Azarpazhooh Amir, Zanjir Maryam, Cardoso Elaine, Harman Nicola L, Khansari Ava, Jafarzadeh Hamid, Malkhassian Gevik, Sabeti Mike, Aminoshariae Anita, Kishen Anil, Sale Joanna E M, Shah Prakesh S
Faculty of Dentistry, University of Toronto, Toronto, ON, Canada; Department of Dentistry, Mount Sinai Hospital, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Faculty of Dentistry, University of Toronto, Toronto, ON, Canada.
J Endod. 2025 Apr;51(4):401-411. doi: 10.1016/j.joen.2025.01.008. Epub 2025 Jan 31.
Methodological heterogeneity and reporting bias complicate interpreting endodontic outcomes. Supported by the American Association of Endodontists and its Foundation, this study developed the Core Outcome Set in Endodontics (COS-ENDO) to standardize reporting for studies of nonsurgical root canal treatment/retreatment, surgical endodontics, vital pulp therapy, apexification, and regenerative endodontics. This article, the first in a 5-part series, outlines the methods for developing COS-ENDO, with detailed findings for each treatment presented in subsequent parts.
Outcomes were identified through scoping reviews, a qualitative study with patients, and a web-based survey of American Association of Endodontists practicing members. In a 2-round Delphi survey, clinicians, patients, and researchers rated outcomes on a 9-point scale. Ratings were assessed against consensus criteria, and a virtual meeting finalized COS-ENDO.
Of the 97 invited participants to round 1, 77 (79%) registered and 73 (95%) completed the survey, including 24 academicians/researchers, 26 clinicians, and 23 patients (or their caregivers/parents). They rated 64 outcomes, totaling 182 occurrences across treatments: 39 for nonsurgical root canal treatment/retreatment, 46 for surgical endodontics, 46 for vital pulp therapy, and 51 for apexification/regenerative endodontics. The outcomes that achieved consensus for inclusion and those lacking consensus (either for inclusion or exclusion) advanced to round 2 for rerating by 70 participants. During the final consensus meeting, 16 participants discussed the outcomes and finalized the COS-ENDO.
COS-ENDO is an important step toward standardizing outcome reporting in endodontics. Its implementation will ensure consistent reporting, enhancing research utility and evidence synthesis. Further efforts are needed to establish optimal measurement methods.
方法学异质性和报告偏倚使牙髓病治疗结果的解读变得复杂。在美国牙髓病学家协会及其基金会的支持下，本研究制定了牙髓病核心结局集（COS-ENDO），以规范非手术根管治疗/再治疗、牙髓外科、活髓治疗、根尖诱导成形术和牙髓再生治疗研究的报告。本文是五部分系列文章的第一篇，概述了COS-ENDO的制定方法，后续部分将介绍每种治疗方法的详细研究结果。
通过范围综述、一项针对患者的定性研究以及对美国牙髓病学家协会执业会员的在线调查来确定结局指标。在两轮德尔菲调查中，临床医生、患者和研究人员对结局指标进行9分制评分。根据共识标准评估评分，并通过一次虚拟会议最终确定了COS-ENDO。
在第一轮邀请的97名参与者中，77人（79%）注册，73人（95%）完成了调查，其中包括24名院士/研究人员、26名临床医生和23名患者（或其护理人员/父母）。他们对64项结局指标进行了评分，各种治疗方法的结局指标出现次数总计182次：非手术根管治疗/再治疗39次，牙髓外科46次，活髓治疗46次，根尖诱导成形术/牙髓再生治疗51次。达成纳入共识的结局指标以及未达成共识（包括纳入或排除）的结局指标进入第二轮，由70名参与者重新评分。在最终的共识会议上，16名参与者讨论了结局指标并最终确定了COS-ENDO。
COS-ENDO是牙髓病治疗结局报告标准化的重要一步。其实施将确保报告的一致性，提高研究的实用性和证据综合水平。还需要进一步努力建立最佳测量方法。
