AIMS: Systematic reviews (SRs) are considered to provide reliable estimates, but flaws in designs, methods of monitoring effects, and outcomes have the potential to bias results. There are several tools for assessing risk of bias (RoB), most of them designed for SRs of beneficial effects. To our knowledge, there is no tool that is adapted specifically to assess RoB in studies of adverse effects associated with orthodontic treatment. To address this, the aim of this study was first to introduce a tool for assessment of RoB in studies of adverse effects associated with orthodontic treatment and, second, to apply it in an SR of external root resorption (ERR) associated with orthodontic treatment with fixed appliance. MATERIALS AND METHODS: The approach with domains supported by signalling questions was used for the tool. Domains and signalling questions were tailored to the review questions of the SR of studies of ERR after orthodontic treatment using periapical radiography or cone beam computed tomography. Duplicate study selection, data extraction, and RoB assessment using the tool, followed by meta-analyses, were performed. RESULTS: Using the tool for the assessment of RoB identified shortcomings and report deficiencies of primary studies concerning the presentation of orthodontic treatment, identification of ERR, and analysis of outcomes. RoB assessment resulted in 12 of 32 studies read in full text being included. Reported severe ERR varied across studies between 2 and 14 per cent for all incisors and 10 and 29 per cent for maxillary incisors. Results of ERR related to patients' age and sex, orthodontic diagnosis, and treatment were contradictory. Quality of evidence evaluated by GRADE was low due to study limitations, imprecision, and inconsistency of study results. CONCLUSIONS: As the tool and its application highlight important issues to consider when planning, conducting, and reporting research, the tool may have a valuable role for quality enhancement of future studies of outcomes of orthodontic treatment. The tool may also serve for authors when planning SRs. Our SR identified a need for studies that use rigorous methodology and transparent reporting. REGISTRATION: PROSPERO (ID = CRD42018084725).

Through the quality kaleidoscope: reflections on research in dentomaxillofacial imaging.

The REduce research Waste And Reward Diligence statement has highlighted how weaknesses in health research can produce misleading results and waste valuable resources. Research on diagnostic efficacy in the field of dentomaxillofacial radiology (DMFR) is no exception to these criticisms and could be strengthened by more robust study designs, consistent use of a core set of outcome measures and completeness in reporting. Furthermore, we advocate that everyone participating in collaborative research on clinical interventions subscribes to the importance of methodological quality in how imaging methods are used. The aim of this paper, therefore, is to present a guide to conducting high-quality research on diagnostic efficacy in DMFR.We initially propose a framework inspired by the hierarchical model of efficacy of Fryback and Thornbury, highlighting study designs, measures of analysis, completeness of reporting and established guidelines to assist in these aspects of research. Bias in research, and measures to prevent or limit it, are then described.It is desirable to climb the Fryback and Thornbury "ladder" from technical efficacy, via accuracy and clinical efficacy, to societal efficacy of imaging methods. Efficacy studies on the higher steps of the ladder may be difficult to perform, but we must strive to answer questions of how useful our methods are in patient management and assess benefits, risks, costs, ethical and social issues. With the framework of six efficacy levels as the structure and based on our experience, we present information that may facilitate quality enhancement of diagnostic efficacy research in DMFR.

Measurability and reliability of assessments of root length and marginal bone level in cone beam CT and intraoral radiography: a study of adolescents.

