Methodological quality assessment of paper-based

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Clin Oral Invest DOI 10.1007/s00784-015-1663-5

REVIEW

Methodological quality assessment of paper-based systematic reviews published in oral health J. Wasiak 1,2,3 & A. Y. Shen 4 & H. B. Tan 5 & R. Mahar 6 & G. Kan 7 & W. R. Khoo 8 & C. M. Faggion Jr 9

Received: 25 February 2015 / Accepted: 11 November 2015 # Springer-Verlag Berlin Heidelberg 2015

Abstract Objectives This study aimed to conduct a methodological assessment of paper-based systematic reviews (SR) published in oral health using a validated checklist. A secondary objective was to explore temporal trends on methodological quality. Material and methods Two electronic databases (OVID Medline and OVID EMBASE) were searched for paperbased SR of interventions published in oral health from inception to October 2014. Manual searches of the reference lists of paper-based SR were also conducted. Methodological quality of included paper-based SR was assessed using an 11-item questionnaire, Assessment of Multiple Systematic Reviews (AMSTAR) checklist. Methodological quality was summarized using the median and inter-quartile range (IQR) of the AMSTAR score over different categories and time periods.

* A. Y. Shen [email protected] 1

Epworth Healthcare, Richmond, VIC, Australia

2

School of Public Health and Preventive Medicine, The Alfred Centre, Monash University, Melbourne, Australia

3

Faculty of Medicine, Dentistry and Health Sciences, Melbourne Dental School, Melbourne, Australia

4

Eastern Health, C/O - Box Hill Hospital, Box Hill, Melbourne, Australia

5

Alfred Health, Melbourne, Australia

6

School of Population Health, University of Queensland, Brisbane, Australia

7

Melbourne Health, Melbourne, Australia

8

Southern Health, Melbourne, Australia

9

Department of Periodontology, Faculty of Dentistry, University of Münster, Münster, Germany

Results A total of 643 paper-based SR were included. The overall median AMSTAR score was 4 (IQR 2–6). The highest median score (5) was found in the pain dentistry and periodontology fields, while the lowest median score (3) was found in implant dentistry, restorative dentistry, oral medicine, and prosthodontics. The number of paper-based SR per year and the median AMSTAR score increased over time (median score in 1990s was 2 (IQR 2–3), 2000s was 4 (IQR 2–5), and 2010 onwards was 5 (IQR 3–6)). Conclusion Although the methodological quality of paperbased SR published in oral health has improved in the last few years, there is still scope for improving quality in most evaluated dental specialties. Clinical relevance Large-scale assessment of methodological quality of dental SR highlights areas of methodological strengths and weaknesses that can be targeted in future publications to encourage better quality review methodology. Keywords Dental research . Dentistry . Meta-analysis . Review . Research design . Trends

Introduction Systematic reviews (SR) play a pivotal role in health sciences by providing the highest level of evidence for supporting clinical decision-making [1]. Moreover, SR can identify areas where there is a lack of evidence to support clinical procedures [2]. As with other types of study designs, however, SR are susceptible to presenting heterogeneous quality and therefore scrutinizing their methodology is an important step for researchers and clinicians understanding whether these reviews are reliable in clinical practice. Most publications assessing the methodological quality of SR in dentistry focused on dental specialties with specific

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research questions [3–5]. This methodological approach generated a limited number of SR, with a few exceptions: Papageorgiou et al. looked at 110 SR, Aziz et al. included 106 SR, and Faggion et al. featured 159 SR [6–8]. Therefore, it appears that it is necessary to provide an overall assessment of SR of all areas in dentistry to generate a comprehensive view of the current quality of these reviews. A measurement tool to assess systematic reviews (AMSTAR) is a validated and reliable checklist to assess their methodological quality [9]. It has been consistently used in the last few years in several medical fields, including dentistry [6, 7]. Hence, the main objective of this study was to evaluate the methodology of a comprehensive number of SR published in oral health using the AMSTAR tool. The present study also aimed to assess potential temporal trends in methodological quality in the several quality domains assessed by the checklist.

search strategy and data analysis. In vivo studies, animal studies, non-English studies, and oral and dental disorders treated specifically by oral and maxillofacial surgeons did not meet our inclusion criteria as they were considered to be surgical. All abstracts retrieved by the initial search underwent a scanning process, in which two review authors (AYS, JW) examined them to exclude any irrelevant studies, and then two authors (AYS, HT) screened titles and abstracts against the inclusion criteria. Full-text articles were retrieved and reviewed independently by two authors (JW, AYS) for the purpose of applying inclusion criteria. In all instances, differences of opinion were resolved by discussion among the authors. A list of all included SR can be found in Appendix 2.

Data extraction

Material and methods The method for this review was derived from the systematic review methodology adopted by the Cochrane Collaboration [10].

Data sources and search strategy A structured literature search was performed in OVID MEDLINE from 1946 to October 2014 and OVID EMBASE from 1980 to October 2014 using keywords related to Bdentistry,^ Bdentists,^ Boral health,^ Bdental,^ and Bteeth,^ Bsystematic review,^ and Bmeta-analysis.^ The utilized dental search terms including the MeSH (medical subject headings) and free-text terms were selected from The Cochrane Collaboration’s Oral Health Group [11] (see Appendix 1), which is primarily used to identify randomized controlled trials of interventions. The thesaurus vocabulary of each database was used to adapt the search terms. In addition to the automated search strategies, reference lists of related journal articles, key journals, and existing reviews were hand searched for additional systematic reviews. No attempt was made to locate unpublished material or to contact authors of unpublished studies.

Study selection criteria and procedures Reports of SR were considered eligible for inclusion if they met the following criteria: Bsystematic review^ and/ or Bmeta-analysis^ were used in the title or abstract, or it was clear in the main text that an SR had been carried out by the authorship team along with the presence of a

Two authors independently (JW, AYS) reviewed all the SR and extracted information related to the number of studies included, clinical area of practice, and study quality. Clinical area of practice was based on the practice guidelines as described by the Dental Board of Australia [12]. Some modifications were made to the categories of clinical practice due to the potential of a study overlapping over multiple clinical fields or specialties; as such, we employed categories including Bimplant dentistry^ and Btemporomandibular dysfunction (TMD).^ We used the AMSTAR tool, to collect data on review quality [9].

Methodological quality The AMSTAR tool is an 11-item questionnaire that assesses the methodological quality of SR by determining the presence of the following items: an a priori design, duplicate study selection or data abstraction, a comprehensive literature search spanning more than one electronic source, inclusion of unpublished or grey literature, lists of included and excluded studies, tabulated characteristics of included studies, assessment of scientific quality, use of appropriate methods to combine data, examination of the likelihood of publication bias, and documentation of conflicts of interest. Each question was scored as a yes, no, cannot answer, or not applicable. A score of 1 was assigned to a yes answer, and a score of 0 was assigned to all other answers, resulting in an overall potential score of 11. Each SR meeting the inclusion criteria was then assessed independently by two reviewers (AYS, JW), with discrepancies checked by a third author (HT) until consensus was achieved with the overall AMSTAR score.

