Faculty Bibliography

Data sourcesMedline, Web of Science and Scopus were searched using a unique search strategy.Study selectionTwo authors independently reviewed and selected Clinical Trials, Randomised Clinical trials and Controlled Trials assessing the efficacy on primary dentition of Carisolv compared to traditional caries removal with drilling instruments. Only studies where total caries removal in each group was completed using Carisolv systems or rotary instruments used without any time limit were considered suitable. Studies assessing the complete caries removal by different methods from the clinical criteria selected (ie using a sharp probe) were excluded.Data extraction and synthesisThe outcomes considered for the review were: the caries removal rate (binary yes/no), the time required to complete the tissue removal (continuous) and the pain threshold during the procedure, assessed through the need for local anaesthesia by the patients (binary yes/no).For dichotomous data Odds Ratio (OR) was calculated along with 95% Confidence intervals (CIs) and for continuous data, the Mean Difference (MD) with 99% Confidence Intervals (CIs) was calculated. Meta-analysis was performed with studies analysing the same outcomes.ResultsFrom 195 studies identified, 28 were analysed. Ten met eligibility criteria. The trials included involved a total of 348 patients for 532 treated teeth. Three studies evaluated clinical efficacy in caries removal. When the data were collected in a meta-analysis no statistically significant difference was observed in regard of the clinical efficacy between Carisolv and the rotary instruments (p= 0.50, OR= 0.33 95% CI 0.01-8.22).In seven studies the length of time to perform the procedures was evaluated and data analysis demonstrated a statistically significant difference (p < 0.01, MD 310.92, 99 % CI 234.57- 387.27) with the Carisolv system, which required a greater amount of time than the conventional drill technique. With regard to pain threshold, a near statistically significant difference was found (p=0.06, OR=0.09 95% CI 0.01-1.07) with less anaesthesia required by patients treated using the Carisolv system technique.ConclusionsThe systematic review indicates that the clinical efficacy of chemo-mechanical removal with Carisolv seems as reliable as with rotary instruments. However, the results should be interpreted cautiously due to the hetero-geneity among study designs and to the shortage of available data. Further large-scale, well-designed randomised controlled trials are needed.

Data sourcesAn electronic search was conducted on PubMed Central. References of retrieved papers and previously published systematic reviews were hand searched.Study selectionRandomised controlled trials (RCTs) with at least six months follow-up evaluating the use of test products used in mouthrinses, toothpastes or gels as adjuncts to mechanical oral hygiene (including toothbrushing) were considered.Data extraction and synthesisTwo trained and calibrated reviewers independently assessed the studies for eligibility, with any disagreement being resolved by discussion. Two reviewers under the supervision of a third reviewer extracted data. Risk of bias was evaluated using the Cochrane risk of bias tool and the CONSORT statement. Outcomes were summarised as means and standard deviation (SD) or standard error (SE), the results were pooled and analysed using weighted mean differences (WMD), and heterogeneity among the studies was calculated.ResultsEighty-seven articles with 133 comparisons were included in the review. A majority of the studies (75) were considered to be at high risk of bias, eight at unclear risk and four at low risk. Fifteen different categories of active agent were used in toothpastes and ten in mouthwashes. The additional effects of the tested products were statistically significant for the Loe & Silness gingival index (46 studies), WMD -0.217, the modified gingival index (23 studies) - 0.415, gingivitis severity index (26 studies) - 14.939% or bleeding index (23 studies) - 7.626% with significant heterogeneity. For plaque, additional effects were found for Turesky (66 studies) W

