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1 FACULDADE IMED MESTRADO EM ODONTOLOGIA RAFAELA BASSANI REVISÕES SISTEMÁTICAS EM ODONTOLOGIA: CENÁRIO ATUAL, CARACTERÍSTICAS EPIDEMIOLÓGICAS E DE REPORTE PASSO FUNDO 2019

Transcript of Rafaela Bassani - Completa.pdf - IMED

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FACULDADE IMED

MESTRADO EM ODONTOLOGIA

RAFAELA BASSANI

REVISÕES SISTEMÁTICAS EM ODONTOLOGIA: CENÁRIO ATUAL, CARACTERÍSTICAS EPIDEMIOLÓGICAS E DE REPORTE

PASSO FUNDO

2019

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RAFAELA BASSANI

REVISÕES SISTEMÁTICAS EM ODONTOLOGIA: CENÁRIO ATUAL, CARACTERÍSTICAS EPIDEMIOLÓGICAS E DE REPORTE

Dissertação apresentada ao Programa de

Pós-Graduação em Odontologia da

Faculdade IMED, como requisito parcial à

obtenção do título de Mestre em

Odontologia.

Professor orientador: Prof. Dr. Rafael Sarkis Onofre

Prof. Dr. Gabriel Kalil Pereira

PASSO FUNDO, 2019

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CIP – Catalogação na Publicação

B317r BASSANI, Rafaela Revisões sistemáticas em odontologia: cenário atual,

características epidemiológicas e de reporte / Rafaela Bassani. – 2019.

94 f., il.; 30 cm.

Dissertação (Mestrado em Odontologia) – Faculdade IMED, Passo Fundo, 2019.

Orientador: Prof. Dr. Rafael Sarkis Onofre.

1. Odontologia. 2. Epidemiologia odontológica. 3. Cirurgia oral. I.

ONOFRE, Rafael Sarkis, orientador. II. Título.

CDU: 616.31-084

Catalogação: Bibliotecária Angela Saadi Machado - CRB 10/1857

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Rafaela Bassani

Revisões Sistemáticas em Odontologia: cenário atual, características

epidemiológicas e de reporte

Dissertação apresentada ao Programa de Pós-Graduação em Odontologia da

Faculdade IMED, como requisito parcial à obtenção do título de Mestre em

Odontologia.

Banca examinadora:

Prof. Dr. Rafael Sarkis Onofre - Faculdade Meridional - IMED, Passo Fundo (orientador) Profa. Dr. Graziela Oro Cericato - Faculdade Meridional - IMED, Passo Fundo (membro interno) Prof. Dr. Mateus Bertolini Fernandes dos Santos - Universidade Federal de Pelotas (membro externo) Prof. Dr. Aloisio Oro Spazzin - Faculdade Meridional - IMED, Passo Fundo (suplente)

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Dedico este trabalho aos meus pais, Milton e Márcia Bassani, pelo incentivo e pelo apoio em todas as minhas escolhas.

À minha irmã Manoela, por estar sempre presente, apoiando e ajudando em tudo.

À minha psicóloga Vivian Bageston, que foi fundamental para que eu conseguisse concluir o mestrado, estando presente em todos os

momentos e, principalmente, me apoiando nos momentos mais difíceis desta caminhada.

Dedico também ao meu orientador, Prof. Dr. Rafael Sarkis Onofre, pela confiança, paciência, incentivo e pela excelente orientação.

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Agradecimentos À Faculdade Meridional (IMED) por abrir as portas para me

proporcionar muito conhecimento técnico e cintífico durante todo o curso e,

principalmente, realizar o sonho de fazer mestrado.

Ao Programa de Pós-Graduação em Odontologia, em especial a

coordenadora do curso, professora Graziela Oro Cericato, pela oportunidade

de fazer parte da PPGO Imed.

Ao meu orientador professor Dr. Rafael Sarkis Onofre pela orientação

e por ter acreditando e confiado em mim a realização deste trabalho.

Ao co-orientador professor Dr. Gabriel Kalil Pereira pela ajuda e

disponibilidade em todos os momentos da realização desta pesquisa.

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“O sucesso nasce do querer, da determinação e persistência em se chegar a

um objetivo. Mesmo não atingindo o alvo, quem busca e vence obstáculos, no

mínimo fará coisas admiráveis.”

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José de Alencar

Notas Preliminares

O projeto de pesquisa relacionado à esta dissertação foi apresentado a

banca de qualificação no dia 14 de dezembro de 2017 e aprovado pela Banca

Examinadora composta pelos Professores Doutores Graziela Oro Cericato e

Rodrigo Varella de Carvalho.

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RESUMO

BASSANI, Rafaela., Revisões Sistemáticas em Odontologia: cenário atual, características de reporte e condução. 2019, 94p. Dissertação Mestrado em

Odontologia – Programa de Pós-Graduação em Odontologia. Faculdade

Meridional, Passo Fundo, 2019.

Este estudo teve como objetivo avaliar características epidemiológicas e de

reporte das revisões sistemáticas (RSs) em odontologia, indexadas no PubMed

no ano de 2017. Buscamos por RSs da área da Odontologia indexadas no

PubMed em 2017. Os estudos foram selecionados por dois revisores de forma

independente. Dados referentes as características epidemiológicas e de

reporte foram extraídos por um dos três revisores. Uma análise descritiva foi

realizada. Características das RSs foram analisadas, levando em consideração

todas os estudos incluídos e separados por especialidade odontológica. Além

disso, exploramos no estudo 24 características das RSs referentes a

tratamento/terapêutica associado ao relado do uso do Prisma, calculando o

Risco Relativo (RR) com intervalo de confiança de 95% para todas as

características. 495 artigos se enquadraram aos critérios de elegibilidade. A

especialidade com maior número de artigos foi classificada como Cirurgia Oral,

com 75 artigos. O Brasil apresentou a maior número de publicações com 117

RSs (23.6%). A qualidade dos relatórios foi variável. Itens como, o uso de

“revisão sistemática” ou “meta-análise” no título ou resumo foram bem

relatados. Em contraste avaliação do risco de viés / qualidade não foi relatado

em 40.5% das RSs. Além disso, apenas quatro características de relato foram

descritas com mais frequência naquelas RS que relataram o uso do PRISMA

Statment. Um grande número de RSs foram publicadas na área da odontologia

em 2017 e, as características de reporte e epidemiológicas variaram entre as

especialidades odontológicas. É notório a necessidade de melhorar a

qualidade das características de reporte e condução das RSs na Odontologia.

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Palavras-chave: odontologia, revisão sistemática, reporte, PRISMA

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ABSTRACT

BASSANI, Rafaela., Systematic reviews in dentistry: Current status, epidemiological and reporting characteristics. 2019 p. 94 Dissertation

(Master degree in Dentistry). Graduate Program in Dentistry. Meridional

Faculty, Passo Fundo, 2019

This study aimed to evaluate the epidemiological and reporting characteristics

of systematic reviews (SRs) in dentistry indexed within PubMed during the year

2017. We searched for SRs in dentistry indexed within PubMed in 2017. Study

selection was undertaken by two reviewers independently. Data related to

epidemiological and reporting characteristics were extracted by one of three

reviewers. A descriptive analysis of the data was performed. Characteristics of

SRs were analyzed considering all SRs included and subgrouped by dental

specialties. In addition, we explored if the reporting of 24 characteristics of

treatment/therapeutic SRs was associated with the self-reported use of the

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Statement calculating the risk ratio (RR) with a 95% confidence interval for each

characteristic. 495 articles fulfilled the eligibility criteria. The main specialty

considered was Oral Surgery numbering 75 articles. Brazil presented the

highest contribution with 117 SRs (23.6%). The reporting quality was variable.

Items such as, use of the term “systematic review”, or “meta-analysis” in the title

or abstract was well reported. In contrast, the study risk of bias/quality

assessment method was not reported in 40.5% of SRs. In addition, only four

reporting characteristics were described more often in those SR that reported

using the PRISMA Statement. A large number of SRs were published in

dentistry in 2017 and the reporting and epidemiological characteristics varied

among dental specialties. There is a mandatory need to improve the quality of

reporting and conduct of SRs in dentistry.

Clinical significance: Poor reporting and conduction of SRs could generate

SRs with imprecise and biased results.

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Keywords: dentistry; systematic reviews, reporting, PRISMA

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SUMÁRIO

RESUMO.............................................................................................................................................10

ABSTRACT.........................................................................................................................................12INTRODUÇÃO...................................................................................................................................15

ARTIGO 1............................................................................................................................................18

MATERIALS AND METHODS......................................................................................................22

CONSIDERAÇÕES FINAIS...........................................................................................................51REFERÊNCIAS.................................................................................................................................52

APÊNDICE..........................................................................................................................................55

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Introdução

Há mais de 20 anos, um movimento chamado Medicina Baseada em

Evidências começou a ser discutido como um “novo paradigma” para o ensino,

a pesquisa e a prática clínica na área da saúde. A utilização da Medicina

Baseada em Evidências significa integrar a experiência clínica do profissional

da saúde, as melhores evidências disponíveis sobre o assunto e a necessidade

e o desejo do paciente para a tomada de decisão (SACKETT, 1996). A

Medicina Baseada em Evidências está em constante adaptação e evolução e

um dos pontos principais desse movimento é o uso das melhores evidências

científicas disponíveis na literatura de uma forma consciente e judiciosa. Um

dos estudos que se apresenta como chave para a ciência baseada em

evidências como componente indispensável na cadeia da informação científica

são as revisões sistemáticas e meta-análises (IONANNIDIS, 2016).

As revisões sistemáticas(RS) são um dos tipos de estudo que fornecem

as evidências mais confiáveis em relação às intervenções na área da saúde.

RSs tem o objetivo de selecionar e sintetizar todos os estudos de um questão

específica baseada em critérios previamente estabelecidos, usando métodos

que minimizem vieses através de uma metodologia sistemática, rigorosa e

replicável (HIGGINS, 2011). No entanto, uma RS pode ter seu uso limitado se

os métodos utilizados para conduzir o estudo são falhos ou o trabalho é

pobremente reportado (PAGE, 2016).

Em um estudo que teve como objetivo avaliar o crescimento das

publicações de RS e meta-análises e estimar com qual frequência elas são

redundantes, com pouco valor, apresentam dados enganosos e/ou apresentam

conflitos de interesse, IONANNIDIS (2016) pode observar que a produção de

revisões sistemáticas e meta-análises atingiram proporções epidêmicas e que

possivelmente, a grande maioria destas publicações são desnecessárias e/ou

apresentam conflito de interesses.

Os critérios para definir a qualidade das RSs podem estar relacionados

com a execução da pesquisa, com a análise e o reporte dos dados. Muitas

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ferramentas foram desenvolvidas nos últimos anos com objetivo de ajudar os

pesquisadores a melhorarem a qualidade de suas RS e disseminarem melhor

suas publicações e por isso as publicações nessa área vem mudando muito.

Ferramentas como o PRISMA Statement publicado em 2009 (MOHER, 2009),

o desenvolvimento de uma ferramenta para avaliação do risco de viés de

ensaios clínicos randomizados (HIGGINS, 2011) e o lançamento de um

periódico open-access chamado Systematic Reviews para disseminação de

revisões sistemáticas completas, protocolos e pesquisas relacionadas, entre

outros fatores foram importantes para essa mudança nos últimos anos

(MOHER, 2012).

A Colaboração Cochrane, é uma rede global e independente de

pesquisadores, que nos últimos 20 anos ajudou a transformar a maneira em

que as decisões são tomadas, através da realização de RS com metodologia

própria (SCHOLTEN, 2005). O trabalho da Colaboração Cochrane está em

constante crescimento, tendo em vista que, o acesso à evidência em saúde

cresce e o risco de interpretar incorretamente conteúdos complexos também

aumenta. Ao mesmo tempo, diminuem as chances de que um indivíduo

compreenda de forma completa e equilibrada esse conteúdo, por isso, as

Revisões Cochrane têm como missão oferecer informação acessível e

confiável para apoiar a tomada de decisões contribuindo para o

desenvolvimento da saúde global (HIGGINS, 2011)

Nos últimos anos houve uma crescente de publicações indexadas no

MEDLINE sendo que em 2016 foram indexadas em torno de 870 mil

publicações (https://www.nlm.nih.gov/bsd/bsd_key.html). As publicações de

RSs também seguem na mesma crescente, observamos isso em um estudo

realizado em novembro de 2004 (MOHER, 2007), o qual, através de uma

busca no MEDLINE, identificou 300 RSs publicadas naquele mês o que

corresponde a 2,500 publicações ao ano, a mesma pesquisa em 2014

encontrou 682 RSs indexadas no mês de fevereiro, o que corresponde a

aproximadamente 8,000 RSs indexadas ao ano (PAGE, 2016), isso aponta que

na última década o número de RS publicadas triplicou.

Esse aumento pode ser resultado de algumas mudanças na última

década. A comunidade científica parece ter percebido que a grande quantidade

de artigos publicados ao longo da última década precisam estar integrados e,

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uma síntese desta literatura é mais viável, do que ler individualmente todos os

estudos publicados. Porém, existem algumas razões negativas para o

crescimento deste tipo de publicação, por exemplo, alguns países começaram

a oferecer incentivo financeiro para aumentar o número de publicações. Isso

porque muitas vezes, a nomeação e promoções dos comitês estão ligadas com

o número de publicações, ao invés de estar ligadas ao rigor, transparência e

reprodutibilidade do estudo. Isso tudo acompanhado da crescente valorização

das RSs. Os pesquisadores ficam fortemente motivados a publicar, em larga

escala as RSs independente de possuírem habilidades/competência para

realizar de maneira confiável este tipo de estudo (PAGE, 2016).

Em Odontologia o crescente número de publicações não é diferente.

Estima-se que em 2012 cerca de 10 mil artigos foram publicados considerando

apenas periódicos incluídos no Journal of Citation Reports (JCR) totalizando o

dobro de artigos publicados em 2003. Estima-se que entre 1991 e 2012 em

torno de 1188 RS foram publicadas na área de odontologia e com as

características variando entre as especialidades (SALJATI, 2013). No entanto,

pouco se sabe sobre a quantidade atual de RS publicadas na área de

odontologia bem como se essas revisões vem sendo conduzidas e reportadas

adequadamente. Assim, o objetivo deste estudo foi avaliar a quantidade e as

características epidemiológicas e de reporte de revisões sistemáticas da área

de odontologia indexadas no MEDLINE durante o ano de 2017.

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ARTIGO 1 Title page Systematic reviews in dentistry: Current status, epidemiological and reporting characteristics Rafaela Bassania - [email protected]

Gabriel Kalil Rocha Pereiraa - [email protected]

Matthew J. Pageb - [email protected]

Andrea C. Triccocd - [email protected]

David Moheref - [email protected]

Rafael Sarkis-Onofrea aGraduate Program in Dentistry, Meridional Faculty/IMED, 304 Senador Pinheiro Machado Street, 99070-220, Passo Fundo, Brazil bSchool of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3004, Australia. cKnowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1T8, Canada dEpidemiology Division, Dalla Lana School of Public Health, University of Toronto, 6th Floor, 155 College Street, Toronto, Ontario, M5T 3M7, Canada eCentre for Journalology and Canadian EQUATOR Centre, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa K1H 8L6, Canada. fSchool of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa K1H 8M5, Canada. Corresponding author Rafael Sarkis-Onofre Graduate Program in Dentistry, Meridional Faculty/IMED, 304 Senador Pinheiro Machado Street, 99070-220, Passo Fundo, Brazil [email protected]

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Artigo aceito para publicação no periódico Journal of Dentistry e formatado segundo suas normas

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Systematic reviews in dentistry: Current status, epidemiological and reporting characteristics

Abstract Objective: This study aimed to evaluate the epidemiological and reporting

characteristics of systematic reviews (SRs) in dentistry indexed within PubMed

during the year 2017.