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Data analysis

Table 1 General characteristics of paper-based systematic reviews published from 1990 to 2012

Details of each paper-based SR and its AMSTAR scores were compiled to a single dataset. Overall methodological quality was summarized using the median and IQR of the AMSTAR score over different categories and 5-year time periods. Interrater agreement on each item of the AMSTAR checklist was assessed using percentage agreement, and an unweighted kappa score [13], for which higher values indicate better agreement. The analysis was performed using Stata 13 [14].

Clinical area or practice

Number of paper-based SR (%)

Periodontics

137 (21.3)

Results Search results From the initial screening, our systematic search yielded 2,108 potential paper-based SR. After the initial inclusion and exclusion criteria were applied, a further 1,240 study articles were considered irrelevant. Full-text screening of 868 articles then took place excluding 225 reviews due to not being systematic reviews or meta-analyses, duplication of retrieved articles, focus on animal studies, Cochrane systematic reviews, or non-dental studies leaving a total of 643 publications to be examined. Description of studies meeting our inclusion criteria The classification of the retrieved articles and the number of articles belonging to each classification is presented in Table 1. The three most common topics were periodontology (n=137; 21.3 %), implant dentistry (n=100; 15.6 %), and orthodontics (n=74; 11.5 %). The three least common topics were restorative dentistry (n=15; 2.3 %), pain (n=11; 1.7 %), and other unclassified studies (n=25; 3.9 %). Although the median number of studies per SR was 15 (IQR 8–28), the majority (70.2 %, n=450) included fewer than 24 studies in their review, while 2.0 % (n=13) included more than 100 studies. Most studies failed to describe study characteristics (88.2 %, n = 567), with terms such as Badults^ (6.5 %, n = 42) or Bpaediatrics^ (5.3 %, n = 34) populations used sparingly among the studies.

Implant dentistry

100 (15.6)

Orthodontics Preventive dentistry

74 (11.5) 66 (10.3)

Prosthodontics

64 (10.0)

Endodontics Oral and maxillofacial surgery

43 (6.7) 38 (5.9)

Oral medicine/pathology TMD

37 (5.8) 33 (5.1)

Restorative dentistry

15 (2.3)

Pain

11 (1.7)

Other Year of SR publication 1990–1999

25 (3.9) 35 (5.4)

2000–2009

394 (61.3)

2010 onwards Population Adult

214 (33.3)

Paediatrics Unknown/not stated

34 (5.3) 567 (88.2)

42 (6.5)

TMD temporomandibular disorder

Figure 1 shows the percentage distribution of total AMSTAR scores among all paper-based SR, with a total of 168 (26.1 %) studies meeting more than five out of the 11 AMSTAR criteria and fewer than 2 % (n=11) attaining more than eight out of the 11 AMSTAR criteria. A total of 23 (3.6 %) studies that met out inclusion criteria did not meet any of the AMSTAR criteria at all. Of the AMSTAR questions, the three most commonly achieved criteria indicating a strong methodological quality were question 3 (a comprehensive literature search of more than one electronic database, performed in 73.3 % of studies), question 6 (provision of characteristics of included studies, found in 84.6 % of studies),

AMSTAR assessment The overall median AMSTAR score was 4 (IQR 2–6). The highest median score of 5 was found in pain dentistry (IQR 4–6) and periodontology (IQR 3–6), while the lowest median score of 3 was achieved in implant dentistry (IQR 2–5.5), restorative dentistry (IQR 3–5), oral medicine/pathology (IQR 1–5), prosthodontics (IQR 2–4), and unspecified (2–4) classifications.

Fig. 1 Distribution of systematic reviews according to AMSTAR

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and question 7 (the inclusion of a quality assessment of the studies featured in the SR, featured in 53.1 % of studies). Figure 2 shows the percentage of paper-based SR that met each AMSTAR criterion. The most significant lapses occurred in question 1 (provision of an a priori study design, given in 10.7 % of studies), question 10 (assessment for publication bias, done in 9.8 % of studies), and question 11 (inclusion of potential conflicts of interest, seen in only 0.9 % of studies). Characteristics of the included paper-based SR per AMSTAR score are shown by publication year in Table 2. Both the number and the median AMSTAR score of paperbased SR published increase with each time period. The end points of the time period were 1990–2012, and the distribution of AMSTAR scores as measured by the IQR also shows a general increase with each time period (score of 1990s was 2 (IQR 2–3), the 2000s was 4 (IQR 2–5), and 2010 onwards was 5 (IQR 3–6)). Reviewer agreement Mean kappa as a measure of inter-observer agreement was 0.90. The AMSTAR criteria with the most agreement between reviewers were also the same criteria that were achieved least often by the included paper-based SR (questions 1, 10, and 11), while the criteria with the most diverse answers were questions 2, 5, and 8, which had a percentage agreement of less than 95 % (94.2, 94.7, and 94.7 %, respectively). Kappa scores for each question had a wider range, ranging from 0.83 (question 11) to 0.96 (question 1).

Discussion This study provided a comprehensive assessment of the design and reporting characteristics of a large cohort of paperbased SR published in the field of oral health until the

Fig. 2 Percentage of systematic reviews meeting each of the AMSTAR criterion

Table 2 AMSTAR scores of paper-based systematic reviews per publication time block Year of publication

No of paper-based SR published

Median (IQR)

1990–1994

11

2 (2–3)

1995–1999

24

2.5 (1.5–4)

2000–2004 2005–2009

131 263

3 (2–5) 4 (3–5)

2010–2012

214

5 (3–6)

IQR inter-quartile range, SE standard error

beginning of 2014. To our knowledge, this current study provided one of the largest samples of systematic reviews (N= 643) ever evaluated by a validated checklist. Our results showed that an overall low AMSTAR score for paper-based SR published in oral health was evident, although a trend towards better scores was found in more recent years. The paper-based SR predominately addressed questions about effectiveness of therapeutic interventions and some clinical entities such as temporomandibular disorders. We also used a series of databases such as MEDLINE to cover North American journals and EMBASE for their ability to capture European journals. More so, we noted that majority of first authors were from the USA or Europe, a finding that proves similar to a recent paper which looked at the assessment of orthodontic methodology [6]. When considering the overall AMSTAR quality score, previous systematic reviews published in generalized dentistry [15], within specific journals [16] or a sub-specialty such as prosthodontics [7], showed not only similar findings but suggested an overall methodological improvement. However, an established threshold for assigning descriptive quality or an overall quality score has not yet been established; therefore, a Bhigher^ AMSTAR score, rather than a Blower^ AMSTAR score, may help to reveal methodologically sound systematic reviews. Conversely, we identified some selected reviews, which showed that 20 % of included SR satisfied nine or more of the 11 AMSTAR criteria [17, 18]. While it was out of the scope of this review to explore reasons for differences in methodological quality of SR across dental disciplines, the present results may serve as reference for further methodological development of SR published in these fields. Some items were better scored than others. For example, the reporting of characteristics of the primary studies included in the paper-based SR was described in the majority of the SR in our sample. These results are in agreement with other systematic reviews from different medical fields such as pharmacology [19] and neurosurgery [20]. A probable explanation for this results is the flexibility of the AMSTAR checklist on accepting different forms for presenting the characteristics of included studies, i.e., table or text format. Furthermore, the checklist does not specify minimal information amount for

