Evidence gaps in orthognathic surgery, a Delphi study protocol

Aim: To assess the research gaps identified in a recent mapping review of orthognathic surgery through their evaluation by clinical experts, leading to a clinically relevant list of research gaps. This will guide future investigations of the topic, focusing on the outcomes of blood loss, infection, and relapse. Methods: The Delphi technique will be used to appraise the identified research gaps. The expert panel will include maxillofacial surgeons who regularly perform orthognathic surgery. Potential participants will be identified through various methods, including contact information from articles in the mapping review, nominations from peers, and social media platforms. Two rounds of surveys will be undertaken with Likert-type and open-ended questions to assess the clinical relevance of research gaps. For the second round, participants will receive a report of the results of the first round. Questions will be modified depending on the answers obtained in the first round. A consensus of 60% will be considered valid. Conclusions: Through this Delphi study, in a collaborative effort between researchers and clinical experts, a comprehensive understanding of the clinical relevance of research gaps in orthognathic surgery will be achieved. The outcomes will guide future investigations, ultimately improving the outcomes and practices in this field.

Systematic Mapping Review of Orthognathic Surgery (Protocol).

Study Design: This document details the planning phase of a systematic mapping review. Objective: The objective of this mapping review is to identify, describe, and organize evidence currently available from systematic reviews and primary studies regarding different co-interventions and surgical modalities used in orthognathic surgery (OS) and their outcomes. Methods: Systematic reviews (SRs), randomized controlled trials (RCTs), and observational studies that evaluate perioperative OS co-interventions and surgical modalities will be identified in an exhaustive search of MEDLINE, EMBASE, Epistemonikos, Lilacs, Web of Science, and CENTRAL. Grey literature will also be screened. Results: Expected results include identification of all PICO questions available in the evidence regarding OS and generation of evidence bubble maps, involving a matrix of all identified co-interventions, surgical modalities, and outcomes presented in the studies. This will achieve identification of research gaps and prioritization of new research questions. Conclusions: The significance of this review will result in a systematic identification and characterization of the available evidence, leading to a reduction in research waste and a guidance of future efforts in developing studies for unsolved questions.

Systematic mapping review of interventions to prevent blood loss, infection and relapse in orthognathic surgery

Background: This systematic mapping review aims to identify, describe, and organize the currently available evidence in systematic reviews (SR) and primary studies regarding orthognathic surgery (OS) co-interventions and surgical modalities, focusing on the outcomes blood loss, infection and relapse. Material and methods: A comprehensive search strategy was performed to identify all SRs, randomized controlled trials and observational studies that evaluate surgical modalities and perioperative co-interventions in OS that evaluate the outcomes blood loss, infection and relapse, regardless of language or publication date. Searches were conducted in MEDLINE, EMBASE, Epistemonikos, Lilacs, Web of Science, and CENTRAL. In addition, grey literature was screened. Results: 27 SRs and 150 primary studies fulfilled the inclusion criteria, 91 from SRs, and 59 from our search strategy. Overall, the quality of the SRs was graded as "Critically low," and only two SRs were rated as "High" quality. 11 PICO questions were extracted from SRs and 31 from primary studies, which focused on osteosynthesis methods, surgical cutting devices, use of antibiotics, and induced hypotension. In addition, evidence bubble maps for each outcome were created to analyze in a visual manner the existing evidence. Conclusions: Future primary and secondary high-quality research should be addressed focused on the eight knowledge gaps identified in this mapping review. We concluded that the evidence mapping approach is a practical methodology for organizing the current evidence and identifying knowledge gaps in OS, helping to reduce research waste and canalize future efforts in developing studies for unsolved questions. (AU)

Systematic mapping review of orthognathic surgery.

