Pub Date : 2025-11-12DOI: 10.1038/s41432-025-01186-9
Rafaella Rodrigues da Gama, Lucas Peixoto de Araújo, Evandro Piva, Leandro Perello Duro, Adriana Fernandes da Silva, Wellington Luiz de Oliveira da Rosa
The risk of bias (RoB) assessment is a critical aspect of systematic reviews, yet a lack of standardization in RoB criteria persists in the endodontic literature. This study aimed to evaluate the RoB tools used in systematic reviews (SRs) of in vitro endodontic studies to synthesize the most commonly employed criteria. A comprehensive search of five databases (PubMed, Embase, Web of Science, Scopus, and Cochrane Library) was conducted, identifying SRs with RoB evaluation. Data were extracted independently by two reviewers, focusing on the criteria used for RoB assessment. All SRs were categorized by main objective and the evaluation test. The study protocol was registered in the Open Science Framework ( https://osf.io/azd8u/ ). Of the 10,409 records initially identified, 142 systematic reviews (SRs) published between January 2018 and September 2024 met the inclusion criteria. These SRs employed 36 distinct RoB criteria, with the most common being blinding (40.9%), sample size (34.5%), adequate statistical analysis (31%), randomization (30.3%), and standardized sample preparation and handling (21.8%). Inconsistencies in the application of RoB criteria were evident, with many SRs employing tools adapted from clinical studies that were not fully suitable for the unique methodological requirements of in vitro research. Although some SRs attempted to adapt criteria from other studies, these adaptations often fell short of addressing the specific needs of in vitro studies. The absence of standardized tools compromises the reliability of current SRs and limits their comparability with future research. The observed inconsistencies in RoB assessments across SRs of in vitro endodontic studies highlight the critical need for a standardized tool specifically designed for this context. Such a tool should account for the methodological nuances of in vitro research, including the relevance of criteria like blinding and sample size calculation, to enhance the reliability, reproducibility, and overall relevance of future SRs.
目的：偏倚风险（RoB）评估是系统评价的一个关键方面，然而在牙髓学文献中仍然缺乏标准化的RoB标准。本研究旨在评估体外牙髓研究系统评价（SRs）中使用的RoB工具，以合成最常用的标准。方法：综合检索PubMed、Embase、Web of Science、Scopus、Cochrane Library等5个数据库，采用RoB评价法对ssr进行鉴定。数据由两位审稿人独立提取，重点关注用于RoB评估的标准。根据主要目标和评价方法对所有的SRs进行分类。研究方案已在开放科学框架（https://osf.io/azd8u/）中注册。结果：在最初确定的10409条记录中，2018年1月至2024年9月期间发表的142篇系统评价（SRs）符合纳入标准。这些SRs采用36个不同的RoB标准，其中最常见的是盲法（40.9%）、样本量（34.5%）、充分的统计分析（31%）、随机化（30.3%）和标准化的样品制备和处理（21.8%）。讨论：RoB标准应用的不一致性很明显，许多SRs采用的工具改编自临床研究，并不完全适合体外研究的独特方法学要求。尽管一些SRs试图适应其他研究的标准，但这些适应往往不能满足体外研究的特定需求。标准化工具的缺乏损害了当前SRs的可靠性，并限制了它们与未来研究的可比性。结论：在体外根管研究中观察到的不同SRs的RoB评估的不一致性突出了对专门为这种情况设计的标准化工具的迫切需要。这样的工具应该考虑到体外研究方法上的细微差别，包括盲法和样本量计算等标准的相关性，以提高未来SRs的可靠性、可重复性和总体相关性。
{"title":"Mapping risk of bias criteria in systematic reviews of in vitro endodontic studies: an umbrella review","authors":"Rafaella Rodrigues da Gama, Lucas Peixoto de Araújo, Evandro Piva, Leandro Perello Duro, Adriana Fernandes da Silva, Wellington Luiz de Oliveira da Rosa","doi":"10.1038/s41432-025-01186-9","DOIUrl":"10.1038/s41432-025-01186-9","url":null,"abstract":"The risk of bias (RoB) assessment is a critical aspect of systematic reviews, yet a lack of standardization in RoB criteria persists in the endodontic literature. This study aimed to evaluate the RoB tools used in systematic reviews (SRs) of in vitro endodontic studies to synthesize the most commonly employed criteria. A comprehensive search of five databases (PubMed, Embase, Web of Science, Scopus, and Cochrane Library) was conducted, identifying SRs with RoB evaluation. Data were extracted independently by two reviewers, focusing on the criteria used for RoB assessment. All SRs were categorized by main objective and the evaluation test. The study protocol was registered in the Open Science Framework ( https://osf.io/azd8u/ ). Of the 10,409 records initially identified, 142 systematic reviews (SRs) published between January 2018 and September 2024 met the inclusion criteria. These SRs employed 36 distinct RoB criteria, with the most common being blinding (40.9%), sample size (34.5%), adequate statistical analysis (31%), randomization (30.3%), and standardized sample preparation and handling (21.8%). Inconsistencies in the application of RoB criteria were evident, with many SRs employing tools adapted from clinical studies that were not fully suitable for the unique methodological requirements of in vitro research. Although some SRs attempted to adapt criteria from other studies, these adaptations often fell short of addressing the specific needs of in vitro studies. The absence of standardized tools compromises the reliability of current SRs and limits their comparability with future research. The observed inconsistencies in RoB assessments across SRs of in vitro endodontic studies highlight the critical need for a standardized tool specifically designed for this context. Such a tool should account for the methodological nuances of in vitro research, including the relevance of criteria like blinding and sample size calculation, to enhance the reliability, reproducibility, and overall relevance of future SRs.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"26 4","pages":"179-180"},"PeriodicalIF":2.3,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145502629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This systematic review evaluated experimental evidence on how incorporating flowable dental composites affects the bond strength of dental cementation. This systematic review, following PRISMA guidelines, assessed in vitro studies (2003–2025) on the effect of flowable composites on cementation bond strength using a comprehensive database search, QUIN Tool for bias assessment, Begg’s and Egger’s tests for publication bias, and random-effects meta-analysis with SMD and I² statistics. This systematic review included eight in vitro studies published between 2003 and 2025. The meta-analysis found no statistically significant differences among the various bond strength test methods. Although the shear bond strength (SBS) test demonstrated a significant effect, the high heterogeneity among studies