Study designs

Randomized Controlled Trial

• is a prospective, analytical, experimental
study using primary data generated in the
clinical environment. Individuals similar at the
beginning are randomly allocated to two or
more groups (treatment and control) then
followed to determine the outcome of the
intervention.
• There are two groups, one treatment group and one
control group. The treatment group receives the
treatment under investigation, and the control
group receives either no treatment or some
standard default treatment.
• Provides strongest evidence for demonstrating
cause & effect.
• RCTs are the standard method of answering
questions about the effectiveness of different
therapies. Can use blind or double blind strategies.
 Does low dose of etoricoxib play
pre‑emptive analgesic effect in third molar
surgery? A randomized clinical trial
Long Xie, Lei Sang and Zhi Li

Methods: Patients were randomised to receive

etoricoxib 60 mg or placebo 30 min before
surgery. Post-operative pain was recorded
using a visual analogue scale during 24 h
within the post-operative period. The total
dose of ibuprofen rescue intake was recorded.
Kaplan–Meier curves and log-rank analyses
were used to evaluate the proportion of
patients without rescue analgesic.
• Cohort Study (prospective) is a study of a group of
individuals, some of whom are exposed to a variable of
interest (e.g., drug or environmental exposure), in
which participants are followed up over time to
determine who develops the outcome of interest and
whether the outcome is associated with the
exposure.
• Cohort Study (retrospective) is when data is gathered
for a cohort that was formed sometime in the past.
Exposures and outcomes have already occurred at the
start of the study. You are studying the risk factor and
see if you can associate a disease to it.
 Repair or replacement of restorations: A prospective
cohort study by dentists in The National Dental
Practice-Based Research Network
Background
A prospective cohort study that included dentists in The National
Dental Practice-Based Research Network was conducted to
quantify 12-month failures of restorations that were repaired or
replaced at baseline. The study tested the hypothesis that no
significant differences exist in failure percentages between
repaired and replaced restorations after 12 months. It also
tested the hypothesis that certain dentist, patient, and
restoration characteristics are significantly associated with the
incidence of restoration failure.
Methods
• Dentists recorded data for 50 or more consecutive defective
restorations. The restorations that were either repaired or
replaced were recalled after 12 months and characterized for
 Assessment of dental caries predictors in 6-year-old school
children - results from 5-year retrospective cohort study

• Masood, M., Yusof, N., Hassan, M.I.A. et al. Assessment of dental caries predictors
in 6-year-old school children - results from 5-year retrospective cohort study. BMC
Public Health 12, 989 (2012). https://doi.org/10.1186/1471-2458-12-989
• Background
This was a retrospective cohort study undertaken to assess the
rate and pattern of dental caries development in 6-year-old
school children followed-up for a period of 5 years, and to
identify baseline risk factors that were associated with 5 years
caries experience in Malaysian children.
• Methods
This 5-years retrospective cohort study comprised primary school
children initially aged 6 years in 2004. Caries experience of
each child was recorded annually using World Health
Organization criteria. The rates of dental caries were recorded
in prevalence and incidence density of carious lesions from
baseline to final examination. Risk assessment was done to
assess relative risk for caries after 5 years in children with
baseline caries status. Simple and multiple logistic regression
analysis were performed to identify significant independent
• Results
The sample consisted of 1830 school children. All components
of DMFT showed significant differences between baseline
and final examination. Filled teeth (FT) component of the
DMFT showed the greatest increases. Results revealed the
initial baseline caries level in permanent dentition was a
strong predictor for future caries after 5 years (RR=3.78, 95%
CI=3.48-4.10, P<0.001). Logistic regression analysis showed
significant association between caries occurrence and
residence (urban/rural) (OR=1.80, P<0.001). However, it was
not significantly associated with gender and ethnicity. The
incidence density of caries, affected persons (IDp) observed
from baseline and after 5 years was 5.80 persons/100
person-year of observation. The rate of new caries-affected
tooth (IDt) in the period from baseline and after 5-years was
0.76 teeth/100 teeth-year of observation.
• Case Control Study
is a study in which patients who already have a
specific condition or outcome are compared with
people who do not. Researchers look back in time
(retrospective) to identify possible exposures.
They often rely on medical records and patient
recall for data collection. Individuals split by
disease.
 External Cervical Resorption: A Retrospective Case-Control Study

• Eleni Irinakis 1, Jolanta Aleksejuniene 2, Ya Shen 1, Markus Haapasalo 3

Methods: The ECR group included data about 76 patients (98 teeth)
diagnosed with ECR at the university graduate endodontics clinic from
2008-2018. An equivalent comparative control group without ECR was
composed of the same pool of patients and matched with cases by sex
and age. Information about dental and medical history, including
potential local risk factors (bruxism, trauma, eruption disorders,
extraction of an adjacent tooth, orthodontics, and restorations) and
systemic risk factors (medical conditions, medication, and allergies), was
collected for both groups. Data were analyzed at tooth and patient
levels. The chi-square test or Fisher exact test compared proportions
between the 2 study groups.
• Results: The overall ECR prevalence among endodontic
patients during the 10-year follow-up was 2.3%. ECR was
most frequent in maxillary anterior teeth (31.6%), and
the Heithersay class 2 was the most frequent (38.8%)
ECR diagnosis. Diabetes was the only significant systemic
risk factor (P < .05). Trauma, as a local risk factor, was
significantly (P < .05) more frequently reported in cases
than in controls.
• Conclusions: The study hypothesis stating that both
systemic and local risk factors were associated with
higher ECR rates was partly confirmed, as one systemic
(diabetes) and one local (trauma) risk factor were
associated with higher ECR rates.
• Keywords: Case-control study; external cervical
• Survey Study is an epidemiologic study
that produces survey results, and will consist
of simultaneous assessments of the health
outcome, primary risk exposure and potential
confounders and effect modifiers. Two types
of survey research are cross-sectional and
longitudinal studies.
• Cross-Sectional Study
is the observation of a defined population at a
single point in time or during a specific time
interval to examine associations between the
outcomes and exposure to interventions.
Exposure and outcome are determined
simultaneously. Often rely on data originally
collected for other purposes.
 Cross Sectional Study on the Association between Dental Caries
and Life Habits in School Age Italian Children