OBJECTIVES: To evaluate measurability and reliability of measurements of root length and marginal bone level in CBCT, periapical (PA) and bitewing (BW) radiographs. METHODS: CBCT of both jaws, PA of maxillary incisors and posterior BW radiographs of 10 adolescents (mean age 13.4) were selected. The radiographs comprised part of the baseline examinations of a trial of orthodontic treatment. Six raters assessed measurability and measured root length and marginal bone level. Three raters repeated their assessments. Measurability was expressed as frequency of interpretable sites and reliability as intraclass correlation coefficient (ICC). RESULTS: Measurability was 100 % in CBCT and 95 % in PA of maxillary incisors for root length measurements. For marginal bone level, measurability was 100 % in CBCT, 76 % in PA and 86 % in posterior BW. Mean ICC for interrater reliability for root length measurements in CBCT was 0.88 (range 0.27-0.96 among different teeth) and 0.69 in PA of maxillary incisors. For marginal bone level measurements, mean ICC was 0.4 in CBCT, 0.38 in PA of maxillary incisors and 0.4 in posterior BW. Intrarater reliability varied among methods, root length or marginal bone level and among raters, except for root length measurements in CBCT, which presented high reliability (above 0.8) for all raters. CONCLUSIONS: As measurability and reliability were high for root length measurements in CBCT, this may be the method of choice for scientific analyses in orthodontics. For clinical praxis, we recommend PA following the "as low as diagnostically acceptable" principle, as clinical decisions seem to be influenced only when severe root resorption occurs.

Threshold values affect predictive accuracy of caries risk assessment.

OBJECTIVE: To evaluate effects of thresholds on estimates of predictive accuracy of methods for caries risk assessment. MATERIAL AND METHODS: Adolescents, aged 12 visiting two dental clinics, were examined by visual/tactile examination and bitewing radiography at baseline and after one year. Three methods for caries risk assessment were applied: previous caries experience, dentists' risk assessment according to set criteria (presence or absence of caries lesion) and acid tolerance of dental biofilm. The measure for validity (the reference standard) comprised caries lesion progression at 1 year. Predictive accuracy estimates were calculated for several thresholds. RESULTS: Accuracy estimates changed with threshold values of the methods and the reference standard. Patient spectrum differed between the clinics, which resulted in different accuracy estimates for the two samples. Generally, negative predictive values were high while positive ones were low indicating that these methods were more efficient in finding individuals who are at low risk of developing caries lesions than those with increased risk. CONCLUSIONS: As thresholds and patient spectrum affected predictive accuracy, it may be difficult to design a universal model with set thresholds for caries risk assessment. Foremost, a model should consider the level of aspiration for prediction and clinical decisions that will be made based on the risk assessment in the actual clinical setting.

A novel classification system for assessment of approximal caries lesion progression in bitewing radiographs.

OBJECTIVES: To design and pilot a novel classification system for the assessment of caries lesion progression in bitewing radiography and to report rater agreement of the system. METHODS: A classification system with drawings and text was designed to assess caries lesion progression. Guidelines for Reporting Reliability and Agreement Studies were used to study and report rater agreement. Pairs of posterior bitewing radiographs (baseline and 1-year follow-up) with different status concerning caries lesion progression were selected from files from public dental health clinics. 10 raters, 5 general dental practitioners and 5 specialists in oral and maxillofacial radiology were asked to assess the radiographs with the aid of the classification system. Seven raters repeated their assessments. Rater agreement was expressed as percentage of agreement and kappa. RESULTS: Kappa for the interrater agreement of 10 raters assessing progression was 0.61, indicating substantial agreement. Agreement was moderate for progression in the outer half of the dentine (kappa 0.55) and within enamel (kappa 0.44). Pairwise interrater agreement varied (range 69-92%; kappa 0.42-0.84). For about half of the pairs of raters, kappa was substantial (≥0.61). Intrarater agreement assessing progression was substantial (kappa 0.66-0.82). CONCLUSIONS: We demonstrated the applicability of the proposed classification system on caries lesion progression with respect to rater agreement. This system can provide a common framework for clinical decision-making on caries interventional methods and patient visiting intervals. Scientifically, this system allows for a comparative analysis of different methods of prevention and treatment of caries as well as of different caries risk assessment methods.

Diagnostic accuracy of different caries risk assessment methods. A systematic review.