limits the reliability of this result. Etchable ceramics showed favourable effect sizes, but again, the high heterogeneity reduces the certainty of this finding. No significant difference was observed between self-etch and self-adhesive resin cements; however, self-etch resin cements tended to perform better in terms of bond strength. Nevertheless, the substantial heterogeneity in both adhesive groups indicates notable variability across studies. For the dual-cured group, a statistically significant standardized mean difference was observed, suggesting a positive effect of the dual-cured luting cement compared to the light-cured luting cement. Flowable dental composites generally perform comparably to conventional resin cements, with dual-cured and self-etch resin cements showing a tendency toward improved bond strength. However, variability across studies limits the certainty of these results. Further standardized in vitro studies are needed to confirm these findings and guide clinical application.
{"title":"Bond strength of flowable dental composites in the cementation of indirect restorations: a systematic review and meta-analysis","authors":"Baharan Ranjbar Omidi, Soolmaz Heidari, Armin Izadpanah","doi":"10.1038/s41432-025-01187-8","DOIUrl":"10.1038/s41432-025-01187-8","url":null,"abstract":"This systematic review evaluated experimental evidence on how incorporating flowable dental composites affects the bond strength of dental cementation. This systematic review, following PRISMA guidelines, assessed in vitro studies (2003–2025) on the effect of flowable composites on cementation bond strength using a comprehensive database search, QUIN Tool for bias assessment, Begg’s and Egger’s tests for publication bias, and random-effects meta-analysis with SMD and I² statistics. This systematic review included eight in vitro studies published between 2003 and 2025. The meta-analysis found no statistically significant differences among the various bond strength test methods. Although the shear bond strength (SBS) test demonstrated a significant effect, the high heterogeneity among studies limits the reliability of this result. Etchable ceramics showed favourable effect sizes, but again, the high heterogeneity reduces the certainty of this finding. No significant difference was observed between self-etch and self-adhesive resin cements; however, self-etch resin cements tended to perform better in terms of bond strength. Nevertheless, the substantial heterogeneity in both adhesive groups indicates notable variability across studies. For the dual-cured group, a statistically significant standardized mean difference was observed, suggesting a positive effect of the dual-cured luting cement compared to the light-cured luting cement. Flowable dental composites generally perform comparably to conventional resin cements, with dual-cured and self-etch resin cements showing a tendency toward improved bond strength. However, variability across studies limits the certainty of these results. Further standardized in vitro studies are needed to confirm these findings and guide clinical application.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"26 4","pages":"178-179"},"PeriodicalIF":2.3,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145471024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-08DOI: 10.1038/s41432-025-01184-x
Celine Raseekaanthan, Pirashani Umassudan
Mohamed M H, Abouauf E A, Mosallam R S. Clinical performance of class II MOD fiber reinforced resin composite restorations: an 18-month randomized controlled clinical trial. BMC Oral Health 2025;25: 159. https://doi.org/10.1186/s12903-025-05521-5 . A double blinded 18-month randomised controlled trial was carried out to compare the clinical performance of fibre reinforced resin composites compared to conventional nanohybrid resin composites in restoring Class II MOD cavities. Participants were allocated to one of three groups: Group 1 with short glass fibre reinforced resin composite, Group 2 with polyethylene fibre reinforced resin composite and Group 3 with conventional nanohybrid resin composite. A principal investigator carried out the restorative procedures for all participants. Participants in the study were enrolled from the educational clinic in Cairo University, Egypt. A total of 45 participants with a mean age of 32.3 ± 7.3 years were included. All participants had class II MOD carious lesions in vital posterior teeth with ICDAS scores of 3,4 or 5. Additionally only those with good oral hygiene, a healthy periodontal status and normal occlusion were included. The study excluded pregnant patients, as well as those with systemic disease or evidence of parafunctional habits. Patients with hypersensitivity, allergy to materials used, secondary caries or delayed response to sensibility testing were also excluded. Outcomes were assessed by two examiners at the baseline and at the following time intervals: 3, 6, 12, 18 months using Modified USPHS criteria. The primary outcome assessed was marginal adaptation, followed by gross fracture, marginal discolouration, colour match and recurrent caries. The clinical significance was determined based on relative risk. The chi-Square test compared between groups with significance set at P ≤ 0.016, and Cochran’s Q test compared within groups with significance at P ≤ 0.005, both adjusted using Bonferroni correction. The study was conducted with a 95% confidence level and an 80% statistical power. The study had a 97.7% retention rate with all but one patient successfully completing the 18 month follow up period. Colour match was the only outcome that showed a statistically significant difference between the groups, with short glass fibre reinforced restorations displaying some colour discrepancies. Other outcomes such as marginal adaptation, marginal discoloration, recurrent caries and gross fracture showed no significant differences between groups. Age, gender and tooth distribution also showed no significant statistical differences. The clinical performance of fibre-reinforced resin composite restorations are similar and comparable to nanohybrid composite restorations over an 18-month duration. Short glass fibre-reinforced restorations displayed variations in colour match, indicating that aesthetic outcomes should be carefully considered.
