High certainty evidence is stable and trustworthy, whereas evidence of moderate or lower certainty may be equally prone to being unstable.

OBJECTIVE: To assess to what extent the overall quality of evidence indicates changes to observed intervention effect estimates when new data become available. STUDY DESIGN AND SETTING: We conducted a meta- epidemiological study. We obtained evidence from meta-analyses of randomized trials of Cochrane reviews addressing the same healthcare question that was updated with inclusion of additional data between January 2016 and May 2021. METHODS: We extracted the reported effect estimates with 95% confidence intervals from meta-analyses and corresponding GRADE (Grading of Recommendations Assessment, Development, and Evaluation) assessments of any intervention comparison for the primary outcome in the first and the last updated review version. We considered the reported overall quality (certainty) of evidence (CoE) and specific evidence limitations (no, serious or very serious for risk of bias, imprecision, inconsistency, and/or indirectness). We assessed the change in pooled effect estimates between the original and updated evidence using the ratio of odds ratio (ROR), absolute ROR (aROR), ratio of standard errors (RoSE), direction of effects, and level of statistical significance. RESULTS: High CoE without limitations characterized 19.3% (n=29) out of 150 included original Cochrane reviews. The update with additional data did not systematically change the effect estimates (mean ROR 1.00; 95%CI 0.99-1.02), which deviated 1.06-fold from the older estimates (median aROR; IQR: 1.01-1.15), gained precision (median RoSE 0.87; IQR 0.76-1.00), and maintained the same direction with the same level of statistical significance in 93% (27 of 29) of cases. Lower CoE with limitations characterized 121 original reviews and graded as moderate CoE in 30.0% (45 of 150), low CoE in 32.0% (48 of 150), and very low CoE in 18.7% (28 of 150) reviews. Their update had larger absolute deviations (median aROR 1.12 to 1.33) and larger gains in precision (median RoSE 0.78 to 0.86) without clear and consistent differences between these categories of CoE. Changes in effect direction or statistical significance were also more common in the lower quality evidence, again with a similar extent across categories (without change in 75.6%, 64.6%, and 75.0% for moderate, low, very low CoE). As limitations increased, effect estimates deviated more (aROR 1.05 with zero, 1.11 with one, 1.25 with two, 1.24 with three limitations) and changes in direction or significance became more frequent (93.2% stable with no limitations, 74.5% with one, 68.2% with two, and 61.5% with three limitations). CONCLUSIONS: High-quality evidence without methodological deficiencies is trustworthy and stable, providing reliable intervention effect estimates when updated with new data. Evidence of moderate and lower quality may be equally prone to being unstable and cannot indicate if available effect estimates are true, exaggerated, or underestimated.

Degree of cure of orthodontic composite attachments underneath aligners.

The aim of this study was to assess the percentage degree of cure (DC%) of 2-mm-thick resin composite attachments used for aligner treatment. Three types of aligner - two thermoformed aligners (Clear Aligner [CLA], polyethylene terephthalate glycol modified; and Invisalign [INV], polyester urethane) and a three-dimensional-printed aligner (Graphy TC-85DAC [GRP], an acrylate-methacrylate copolymer) - were selected, along with two universal resin composites (3M Filtek Universal [FTU] and Charisma Topaz ONE [CTO]). Samples of each composite were placed under each aligner, and the degree of cure of each composite was evaluated on the top (facing the aligner) and the bottom (facing the substrate) attachment surfaces after curing. Five specimens were used per combination of aligner and composite, and an additional group of composites irradiated without aligners served as the control. The DC% measurements were performed using attenuated total reflection Fourier transform infrared (ATR-FTIR) spectroscopy. The DC% across the aligners were (median values) 33.8%-44.8% for CLA, 33.6%-40.8% for INV, 32.8%-40.6% for GRP, and 40.0%-51.7% for the control group. The DC% values of the attachments cured under any aligner were significantly lower than that of the corresponding control, with the values recorded on the top surfaces being 6% higher than those on the bottom surfaces after adjusting for aligner group and composite type.

Gender-specific treatment effects and outcomes reported in orthodontic research. A cross-sectional empirical study.