OBJECTIVES: To evaluate the accuracy of different methods used to identify individuals with increased risk of developing dental coronal caries. DATA: Studies on following methods were included: previous caries experience, tests using microbiota, buffering capacity, salivary flow rate, oral hygiene, dietary habits and sociodemographic variables. QUADAS-2 was used to assess risk of bias. Sensitivity, specificity, predictive values, and likelihood ratios (LR) were calculated. Quality of evidence based on ≥3 studies of a method was rated according to GRADE. SOURCES: PubMed, Cochrane Library, Web of Science and reference lists of included publications were searched up to January 2015. STUDY SELECTION: From 5776 identified articles, 18 were included. Assessment of study quality identified methodological limitations concerning study design, test technology and reporting. No study presented low risk of bias in all domains. Three or more studies were found only for previous caries experience and salivary mutans streptococci and quality of evidence for these methods was low. Evidence regarding other methods was lacking. For previous caries experience, sensitivity ranged between 0.21 and 0.94 and specificity between 0.20 and 1. Tests using salivary mutans streptococci resulted in low sensitivity and high specificity. For children with primary teeth at baseline, pooled LR for a positive test was 3 for previous caries experience and 4 for salivary mutans streptococci, given a threshold ≥10(5) CFU/ml. CONCLUSIONS: Evidence on the validity of analysed methods used for caries risk assessment is limited. As methodological quality was low, there is a need to improve study design. CLINICAL SIGNIFICANCE: Low validity for the analysed methods may lead to patients with increased risk not being identified, whereas some are falsely identified as being at risk. As caries risk assessment guides individualized decisions on interventions and intervals for patient recall, improved performance based on best evidence is greatly needed.

Reimbursement systems influence prosthodontic treatment of adult patients.

OBJECTIVE: To evaluate the influence of reimbursement system and organizational structure on oral rehabilitation of adult patients with tooth loss. MATERIALS AND METHODS: Patient data were retrieved from the databases of the Swedish Social Insurance Agency. The data consisted of treatment records of patients aged 19 years and above claiming reimbursement for dental care from July 1, 2007 until June 30, 2009. Before July 1, 2008, a proportionately higher level of subsidy was available for dental care in patients 65 years and above, but thereafter the system was changed, so that the subsidy was the same, regardless of the patient's age. Prosthodontic treatment in patients 65 years and above was compared with that in younger patients before and after the change of the reimbursement system. Prosthodontic treatment carried out in the Public Dental Health Service and the private sector was also analyzed. RESULTS: Data were retrieved for 722,842 adult patients, covering a total of 1,339,915 reimbursed treatment items. After the change of the reimbursement system, there was a decrease in the proportion of items in patients 65 years and above in relation to those under 65. Overall, there was a minimal change in the proportion of treatment items provided by the private sector compared to the public sector following the change of the reimbursement system. CONCLUSIONS: Irrespective of service provider, private or public, financial incentive such as the reimbursement system may influence the provision of prosthodontic treatment, in terms of volume of treatment.

Economic evaluation of diagnostic methods used in dentistry. A systematic review.

OBJECTIVES: To review the literature of economic evaluations regarding diagnostic methods used in dentistry. DATA SOURCES: Four databases (MEDLINE, Web of Science, The Cochrane library, the NHS Economic Evaluation Database) were searched for studies, complemented by hand search, until February 2013. STUDY SELECTION: Two authors independently screened all titles or abstracts and then applied inclusion and exclusion criteria to select full-text publications published in English, which reported an economic evaluation comparing at least two alternative methods. Studies of diagnostic methods were assessed by four reviewers using a protocol based on the QUADAS tool regarding diagnostic methods and a check-list for economic evaluations. The results of the data extraction were summarized in a structured table and as a narrative description. RESULTS: From 476 identified full-text publications, 160 were considered to be economic evaluations. Only 12 studies (7%) were on diagnostic methods, whilst 78 studies (49%) were on prevention and 70 (40%) on treatment. Among studies on diagnostic methods, there was between-study heterogeneity methodologically, regarding the diagnostic method analysed and type of economic evaluation addressed. Generally, the choice of economic evaluation method was not justified and the perspective of the study not stated. Costing of diagnostic methods varied. CONCLUSIONS: A small body of literature addresses economic evaluation of diagnostic methods in dentistry. Thus, there is a need for studies from various perspectives with well defined research questions and measures of the cost and effectiveness. CLINICAL SIGNIFICANCE: Economic resources in healthcare are finite. For diagnostic methods, an understanding of efficacy provides only part of the information needed for evidence-based practice. This study highlighted a paucity of economic evaluations of diagnostic methods used in dentistry, indicating that much of what we practise lacks sufficient evidence.