Mohamed M H, Abouauf E A, Mosallam R s。ⅱ类MOD纤维增强树脂复合材料修复体的临床性能：18个月随机对照临床试验。BMC口腔健康2025；25: 159。https://doi.org/10.1186/s12903 - 025 - 05521 - 5。设计：进行了一项为期18个月的双盲随机对照试验，比较纤维增强树脂复合材料与传统纳米混合树脂复合材料在修复II类MOD腔中的临床性能。参与者被分配到三组中的一组：第一组使用短玻璃纤维增强树脂复合材料，第二组使用聚乙烯纤维增强树脂复合材料，第三组使用常规纳米混合树脂复合材料。一名首席研究员对所有参与者进行了修复程序。病例选择：研究的参与者来自埃及开罗大学的教育诊所。共纳入45名参与者，平均年龄为32.3±7.3岁。所有参与者都有II级MOD龋齿病变，ICDAS评分为3,4或5。此外，仅包括口腔卫生良好、牙周健康、咬合正常的患者。该研究排除了怀孕患者，以及那些有全身性疾病或有不良习惯的患者。对所用材料过敏、继发性龋齿或敏感性测试反应延迟的患者也被排除在外。数据分析：结果由两名审查员在基线和以下时间间隔进行评估：3、6、12、18个月，使用修改的USPHS标准。评估的主要结果是边缘适应，其次是大体骨折、边缘变色、颜色匹配和复发性龋齿。临床意义是根据相对风险来确定的。卡方检验组间比较P≤0.016，科克伦Q检验组内比较P≤0.005，均采用Bonferroni校正。该研究的置信度为95%，统计效力为80%。结果：该研究的保留率为97.7%，除1例患者外，其余患者均成功完成18个月的随访期。颜色匹配是两组之间唯一有统计学差异的结果，短玻璃纤维增强修复体显示出一些颜色差异。其他结果如边缘适应、边缘变色、复发性龋齿和大体骨折在两组间无显著差异。年龄、性别、牙齿分布差异无统计学意义。结论：在18个月的时间内，纤维增强树脂复合材料修复体的临床性能与纳米复合材料修复体相似且相当。短玻璃纤维增强修复体在颜色匹配上表现出变化，表明应该仔细考虑美学结果。
{"title":"Fibre or facade? Do fibre reinforced composites really hold up in Class II restorations?","authors":"Celine Raseekaanthan, Pirashani Umassudan","doi":"10.1038/s41432-025-01184-x","DOIUrl":"10.1038/s41432-025-01184-x","url":null,"abstract":"Mohamed M H, Abouauf E A, Mosallam R S. Clinical performance of class II MOD fiber reinforced resin composite restorations: an 18-month randomized controlled clinical trial. BMC Oral Health 2025;25: 159. https://doi.org/10.1186/s12903-025-05521-5 . A double blinded 18-month randomised controlled trial was carried out to compare the clinical performance of fibre reinforced resin composites compared to conventional nanohybrid resin composites in restoring Class II MOD cavities. Participants were allocated to one of three groups: Group 1 with short glass fibre reinforced resin composite, Group 2 with polyethylene fibre reinforced resin composite and Group 3 with conventional nanohybrid resin composite. A principal investigator carried out the restorative procedures for all participants. Participants in the study were enrolled from the educational clinic in Cairo University, Egypt. A total of 45 participants with a mean age of 32.3 ± 7.3 years were included. All participants had class II MOD carious lesions in vital posterior teeth with ICDAS scores of 3,4 or 5. Additionally only those with good oral hygiene, a healthy periodontal status and normal occlusion were included. The study excluded pregnant patients, as well as those with systemic disease or evidence of parafunctional habits. Patients with hypersensitivity, allergy to materials used, secondary caries or delayed response to sensibility testing were also excluded. Outcomes were assessed by two examiners at the baseline and at the following time intervals: 3, 6, 12, 18 months using Modified USPHS criteria. The primary outcome assessed was marginal adaptation, followed by gross fracture, marginal discolouration, colour match and recurrent caries. The clinical significance was determined based on relative risk. The chi-Square test compared between groups with significance set at P ≤ 0.016, and Cochran’s Q test compared within groups with significance at P ≤ 0.005, both adjusted using Bonferroni correction. The study was conducted with a 95% confidence level and an 80% statistical power. The study had a 97.7% retention rate with all but one patient successfully completing the 18 month follow up period. Colour match was the only outcome that showed a statistically significant difference between the groups, with short glass fibre reinforced restorations displaying some colour discrepancies. Other outcomes such as marginal adaptation, marginal discoloration, recurrent caries and gross fracture showed no significant differences between groups. Age, gender and tooth distribution also showed no significant statistical differences. The clinical performance of fibre-reinforced resin composite restorations are similar and comparable to nanohybrid composite restorations over an 18-month duration. Short glass fibre-reinforced restorations displayed variations in colour match, indicating that aesthetic outcomes should be carefully considered.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"26 3","pages":"144-145"},"PeriodicalIF":2.3,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-05DOI: 10.1038/s41432-025-01183-y
Mona Nasser
{"title":"We still need to bridge the gap","authors":"Mona Nasser","doi":"10.1038/s41432-025-01183-y","DOIUrl":"10.1038/s41432-025-01183-y","url":null,"abstract":"","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"26 3","pages":"121-122"},"PeriodicalIF":2.3,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41432-025-01183-y.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-28DOI: 10.1038/s41432-025-01185-w
Rosie Fletcher, Adam Jones
Sperotto F, France K, Gobbo M et al. Antibiotic prophylaxis and infective endocarditis incidence following invasive dental procedures: a systematic review and meta-analysis. JAMA Cardiol 2024; 9:599. https://doi.org/10.1001/jamacardio.2024.0873 . This systematic review evaluates the association between antibiotic prophylaxis (AP) and the incidence of infective endocarditis (IE) following invasive dental procedures (IDPs). A systematic search was conducted across PubMed, Cochrane-CENTRAL, Scopus, Web of Science, Proquest, and Embase, from inception to May 2023. Observational studies, including case-control, case-crossover, cohort, self-controlled case-series, and time-trend studies were included. Data were extracted independently, and structured tools were used to evaluate study quality. A random-effects meta-analysis estimated the pooled-relative risk (RR) of developing IE in high-risk subjects who received AP compared to those who did not. Of 11,217 identified records, 30 studies met inclusion criteria, comprising 1,152,345 IE cases. Among 12 relevant studies, five found a significant protective effect of AP in high-risk subjects. Four studies were combined in meta-analysis and showed AP was associated with a significantly lower IE risk in high-risk individuals (pooled-RR = 0.41, 95% CI: 0.29–0.57). No significant association was found for moderate- or low/unknown-risk subjects. Time-trend studies showed mixed results: some indicated increased IE incidence after AP guideline changes, while others found no change or a decrease. Despite limitations, this review provides an important update on AP use in preventing IE after IDPs. Evidence supports AP use for high-risk individuals, while data remain inconclusive for moderate-risk populations, highlighting the need for further research.