Data sourcesElectronic Databases searched in PubMed, Embase and Scopus. Unpublished literature was traced through OpenSIGLE, annals of IADR/AADR (International and American Associations for Dental Research) and ORCA (European Organisation for Caries Research) from 2003-2014. Studies were limited to English.Study selectionStudies involving visual inspection for detection of primary coronal caries lesions in primary or permanent human teeth were considered. All papers needed to include a clearly defined reference standard and the reporting of absolute numbers of true positives, false positives, true negatives and false negatives or a presentation of sufficient data to calculate these figures. Reference methods considered appropriate were histologic evaluation, operative intervention, direct visual inspection after temporary tooth separation and radiography. For studies with the same data set only the most complete study was included. Articles that reported caries detection using artificial caries, root caries or recurrent decay adjacent to restorations were excluded.Data extraction and synthesisStudy selection for inclusion was performed independently by two reviewers and disagreements were resolved by discussion with a third reviewer. Data were collected by two reviewers on structured tables. Discrepancies were resolved by consensus. A meta-analysis was performed. The following information was extracted; reference standard method, setting (clinical or laboratory), type of teeth (primary or permanent), surface evaluated (smooth, proximal or occlusal), sample size, examiner's experience. Also recorded were visual scoring systems. Studies that did not report any criteria were classified as 'with no criteria'. If authors used criteria with no reference to previously published studies they were classified as 'own criteria'. The PRISMA guideline was followed to report the review and the QUADAS-2 checklist (Quality assessment of studies of diagnostic performance included in systematic reviews) was used to assess the risk of bias of the included studies.ResultsData were used to calculate the pooled sensitivity, specificity, diagnostic odds ratio and summary receiver operating characteristics curve. Heterogeneity of the studies was also assessed. A total of 102 manuscripts and one abstract were included. The analysis demonstrated that the visual method had good accuracy for detecting carious lesions. Clinically obtained specificity was higher. Also observed was moderate to high heterogeneity and evidence of publication bias. Studies employing well known visual scoring systems were significantly more accurate than those that used their own criteria. The results were grouped and differentiate the type of dentition (permanent or primary), type of lesion (initial or advanced), proximal or occlusal surface and clinical settings from laboratory settings.The pooled specificity calculated was high in most of the groups and ranged from 0.573 to 0.992 mostly > 0.90; the lowest was in the occlusal initial caries lesions in primary teeth.The sensitivity ranged from 0.274 to 0.77; the lowest from clinical studies in proximal surfaces in permanent teeth, the highest from three studies evaluating the occlusal initial caries lesions in permanent teeth. Most of the pooled sensitivities were around a low level.ConclusionsVisual caries detection method has good overall performance. Although the studies together had high heterogeneity and risk of bias, the use of detailed and validated indices seems to improve the accuracy of the method.

Data sourcesMedline, Embase, Cochrane Central and grey literature, complemented by cross-referencing from bibliographies. Diagnostic reviews were searched using the Medion database.Study selectionStudies reporting on the accuracy (sensitivity/specificity) of radiographic detection of primary carious lesions under clinical (in vivo) or in vitro conditions were included. The outcome of interest was caries detection using radiographs. The study also assessed the effect of the histologic lesion stage and included articles to assess the differences between primary or permanent teeth, if there had been improvements recently due to technical advances or radiographic methods, or if there are variations within studies (between examiners or applied radiographic techniques).Data extraction and synthesisData extraction was done by one reviewer first, using a piloted electronic spreadsheet and repeated independently by a second reviewer. Consensus was achieved by discussion. Data extraction followed guidelines from the Cochrane Collaboration. Risk of bias was assessed using QUADAS-2. Pooled sensitivity, specificity and diagnostic odds ratios (DORs) were calculated using random effects meta-analysis. Analyses were performed separately for occlusal and proximal lesions. Dentine lesions and cavitated lesions were analysed separately.Results947 articles were identified with the searches and 442 were analysed full text. 117 studies (13,375 teeth, 19,108 surfaces) were included. All studies were published in English. 24 studies were in vivo and 93 studies were in vitro. Risk of bias was found to be low in 23 and high in 94 studies. The pooled sensitivity for detecting any kind of occlusal carious lesions was 0.35 (95% CI : 0.31/40) and 0.41 (0.39/0.44) in clinical and in vitro studies respectively while the pooled specificity was 0.78 (0.73/0.83) and 0.70 (0.76/0.84). For the detection of any kind of proximal lesion the sensitivity in the clinical studies was 0.24 (CI 0.21/0/26) and 0.43 (0.41/0.45) and the specificity was 0.97 (0.95/0.98) and 0.89 (0.88/0.90).With regard to the dentine lesions the sensitivities were 0.36 (0.24-0.49) for proximal to 0.56 (0.53-0.59) for occlusal lesions and specificities ranged between 0.87 (0.85-0.89) and 0.95 (0.94-0.96). No reports were found for cavitated occlusal lesions. For proximal lesions sensitivities were above 0.60 and sensitivities above 0.90. Diagnostic Odds Ratios (DOR) were >1 (indicates a useful test) and were higher in proximal than in occlusal lesions. The DOR calculated for proximal lesions in vitro studies was 16.0 (11.5/22.4) and DOR 7.5 (3.4/16.5) for clinical studies). Heterogeneity calculated using I(2) test was moderate: > 50-67%.ConclusionsCaries detection determined by dental radiographs is highly accurate for proximal lesions and dentine caries lesions. For initial carious lesions the test needs to be used with other more sensitive methods in populations that present with high caries risk.