The combination of non-selective NSAID 400 mg and paracetamol 1000 mg is more effective than each drug alone for treatment of acute pain. A systematic review.

The aim was to evaluate the evidence on outcomes of the combination of non-selective NSAID/ paracetamol compared to either drug alone, to relieve acute pain following oral surgery in adult patients. A systematic review of available literature was performed. The first step comprised searches in three electronic databases. Original studies written in English were searched. As a second step, the reference lists of included publications were searched for additional publications. Abstracts were retrieved if the title contained information on postoperative pain, NSAID, and paracetamol in combination with oral surgery. Two reviewers selected publications on the basis of predetermined inclusion criteria. Data were extracted using one protocol and the quality of each study was assessed using another protocol. The initial search in PubMed resulted in 138 abstracts and in the Cochrane library a further four. The search in the Web of Science resulted in no additional abstract. Five RCTs fulfilled the inclusion criteria. Pain relief from the combination of non-selective NSAID with paracetamol was significantly better than with paracetamol alone as well as with NSAID alone. Nausea, vomiting, headache, and dizziness were among the most common adverse events in all treatment groups. Most of the adverse events were of mild to moderate severity. Two studies reported no significant differences in adverse events between the treatment groups. According to one study the adverse events were significantly lower for the combination ibuprofen 400 mg/paracetamol 1000 mg compared to ibuprofen 400 mg alone. The need for rescue drugs in the different groups varied between the studies. Since the studies reported a significantly better postoperative pain relief with the combination of non-selective NSAIDs/paracetamol compared to each drug alone, this combination might be considered the treatment of choice, as long as side effects of NSAIDs are observed.

Qualitative studies of patients' perceptions of loss of teeth, the edentulous state and prosthetic rehabilitation: a systematic review with meta-synthesis.

OBJECTIVE: To conduct a systematic review and meta-synthesis of qualitative studies addressing patients' perceptions of loss of teeth, edentulism and oral rehabilitation. BACKGROUND: Qualitative studies can complement quantitative studies by achieving deep understanding of patients' subjective experiences of losing teeth and coping with edentulism. They can also explore the perception that the benefits of prosthetic rehabilitation extend far beyond primary clinical treatment goals of restoration of oral function. MATERIALS AND METHODS: The major data bases were searched extensively for relevant qualitative and quantitative studies, followed by manual searching of the reference lists of included publications. Two authors independently read all abstracts. Relevant papers were retrieved in full-text and included or excluded according to a specially designed protocol. The included articles were then appraised and rated for quality: high, moderate or low. Articles of low quality were excluded. RESULTS: The database search yielded 36 abstracts of qualitative studies; manual search disclosed one further article. All were read in full-text by two independent authors: 28 were excluded. Of the remaining nine, two (assessed as of low quality) were excluded for further analysis. Meta-synthesis, based on seven studies, disclosed two major themes: loss of quality-of-life associated with losing teeth and restored quality-of-life after oral rehabilitation. CONCLUSIONS: In this relatively new field of research, there are few published papers. Nevertheless, the studies to date show that loss of teeth is associated not only with compromised oral function, but also loss of social status and diminished self-esteem. Oral rehabilitation has broad positive implications, restoring quality of life and self-worth.

Oral rehabilitation of tooth loss: a systematic review of quantitative studies of OHRQoL.