注：Sperotto F， France K， Gobbo M等。侵入性牙科手术后抗生素预防和感染性心内膜炎的发生率：一项系统回顾和荟萃分析。JAMA Cardiol 2024；9:599。https://doi.org/10.1001/jamacardio.2024.0873。目的：本系统综述评估了侵入性牙科手术（IDPs）后抗生素预防（AP）与感染性心内膜炎（IE）发生率之间的关系。材料和方法：系统检索PubMed、Cochrane-CENTRAL、Scopus、Web of Science、Proquest和Embase，检索时间从成立到2023年5月。观察性研究包括病例对照、病例交叉、队列、自控病例系列和时间趋势研究。数据独立提取，并使用结构化工具评估研究质量。一项随机效应荟萃分析估计了接受AP治疗的高危受试者与未接受AP治疗的受试者发生IE的综合相对风险（RR）。结果：在11,217份确定的记录中，30项研究符合纳入标准，包括1,152,345例IE病例。在12项相关研究中，有5项研究发现AP对高危人群有显著的保护作用。在荟萃分析中合并了四项研究，结果显示AP与高危人群显著降低IE风险相关（合并rr = 0.41, 95% CI: 0.29-0.57）。在中度或低风险/未知风险受试者中未发现显著相关性。时间趋势研究显示了不同的结果：一些研究表明在AP指南改变后IE发病率增加，而另一些研究发现没有变化或减少。结论：尽管存在局限性，但本综述为应用AP预防IDPs后IE提供了重要的更新。证据支持高危人群使用AP，而中等风险人群的数据仍不确定，这突出了进一步研究的必要性。
{"title":"Matters of the heart; antibiotic prophylaxis for prevention of infective endocarditis—are we getting it right?","authors":"Rosie Fletcher, Adam Jones","doi":"10.1038/s41432-025-01185-w","DOIUrl":"10.1038/s41432-025-01185-w","url":null,"abstract":"Sperotto F, France K, Gobbo M et al. Antibiotic prophylaxis and infective endocarditis incidence following invasive dental procedures: a systematic review and meta-analysis. JAMA Cardiol 2024; 9:599. https://doi.org/10.1001/jamacardio.2024.0873 . This systematic review evaluates the association between antibiotic prophylaxis (AP) and the incidence of infective endocarditis (IE) following invasive dental procedures (IDPs). A systematic search was conducted across PubMed, Cochrane-CENTRAL, Scopus, Web of Science, Proquest, and Embase, from inception to May 2023. Observational studies, including case-control, case-crossover, cohort, self-controlled case-series, and time-trend studies were included. Data were extracted independently, and structured tools were used to evaluate study quality. A random-effects meta-analysis estimated the pooled-relative risk (RR) of developing IE in high-risk subjects who received AP compared to those who did not. Of 11,217 identified records, 30 studies met inclusion criteria, comprising 1,152,345 IE cases. Among 12 relevant studies, five found a significant protective effect of AP in high-risk subjects. Four studies were combined in meta-analysis and showed AP was associated with a significantly lower IE risk in high-risk individuals (pooled-RR = 0.41, 95% CI: 0.29–0.57). No significant association was found for moderate- or low/unknown-risk subjects. Time-trend studies showed mixed results: some indicated increased IE incidence after AP guideline changes, while others found no change or a decrease. Despite limitations, this review provides an important update on AP use in preventing IE after IDPs. Evidence supports AP use for high-risk individuals, while data remain inconclusive for moderate-risk populations, highlighting the need for further research.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"26 3","pages":"141-143"},"PeriodicalIF":2.3,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41432-025-01185-w.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144948257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-08DOI: 10.1038/s41432-025-01182-z
Sviatlana Anishchuk, Aidan Seery
Empathy has an important role in the patient-clinician relationship. However, there is a risk of an emotional overabundance, which can lead to a burnout and exhaustion. The nature of its relationship is yet not clear. This study aims to investigate the relationship between empathy and burnout in dental undergraduate students. A systematic review was carried out in accordance with Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) using electronic searches on electronic databases: PubMed (PMC), Taylor and Francis, Google Scholar and EBSCO. The databases were examined for studies that were published in English language from 2012 to 2022. There were 2375 articles in total. The studies that only assessed empathy or burnout and targeted other than dental cohorts were excluded from the list. Any studies that were not in English language and had been published before 2012 were also excluded. As a result, only 2 studies were selected for further analysis. Based on this review it can be assumed that the level of burnout depends on the level of empathy in dental cohort students; low empathy can predict high burnout. However, further research is necessary to confirm this relationship.
