CONTEXT: Systematic review evidence provides best justification for specific beliefs regarding clinical interventions. The degree of such belief depends on the precision and internal validity of the evidence. While precision is often achieved on basis of quantification and statistical analysis, the (internal) validity of the evidence is appraised through judgement of the risk for several known biases. Against the background of the subsequent results, a conclusion is formulated in answer t...
CONTEXT: Clinical knowledge, as any other type of knowledge, can be regarded as justified belief. The justification of belief follows two cognitive strategies: coherence of logic and correspondence of facts. PROBLEM: Coherence strategy has been traditionally favoured in the justification of beliefs concerning medical interventions throughout the centuries and is today still preferred by many clinicians as providing “logical sense” for or against the application of therapies, diagnostic...
BACKGROUND: This 3rd systematic review update includes evidence from further Chinese trials that were identified during reference re-check and regression analysis of the possible influence of split-mouth study design on overall results. REVIEW OBJECTIVE: This systematic review seeks to answer the question as to whether, in patients with carious cavities of any class in primary and permanent teeth, ART restorations with high-viscosity GIC have a higher failure rate than amalgam restorations...
BACKGROUND: This further systematic review update includes evidence from Chinese trials that were initially still under translation, as well as corrections of all identified errata. Atraumatic Restorative Treatment (ART) is a minimally invasive procedure that involves removing markedly softened carious enamel and dentine, using only hand instruments, and then restoring the resulting cavity with an adhesive restorative material. Although developed for use in the less industrialized parts o...
The following errors have been identified for: Mickenautsch S, Yengopal V. Failure rate of atraumatic restorative treatment using high-viscosity glass-ionomer cement compared to conventional amalgam restorative treatment in primary and permanent teeth: a systematic review update. J Minim Interv Dent 2012; 5: 63 – 124. These errors do not change its overall conclusion. Nonetheless, the corrections listed below should be taken into considerations when reading this particular systematic re...
CONTEXT: Selection bias interferes with the internal validity of clinical trials and leads to favouring one clinical outcome over another. In order to limit the influence of selection bias on clinical trials, the methodological interventions: random sequence generation and allocation concealment of such sequence have been proposed. Subsequently, authors of systematic reviews judge risk of selection bias in trials according to the reported details concerning how random sequence generation ...
BACKGROUND: Atraumatic restorative treatment (ART) is a minimally invasive procedure that involves removing markedly softened carious enamel and dentine, using only hand instruments, and then restoring the resulting cavity with an adhesive restorative material. Although developed for use in the less industrialized parts of the world ART has now been accepted as part of the minimum intervention (MI) dentistry philosophy in developed countries. Currently the restorative material of choice f...
CONTEXT: Selection bias interferes with the internal validity of clinical trials and leads to favoring one clinical outcome over another. Risk of selection bias is introduced when knowledge of certain patient characteristics, known to be conducive to the success of one particular intervention, is applied together with foreknowledge regarding the allocation of such patients in a specific sequence of interventions. PROBLEM: Selection bias testing has been proposed and recommended on basis of...
This protocol has been registered with the International Prospective Register for Systematic Reviews (PROSPERO) on the 05 January 2012 under registration number CRD42012001887 (Available online from http://www.crd.york.ac.uk/PROSPERO/full_doc.asp?ID=CRD42012001887). This protocol comprises an update of an existing systematic review report by the authors as part of the SYSTEM initiative: Mickenautsch S, Yengopal V, Banerjee A. Atraumatic restorative treatment versus amalgam restoration lon...
CONTEXT: Systematic reviews of clinical trials need to assess the risk of attrition bias as part of its appraisal of the currently available evidence to a particular review question. PROBLEM: Notwithstanding the possible merits of different approaches to estimate the potential intervention outcomes of lost trial participants as the main reason for attrition bias, most remain arbitrary. SUGGESTED SOLUTION: Assuming a worst- and best-case scenario of intervention outcomes provides the certain...
CONTEXT: Systematic reviews aim to assess precision and internal validity of the current clinical evidence. The precision and internal validity of clinical evidence is limited by the risk of biases, one of which is publication bias. Publication bias is created when trials, often with small sample size that have found negative or non-significant results are not being published and thus are not identified during systematic reviews as part of the of current clinical evidence. In that way, publ...
CONTEXT: Quantitative systematic reviews need to consider clinical, methodological and statistical heterogeneity of trials or datasets from trials before combining their results in meta-analyses, as combining results from heterogeneous datasets and/or trials will lead to meaningless results and thus should be avoided. Potential statistical heterogeneity between trials/datasets that have been considered as being clinically/methodologically homogeneous is usually investigated using I2 – t...
The success of tooth restorations rendered according to principles of the Atraumatic Restorative Treatment (ART) approach is dependant on various clinical factors. The most common failures, due to these factors, are partial material loss; complete material loss; caries related to restoration margin and material wear > 0.5mm. The main reason for clinical ART failures are related to operator skills and performance. The prevention and management of ART failures includes emphasis on correct cl...
Objective: To investigate potential barriers to the utilisation of the ART approach in a South African public oral health service. Method: 7 barriers were identified: patient load/work load, operator opinion, patient opinion, service management, material supply, clinical ART skill, chair-side assistance. Operators were asked to answer a questionnaire one year after completing the ART training. Responses ranged from 1 = no barrier to 5 = highest barrier. Treatment data per operator were co...
Objective: To appraise existing evidence for a therapeutic / anti-cariogenic effect of sugar-free chewing gum for patients. Method: 9 English and 2 Portuguese databases were searched using English and Portuguese keywords. Relevant articles in English, German, Portuguese and Spanish were included for review. Trials were excluded on lack of randomisation, control group, blinding and baseline data, drop out rate >33%, no statistical adjustment of baseline differences and no assessment of clin...