AIM: To identify practices of assessment of gender effects in research articles in orthodontics and detect whether there were significant differences in the treatment effects on outcomes according to gender. MATERIALS AND METHODS: Four major orthodontic journals were sought over a 3-year period to identify publications which included assessment of gender effects on outcomes in their reporting. Data were extracted on the following characteristics: journal, year of publication, region of authorship, and study design. For the studies including reporting of gender effects, whether a significant effect existed was further documented. Additionally, for these studies, data were extracted on population, sample size per gender, treatment, comparison, outcome type, and nature and whether gender analysis was based on subgroup testing or included as a main effect. Descriptive statistics, cross-tabulations, univariable, and multivariable regression models were utilized as appropriate. RESULTS: A total of 718 research articles were eligible for inclusion out of a pool of 1,132 screened articles. Of those, 95 reported on any type of analysis on gender effects (95/718; 13.2%). In the 95 studies that reported assessment of gender effects, it was clear that the majority did not detect significant gender-related differences across the documented outcomes (range of frequency distribution for significant gender differences across all outcomes: 0-50%). Twenty-two articles overall (22/95; 23.2%) described a significant gender effect classified by outcome, 12 favoring female and 10 favoring male participants. Patterns of efficacy and adverse outcomes were schemed either favoring female (root resorption: 4/10; 40.0%, periodontal outcomes: 3/11; 27.3%) or male (cephalometric/growth changes following orthodontic treatment: 4/17; 23.5%) patients across the 22 studies with significant effects. Appropriately designed and adequately powered statistical analyses, with gender effect assessment as a main effect in a multivariable regression model was associated with 6.53 times higher odds for identifying significant gender effects (OR = 6.53; 95% CI: 2.15, 19.8; P = .001). CONCLUSIONS: A very small proportion of research studies included gender effect assessment in their analyses. Of those, a quarter described significant effects. Nevertheless, careful analysis planning and strategies should be prioritized to allow for any meaningful interpretation.

Surface profile characterization of prefabricated resin composite veneers following simulated abrasion. An in vitro study.

Background: The surface of resin composite veneers is susceptible to the effect of the oral environment and surface profile characterization of different veneer systems is of importance to the longevity and clinical performance of the materials. The aim of the present study was to evaluate surface profile properties, as defined by gloss and roughness parameters, of prefabricated resin composite veneers (PCV) and compare with a laboratory resin composite (LRC) system, following simulated abrasion. Material and Methods: Twenty eight composite veneers equally divided to a prefabricated composite veneer (PCV) system and a laboratory resin composite (LRC) (control group) were tested following abrasion under a toothbrush simulator. Alterations in gloss (ΔGloss) and roughness (ΔSa, ΔSz, ΔSci, ΔSdr) parameters were examined (after- before abrasion) using a glossmeter and a 3D-optical profilometer, respectively. Correlation matrices between ΔGloss and ΔRoughness parameters were sought across the two resin composite veneer groups. Results: Τhere was weak evidence that the PCV group exhibited less change in surface gloss after experimental abrasion (PCV vs LRC: mean difference ΔGloss in GU, (MD: -1.7; 95% CI: -3.3, -0.1; p=0.04). For the roughness parameters, ΔSci in nm3/nm2 (MD : 0.2; 95% CI: 0.1, 0.3; p=0.002) and ΔSdr in percentage (MD: 10.6; 95% CI: 3.7, 17.5; p=0.004), exhibited the most pronounced differences between the groups with strong evidence demonstrating greater changes for the PCV group compared to the LRC. No strong correlation pattern could be identified between changes in gloss and roughness parameters across the groups. Conclusions: After abrasion, both PCV and LCR showed an increase in surface gloss, while the PCV group demonstrated a rougher core surface profile than LRC. Key words:Prefabricated, resin composite, veneers, gloss, roughness.

Short fiber-reinforced composite resins as post-and-core materials for endodontically treated teeth: A systematic review and meta-analysis of in vitro studies.

STATEMENT OF PROBLEM: As the use of traditional posts has been associated with complications and failure outcomes, the introduction of novel materials and minimally invasive dentistry has shifted toward the use of composite resin post-and-core restorations for endodontically treated teeth. As a further process, to improve stress absorption environment in restored teeth, the invention of short fiber-reinforced composite resins (SFRCs) as post-and-core restorations has recently emerged. However, evidence regarding its performance is still scarce, and a synthesis of existing data is lacking. PURPOSE: The purpose of this systematic review and meta-analysis was to assess the performance of SFRC post-and-core restorations, regarding fracture resistance and failure mode and considering both cyclic and static loading. MATERIAL AND METHODS: An electronic search in 5 databases was conducted up to August 2022, and the protocol of the study was registered a priori. The search terms included "fiber reinforced composite," "core build-up," and "post." Studies were considered if they compared SFRC restorations with other types of conventional posts and teeth restored using bulk fill composite resin. The internal validity of the studies was assessed by using a custom-made risk of bias tool. RESULTS: A total of 1271 records were identified, of which 13 were considered for full-text assessment. Eight were ultimately included, all being in vitro studies, and 7 of them were deemed eligible for quantitative syntheses. The results varied considerably across studies with divergent fracture resistance values and percentages of catastrophic failure being reported. Standard depth (6 mm) SFRCs presented fewer repetitions until fracture on average, compared with the individually made FRCs (3 studies: mean difference (MD): -4062; 95% CI: -6148, -1975; P<.001) under cyclic loading. Under static loading, SFRCs (standard depth) presented a nearly 300 N lower fracture force compared with that of intact teeth, (3 studies: MD: -297; 95%CI: -378, -216; P<.001). CONCLUSIONS: Evidence on the laboratory fracture and failure performance of SFRCs is limited, and future studies should incorporate more standardized experimental conditions, as well as SFRCs with limited sacrifice of tooth substrate within the root canal of endodontically treated teeth.

