Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.
School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.
Int Endod J. 2022 Nov;55(11):1128-1164. doi: 10.1111/iej.13812. Epub 2022 Aug 22.
Studies related to non-surgical root canal treatment are amongst the most frequently performed clinical studies in endodontics. However, heterogeneity in reporting outcomes and lack of standardization is a significant challenge to evidence synthesis and guideline development.
The aims of the present scoping review were to (a) identify outcomes reported in systematic reviews evaluating non-surgical root canal treatment; (b) identify how and when the reported outcomes were measured; (c) assess possible selective reporting bias in the included studies. The information obtained in this study should inform the development of a core outcome set (COS) for non-surgical root canal treatment.
Structured literature searches were performed to identify systematic reviews on non-surgical root canal treatments published in English between January 1990 and December 2020. Two reviewers undertook study selection and data extraction. Outcomes were categorized according to a healthcare taxonomy into five core areas (survival, clinical/physiological changes, life impact, resource use, and adverse events). The outcome measurement tools and length of follow-up were recorded.
Seventy-five systematic reviews were included, of which 40 included meta-analyses. Most reviews reported on physiological and clinical outcomes, primarily pain and/or radiographic assessment of periapical status, and a variety of measurement tools and scales were used. Few reviews focused on tooth survival, life impact, resources, and adverse events. The heterogeneity amongst the reviews was large on all parameters. Less than 40% of the reviews assessed the risk of selective reporting.
Overall aims of the included reviews were highly heterogenic; thus, outcomes and how they were measured also varied considerably. Patient-centred outcomes and the use of resources were rarely reported on.
Most studies reported on physiological and clinical outcomes, in particular pain and/or radiographic healing. Measurement tools, scales, thresholds, and follow-up periods varied greatly within each outcome, making comparison across studies complicated. Less than 40% of the reviews assessed risk of selective reporting; thus, selective bias could not be ruled out. The presented information on reported outcomes, measurement tools and scales, and length of follow-up may guide the planning of future research and inform the development of a COS for non-surgical root canal treatment.
非手术根管治疗相关的研究是牙髓病学中最常进行的临床研究之一。然而，结果报告的异质性和缺乏标准化是证据综合和指南制定的重大挑战。
本范围综述的目的是：(a) 确定系统评价评估非手术根管治疗的报告结果；(b) 确定报告结果的测量方式和时间；(c) 评估纳入研究中可能存在的选择性报告偏倚。本研究获得的信息应有助于制定非手术根管治疗的核心结局集（COS）。
系统检索了 1990 年 1 月至 2020 年 12 月期间以英文发表的非手术根管治疗的系统评价。两名审查员进行了研究选择和数据提取。结果根据医疗保健分类法分为五个核心领域（生存、临床/生理变化、生活影响、资源利用和不良事件）。记录了结局测量工具和随访时间。
共纳入 75 项系统评价，其中 40 项包含荟萃分析。大多数综述报告了生理和临床结局，主要是疼痛和/或根尖周状况的放射学评估，以及各种测量工具和量表。很少有综述关注牙齿生存、生活影响、资源和不良事件。所有参数的综述之间的异质性都很大。不到 40%的综述评估了选择性报告的风险。
纳入综述的总体目标高度异质；因此，结局及其测量方法也有很大差异。很少有研究报告患者为中心的结局和资源的利用情况。
大多数研究报告了生理和临床结局，特别是疼痛和/或放射学愈合。在每个结局中，测量工具、量表、阈值和随访时间差异很大，使得跨研究比较变得复杂。不到 40%的综述评估了选择性报告的风险；因此，无法排除选择性偏倚。本研究报告的结果、测量工具和量表以及随访时间的信息可能会指导未来研究的规划，并为非手术根管治疗的核心结局集的制定提供信息。