Methods: We searched for SRs in dentistry indexed within PubMed in 2017.

Study selection was undertaken by two reviewers independently. Data related

to epidemiological and reporting characteristics were extracted by one of three

reviewers. A descriptive analysis of the data was performed. Characteristics of

SRs were analyzed considering all SRs included and subgrouped by dental

specialties. In addition, we explored if the reporting of 24 characteristics of

treatment/therapeutic SRs was associated with the self-reported use of the

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Statement calculating the risk ratio (RR) with a 95% confidence interval for each

characteristic.

Results: 495 articles fulfilled the eligibility criteria. The main specialty

considered was Oral Surgery numbering 75 articles. Brazil presented the

highest contribution with 117 SRs (23.6%). The reporting quality was variable.

Items such as, use of the term “systematic review”, or “meta-analysis” in the title

or abstract was well reported. In contrast, the study risk of bias/quality

assessment method was not reported in 40.5% of SRs. In addition, only four

reporting characteristics were described more often in those SR that reported

using the PRISMA Statement.

Conclusion: A large number of SRs were published in dentistry in 2017 and

the reporting and epidemiological characteristics varied among dental

specialties. There is a mandatory need to improve the quality of reporting and

conduct of SRs in dentistry.

Clinical significance: Poor reporting and conduction of SRs could generate

SRs with imprecise and biased results.

Keywords: dentistry; systematic reviews, reporting, PRISMA

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Introduction

The principal aim of systematic reviews (SRs) is to select and synthesize

all studies addressing a specific question based on previously established

criteria employing methods that minimize bias through a systematic, rigorous

and replicable methodology [1, 2]. SR is a useful methodology for identifying,

appraising and integrating the findings of studies on a specific topic and, when

well-designed, conducted and reported, is considered a gold standard for

decision-making and an important step towards evidence-informed medicine [1,

2].

Recent studies have demonstrated the rapidly increased number of SRs

being published. Ioannidis (2016) suggested that between 1986 and 2015, the

PubMed filters identified 266,782 items as “SRs” [3]. Page et al. (2016)

demonstrated that 22 SRs were published daily in 2014 corresponding to a

three-fold increase over the previous ten years [4]. In addition, both studies

highlighted that many SRs are poorly conducted, reported and/or unnecessary.

In dentistry, the same tendency exists. Saltaji et al. (2013) demonstrated

that 1,188 SRs were published between 1991-2012 and the characteristics

varied across dental specialties [5]. Additionally, the authors observed that the

increased volume of SRs may not necessarily reflect an improvement in

methodological quality. El-Rabbany et al., 2017 suggested that 208 systematic

reviews with meta-analysis of randomized controlled trials were published

between 2000-2013 and highlighted that there is a room for improvement in the

reporting and methodology of SRs [6]. In addition, recent study has

demonstrated

that SRs in endodontics present variability in the methodologic and

reporting quality [7].

Currently there has been no data available concerning a quantitative

evaluation of SRs published in dentistry as well as details regarding the

reporting/conduct of such reviews considering different SRs questions

addressed (epidemiological, therapeutic, diagnostic, among others) and all

dental specialties. In addition, there is no report in the literature considering the

large number of SRs characteristics explored in this article. Thus, this study

aimed to evaluate the epidemiological and reporting characteristics of

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systematic reviews (SRs) in dentistry indexed within PubMed during the year

2017.

Materials and Methods

Protocol We did not pre-register the protocol of this study, as, to date, there is no

register for research of this nature. However, the protocol is available on

request from the corresponding author.

Eligibility Criteria

We included SRs that met the Preferred Reporting Items for Systematic

Reviews and Meta-Analysis Protocols (PRISMA-P) definition of a SR [8], that is,

articles that explicitly stated methods for identifying studies, study selection, and

data synthesis. Studies were not excluded based on the type of methods used

or level of details reported. Further, articles were included independent of the

type of SR questions addressed (epidemiological, therapeutic, diagnostic,

among others).

We considered a SR in dentistry, articles related to evaluation,

diagnostic, prevention and/or treatment of diseases, disorders and/or conditions

of the oral cavity, maxillofacial and/or adjacent area and associated structures

independent of the type of study included.

Articles reported as narrative/non-systematic literature reviews, rapid

reviews, overviews of reviews (or umbrella reviews), scoping reviews,

methodology articles evaluating quality of studies, comments and protocols or

summaries of SRs and those published in languages other than English were

excluded.

Search

The search was performed in PubMed for SRs indexed in 2017 (from

January 01 until December 31) and limited to articles written in the English

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language. The search strategy was created by one of authors (R.S-O) based on

MeSH terms of PubMed and a specific filter (U.S. National Library of Medicine)

to retrieve reports of SRs (Supplemental Material). We considered only SRs

indexed in PubMed based on the study of Page et al., 2016 [4].

Screening

Study selection was undertaken using the EndNote program (EndNote

X7, Thomson Reuters, New York, NY). Initially, we randomly selected 20

references to perform a pilot test of screening to ensure consistency between

the two reviewers involved during that phase using Excel (Microsoft Office).

Subsequently, two researchers (R.B. and R.S-O) identified, independently,

articles by reviewing titles and abstracts for relevance. Retrieved records were

classified as include, exclude or uncertain. The full-text articles of the included

and uncertain records were selected for further eligibility screening by the same

two reviewers. Discrepancies in screening of titles/abstracts and full-text articles

were resolved through discussion. In the case of disagreement, the opinion of a

third reviewer was garnered (M.J.P.).

Data Extraction

We created a standardized form using the Excel program (Microsoft

Excel 2011) based on the data extraction form developed by Page et al. [4].

Initially, we performed a pilot data extraction on a random sample of 10

included SRs. The pilot test was carried out through a discussion between the

reviewers (R.B, G.K.R.P, R.S-O) in order to consider all data for extraction.

Subsequently, data from each SR were extracted by one of three reviewers

(R.B, G.K.R.P, R.S-O). The following data were collected: number of SRs per

journal, year of publication, dentistry specialty (e.g., periodontology, operative

dentistry, prosthesis, public health, among others), details surrounding

administrative information, study eligibility criteria, search methods, screening,

data extraction, risk-of-bias assessment methods, outcomes, statistical

methods, limitations, conclusion and funding. At the end of the data extraction

phase, one author (R.S-O) verified the consistency of all data and in the case of

doubt or inconsistency, the data were extracted again.

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Data Analysis

A descriptive analysis of the data was performed with data summarized

as frequency for categorical items or median and interquartile range for

continuous data. Characteristics of SRs were evaluated considering all SRs

included and were grouped by dental specialties. We analyzed the reporting

characteristics of included SRs related to administrative information, study

eligibility criteria, search methods, screening, data extraction, risk-of-bias

assessment methods, included/excluded studies and participants, outcomes,

statistical methods, limitations, conclusions and funding subgrouped by dental

specialties. The analyses were carried out with Stata 14.0 software (Stata

Corp., College Station, TX, USA). We created a map considering the number of

SRs by country of corresponding authors using the tool infogram.com.

In addition, we explored if the reporting of 24 characteristics of

treatment/therapeutic SRs was associated with the self-reported use of the

PRISMA Statement to guide conduct/reporting. These domains were selected

because they are categorized dichotomously as “it was reported” or “it was not

reported”. For this outcome, the proportion of SRs with adequate reporting of

these items was calculated. Utilizing these proportions, we compared the

completeness of reporting between SRs describing the use of the PRISMA

Statement versus SRs not reporting the calculation of the RR with a 95%

confidence interval for each characteristic. A RR greater than 1 indicated

increased reporting of the item. The analysis was performed in Review Manager

Software (RevMan Copenhagen: The Nordic Cochrane Centre, The Cochrane

Collaboration, 2014). This analysis was not prespecified in the protocol and it

was planned following the completion of data extraction.

Results

Search

The search of PubMed yielded a total of 1375 records and the study

screening based on titles and abstracts resulted in the exclusion of 759 records.

The remaining 616 studies were submitted to full-text analysis, leading to 495

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articles included. Figure 1 presents a flow diagram depicting the review

process.

Epidemiological characteristics and Prevalence of SRs

With regards to the prevalence of SRs published, Page et al. (2016)

suggested that 8184 SRs are indexed by year [4]. We observed that in 2017,

495 SRs were published in dentistry, which suggests that at least 6.05% of

published SRs would be from dentistry. Among the 495 studies, we identified

only 13 Cochrane reviews, which corresponds to 2.6% of published SRs in

dentistry. Besides this, the vast majority were original SRs, where only four

updates were identified (0.8%).

Table 1 presents the epidemiological characteristics of all included

studies and Table 2 features the data grouped by dental specialties. It was

observed that the 495 SRs originated from 165 journals and that most journals

published four or less SRs in 2017 (133 - 80.6%). The median number of

authors was five (IQR: 3 - 6), and the median number of included studies was

14 (IQR: 8 - 25). Two hundred and fifteen (43.4%) SRs were classified as

treatment/therapeutic. With respect to the country where those SRs were

produced, 13 countries produced 77.4% of SRs published, where Brazil had the

greatest contribution with 117 SRs (23.6%) followed by the USA with 53

(10.7%) SRs. Figure 2 portrays a map considering the number of SRs by

country of corresponding author.

Most SRs 362 (73.1%) were published in specialty journals, where the

main specialty was Oral and Maxillofacial Surgery numbering 75 articles (15.1

%), followed closely by Oral and Maxillofacial Pathology/stomatology at 71

articles (14.3%) and Implantology and Periodontology with 61 and 53 articles,

respectively (12.3% and 10.7%). The four main specialties together are

responsible for 52.4% of the published SRs. The other 47.6% are related to the

following specialties: Radiology, Prosthodontics, Public Health, Pediatric

Dentistry, Endodontics, Restorative and Esthetic Dentistry, Orthodontics and

the remaining specialties that were categorized as Other. Two-hundred and

twenty-one SRs (44.6%) synthesized statistically two or more studies and the

Oral and Maxillofacial Surgery specialty was responsible for 34 of them. Only 22

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SRs (10.7%) considered harms of intervention and only 18 (5.6%) considered

economic factors.

Reporting characteristics of SRs

Table 3 presents the reporting characteristics of all included SRs

subgrouped by dental specialties divided into eight main categories:

Administrative information

The use of descriptive terms, such as “systematic review”, “meta-

analysis” or both (when applied), in the title/abstract was not reported in 58 SRs

(11.7%), and 241 (48.7%) made use of the term “systematic review” only. With

regards to protocol registration, 152 (30.7%) of SRs mentioned it and only 76

(15.3%) were publicly available. Most SRs included (336 (67.9%)) reported

using guidelines to either design/conduct or report it. The utility of Cochrane

methods was mentioned in 168 SRs (33.9%) and was more frequent with the

Oral and Maxillofacial Surgery specialty (29 SRs (17.3%)) followed by

Orthodontics (24 SRs (14.3%)).

Study eligibility criteria

In 235 (47.5%) SRs, authors specified that only published studies were

eligible for inclusion, whereas just 94 (19%) considered both published and

unpublished data. 166 (33.5%) SRs did not report the publication status as

eligibility criteria, whereas studies from Oral and Maxillofacial Surgery and Oral

and Maxillofacial Pathology/stomatology represented the greatest proportion of

those (51 SRs (30.7%)). Most SRs (88.1%) reported eligible languages, with

“English only” being the most common approach (219 (44.2%)). Only 186 SRs

(37.6%) reported the eligibility/ineligibility criteria based on study design. Two-

hundred and thirty-six SRs (47.7%) included randomized controlled trials and

88 (17.8%) included cohort studies. Considering dental specialties, Oral and

Maxillofacial Surgery was the specialty with more SRs, including randomized

controlled trials. One-hundred and thirty-seven SRs (27.7%) did not state the

design of the included studies, or such information was unclear. Among them,

the specialties of Oral and Maxillofacial Surgery and Implant Dentistry

accounted for 48 SRs (35%).

27

Search methods

A median of three (IQR: 3 - 5) electronic databases was searched,

although 31 SRs (6.33%) reported searching only one database. Eighty-four

(17%) SRs reported no restrictions for years of coverage, while most SRs (298

(60.3%)) reported the start and end dates for all databases. A full Boolean

search logic was reported for one or more databases in 204 SRs (41.7%), as

was the use of only free-text words in 113 (23%). The employment of searching

some trial registry was reported in just 85 (17.2%) SRs.

Screening, data extraction, and risk-of-bias assessment methods

With respect to screening methods, the majority of SRs (308 (62.2%))

reported that “all titles/abstracts and full-text articles were screened by two

reviewers independently”, and only 10 SRs (2%) reported that “titles/abstracts

were screened by one reviewer, and a second reviewer screened a sample of

records”.

The data extraction method used in 278 (56.8%) SRs was “two reviewers

independently extracted data from all studies”, however almost a third (129

(26.4%)) did not report the data extraction method applied.

Risk of bias/quality assessment was reported in 365 SRs (73.7%), being

more frequently reported for the Oral and Maxillofacial Surgery specialty (58

SRs (15.9%)). The most common approach for assessing the risk of bias/quality

was “two reviewers independently” (176 SRs (48.2%)), although the lack of

reporting the approach used was also common (148 SRs (40.5%)). The

Cochrane risk-of-bias tool was the most common tool used (117 SRs (32%)),

while the QUADAS-2 was less commonly used (9 SRs (2.5%)), with other tools

being reported in 27.9% (102 SRs). The risk-of-bias/quality assessment was

incorporated into the meta-analysis in 41.1% of SRs (81/202).

Included/excluded studies and participants

The majority of SRs (330 (66.7%) presented a review flow that was

reported in text/table and in a PRISMA -like flow diagram, 19.4% (96) reported

only in a PRISMA -like flow diagram, and 40 SRs (8.1%) did not describe a

review flow.

28

The majority of SRs (308/478 (64.4%)) noted the reasons for exclusion of

studies in a PRISMA-like flow diagram or text/table. However, the number of

SRs that did not report reasons for exclusion of full-text articles was also high

(158 SRs (33%)). SRs that reported including grey literature were infrequent

(90/491 (18.3%)).

In terms of reporting the total number of included participants, just 91

SRs presented such information. The median number of participants

considered was 925 (IQR 335 - 3932). However, 41 of those SRs (45%) did not

state the number of participants in the Abstract section, where no SR on the

Radiology specialty presented such information. In 34 SRs (37.4%) only the

number of participants included in at least one meta-analysis was reported.

Outcomes

Two-hundred and fifty-eight SRs (52.1%) reported at least one outcome

in the methods, where the median number of outcomes observed was two (CI

95% 1 - 3). The majority of SRs (304 (63.3%)) did not state a primary outcome.

Moreover, most primary outcomes were continuous (31.2%). The statistical

significance of the intervention effect estimates for the primary outcome was

reported as favorable and statistically significant in 53% of SRs.

Statistical methods

Two or more studies were synthesized statistically in 221 SRs (44.6%),

and the use of a random-effects model (134 SRs (62%)) was more often

reported than a fixed-effect model (21 SRs (9.7%)). Statistical heterogeneity

was investigated in only 221 SRs, where this data inappropriately guided the

choice of meta-analysis model (e.g., random-effects model selected if I2 > 50%)

in 115 SRs (61.2%).

