New Cochrane Oral Health Group publications in the new edition of the Cochrane Library

Issue 4 of the Cochrane Library for 2013 has been published and features one update, one new review and one new protocol from the Oral Health Group. Follow the links to read more!


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Updated review:
Initial arch wires for tooth alignment during orthodontic treatment with fixed appliances
Fan Jian, Wenli Lai, Susan Furness, Grant T McIntyre, Declan Millett, Joy Hickman, Yan Wang

Over recent years a number of new materials (various metal alloys, or mixtures, of nickel and titanium (NiTi)) have been developed which manufacturers claim offer benefits in terms of tooth alignment. Clinical trials of these products in people undergoing orthodontic treatment are required to understand whether different types of initial arch wires actually result in important differences, such as faster alignment, reduced pain or reduced side-effects, during orthodontic treatment. The Cochrane Oral Health Group undertook this review of existing studies to identify and assess the evidence for the effects of initial arch wires of different materials, shape and size of cross-section for alignment of teeth with fixed orthodontic braces in relation to alignment speed, root resorption and pain intensity. 9 trials were included, with 571 participants.

Interventions for treating traumatised permanent front teeth: luxated (dislodged) teeth
Flavia M Belmonte, Cristiane Macedo, Peter F Day, Humberto Saconato, Virginia Fernandes Moça Trevisani

Traumatic injuries to upper front teeth in children and young adults are common. The Cochrane Oral Health Group conducted this review to look at interventions to treat the front permanent (adult) tooth or teeth when they have been displaced from their original position following injury. This review does not include teeth that have been completely knocked out (avulsion). No studies were identified which met the inclusion criteria.

New protocol:
Interventions for the management of taste disturbances
Nagraj Sumanth Kumbargere, Yedthare Shetty Naresh, Kandula Srinivas, P Renjith George, Ashish Shrestha, David Levenson, Debra M Ferraiolo

A protocol for a new Cochrane review which will focus on randomized controlled trials of any pharmacological or non-pharmacological agent which aims to improve taste acuity in patients with taste disorders.

Other highlights of the Cochrane Library, Issue 4, 2013 include:

This month’s edition also features three editorials:

Updated Oral Health Group reviews in Issue 3, 2013 of the Cochrane Library

Issue 3, 2013 of the Cochrane Library features three review updates and two new protocols from the Cochrane Oral Health Group.


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Review update:
Interventions for replacing missing teeth: different times for loading dental implants
Marco Esposito,  Maria Gabriella Grusovin, Hassan Maghaireh, Helen V Worthington

When people have dental implants in their jaws, they usually wait several months for the bone around the implants to heal before artificial teeth are attached to the implant. During this period they use removable dentures. This review looked at the effects of attaching artificial teeth either the same day that the implant was placed, or early (after only 6 weeks) compared to the usual delay of at least 3 months. 26 clinical trials were included, featuring a total of 1217 participants. Follow the link to read the conclusions…

Review update:
Operative caries management in adults and children
David Ricketts, Thomas Lamont, Nicola PT Innes, Edwina Kidd, Jan E Clarkson

Tooth decay (dental caries) is a common problem around the world. It can cost a lot of money to treat and causes infection, pain and the loss of teeth. Tooth decay can be controlled by what are known as ‘non-operative’ methods which include cleaning plaque from teeth thoroughly, advising a healthy diet and using fluoride to prevent the decay getting worse. If the decay progresses these ‘non-operative’ techniques may need to be combined with ‘operative’ management which involves filling and restoring teeth where the holes caused by decay prevent cleaning. The fillings will improve the appearance of the teeth and allow the patient to clean them.  Traditionally dentists have removed all of the decay with a dental drill or instruments before a filling is placed. However, removal of all the decay has some disadvantages, including damage to the nerve of the tooth, toothache and possibly weakening of the tooth structure. This method is known as one step complete caries removal. Despite the large number of fillings and restorations placed worldwide on a daily basis, dentists remain uncertain as to which is the best ‘operative management’ strategy for tooth decay. This review included 8 clinical trials with 934 participants.

