Aristotle University of Thessaloniki, Greece
Aristotle University of Thessaloniki, Greece
* Corresponding author

Article Main Content

Introduction: Clinical decision making in dentistry is directly impacted by the systematic reviews available. The increasing number of systematic reviews along with their direct impact in clinical practice has emerged a need to assess their quality. Pulp capping is an important alternative to the more invasive interventions such as endodontic treatment and aims to preserve pulp tissue. The aim of this study is to methodologically assess the weaknesses of systematic reviews on pulp capping and provide recommendations on how to improve them.

Methods: An electronic literature search was conducted in Pubmed, Cochrane Library and Web of Science up to January 2022. Systematic reviews with or without meta-analysis including randomized and non-randomized studies on pulp capping were retrieved. A methodological assessment of their quality was performed using AMSTAR 2.

Results: A total of 203 publications were identified and reviewed for eligibility. Twenty-seven fulfilled the inclusion criteria. The reviews were assessed using AMSTAR 2 by two independent reviewers. The results were analyzed, and weaknesses were noted.

Conclusion: The study suggests an inconsistency in methods and structure in systematic reviews on pulp capping. Readers of the reviews should make use of AMSTAR 2 in order to evaluate their quality. Suggestions and weaknesses pinpointed can aid future systematic reviews to be more comprehensive with a more unified methodology.

References

  1. Murad MH, Asi N, Alsawas M, Alahdab F. New evidence pyramid. Evid Based Med. 2016; 21(4): 125-7.
     Google Scholar
  2. Mulrow CD. Rationale for systematic reviews. BMJ. 1994; 309(6954): 597-9.
     Google Scholar
  3. Wasiak J, Shen AY, Tan HB, Mahar R, Kan G, Khoo WR, et al. Methodological quality assessment of paper-based systematic reviews published in oral health. Clin Oral Investig. 2016; 20(3): 399-431.
     Google Scholar
  4. Nagendrababu V, Faggion CM Jr, Pulikkotil SJ, Alatta A, Dummer PMH. Methodological assessment and overall confidence in the results of systematic reviews with network meta-analyses in Endodontics. Int Endod J. 2022.
     Google Scholar
  5. Jayaraman J, Nagendrababu V, Pulikkotil SJ, Innes NP. Critical appraisal of methodological quality of Systematic Reviews and Meta-analysis in Paediatric Dentistry journals. Int J Paediatr Dent. 2018; 28(6): 548-560.
     Google Scholar
  6. Natto ZS, Hameedaldain A. Methodological Quality Assessment of Meta-analyses and Systematic Reviews of the Relationship Between Periodontal and Systemic Diseases. J Evid Based Dent Pract. 2019; 19(2): 131-139.
     Google Scholar
  7. Cushley S, Duncan HF, Lappin MJ, Chua P, Elamin AD, Clarke M, et al. Efficacy of direct pulp capping for management of cariously exposed pulps in permanent teeth: a systematic review and meta-analysis. Int Endod J. 2021; 54(4): 556-571.
     Google Scholar
  8. Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017; 358: j4008.
     Google Scholar
  9. Ismail AI, Bader JD; ADA Council on Scientific Affairs and Division of Science; Journal of the American Dental Association. Evidence-based dentistry in clinical practice. J Am Dent Assoc. 2004; 135(1): 78-83.
     Google Scholar
  10. Schiavo JH. PROSPERO: An International Register of Systematic Review Protocols. Med Ref Serv Q. 2019; 38(2): 171-180.
     Google Scholar
  11. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372: n71.
     Google Scholar
  12. Savović J, Jones H, Altman D, Harris R, Jűni P, Pildal J, et al.Influence of reported study design characteristics on intervention effect estimates from randomised controlled trials: combined analysis of meta-epidemiological studies. Health Technol Assess. 2012; 16(35): 1-82.
     Google Scholar
  13. Higgins JP, Ramsay C, Reeves BC, Deeks JJ, Shea B, Valentine JC, et al. Issues relating to study design and risk of bias when including non-randomized studies in systematic reviews on the effects of interventions. Res Synth Methods. 2013; 4(1): 12-25.
     Google Scholar
  14. Paez A. Gray literature: An important resource in systematic reviews. J Evid Based Med. 2017; 10(3): 233-240.
     Google Scholar
  15. Lexchin J. Sponsorship bias in clinical research. Int J Risk Saf Med. 2012; 24(4): 233-42.
     Google Scholar
  16. Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ. 2011; 343: d5928.
     Google Scholar
  17. Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019; 366: l4898.
     Google Scholar
  18. Sterne JAC, Higgins JPT, Reeves BC on behalf of the development group for ACROBAT-NRSI. A Cochrane Risk Of Bias Assessment Tool: for Non-Randomized Studies of Interventions (ACROBAT-NRSI), Version 1.0.0. [Internet] 2014. Available from: http://www.bristol.ac.uk/population-health-sciences/centres/cresyda/barr/riskofbias/robins-i/acrobat-nrsi/.
     Google Scholar


Most read articles by the same author(s)