Outcome of Partial Pulpotomy in Immature Permanent Teeth with Symptomatic Irreversible Pulpitis: A Prospective Case Series Assessment.

INTRODUCTION: The aim of this prospective case series was to assess the clinical and radiographic outcome of partial pulpotomy in caries-exposed symptomatic, vital, immature, permanent molars. METHODS: Thirty-four immature molars with deep caries and symptoms of irreversible pulpitis were treated by partial pulpotomy and ProRoot MTA as a capping material. After complete caries removal, the inflamed part of the pulp was removed. Complete hemostasis was achieved using a sterile cotton pellet moist initially with sodium hypochlorite 1.5% and then with sterile saline. ProRoot MTA (Dentsply Sirona, Charlotte, NC) was placed as a capping material onto the remaining pulp tissue. The cavity was sealed using a light-curing resin-modified Ca(OH)2 cavity liner, and patients were referred to a pediatric dentist for permanent restoration. Descriptive statistics and cross tabulations were performed including variables examined before, during, and after the procedure. RESULTS: All examined teeth presented a favorable clinical and radiographic outcome with normal periapical tissues, complete apical closure, and formation of a dentinal bridge beneath the capping material. Signs of partial pulp chamber calcification were only detected in 2 cases. Postoperatively, most patients did not report any pain (23/34, 67.7%), whereas the rest reported minor intensity pain (11/34, 32.3) and the use of analgesic or anti-inflammatory drugs only for 1 day (10/34, 29.4%). CONCLUSIONS: Partial pulpotomy seems to provide a universally successful outcome when managing symptomatic vital immature teeth with no signs of complications and completion of apical closure. It could be a viable treatment of choice in cases of caries-exposed vital immature teeth with symptoms of irreversible pulpitis.

Treatment outcome of partial pulpotomy using two different calcium silicate materials in mature permanent teeth with symptoms of irreversible pulpitis: A randomized clinical trial.

AIM: To assess the clinical and radiographic outcome of partial pulpotomy by comparing MTA Angelus and Total Fill BC, as pulpotomy agents, in mature teeth with deep caries and symptoms indicative of irreversible pulpitis. METHODOLOGY: The study was designed as a parallel-two arm, double-blind, randomized superiority clinical trial registered at www. CLINICALTRIALS: gov (NCT04870398). Symptomatic mature permanent teeth with deep caries fulfilling the inclusion criteria were randomly treated using either MTA Angelus or Total Fill BC. A partial pulpotomy was performed and following complete haemostasis, the capping material was placed over the remaining pulp tissue and a postoperative periapical radiograph was taken. Clinical and radiographic follow-up evaluation was performed for a median time of 2 years, whereas levels of pain intensity were evaluated preoperatively and for 7 days after intervention using Visual Analogue Scale. For the primary outcome (failure/success of treatment), the Kaplan-Meier survival curves for the capping materials were plotted and a log-rank test for equality of survivor functions was applied. A multivariable random effects Cox Regression model was also applied. For the secondary outcome (postoperatively reported pain), a multivariable mixed effects ordinal logistic regression was structured. RESULTS: One hundred and thirty-seven teeth in 123 patients underwent partial pulpotomy using randomly either MTA Angelus (N = 74) or Total Fill BC (n = 63). The percentage failure for MTA Angelus and Total Fill BC was 10.8% (8/74) and 17.5% (11/63), respectively, but the difference was not statistically significant [adjusted HR: 1.83; 95% confidence interval (CI): 0.68, 4.91; p = .23]. Weak evidence was found that secondary caries involvement may impose a 3.54 times greater hazard for treatment failure (adjusted HR: 3.54; 95% CI: 1.00, 12.51; p = .05). For each passing minute of procedural bleeding control, there was also a 57% higher hazard for treatment failure (adjusted HR: 1.57; 95% CI: 0.99, 2.48; p = .05). The odds for higher postoperative pain were 4.73 times greater for the Total Fill BC compared to MTA Angelus (adjusted OR: 4.73; 95% CI: 2.31, 9.66; p < .001). CONCLUSIONS: Both materials exhibited similar and favourable outcome rates after partial pulpotomy in teeth with deep caries and symptoms of irreversible pulpitis. Total Fill BC was associated with a higher level of postoperative pain intensities.