Review update:
Sealants for preventing dental decay in the permanent teeth
Anneli Ahovuo-Saloranta, Helena Forss, Tanya Walsh, Anne Hiiri, Anne Nordblad, Marjukka Mäkelä, Helen V Worthington

This review update  considers whether dental sealants are an effective preventative treatment for tooth decay. Dental sealants are intended to prevent the growth of bacteria that promote tooth decay in grooves of back teeth. Sealants are applied onto these grooves by a dentist or by another member of the dental care team. There are several sealant materials available, the main types in use are resin-based sealants and glass ionomer cements. This review summarised information from 34 separate studies involving 6529 young people to whom a variety of dental sealants were used for preventing caries and found evidence that applying sealants to the biting surfaces of the back teeth reduces caries when compared to not using sealants.

New protocol:
Enamel matrix derivative for periodontal regeneration in teeth with furcation involvement
Brian Stevenson, David Ricketts, Joseph LY Liu

This review aims to examine the effects of enamel matrix derivative in the treatment of teeth with furcation involvement and to compare it’s effectiveness with the various guided tissue regeneration procedures used in the treatment of these teeth.

New protocol:
Proximal sealing for managing dental decay in primary and permanent teeth
Mojtaba Dorri, Stephen M Dunne, Wael Sabbah, Bahar Kiani

The primary objective of this review is to evaluate the effects of proximal sealing in managing dental decay in primary and permanent dentition in children and adults.

Other highlights of the Cochrane Library, Issue 3, 2013 include:

3 editorials:

Highlighted reviews:

New edition of the Cochrane Library is out today!

A new edition of the Cochrane Library has been published, and features one new review and 5 new protocols from the Oral Health Group, a bumper month!

New review: AntibioticsImage to prevent complications following tooth extraction
Giovanni Lodi, Lara Figini, Andrea Sardella, Antonio Carrassi, Massimo Del Fabbro, Susan Furness

This review looks at whether antibiotics, given to dental patients as part of their treatment, prevent infection after tooth extraction. There were 18 studies considered, with a total of 2456 participants who received either antibiotics (of different kinds and dosages) or placebo, immediately before and/or just after tooth extraction. Do they do more harm than good? Follow the link to read more!

New Protocol: Clinical assessment to screen for the detection of oral cavity cancer and potentially malignant disorders in apparently healthy adults
Tanya Walsh, Joseph LY Liu, Paul Brocklehurst, Mark Lingen, Alexander R Kerr, Graham Ogden, Saman ImageWarnakulasuriya, Crispian Scully

This is a protocol for the Oral Health Group’s first review of diagnostic test accuracy, a new area of research for the Group. The objective of this review is to estimate the accuracy of the conventional oral examination (COE) used singly or in combination with another index test as a screening test for the detection of oral cancer and potentially malignant disorders (PMD) of the lip and oral cavity of apparently healthy adults.

New Protocol: Interventions for replacing missing teeth: alveolar ridge preservation techniques for oral implant site development
Momen A Atieh, Nabeel HM Alsabeeha, Alan GT Payne, Warwick Duncan, Marco Esposito

A protocol for a new review. The aim is to assess the clinical effects of various materials and techniques for alveolar ridge preservation (ARP) after tooth extraction compared with extraction alone and/or other methods of ARP for patients requiring oral implant placement following healing of extraction socket.

ImageNew Protocol:Lasers for caries removal in deciduous and permanent teeth
Alessandro Montedori, Iosief Abraha, Massimiliano Orso, Potito Giuseppe D’Errico, Stefano Pagano, Guido Lombardo

This protocol is for a new review which will compare the effects of laser-based methods to conventional mechanical methods for the removal of dental caries in deciduous and permanent teeth.