More than a third of the SRs (364 (73.4%)) commented that publication

bias was not assessed and just 85 (17.2%) declared that publication bias was

assessed. The possibility of the existence of publication bias was

discussed/considered in the Results, Discussion or Conclusion sections in only

88 SRs (17.8%), whereas just one SR reported such considerations for the

Prosthodontics and Radiology specialties. The use of additional analyses was

noted in 221 SRs, where the subgroup analysis was the most frequent (68 SRs

29

(30.8%)) and network meta-analysis was utilized in just two SRs (0.8%).

Limitations, conclusions, conflicts of interest and funding

Only a small proportion of SRs (44 (19%)) reported a GRADE

assessment of the body of evidence. Most of the SRs (296 (59.8%)) did not

note the existence of limitations, whereas the report of limitations at the study

and review levels was seen in 95 SRs (19.2%). Further, the incorporation of

information with regards to study risk-of-bias/quality/limitations in the Abstract

conclusions section was only seen in 49 SRs (19.5%). The source of funding

not was described in 192 (38.8%) of SRs, and 181 (36.6%) reported that the

authors had no funding.

Association between self-reported use of the PRISMA Statement and reporting

characteristics

Figure 3 demonstrates that only four reporting characteristics were

described statistically significantly in SR noting the use of the PRISMA

Statement (SR or meta-analysis in title/abstract; eligible publication status

reported; full Boolean search strategy; outcomes specified in Methods section)

than SRs that did not.

Discussion Our study is the first in the oral health literature to analyze 41 reporting

characteristics of SRs and demonstrate that the reporting quality is highly

variable. Items such as use of the term “systematic review” or “meta-analysis” in

the title or abstract, eligible languages and search terms were well reported. In

contrast, just 30.7% of SRs mentioned the SR registration information and the

study risk-of-bias/quality assessment methods were not reported in 40.5% of

SRs, while the primary outcome was not stated in 63.3% of SRs. In addition, we

estimated that almost 500 SRs were indexed in PubMed in 2017, a

considerable increase compared to previous years [5].

Page et al. (2016) and Ioannidis (2016) reported the massive publication

of SRs over the last years considering all subject areas. Our results

demonstrate that in dentistry, the same tendency exists. The large number of

published SRs reflects positive and more challenging results. Positive results

30

include the recognition of the importance of SRs by stakeholders, including

funding agencies requiring the use of SRs as references to justify applications

[9] and the development of free software to perform meta-analysis [10]. In

contrast, some of the challenging results are related to incentives by funding

agencies and universities to increase publication rates and the fact that in

certain countries, such as Brazil, a researcher’s promotions and appointments

are based on number of published articles [11, 12].

Comparing the results of Saljati et al. (2013) [5] and our, we can observe

that in their results, the specialty with the highest number of SRs published was

Periodontics, while in our study, the most abundant specialty was Oral and

Maxillofacial Surgery. In both analyses, most SRs were published in specialty

journals and the primary focus of SRs was treatment/therapeutic. In the other

study, most SRs did not report the source of funding while in ours, 38.8% did

not report it. In relation to the countries of the corresponding authors, between

1991 and 2012, the majority of corresponding authors were from the USA and

United Kingdom, while Brazil appeared in 7th place, while our results show that

Brazil has the most SRs followed by the USA. In addition, we can observe in

both studies the following factors: a small number of SRs were an update of

previous study, small number of Cochrane reviews, similar number of included

studies in the SRs and similar number of studies in largest meta-analysis.

Similar findings were reported in recent studies evaluating the reporting

and methodologic quality of SRs in dentistry. El-Rabbany et al., 2017 evaluated

systematic reviews with meta-analysis of randomized controlled trials published

between 2000-2013 and demonstrated that the overall methodologic quality still

needs improvement [6]. Nagendrababu et al., 2018 assessed the reporting and

methodologic quality of SRs in endodontics and the results presented a high

variability. Items such as objectives, protocol registration and funding were poor

reported. In contrast, use of the term “systematic review” or “meta-analysis” in

the title or abstract and structured summary were well reported [7].

The substantially greater volume of SRs published in Brazil is probably

owing to several reasons: 1) an increase in the number of graduate programs in

dentistry; 2) SRs are low cost when compared to conducting some primary

research, such as randomized trials; 3) the main Brazilian agencies (CAPES

31

and CNPq) evaluate graduate programs and researchers based on the quantity

of articles published over quality [11, 13, 14].

Our results demonstrated that just four reporting characteristics were

described more often in SRs that reported the use of the PRISMA Statement

and there are a few possible explanations for this. Researchers reporting the

use of the PRISMA Statement based on previous publications, even without

knowledge of its use. Furthermore, the use of the PRISMA Statement is

considered suboptimal in dentistry [15, 16] and the action taken by journals

related to the PRISMA Statement varies - some journals only requiring

following the PRISMA recommendations/checklist and others the editorial team

reviewing the fulfilled checklist [16]. More dissemination and training

surrounding reporting guidelines is necessary involving editors, researchers and

students. In addition, novel approaches to improve the reporting should be

encouraged and tested [17].

Other important topics evaluated in the present study is related to the

conduct of SRs. Our results showed that conduct is variable with improvement

in certain aspects but not others. Most of the SRs searched more than one

database and assessed the risk of bias of included studies while, at the same

time, most SRs did not search trials registry databases, use heterogeneity

statistics inappropriately to guide the choice of meta-analysis model or assess

publication bias. All these elements and others could generate SRs with

imprecise and biased results [12].

There are several limitations of our study. We searched one database

and included only articles published in English, so the results may not be

generalized to other databases and SRs published in other languages. The

analysis was based on the report of the SR and it is possible that some SRs

were carried out more rigorously than was specified in the report. We did not

perform the data extraction in duplicate, however in order to minimize errors,

one author reviewed possible data inconsistencies.

The results of this study provided evidence that there is room for

improvement in the conduction and reporting of SRs in the field of dentistry.

Several suggestions to address these problems include:

1. Researchers and students should be trained in all methodological

aspects of SRs;

32

2. Editors, researchers and students should be trained to use the

PRISMA Statement;

3. Funding agencies, governments and universities should encourage

researchers and students to publish with a focus on quality, and

consequently, not base a researcher’s promotions or appointments

solely the quantity of published articles.

Conclusion In conclusion, a massive number of SRs were published in dentistry in

2017 and the reporting and conduction characteristics varied among dental

specialties which could generate in some situations imprecise and biased

results. Based on this, there is an urgent need for improving the quality of

reporting and conduct of SRs in dentistry.

Furthermore, although the use of PRISMA has been linked with some

improvement in the completeness of SRs reports in the biomedical literature,

this was not reflected in the present analysis confined to dentistry. More

innovative and involved approaches to enhancing reported may therefore be

required

References

[1] D.J. Cook, C.D. Mulrow, R.B. Haynes, Systematic reviews: synthesis of bestevidenceforclinicaldecisions,Ann.Intern.Med.126(1997)376-80.[2] M.H. Murad, V.M. Montori, Synthesizing evidence: shifting the focus fromindividualstudiestothebodyofevidence,JAMA.309(2013)2217-8.[3] J.P. Ioannidis, TheMass Production ofRedundant,Misleading, andConflictedSystematicReviewsandMeta-analyses,Milbank.Q.94(2016)485-514.[4] M.J. Page, L. Shamseer, D.G. Altman, J. Tetzlaff, M. Sampson, A.C. Tricco, F.Catala-Lopez, L. Li, E.K. Reid, R. Sarkis-Onofre, D. Moher, Epidemiology andReportingCharacteristicsofSystematicReviewsofBiomedicalResearch:ACross-SectionalStudy,PLoS.Med.13(2016)e1002028.[5]H.Saltaji,G.G.Cummings,S.Armijo-Olivo,M.P.Major,M.Amin,P.W.Major,L.Hartling, C. Flores-Mir, A descriptive analysis of oral health systematic reviewspublished1991-2012:crosssectionalstudy,PLoS.One.8(2013)e74545.[6]M.El-Rabbany,S.Li,S.Bui, J.M.Muir,M.Bhandari,A.Azarpazhooh,AQualityAnalysisofSystematicReviewsinDentistry,Part1:Meta-AnalysesofRandomizedControlledTrials,J.Evid.Based.Dent.Pract.17(2017)389-398.[7] V. Nagendrababu, S.J. Pulikkotil, O.S. Sultan, J. Jayaraman, O.A. Peters,MethodologicalandReportingQualityofSystematicReviewsandMeta-analysesinEndodontics,J.Endod.44(2018)903-913.

33

[8] D. Moher, L. Shamseer, M. Clarke, D. Ghersi, A. Liberati, M. Petticrew, P.Shekelle,L.A.Stewart,P.-P.Group,Preferredreportingitemsforsystematicreviewandmeta-analysisprotocols(PRISMA-P)2015statement,Syst.Rev.4(2015)1.[9]D.Moher,P.Glasziou, I.Chalmers,M.Nasser,P.M.Bossuyt,D.A.Korevaar, I.D.Graham,P.Ravaud,I.Boutron,Increasingvalueandreducingwasteinbiomedicalresearch:who'slistening?,Lancet.387(2016)1573-86.[10] S. Brown, B. Hutton, T. Clifford, D. Coyle, D. Grima, G.Wells, C. Cameron, AMicrosoft-Excel-based tool for running and critically appraising network meta-analyses--anoverviewandapplicationofNetMetaXL,Syst.Rev.3(2014)110.[11]R.C.B. Barata, Ten things you should know about theQualis, Rev. Bras Pós-Grad.13(2016)13-40.[12]J.P.A.Ioannidis,S.Greenland,M.A.Hlatky,M.J.Khoury,M.R.Macleod,D.Moher,K.F.Schulz,R.Tibshirani,Increasingvalueandreducingwasteinresearchdesign,conduct,andanalysis,Lancet.383(2014)166-175.[13] Coordenação de Aperfeiçoamento de Pessoal de Nível Superior.http://www.capes.gov.br.(Accessed09November,2018).[14] Conselho Nacional de Desenvolvimento Científico e Tecnológico.http://www.cnpq.br.(Accessed09November,2018).[15]F.Hua,T.Walsh,A.M.Glenny,H.Worthington,SurveysonReportingGuidelineUsageinDentalJournals,J.Dent.Res.95(2016)1207-13.[16]R. Sarkis-Onofre,M.S. Cenci,D.Moher, T. Pereira-Cenci, ResearchReportingGuidelinesinDentistry:ASurveyofEditors,Braz.Dent.J.28(2017)3-8.[17] D. Koletsi, P.S. Fleming, R.G. Behrents, C.D. Lynch, N. Pandis, The use oftailoredsubheadingswassuccessfulinenhancingcompliancewithCONSORTinadentaljournal,J.Dent.67(2017)66-71.

Table Captions

Table 1. Epidemiology characteristics of 495 indexed in PubMed in 2017.

Table 2. Epidemiology characteristics of 495 indexed in PubMed in 2017 subgrouped by dental

specialties.

Table 3. Reporting characteristics of 495 indexed in PubMed in 2017 subgrouped by dental specialties.

Figure captions

Figure 1. Flow diagram of study selection.

Figure 2. Map considering the number of SRs by country of corresponding author. Dark colors represent

countries with higher number of SRs.

Figure 3. Pooled relative risks across assessed reporting characteristics of treatment/therapeutic SRs with

95% confidence intervals comparing the completeness of reporting between SRs describing the use of the

PRISMA Statement versus SRs not reporting.

34

Table 1. Epidemiological characteristics of 495 SRs indexed in PubMed in 2017 Characteristics Category Number (Percent) Total number of journals 165 Number of SRs per journal ≤4 133 (80.6%)

5-9 21 (12.7%) ≥10 11 (6.7%)

Number of authors 5 (3-6) Country of corresponding author

Brazil 117 (23.6%)

USA 53 (10.7%) Australia 27 (5.4%) China 26 (5.2%) Spain 24 (4.5%) United Kingdom 23 (4.6%) Germany 22 (4.4%) Iran 22 (4.4%) Netherlands 16 (3.2%) India 15 (3%) Italy 14 (2.8%) Saudi Arabia 13 (2.6%) Switzerland 11 (2.2%) Other (≤10 SRs, 35 countries and

unclear) 123 (22.6%)

Focus of SR Treatment/Therapeutic 215 (43.4%) Diagnosis 93 (18.8%) Prognosis 52 (10.5%) Other 46 (9.3%) Epidemiology 44 (8.9%) Unclear 20 (4%) Prevention 19 (3.8%) Mixed 6 (1.2%)

Dental specialties Oral and Maxillofacial Surgery 75 (15.1%) Oral and Maxillofacial

Pathology/stomatology 71 (14.3%)

Implantology 61 (12.3%) Periodontology 53 (10.7%) Orthodontics 42 (8.5%) Restorative and Esthetic

Dentistry 41 (8.3%)

Endodontics 37 (7.5%) Pediatric Dentistry 34 (6.9%) Public Health 30 (6.1%) Prosthodontics 26 (5.2%) Radiology 13 (2.6%) Other 12 (2.4%)

Cochrane review 13 (2.6%)

35

Table 2. Epidemiological characteristics of 495 SRs indexed in PubMed in 2017, sub-grouped by dental specialties Characteristic Dental specialties

All (n=495) Oral and Maxillofacial Surgery (n=75)

Oral and Maxillofacial Pathology/stomatology (n=71)

Implantology (n=61)

Periodontology (n=53)

Orthodontics (n=42)

Restorative and Esthetic Dentistry (n=41)

Endodontics (n=37)

Pediatric Dentistry (n=34)

Public Health (n=30)

Prosthodontics (n=26)

Radiology (n=13)

Other (n=12)

Journal type

General 133 (26.9%)

17 (12.8%)

17 (12.8%)

13 (9.8%)

17 (12.8%)

15 (11.3%)

14 (10.5%)

10 (7.5%)

8 (6%)

10 (7.5)

6 (4.5%)

4 (3%)

2 (1.5)

Specialty 362 (73.1%)

58 (16%)

54 (14.9%)

48 (13.26%)

36 (9.9%)

27 (7.5%)

27 (7.5%)

27 (7.5%)

26 (7.2%)

20 (5.5)

20 (5.5%)

9 (2.5%)

10 (2.8%)

Number of authors 5 (3-6)

5 (4-6)

5 (3-6)

5 (3-5)

5 (4-6)

5 (3-6)

5 (4-6)

4 (4-5)

5 (4-5)

4 (4-6)

4 (3-6)

5 (4-6)

5.5 (3.5-6.5)

Update of a previous SR 4 (0.8%)

2 (0.4%)

0 (0%)

0 (0%)

0 (0%)

2 (0.4%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

Number of included studies

14 (8-25)

11 (7-18)

16.5 (8.5-34.5)

11 (6-18)

19 (10-25)

9 (6-20)

17.5 (11-35.5)

15.5 (8-28)

12 (7-25)

14 (10-28)

23 (10-35)

23 (12-32)

30.5 (13-42)

Number of included participants*

924.5 (335-3932)

605 (157-986)

1753 (439-3616)

262 (188-535)

1724 (641-5345)

616 (315-1769)

4269 (604-113144)

1504 (955-3603)

9293.5 (4948.5-16707)

1328.5 (734-

7563.5)

802 (448-5317)

NA 534 (534-534)

Empty reviews (no eligible studies)

1 (4.9%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

1 (4.9%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

Two or more studies synthesized statistically

221 (44.6%)

34 (6.9%)

24 (4.8%)

31 (6.3%)

29 (5.9%)

26 (5.2%)

19 (3.8%)

14 (2.8%)

19 (3.8%)

13 (2.6%)

6 (1.2%)

5 (1%)

1 (0.2%)

Number of studies included in the largest meta-analysis in each SR that included meta-analysis

8 (5-16)

7 (5-12)

9 (5-12)

8 (6-12)

10 (6-20)

5.5 (3-12.5)

11 (5-26)

12 (8-22)

9 (6-17)

8 (4-20)

10 (7-17)

24 (16-28)

3 (3-3)

Harms considered 22 (10.7%)

6 (27.3%)

3 (13.3%)

7 (31.8%)

2 (9%)

2 (9%)

1 (4.5%)

0 (0%)

1 (4.5%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

Economics considered# 18 (5.6%)

3 (16.7%)

1 (5.6%)

2 (11.1%)

1 (5.6%)

3 (16.7%)

2 (11.1%)

1 (5.6%)

1 (5.6%)

1 (5.6%)

1 (5.6%)

1 (5.6%)

1 (5.6%)

Data reported as number (percent) or median (interquartile range); * considering 94 SRs; # considering if authors reported the outcome or planned collect the data.