目的：共情在医患关系中具有重要作用。然而，情绪过剩的风险是存在的，这可能会导致精疲力竭。二者关系的性质尚不清楚。本研究旨在探讨牙科大学生共情与职业倦怠的关系。方法：采用电子检索PubMed （PMC）、Taylor and Francis、谷歌Scholar和EBSCO等电子数据库，按照系统评价和荟萃分析首选报告项目（PRISMA）进行系统评价。数据库检查了从2012年到2022年用英语发表的研究。结果：共纳入文献2375篇。那些只评估同理心或倦怠的研究，以及针对牙科以外的人群的研究，被排除在名单之外。2012年之前发表的非英语研究也被排除在外。因此，仅选择2项研究进行进一步分析。结论：基于本综述，可以假设牙科队列学生的职业倦怠水平与共情水平有关；低同理心预示着高倦怠。然而，需要进一步的研究来证实这种关系。
{"title":"Examining the relationship between empathy and burnout in dental students: a systematic review","authors":"Sviatlana Anishchuk, Aidan Seery","doi":"10.1038/s41432-025-01182-z","DOIUrl":"10.1038/s41432-025-01182-z","url":null,"abstract":"Empathy has an important role in the patient-clinician relationship. However, there is a risk of an emotional overabundance, which can lead to a burnout and exhaustion. The nature of its relationship is yet not clear. This study aims to investigate the relationship between empathy and burnout in dental undergraduate students. A systematic review was carried out in accordance with Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) using electronic searches on electronic databases: PubMed (PMC), Taylor and Francis, Google Scholar and EBSCO. The databases were examined for studies that were published in English language from 2012 to 2022. There were 2375 articles in total. The studies that only assessed empathy or burnout and targeted other than dental cohorts were excluded from the list. Any studies that were not in English language and had been published before 2012 were also excluded. As a result, only 2 studies were selected for further analysis. Based on this review it can be assumed that the level of burnout depends on the level of empathy in dental cohort students; low empathy can predict high burnout. However, further research is necessary to confirm this relationship.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"26 4","pages":"178-178"},"PeriodicalIF":2.3,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41432-025-01182-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144803900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To assess the effectiveness of supervised toothbrushing programs in improving oral health outcomes among children and adolescents aged 3 to 18 years and to explore stakeholders’ perceptions in implementing and sustaining tooth brushing programs. This mixed-method umbrella review followed JBI methodology and PRISMA guidelines. A systematic search was conducted across databases including MEDLINE, Cochrane, Scopus, Web of Science, CINAHL, Epistemonikos, ProQuest, and Google Scholar. A total of 159 articles were identified, and after screening, three systematic reviews met the inclusion criteria. The quantitative and qualitative findings were synthesized using a convergent segregated approach. The Theoretical Domains Framework (TDF) was applied to map barriers and facilitators influencing program adoption and sustainability. The quantitative synthesis included one systematic review with four included trials, two of which found statistically significant reductions in dental caries with supervised toothbrushing. The qualitative synthesis (two mixed-method systematic reviews) revealed key facilitators and barriers. The most prominent enablers and barriers identified across these reviews were knowledge about oral health/tooth brushing, social influences, and environmental context and resources. Specifically, the knowledge domain received 32 enabler responses and 25 barrier responses, underscoring the importance of understanding oral health practices to improve toothbrushing behavior. Social support garnered 35 enabler responses and 26 barrier responses, highlighting the role of a supportive environment in enhancing adherence to toothbrushing routines. This review highlights the effectiveness of supervised toothbrushing programs in reducing dental caries. The qualitative synthesis, guided by the Theoretical Domains Framework (TDF), identifies key barriers and facilitators, including knowledge gaps, environmental constraints, social influences, and behavioural regulation factors.