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scoring yes, which suggests that even SR which report fewer characteristics may have received a yes for this criterion. Question 3 (a comprehensive literature search of more than one electronic database) received the second-most positive scores in the present assessment, reflecting similar results from SR published in dentistry [21] and other fields [22, 23]. Nevertheless, some SR provided poor results for this criterion [6, 20]. One possible explanation is the stricter guidelines for the interpretation of the question. AMSTAR requires an extra supplementary strategy (besides the search in at least two electronic databases) to have this criterion met. It is important to emphasize that a SR is updated until a new high quality trial meeting the proposed eligibility criteria is published. Sometimes, due to heterogeneous peer review or editorial processes, the evidence available in SR may become outdated when the manuscript is published. One strategy to minimize this problem is to update the whole search strategy in the last steps of the SR conducting to generate new data input. One interesting result was the low percentage of paperbased SR fulfilling the criterion 1 (provision of an a priori study design). In contrast, other paper-based SR presented a 100 % fulfillment of this criterion [19, 21]. The difference in results is likely related to the reviewer criteria used to evaluate the question. In this instance, we said yes to paper-based SR that specifically mentioned the term a priori or used some kind of preset protocol, rather than simply an inclusion or exclusion criteria. Higher scores may also be representative of differences in methodological rigor between the paper-based SR evaluated; more than 50 % of the paper-based SR reported their method of assessment and documentation of the scientific quality of the included studies. Evaluation of the quality of primary studies included in a SR is of pivotal importance [8]. SR with meta-analyses have the advantage of improving power and precision of estimates of treatment effects [24], but they are unable to improve the quality of studies included in the review. Therefore, readers of SR should be given comprehensive information about the quality of the included evidence in order to assess whether the data is of use in aiding clinical decision-making [25]. Question 11, related to the report of conflict of interest, had the lowest percentage met. A probable explanation is the requirement of the checklist in reporting conflicts of interest of not only the authors of the paper-based SR itself but also of the individual studies included. Normally, editors of journals require the declaration of potential conflict of interest only from the authors of SR. However, the declaration of conflicts of interest of all included parties may prove to be important, as there is overwhelming evidence suggesting that trials supported by industries may provide more positive treatment effect estimates than stand-alone trials [26]. Hence, in order to provide comprehensive and detailed information on potential COI to the reader, this reporting may be necessary.

One potential limitation of the present study is the use of only two databases, MEDLINE and EMBASE. The noninclusion of SR from other databases, such as Cochrane reviews, may slightly reduce the number of SR we analyzed. However, new evidence shows that searching beyond major databases such as MEDLINE has increasingly limited returns for the amount of time taken [27]. As such, we believe that our search strategy of using MEDLINE and EMBASE augmented by hand searches through journals and references allowed us to identify a highly representative number of SR. For further research, because some evidence suggests that Cochrane reviews may have better methodological quality than those paper-based reviews [28, 29], the comparison of a larger sample of Cochrane reviews to the present paper-based review sample would be interesting. The assessment of temporal trends suggests an improvement in the methodological quality of SR published in more recent years. Checklists such as AMSTAR have been used extensively since their publication, which may explain the better scores in more recent reviews. More so, there has been a consistent push by evidence-based medicine organizations such as The Cochrane Collaboration for superior-quality reporting [30], aided by the strict set of rules and guidelines provided by the organization as well as electronic publishing, which allows authors to freely submit more complete details of study conduct. In some specific questions, it was difficult to differentiate whether the aim of the AMSTAR checklist was to evaluate the true methodological quality of the SR or simply the quality of reporting. For example, question 7, which enquired after the quality assessment of studies included in the SR, did not differentiate whether one specific methodological approach was more valid than other (for example, a scale vs. a checklist) [8]. Furthermore, question 9, which looked at the method used to combine the findings of the included studies, seemed to provide superficial information for the question that did not actually check whether the meta-analysis was correctly performed. Merely providing information on the statistical heterogeneity may suggest a uni-dimensional perspective on the feasibility of the meta-analysis. In the present version of AMSTAR, important questions such as the combination of different types of studies [31] or clinical heterogeneity regarding procedures [32] are not taken into account when judging the appropriateness of combined results. A complete critical evaluation of the AMSTAR checklist is reported elsewhere (Faggion 2015, provisionally accepted). Therefore, it is suggested that these concerns are addressed in the next version of the checklist, which have been developed by Kung [33], who revised the AMSTAR tool (e.g., AMSTAR-R), which successfully quantified the quality of systematic reviews. In addition, there has been a move away from review quality to that of reporting Bstudy characteristics^ using former checklists developed in the 1990s (i.e., QUOROM

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Statement—Quality of Reporting of Meta-analyses) [34] to current checklists such as Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA), which have been endorsed by dental journals [35]. In PRISMA, the checklist considers 27 specific items relevant to a SR, so when in instances the SR may rely on evidence outside the RCT, PRISMA allows authors to more appropriately weigh the methodological rigor of existing studies when making conclusions based on their systematic reviews. Setting thresholds for classifying the methodological quality (for example, in low, moderate, or high quality) of the SR may provide misleading information. For example, in the case that one SR has items 1 to 6 with score yes, and a second SR has item 6 to 11 with a score yes, it is unclear which would be considered to have better methodological quality. It seems very difficult to adequately weigh the different 11 domains of the checklist in order to provide a final reliable score. Another potential limitation with the AMSTAR checklist is the lack of more comprehensive information to support the evaluation of the items. For example, some items such as number 5 does not explicitly clarify whether a full list of excluded publications should be reported earlier in the data selection process, i.e., after assessment of titles and abstracts.

Conclusions The present SR provided a comprehensive assessment of a large sample of paper-based SR published in oral health. More recent SR appear to present higher methodological quality than those published more than 15 years ago, although there is still room for improving paper-based SR. The present findings may help people working in the oral health field to understand better the methodological strengths and weaknesses of SR published in this field.

