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Evidens-basertodontologi
…og kliniske retningslinjerAsbjørn Jokstad
Institutt for klinisk odontologiUniversitetet i Oslo
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evaluerer primærstudier2. Systematiske oversikter• Cochrane Collaboration • Nat. Health Serv. R&D • Litteratur
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Wisdom tooth extractions
Why do you remove/retain
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S o utl1 Afri ca n S o' ti et y of Maxillofatiål <fn'd Oral Surgeons
2 0'0'1 13uidelines in Oral and Max'illofacial Surgery
2 0'0'1 Ros-ition paper{ Tis"sue B.anking of Bone AII·ografts. Us ed in Periodontal Re.generation
2 0'0'1 We'isheitsz . .ahnextraktion [Wi's tlom to.6th e x,tractions]
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r Anaesthesia for treating distal radial fracture in adults,
r Single dose dextropropoxyphene, alone and with paraeetamol (acetaminophen), for postoperative pam,
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r am Interventions for treating trouble-free impacted wisdom teeth in adults,
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FlttD AOOUT EXIT
Send a comment about this protocol
IHTERVEHTlOHS FOR TREATlHG TROUBlE-FREE IMPACTED WlSDOM TEETH IH ADUl TS
(Protoeol)
van der Sanden WJM, Mettes TG, Verdonschot EH, van't Hof MA, Nienhuijs M, Plasschaert AJM
Date of most recent substantive update: 24 April 2002
This protocol should be cited as: van der Sanden WJM, Mettes TG, Verdonschot EH, van't
Hof MA, Nienhuijs M, Plasschaert AJM, Interventions for treating trouble-free impacted wisdom teeth in adults (Protocol for a Cochrane
Review), In: The Cochrane Library, Issue 4, 2002, Oxford: Update Software
BACKGRDUND
Wisdom teeth or third molars generally erupt into the mouth between the ages of 17 to 24 years (Garcia 1989; Hugoson 1988), More than other teeth, wisdom teeth often fail to erupt or erupt on ly partially (Hugoson 1988), Impaction occurs where complete
the cochrane Ubrary
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The Cochrane Library presents the work of the Cochrane Collaboration and others interested in assembling reliable information to guide health-care decisions,
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((impacted and (tooth or teeth)) or (wisdom and (tooth or teeth))) - 408 hits
• The Cochrane Database of Systematic Revie",s (10 out of 2655)
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• Abstracts of quality assessed systematic reviews (4 out of 2940)
r Prophylactic Removal of Impacted Third Molars: is it Justified? (Provisional record),
r The effectiveness and cost-effectiveness of prophylactic removal of wisdom teeth (Provisional record) ,
r The effectiveness of acupuncture in treating acute dental pain: a systematie review (Structured abstract) ,
r The use of acupuncture in dentistry: a systematie review (Structured abstract),
• Other reviews: bibliographic details only (O out of 800)
• The Cochrane Central Register of Controlled Trials (CENTRAL) (389 out of 345378;..) __ .. __ _
• The Cochrane Database of Methodology Reviews (O out of 15)
• The Cochrane Methodology Register (CMR) (O out of 4002)
• About the Cochrane Collaboration (2 out of 86)
• Health technology assessment database (HTA) (3 out of 2838)
r Guidanee on the removal of wisdom teeth,
r Prophylactic removal of impacted third molars: is it justified?,
r The effectiveness and cost-effectiveness of prophylactic removal of wisdom teeth,
• NHS Economic evaluation database (NHS EED) (O out of 10255)
Send a comment about this protocol
ItHERVENTIONS fOR TREATING TROUBLE-fREE IMPACTED WlSDOM TEETH IN ADUL TS
(Protoeol)
van der Sanden WJM, Mettes TG, Verdonschot EH, van't Hof MA, Nienhuijs M, Plasschaert AJM
Date of most recent substantive update: 24 April 2002
This protocol should be cited as: van der Sanden WJM, Mettes TG, Verdonschot EH, van't
Hof MA, Nienhuijs M, Plasschaert AJM, Interventions for treating trouble-free impacted wisdom teeth in adults (Protocol for a Cochrane
Review), In: The Cochrane Library, Issue 4, 2002, O xford: Update Software
BACKGROUNO
Wisdom teeth or third molars generally erupt into the mouth between the ages of 17 to 24 years (Garcia 1989: Hugoson 1988), More than other teeth, wisdom teeth often fail to erupt or erupt only partially (Hugoson 1988), Impaction occurs where complete .:.l'llliri .... n int"("a -=- 1"'1""1'11'1;.1 flln.-ri .... n;.1 n.-.-:::i,.i .... n .-.f -=- ,..-..-.rh i-::
the cochrane Ubrary
the best single source of reliable evidence about the effects of health care
The Cochrane Library presents the work of the Cochrane Collaboration and others interested in assembling reliable information to guide health-care decisions,
N=17 vs. N=280 vs. N=27
I'< PubMed Clinical Queries - Microsoft Internet EKplorer ::
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PubMed Clinical Queries
Sele et from two filters to limit your retrieval. Cho ose either Clinie al Querie s or Systematie Reviews. Enter your se areh topie in the b ox b elow and eliek Go.
r. Clinical Queries using Research Methodology Filters
This specialized search is intended for clinicians and has built-in search "filters" based largelyon Haynes RE et al .. F our study categories are provided, and the emphasis may be more sensitive (i.e., most relevant artic1es but probably some less relevant ones) or more specifie (i.e., mostly relevant artic1es but pro b ably omiting a few). Se e filter table for details .
r therapy r diagnosis r etiology r. prognosis
r s ensitivity r. sp e eifieity
ure retrieve s systematie review provide .