Critical analysis of the reporting quality of animal studies within Endodontics using the Preferred Reporting Items for Animal Studies in Endodontics (PRIASE) 2021 quality standard checklist.

AIM: To critically evaluate the reporting quality of a random sample of animal studies within the field of endodontics against the Preferred Reporting Items for Animal Studies in Endodontics (PRIASE) 2021 checklist and to investigate the association between the quality of reporting and several characteristics of the selected studies. METHODOLOGY: Fifty animal studies related to endodontics were randomly selected from the PubMed database with publication dates from January 2017 to December 2021. For each study, a score of '1' was given when the item of the PRIASE 2021 checklist was fully reported, whereas a score of '0' was given when an item was not reported; when the item was inadequately or partially reported, a score of '0.5' was given. Based on the overall scores allocated to each manuscript, they were allocated into three categories of reporting quality: low, moderate and high. Associations between study characteristics and reporting quality scores were also analysed. Descriptive statistics and Fisher's exact tests were used to describe the data and determine associations. The probability value of .05 was selected as the level of statistical significance. RESULTS: Based on the overall scores, four (8%) and 46 (92%) of the animal studies evaluated were categorized as 'High' and 'Moderate' reporting quality, respectively. A number of items were adequately reported in all studies related to background (Item 4a), relevance of methods/results (7a) and interpretation of images (11e), whereas only one item related to changes in protocol (6d) was not reported in any. No associations were confirmed between reporting quality scores and number of authors, origin of the corresponding author, journal of publication (endodontic specialty vs. non- specialty), impact factor or year of publication. CONCLUSIONS: Animal studies published in the specialty of endodontics were mostly of 'moderate' quality in terms of the quality of reporting. Adherence to the PRIASE 2021 guidelines will enhance the reporting of animal studies in the expectation that all future publications will be high quality.

Long-term stability after high-pull headgear combined with fixed appliances: A retrospective cohort study of growing class II patients.

BACKGROUND: High-pull headgear with fixed appliances is a common therapeutic plan in class II growing individuals, especially in those with a tendency to hyperdivergence. The stability of this approach has not been adequately assessed in the long-term. The aim of this retrospective study was to assess that long-term stability by means of lateral cephalograms. Seventy-four consecutive patients were included and examined at three time-points: pre-treatment (T1), end of treatment (T2), and at least five years post-treatment (T3). RESULTS: The average initial age of the sample was 9.3 years (standard deviation, SD: 1.6). At T1, the mean ANB was 5.1 degrees (SD: 1.6), the mean SN-PP 5.6 (SD: 3.0) and the mean MP-PP 28.7 degrees (SD: 4.0). The median follow-up time was 8.6 years with an interquartile range of 2.7. A statistically significant, but of small magnitude increase in the SNA angle was noted at T3 compared to T2 after adjusting for the pre-treatment SNA value (mean difference (MD): 0.75; 95% CI: 0.34, 1.15; P<0.001). The inclination of the palatal plane appeared stable in the post-treatment period, while the MP-PP angle showed scarce evidence of decrease during the post-treatment period after adjusting for sex, pre-treatment SNA and SN-PP angles (MD: -2.29; 95% CI: -2.85, -1.74; P<0.001). CONCLUSIONS: The sagittal position of the maxilla and the inclination of the palatal plane appeared to be stable after treatment with high-pull headgear and fixed appliances in the long-term. Continuous mandibular growth, both sagittaly and vertically, contributed to the stability of class II correction.

Reporting completeness of scoping reviews in orthodontic literature up to 2022. An empirical study.

AIM: To assess the quality of reporting of Scoping Reviews (ScRs) in Orthodontics according to the PRISMA Extension Checklist for Scoping Reviews (PRISMA-ScR). Our secondary aim was to identify publication characteristics, such as year of publication, journal, inclusion of a reporting guideline, and study registration, associated with ScRs reporting quality. MATERIALS AND METHODS: Pubmed, Scopus, and Web of Science Core Collection were searched as of 1 August 2022 for identification of orthodontic ScRs. This was supplemented by electronic searches within the contents of eleven specialty journals. The item-specific and overall reporting quality score of the examined orthodontic ScRs, based on the PRISMA Extension Checklist for Scoping Reviews were recorded. Association of reporting quality score with publication characteristics was further examined. RESULTS: A total of 40 ScRs were identified and included, with a mean reporting quality score of 73.0 per cent (standard deviation = 14). The majority of studies were published from 2020 onwards (32/40; 80.0%). Of the most adequately reported items were the summary of the evidence description in the Discussion (38/40; 95.0%) and the selection of the sources of evidence in the Results section (34/40; 85.0%). Protocol registration and reporting of limitations were missed in almost half of the ScRs (19/40; 47.5%), while less than half studies were adequately justified (18/40; 45.0%). According to the multivariable linear regression, adherence to appropriate reporting guidelines resulted in improved reporting quality score by 10 per cent (ß-coefficient: 0.10; 95% CI: 0.002, 0.19; P = 0.04), conditional on year and journal of publication. Year, journal of publication, and registration practices did not appear as significant predictors (P > 0.05 in all instances). CONCLUSIONS: The reporting quality of the examined orthodontic ScRs was suboptimal, with questionable justification for their conduct and certain items being mostly affected.