PURPOSE: This study aimed to review published quantitative studies for evidence regarding the influence of oral rehabilitation following total or partial tooth loss on self-perceived oral health-related quality of life (OHRQoL). MATERIALS AND METHODS: Three databases were searched using specified indexing terms. The reference lists of relevant publications were also searched manually. Quality of evidence was classified according to GRADE guidelines as high, moderate, low, or very low. RESULTS: The search yielded 2,138 titles and abstracts, 2,102 of which were of a quantitative study design. Based on pre-established criteria, the full-text versions of 322 articles were obtained. After data extraction and interpretation, 5 publications of high or moderate study quality remained. The results of these 5 studies showed positive effects of oral rehabilitation on OHRQoL. Two studies showed substantial improvements. CONCLUSIONS: This is a relatively new field of research; there are very few quantitative studies of how patients perceive OHRQoL following tooth loss and subsequent rehabilitation. While this review indicates that treatment has positive effects on quality of life, the scientific basis is insufficient to support general conclusions about the influence of various interventions on the OHRQoL of patients who have experienced total or partial tooth loss. To achieve a more comprehensive analysis, it is recommended that future studies be based on a combination of quantitative and qualitative methods, ie, questionnaires and semi-structured interviews. The follow-up period must also be appropriate for the specific intervention studied.

Treatment of adult patients with edentulous arches: a systematic review.

PURPOSE: This study aimed to evaluate the outcomes of treatment methods used to rehabilitate adult patients with maxillary and/or mandibular edentulism after at least 5 years of follow-up. The risks, adverse effects, and cost effectiveness of these methods were also evaluated. MATERIALS AND METHODS: Three databases as well as the reference lists of included publications were searched using specified indexing terms. Publications that met the inclusion criteria were read and interpreted using pre-established protocols. Quality of evidence was classified according to the GRADE system (high, moderate, low, or very low). RESULTS: The search yielded 2,130 titles and abstracts. Of these, the full-text versions of 488 publications were obtained. After data extraction and interpretation, 10 studies with moderate study quality of evidence and 1 study with low quality of evidence regarding outcomes, risks, and adverse effects remained. Three studies on the economic aspects of treatment were also included (1 with moderate quality and 2 with low quality). Low-quality evidence showed that the survival rate of implant-supported fixed prostheses is 95% after 5 years in patients with maxillary edentulism and 97% after 10 years in patients with mandibular edentulism. The survival rate of implant-supported overdentures is 93% after 5 years (low-quality evidence). In implant-supported fixed prostheses, 70 of every 1,000 implants are at risk of failing in the maxilla after 5 years and 17 of every 1,000 implants in the mandible are at risk after 10 years. Regarding economic aspects, the evidence was insufficient to provide reliable results. CONCLUSIONS: Due to the low quality of evidence found in the included studies, further research with a higher quality of evidence is recommended to better understand the outcomes of treatment for patients with maxillary and/or mandibular edentulism.

Treatment of adult patients with partial edentulism: a systematic review.

PURPOSE: The purpose of this systematic review was to identify and critically appraise published studies of treatment methods used in general practice to rehabilitate adult patients with single tooth loss or partial edentulism, with special emphasis on outcomes reported after at least 5 years of follow-up. MATERIALS AND METHODS: Three databases were searched using specified indexing terms. Publications were included if the study design, research questions, and sample size satisfied pre-established criteria. Reference lists of relevant publications and systematic reviews were also searched. The quality of evidence was classified according to the GRADE system as high, moderate, low, or very low. RESULTS: The search yielded 7,675 titles, of which 1,130 were read in full text. A final total of 15 publications were deemed eligible for inclusion: 5 of moderate quality and 10 of low quality. The five studies of moderate quality were all related to implant-based treatment. The 5-year survival rates for implant-supported single crowns and prostheses were 91% and 94.7%, respectively (implant survival rates: 98.5% and 94.9%, respectively). The underlying scientific evidence was low in quality. No relevant publications were identified regarding the economic aspects of treatment. CONCLUSION: Due to the low scientific evidence of the included studies, it was not possible to compare various treatment methods used for rehabilitation of single tooth loss or partial edentulism.

Important technical parameters are not presented in reports of intraoral digital radiography in endodontic treatment: recommendations for future studies.

