Evidence Based Periodontal Therapy- A ReviewCorrespondence Address :
DR. VANDANA K.L.MDS, Dept. of Periodontics, College of Dental Sciences, Davangere. PH: 001-08192-31285, FAX: 91-8192-51070 E-mail: firstname.lastname@example.org
With regard to dentistry, these are indeed the best of times. We have available materials and techniques that visionaries could only dream of 25 years ago. We can predictably replace missing teeth with implant-supported prosthesis, regenerate tissues lost to disease and trauma. Yet as our profession hurdles ahead these are also the worst of times. The new technologies are so enamoring that the collective common sense is lost.
This paper attempts to review the periodontal therapy and evidence based approach.
Evidence based dentistry, Systematic Review, Meta analysis, Guided tissue regeneration(GTR), Open flap debridement(OFD).
Introduction:The concept of evidence-based medicine dates back to the time of Frederick II, Emperor of the Romans and King of Sicily and Jerusalem, who lived from 1192 to 1250 AD, and who was interested in the effect of exercise on the digestion, took 2 knights and gave them identical meals. One was then sent out hunting and the other ordered to bed. At the end of several hours he killed both and examined the contents of their alimentary canals; digestion had proceeded further in the stomach of the sleeping knight. (1)
(Table/Fig 1),(Table/Fig 2),(Table/Fig 3),(Table/Fig 4),(Table/Fig 5),(Table/Fig 6),(Table/Fig 7)and (Table/Fig 8)
EBD was borrowed from medicine. (2) Evidence based medicine has only been known for just over a decade and the term was coined by the clinical epidemiology group at McMaster University in Canada. One of the earliest to take up the challenge in periodontology was Alexia Antczak Bouckoms in Boston, USA. (3)
1980s: Bouckoms and colleagues challenged the methods and quality of periodontal clinical research.
1994: Oral Health Group as part of the Cochrane Collaboration set up
1996: World Workshop in Periodontology held by the American Academy of Periodontology included elements of evidence- based healthcare, supported by Michael Newman at UCLA.
1997: The editorial base of the Oral Health group subsequently moved to Manchester University with Bill Shaw and Helen Worthington as co-coordinating editors.
2001: The first Cochrane systematic review in periodontology was published and researched the effect of guided tissue regeneration for infrabony defects.
2002: European Workshop on Periodontology became the first international workshop to use rigorous systematic reviews to inform the consensus.
The PICO Process[ 5 ]
The formality of using PICO to frame the question forces the questioner to focus on what the patient/client believes is the most important problem and the desired outcome. It allows you to determine the type of evidence and information required to solve the problem and the outcome measures that will be used to determine the effectiveness of the intervention.
One of the greatest difficulties in developing each aspect of the PICO question is providing an adequate amount of information without being too detailed. Each component of the PICO question should be stated as a concise short phrase.
Applying the PICO Process
The first step in developing a well-built question is to identify the patient problem or population [P] by describing either the patient's chief complaint or by generalizing the patient's condition to a larger population.
Identifying the Intervention [I] is the second step in the PICO process. It is important to identify what you plan to do for that patient. This may include the use of a specific diagnostic test, treatment, adjunctive therapy, medication, or the recommendation to the patient to use a product or procedure. The intervention is the main consideration for that patient.
The third phase of the well-built question is the Comparison [C], which is the main alternative you are considering. It should be specific and limited to one alternative choice in order to facilitate an effective computerized search. The Comparison is the only optional component in the PICO questi
A major push to integrate the principles of the evidence-based approach into the mainstream of clinical practice has come from the fact that there is great variation in both clinical decision-making and results of therapy.
Evidence based approach conducts systematic appraisal of quality evidence, is more objective, transparent and less biased. It allows greater acceptance of levels of uncertainty.
The traditional approach however has unclear basis of evidence, unclear or absent appraisal or quality evidence, is more subjective, more opaque and more biased. It has greater tendency to black and white conclusions.
Despite the cited differences both the evidence-based and traditional approach emphasize on high value of clinical skills, experience and integrating evidence with patient values. Research evidence helps to decide which interventions are most effective. It should not replace our clinical findings from history and examination, but harness our clinical intuition from years of experience and help us recognizing gaps and uncertainties in our knowledge.
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
- Index Copernicus ICV 2017: 134.54
- Academic Search Complete Database
- Directory of Open Access Journals (DOAJ)
- Google Scholar
- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
- Journal seek Database
- Popline (reproductive health literature)