New Protocol: Maternal consumption of xylitol for preventing dental decay in children
Derek Richards, Brett Duane, Andrea Sherriff

Protocol for a new review. The aim is to evaluate the effects of xylitol (consumed by mothers) at reducing tooth decay in their children compared with alternative treatments (e.g. chlorhexidine, fluoride varnish, placebo, or no treatment).

New Protocol: Orthodontic treatment for bimaxillary proclination in children and adults
Padhraig S Fleming, Nikolaos Pandis, Zbys Fedorowicz, Reshma A Carlo, Jadbinder Seehra

This new protocol is for a Cochrane review which will assess the effects of different types of orthodontic treatment for bimaxillary proclination particularly their impact on occlusal results, facial outcomes and patient experiences.

Other highlights of the Cochrane Library, Issue 11, 2012:

There is also an editorial on Measuring the Performance of the Cochrane Library.

New edition of the Cochrane Library features one new protocol from the Cochrane Oral Health Group

The latest edition of the Cochrane Library has been published, including a new Oral Health Group protocol:

Systemic antibiotics for symptomatic apical periodontitis and acute apical abscess in adults
Anwen Cope, Nick Francis, Fiona Wood, Mala K Mann, Ivor G Chestnut

This is a protocol for a new Cochrane review. The review will evaluate the effects of systemic antibiotics for apical periodontitis and apical abscess in adults by comparing participant reported measures of pain and swelling, or clinician reported measures of infection.

Other highlights of the Cochrane Library, Issue 10 2012, include:

Also featured is an editorial on General health checks for reducing morbidity and mortality from disease.

Cochrane Bias Methods Group: presentations available

The Cochrane Bias Methods Group has made four presentations available for viewing on their website. The presentations are from the Annual Methods Training Event held in Loughborough UK in March 2012.

Topics included:

  • Identifying and getting consistency on good practice Risk of Bias ratings – including useful examples of high and low risk papers
  • Developing areas of methods, such as outcome reporting bias
  • Reaching overall judgements and incorporating risk of bias into analysis
  • Establishing a Bias Methods Network, linking entity representatives with an interest in implementing Risk of Bias assessment in reviews.

The Bias Methods Group is one of 16 Cochrane Methods Groups world-wide comprised of individuals with an interest and expertise in the science of systematic reviews. This group strives to raise awareness of the problem of bias and is exploring important questions with respect to the epidemiology of research results and outcomes. It was established in 2001, recognizing that a deeper understanding of bias was required so that previously published systematic reviews and meta-analyses could be evaluated, and evidence-based guidelines for the conduct of future reviews and meta-analyses be developed. Read more on their website.

The new edition of the Cochrane Library for July 2012 is out today!

The July 2012 edition of the Cochrane Library has been published and features two new protocols from the Cochrane Oral Health Group:

Chlorhexidine versus topical fluoride treatment for the prevention and management of dental caries in children and adolescents
Joerg Eberhard, Tobias Sandmann, Valeria CC Marinho, Henrik Dommisch, Sören Jepsen, Meike Stiesch, Werner Geurtsen

 A protocol for a new review which will consider how topical chlorhexidine compares with topical fluoride on all tooth surfaces in children and adolescents in the prevention and management of tooth decay. The treatment could be a varnish, toothpaste, mouth rinse, gel, spray or chewing gum. The review and results will be published soon!

Direct versus indirect bonding for bracket placement in orthodontic patients
Wenya Huang, Fan Jian, Wenli Lai, Wen Li, Declan T Millett, Grant T McIntyre, Zhihe Zhao, Yan Wang, Zongdao Shi, Taixiang Wu, Guan J Liu, Joy Hickman, Amit Arora

This protocol sets out the methodology for a new review on bonding in placing brackets in orthodontic treatment. It will consider whether directly bonding braces to the teeth is more effective than indirect bonding,  i.e. placing brackets on a plaster model of the patient’s teeth first for adjustment and then transferring to the mouth via a tray.