1'l1I!!"'IiIi1~ch topic(s). For more information, see Help . Related sources are also
How many reports related to the topic can be identified?
How are these approximately 300 reports characterized according to study design?
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SRRCTCCTReviewOther
How many reports related to the topic can be identified?
How can these reports be characterized. Which study design? How many reports are included within each category?
What is the methodological scientific quality of these reports?
How many reports can be excluded due to questionable methodological validity?
Prognosis
• An inception cohort of persons, all initially free of the outcome of interest
• Follow-up of at least 80 per cent of patients until the occurrence of either a major study criteria or the end of the study
• A statistical analysis consistent with the study design.
baoms 1995
1997anaes
SIGN 2000
Nhs hta
File Edi~
El···D Health Technology Asses
~""'D NHS R&D HTA Prograr i·····D Contents i···· O List of abbreviations
i······O Executive summary
$"'0 Chapter 1 - Backgrounr ~ ~"' D Introduction i i····D Impacted third mola i i····D Pathological chang{ i L.··D Complications and I
$"'0 Chapter 2 - Aims and n ~ ~ ·····D .Aims i L.··D Methods
$"0 Chapter 3 - Results ~ ~"'D Included studies i i····D Excluded studies
i i····D Results from RCTs
i i·· .o Results from literatl
i i·· .o Decision analyses f i L. D Cost and cost-effec'
$·· 0 Chapter 4 - Discussion
~ ~" D Quality of available i L. D Conclusions
i·····D Acknowledgements i·····D References
i···D Appendix 1 - Search st.
i"'D Appendix 2 - Summary' i·D Appendix 3 - Summary
i· D Appendix 4 - Data extn i·D Appendix 5 - Studies e L.·D Health Technology Ass
e j1 25%
' eald echnology Assessr1 e lt 100 O; Vol 4: No, 15
The effectiveness and eost .. effectiveness of prophyl actic removal of wisdom teeth
F Sang S Q 'Meara
PWilson S Galder J Kleijnen
© Queen's Printer and Controller of HMSO 2001
Rapid review
dgzmk 2001
Selection of papers
CCTs + Clinic trials
60BAOMS, UK, 1995
CCTs + Clinic trials
77ANAES, France, 1997
RCTs + CCTs
64SIGN, Scotland, 2000
RCTs + Reviews
52NHS R&D, UK, 2000
SRs + Clinic trials
23DGZMK, Germany, 2001
11
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18
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1997 (n=77)
1995 (n=60)
2000 (n=64)
5
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2000 (n=52)
USA1979: NIH Consensus dev. Conference for removal of third molars
1995: Am.Acad.Oral Med.Surg. Parameters of Care
1991 Am.Acad.Oral Med.SurgParameters of Care
1993: Am.Acad.Or.Med.Surg. Workshop on the managem. of patients with third molar teeth
2000: SIGN Guidelines
1980 1990 20001995: Br. Assoc.Oral Med. Surg. Pilot Clinical Guidelines
1996: NHS R&D. National guidelines
Sept 1997: FacDentSurg RoyCollSurg(Eng)
1998: Effectiveness Matters 3(2)
2000: NHS R&D HTA Programme2000: NICE Guidelines
Dentists' decisions on proph)rlactic remo\Tal of mandibular third molars: a lO-year follo'Vv-up stu ,dy Knutsson Kr L s I.l Lr R hUn M: Dentists' d d.sions n pr ph la ti 1 mo 'il l of ma nd ibular third m lars: a 1 -y ar foll ~ -Llp s l-ud . mm w1iJ . D at raI E id n ,iol 20 1; 2 : ~C8-1 ,e M unksgaardr 20 1
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We have learned:
Systematic reviews and guidelines are not necessarily known to the community of dental practitioners
Who’s responsibility to disseminate new research findings to the community of dental practitioners?
Who’s responsibility for disseminating new research findings to the community of (dental) practitioners?
… and verify its implementation?
Nhs hta
File Edi~
El···D Health Technology Asses
~""'D NHS R&D HTA Prograr i·····D Contents i···· O List of abbreviations
i······O Executive summary
$"'0 Chapter 1 - Backgrounr ~ ~"' D Introduction i i····D Impacted third mola i i····D Pathological chang{ i L.··D Complications and I
$"'0 Chapter 2 - Aims and n ~ ~ ·····D .Aims i L.··D Methods
$"0 Chapter 3 - Results ~ ~"'D Included studies i i····D Excluded studies
i i····D Results from RCTs
i i·· .o Results from literatl
i i·· .o Decision analyses f i L. D Cost and cost-effec'
$·· 0 Chapter 4 - Discussion
~ ~" D Quality of available i L. D Conclusions
i·····D Acknowledgements i·····D References
i···D Appendix 1 - Search st.
i"'D Appendix 2 - Summary' i·D Appendix 3 - Summary
i· D Appendix 4 - Data extn i·D Appendix 5 - Studies e L.·D Health Technology Ass
e j1 25%
' eald echnology Assessr1 e lt 100 O; Vol 4: No, 15
The effectiveness and eost .. effectiveness of prophyl actic removal of wisdom teeth
F Sang S Q 'Meara
PWilson S Galder J Kleijnen
© Queen's Printer and Controller of HMSO 2001
Rapid review
Nice
2001
www.agreecollaboration.org
foroppmerksomheten!
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