36

Table 3. Reporting characteristics of 495 SRs indexed in PubMed in 2017, sub-grouped by dental specialties Category Characteristics Dental specialtiesa

All

(n=495) Surg. Pat/

stomat Imp. Perio. Orth. Rest. Endod. Ped. Public

Health Prosth. Rad. Other

Administrative information

Terms in the title/abstract

"Systematic review" and "meta-analysis"

168 (33.9%)

24 (4.8%)

15 (3%)

27 (5.4%)

22 (4.4%)

21 (4.2%)

16 (3.2%)

9 (1.8%)

17 (3.4%)

10 (2%)

3 (0.6%)

3 (0.6%)

1 (0.2%)

only "Meta-analysis" 28 (5.7%)

5 (1%)

7 (1.4%)

2 (0.4%)

2 (0.4%)

2 (0.4%)

0 (0%)

5 (1%)

0 (0%)

2 (0.4%)

1 (0.2%)

2 (0.4%)

0 (0%)

only "Systematic review"

241 (48.7%)

36 (7.3%)

38 (7.7%)

28 (5.7%)

25 (5%)

15 (3%)

18 (3.6%)

19 (3.8%)

12 (2.4%)

14 (2.8%)

18 (3.8%)

8 (1.6%)

10 (2%)

Neither 58 (11.7%)

10 (2%)

11 (2.2%)

4 (0.8%)

4 (0.8%)

4 (0.8%)

7 (1.4%)

4 (0.8%)

5 (1%)

4 (0.8%)

4 (0.8%)

0 (0%)

1 (0.2%)

SR registration mentioned (e.g., PROSPERO)

152 (30.7%)

18 (3.6%)

19 (3.8%)

16 (3.2%)

21 (4.2%)

17 (3.4%)

16 (3.2%)

10 (2%)

9 (1.8%)

10 (2%)

5 (1%)

6 (1.2%)

5 (1%)

SR protocol mentioned

Protocol is publicly available

76 (15.3%)

9 (1.8%)

11 (2.2%)

10 (2%)

9 (1.8%)

11 (2.2%)

9 (1.8%)

3 (0.6%)

1 (0.2%)

6 (1.2%)

3 (0.6%)

1 (0.2%)

3 (0.6%)

Protocol mentioned but not publicly available

14 (2.8%)

1 (0.2%)

1 (0.2%)

2 (0.4%)

2 (0.4%)

1 (0.2)

0 (0%)

2 (0.4%)

3 (0.6%)

1 (0.2%)

1 (0.2%)

0 (0%)

0 (0%)

Reporting guideline mentioned (e.g., PRISMA)

336 (67.9%)

56 (11.3%)

43 (8.7%)

48 (9.7%)

41 (8.3%)

27 (5.4%)

28 (5.7%)

20 (4%)

19 (3.8%)

22 (4.4%)

16 (3.2%)

8 (1.6%)

8 (1.6%)

Cochrane methods used

168 (33.9%)

29 (5.9%)

16 (3.2%)

22 (4.4%)

18 (3.6%)

24 (4.8%)

15 (3%)

9 (1.8%)

15 (3%)

9 (1.8%)

8 (1.6%)

1 (0.2%)

2 (0.4%)

Study eligibility criteria

Eligible publication status

Published and unpublished studies

94 (19%)

11 (2.2%)

7 (1.4%)

9 (1.8%)

14 (2.8%)

13 (2.6%)

12 (2.4%)

9 (1.8%)

7 (1.4%)

6 (1.2%)

4 (0.8%)

2 (0.4%)

0 (0.0%)

Only published studies 235 38 39 36 25 13 19 11 17 14 12 5 6

37

(47.5%) (7.7%) (7.8%) (7.2%) (5%) (2.6%) (3.8%) (2.2%) (3.4%) (2.8%) (2.4%) (1%) (1.2%)

Not reported 166 (33.5%)

26 (5.2%)

25 (5%)

16 (3.2%)

14 (2.8%)

16 (3.2%)

10 (2%)

17 (3.4%)

17 (3.4%)

10 (2%)

10 (2%)

6 (1.2%)

6 (1.2%)

Eligible languages

All languages considered

170 (34.3%)

28 (5.7%)

15 (3%)

17 (3.4%)

16 (3.2%)

25 (5%)

17 (3.4%)

14 (2.8%)

14 (2.8%)

8 (1.6%)

6 (1.2%)

6 (1.2%)

4 (0.8%)

English only 219 (44.2%)

35 (7.1%)

35 (7.1%)

33 (6.7%)

22 (4.4%)

11 (2.2%)

14 (2.8%)

15 (3%)

15 (3%)

16 (3.2%)

13 (2.6%)

3 (0.6%)

7 (1.4%)

Language (s) other than English only

23 (4.6%)

3 (0.6%)

3 (0.6%)

2 (0.4%)

7 (1.4%)

0 (0%)

2 (0.4%)

1 (0.2%)

2 (0.4%)

1 (0.2%)

1 (0.2%)

1 (0.2%)

0 (0%)

Mixed: English and other language

24 (4.8%)

2 (0.4%)

6 (1.2%)

2 (0.4%)

2 (0.4%)

3 (0.6%)

2 (0.4%)

2 (0.4%)

2 (0.4%)

1 (0.2%)

1 (0.2%)

0 (0%)

1 (0.2%)

Not reported 59 (11.9%)

7 (1.4%)

12 (2.4%)

7 (1.4%)

6 (1.2%)

3 (0.6%)

6 (1.2%)

5 (1%)

6 (1.2%)

4 (0.8%)

5 (1%)

3 (0.6%)

0 (0%)

Eligibility/ineligibility criteria based on studies designs reported

186 (37.6%)

36 (7.3%)

21 (4.2%%)

26 (5.2%)

23 (4.6%)

18 (3.6%)

13 (2.6%)

12 (2.4%)

11 (2.2%)

11 (2.2%)

9 (1.8%)

2 (0.4%)

4 (0.8%)

Eligible studies designs

Randomized controlled trials

236 (47.7%)

43 (8.7%)

26 (5.2%)

34 (6.9%)

29 (5.9%)

30 (6.1%)

22 (4.4%)

12 (2.4%)

13 (2.6%)

10 (2%)

11 (2.2%)

2 (0.4%)

4 (0.8%)

Observational - cohort studies

88 (17.8%)

14 (2.8%)

11 (2.2%)

10 (2%)

14 (2.8%)

8 (1.6%)

6 (1.2%)

4 (0.8%)

8 (1.6%)

8 (1.6%)

3 (0.6%)

1 (0.2%)

1 (0.2%)

Observational - case-control studies

68 (13.7%)

6 (1.2%)

13 (2.6%)

5 (1%)

11 (2.2%)

5 (1%)

4 (0.8%)

5 (1%)

6 (1.2%)

9 (1.8%)

3 (0.6%)

1 (0.2%)

0 (0%)

Observational - cross-sectional studies

54 (10.9%)

6 (1.2%)

5 (1%)

6 (1.2%)

11 (2.2%)

2 (0.4%)

3 (0.6%)

2 (0.4%)

7 (1.4%)

7 (1.4%)

4 (0.8%)

1 (0.2%)

0 (0%)

Observational - case studies or case series

37 (7.4%)

9 (1.8%)

5 (1%)

7 (1.4%)

3 (0.6%)

1 (0.2%)

1 (0.2%)

3 (0.6%)

4 (0.8%)

1 (0.2%)

1 (0.2%)

1 (0.2%)

1 (0.2%)

Other controlled experimental studies

39 (7.9%)

9 (1.8%)

4 (0.8%)

7 (1.4%)

8 (1.6%)

2 (0.4%)

1 (0.2%)

3 (0.6%)

2 (0.4%)

1 (0.2%)

2 (0.4%)

0 (0%)

0 (0%)

Non-randomized controlled trials

22 (4.4%)

2 (0.4%)

0 (0%)

2 (0.4%)

2 (0.4%)

8 (1.6%)

2 (0.4%)

1 (0.2%)

2 (0.4%)

1 (0.2%)

1 (0.2%)

0 (0%)

1 (0.2%)

Quase-randomized 11 0 1 0 1 3 3 1 1 1 0 0 0

38

controlled trials (2.2%) (0%) (0.2%) (0%) (0.2%) (0.6%) (0.6%) (0.2%) (0.2%) (0.2%) (0%) (0%) (0%)

Other 104 (21%)

14 (2.8%)

12 (2.4%)

17 (3.4%)

11 (2.2%)

6 (1.2%)

9 (1.8%)

14 (2.8%)

7 (1.4%)

1 (0.2%)

8 (1.6%)

3 (0.6%)

2 (0.4%)

Unclear/Not stated 137 (27.7%)

28 (5.7%)

17 (3.4%)

20 (4%)

14 (2.8%)

7 (1.4%)

5 (1%)

12 (2.4%)

7 (1.4%)

5 (1%)

11 (2.2%)

5 (1%)

6 (1.2%)

Search method Number of databases searched

3 (3-5)

3 (3-4)

3 (2-4)

3 (2-4)

3 (3-4)

5 (3-6)

3 (3-4)

4 (3-5)

4 (3-5)

3 (2-5)

3 (2-3)

3.5 (3-4)

3.5 (2.5-4.5)

Only one database searchedb

31/490 (6.33%)

2 (0.4%)

6 (1.2%)

5 (1%)

1 (0.2%)

1 (0.2%)

4 (0.8%)

2 (0.4%)

1 (0.2%)

5 (1%)

2 (0.4%)

0 (0%)

2 (0.4%)

Years of coverage reported

No restrictions 84 (17%)

15 (3%)

11 (2.3%)

9 (1.8%)

9 (1.8%)

10 (2%)

11 (2.3%)

4 (0.81%)

3 (0.6%)

8 (1.6%)

2 (0.4%)

0 (0%)

2 (0.4%)

Not reported 60 (12.5%)

6 (1.2%)

3 (0.6%)

8 (1.6%)

11 (2.3%)

5 (1%)

5 (1%)

4 (0.81%)

4 (0.8%)

5 (1%)

3 (0.6%)

4 (0.8%)

2 (0.4%)

Partially - start and end dates are reported for only one of many databases, or only the end date is reported for all databases

52 (10.5%)

7 (1.4%)

6 (1.2%)

6 (1.2%)

5 (1%)

11 (2.2%)

3 (0.6%)

5 (1%)

2 (0.4%)

1 (0.2%)

5 (1%)

0 (0%)

1 (0.2%)

Start and end dates are reported for all databases

298 (60.3%)

47 (9.5%)

50 (10.1%)

50 (10.1%)

28 (5.7%)

16 (3.2%)

22 (4.4%)

24 (4.9%)

25 (5.1%)

16 (3.2%)

16 (3.2%)

9 (1.8%)

7 (1.4%)

Search terms reported

Full Boolean search logic was reported for one or more database

204 (41.7%)

33 (6.7%)

27 (5.5%)

25 (5.1%)

28 (5.7%)

21 (4.3%)

19 (3.9%)

11 (2.2%)

15 (3%)

11 (2.2%)

8 (1.6%)

3 (0.6%)

3 (0.6%)

Only free text words were reported

113 (23%)

18 (3.6%)

20 (4.1%)

13 (2.6%)

10 (2%)

4 (0.8%)

8 (1.6%)

13 (2.6%)

5 (1%)

8 (1.6%)

6 (1.2%)

4 (0.8%)

4 (0.8%)

39

Only main index terms (e.g. MeSH) were reported

82 (16.7%)

10 (2%)

13 (2.6%)

15 (3.5%)

9 (1.8%)

4 (0.8%)

4 (0.8%)

3 (0.6%)

10 (2%)

2 (0.4%)

6 (1.2%)

2 (0.4%)

4 (0.8%)

Both main index terms and free text words were listed, but no full Boolean search logic was reported

43 (8.7%)

9 (1.8%)

7 (1.4%)

5 (1%)

3 (0.6%)

6 (1.2%)

3 (0.6%)

2 (0.4%)

0 (0%)

3 (0.6%)

3 (0.6%)

2 (0.4%)

0 (0%)

No search terms were reported

32 (8.5%)

3 (0.6%)

2 (0.4%)

3 (0.6%)

0 (0%)

4 (0.8)

4 (0.8%)

4 (0.8%)

3 (0.6%)

5 (1%)

2 (0.4%)

2 (0.4%)

4 (0.8%)

Readers are referred elsewhere for full search strategy

18 (3.7%)

2 (0.4%)

2 (0.4%)

0 (0%)

3 (0.6%)

3 (0.6%)

2 (0.4%)

4 (0.8%)

0 (0%)

1 (0.2%)

1 (0.2%)

0 (0%)

0 (0%)

Trial registry searched (e.g., ClinicalTrials.gov)

85 (17.2%)

10 (2%)

8 (1.6%)

9 (1.8%)

10 (2%)

14 (2.8%)

14 (2.8%)

3 (0.6%)

5 (1%)

3 (0.6%)

5 (1%)

4 (0.8%)

0 (0%)

Number of other sources searched

1 (0-1)

1 (0-1)

1 (0-1)

1 (0-1)

1 (0-2)

1 (1-4)

1 (0-1)

1 (0-1)

1 (1-1)

0.5 (0-1)

1 (0-1)

1 (0-1)

1 (0-1)

Screening, extraction, and risk of bias assessment methods

Screening method

All titles/abstracts and full text articles were screened by two reviewers independently

308 (62.2%)

46 (9.3%)

39 (7.9%)

36 (7.3%)

39 (7.9%)

29 (5.9%)

25 (5%)

20 (4%)

25 (5%)

21 (4.2%)

15 (3%)

7 (1.4%)

6 (1.2%)

All titles/abstracts and full text articles were screened by one reviewer, and a second reviewer screened a

10 (2%)

1 (0.2%)

2 (0.4%)

2 (0.4%)

0 (0%)

0 (0%)

0 (0%)

1 (0.2%)

0 (0%)

2 (0.4%)

0 (0%)

1 (0.2%)

1 (0.2%)

40

sample of records

All titles/abstracts and full text articles were screened by only one reviewer

21 (4.2%)

3 (0.6%)

2 (0.4%)

1 (0.2%)

2 (0.4%)

4 (0.8%)

2 (0.4%)

1 (0.2%)

0 (0%)

2 (0.4%)

4 (0.8%)

0 (0%)

0 (0%)

Different method applied to titles/abstracts and full text articles

6 (1.2%)

0 (0%)

0 (0%)

2 (0.4%)

0 (0%)

0 (0%)

1 (0.2%)

2 (0.4%)

0 (0%)

0 (0%)

0 (0%)

1 (0.2%)

1 (0.2%)

Two reviewers screened records for eligibility, but authors did not specify whether this method was applied independently to both titles/abstracts AND full text articles

30 (6.1%)

4 (0.8%)

6 (1.2%)

7 (1.4%)

