School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.
Division of Restorative Dentistry & Periodontology, Dublin Dental University Hospital, Trinity College Dublin, Dublin, UK.
Int Endod J. 2022 Sep;55(9):891-909. doi: 10.1111/iej.13785. Epub 2022 Jun 30.
A large number of research reports on vital pulp treatment (VPT) has been published over the last two decades. However, heterogeneity in reporting outcomes of VPT is a significant challenge for evidence synthesis and clinical decision-making.
To identify outcomes assessed in VPT studies and to evaluate how and when outcomes are measured. A subsidiary aim was to assess evidence for selective reporting bias in the included studies. The results of this review will be used to inform the development of a core outcome set (COS) for endodontic treatments.
Multiple healthcare bibliographic databases, including PubMed/MEDLINE, Ovid EMBASE, Scopus, Cochrane Database of Systematic Reviews and Web of Science were searched for systematic reviews published between 1990 and 2020, reporting on VPT. Screening, data extraction and risk of bias assessment were completed independently by two reviewers. Outcomes' information was extracted and aligned with a healthcare taxonomy into five core areas: survival, clinical/physiological changes, life impact, resource use and adverse events.
Thirty-six systematic reviews were included, 10 reporting on indirect pulp capping or selective caries removal, nine on direct pulp capping, eight on pulpotomy and nine on combined VPTs. There was considerable variation in the outcomes reported in these reviews and their included studies. Clinician-reported outcomes were used considerably more often than patient-reported outcomes. A range of instruments and time points were used for measuring outcomes. Several of the reviews were assessed as having low risk of selective reporting bias, but many did not specifically report this domain, whilst others did not provide risk of bias assessment at all.
Considerable variation in selection of outcomes and how and when they are measured and reported was evident, and this heterogeneity has implications for evidence synthesis and clinical decision-making.
Whilst there is a lack of consistency, several potentially important outcomes for VPT, including pulp survival, incidence of post-operative pain and need for further intervention, have been identified which could inform the development of a COS for endodontic treatment.
Core Outcome Measures in Effectiveness Trials (COMET) (No. 1879).
在过去的二十年中，已经发表了大量关于活髓治疗（VPT）的研究报告。然而，VPT 结果报告的异质性是证据综合和临床决策的重大挑战。
确定 VPT 研究中评估的结果，并评估如何以及何时测量结果。一个次要目的是评估纳入研究中选择性报告偏倚的证据。本综述的结果将用于为牙髓治疗制定核心结局集（COS）提供信息。
检索了多个医疗保健文献数据库，包括 PubMed/MEDLINE、Ovid EMBASE、Scopus、Cochrane 系统评价数据库和 Web of Science，以获取 1990 年至 2020 年间发表的关于 VPT 的系统评价。两名审查员独立进行了筛选、数据提取和偏倚风险评估。提取了结果信息，并与医疗保健分类法对齐，分为五个核心领域：生存、临床/生理变化、生活影响、资源利用和不良事件。
共纳入 36 项系统评价，其中 10 项报告间接盖髓或选择性去龋，9 项报告直接盖髓，8 项报告牙髓切断术，9 项报告联合 VPT。这些综述及其纳入的研究中报告的结果差异很大。临床医生报告的结果比患者报告的结果使用得更频繁。用于测量结果的仪器和时间点多种多样。一些综述被评估为选择性报告偏倚的风险较低，但许多综述没有专门报告这一领域，而其他综述则根本没有进行偏倚风险评估。
选择结果以及如何和何时测量和报告结果存在很大差异，这种异质性对证据综合和临床决策具有影响。
尽管存在不一致性，但已经确定了几个可能对 VPT 重要的结果，包括牙髓存活、术后疼痛的发生率和进一步干预的需要，这可以为牙髓治疗的 COS 制定提供信息。
疗效试验的核心结局测量（COMET）（编号 1879）。