目的：评估监督式刷牙计划在改善3至18岁儿童和青少年口腔健康结果方面的有效性，并探讨利益相关者对实施和维持刷牙计划的看法。方法：采用JBI方法学和PRISMA指南进行综合综述。系统检索了MEDLINE、Cochrane、Scopus、Web of Science、CINAHL、Epistemonikos、ProQuest和谷歌Scholar等数据库。共纳入159篇文献，经筛选，有3篇系统评价符合纳入标准。定量和定性的发现是综合使用收敛隔离的方法。理论领域框架（TDF）被用于绘制影响项目采用和可持续性的障碍和促进因素。结果：定量综合包括一项系统综述和四项纳入试验，其中两项发现在监督下刷牙可以显著减少龋齿。定性综合（两个混合方法的系统评价）揭示了关键的促进因素和障碍。在这些综述中发现的最突出的促进因素和障碍是关于口腔健康/刷牙的知识、社会影响、环境背景和资源。具体而言，知识领域收到了32个促进性回答和25个障碍性回答，强调了了解口腔健康实践对改善刷牙行为的重要性。社会支持获得了35个促成反应和26个障碍反应，突出了支持性环境在增强坚持刷牙习惯方面的作用。结论：本综述强调了监督刷牙计划在减少龋齿方面的有效性。在理论领域框架（TDF）的指导下，定性综合确定了主要障碍和促进因素，包括知识差距、环境约束、社会影响和行为调节因素。
{"title":"Supervised toothbrushing programs: evaluating impact, barriers, and facilitators – a mixed-method umbrella review","authors":"Chandrashekar Janakiram, Anju James, Sujay Vivek Vattiprolu, Nitika Monga, Monika Arora","doi":"10.1038/s41432-025-01178-9","DOIUrl":"10.1038/s41432-025-01178-9","url":null,"abstract":"To assess the effectiveness of supervised toothbrushing programs in improving oral health outcomes among children and adolescents aged 3 to 18 years and to explore stakeholders’ perceptions in implementing and sustaining tooth brushing programs. This mixed-method umbrella review followed JBI methodology and PRISMA guidelines. A systematic search was conducted across databases including MEDLINE, Cochrane, Scopus, Web of Science, CINAHL, Epistemonikos, ProQuest, and Google Scholar. A total of 159 articles were identified, and after screening, three systematic reviews met the inclusion criteria. The quantitative and qualitative findings were synthesized using a convergent segregated approach. The Theoretical Domains Framework (TDF) was applied to map barriers and facilitators influencing program adoption and sustainability. The quantitative synthesis included one systematic review with four included trials, two of which found statistically significant reductions in dental caries with supervised toothbrushing. The qualitative synthesis (two mixed-method systematic reviews) revealed key facilitators and barriers. The most prominent enablers and barriers identified across these reviews were knowledge about oral health/tooth brushing, social influences, and environmental context and resources. Specifically, the knowledge domain received 32 enabler responses and 25 barrier responses, underscoring the importance of understanding oral health practices to improve toothbrushing behavior. Social support garnered 35 enabler responses and 26 barrier responses, highlighting the role of a supportive environment in enhancing adherence to toothbrushing routines. This review highlights the effectiveness of supervised toothbrushing programs in reducing dental caries. The qualitative synthesis, guided by the Theoretical Domains Framework (TDF), identifies key barriers and facilitators, including knowledge gaps, environmental constraints, social influences, and behavioural regulation factors.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"26 4","pages":"176-177"},"PeriodicalIF":2.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144764802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-26DOI: 10.1038/s41432-025-01181-0
Lucy Bennett, Lucy Tiplady, Greig Taylor
Rokhshad R, Banakar M, Shobeiri, P, Zhang P. Artificial intelligence in early childhood caries detection and prediction: a systematic review and meta-analysis. Pediatr Dent. 2024;46:385–394. A literature search was performed in May 2024 via PubMed, Scopus, Embase, Web of Science, Institute of Electrical and Electronics Engineer database sources, and across the grey literature. Further studies were identified after analysis of reference lists. The research question was defined using the population-intervention-comparison-outcome (PICO) framework. Studies published between 2010 and 2024 were included, that used artificial intelligence (AI) algorithms including machine learning (ML), deep learning (DL) and neutral networks (NN) for detecting and predicting early childhood caries (ECC). Exclusion occurred where the full text was inaccessible and non-English papers. Two independent reviewers screened titles and abstracts, with the use of a third reviewer in the case of any disagreement. The process was then repeated with the full texts to assess eligibility, again with a third reviewer where necessary. A