Appendix 1 Cochrane Oral Health Group Dental Search Terms #1. Exp STOMATOGNATHIC-DISEASES #2. Exp PHARYNGEAL-DISEASES #3. #1 NOT #2 #4. Exp SKULL #5. Exp DENTISTRY #6. Exp STOMATOGNATHIC-SYSTEM #7. Exp PHARYNX #8. #6 NOT #7 #9. Exp OROPHARYNX #10. Exp BIOMEDICAL-AND-DENTAL-MATERIALS

#11. #10 AND (dent* OR tooth OR teeth OR periodont* OR (oral NEXT implant*) or guided NEXT tissue NEXT regen-eration OR gtr:ti OR gtr:ab OR endodont*) #12. #3 or #4 or #5 or #8 or #9 or #11 #13. Exp CRANIOFACIAL-ABNORMALITIES #14. Exp PUBLIC-HEALTH-DENTISTRY #15. Exp DENTAL-PHYSIOLOGY #16. Exp FACIAL-NERVE-DISEASES #17. FACIAL-NEURALGIA #18. GLOSSOPHARYNGEAL-NERVE #19. Exp TRIGEMINAL-NERVE #20. TRIGEMINAL-NEURALGIA #21. Exp CEPHALOMETRY #22. Exp MAXILLOFACIAL-DEVELOPMENT #23. Exp FACIAL-INJURIES #24. Exp EYE-INJURIES #25. #23 NOT #24) #26. ORAL-HEALTH #27. Exp DENTAL-STAFF #28. Exp DENTISTS #29. Exp DENTAL-AUXILIARIES #30. DENTAL-ANXIETY #31. Exp DENTAL-DISINFECTANTS #32. COMPREHENSIVE-DENTAL-CARE #33. DENTAL-AUDIT #34. Exp DENTAL-FACILITIES #35. Exp DENTAL-HEALTH-SERVICES #36. FACIAL-PARALYSIS #37. HEMIFACIAL-SPASM #38. NOMA #39. DENTAL-WASTE #40. Exp FLUORIDES #41. #40 AND (dental OR tooth OR teeth OR enamel OR toothpaste* OR dentifrice* OR mouthwash* OR Bmouth wash*^ OR mouthrinse* OR Bmouth rinse*^ OR topical* OR gel* OR varnish* OR foam*) #42. #12 OR #13 OR #14 OR #15 OR #16 OR #17 OR #18 OR #19 OR #20 OR #21 OR #22 OR #25 OR #26 OR #27 OR #28 OR #29 OR #30 OR #31 OR #32 OR #33 OR #34 OR #35 OR #36 OR #37 OR #38 OR #39 OR #41 #43. BELL PALSY #44. Exp BRUXISM #45. Bell* NEXT palsy #46. facial NEXT hemiatroph* #47. bruxis* #48. (dental OR tooth OR teeth OR enamel) AND fluoros* #49. open NEXT bite* #50. tooth NEXT ankylosis #51. tooth NEXT socket* #52. ((air NEXT abrasion) AND dental) #53. (dental OR intraoral or extraoral) AND (photograph* or radiograph or x-ray) #54. (dental OR oral OR zygoma*) AND implant*)

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#55. hard palate* OR soft palate* #56. fluorid* AND (teeth OR tooth OR enamel OR dental OR water OR topical* OR varnish* OR gel* OR foam* OR mouthwash*OR mouthrinse* OR dentifrice* OR toothpaste*) #57. BMobius syndrome^ or BMoebius syndrome^ #58. dental* OR dentist* OR periodont* OR gingiv* OR maxilla* OR mandib* OR toothache* #59. (tooth OR teeth) AND (wisdom OR third NEXT molar*) #60. (post NEXT herpetic OR trigemin*) AND neuralgi*^ #61. (Boral NEAR ulcer*) OR (aphth* NEAR ulcer*) OR (mouth NEAR ulcer*) #62. phantom NEXT tooth NEXT pain #63. dental adj therapist* OR dental ADJ auxiliary* OR dental ADJ hygien* OR oral ADJ hygien* OR dental ADJ technician* OR dental ADJ nurse* OR dental ADJ assistant* #64. orthognathic* #65. oral ADJ candidiasis OR oral ADJ candidosis #66. xerostomi* OR dry ADJ mouth* #67. orthodontic* #68. mucositis #69. (dental OR tooth OR teeth OR enamel) AND (carie* OR carious OR deminerali* OR reminerali* OR decay*) #70. temporomandibular OR tmj:ti OR tmj:ab OR temporo-mandibular #71. apicectom* OR apicoectom* #72. ((lichen ADJ planus) NEAR oral) #73. oral ADJ surg* OR maxillofacial ADJ surg* OR maxillo ADJ facial ADJ surg* OR faciomaxillo ADJ surg* #74. ((mouth OR jaw* OR teeth OR tooth OR tongue* OR maxillofacial OR faciomaxil*) AND (disease* OR cancer* OR carcinoma* OR tumor* OR tumour* OR lesion* OR abnormalit* OR injur* OR disorder* OR malform*)) #75. ((Sjogren* OR sjoegren*) AND syndrome*) #76. ((dental OR tooth OR teeth OR mouth OR jaw*) AND (restor* OR surg* OR prevent* OR prosthe* OR implant* OR reparative OR calculus OR tartar OR plaque)) #77. dental material* #78. Rubinstein ADJ syndrome* #79. hemifacial ADJ atroph* OR hemi-facial ADJ atroph* #80. (mandib* OR maxilla* OR orbit* OR zygoma* OR tooth OR teeth OR facial OR jaw*) AND fracture* #81. toothpaste* OR dentifrice* OR toothbrush* OR tooth ADJ brush* OR mouthwash* OR mouthrinse* #82. Bfacial* deform*^ #83. halitosis OR mouth ADJ odor* OR mouth ADJ odour* OR glossitis OR glossalgia OR glossopyros* #84. cyst* NEAR dental*^ #85. ((dental* NEAR fear*) OR (dental NEAR fright*) OR (dental NEAR anxi*) OR (dental NEAR phobi*) OR (dentist* NEAR fear*) OR (dentist* NEAR fright*)) #86. #42 OR #43 OR #44 OR #45 OR #46 OR #47 OR #48 OR #49 OR #50 OR #51 OR #52 OR #53 OR #54 OR #55

OR #56 OR #57 OR #58 OR #59 OR #60 OR #61 OR #62 OR #63 OR #64 OR #65 OR #66 OR #67 OR #68 OR #69 #87. #70 OR #71 OR #72 OR #73 OR #74 OR #75 OR #76 OR #77 OR #78 OR #79 OR #80 OR #81 OR #82 OR #83 OR #84 OR #85 #88. #86 OR #87 Systematic review and meta-analysis search terms #89. review.pt #90. metanalysis.pt #91. systematic$.tw and (review$ or overview$).tw, #92. meta?analy$.tw #93. meta analy$.tw #94. or/89-93 #95. 88 and 94 #96. LIMIT TO ENGLISH AND HUMAN