Other highlights of the Cochrane Library, Issue 7, 2012 include:

Screening studies for elibility for a Cochrane review: what authors need to know

After the searches have taken place, the next step is for authors to screen the results for eligibility for inclusion in the review.

The Oral Health Group strongly advises using a reference management software package to manage and keep track of results. For example, EndNote is a useful tool which allows import of references directly into RevMan. Many of these software packages (including EndNote) require a subscription but may be available at authors’ institutions. There are some free packages available (eg Zotero, designed to work with the Firefox browser) but these have more limited functionality than subscription versions.

References should be imported in the reference management software and merged to remove duplicates; Anne will screen for duplicates but it is possible that some might be missed.

According to the Cochrane Handbook (Section 7.2.3), the process should then be as follows:

  • Examine titles and abstracts to remove obviously irrelevant reports (authors should generally be over-inclusive at this stage).
  • Retrieve full text of the potentially relevant reports.
  • Link together multiple reports of the same study.
  • Examine full-text reports for compliance of studies with inclusion criteria of the review (please note however, that for most reviews, the absence of one or more relevant outcomes, or outcome data not in the desired format, is NOT a valid reason for excluding a study)
  • Correspond with investigators, where appropriate, to clarify study eligibility (it may be appropriate to request further information, such as missing results, at the same time).
  • Make final decisions on study inclusion and proceed to data collection.

It is most important that the final selection of studies into the review is undertaken by more than one author (Cochrane Handbook, Section 7.2.4).

(From the Cochrane Handbook, Section 7.2.4) Disagreements about whether a study should be included can generally be resolved by discussion. Often the cause of disagreement is a simple oversight on the part of one of the review authors. When the disagreement is due to a difference in interpretation, this may require arbitration by another person. Occasionally, it will not be possible to resolve disagreements about whether to include a study without additional information. In these cases, authors may choose to categorize the study in their review as one that is awaiting assessment until the additional information is obtained from the study authors.

(From the Cochrane Handbook, Section 7.2.4). The methods section of both the protocol and the review should detail:

  • which author(s) examine each title and abstract to discard obviously irrelevant reports;
  • whether those who examine each full-text report to determine eligibility will do so independently (this should be done by at least two people);
  • whether the decisions on the above are made by content area experts, methodologists, or both;
  • whether the people assessing the relevance of studies know the names of the authors, institutions, journal of publication and results when they apply the eligibility criteria; and
  • how disagreements are handled.

Jo Leese at the Editorial Base can be contacted to obtain full text papers, but only if the particular journal is not already available to the authors.

PRISMA Flowchart

All new Cochrane Reviews (not updated reviews) are required to have a PRISMA Flowchart. This can be generated by the RevMan software. It is a diagram to demonstrate how many studies have been assessed for eligibility at each stage of the screening process. Sections include:

  • Number of records found through database searching
  • Number of additional records found through other means
  • Number of records after duplicates removed
  • Number of records screened
  • Number of records discarded after assessment of title and abstract
  • Number of full text articles assessed for eligibility
  • Number of studies included
  • Number of studies excluded (listed in Excluded studies)

ONLY studies which, based on assessment of the full text report, do not meet the inclusion criteria for the review, should be listed in the Excluded Studies section.

(Cochrane Handbook, Section 7.2.5): “The list of excluded studies should be as brief as possible. It should not list all of the reports that were identified by a comprehensive search. It should not list studies that obviously do not fulfil the entry criteria for the review as listed under ‘Types of studies’, ‘Types of participants’, and ‘Types of interventions’, and in particular should not list studies that are obviously not randomized if the review includes only randomized trials.”

The list of excluded studies should not include in vitro studies, CCTs or any other study designs

Authors should therefore document the screening process carefully, and take note of the number of references and studies that they are dealing with at each stage.

If you have any questions about searching, or screening for eligibility, contact the Editorial Base.