Clinical evaluation of different alveolar ridge preservation techniques after tooth extraction: a randomized clinical trial.

OBJECTIVE: The aim of the present randomized controlled trial (RCT) was to evaluate the efficacy of different alveolar ridge preservation (ARP) techniques on dimensional alterations after tooth extraction, based on clinical measurements. BACKGROUND: Alveolar ridge preservation (ARP) is a common procedure in every day clinical practice, when dental implants are involved in treatment planning. In ARP procedures, a bone grafting material is combined with a socket sealing (SS) material in order to compensate the alveolar ridge dimensional alterations after tooth extraction. Xenograft and allograft are the most frequently used bone grafts in ARP, while free gingival graft (FGG), collagen membrane, and collagen sponge (CS) usually applied as SS materials. The evidence comparing xenograft and allograft directly in ARP procedure is scarce. In addition, FGG is usually combined with xenograft as SS material, while the evidence combing allograft with FGG is absent. Moreover, CS could probably be an alternative choice in ARP as SS material, since it has been used in previous studies but more clinical trials are required to evaluate its effectiveness. MATERIALS AND METHODS: Forty-one patients were randomly assigned in four treatment groups: (A) freeze-dried bone allograft (FDBA) covered with collagen sponge (CS), (B) FDBA covered with free gingival graft (FGG), (C) demineralized bovine bone mineral xenograft (DBBM) covered with FGG, and (D) FGG alone. Clinical measurements were performed immediately after tooth extraction and 4 months later. The related outcomes pertained to both vertical and horizontal assessment of bone loss. RESULTS: Overall, groups A, B, and C presented significantly less vertical and horizontal bone resorption compared to group D. No statistically significant difference was observed between allograft and xenograft, except for the vertical bone resorption at the buccal central site, where xenograft showed marginally statistically significantly reduced bone loss compared to allograft (group C vs group B: adjusted ß coef: 1.07 mm; 95%CI: 0.01, 2.10; p = 0.05). No significant differences were observed in hard tissue dimensions when CS and FGG were applied over FDBA. CONCLUSIONS: No differences between FDBA and DBBM could practically be confirmed. In addition, CS and FGG were equally effective socket sealing materials when combined with FDBA, regarding bone resorption. More RCTs are needed to compare the histological differences between FDBA and DBBM and the effect of CS and FGG on soft tissue dimensional changes. CLINICAL RELEVANCE: Xenograft and allograft were equally efficient in ARP 4 months after tooth extraction in horizontal level. Xenograft maintained the mid-buccal site of the socket marginally better than the allograft, in vertical level. FGG and CS were equally efficient as SS materials regarding the hard tissue dimensional alterations. TRIAL REGISTRATION: Clinical trial registration Number: NCT04934813 (clinicaltrials.gov).

In vivo aging-induced surface roughness alterations of Invisalign® and 3D-printed aligners.

OBJECTIVE: To assess the surface roughness of in-house 3D-printed orthodontic aligners compared with Invisalign® appliances, both retrieved as well as in the 'as-received' control status. DESIGN: An in vitro study following intra-oral material aging. SETTING AND PARTICIPANTS: Twelve clinically used Invisalign® appliances and the same number of 3D-printed aligners, without involvement of attachments, were obtained from a respective number of patients. A similar number of 'as-received' aligners, of each material, were used as control (CON) groups. METHOD: Four groups of materials were examined: A = Invisalign® CON; B = Invisalign® used; C = 3D-printed CON; and D = 3D-printed used. Optical profilometry was employed to examine the following surface roughness parameters: amplitude parameters Sa, Sq and Sz and functional parameters Sc and Sv. Descriptive statistics and quantile regression modeling were conducted, and the level of statistical significance was set at α = 0.05. RESULTS: Intra-oral exposure of 3D-printed aligners was significantly associated with increase in all tested parameters (P < 0.001 at all occasions). Significant differences were detected in the retrieved 3D-printed aligners compared with Invisalign® retrieved, with the exception of Sz. The respective effect sizes (median differences) were as follows: Sa: 169 nm, 95% confidence interval [CI] = 89-248, P < 0.001; Sq: 315 nm, 95% CI = 152-477, P < 0.001; Sc: 233 nm3/nm2, 95% CI = 131-335, P < 0.001; and Sv: 43 nm3/nm2, 95% CI = 17-68, P = 0.002. CONCLUSION: Within the limitations of this study, we concluded that surface roughness differences existed between 3D-printed aligners and Invisalign® in the retrieved status, as well as between the control and retrieved 3D-printed groups.