Appendix 2 Bibliography Abduo, J, Lyons, K, Bennani, V, Waddell, N & Swain, M 2011, 'Fit of screw-retained fixed implant frameworks fabricated by different methods: a systematic review', The International Journal of Prosthodontics, vol. 24, no. 3, pp. 207-20. Abduo, J, Lyons, K & Swain, M 2010, 'Fit of zirconia fixed partial denture: a systematic review', Journal of Oral Rehabilitation, vol. 37, no. 11, pp. 866-76. Addy, M, Moran, J & Newcombe, RG 2007, 'Metaanalyses of studies of 0.2 % delmopinol mouth rinse as an adjunct to gingival health and plaque control measures', Journal of Clinical Periodontology, vol. 34, no. 1, pp. 58-65. Adeyemo, WL & Akadiri, OA 2011, 'A systematic review of the diagnostic role of ultrasonography in maxillofacial fractures', International Journal of Oral and Maxillofacial Surgery, vol. 40, no. 7, pp. 655-61. Afennich, F, Slot, DE, Hossainian, N & Van der Weijden, GA 2011, 'The effect of hexetidine mouthwash on the prevention of plaque and gingival inflammation: a systematic review', International Journal of Dental Hygiene, vol. 9, no. 3, pp. 182-90. Aframian, DJ, Lalla, RV & Peterson, DE 2007, 'Management of dental patients taking common hemostasis-altering medications', Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics, vol. 103 Suppl, pp. S45 e1-11. Aghaloo, TL & Moy, PK 2007, 'Which hard tissue augmentation techniques are the most successful in furnishing bony support for implant placement?', The International Journal of Oral & Maxillofacial Implants, vol. 22 Suppl, pp. 49-70. Aguilar, P & Linsuwanont, P 2011, 'Vital pulp therapy in vital permanent teeth with cariously exposed pulp: a systematic review', Journal of Endodontics, vol. 37, no. 5, pp. 581-7.

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Ahmad, N, Grad, HA, Haas, DA, Aronson, KJ, Jokovic, A & Locker, D 1997, 'The efficacy of nonopioid analgesics for postoperative dental pain: a meta-analysis', Anesthesia Progress, vol. 44, no. 4, pp. 119-26. Akadiri, OA & Obiechina, AE 2009, 'Assessment of difficulty in third molar surgery—a systematic review', Journal of Oral and Maxillofacial Surgery, vol. 67, no. 4, pp. 771-4. Akinbami, BO 2011, 'Evaluation of the mechanism and principles of management of temporomandibular joint dislocation. Systematic review of literature and a proposed new classification of temporomandibular joint dislocation', Head & Face Medicine, vol. 7, p. 10. Al Ansary, MA, Day, PF, Duggal, MS & Brunton, PA 2009, 'Interventions for treating traumatized necrotic immature permanent anterior teeth: inducing a calcific barrier & root strengthening', Dental Traumatology, vol. 25, no. 4, pp. 367-79. Al-Amleh, B, Lyons, K & Swain, M 2010, 'Clinical trials in zirconia: a systematic review', Journal of Oral Rehabilitation, vol. 37, no. 8, pp. 641-52. Al-Hamdan, K, Eber, R, Sarment, D, Kowalski, C & Wang, HL 2003, 'Guided tissue regeneration-based root coverage: meta-analysis', Journal of Periodontology, vol. 74, no. 10, pp. 1520–1533. Al-Jewair, TS, Azarpazhooh, A, Suri, S & Shah, PS 2009, 'Computer-assisted learning in orthodontic education: a systematic review and meta-analysis', Journal of Dental Education, vol. 73, no. 6, pp. 730-9. Al-Jewair, TS, Qutub, AF, Malkhassian, G & Dempster, LJ 2010, 'A systematic review of computer-assisted learning in endodontics education', Journal of Dental Education, vol. 74, no. 6, pp. 601-11. Al-Jundi, MA, John, MT, Setz, JM, Szentpetery, A & Kuss, O 2008, 'Meta-analysis of treatment need for temporomandibular disorders in adult nonpatients', Journal of Orofacial Pain, vol. 22, no. 2, pp. 97-107. Al-Omiri, MK, Mahmoud, AA, Rayyan, MR & AbuHammad, O 2010, 'Fracture resistance of teeth restored with post-retained restorations: an overview', Journal of Endodontics, vol. 36, no. 9, pp. 1439-49. Al-Riyami, S, Cunningham, SJ & Moles, DR 2009, 'Orthognathic treatment and temporomandibular disorders: a systematic review. Part 2. Signs and symptoms and meta-analyses', American Journal of Orthodontics and Dentofacial Orthopedics, vol. 136, no. 5, pp. 626 e1-16, discussion-7. Alaluusua, S 2010, 'Aetiology of molar-incisor hypomineralisation: a systematic review', European Archives of Paediatric Dentistry, vol. 11, no. 2, pp. 53-8. Alanko, OM, Svedstrom-Oristo, AL & Tuomisto, MT 2010, 'Patients' perceptions of orthognathic treatment, wellbeing, and psychological or psychiatric status: a systematic review', Acta Odontologica Scandinavica, vol. 68, no. 5, pp. 249-60.