total of 21 studies were used in the final analysis following assessment, 7 of which described ECC detection, and 14 for ECC prediction. The extracted data included author, publication year, study objectives, data modalities, datasets, annotation procedures, follow ups, ML test, AI model architecture, outcome measures and evaluation metrics. The findings were summarised descriptively. Quantitative synthesis was performed on six studies that reported sensitivity and specificity. Summary receiver operator characteristic curves were used to assess discriminatory ability. Statistical analysis was completed. A total of 21 studies were included in the final analysis. It revealed that AI based methods, especially DL algorithms showed promising results in detecting ECC, with accuracy range of 78–86%, sensitivity of 67–96%, and specificity from 81–99%. ECC prediction had accuracy range of 60-100%, sensitivity of 20–100%, and specificity of 54–94%. The pooled sensitivity and specificity of these studies was 80% and 81% respectively, with confidence intervals of 95%, indicating statistically significant effects. AI has demonstrated substantial potential in the detection and prediction of ECC. Further research is required to refine the technology and establish its application in paediatric dentistry.
Rokhshad R, Banakar M, Shobeiri， P, Zhang P.人工智能在儿童早期龋齿检测和预测中的应用综述。儿科杂志。2024;46:385-394。数据来源：文献检索于2024年5月通过PubMed， Scopus, Embase, Web of Science， Institute of Electrical and Electronics Engineer数据库资源和灰色文献进行。在对参考文献进行分析后，确定了进一步的研究。研究问题采用人口-干预-比较-结果（PICO）框架定义。研究选择：纳入了2010年至2024年间发表的研究，这些研究使用人工智能（AI）算法，包括机器学习（ML）、深度学习（DL）和神经网络（NN）来检测和预测儿童早期龋齿（ECC）。排除发生在全文无法访问和非英文论文。两名独立审稿人筛选标题和摘要，如果有任何分歧，则使用第三名审稿人。然后对全文重复该过程以评估合格性，必要时再次由第三方审稿人进行审查。评估后的最终分析共有21项研究，其中7项研究描述了ECC检测，14项研究描述了ECC预测。数据提取和综合：提取的数据包括作者、出版年份、研究目标、数据模式、数据集、注释过程、随访、ML测试、AI模型架构、结果测量和评估指标。对调查结果进行了描述性总结。对六项报告敏感性和特异性的研究进行了定量综合。摘要接收者操作者特征曲线用于评估鉴别能力。完成统计分析。结果：最终分析共纳入21项研究。结果表明，基于AI的方法，特别是DL算法在检测ECC方面显示出良好的效果，准确率范围为78-86%，灵敏度为67-96%，特异性为81-99%。ECC预测准确率为60-100%，灵敏度为20-100%，特异性为54-94%。这些研究的合并敏感性和特异性分别为80%和81%，置信区间为95%，表明有统计学意义。结论：人工智能在ECC的检测和预测方面显示出巨大的潜力。需要进一步的研究来完善该技术并确定其在儿科牙科中的应用。
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Pub Date : 2025-07-23DOI: 10.1038/s41432-025-01180-1
Quang Tuan Lam, Minh Huu Nhat Le, I-Ta Lee, Nguyen Quoc Khanh Le
Recent advancements in the You Only Look Once (YOLO) algorithm show promise for dental caries diagnosis. We aimed to evaluate the diagnostic performance of different YOLO versions using photographic and radiographic images for caries detection. We searched PubMed (MEDLINE), EMBASE, Web of Science, and Scopus for studies up to December 12, 2024. Studies using any YOLO version for caries detection were included. Binary diagnostic accuracy data were extracted to calculate pooled sensitivity, specificity, and area under the curve (AUC) using a bivariate random-effects model. Quality was assessed with QUADAS-2 and the Radiomics Quality Score (RQS). This review is registered in PROSPERO (CRD42024615440). We included 15 studies in the systematic review and 14 in the meta-analysis. Overall, YOLO-based models achieved a pooled sensitivity of 79.3% and specificity of 84.9%, with an AUC of 0.832. YOLO using radiographic images demonstrated higher specificity (92.5% vs 72.0%) and AUC (0.847 vs 0.735) than using photographic images, while sensitivity was similar (78.6% vs 80.0%). Differences between YOLO versions (v5 and earlier vs v6 and later) and the use of external validation did not significantly affect diagnostic accuracy. Radiograph-based YOLO models showed superior specificity to photograph-based models, reflecting the higher diagnostic detail of radiographs. However, photographic approaches are completely radiation-free and more accessible, which could benefit screening in low-resource settings. Newer YOLO versions did not significantly outperform older versions, likely due to the limited complexity of the task and dataset constraints in current studies. YOLO algorithms provide a reliable tool for dental caries detection. Radiograph imaging combined with YOLO offers enhanced diagnostic specificity, while even older YOLO versions remain effective for caries detection in practice.