Data sourcesThe electronic databases searched included: PubMed/MEDLINE, Cochrane Central Register of Controlled Trials (Central) and Web of Science until June 2015. There was no restriction to language and the reference lists from relevant studies were searched for further articles.Study selectionRandomised and prospective controlled trials that compared the effect of submucosal injection of dexamethasone with that of placebo after impacted third molar surgery in humans. Studies involving volunteers with decompensated metabolic disease were excluded.Data extraction and synthesisStudy selection, data extraction and quality assessment (risk of bias) were assessed by two reviewers. All disagreements were resolved through discussion. A meta-analysis was performed for all continuous variables (oedema, pain and trismus) when at least two of the studies analysed the same data type.ResultsEight studies involving a total of 476 patients of which six were included in the meta-analysis. All of the surgical procedures were performed on the lower molars, submucosal injections of dexamethasone were used in concentrations of 4 mg, 8 mg, or 10 mg, and saline was used as a control. Antibiotic medications were administered prophylactically before surgery or by continuous use after the procedure. Seven of the eight studies identified the impactions according to the Pell and Gregory Classification. Oedema was measured using facial contours of pre-established reference points. The meta-analysis presented a mean difference (MD) of -2.20 (95% CI -2.70 to -1.70), with a statistically significant difference favouring dexamethasone (P< 0.00001). Trismus (assessed using inter-incisal distance upon maximum opening) had a MD of -2.92 (95% CI -7.13 to 1.29) and showed no statistically significant difference between groups. Pain was assessed using both visual analogue scales and number of analgesic taken; however, only studies including a VAS were used for meta-analysis. Pain presented with a MD of -1.79 (95% CI -3.28 to -0.30) and showed a statistically significant difference favouring dexamethasone.ConclusionsThe review found moderate quality evidence that submucosal injections of dexamethasone reduced post-operative oedema and pain compared to a placebo following impacted third molar surgery. There was no significant difference, in regards to trismus, between placebo and dexamethasone.