Alavaikko, S, Jaakkola, MS, Tjaderhane, L & Jaakkola, JJ 2011, 'Asthma and caries: a systematic review and meta-analysis', American Journal of Epidemiology, vol. 174, no. 6, pp. 631-41. Alsabeeha, N, Atieh, M & Payne, AG 2010, 'Loading protocols for mandibular implant overdentures: a systematic review with meta-analysis', Clinical Implant Dentistry and Related Research, vol. 12 Suppl 1, pp. e28-38. Alvares Capelozza, A, Gião Dezotti, M, Casati Alvares, L, Negrão Fleury, R & Sant'Ana, E 2005, 'Osteoblastoma of the mandible: systematic review of the literature and report of a case', Dentomaxillofacial Radiology, vol. 34, no. 1, pp. 1-8. Alzahem, AM, van der Molen, HT, Alaujan, AH, Schmidt, HG & Zamakhshary, MH 2011, 'Stress amongst dental students: a systematic review', European Journal of Dental Education, vol. 15, no. 1, pp. 8-18. Amaral Cda, S, Vettore, MV & Leao, A 2009, 'The relationship of alcohol dependence and alcohol consumption with periodontitis: a systematic review', Journal of Dentistry, vol. 37, no. 9, pp. 643-51. Aminzadeh, KK & Etminan, M 2007, 'Dental amalgam and multiple sclerosis: a systematic review and meta-analysis', Journal of Public Health Dentistry, vol. 67, no. 1, pp. 64-6. Ammari, AB, Bloch-Zupan, A & Ashley, PF 2003, 'Systematic review of studies comparing the anti-caries efficacy of children's toothpaste containing 600 ppm of fluoride or less with high fluoride toothpastes of 1,000 ppm or above', Caries Research, vol. 37, no. 2, pp. 85-92. Ammari, JB, Baqain, ZH & Ashley, PF 2007, 'Effects of programs for prevention of early childhood caries. A systematic review', Medical Principles and Practice, vol. 16, no. 6, pp. 437-42. Anders, PL & Davis, EL 2010, 'Oral health of patients with intellectual disabilities: a systematic review', Special Care in Dentistry, vol. 30, no. 3, pp. 110-7. Andrade, A, Gameiro, G, DeRossi, M & Gavião, M 2009, 'Posterior crossbite and functional changes', The Angle Orthodontist, vol. 79, no. 2, pp. 380-386. Andreasen, JO, Storgard Jensen, S, Kofod, T, Schwartz, O & Hillerup, S 2008, 'Open or closed repositioning of mandibular fractures: is there a difference in healing outcome? A systematic review', Dental Traumatology, vol. 24, no. 1, pp. 17-21. Andreiotelli, M, Wenz, HJ & Kohal, RJ 2009, 'Are ceramic implants a viable alternative to titanium implants? A systematic literature review', Clinical Oral Implants Research, vol. 20, suppl. 4, pp. 32-47. Angaji, M, Gelskey, S, Nogueira-Filho, G & Brothwell, D 2010, 'A systematic review of clinical efficacy of adjunctive antibiotics in the treatment of smokers with periodontitis', Journal of Periodontology, vol. 81, no. 11, pp. 1518-28. Angelillo, IF, Nobile, CG & Pavia, M 2002, 'Evaluation of the effectiveness of a pre-brushing rinse in plaque removal: a

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meta-analysis', Journal of Clinical Periodontology, vol. 29, no. 4, pp. 301-9. Annibali, S, Cristalli, MP, Dell'Aquila, D, Bignozzi, I, La Monaca, G & Pilloni, A 2012, 'Short dental implants: a systematic review', Journal of Dentistry Research, vol. 91, no. 1, pp. 25-32. Antczak-Bouckoms, A, Joshipura, K, Burdick, E & Tulloch, JF 1993, 'Meta-analysis of surgical versus nonsurgical methods of treatment for periodontal disease', Journal of Clinical Periodontology, vol. 20, no. 4, pp. 259-68. Antonarakis, GS & Kiliaridis, S 2007, 'Short-term anteroposterior treatment effects of functional appliances and extraoral traction on class II malocclusion. A meta-analysis', The Angle Orthodontist, vol. 77, no. 5, pp. 907-14. Antonarakis, GS & Kiliaridis 2008, 'Maxillary molar distalization with noncompliance intramaxillary appliances in class II malocclusion. A systematic review', The Angle Orthodontist, vol. 78, no. 6, pp. 1133-40. Antonaya-Mira, R, Barona-Dorado, C, MartinezRodriguez, N, Caceres-Madrono, E & Martinez-Gonzalez, JM 2012, 'Meta-analysis of the increase in height in maxillary sinus elevations with osteotome', Medicina Oral, Patología Oral y Cirugía Bucal, vol. 17, no. 1, pp. e146-52. Antonio, AG, Pierro, VS & Maia, LC 2011, 'Caries preventive effects of xylitol-based candies and lozenges: a systematic review', Journal of Public Health Dentistry, vol. 71, no. 2, pp. 117-24. Anusavice, KJ, Kakar, K & Ferree, N 2007, 'Which mechanical and physical testing methods are relevant for predicting the clinical performance of ceramic-based dental prostheses?', Clinical Oral Implants Research, vol. 18 Suppl 3, pp. 218-31. Archambault, A, Lacoursiere, R, Badawi, H, Major, PW, Carey, J & Flores-Mir, C 2010, 'Torque expression in stainless steel orthodontic brackets. A systematic review', The Angle Orthodontist, vol. 80, no. 1, pp. 201-10. Arias-Irimia, O, Barona-Dorado, C, Santos-Marino, JA, Martinez-Rodriguez, N & Martinez-Gonzalez, JM 2010, 'Meta-analysis of the etiology of odontogenic maxillary sinusitis', Medicina Oral, Patología Oral y Cirugía Bucal, vol. 15, no. 1, pp. e70-3. Arora, NS, Ramanayake, T, Ren, YF & Romanos, GE 2010, 'Platelet-rich plasma in sinus augmentation procedures: a systematic literature review: part II', Implant Dentistry, vol. 19, no. 2, pp. 145-57. Atherton, GJ, Glenny, AM & O'Brien, K 2002, 'Development and use of a taxonomy to carry out a systematic review of the literature on methods described to effect distal movement of maxillary molars', Journal of Orthodontics, vol. 29, no. 3, pp. 211-6; discussion 195-6. Atieh, MA 2010, 'Photodynamic therapy as an adjunctive treatment for chronic periodontitis: a meta-analysis', Lasers in Medical Science, vol. 25, no. 4, pp. 605-13.

Atieh, MA, Atieh, AH, Payne, AG & Duncan, WJ 2009, 'Immediate loading with single implant crowns: a systematic review and meta-analysis', The International Journal of Prosthodontics, vol. 22, no. 4, pp. 378-87. Atieh, MA, Ibrahim, HM & Atieh, AH 2010, 'Platform switching for marginal bone preservation around dental implants: a systematic review and meta-analysis', Journal of Periodontology, vol. 81, no. 10, pp. 1350-66. Atieh, MA, Payne, AG, Duncan, WJ & Cullinan, MP 2009, 'Immediate restoration/loading of immediately placed single implants: is it an effective bimodal approach?', Clinical Oral Implants Research, vol. 20, no. 7, pp. 645-59. Atieh, MA, Payne, AG, Duncan, WJ, de Silva, RK & Cullinan, MP 2010, 'Immediate placement or immediate restoration/loading of single implants for molar tooth replacement: a systematic review and meta-analysis', The International Journal of Oral & Maxillofacial Implants, vol. 25, no. 2, pp. 401-15. Attin, T, Hannig, C, Wiegand, A & Attin, R 2004, 'Effect of bleaching on restorative materials and restorations—a systematic review', Dental Materials, vol. 20, no. 9, pp. 852-61. Azarpazhooh, A & Leake, JL 2006, 'Systematic review of the association between respiratory diseases and oral health', Journal of Periodontology, vol. 77, no. 9, pp. 1465-82. Azarpazhooh, A & Limeback, H 2008, 'Clinical efficacy of casein derivatives: a systematic review of the literature', Journal of the American Dental Association, vol. 139, no. 7, pp. 915-24; quiz 94-5. Azarpazhooh, A & Limeback, H 2008, 'The application of ozone in dentistry: a systematic review of literature', Journal of Dentistry, vol. 36, no. 2, pp. 104-16. Azarpazhooh, A & Main, PA 2008, 'Fluoride varnish in the prevention of dental caries in children and adolescents: a systematic review', Journal of the Canadian Dental Association, vol. 74, no. 1, pp. 73-9. Azarpazhooh, A & Main, PA 2008, 'Is there a risk of harm or toxicity in the placement of pit and fissure sealant materials? A systematic review', Journal of the Canadian Dental Association, vol. 74, no. 2, pp. 179-83. Azarpazhooh, A & Main, PA 2008, 'Pit and fissure sealants in the prevention of dental caries in children and adolescents: a systematic review', Journal of the Canadian Dental Association, vol. 74, no. 2, pp. 171-7. Azarpazhooh, A & Main, PA 2009, 'Efficacy of dental prophylaxis (rubber cup) for the prevention of caries and gingivitis: a systematic review of literature', British Dental Journal, vol. 207, no. 7, pp. E14; discussion 328-9. Azarpazhooh, A, Shah, PS, Tenenbaum, HC & Goldberg, MB 2010, 'The effect of photodynamic therapy for periodontitis: a systematic review and meta-analysis', Journal of Periodontology, vol. 81, no. 1, pp. 4-14. Baccaglini, L, Atkinson, JC, Patton, LL, Glick, M, Ficarra, G & Peterson, DE 2007, 'Management of oral lesions in HIV-