2 (0.4%)

2 (0.4%)

3 (0.6%)

3 (0.6%)

2 (0.4%)

0 (0%)

0 (0%)

0 (0%)

1 (0.2%)

Not reported 86 (17.4%)

17 (3.4%)

19 (3.8%)

8 (1.6%)

6 (1.2%)

1 (0.2%)

5 (1%)

9 (1.8%)

2 (0.4%)

5 (1%)

6 (1.2%)

5 (1%)

3 (0.6%)

Other 34 (6.9%)

4 (0.8%)

3 (0.6%)

5 (1%)

4 (0.8%)

6 (1.2%)

5 (1%)

1 (0.2%)

5 (1%)

0 (0%)

1 (0.2%)

0 (0%)

0 (0%)

Data extraction method

Two reviewers independently extracted data from all studies

278 (56.8%)

44 (9%)

34 (6.9%)

35 (3.1%)

36 (7.4%)

26 (5.3%)

19 (3.9%)

15 (3.1%)

22 (4.5%)

20 (2.4%)

12 (2.4%)

8 (1.6%)

7 (1.4%)

Two reviewers extracted data from all studies, but authors did not state whether extraction was done independently

23 (4.7%)

6 (1.2%)

3 (0.6%)

1 (0.2%)

1 (0.2%)

0 (0%)

4 (0.8%)

1 (0.2%)

1 (0.2%)

2 (0.4%)

4 (0.8%)

0 (0%)

0 (0%)

Other 59 (12.1%)

8 (1.6%)

9 (1.8%)

8 (1.6%)

4 (0.8%)

8 (1.6%)

9 (1.8%)

4 (0.8%)

4 (0.8%)

1 (0.2%)

2 (0.4%)

1 (0.2%)

1 (0.2%)

41

Not reported 129 (26.4%)

16 (3.3%)

25 (5.1%)

16 (3.7%)

11 (2.2%)

8 (1.6%)

8 (1.6%)

16 (3.3%)

7 (1.4%)

6 (1.6%)

8 (1.6%)

4 (0.8%)

4 (0.8%)

Study risk of bias/quality formally assessed

365/495 (73.7%)

58 (11.7%)

43 (8.7%)

48 (9.7%)

41 (8.3%)

38 (7.7%)

31 (6.3%)

26 (5.2%)

24 (4.8%)

23 (4.6%)

17 (3.4%)

10 (2%) 7 (1.4%)

Study risk of bias/quality assessment method

Two reviewers assessed all studies, but authors did not state whether assessment was done independently

15/365 (4.1%)

2 (0.5%)

2 (0.5%)

1 (0.3%)

0 (0%)

1 (0.3%)

1 (0.3%)

1 (0.3%)

4 (1.1%)

0 (0%)

2 (0.5%)

0 (0%)

1 (0.3%)

Two reviewers independently assessed all studies

176/365 (48.2%)

23 (6.3%)

20 (5.5%)

25 (6.9%)

23 (6.3%)

22 (6%)

16 (4.4%)

8 (2.2%)

10 (2.7%)

12 (3.3%)

6 (1.6%)

7 (1.9%)

4 (1.1%)

Not reported 148/365 (40.5%)

29 (7.9%)

18 (4.9%)

19 (5.2%)

18 (4.9%)

11 (3%)

10 (2.7%)

14 (3.8%)

7 (1.9%)

10 (2.7%)

8 (2.2%)

2 (0.5%)

2 (0.5%)

Other 26/365 (7.1%)

4 (1.1%)

3 (0.8%)

3 (0.8%)

0 (0%)

4 (1.1%)

4 (1.1%)

3 (0.8%)

2 (0.5%)

1 (0.3%)

1 (0.3%)

1 (0.3%)

0 (0%)

Risk of bias/quality tool used

Cochrane risk of bias tool

117/365 (32%)

21 (5.7%)

8 (2.2%)

17 (4.7%)

13 (3.6%)

16 (4.4%)

11 (3%)

7 (1.9%)

9 (2.5%)

4 (1.1%)

9 (2.5%)

0 (0%)

2 (0.5%)

Cochrane risk of bias tool and other

19/365 (5.1%)

1 (0.3%)

4 (1.1%)

6 (1.6%)

1 (0.3%)

3 (0.8%)

0 (0%)

3 (0.8%)

0 (0%)

0 (0%)

0 (0%)

1 (0.3%)

0 (0%)

Jadad Scale 12/365 (3.3%)

5 (1.4%)

2 (0.5%)

0 (0%)

2 (0.5%)

2 (0.5%)

1 (0.3%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

Newcastle-Ottawa Scale 42/365 (11.5%)

5 (1.4%)

4 (1.1%)

4 (1.1%)

9 (2.5%)

3 (0.8%)

3 (0.8%)

1 (2.3%)

5 (1.4%)

6 (1.6%)

2 (0.5%)

0 (0%)

0 (0%)

QUADAS-2 9/365 (2.5%)

2 (0.5%)

1 (0.3%)

1 (0.3%)

0 (0%)

1 (0.3%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

5 (1.4%)

0 (0%)

Reporting guideline 33/365 (9.4%)

10 (2.7%)

5 (1.4%)

6 (1.6%)

3 (0.8%)

1 (0.3%)

1 (0.3%)

1 (0.3%)

1 (0.3%)

2 (0.5%)

1 (0.3%)

1 (0.3%)

1 (0.3%)

Self-developed tool 6/365 (1.6%)

0 (0%)

1 (0.3%)

1 (0.3%)

1 (0.3%)

0 (0%)

2 (0.5%)

1 (0.3%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

42

Other 102/365 (27.9%)

11 (3%)

13 (3.6%)

11 (3%)

11 (3%)

9 (2.5%)

7 (1.9%)

10 (2.7%)

7 (1.9%)

11 (3%)

5 (1.4%)

3 (0.8%)

4 (1.1%)

Not reported 25/365 (6.8%)

3 (0.8%)

6 (1.6%)

2 (0.5%)

1 (0.3%)

3 (0.8%)

6 (1.6%)

3 (0.8%)

1 (0.3%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

Study risk of bias/quality assessment incorporated into meta-analysisc

81/202 (41.1%)

8 (4%)

10 (4.9%)

12 (5.4%)

11 (5.4%)

10 (4.9%)

10 (4.9%)

7 (3.5%)

6 (3%)

3 (1.5%)

2 (1%)

3 (1.5%)

1 (0.5%)

Included/excluded studies and participants

Review flow reported

Review flow was reported in text/table and in a PRISMA/QUOROM-like flow diagram

330/495 (66.7%)

53 (10.7%)

48 (9.7%)

39 (7.9%)

36 (7.3%)

27 (5.4%)

28 (5.7%)

25 (5%)

27 (5.4%)

14 (2.8%)

15 (3%)

8 (1.6%)

10 (2%)

Only reported in a PRISMA/QUOROM-like flow diagram

96/495 (19.4%)

15 (3%)

10 (2%)

11 (2.2%)

13 (2.6%)

10 (2%)

7 (1.4%)

5 (1%)

4 (0.8%)

12 (2.4%)

3 (0.6%)

5 (1%)

1 (0.2%)

Review flow was only reported in text/table

29/495 (5.9%)

5 (1%)

6 (1.2%)

7 (1.4%)

1 (0.2%)

4 (0.8%)

0 (0%)

1 (0.2%)

1 (0.2%)

1 (0.2%)

3 (0.6%)

0 (0%)

0 (0%)

Not reported 40/495 (8.1%)

2 (0.4%)

7 (1.4%)

4 (0.8%)

3 (0.6%)

1 (0.2%)

6 (1.2%)

6 (1.2%)

2 (0.4%)

3 (0.6%)

5 (1%)

0 (0%)

1 (0.2%)

Reasons for exclusion of full text articles reported

Yes - Reasons for all excluded articles reported in PRISMA-like flow diagram or text/table

308/478 (64.4%)

43 (9%)

40 (8.4%)

41 (8.6%)

38 (7.9%)

34 (7.1%)

26 (5.4%)

22 (4.6%)

20 (4.2%)

17 (3.6%)

13 (2.7%)

6 (1.3%)

8 (1.7%)

Partially - reasons for exclusion of only some excluded full text articles were reported

12/478 (2.5%)

3 (0.6%)

2 (0.4%)

1 (0.2%)

2 (0.4%)

0 (0%)

0 (0%)

1 (0.2%)

0 (0%)

2 (0.4%)

0 (0%)

1 (0.2%)

0 (0%)

43

Not reported 158/478 (33%)

28 (5.9%)

26 (5.4%)

16 (3.3%)

11 (2.3%)

6 (1.3%)

15 (3.4%)

13 (2.7%)

12 (2.5%)

10 (2.1%)

12 (2.5%)

5 (1%)

4 (0.8%)

Grey literature included (e.g., conference abstracts)

90/491 (18.3%)

12 (2.4%)

11 (2.2%)

9 (1.8%)

12 (2.4%)

10 (2%)

8 (1.6%)

9 (1.8%)

6 (1.2%)

3 (0.6%)

5 (1%)

5 (1%)

1 (0.2%)

Number of included participants reported in main text

924.5 (335-3932)

605 (157-986)

1753 (439-3616)

262 (188-535)

1724.5 (641-5345)

616 (315-1769)

4269 (604-

113144

1504 (955-3603)

9293.5 (4948.5-16707)

1328.5 (734-

7563.5)

802 (448-5317)

NA 534 (534-534)

Total number of included participants reported in abstract

No number of participants reported

41/91 (45%)

2 (2.2%)

4 (4.4%)

13 (14.3%)

8 (8.8%)

3 (3.3%)

2 (2.2%)

3 (3.3%)

2 (2.2%)

1 (1.1%)

3 (3.3%)

NA 0 (0%)

Only the number of participants included in at least one meta-analysis

5/91 (5.5%)

0 (0%)

0 (0%)

1 (1.1%)

0 (0%)

0 (0%)

5 (5.5%)

1 (1.1%)

1 (1.1%)

0 (0%)

0 (0%)

NA 0 (0%)

Only the total number of participants summed across all studies in the systematic review

34/91 (37.4%)

1 (1.1%)

11 (12.1%)

8 (8.8%)

0 (0%)

2 (2.2%)

34 (37.4%)

4 (4.4%)

3 (3.3%)

0 (0%)

0 (0%)

NA 2 (2.2%)

Both the total number of participants summed across all studies in the systematic review AND the number of participants included in at least one meta-analysis

11/91 (12.1)

2 (2.2%)

2 (2.2%)

0 (0%)

0 (0%)

1 (1.1%)

11 (12.1%)

0 (0%)

0 (0%)

2 (2.2%)

0 (0%)

NA 0 (0%)

Outcomes At least one outcome stated in methods

258 (52.1%)

41 (8.3%)

35 (7.1%)

36 (7.3%)

31 (6.3%)

41 (8.3%)

18 (3.6%)

18 (3.6%)

23 (4.6%)

12 (2.4%)

12 (2.4%)

3 (0.6%)

6 (1.2%)

Number of outcomes stated

2 (1-3)

2 (1-3)

2 (1-2)

2 (2-4)

2 (1-2)

2 (2-4)

2 (1-3)

2 (1-3)

2 (1-2)

1 (1-2)

2 (1-2)

3 (1-4)

2 (1-4)

Primary outcome

44

stated

No 304/480 (63.3%)

42 (8.7%)

47 (9.8%)

38 (7.9%)

30 (6.2%)

22 (4.6%)

25 (5.2%)

24 (5%)

17 (3.5%)

22 (4.6%)

16 (3.3%)

12 (2.5%)

9 (1.9%)

No but only one outcome reported

25/480 (5.2%)

3 (0.6%)

6 (1.2%)

3 (0.6%)

1 (0.2%)

1 (0.2%)

1 (0.2%)

5 (1%)

4 (0.8%)

0 (0%)

1 (0.2%)

0 (0%)

0 (0%)

Yes 151/480 (31.5%)

28 (5.8%)

17 (3.5%)

18 (3.7%)

19 (4%)

19 (4%)

13 (2.7%)

6 (1.2%)

13 (2.7%)

8 (1.7%)

7 (1.5%)

1 (0.2%)

2 (0.4%)

Type of primary outcome

Continuous 55/176 (31.2%)

6 (3.4%)

9 (5.1%)

4 (2.3%)

11 (6.2%)

8 (4.5%)

4 (2.3%)

2 (1.1%)

4 (2.3%)

3 (1.7%)

2 (1.1%)

1 (0.6%)

3 (1.7%)

Dichotomous 35/176 (19.9%)

9 (5.1%)

4 (2.3%)

5 (2.8%)

1 (0.6%)

3 (1.7%)

2 (1.1%)

3 (1.7%)

6 (3.4%)

1 (0.6%)

1 (0.6%)

0 (0%)

1 (0.6%)

Dichotomous and continuous

27/176 (15.3%)

6 (3.4%)

3 (1.7%)

4 (2.3%)

2 (1.1%)

3 (1.7%)

4 (2.3%)

1 (0.6%)

1 (0.6%)

2 (1.1%)

1 (0.6%)

0 (0%)

2 (1.1%)

Rate 21/176 (11.9%)

5 (2.8%)

3 (1.7%)

2 (1.1%)

2 (1.1%)

1 (0.6%)

0 (0%)

3 (1.7%)

2 (1.1%)

2 (1.1%)

1 (0.6%)

0 (0%)

2 (1.1%)

Other 23/176 (13.1%)

3 (1.7%)

2 ( 1.1%)

5 (2.8%)

3 (1.7%)

3 (1.7%)

2 (1.1%)

1 (0.6%)

1 (0.6%)

0 (0%)

2 (1.1%)

0 (0%)

0 (0%)

Unclear 15/176 (8.5%)

2 (1.1%)

2 (1.1%)

1 (0.6%)

1 (0.6%)

2 (1.1%)

2 (1.1%)

1 (0.6%)

3 (1.7%)

0 (0%)

1 (0.6%)

0 (0%)

0 (0%)

Statistical significance of intervention effect estimates for primary outcome

Favourable, non-statistically significant

28/151 (18.5%)

3 (2%)

7 (4.6%)

5 (3.3%)

3 (2%)

2 (1.3%)

1 (0.7%)

2 (1.3%)

2 (1.3%)

1 (0.7%)

1 (0.7%)

1 (0.7%)

1 (0.7%)

Favourable, statistically significant

80/151 (53%)

15 (9.9%)

4 (2.6%)

10 (6.6%)

9 (6%)

13 (8.6%)

6 (4%)

3 (2%)

8 (5.3%)

6 (4%)

3 (2%)

3 (2%)

6 (4%)

Unfavourable, non-statistically significant

17/151 (11.3%)

2 (1.3%)

2 (1.3%)

3 (2%)

1 (0.7%)

2 (1.3%)

2 (1.3%)

0 (0%)

2 (1.3%)

1 (0.7%)

0 (0%)

0 (0%)

1 (0.7%)

Unfavourable, statistically significant

14/151 (9.3%)

3 (2%)

0 (0%)

2 (1.3%)

3 (2%)

1 (0.7%)

1 (0.7%)

1 (0.7%)

1 (0.7%)

2 (1.3%)

0 (0%)

0 (0%)

2 (1.3%)

Unclear 12/151 (7.9%)

1 (0.7%)

3 (1.3%)

1 (0.7%)

4 (2.6%)

0 (0%)

1 (0.7%)

2 (1.3%)

0 (0%)

0 (0%)

1 (0.7%)

0 (0%)

0 (0%)

45

Statistical methods

Two or more studies synthesized statistically

221 (44.6%)

34 (6.9%)

24 (4.8%)

31 (6.3%)

29 (5.9%)