Data sourcesMedline (via Pubmed), Embase, Web of Science, CENTRAL (The Cochrane Library), and the Chinese Biomedical Literature Database. Search strategy was limited to articles published in English and Chinese. No restriction applied to date of publication and a supplemental manual search was conducted by reviewing the reference lists for related paper and articles. Grey literature was also searched in ClinicalTrials.gov, the National Research Register, OpenGrey and the WHO's international clinical Trial Registry Platform.Study selectionRandomised controlled trials in humans with DH that compared topical CSPS in any modality and any concentration to a negative (placebo) control. The primary outcome was the DH pain response to routine activities or to thermal, tactile, evaporative or electrical stimuli, and the secondary outcome was the side effect of CSPS use including discomfort, oral hygiene deterioration or dental staining.Data extraction and synthesisStudy selection, data extraction and risk bias assessment were carried out in duplicate by two calibrated reviewers. Any disagreement was resolved via discussion after consulting a third reviewer. Mean differences (MDs) and standard deviations (SDs) were used to summarise data in studies with continuous outcomes. Heterogeneity was assessed using the I(2) test. Meta-analysis was performed when similarities were found among the included studies. The Grading of Recommendations Assessment Development and Evaluation (GRADE) System's Profiler was used to assess the quality of the body of the evidence.ResultsEleven trials were included comparing CSPS with a negative control. Four articles that focused on post-periodontal therapy were extracted as an independent analysis group. CSPS was used in topical administration with concentrations ranging from 2.5%-15%. Follow-up times ranged from 15 days to eight weeks. DH pain was elicited by tactile, evaporative or thermal stimuli. A 10 cm visual analogue scale (VAS) was the most commonly used for measurements. Five studies revealed a low risk of bias, one study had a high risk of bias and five studies had an unclear risk of bias. Seven of the studies were regarded as having a potential conflict of interest.For the primary outcome (DH) Subjects in the DH group (four studies) showed that toothpaste containing 5% CSPS was favoured compared with a negative control at almost every time point, however one study did not report a significant difference between these treatments at two weeks.The results from the from the grey literature (two studies) did not show significant differences between the CSPS and control groups and the results were not in agreement with the other studies.Another study observed effects of both 2.5% and 7.5% CSPS-containing toothpaste: 7.5% CSPS was more effective at relieving DH than a negative control, whereas no significant difference was found between 2.5% and the negative controls.For the secondary outcome (adverse events): six studies did not observe adverse reactions. The remaining studies reported minor adverse events, although most were not orally related.Toothpaste containing 5% CSPS versus negative control: the 5% CSPS-containing toothpaste showed a better desensitising effect at both two and six weeks regardless of the applied stimuli (evaporative, two weeks: MD = -0.68; 95% CIs = -1.15, -0. 20; I2 = 59%; evaporative, six weeks: MD = -1.69; 95% CIs = -1.86, -1.52; I2 = 42%; thermal, two weeks: MD = -0.59; 95% CIs = -1.33, 0.14; I2 = 84%; and thermal, six weeks: MD = -1.70; 95% CIs = -2.17, -1.23;I2 = 72%). The quality of evidence was categorised as 'moderate'.Prophylaxis paste containing 15% CSPS versus negative control: prophylaxis paste containing 15% CSPS showed a better desensitising effect on post-periodontal therapy DH pain than a negative control, immediately after prophylaxis and at four weeks, as determined using evaporative or tactile stimuli, and the results showed relatively low heterogeneity (evaporative, immediate: MD = -0.87; 95% CIs = -1.23, -0.51; I2 = 0%; evaporative, four weeks: MD = -0.93; 95% CIs = -1.11, -0.75; I2 = 41%; tactile, immediate: MD = -9.59; 95%CIs = -12.17, -7.01; I2 = 55%; and tactile, four weeks: MD = -8.34; 95% CIs = -10.87, -5.80; I2 =0%). The quality of evidence was classified as 'low'.The two studies that assessed patients' self-assessments of dentine sensitivity were not pooled because of clinical heterogeneity.ConclusionsThe majority of the studies included in the review found that sodium phosphosilicate was more effective than negative control at alleviating dentine hypersensitivity, used either as toothpaste to alleviate DH or as a prophylaxis paste to treat post-periodontal therapy DH. The review found moderate quality of evidence that 5% CSPS-containing toothpaste is effective for use as an at-home treatment to relieve DH. There is low quality evidence that prophylaxis paste containing 15% CSPS is favoured over a negative control at reducing post-periodontal therapy hypersensitivity. It remains unclear whether concentrations of more than 5% CSPS have increased risk of side effects. The results are based on a small number of clinical trials. Seven of the studies were industry or partially industry-sponsored.