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positive patients', Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics, vol. 103 Suppl, pp. S50 e1-23. Baccaglini, L, Lalla, RV, Bruce, AJ, Sartori-Valinotti, JC, Latortue, MC, Carrozzo, M & Rogers, RS, 3rd 2011, 'Urban legends: recurrent aphthous stomatitis', Oral Diseases, vol. 17, no. 8, pp. 755-70. Bader, JD, Rozier, RG, Lohr, KN & Frame, PS 2004, 'Physicians' roles in preventing dental caries in preschool children: a summary of the evidence for the U.S. Preventive Services Task Force', American Journal of Preventive Medicine, vol. 26, no. 4, pp. 315-25. Bader, JD & Shugars, DA 2004, 'A systematic review of the performance of a laser fluorescence device for detecting caries', Journal of the American Dental Association, vol. 135, no. 10, pp. 1413-26. Bader, JD, Shugars, DA & Bonito, AJ 2001, 'A systematic review of selected caries prevention and management methods', Community Dentistry and Oral Epidemiology, vol. 29, no. 6, pp. 399-411. Bader, JD, Shugars, DA & Bonito, AJ 2002, 'A systematic review of the performance of methods for identifying carious lesions', Journal of Public Health Dentistry, vol. 62, no. 4, pp. 201-13. Bae, JH, Kim, YK & Myung, SK 2011, 'Effects of plateletrich plasma on sinus bone graft: meta-analysis', Journal of Periodontology, vol. 82, no. 5, pp. 660-7. Bahekar, AA, Singh, S, Saha, S, Molnar, J & Arora, R 2007, 'The prevalence and incidence of coronary heart disease is significantly increased in periodontitis: a meta-analysis', American Heart Journal, vol. 154, no. 5, pp. 830-7. Baratieri, C, Alves, M, Jr., de Souza, MM, de Souza Araujo, MT & Maia, LC 2011, 'Does rapid maxillary expansion have long-term effects on airway dimensions and breathing?', American Journal of Orthodontics and Dentofacial Orthopedics, vol. 140, no. 2, pp. 146-56. Barbosa, TS & Gaviao, MB 2008, 'Oral health-related quality of life in children: part I. How well do children know themselves? A systematic review', International Journal of Dental Hygiene, vol. 6, no. 2, pp. 93-9. Barbosa, TS & Gaviao, MB 2008, 'Oral health-related quality of life in children: part II. Effects of clinical oral health status. A systematic review', International Journal of Dental Hygiene, vol. 6, no. 2, pp. 100-7. Barbosa, TS & Gaviao, MB 2008, 'Oral health-related quality of life in children: part III. Is there agreement between parents in rating their children's oral health-related quality of life? A systematic review', International Journal of Dental Hygiene, vol. 6, no. 2, pp. 108-13. Barlow, M & Kula, K 2008, 'Factors influencing efficiency of sliding mechanics to close extraction space: a systematic review', Orthodontics & Craniofacial Research, vol. 11, no. 2, pp. 65-73.

Bardsen, A 1999, '"Risk periods" associated with the development of dental fluorosis in maxillary permanent central incisors: a meta-analysis', Acta Odontologica Scandinavica, vol. 57, no. 5, pp. 247-56. Bastos, JL, Boing, AF, Peres, KG, Antunes, JL & Peres, MA 2011, 'Periodontal outcomes and social, racial and gender inequalities in Brazil: a systematic review of the literature between 1999 and 2008', Cadernos de Saúde Pública, vol. 27 Suppl 2, pp. S141-53. Bateman, G, Ricketts, DN & Saunders, WP 2003, 'Fibrebased post systems: a review', British Dental Journal, vol. 195, no. 1, pp. 43-8; discussion 37. Beiruti, N, Frencken, JE, van 't Hof, MA & van Palenstein Helderman, WH 2006, 'Caries-preventive effect of resinbased and glass ionomer sealants over time: a systematic review', Community Dentistry and Oral Epidemiology, vol. 34, no. 6, pp. 403-9. Benson, PE, Shah, AA, Millett, DT, Dyer, F, Parkin, N & Vine, RS 2005, 'Fluorides, orthodontics and demineralization: a systematic review', Journal of Orthodontics, vol. 32, no. 2, pp. 102-14. Berchier, CE, Slot, DE, Haps, S & Van der Weijden, GA 2008, 'The efficacy of dental floss in addition to a toothbrush on plaque and parameters of gingival inflammation: a systematic review', International Journal of Dental Hygiene, vol. 6, no. 4, pp. 265-79. Berchier, C, Slot, D & Van der Weijden, G 2010, 'The efficacy of 0.12 % chlorhexidine mouthrinse compared with 0.2 % on plaque accumulation and periodontal parameters: a systematic review', Journal of Clinical Periodontology, vol. 37, no. 9, pp. 829-839. Berg, M 2003, ‘Childhood dental fear in relation to parental child-rearing attitudes’, Psychological Reports, vol. 92, no. 1, p. 43. Berglundh, T, Persson, L & Klinge, B 2002, 'A systematic review of the incidence of biological and technical complications in implant dentistry reported in prospective longitudinal studies of at least 5 years', Journal of Clinical Periodontology, vol. 29 Suppl 3, pp. 197212; discussion 32-3. Bhatavadekar, N 2008, 'Assessing the evidence supporting the claims of select dental implant surfaces: a systematic review', International Dental Journal, vol. 58, no. 6, pp. 36370. Bidra, AS & Huynh-Ba, G 2011, 'Implants in the pterygoid region: a systematic review of the literature', International Journal of Oral and Maxillofacial Surgery, vol. 40, no. 8, pp. 773-81. Blanas, N, Freund, B, Schwartz, M & Furst, IM 2000, 'Systematic review of the treatment and prognosis of the odontogenic keratocyst', Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics, vol. 90, no. 5, pp. 553-8.