Scoping reviews in orthodontics: are they justified?

BACKGROUND: Scoping Reviews (ScRs) have emerged in the orthodontic literature as a new methodological perspective to collate and summarize scientific evidence. The aim of the present study was to identify and record the proportion of Scoping Reviews in orthodontics that have been clearly and adequately justified, based on the methodological framework of such types of reviews. Associations with a number of publication characteristics were also sought. Three major databases, namely PubMed, Scopus and Web of Science Core Collection, as well as 11 specialty orthodontic journals were electronically sought from inception until August 1, 2022, for ScRs. The primary outcome pertained to whether the published reports of the ScRs included an appropriate justification and explanation for the selection of this kind of knowledge synthesis methodology. Potential association with year, journal, continent of authorship, number of authors, methodologist involvement, appropriate reporting guidelines and registration practices followed were explored. RESULTS: A total of 40 ScRs were eligible for inclusion, with the majority not being adequately justified (22/40; 55.0%). The majority of studies were published from 2020 onward (32/40; 80.0%). The regression model did not reveal any significant association between justification of ScRs and a number of publication characteristics (p > 0.05 at all levels). CONCLUSIONS: Less than half of the included ScRs were adequately justified in terms of selection of the appropriate synthesis methodology. Awareness should be raised in the scientific community regarding the correctness of the use of this newly emerging type of study in orthodontics, to safeguard against any trace of research waste.

Changes in the Pulp Tissue Complex Induced by Orthodontic Forces: Is There a Need for Concern? A Systematic Review and Meta-Analysis of RCTs and Prospective Clinical Trials.

PURPOSE: To identify and assess any changes in the pulp tissue complex following orthodontic force application. MATERIALS AND METHODS: Published and unpublished literature was searched in seven databases until 9 August 2022 for randomised controlled trials (RCTs) and prospective trials (nR-PCT). Representative key words included 'pulp response', 'pulp tissue', 'orthodontic force', and 'tooth movement'. Study selection, data extraction, risk of bias and certainty of evidence assessment were conducted independently by two reviewers. Random effects meta-analyses with respective confidence intervals (95%CIs) were conducted where applicable. RESULTS: A total of 363 records were screened, a final number of 24 articles were eligible for qualitative synthesis, while 8 of those contributed to meta-analyses. There was evidence that pulpal blood flow (PBF) decreased after 3 weeks of tooth movement compared to no force application (4 studies, mean difference: -1.68; 95% CI: -3.21, -0.15; p = 0.03). However, this was not the case after 6 months of treatment (p = 0.68). A rise in the activity of aspartate aminotransferase (AST) was detected after 7 days of treatment, but combining 2 studies, this was not statistically significant (p = 0.25). Other outcomes were assessed through single studies. Risk of bias was within the range of 'some concerns/moderate to high/critical overall', while certainty of evidence was low to very low according to GRADE. CONCLUSIONS: As a short-term effect, PBF decreased upon initiation of orthodontic force application, while enzymatic and peptide activity within the pulp was transiently affected. Further long-term evidence of improved quality and certainty is needed.

Assessment of spin in abstracts of Endodontic Systematic Reviews with meta-analyses published between 2010 and 2022. Are we in need of more transparent interpretation of findings?

AIM: Spin refers to reporting, interpretation and extrapolation related distortion or manipulation of the findings of a study. The aim of this report was to identify the prevalence and extent of spin in the abstracts of systematic reviews (SRs) including meta-analyses in the scientific field of Endodontics. METHODOLOGY: A sensitive and inclusive search strategy in PubMed was developed to identify eligible SRs with meta-analyses in Endodontics, supplemented by an electronic search within 3 major specialty journals, from January 1, 2010 to April 16, 2022. Inclusion and extent of spin was recorded, per domain and following issues related to misleading reporting, interpretation and inappropriate extrapolation of meta-analyses' findings. Association of spin with publication characteristics such as year, journal type, number of authors, continent of authorship, funding, primary study design and significance of the outcome was explored. RESULTS: A hundred and eighty-six SRs with meta-analyses were retrieved, and inclusion of spin was detected in 125 abstracts (67.2%), for one or more domains. The majority of abstracts were affected by more than one types of spin (91/125; 72.8%). There was evidence that abstracts of meta-analyses of non-significant findings had 60% lower odds for inclusion of spin (Odds ratio, OR: 0.40; 95%CI: 0.19, 0.83; p= 0.04), after adjusting for year, journal type and number of authors. CONCLUSIONS: Misleading reporting and misinterpretation of findings in abstracts of meta-analyses is evident in endodontic research. Efforts should be reinforced to increase awareness within the scientific and academic community to improve adherence to transparent reporting and interpretation.

