van Doornik Sebastiaan P, Pijnenburg Marlotte B M, Janssen Krista I, Ren Yijin, Kuijpers-Jagtman Anne Marie
Department of Orthodontics, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
Center for Dentistry and Oral Hygiene, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, FB 21, 9713 AV, Groningen, The Netherlands.
Prog Orthod. 2024 Apr 22;25(1):15. doi: 10.1186/s40510-024-00515-5.
External apical root resorption (EARR) is a frequently observed adverse event in patients undergoing fixed appliance therapy. Assessing the patients' risk during treatment is important, as certain factors are assumed to be associated with an increased likelihood of occurrence. However, their predictive value remains limited, making evidence-based clinical decision-making challenging for orthodontists. To address this issue, the Dutch Association of Orthodontists (NvVO) developed a clinical practice guideline (CPG) for EARR in accordance with the AGREE II instrument (Appraisal of Guidelines for Research and Evaluation II) in 2018. The aim of this study is to get insight into the actual utilization and the practical implementation of the guideline among orthodontists. The hypothesis to be tested was that after its introduction, clinical practice for EARR has changed towards the recommendations in the CPG.
To investigate the use of the 2018 clinical practice guidelines for EARR among orthodontists 3 years after its introduction.
A questionnaire using a 7-point Likert scale was developed concerning four domains of EARR described in the guideline. The questionnaire was piloted, finalised, and then distributed digitally among Dutch orthodontists. REDCap was used for data collection, starting with an invitation email in June 2021, followed by two reminders. Effect was tested by the Mann-Whitney U test, and the influence of demographic variables was analysed.
Questionnaires were sent out to all 275 and completed by 133 (response rate 48%); N = 59 females and N = 73 males were included; 81% had their training in the Netherlands, 89% had ≥ 6 years of work experience, and 89% worked in private orthodontic practice. One hundred thirty orthodontists (98.5%) reported changes in clinical practice. The biggest positive change in clinical behaviour regarding EARR occurred if EARR was diagnosed during treatment. Sex, clinical experience, country of specialist training, and working environment of the respondents did not affect clinical practices regarding EARR.
This questionnaire demonstrated that, 3 years after introduction of the guideline, orthodontists improved their self-reported clinical practices to a more standardised management of root resorption. None of the demographic predictors had a significant effect on the results.
根尖外吸收（EARR）是接受固定矫治器治疗患者中常见的不良事件。在治疗过程中评估患者风险很重要，因为某些因素被认为与发生可能性增加有关。然而，它们的预测价值仍然有限，这使得正畸医生基于证据的临床决策具有挑战性。为解决这一问题，荷兰正畸医师协会（NvVO）于2018年根据AGREE II工具（研究与评价指南II评估）制定了EARR临床实践指南（CPG）。本研究的目的是深入了解正畸医生对该指南的实际使用情况和实际实施情况。待检验的假设是，在引入该指南后，EARR的临床实践已朝着CPG中的建议转变。
调查2018年EARR临床实践指南在引入3年后正畸医生中的使用情况。
针对指南中描述的EARR的四个领域编制了一份使用7点李克特量表的问卷。该问卷经过预试验、定稿，然后以数字方式分发给荷兰正畸医生。使用REDCap进行数据收集，从2021年6月发送邀请电子邮件开始，随后发送两次提醒。通过曼-惠特尼U检验检验效果，并分析人口统计学变量的影响。
向所有275名正畸医生发放了问卷，133名完成问卷（回复率48%）；纳入59名女性和73名男性；81%在荷兰接受培训，89%有≥6年工作经验，89%在私人正畸诊所工作。130名正畸医生（98.5%）报告临床实践有变化。如果在治疗期间诊断出EARR，在EARR临床行为方面最大的积极变化就会发生。受访者的性别、临床经验、专科培训国家和工作环境对EARR的临床实践没有影响。
这份问卷表明，在引入该指南3年后，正畸医生将他们自我报告的临床实践改进为对牙根吸收进行更标准化的管理。没有任何人口统计学预测因素对结果有显著影响。