26 (5.2%)

19 (3.8%)

14 (2.8%)

19 (3.8%)

13 (2.6%)

6 (1.2%)

5 (1%)

1 (0.2%)

Meta-analysis model used

Fixed-effect model for all meta-analyses

21/216 (9.7%)

3 (1.4%)

3 (1.4%)

3 (1.4%)

2 (0.9%)

0 (0%)

3 (1.4%)

2 (0.9%)

3 (1.4%)

0 (0%)

1 (0.5%)

1 (0.5%)

0 (0%)

Random-effects model for all meta-analyses

134/216 (62%)

15 (6.9%)

12 (5.6%)

21 (9.7%)

18 (8.3%)

20 (9.3%)

12 (5.6%)

7 (3.2%)

12 (5.6%)

10 (4.6%)

3 (1.4%)

4 (1.8%)

0 (0%)

Varied 49/216 (22.7%)

11 (5.1%)

6 (2.8%)

5 (2.3%)

9 (4.2%)

5 (2.3%)

2 (0.9%)

5 (2.3%)

3 (1.4%)

2 (0.9%)

0 (0%)

0 (0%)

1 (0.5%)

Other 2/216 (0.9%)

0 (0%)

1 (0.5%)

0 (0%)

0 (0%)

0 (0%)

1 (0.5%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

Not reported 10/216 (4.6%)

3 (1.4%)

0 (0%)

2 (0.9%)

0 (0%)

1 (0.5%)

1 (0.5%)

0 (0%)

1 (0.5%)

1 (0.5%)

1 (0.5%)

0 (0%)

0 (0%)

Statistical heterogeneity investigated

No 31/221 (14%)

3 (1.4%)

6 (2.7%)

3 (1.4%)

4 (1.8%)

4 (1.8%)

2 (0.9%)

1 (0.4%)

1 (0.4%)

2 (0.9%)

3 (1.4%)

1 (0.4%)

1 (0.4%)

Yes 188/221 (85.1%)

31 (14%)

18 (8.1%)

27 (12.2%)

25 (11.3%)

21 (9.5%)

17 (7.7%)

13 (5.9%)

18 (8.1%)

11 (5%)

3 (1.4%)

4 (1.8%)

0 (0%)

Heterogeneity of the studies was qualitatively assessed

2/221 (0.9%)

0 (0%)

0 (%)

1 (0.4%)

0 (0%)

1 (0.4%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

Heterogeneity statistic inappropriately guided choice of meta-analysis model (e.g., random-effects model selected if I2 > 50%)

115/188 (61.2%)

23 (12.3%)

12 (6.4%)

17 (9%)

14 (7.4%)

12 (6.4%)

12 (6.4%)

8 (4.3%)

8 (4.3%)

5 (2.7%)

2 (1.1%)

2 (1.1%)

NA

Risk of publication bias assessed (or intent to assess)

Publication bias was not assessed

364 (73.4%)

57 (11.5%)

55 (11.1%)

45 (9.1%)

38 (7.7%)

25 (5%)

28 (5.7%)

29 (5.9%)

24 (4.8%)

22 (4.4%)

21 (4.2%)

9 (1.8%)

11 (2.2%)

46

Not assessed, but authors planned to if they identified a sufficient number of studies

46 (9.3%)

5 (1%)

5 (1%)

7 (1.4%)

3 (0.6%)

8 (1.6%)

5 (1%)

1 (0.2%)

5 (1%)

1 (0.2%)

3 (0.6%)

2 (0.4%)

7 (1.4%)

Yes, publication bias was assessed

85 (17.2%)

13 (2.6%)

11 (2.2%)

9 (1.8%)

12 (2.4%)

9 (1.8%)

8 (1.6%)

7 (1.4%)

5 (1%)

7 (1.4%)

2 ( 0.4%)

2 (0.4%)

9 (1.8%)

Possibility of publication bias discussed/considered in results, discussion, or conclusion

88 (17.8%)

13 (2.6%)

10 (2%)

8 (1.6%)

11 (2.2%)

14 (2.8%)

12 (2.4%)

3 (0.6%)

7 (1.4%)

4 (0.8%)

4 (0.8%)

1 (0.2%)

1 (0.2%)

Additional analyses

Subgroup analysis 68/221 (30.8%)

10 (4.5%)

6 (2.7%)

3 (1.4%)

9 (4.1%)

12 (5.4%)

9 (4.1%)

4 (1.8%)

8 (3.6%)

5 (2.3%)

2 (0.9%)

0 (0%)

0 (0%)

Sensitivity analysis 40/221 (18.1%)

3 (1.4%)

8 (3.6%)

1 (0.4%)

5 (2.3%)

8 (3.6%)

8 (3.6%)

2 (0.9%)

2 (0.9%)

2 (0.9%)

1 (0.4%)

0 (0%)

0 (0%)

Meta-regression 23/221 (10.4%)

0 (0%)

1 (0.4%)

4 (1.8%)

4 (1.8%)

6 (2.7%)

2 (0.9%)

2 (0.9%)

1 (0.4%)

3 (1.4%)

0 (0%)

0 (0%)

0 (0%)

Network meta-analysis 2/221 (0.8%)

0 (0%) 0 (0%) 0 (0%) 0 (0%) 1 (0.4%) 0 (0%) 0 (0%) 1 (0.4%) 0 (0%) 0 (0%) 0 (0%) 0 (0%)

Other 1/221 (0.4%)

1 (0.4%)

0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%)

Limitations, conclusions and funding

GRADE assessment reported in a summary of findings table or text

44/231 (19%)

3 (1.3%)

6 (2.6%)

3 (1.3%)

3 (1.3%)

10 (4.3%)

2 (2.6%)

2 (0.9%)

4 (1.7%)

3 (1.3%)

4 (1.7%)

0 (0%)

0 (0%)

Limitations reported

No limitations were reported

296 (59.8%)

53 (10.7%)

43 (8.7%)

40 (8.1%)

26 (5.2%)

18 (3.6%)

27 (5.4%)

29 (5.9%)

18 (3.6%)

14 (2.8%)

13 (2.6%)

8 (1.6%)

7 (1.4%)

Yes – both limitations at the study level and review level were reported

95 (19.2%)

8 (1.6%)

12 (2.4%)

8 (1.6%)

14 (2.8%)

14 (2.8%)

6 (1.2%)

4 (0.8%)

11 (2.2%)

10 (2%)

4 (0.8%)

1 (0.2%)

3 (0.6%)

47

Yes – only limitations at the review level were reported

28 (5.7%)

3 (0.6%)

4 (0.8%)

5 (1%)

4 (0.8%)

3 (0.6%)

2 (0.4%)

1 (0.2%)

1 (0.2%)

1 (0.2%)

3 (0.6%)

1 (0.2%)

0 (0%)

Yes – only limitations at the study level were reported

76 (15.3%)

11 (2.2%)

12 (2.4%)

8 (1.6%)

9 (1.8%)

7 (1.4%)

6 (1.2%)

3 (0.6%)

4 (0.8%)

5 (1%)

6 (1.2%)

3 (0.6%)

2 (0.4%)

Study risk of bias/quality/limitations incorporated into therapeutic SR abstract conclusions

42/215 (19.5%)

4 (1.9%)

8 (3.7%)

9 (4.2%)

2 (0.9%)

9 (4.2%)

3 (1.4%)

3 (1.4%)

3 (1.4%)

0 (0%)

1 (0.5%)

NA 0 (0%)

Source of funding

Authors specified there was no funding

181 (36.6%)

32 (6.5%)

26 (5.2%)

24 (4.8%)

18 (3.6%)

20 (4%)

13 (2.6%)

11 (2.2%)

10 (2%)

9 (1.8%)

9 (1.8%)

7 (1.4%)

2 (0.4%)

For-profit sponsor 3 (0.6%)

0 (0%)

0 (0%)

1 (0.2%)

1 (0.2%)

0 (0%)

0 (0%)

0 (0%)

1 (0.2%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

Mixed 4 (0.8%)

0 (0%)

1 (0.2%)

0 (0%)

1 (0.2%)

0 (0%)

1 (0.2%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

1 (0.2%)

0 (0%)

Non-profit sponsor 115 (23.2%)

12 (2.4%)

20 (4%)

12 (2.4%)

18 (3.6%)

7 (1.4%)

11 (2.2%)

7 (1.4%)

11 (2.2%)

10 (2%)

3 (0.6%)

1 (0.2%)

3 (0.6%)

Not reported 192 (38.8%)

31 (6.3%)

24 (4.8%)

24 (4.8%)

15 (3%)

15 (3%)

16 (3.2%)

19 (3.8%)

12 (2.4%)

11 (2.2%)

14 (2.8%)

4 (0.8%)

7 (1.4%)

Data reported as number (percent); a – Surg.: Oral and Maxillofacial Surgery; Pat/stomat.: Oral and Maxillofacial Pathology/stomatology; Imp.: Implantology; Perio.: Periodontology; Orth.: Orthodontics; Rest.: Restorative and Esthetic Dentistry; Endod.: Endodontics; Prosth.: Prosthodontics: Rad.: Radiology; b – 5 SRs did not reported; c - considering only SRs that synthetize studies and assessed the risk of bias/quality of included studies

48

Figure1. Flow diagram of study selection

49

Figure 2. Map considering the number of SRs by country of corresponding author.

Dark colors represent countries with higher number of SRs.

50

Figure 3. Pooled relative risks across assessed reporting characteristics of

treatment/therapeutic SRs with 95% confidence intervals comparing the completeness

of reporting between SRs describing the use of the PRISMA Statement versus SRs not

reporting.

51

Considerações Finais

Um grande número de RS foram publicadas na área da odontologia em

2017 e as características de notificação e condução variaram entre

especialidades odontológicas, o que poderia gerar, em algumas situações,

resultados imprecisos e tendenciosos. Com base nisso, há uma necessidade

urgente de melhorar a qualidade de reporte e condução de RSs em

odontologia.

Além disso, embora o uso do PRISMA tenha sido relacionado com

alguma melhoria no reporte das RS na literatura médica, isso não se refletiu

nesta análise restrita à odontologia. Abordagens mais inovadoras para

melhorar o reporte podem, portanto, ser necessárias.

52

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Systematic Review and Meta-Analysis, Int J Oral Maxillofac Implants 32(2) (2017) 291-312. [490] S. Aljohani, R. Fliefel, J. Ihbe, J. Kuhnisch, M. Ehrenfeld, S. Otto, What is the effect of anti-resorptive drugs (ARDs) on the development of medication-related osteonecrosis of the jaw (MRONJ) in osteoporosis patients: A systematic review, J Craniomaxillofac Surg 45(9) (2017) 1493-1502. [491] J. Ata-Ali, J.V. Diago-Vilalta, M. Melo, L. Bagan, M.C. Soldini, C. Di-Nardo, F. Ata-Ali, J.F. Manes-Ferrer, What is the frequency of anatomical variations and pathological findings in maxillary sinuses among patients subjected to maxillofacial cone beam computed tomography? A systematic review, Med Oral Patol Oral Cir Bucal 22(4) (2017) e400-e409. [492] G.D. Soeteman, C. Valkenburg, G.A. Van der Weijden, C. Van Loveren, E. Bakker, D.E. Slot, Whitening dentifrice and tooth surface discoloration-a systematic review and meta-analysis, Int J Dent Hyg (2017). [493] J.S. Sehrawat, M. Singh, Willems method of dental age estimation in children: A systematic review and meta-analysis, J Forensic Leg Med 52 (2017) 122-129. [494] G. Lim, G.H. Lin, A. Monje, H.L. Chan, H.L. Wang, Wound Healing Complications Following Guided Bone Regeneration for Ridge Augmentation: A Systematic Review and Meta-Analysis, Int J Oral Maxillofac Implants (2017). [495] C. Janakiram, C.V. Deepan Kumar, J. Joseph, Xylitol in preventing dental caries: A systematic review and meta-analyses, J Nat Sci Biol Med 8(1) (2017) 16-21. Excludídos com as razões [1] D.J. Worsley, P.G. Robinson, Z. Marshman, Access to urgent dental care: a scoping review, Community Dent Health 34(1) (2017) 19-26. (other synthesis) [2] B.L. Greenberg, M. Glick, M. Tavares, Addressing obesity in the dental setting: What can be learned from oral health care professionals' efforts to screen for medical conditions, J Public Health Dent 77 Suppl 1 (2017) S67-s78. (other synthesis) [3] F. Cieplik, W. Buchalla, E. Hellwig, A. Al-Ahmad, K.A. Hiller, T. Maisch, L. Karygianni, Antimicrobial photodynamic therapy as an adjunct for treatment of deep carious lesions-A systematic review, Photodiagnosis Photodyn Ther 18 (2017) 54-62. (indexed in 2016) [4] P. Madurantakam, S. Kumar, Are there more adverse effects with lingual orthodontics?, Evid Based Dent 18(4) (2017) 101-102. (other synthesis) [5] C.S. Lin, S.Y. Wu, C.A. Yi, Association between Anxiety and Pain in Dental Treatment: A Systematic Review and Meta-analysis, J Dent Res 96(2) (2017) 153-162. (indexed in 2016) [6] Y. Berlin-Broner, M. Febbraio, L. Levin, Association between apical periodontitis and cardiovascular diseases: a systematic review of the literature, Int Endod J 50(9) (2017) 847-859. (indexed in 2016) [7] J. Castro-Nunez, L.L. Cunningham, J.E. Van Sickels, Atrophic Mandible Fractures: Are Bone Grafts Necessary? An Update, J Oral Maxillofac Surg 75(11) (2017) 2391-2398. (other synthesis) [8] M. Hoben, A. Clarke, K.T. Huynh, N. Kobagi, A. Kent, H. Hu, R.A.C. Pereira, T. Xiong, K. Yu, H. Xiang, M.N. Yoon, Barriers and facilitators in providing oral care to nursing home residents, from the perspective of care aides: A systematic review and meta-analysis, Int J Nurs Stud 73 (2017) 34-51. (not dentistry) [9] H. Harnagea, Y. Couturier, R. Shrivastava, F. Girard, L. Lamothe, C.P. Bedos, E. Emami, Barriers and facilitators in the integration of oral health into primary care: a scoping review, BMJ Open 7(9) (2017) e016078. (other synthesis)