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Blanes, RJ 2009, 'To what extent does the crownimplant ratio affect the survival and complications of implant-supported reconstructions? A systematic review', Clinical Oral Implants Research, vol. 20 Suppl 4, pp. 67-72. Bloemendal, E, de Vet, HC & Bouter, LM 2004, 'The value of bitewing radiographs in epidemiological caries research: a systematic review of the literature', Journal of Dentistry, vol. 32, no. 4, pp. 255-64. Bogowicz, P, Flores-Mir, C, Major, PW & Heo, G 2008, 'Sequential analysis applied to clinical trials in dentistry: a systematic review', Evidence-Based Dentistry, vol. 9, no. 2, pp. 55-60. Boillot, A, El Halabi, B, Batty, GD, Range, H, Czernichow, S & Bouchard, P 2011, 'Education as a predictor of chronic periodontitis: a systematic review with meta-analysis population-based studies', PLoS One, vol. 6, no. 7, p. e21508. Boioli, LT, Penaud, J & Miller, N 2001, 'A meta-analytic, quantitative assessment of osseointegration establishment and evolution of submerged and non-submerged endosseous titanium oral implants', Clinical Oral Implants Research, vol. 12, no. 6, pp. 579-88. Bollen, AM, Cunha-Cruz, J, Bakko, DW, Huang, GJ & Hujoel, PP 2008, 'The effects of orthodontic therapy on periodontal health: a systematic review of controlled evidence', Journal of the American Dental Association, vol. 139, no. 4, pp. 413-22. Bondemark, L, Holm, AK, Hansen, K, Axelsson, S, Mohlin, B, Brattstrom, V, Paulin, G & Pietila, T 2007, 'Long-term stability of orthodontic treatment and patient satisfaction. A systematic review', The Angle Orthodontist, vol. 77, no. 1, pp. 181-91. Bonecker, M & Cleaton-Jones, P 2003, 'Trends in dental caries in Latin American and Caribbean 5-6- and 11-13-yearold children: a systematic review', Community Dentistry and Oral Epidemiology, vol. 31, no. 2, pp. 152-7. Bonito, AJ, Lux, L & Lohr, KN 2005, 'Impact of local adjuncts to scaling and root planing in periodontal disease therapy: a systematic review', Journal of Periodontology, vol. 76, no. 8, pp. 1227-36. Borrie, F & Bearn, D 2011, 'Early correction of anterior crossbites: a systematic review', Journal of Orthodontics, vol. 38, no. 3, pp. 175-84. Bosch-Aranda, ML, Vazquez-Delgado, E & Gay-Escoda, C 2011, 'Atypical odontalgia: a systematic review following the evidence-based principles of dentistry', Cranio, vol. 29, no. 3, pp. 219-26. Bozini, T, Petridis, H, Garefis, K & Garefis, P 2011, 'A meta-analysis of prosthodontic complication rates of implant-supported fixed dental prostheses in edentulous patients after an observation period of at least 5 years', The International Journal of Oral & Maxillofacial Implants, vol. 26, no. 2, pp. 304-18.

Brandt, RG, Anderson, PF, McDonald, NJ, Sohn, W & Peters, MC 2011, 'The pulpal anesthetic efficacy of articaine versus lidocaine in dentistry: a meta-analysis', Journal of the American Dental Association, vol. 142, no. 5, pp. 493-504. Brazzelli, M, McKenzie, L, Fielding, S, Fraser, C, Clarkson, J, Kilonzo, M & Waugh, N 2006, 'Systematic review of the effectiveness and cost-effectiveness of HealOzone for the treatment of occlusal pit/fissure caries and root caries', Health Technology Assessment, vol. 10, no. 16, pp. iii-iv, ix80. Brennan, MT, Shariff, G, Lockhart, PB & Fox, PC 2002, 'Treatment of xerostomia: a systematic review of therapeutic trials', Dental Clinics of North America, vol. 46, no. 4, pp. 847-56. Brietzke, SE & Jones, DT 2005, 'Pediatric oropharyngeal trauma: what is the role of CT scan?', International Journal of Pediatric Otorhinolaryngology, vol. 69, no. 5, pp. 669-79. Bryant, SR, MacDonald-Jankowski, D & Kim, K 2007, 'Does the type of implant prosthesis affect outcomes for the completely edentulous arch?', The International Journal of Oral & Maxillofacial Implants, vol. 22 Suppl, pp. 117-39. Buduneli, N & Kinane, DF 2011, 'Host-derived diagnostic markers related to soft tissue destruction and bone degradation in periodontitis', Journal of Clinical Periodontology, vol. 38 Suppl 11, pp. 85-105. Burke, SP, Silveira, AM, Goldsmith, LJ, Yancey, JM, Van Stewart, A & Scarfe, WC 1998, 'A meta-analysis of mandibular intercanine width in treatment and postretention', The Angle Orthodontist, vol. 68, no. 1, pp. 53-60. Burt, BA & Pai, S 2001, 'Sugar consumption and caries risk: a systematic review', Journal of Dental Education, vol. 65, no. 10, pp. 1017-23. Buwembo, W & Luboga, S 2004, 'Moyer's method of mixed dentition analysis: a meta-analysis', African Health Sciences, vol. 4, no. 1, pp. 63-6. Cabezas-Mojon, J, Barona-Dorado, C, Gomez-Moreno, G, Fernandez-Caliz, F & Martinez-Gonzalez, J 2012, 'Metaanalytic study of implant survival following sinus augmentation', Medicina Oral, Patología Oral y Cirugía Bucal, vol. 17, no. 1, pp. e135-e139. Cairo, F, Pagliaro, U & Nieri, M 2008, 'Treatment of gingival recession with coronally advanced flap procedures: a systematic review', Journal of Clinical Periodontology, vol. 35, no. Suppl 8, pp. 136-162. Carlsson, G 2009, 'Critical review of some dogmas in prosthodontics', Journal of Prosthodontic Research, vol. 53, no. 1, pp. 3-10. Carvalho, D, Salazar, M, de Oliveira, B & Coutinho, E 2010, 'Fluoride varnishes and caries incidence decrease in preschool children: a systematic review', Revista Brasileira de Epidemiologia, vol. 13, no. 1, pp. 1-11. Cascos-Romero, J, Vázquez-Delgado, E, VázquezRodríguez, E & Gay-Escoda, C 2009, 'The use of tricyclic

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