Developing evidence-based dentistry skills: how to interpret randomized clinical trials and systematic reviews

Progress in Orthodontics, Oct 2014

Decision-making based on reliable evidence is more likely to lead to effective and efficient treatments. Evidence-based dentistry was developed, similarly to evidence-based medicine, to help clinicians apply current and valid research findings into their own clinical practice. Interpreting and appraising the literature is fundamental and involves the development of evidence-based dentistry (EBD) skills. Systematic reviews (SRs) of randomized controlled trials (RCTs) are considered to be evidence of the highest level in evaluating the effectiveness of interventions. Furthermore, the assessment of the report of a RCT, as well as a SR, can lead to an estimation of how the study was designed and conducted.

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Developing evidence-based dentistry skills: how to interpret randomized clinical trials and systematic reviews

Juliana Kiriakou 0 Nikolaos Pandis 2 Phoebus Madianos 1 Argy Polychronopoulou 0 0 Department of Preventive and Community Dentistry, School of Dentistry, University of Athens , 2 Thivon Str, P.O. Box 18018, Athens 115 27, Greece 1 Department of Periodontology, School of Dentistry, University of Athens , 2 Thivon Str, Athens 115 27, Greece 2 Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine/Medical Faculty, University of Bern , Freiburgstrasse 7 CH-3010, Bern, Switzerland Decision-making based on reliable evidence is more likely to lead to effective and efficient treatments. Evidence-based dentistry was developed, similarly to evidence-based medicine, to help clinicians apply current and valid research findings into their own clinical practice. Interpreting and appraising the literature is fundamental and involves the development of evidence-based dentistry (EBD) skills. Systematic reviews (SRs) of randomized controlled trials (RCTs) are considered to be evidence of the highest level in evaluating the effectiveness of interventions. Furthermore, the assessment of the report of a RCT, as well as a SR, can lead to an estimation of how the study was designed and conducted. - Review Introduction We live in the age of information, innovation, and change. The number of published studies in the dental literature increases dramatically every year. Clinicians are required to base their decisions on the best available research evidence by critically appraising and incorporating sound scientific evidence into everyday clinical practice [1]. The clinicians' difficulty of staying current can be facilitated by integrating basic skills of evidence-based dentistry (EBD), such as the ability to identify and critically appraise evidence, into everyday practice [2]. Defining evidence-based dentistry The practice of evidence-based dentistry consists in dentists critically applying relevant research findings to the care of patients [3]. The American Dental Association (A.D.A.) defines evidence-based dentistry as an approach to oral health care that requires the judicious integration of systematic assessments of clinically relevant scientific evidence, relating to the patient's oral and medical condition and history, with the dentist's clinical expertise and the patient's treatment needs and preferences. Evidence-based dentistry is based on three important domains: the best available scientific evidence, dentist's clinical skills and judgment, and patient's needs and preferences. Only when all three are given due consideration in individual patient care is EBD actually being practiced [4]. Why is evidence-based dentistry important? Practicing evidence-based dentistry reassures the quality improvement of health-care delivery by incorporating effective practices, while eliminating those that are ineffective or inappropriate [5]. The main advantage of EBD is that, in fact, it uses significant findings obtained from large clinical trials and systematic reviews and applies them to the individual patient's needs. In this way, clinicians are able to deliver more focused treatment, while patients receive optimal care [6]. The five steps of evidence-based dentistry practice The practice of EBD involves five essential steps [4,7,8]: 1. Developing a clear, clinically focused question 2. Identifying, summarizing, and synthesizing all relevant studies that directly answer the formulated question 3. Appraising evidence in terms of validity and applicability 4. Combining research evidence with clinical expertise and patients characteristics 5. Assessing the successful implementation of previous steps Choosing the best form of evidence Some research designs are more effective than others in their ability to answer specific research questions. Rules of evidence have been established to grade evidence according to its strength, giving rise to the concept of hierarchy of evidence. The hierarchy provides a framework for rating evidence and indicates which study types should be given more weight when assessing the same question [9]. At the top of the hierarchy, we find high-quality systematic reviews of randomized controlled trials, with or without meta-analysis together with randomized controlled trials (RCTs) of very low risk of bias (Table 1) [10]. Classification of studies based on research design Clinical research can be either observational or experimental. In observational studies, the investigator observes patients at a point in time or over time, without intervening. They may be cross-sectional, providing a snapshot picture of a population at a particular point in time, or longitudinal, following the individuals over a period of time. Observational studies may also be prospective, when the data are collected forward in time from the beginning of the study, or retrospective, in which the information is obtained by going backwards in time [11,12]. The most common types of observational studies are: (...truncated)


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Juliana Kiriakou, Nikolaos Pandis, Phoebus Madianos, Argy Polychronopoulou. Developing evidence-based dentistry skills: how to interpret randomized clinical trials and systematic reviews, Progress in Orthodontics, 2014, pp. 58, Volume 15, Issue 1, DOI: 10.1186/s40510-014-0058-5