STUDY DESIGN: Systematic mapping review AIM AND SCOPE: The objective of this mapping review was to identify, describe, and organize clinical research currently available from systematic reviews and primary studies regarding co-interventions and different surgical modalities used in orthognathic surgery (OS) and their outcomes. METHODS: Systematic reviews (SRs), randomized controlled trials, and observational studies that evaluated perioperative OS co-interventions and surgical modalities were identified in an exhaustive search of MEDLINE, EMBASE, Epistemonikos, Lilacs, Web of Science, and CENTRAL. Grey literature was also screened. RESULTS: Included were 35 SRs and 253 primary studies, 103 from SRs, and another 150 identified in our search. Overall, SR quality was rated as critically low, with only two SRs rated as of high quality. 19 questions on population, interventions, comparisons, and outcomes (PICO) extracted from the SRs focused on osteosynthesis methods, surgical cutting devices, and use of antibiotics, corticosteroids, and induced hypotension. Also identified were 15 research gaps. Evidence bubble maps were created to graphically depict the available evidence. CONCLUSION: Future high-quality research, both primary and secondary, is needed to address the knowledge gaps identified in this systematic mapping review.

Silver diamine fluoride compared to atraumatic restorative technique for the treatment of caries in primary and mixed first phase dentition. / Fluoruro diamino de plata comparado con técnica de restauración atraumática para el tratamiento de caries cavitadas en dentición primaria y mixta primera fase.

INTRODUCTION: Cavitated carious lesions in primary and mixed dentition require prompt treatment to control caries progression. Silver diamine fluoride has emerged as an alternative to the atraumatic restorative technique due to its easy application. However, there is still uncertainty regarding its effectiveness and safety. METHODS: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a metanalysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified ten systematic reviews, including two studies overall, which are randomized trials. We concluded that silver diamine fluoride compared to the atraumatic restorative technique may increase the arrest of caries in primary and mixed first phase dentition, however, the certainty of the evidence has been assessed as low. On the other hand, treatment with silver diamine fluoride compared to the atraumatic restorative technique (ART) probably increases the risk of adverse events.

INTRODUCCIÓN: Las lesiones de caries cavitadas en dentición primaria y mixta requieren un tratamiento oportuno, para evitar así la progresión de la caries. El fluoruro diamino de plata ha surgido como una alternativa a la técnica de restauración atraumática debido a su fácil aplicación. Sin embargo, aún existe incertidumbre en relación a su efectividad y seguridad. MÉTODOS: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos diez revisiones sistemáticas que en conjunto incluyeron dos estudios primarios, ambos ensayos aleatorizados. Concluimos que el fluoruro diamino de plata en comparación a la técnica de restauración atraumática podría aumentar el arresto de caries en dentición primaria y mixta primera fase, pero la certeza de la evidencia ha sido evaluada como baja. Por otra parte, el tratamiento con fluoruro diamino de plata comparado con la técnica de restauración atraumática (ART) probablemente aumenta el riesgo de eventos adversos.

Fluoruro diamino de plata comparado con técnica de restauración atraumática para el tratamiento de caries cavitadas en dentición primaria y mixta primera fase / Silver diamine fluoride compared to atraumatic restorative technique for the treatment of caries in primary and mixed first phase dentition

INTRODUCCIÓN: Las lesiones de caries cavitadas en dentición primaria y mixta requieren un tratamiento oportuno, para evitar así la progresión de la caries. El fluoruro diamino de plata ha surgido como una alternativa a la técnica de restauración atraumática debido a su fácil aplicación. Sin embargo, aún existe incertidumbre en relación a su efectividad y seguridad. MÉTODOS: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos diez revisiones sistemáticas que en conjunto incluyeron dos estudios primarios, ambos ensayos aleatorizados. Concluimos que el fluoruro diamino de plata en comparación a la técnica de restauración atraumática podría aumentar el arresto de caries en dentición primaria y mixta primera fase, pero la certeza de la evidencia ha sido evaluada como baja. Por otra parte, el tratamiento con fluoruro diamino de plata comparado con la técnica de restauración atraumática (ART) probablemente aumenta el riesgo de eventos adversos

INTRODUCTION: Cavitated carious lesions in primary and mixed dentition require prompt treatment to control caries progression. Silver diamine fluoride has emerged as an alternative to the atraumatic restorative technique due to its easy application. However, there is still uncertainty regarding its effectiveness and safety. METHODS: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a metanalysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified ten systematic reviews, including two studies overall, which are randomized trials. We concluded that silver diamine fluoride compared to the atraumatic restorative technique may increase the arrest of caries in primary and mixed first phase dentition, however, the certainty of the evidence has been assessed as low. On the other hand, treatment with silver diamine fluoride compared to the atraumatic restorative technique (ART) probably increases the risk of adverse events.