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[10] R.H.L. Motta, C.C. Bergamaschi, N.K. de Andrade, C.C. Guimaraes, J.C. Ramacciato, J.O. Araujo, L.C. Lopes, Bleeding risk in patients using oral anticoagulants submitted to surgical procedures in dentistry: a systematic review protocol, BMJ Open 7(12) (2017) e019161. (other) [11] N.Z. Arandi, Calcium hydroxide liners: a literature review, Clin Cosmet Investig Dent 9 (2017) 67-72. (other synthesis) [12] A.S. Gharpure, N.B. Bhatavadekar, Clinical Efficacy of Tooth-Bone Graft: A Systematic Review and Risk of Bias Analysis of Randomized Control Trials and Observational Studies, Implant Dent (2017). (indexed in 2018) [13] S. Vytla, D. Gebauer, Clinical guideline for the management of odontogenic infections in the tertiary setting, Aust Dent J 62(4) (2017) 464-470. (other synthesis) [14] F. Schwendicke, N. Opdam, Clinical studies in restorative dentistry: Design, conduct, analysis, Dent Mater 34(1) (2018) 29-39. (other synthesis) [15] M.K. Al-Omiri, M. Al-Masri, M.M. Alhijawi, E. Lynch, Combined Implant and Tooth Support: An Up-to-Date Comprehensive Overview, Int J Dent 2017 (2017) 6024565. (other synthesis) [16] J. Yi, M. Ge, M. Li, C. Li, Y. Li, X. Li, Z. Zhao, Comparison of the success rate between self-drilling and self-tapping miniscrews: a systematic review and meta-analysis, Eur J Orthod 39(3) (2017) 287-293. (indexed in 2016) [17] N. Shah, Compliance with removable orthodontic appliances, Evid Based Dent 18(4) (2017) 105-106. (other) [18] S. Mousoulea, D. Kloukos, D. Sampaziotis, T. Vogiatzi, T. Eliades, Condylar resorption in orthognathic patients after mandibular bilateral sagittal split osteotomy: a systematic review, Eur J Orthod 39(3) (2017) 294-309. (indexed in 2016) [19] F. Schwendicke, C.H. Splieth, W.M. Thomson, S. Reda, M. Stolpe, L. Foster Page, Cost-effectiveness of caries-preventive fluoride varnish applications in clinic settings among patients of low, moderate and high risk, Community Dent Oral Epidemiol (2017). (other synthesis) [20] H.F. Marei, K. Mahmood, K. Almas, Critical Size Defects for Bone Regeneration Experiments in the Dog Mandible: A Systematic Review, Implant Dent (2017). (other) [21] A. Skrzat, D. Olczak-Kowalczyk, A. Turska-Szybka, Crohn's disease should be considered in children with inflammatory oral lesions, Acta Paediatr 106(2) (2017) 199-203. (other synthesis) [22] M. Yamada, H. Egusa, Current bone substitutes for implant dentistry, J Prosthodont Res (2017). (other synthesis) [23] W. Xue, Z. Xiaobo, H. Bin, D. Yanhan, L. Shumei, [Decalcified freeze-dried bone allograft combined with rich platelet derivatives for the treatment of human periodontal intrabony defects: a Meta-analysis], Hua Xi Kou Qiang Yi Xue Za Zhi 35(6) (2017) 636-642. (chinese) [24] L.D. Seligman, J.D. Hovey, K. Chacon, T.H. Ollendick, Dental anxiety: An understudied problem in youth, Clin Psychol Rev 55 (2017) 25-40. (other synthesis) [25] P.D. Marsh, E. Zaura, Dental biofilm: ecological interactions in health and disease, J Clin Periodontol 44 Suppl 18 (2017) S12-s22. (other) [26] J.A. Griggs, Dental Implants, Dent Clin North Am 61(4) (2017) 857-871. (other synthesis) [27] H. Foulds, Developmental defects of enamel and caries in primary teeth, Evid Based Dent 18(3) (2017) 72-73. (other) [28] N.A. Ghallab, Diagnostic potential and future directions of biomarkers in gingival crevicular fluid and saliva of periodontal diseases: Review of the current evidence, Arch Oral Biol 87 (2017) 115-124. (other synthesis)

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[29] F. Angelieri, V.Q. Yujra, C.T.F. Oshima, D.A. Ribeiro, Do Dental X-Rays Induce Genotoxicity and Cytotoxicity in Oral Mucosa Cells? A Critical Review, Anticancer Res 37(10) (2017) 5383-5388. (other synthesis) [30] C. Li, J. Lin, Y. Men, W. Yang, F. Mi, L. Li, Does Medullary Versus Cortical Invasion of the Mandible Affect Prognosis in Patients With Oral Squamous Cell Carcinoma?, J Oral Maxillofac Surg 75(2) (2017) 403-415. (other synthesis) [31] R.S.D. Smyth, F.S. Ryan, Early treatment of class III malocclusion with facemask, Evid Based Dent 18(4) (2017) 107-108. (other) [32] E.J. Dogramaci, G. Rossi-Fedele, C.W. Dreyer, Effect of breastfeeding on different features of malocclusions in the primary dentition: a systematic review protocol, JBI Database System Rev Implement Rep 15(7) (2017) 1856-1866. (other) [33] J. Yi, J. Xiao, H. Li, Y. Li, X. Li, Z. Zhao, Effectiveness of adjunctive interventions for accelerating orthodontic tooth movement: a systematic review of systematic reviews, J Oral Rehabil 44(8) (2017) 636-654. (other synthesis) [34] S.N. Papageorgiou, E. Kutschera, S. Memmert, L. Golz, A. Jager, C. Bourauel, T. Eliades, Effectiveness of early orthopaedic treatment with headgear: a systematic review and meta-analysis, Eur J Orthod 39(2) (2017) 176-187. (not dentistry) [35] V. Fau, D. Diep, G. Bader, D. Brezulier, O. Sorel, [Effectiveness of selective alveolar decortication in accelerating orthodontic treatment: a systematic review], Orthod Fr 88(2) (2017) 165-178. (french) [36] A. Shirvani, S. Shamszadeh, M.J. Eghbal, S. Asgary, The efficacy of non-narcotic analgesics on post-operative endodontic pain: A systematic review and meta-analysis: The efficacy of non-steroidal anti-inflammatory drugs and/or paracetamol on post-operative endodontic pain, J Oral Rehabil 44(9) (2017) 709-721. (other) [37] C. Theodoridis, A. Grigoriadis, G. Menexes, I. Vouros, Erratum to: Outcomes of implant therapy in patients with a history of aggressive periodontitis. A systematic review and meta-analysis, Clin Oral Investig 21(3) (2017) 965. (other) [38] S. Cianetti, L. Paglia, R. Gatto, A. Montedori, E. Lupatelli, Evidence of pharmacological and non-pharmacological interventions for the management of dental fear in paediatric dentistry: a systematic review protocol, BMJ Open 7(8) (2017) e016043. (other) [39] T. Dietrich, I. Webb, L. Stenhouse, A. Pattni, D. Ready, K.L. Wanyonyi, S. White, J.E. Gallagher, Evidence summary: the relationship between oral and cardiovascular disease, Br Dent J 222(5) (2017) 381-385. (other synthesis) [40] D. Manger, M. Walshaw, R. Fitzgerald, J. Doughty, K.L. Wanyonyi, S. White, J.E. Gallagher, Evidence summary: the relationship between oral health and pulmonary disease, Br Dent J 222(7) (2017) 527-533. (other synthesis) [41] E. Lempesi, E. Toulia, N. Pandis, Expert panels as a reference standard in orthodontic research: An assessment of published methods and reporting, Am J Orthod Dentofacial Orthop 151(4) (2017) 656-668. (other synthesis) [42] K.I. Afrashtehfar, E. Emami, M. Ahmadi, O. Eilayyan, S. Abi-Nader, F. Tamimi, Failure rate of single-unit restorations on posterior vital teeth: A systematic review, J Prosthet Dent 117(3) (2017) 345-353.e8. (other) [43] L.N. Buzatta, R.H. Shimizu, I.A. Shimizu, C. Pacheco-Pereira, C. Flores-Mir, M. Taba, Jr., A.L. Porporatti, G. De Luca Canto, Gingival condition associated with two types of orthodontic fixed retainers: a meta-analysis, Eur J Orthod 39(4) (2017) 446-452. (other) [44] M. Parra, C. Atala-Acevedo, R. Farina, Z.S. Haidar, C. Zaror, S. Olate, Graftless Maxillary Sinus Lift Using Lateral Window Approach: A Systematic Review, Implant Dent (2017). (other)

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[45] A. Wolff, R.K. Joshi, J. Ekstrom, D. Aframian, A.M. Pedersen, G. Proctor, N. Narayana, A. Villa, Y.W. Sia, A. Aliko, R. McGowan, A.R. Kerr, S.B. Jensen, A. Vissink, C. Dawes, A Guide to Medications Inducing Salivary Gland Dysfunction, Xerostomia, and Subjective Sialorrhea: A Systematic Review Sponsored by the World Workshop on Oral Medicine VI, Drugs R D 17(1) (2017) 1-28. (indexed in 2016) [46] L. Nibali, A. Di Iorio, Y.K. Tu, A.R. Vieira, Host genetics role in the pathogenesis of periodontal disease and caries, J Clin Periodontol 44 Suppl 18 (2017) S52-s78. (other) [47] S.K. Tan, W.K. Leung, A.T.H. Tang, R.A. Zwahlen, How does mandibular advancement with or without maxillary procedures affect pharyngeal airways? An overview of systematic reviews, PLoS One 12(7) (2017) e0181146. (other synthesis) [48] C.P. Ferrua, E.G.Z. Centeno, L.C.D. Rosa, C.C.D. Amaral, R.F. Severo, R. Sarkis-Onofre, G.G. Nascimento, G. Cordenonzi, R.K. Bast, F.F. Demarco, F. Nedel, How has dental pulp stem cells isolation been conducted? A scoping review, Braz Oral Res 31 (2017) e87. (other synthesis) [49] V. Candotto, D. Lauritano, M. Nardone, L. Baggi, C. Arcuri, R. Gatto, R.M. Gaudio, F. Spadari, F. Carinci, HPV infection in the oral cavity: epidemiology, clinical manifestations and relationship with oral cancer, Oral Implantol (Rome) 10(3) (2017) 209-220. (other synthesis) [50] S. Zhang, S. Wang, Y. Song, Immediate loading for implant restoration compared with early or conventional loading: A meta-analysis, J Craniomaxillofac Surg 45(6) (2017) 793-803. (other) [51] D. Dalessandri, S. Parrini, R. Rubiano, D. Gallone, M. Migliorati, Impacted and transmigrant mandibular canines incidence, aetiology, and treatment: a systematic review, Eur J Orthod 39(2) (2017) 161-169. (other) [52] M.S. Howe, Implant maintenance treatment and peri-implant health, Evid Based Dent 18(1) (2017) 8-10. (other synthesis) [53] H. Silva, L.B.D. Gottems, [The interface between primary and secondary care in dentistry in the Unified Health System (SUS): an integrative systematic review], Cien Saude Colet 22(8) (2017) 2645-2657. (other synthesis) [54] D. Hochli, M. Hersberger-Zurfluh, S.N. Papageorgiou, T. Eliades, Interventions for orthodontically induced white spot lesions: a systematic review and meta-analysis, Eur J Orthod 39(2) (2017) 122-133. (other synthesis) [55] K. Sridharan, G. Sivaramakrishnan, Interventions for Refractory Trigeminal Neuralgia: A Bayesian Mixed Treatment Comparison Network Meta-Analysis of Randomized Controlled Clinical Trials, Clin Drug Investig 37(9) (2017) 819-831. (not dentistry) [56] E. Siegel, M. Cations, C. Wright, V. Naganathan, A. Deutsch, L. Aerts, H. Brodaty, Interventions to Improve the Oral Health of People with Dementia or Cognitive Impairment: A Review of the Literature, J Nutr Health Aging 21(8) (2017) 874-886. (other synthesis) [57] H. Fernandez-Olarte, A. Gomez-Delgado, D. Lopez-Davila, R. Rangel-Perdomo, G.I. Lafaurie, L. Chambrone, Is the Mandibular Growth Affected by Internal Rigid Fixation?: A Systematic Review, J Maxillofac Oral Surg 16(3) (2017) 277-283. (other) [58] P. Poudel, R. Griffiths, V.W. Wong, A. Arora, A. George, Knowledge and practices of diabetes care providers in oral health care and their potential role in oral health promotion: A scoping review, Diabetes Res Clin Pract 130 (2017) 266-277. (other synthesis) [59] M. Osterberg, A. Holmlund, B. Sunzel, S. Tranaeus, S. Twetman, B. Lund, KNOWLEDGE GAPS IN ORAL AND MAXILLOFACIAL SURGERY: A

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SYSTEMATIC MAPPING, Int J Technol Assess Health Care 33(1) (2017) 93-102. (other synthesis) [60] J. Gold, Limited Evidence Links Silver Diamine Fluoride and Caries Arrest in Children, J Evid Based Dent Pract 17(3) (2017) 265-267. (other synthesis) [61] D. Richards, Little evidence available for arginine and caries prevention, Evid Based Dent 18(3) (2017) 71. (other synthesis) [62] C.C. Guimaraes, R.H. Lopes Motta, C.C. Bergamaschi, J.O. Araujo, N.K. Andrade, M.F. Figueiro, J.C. Ramacciato, L.C. Lopes, Local anaesthetics combined with vasoconstrictors in patients with cardiovascular disease undergoing dental procedures: systematic review and meta-analysis protocol, BMJ Open 7(11) (2017) e014611. (other synthesis) [63] M. Sonesson, F. Bergstrand, S. Gizani, S. Twetman, Management of post-orthodontic white spot lesions: an updated systematic review, Eur J Orthod 39(2) (2017) 116-121. (other synthesis) [64] L. Guarda-Nardini, D. Trojan, A. Paolin, D. Manfredini, Management of temporomandibular joint degenerative disorders with human amniotic membrane: Hypothesis of action, Med Hypotheses 104 (2017) 68-71. (other synthesis) [65] S. Kattan, S.M. Lee, M.R. Kohli, F.C. Setzer, B. Karabucak, Methodological Quality Assessment of Meta-analyses in Endodontics, J Endod 44(1) (2018) 22-31. (other synthesis) [66] A.S. Dhadwal, D. Hurst, No difference in the long-term clinical performance of direct and indirect inlay/onlay composite restorations in posterior teeth, Evid Based Dent 18(4) (2017) 121-122. (other synthesis) [67] A. Veitz-Keenan, J. Keenan, No evidence available on best therapies for postextraction haemorrhage, Evid Based Dent 18(2) (2017) 52-53. (other synthesis) [68] S.A. Steenen, L. Dubois, J. de Lange, [Ocular complications of local anaesthesia in dentistry], Ned Tijdschr Tandheelkd 124(3) (2017) 149-153. (german) [69] G.S. Sarode, S.C. Sarode, N. Maniyar, R. Anand, S. Patil, Oral cancer databases: A comprehensive review, J Oral Pathol Med (2017). (other synthesis) [70] W. Xi, H. Bo, P. Haiyang, L. Chang, S. Jinlin, T. Ming, [Oral health status of patients undergoing hemodialysis: a Meta-analysis], Hua Xi Kou Qiang Yi Xue Za Zhi 35(2) (2017) 155-161. (chinese) [71] M. Sykara, P. Ntovas, E.M. Kalogirou, K.I. Tosios, A. Sklavounou, Oral lymphoepithelial cyst: A clinicopathological study of 26 cases and review of the literature, J Clin Exp Dent 9(8) (2017) e1035-e1043. (other synthesis) [72] J.S. Hebert, M. Rehani, R. Stiegelmar, Osseointegration for Lower-Limb Amputation: A Systematic Review of Clinical Outcomes, JBJS Rev 5(10) (2017) e10. (not dentistry) [73] S. Titsinides, N.G. Nikitakis, J. Tasoulas, A. Daskalopoulos, L. Goutzanis, A. Sklavounou, Ossifying Fibromyxoid Tumor of the Retromolar Trigone: A Case Report and Systematic Review of the Literature, Int J Surg Pathol 25(6) (2017) 526-532. (other synthesis) [74] S. Kuroshima, M. Kaku, T. Ishimoto, M. Sasaki, T. Nakano, T. Sawase, A paradigm shift for bone quality in dentistry: A literature review, J Prosthodont Res 61(4) (2017) 353-362. (other synthesis) [75] E. Emami, N. Kadoch, S. Homayounfar, H. Harnagea, P. Dupont, N. Giraudeau, R. Marino, Patient satisfaction with E-Oral Health care in rural and remote settings: a systematic review protocol, Syst Rev 6(1) (2017) 174. (other synthesis)