OBJECTIVES: The aims of this study were to review the literature on intraoral digital radiography in endodontic treatment with focus on technical parameters and to propose recommendations for improving the quality of reports in future publications. STUDY DESIGN: Two electronic databases were searched. Titles and abstracts were selected according to preestablished criteria. Data were extracted using a model of image acquisition and interpretation. RESULTS: The literature search yielded 233 titles and abstracts; 61 reports were read in full text. Recent reports presented technical parameters more thoroughly than older reports. Most reported important parameters for the x-ray unit, but for image interpretation only about one-half of the publications cited resolution of the display system and fewer than one-half bit depth of the graphics card. CONCLUSIONS: The methodologic quality of future publications must be improved to permit replication of studies and comparison of results between studies in dental digital radiography. Our recommendations can improve the quality of studies on diagnostic accuracy.

A framework for costing diagnostic methods in oral health care: an application comparing a new imaging technology with the conventional approach for maxillary canines with eruption disturbances.

OBJECTIVES: The aims were (i) to propose a framework for costing diagnostic methods in oral health care and (ii) to illustrate the application of the framework to the radiographic examination of maxillary canines with eruption disturbances. METHODS: The framework for costing, following Drummond et al. (2005), includes three elements: (i) identification of different resources used in producing and delivering the service, (ii) measurement of the amount of each resource required and (iii) valuation of the resources in monetary terms. Four data collection instruments were designed - a protocol for apportioning the cost of capital equipment to each diagnostic procedure, separate forms for recording consumable items, for the time of different health care providers used for a diagnostic examination and a patient survey for calculation of the total cost to the patient associated with the examination. The framework was applied to the radiographic examination of maxillary canines with eruption disturbances comparing two imaging methods: (i) a new method with cone beam computed tomography and panoramic radiography and (ii) a conventional method using intraoral and panoramic radiography. The primary analysis was performed from the perspective of the health care system. A separate analysis included patient costs with health care system costs to provide a societal perspective. Comparison of the two perspectives allows consideration of whether any costs savings to the health care system are generated at the expense of greater costs for patients and their families. Data for the cost-analysis were retrieved from 47 patients (mean age 14 years) referred to a department of radiology for examination of maxillary canines. RESULTS: Application of the framework for costing allowed us to compare the resources used to perform examinations of the two methods. The mean total cost per examination for the new method was 128.38€ and 81.80€ for the conventional method, resulting in an incremental cost per examination of the new method of 46.58€. CONCLUSIONS: The application of the framework demonstrates the feasibility of measuring and comparing the total costs as well as the distribution of total costs between providers and patients for different approaches to this common examination.

Ambiguity in bone tissue characteristics as presented in studies on dental implant planning and placement: a systematic review.

OBJECTIVES: To survey definitions of bone tissue characteristics and methods of assessing them in studies of dental implant planning and placement. MATERIAL AND METHODOLOGY: Three databases were searched using specified indexing terms. Three reviewers selected from the titles and retrieved abstracts in accordance with inclusion and exclusion criteria. Descriptions of bone tissue characteristics (bone quality, density and quantity) used before or during dental implant placement were searched for and categorized. RESULTS: The search yielded 488 titles. One hundred and fort-nine publications were selected and read in full text. One hundred and eight were considered relevant. There were many different definitions and classification systems for bone tissue characteristics and examination protocols. Approximately two-third of the included publications reported the Lekholm & Zarb classification system for bone quality and quantity. However, only four studies implemented the Lekholm & Zarb system as originally proposed. A few publications described bone quality in accordance with the Misch or Trisi and Rao classifications systems. Assessment methods were often described only briefly (or not at all in one-fifth of the publications). Only one study presented the diagnostic accuracy of the assessment method, while only two presented observer performance. CONCLUSION: The differing definitions and classification systems applied to dental implant planning and placement make it impossible to compare the results of various studies, particularly with respect to whether bone quality or quantity affect treatment outcomes. A consistent classification system for bone tissue characteristics is needed, as well as an appropriate description of bone tissue assessment methods, their diagnostic accuracy and observer performance.