目的：你只看一次（YOLO）算法的最新进展显示了龋齿诊断的希望。我们的目的是评估不同的YOLO版本的诊断性能，使用摄影和放射图像检测龋。方法：检索截至2024年12月12日的PubMed （MEDLINE）、EMBASE、Web of Science和Scopus。使用任何YOLO版本进行龋齿检测的研究都包括在内。提取二元诊断准确性数据，使用二元随机效应模型计算合并敏感性、特异性和曲线下面积（AUC）。采用QUADAS-2和放射组学质量评分（RQS）评估质量。本综述已在PROSPERO注册（CRD42024615440）。结果：我们在系统评价中纳入了15项研究，在meta分析中纳入了14项研究。总体而言，基于yolo的模型的总灵敏度为79.3%，特异性为84.9%，AUC为0.832。x线影像的YOLO特异性（92.5% vs 72.0%）和AUC （0.847 vs 0.735）高于摄影影像，而灵敏度相似（78.6% vs 80.0%）。YOLO版本之间的差异（v5和更早的版本与v6和更高的版本）和外部验证的使用并没有显著影响诊断的准确性。讨论：基于x线片的YOLO模型比基于照片的模型具有更好的特异性，反映了x线片更高的诊断细节。然而，照相方法是完全无辐射和更容易获得的，这可能有利于在资源匮乏的情况下进行筛查。较新的YOLO版本并没有明显优于旧版本，这可能是由于当前研究中任务和数据集约束的复杂性有限。结论：YOLO算法为龋病检测提供了可靠的工具。x线影像结合YOLO提供了增强的诊断特异性，而即使是较老的YOLO版本在龋齿检测中仍然有效。
{"title":"Evaluating YOLO for dental caries diagnosis: a systematic review and meta-analysis","authors":"Quang Tuan Lam, Minh Huu Nhat Le, I-Ta Lee, Nguyen Quoc Khanh Le","doi":"10.1038/s41432-025-01180-1","DOIUrl":"10.1038/s41432-025-01180-1","url":null,"abstract":"Recent advancements in the You Only Look Once (YOLO) algorithm show promise for dental caries diagnosis. We aimed to evaluate the diagnostic performance of different YOLO versions using photographic and radiographic images for caries detection. We searched PubMed (MEDLINE), EMBASE, Web of Science, and Scopus for studies up to December 12, 2024. Studies using any YOLO version for caries detection were included. Binary diagnostic accuracy data were extracted to calculate pooled sensitivity, specificity, and area under the curve (AUC) using a bivariate random-effects model. Quality was assessed with QUADAS-2 and the Radiomics Quality Score (RQS). This review is registered in PROSPERO (CRD42024615440). We included 15 studies in the systematic review and 14 in the meta-analysis. Overall, YOLO-based models achieved a pooled sensitivity of 79.3% and specificity of 84.9%, with an AUC of 0.832. YOLO using radiographic images demonstrated higher specificity (92.5% vs 72.0%) and AUC (0.847 vs 0.735) than using photographic images, while sensitivity was similar (78.6% vs 80.0%). Differences between YOLO versions (v5 and earlier vs v6 and later) and the use of external validation did not significantly affect diagnostic accuracy. Radiograph-based YOLO models showed superior specificity to photograph-based models, reflecting the higher diagnostic detail of radiographs. However, photographic approaches are completely radiation-free and more accessible, which could benefit screening in low-resource settings. Newer YOLO versions did not significantly outperform older versions, likely due to the limited complexity of the task and dataset constraints in current studies. YOLO algorithms provide a reliable tool for dental caries detection. Radiograph imaging combined with YOLO offers enhanced diagnostic specificity, while even older YOLO versions remain effective for caries detection in practice.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"26 4","pages":"176-176"},"PeriodicalIF":2.3,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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