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[76] R. Sarkis-Onofre, D. Fergusson, M.S. Cenci, D. Moher, T. Pereira-Cenci, Performance of Post-retained Single Crowns: A Systematic Review of Related Risk Factors, J Endod 43(2) (2017) 175-183. [77] L. Winning, G.J. Linden, Periodontitis and Systemic Disease: Association or Causality?, Curr Oral Health Rep 4(1) (2017) 1-7. (other synthesis) [78] J.A. Figueira, V.C. Veltrini, Photodynamic therapy in oral potentially malignant disorders-Critical literature review of existing protocols, Photodiagnosis Photodyn Ther 20 (2017) 125-129. (not dentistry) [79] Z. Akram, F. Javed, M. Hosein, M.A. Al-Qahtani, F. Alshehri, A.I. Alzahrani, F. Vohra, Photodynamic therapy in the treatment of symptomatic oral lichen planus: A systematic review, Photodermatol Photoimmunol Photomed (2017). (other) [80] S.M. Gondivkar, A.R. Gadbail, M.G. Choudhary, P.R. Vedpathak, M.S. Likhitkar, Photodynamic treatment outcomes of potentially-malignant lesions and malignancies of the head and neck region: A systematic review, J Investig Clin Dent (2017). (not dentistry) [81] U.P. Verma, R.K. Yadav, M. Dixit, A. Gupta, Platelet-rich Fibrin: A Paradigm in Periodontal Therapy - A Systematic Review, J Int Soc Prev Community Dent 7(5) (2017) 227-233. (other synthesis) [82] F.A. Khan, P. Parayaruthottam, G. Roshan, V. Menon, M. Fidha, A.K. Fernandes, Platelets and Their Pathways in Dentistry: Systematic Review, J Int Soc Prev Community Dent 7(Suppl 2) (2017) S55-s60. (other synthesis) [83] N. Su, A. van Wijk, E. Berkhout, G. Sanderink, J. De Lange, H. Wang, G. van der Heijden, Predictive Value of Panoramic Radiography for Injury of Inferior Alveolar Nerve After Mandibular Third Molar Surgery, J Oral Maxillofac Surg 75(4) (2017) 663-679. (other synthesis) [84] A.D. Loguercio, B.M. Maran, T.A. Hanzen, A.M. Paula, J. Perdigao, A. Reis, Randomized clinical trials of dental bleaching - Compliance with the CONSORT Statement: a systematic review, Braz Oral Res 31(suppl 1) (2017) e60. (other synthesis) [85] H. Nazzal, M.S. Duggal, Regenerative endodontics: a true paradigm shift or a bandwagon about to be derailed?, Eur Arch Paediatr Dent 18(1) (2017) 3-15. (other synthesis) [86] A.B. Castro, N. Meschi, A. Temmerman, N. Pinto, P. Lambrechts, W. Teughels, M. Quirynen, Regenerative potential of leucocyte- and platelet-rich fibrin. Part A: intra-bony defects, furcation defects and periodontal plastic surgery. A systematic review and meta-analysis, J Clin Periodontol 44(1) (2017) 67-82. (other) [87] B. Gonzalez Navarro, X. Pinto Sala, E. Jane Salas, Relationship between cardiovascular disease and dental pathology. Systematic review, Med Clin (Barc) 149(5) (2017) 211-216. (spanish) [88] P. Ramos-Garcia, I. Ruiz-Avila, J.A. Gil-Montoya, A. Ayen, L. Gonzalez-Ruiz, F.J. Navarro-Trivino, M.A. Gonzalez-Moles, Relevance of chromosomal band 11q13 in oral carcinogenesis: An update of current knowledge, Oral Oncol 72 (2017) 7-16. (other synthesis) [89] J.N. Zimmerman, J. Lee, B.T. Pliska, Reliability of upper pharyngeal airway assessment using dental CBCT: a systematic review, Eur J Orthod 39(5) (2017) 489-496. (other) [90] B.T. Amaechi, Remineralisation - the buzzword for early MI caries management, Br Dent J 223(3) (2017) 173-182. (other synthesis) [91] W. Xiaotong, R. Nanquan, X. Jing, Z. Yuming, G. Lihong, [Remineralization effect of casein phosphopeptide-amorphous calcium phosphate for enamel

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demineralization: a system review], Hua Xi Kou Qiang Yi Xue Za Zhi 35(6) (2017) 629-635. (chinese) [92] A.Y. Ibrahim, S. Gudhimella, S.N. Pandruvada, S.S. Huja, Resolving differences between animal models for expedited orthodontic tooth movement, Orthod Craniofac Res 20 Suppl 1 (2017) 72-76. (other synthesis) [93] T. Abduljabbar, F. Javed, A. Shah, M.S. Samer, F. Vohra, Z. Akram, Role of lasers as an adjunct to scaling and root planing in patients with type 2 diabetes mellitus: a systematic review, Lasers Med Sci 32(2) (2017) 449-459. (other) [94] R.A. Magesty, E.L. Galvao, C. de Castro Martins, C.R.R. Dos Santos, S.G.M. Falci, Rotary Instrument or Piezoelectric for the Removal of Third Molars: a Meta-Analysis, J Maxillofac Oral Surg 16(1) (2017) 13-21. (other) [95] E.C. Porto-Mascarenhas, D.X. Assad, H. Chardin, D. Gozal, G. De Luca Canto, A.C. Acevedo, E.N. Guerra, Salivary biomarkers in the diagnosis of breast cancer: A review, Crit Rev Oncol Hematol 110 (2017) 62-73. (other) [96] A. Tsichlaki, K. O'Brien, A. Johal, P.S. Fleming, A scoping review of outcomes related to orthodontic treatment measured in cleft lip and palate, Orthod Craniofac Res 20(2) (2017) 55-64. (other synthesis) [97] C. Zemouri, H. de Soet, W. Crielaard, A. Laheij, A scoping review on bio-aerosols in healthcare and the dental environment, PLoS One 12(5) (2017) e0178007. (other synthesis) [98] F. Edher, C.T. Nguyen, Short dental implants: A scoping review of the literature for patients with head and neck cancer, J Prosthet Dent (2017). (other synthesis) [99] V.T. Noronha, A.J. Paula, G. Duran, A. Galembeck, K. Cogo-Muller, M. Franz-Montan, N. Duran, Silver nanoparticles in dentistry, Dent Mater 33(10) (2017) 1110-1126. (other synthesis) [100] E.A. Al-Moraissi, S.R. Thaller, E. Ellis, Subciliary vs. transconjunctival approach for the management of orbital floor and periorbital fractures: A systematic review and meta-analysis, J Craniomaxillofac Surg 45(10) (2017) 1647-1654. (not dentistry) [101] M. Steven-Howe, D. Richards, Surgical regenerative treatment of peri-implantitis, Evid Based Dent 18(3) (2017) 79-81. (other synthesis) [102] A. Hasuike, S. Iguchi, D. Suzuki, E. Kawano, S. Sato, Systematic review and assessment of systematic reviews examining the effect of periodontal treatment on glycemic control in patients with diabetes, Med Oral Patol Oral Cir Bucal 22(2) (2017) e167-e176. (other synthesis) [103] S.S. Zhang, Y. Zhang, P. Di, Y. Lin, [Systematic review and meta-analysis on the effect of implant supported overdentures on the oral health related quality of life of edentulous patients], Zhonghua Kou Qiang Yi Xue Za Zhi 52(5) (2017) 305-309. (chinese) [104] J.M. Zakrzewska, J. Wu, S.L.B. T, A systematic review of the management of trigeminal neuralgia in patients with multiple sclerosis, World Neurosurg (2017). (not dentistry) [105] A.M. Kielbassa, G. Glockner, M. Wolgin, K. Glockner, Systematic review on highly viscous glass-ionomer cement/resin coating restorations (Part II): Do they merge Minamata Convention and minimum intervention dentistry?, Quintessence Int 48(1) (2017) 9-18. (other synthesis) [106] M.E. Mesko, B. Hutton, J.A. Skupien, R. Sarkis-Onofre, D. Moher, T. Pereira-Cenci, Therapies for bruxism: a systematic review and network meta-analysis (protocol), Syst Rev 6(1) (2017) 4. (other synthesis)

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[107] A.B. Paula, A.R. Fernandes, A.S. Coelho, C.M. Marto, M.M. Ferreira, F. Caramelo, F. do Vale, E. Carrilho, Therapies for White Spot Lesions-A Systematic Review, J Evid Based Dent Pract 17(1) (2017) 23-38. (other) [108] A. Lewyllie, M. Cadenas De Llano-Perula, A. Verdonck, G. Willems, Three-dimensional imaging of soft and hard facial tissues in patients with craniofacial syndromes: a systematic review of methodological quality, Dentomaxillofac Radiol (2017) 20170154. (other synthesis) [109] A.K. Shakya, U. Kandalam, Three-dimensional macroporous materials for tissue engineering of craniofacial bone, Br J Oral Maxillofac Surg 55(9) (2017) 875-891. (other synthesis) [110] R. Elhaddaoui, L. Bahije, F. Zaoui, W. Rerhrhaye, [Timing of alveolar bone graft and sequences of canine eruption in cases of cleft lip and palate: a systematic review], Orthod Fr 88(2) (2017) 193-198. (french) [111] A. Veitz-Keenan, J.R. Keenan, To cord or not to cord? That is still a question, Evid Based Dent 18(1) (2017) 21-22. (other) [112] S. Spivakovsky, Treatment for bisphosphonate-related osteonecrosis of the jaw, Evid Based Dent 18(2) (2017) 56. (other) [113] A. Mohamed, L. Steier, Uncertain Decision-Making in Primary Root Canal Treatment, J Evid Based Dent Pract 17(3) (2017) 205-215. (other) [114] R. Brignardello-Petersen, Uncertainty about whether periodontal therapy improves oral health-related quality of life owing to serious limitations in systematic review addressing this question, J Am Dent Assoc 149(1) (2018) e35. (other) [115] P.N. Madianos, P.A. Koromantzos, An update of the evidence on the potential impact of periodontal therapy on diabetes outcomes, J Clin Periodontol 45(2) (2018) 188-195. (other synthesis) [116] H.F. Rios, W.S. Borgnakke, E. Benavides, The Use of Cone-Beam Computed Tomography in Management of Patients Requiring Dental Implants: An American Academy of Periodontology Best Evidence Review, J Periodontol 88(10) (2017) 946-959. (other synthesis) [117] Use of Pit-and-Fissure Sealants, Pediatr Dent 39(6) (2017) 156-172. (other synthesis) [118] Y.O. Crystal, A.A. Marghalani, S.D. Ureles, J.T. Wright, R. Sulyanto, K. Divaris, M. Fontana, L. Graham, Use of Silver Diamine Fluoride for Dental Caries Management in Children and Adolescents, Including Those with Special Health Care Needs, Pediatr Dent 39(5) (2017) 135-145. (other synthesis) [119] V. Dhar, A.A. Marghalani, Y.O. Crystal, A. Kumar, P. Ritwik, O. Tulunoglu, L. Graham, Use of Vital Pulp Therapies in Primary Teeth with Deep Caries Lesions, Pediatr Dent 39(5) (2017) 146-159. (other synthesis) [120] L.M. Buck, O. Dalci, M.A. Darendeliler, S.N. Papageorgiou, A.K. Papadopoulou, Volumetric upper airway changes after rapid maxillary expansion: a systematic review and meta-analysis, Eur J Orthod 39(5) (2017) 463-473. (other) [121] S. Al-Harasi, P.F. Ashley, D.R. Moles, S. Parekh, V. Walters, WITHDRAWN: Hypnosis for children undergoing dental treatment, Cochrane Database Syst Rev 6 (2017) Cd007154. (other) Other: comment of SR, protocol of SR or animal study Não encontrados [1] Z. Chen, D. Chen, S. Zhang, L. Tang, Q. Li, Antibiotic prophylaxis for preventing dental implant failure and postoperative infection: A systematic review of randomized controlled trials, Am J Dent 30(2) (2017) 89-95.

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[2] T. Cai, Z.Y. Yang, L. Nie, J.X. Zhen, L. Deng, Z. Zhou, Association between vitamin D receptor BsmI gene polymorphism and periodontitis: a meta-analysis in a single ethnic group, Cell Mol Biol (Noisy-le-grand) 63(11) (2017) 1-4. [3] R.A. Pedigo, Dental Emergencies: Management Strategies That Improve Outcomes, Emerg Med Pract 19(6) (2017) 1-24. [4] C. Grunberg, F. Bauer, A. Crispin, M. Jakob, R. Hickel, M.E. Draenert, Effectiveness of dentifrices with new formulations for the treatment of dentin hypersensitivity - A meta-analysis, Am J Dent 30(4) (2017) 221-226. [5] B. Gupta, S. Singh, R.H. Tallents, E. Rossouw, Effects of Bisphosphonates on Orthodontic Treatment and the TMJ: A Systematic Review, J Clin Orthod 51(8) (2017) 471-478. [6] J.C. Tunnell, S.K. Harrel, Minimally Invasive Surgery in Periodontal Regeneration: A Review of the Literature, Compend Contin Educ Dent 38(4) (2017) e13-e16. [7] S. Storelli, M. Scanferla, G. Palandrani, D. Mosca, E. Romeo, Stratification of prosthetic complications by manufacturer in implant-supported restorations with a 5 years' follow-up: systematic review of the literature, Minerva Stomatol 66(4) (2017) 178-191. Estratégia de busca "Oral Health"[Mesh] OR "Oral Health" OR "Health, Oral" OR "Dentistry"[Mesh] OR "Dentistry" OR "Dental Research"[Mesh] OR "Dental Research" AND (((systematic review [ti] OR meta-analysis [pt] OR meta-analysis [ti] OR systematic literature review [ti] OR this systematic review [tw] OR pooling project [tw] OR (systematic review [tiab] AND review [pt]) OR meta synthesis [ti] OR meta synthesis [ti] OR integrative review [tw] OR integrative research review [tw] OR rapid review [tw] OR consensus development conference [pt] OR practice guideline [pt] OR drug class reviews [ti] OR cochrane database syst rev [ta] OR acp journal club [ta] OR health technol assess [ta] OR evid rep technol assess summ [ta] OR jbi database system rev implement rep [ta]) OR (clinical guideline [tw] AND management [tw]) OR ((evidence based[ti] OR evidence-based medicine [mh] OR best practice* [ti] OR evidence synthesis [tiab]) AND (review [pt] OR diseases category[mh] OR behavior and behavior mechanisms [mh] OR therapeutics [mh] OR evaluation studies[pt] OR validation studies[pt] OR guideline [pt] OR pmcbook)) OR ((systematic [tw] OR systematically [tw] OR critical [tiab] OR (study selection [tw]) OR (predetermined [tw] OR inclusion [tw] AND criteri* [tw]) OR exclusion criteri* [tw] OR main outcome measures [tw] OR standard of care [tw] OR standards of care [tw]) AND (survey [tiab] OR surveys [tiab] OR overview* [tw] OR review [tiab] OR reviews [tiab] OR search* [tw] OR handsearch [tw] OR analysis [ti] OR critique [tiab] OR appraisal [tw] OR (reduction [tw]AND (risk [mh] OR risk [tw]) AND (death OR recurrence))) AND (literature [tiab] OR articles [tiab] OR publications [tiab] OR publication [tiab] OR bibliography [tiab] OR bibliographies [tiab] OR published [tiab] OR pooled data [tw] OR unpublished [tw] OR citation [tw] OR citations [tw] ,OR database [tiab] OR internet [tiab] OR textbooks [tiab] OR references [tw] OR scales [tw] OR papers [tw] OR datasets [tw] OR trials [tiab] OR meta-analy* [tw] OR (clinical [tiab] AND studies [tiab]) OR treatment outcome [mh] OR treatment outcome [tw] OR pmcbook)) NOT (letter [pt] OR newspaper article [pt])))

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