Publication bias in randomized controlled trials in dentistry. What factors affect statistical significance of outcomes?

OBJECTIVES: To record the proportion of Randomized Controlled Trials (RCTs) reporting significant (versus non- significant) primary outcomes, published across 12 high impact journals in Dentistry, covering 6 specialty domains. Associations with certain journal, publication and outcome characteristics were examined. METHODS: We identified and included all RCTs published from January 1st, 2017 to December 31st, 2021 in the two journals with the highest impact factors (Clarivate Analytics, 2020) from each of the following domains: Periodontology, Endodontics, Restorative Dentistry/ Prosthodontics, Orthodontics, Paediatric Dentistry, Oral and Maxillofacial Surgery. The primary outcome was the proportion of significant/ non- significant findings reported for the primary outcomes under study, while a range of characteristics such as: journal, year of publication, impact factor, funding, registration and others, were tested for associations. RESULTS: A total of 474 RCTs were identified and included, with the majority reporting statistically significant outcomes (321/474; 67.7%). The multivariable model revealed significant effects of predictors related to specialty domain (p = 0.01), continent (p = 0.003) and registration (p = 0.004). Compared to Periodontology, RCTs published in Endodontics (OR= 0.40; 95%CIs: 0.22, 0.76) and Orthodontics (OR= 0.41; 95%CIs: 0.23, 0.74) were less likely to present statistically significant effects. There was strong evidence that registered trials presented lower odds of reporting statistically significant findings (OR= 0.52; 95%CIs: 0.34, 0.81). CONCLUSIONS: The entirety of dentistry domains demonstrated preferential publication practices of outcomes considered as "successful" and statistically significant, with domains such as Orthodontics and Endodontics being more balanced. Trial non- registration is still prevalent and associated with reporting of statistically significant effects. CLINICAL SIGNIFICANCE: The findings of this empirical report bring attention to the interpretation of Systematic Reviews (SRs) conclusions. These largely depend on the availability and nature of outcomes of randomized controlled trials (RCTs) on a topic, which may impact on the synthesized estimate of a pooled effect and its direction.

Gender disparity in speakers of the European Orthodontic Society conferences held between 2015 and 2020: a cross-sectional report.

OBJECTIVES: To assess the representation of female scientists as speakers of blindly selected oral presentations or invited speakers in the latest European Orthodontic Society (EOS) conferences between 2015 and 2020. To examine the association with a number of study- and author-related characteristics. MATERIALS AND METHODS: Abstract books and programmes of the EOS conferences held between 2015 and 2020, were electronically searched to identify the gender of all speakers. The following predictor variables were assessed: year, continent of authorship, number of centres, number of authors involved, study design, study topic, and presentation as a WJB Houston Award nominee. RESULTS: A total of 312 oral presentations were recorded with almost even distribution of female/male gender. In the majority of oral presentations, a European-origin speaker affiliation was confirmed (208/312; 66.7%), with a relatively equal representation of women (P = 0.05). Seniority in authorship of oral presentations belonged to male scientists (209/312; 67%). Furthermore, a total of 84 invited speakers were identified, of which only 15 (17.9%) were female, indicating a substantial gender gap. No more than four women were invited to lecture annually, compared to a minimum of 10 male scientists. Overall, a significant difference was recorded for the odds of a female scientist to be invited as a speaker in the EOS conference (range of odds across years: 0.20-0.36), compared to the odds for conducting an oral presentation in the same context and timescale (range of odds across years: 0.75-1.45) (Mantel-Haenszel test for homogeneity, P-value < 0.001). LIMITATIONS: Findings were based solely on the annual orthodontic conference of the EOS, without further insights on national conferences, or identification of wide-range timescale effects. CONCLUSIONS AND IMPLICATIONS: Gender disparity related to invited speakers at the EOS 2015-20 annual conferences was unequivocally confirmed. Nevertheless, gender differences were not identified in oral presentations. Firm efforts to ensure female scientist's voice is equally represented are needed including a move from theory to practice.

Most healthcare interventions tested in Cochrane Reviews are not effective according to high quality evidence: a systematic review and meta-analysis.