DATA SOURCES/METHODS:An electronic search was performed in PubMed, Web of Science and the Cochrane Central Register of Controlled Trials up to February 2015. References of included studies were also searched. No language restrictions were applied. Study selection: Prospective, retrospective and randomised clinical trials that compared marginal bone loss and failure rates between smokers and non-smokers. Implant failure was considered as total loss of the implant. Studies with patients who had periodontal disease prior to treatment or who had metabolic diseases were excluded. DATA EXTRACTION AND SYNTHESIS/METHODS:Two reviewers were involved in the research and screening process and disagreements were resolved by discussion. The quality of the studies was analysed using the Newcastle-Ottawa scale for non-randomised clinical trials. Data extracted from the studies included, when available: follow up period, number of subjects, smoking status, number of implants placed, implant system, implant length and diameter, healing period, antibiotics and mouth-rinse use, marginal bone loss, failure rate and drop-outs. For binary outcomes (implant failure) the estimate of the intervention effect was expressed in the form of an odds ratio (OR) with the confidence interval (CI) of 95%. For continuous outcomes (marginal bone loss) the average and standard deviation (SD) were used to calculate the standardised mean difference with a 95% CI. Meta-analysis was performed for studies with similar outcomes, I(2) a statistical test was used to express the heterogeneity among the studies. Publication bias was explored as well. RESULTS:A total of 15 observational studies were included in the review. The number of participants ranged from 60 to 1727 and the average age was 52.5 years. The follow-up period ranged from eight to 240 months. The total number of implants placed was 5840 in smokers and 14,683 in non-smokers. The Branemak system, (Noble Biocare AB, Goteborg, Sweden), was the most commonly used implant system. There was a statistically significant difference in marginal bone loss favouring the non-smoking group (SMD 0.49, 95% CI 0.07-0.90). There was an increase in marginal bone loss in the maxillae of smokers compared to the mandible (SMD 0.40, 95% CI 0.24-0.55) and a statically significant difference in implant failure in favour of the non-smoking group OR 1.96, 95% CI 1.68-2.30. CONCLUSIONS:The risk of marginal bone loss and implant failure is increased in smokers compared to non-smokers, however, the results should be interpreted with caution since the data from the review are provided by retrospective and cohort studies.

DATA SOURCES/METHODS:Electronic searches were undertaken in PubMed/Medline, Web of Science, Cochrane Oral Health Group Trials Register as well as hand searching. STUDY SELECTION/METHODS:Clinical human studies, either randomised or not, providing outcome data for dental implant failure in smokers and non-smokers in any group of patients with no follow-up restrictions. Patients smoking a minimum of one cigarette a day were classified as smokers and implant failure was considered as the complete loss of the implant.Data extraction and synthesisThree authors independently participated in the inclusion criteria and disagreements were resolved by discussion. Quality assessment of the studies was performed using a scale to appraise observational studies. From the selected studies, data were extracted when available which included year of publication, study design, country, setting, number of patients, type of smokers, age, follow-up, days of antibiotic prophylaxis, failure, postoperative infection, marginal bone loss, implant surface, dental arch receiving implants, type of prosthetic rehabilitation and opposing dentition. For the meta-analysis, implant failure and postoperative infection were evaluated as dichotomous outcomes, while weighted mean differences were used for marginal bone loss as a continuous outcome. The statistical unit was the implant. Heterogeneity was calculated using I(2) test. RESULTS:From 1432 records identified, 107 publications were included in the review for the qualitative and quantitative synthesis. One hundred and four studies compared implant failure rates. From the total studies, the authors judged 85 to be of high quality and 22 of moderate quality. The meta-analysis for failure rate resulted in a statistically significant overall result of risk ratio (RR) of 2.23 (95% CI 1.96-2.53) heterogeneity of I(2): 51%. The meta-analysis of four studies evaluating the risk of postoperative infections in smokers presented a statistically significant result with an RR: 2.01, 95% CI 1.09-3.72, heterogeneity I(2): 0%, and the marginal bone loss had an overall statistically significant difference of MD 0.32, 95% CI 0,21-043; heterogeneity in this case was I(2): 95%. CONCLUSIONS:The insertion of implants in smokers affected the failure rates, the risk of postoperative infections, as well as the marginal bone loss. The results should be interpreted with caution due to the presence of uncontrolled confounding factors in the included studies.

Most of us assume that what we do, and teach, is evidence-based. The challenge is to insure that this is indeed the case. More to the point, how can we readily find the credible evidence we need to guide practice and teaching? And, can we differentiate high-quality evidence from less trustworthy reports? This paper presents a basic, three-step process for querying the literature, identifying levels of evidence, evaluating the evidence, and summarizes the early experiences of three dental schools in developing a curriculum that incorporates EBD and critical thinking.

This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects of interventions for: preventing or treating denture stomatitis; treating denture stomatitis.