OBJECTIVE: To estimate the proportion of healthcare interventions tested within Cochrane Reviews that are effective according to high-quality evidence. METHODS: We selected a random sample of 2,428 (35%) of all Cochrane Reviews published between 1 January 2008 and 5 March 2021. We extracted data about interventions within these reviews that were compared with placebo, or no treatment, and whose outcome quality was rated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. We calculated the proportion of interventions whose benefits were based on high-quality evidence (defined as having high quality GRADE rating for at least one primary outcome, statistically significant positive results, and being judged by review authors as effective. We also calculated the proportion of interventions that suggested harm. RESULTS: Of 1,567 eligible interventions, 87 (5.6%) had high-quality evidence supporting their benefits. Harms were measured for 577 (36.8%) interventions. There was statistically significant evidence for harm in 127 (8.1%) of these. Our dependence on the reliability of Cochrane author assessments (including their GRADE assessments) was the main potential limitation of our study. CONCLUSION: More than 9 in 10 healthcare interventions studied within recent Cochrane Reviews are not supported by high-quality evidence, and harms are under-reported.

The Effect of Cone-Beam Computed Tomography (CBCT) Evaluation on Treatment Planning after Endodontic Instrument Fracture.

Intracanal instrument fracture is a procedural iatrogenic event during endodontic treatment that may affect treatment planning and eventually treatment outcome. Cone Beam Computed Tomography (CBCT) has offered several advantages, especially in endodontic cases in which information from conventional periapical radiograph may not be adequate to allow a precise treatment planning decision and a subsequent appropriate management of the cases. The present study was firstly conducted to assess the effect of CBCT evaluation on the decision-making process after instrument fracture; secondly, to introduce a new clinical approach in cases with fractured instruments located in the mesial roots of mandibular and maxillary molars. The study design was observational. The sample comprised all cases of mandibular and maxillary molars where an instrument fracture had occurred in the mesial roots. Two qualified (National and Kapodistrian University of Athens, Greece) and experienced (more than fifteen years of daily practicing) endodontists evaluated all the cases. The initial treatment plan made by evaluating periapical radiographs of each case was compared to the final plan set after CBCT evaluation. A marginal homogeneity test for paired data was conducted to test the concordance of treatment planning with periapical radiographs versus CBCT. Multivariable logistic regression was structured to identify predictors of modification in treatment planning following CBCT assessment, and to record estimators for decision to remove, bypass or retain the fragment. The level of statistical significance was pre-specified at p < 0.05. Of a total 52 cases evaluated, change in treatment planning with conventional periapical radiograph as a reference, following evaluation of CBCT, was observed in more than half of the teeth. The difference was statistically significant (p < 0.001). Apical location of the fragment was more likely to induce a perceived change in treatment planning after CBCT evaluation (p < 0.01). Canal merging induced 95% lower odds (p = 0.01) for taking a decision to remove or bypass, revealing that retaining the fragment was by far a more likely decision. A significant impact of CBCT preoperative evaluation on treatment planning for the management of such cases was demonstrated. Apical location of the fragment and canal merging seem to influence the decision-making process.

Is data missing? An assessment of publication bias in orthodontic systematic reviews from 2010 to 2021.

AIM: To assess the extent of publication bias assessment in systematic reviews (SRs) across the orthodontic literature over the last 12 years and to identify the appropriateness of assessment and association with publication characteristics, including year of publication, journal, searching practices within unpublished literature or attempts to contact primary study authors and others. MATERIALS AND METHODS: We searched six journals and the Cochrane Database of Systematic Reviews for relevant articles, since January 2010, until November 2021. We recorded practices interrelated with publication bias assessment, at the SR and meta-analysis level. These pertained to reporting strategies for searching within unpublished literature, attempts to communicate with authors of primary studies and formal assessment of publication bias either graphically or statistically. Potential associations between publication bias assessment practices with variables such as journal, year, methodologist involvement, and others were sought at the meta-analysis level. RESULTS: A sum of 289 SRs were ultimately included, with 139 of those incorporating at least one available mathematical synthesis. Efforts to search within unpublished literature were reported in 191 out of 289 Reviews (66.1%), while efforts to communicate with primary study authors were recorded for 150 of 289 of those (51.9%). An appropriate strategy plan to address issues of publication bias, conditional on the number of studies available and the methodology plan reported, was followed in 78 of the 139 meta-analyses (56.1%). Formal publication bias assessment was actually reported in 35 of 139 meta-analyses (25.2%), while only half of those (19/35; 54.3%) followed an appropriately established methodology. Ten of the latter 19 studies detected the presence of publication bias (52.6%). Predictor variables of appropriate publication bias assessment did not reveal any significant effects. CONCLUSIONS: Appropriate methodology and rigorous practices for appraisal of publication bias are underreported in SRs within the orthodontic literature since 2010 and up-to-date, while other established methodologies including search strategies for unpublished data or communication with authors appear currently suboptimal.