• Massimiliano Ciribè,1 Angela Galeotti,1,* Chiara Dolci,1 Livia Gargiullo,2

Martina Mammone,1 Erika Cirillo,1 Paola Festa,1 and Giuseppe La Torre3
• Joseph Nissan, Academic Editor, Gavriel Chaushu, Academic Editor, and
Takahiro Kanno, Academic Editor
• Dental caries is still a major public health issue and
influences the overall health of children. The risk
factors for caries include biological, socio-
behavioral, and environmental factors. Our aim is to
assess the association between dental caries and
the life habits of children and their parents. A cross-
sectional study was conducted in Rome (Italy)
among primary school children aged 5 to 11.
Parents completed the anamnestic questionnaire,
and a dental clinical examination was performed on
333 children. Caries prevalence was 38.7% overall,
47% in males and 31.9% in females. The association
between bottle night-time feeding and caries was
statistically significant (43.2%; p = 0.013
Usage of a honeyed pacifier was also significantly
associated with the presence of caries
(72.7%; p = 0.027). Finally, higher caries
prevalence was found among male children (47%
vs. 31.9%; p = 0.005). The present study shows
that the percentage of caries is still high in the
paediatric population, and caries prevalence is
associated with life habits. Our results highlight
the importance of oral health education
programs at primary school that involve teachers
and parents to contribute to improving lifestyles.
• Longitudinal Study
follow subjects over time with continuous or
repeated monitoring of risk factors or health
outcomes, or both. Researchers conduct
several observations of the same subjects over
a period of time, sometimes lasting many
years.
 A longitudinal study of dental erosion and associated
lifestyle factors in a group of Swedish children and
adolescents
• Background: Erosive wear has been observed among Swedish
adolescents, but with unknown prevalence. High prevalence of dental
erosion is reported from different parts of the world, and often linked
to an increasing consumption of soft drinks. Objective: The aim was
to study the prevalence and progression of dental erosion among
Swedish children and adolescents related to some health and lifestyle
parameters, and to develop a simplified system for scoring dental
erosion. Methods: 609 out of 801 individuals aged 5-6-, 13-14- and
18-19-years participated in the cross-sectional, prospective,
longitudinal study, based on a clinical examination and
questionnaires. 4-year progression was studied in the 13-14-year
cohort. A Simplified Erosion Partial Recording System (SEPRS) was
developed..
The consumption of soft drinks was studied in relation to health and
lifestyle. Results: Severe erosion was found in 13.3%, 11.9% and
22.3% of the respective groups . Correlation was found between
soft drink consumption, male gender and severity of dental erosion.
High soft drink consumers showed worse oral health and dietary
and other unhealthy behaviors. After 4 years 32.3% of tooth
surfaces had deteriorated by one grade and 2.6% by two grades.
SEPRS showed 100% sensitivity and 98% specificity for detecting
severe erosion in permanent teeth, and 100% each for primary
teeth. Conclusion: Dental erosion was common among Swedish
adolescents, especially among males. The high prevalence and
progression was associated with worse oral health and some less
healthy lifestyle factors. The simplified recording system, SEPRS, is a
useful tool for screening for dental erosion in these age groups.
Consequences: In view of the high prevalence of dental erosion and
soft drink consumption among Swedish adolescents, there is a need
to introduce community- based preventive programs from early
ages as well as epidemiological recording of dental erosion.
• Case Series and Case Reports
are descriptive study/studies that consist of
collections of reports on the treatment of
individual patients or a report on a single
patient.
 • A case report on endodontic management of
the rarest Vertucci's Type VIII configuration in
maxillary second molar with three
mesiobuccal canals
• Govil SA, Asthana G, Kanodia S, Parmar A. A case report on endodontic
management of the rarest Vertucci's Type VIII configuration in maxillary
second molar with three mesiobuccal canals. J Conserv Dent. 2021 Jul-
Aug;24(4):404-407. doi: 10.4103/JCD.JCD_310_21. Epub 2022 Jan 13. PMID:
35282572; PMCID: PMC8896129.
• Abstract
Anatomic variations in mesiobuccal root (MBR) of
maxillary molars are common. This variation is
found to be more common in maxillary first
molars as compared to second molars. However,
finding three independent mesiobuccal (MB)
canals in the MBR of maxillary molars is clinically
a rare entity. With the use of magnification,
illumination, and cone-beam computed
tomography, combined with the skill of the
operator, there is an increased possibility of
detecting such additional canals.
The present case report describes the successful clinical
management of a second molar in a 58-year-old
female patient having three MBR canals (MB1, MB2,
and MB3) with a Vertucci's Type VIII canal
configuration and an almost obliterated pulp
chamber. The canals were prepared using hand and
rotary instruments, followed by obturation. Very few
such cases have been documented clinically in the
literature.
• Keywords: Anatomic variation, cone-beam computed
tomography, maxillary second molar, mesiobuccal
canal, third mesiobuccal canal, Vertucci's Type VIII
• Systematic Review usually focuses on a
specific clinical question and conducts an
extensive literature search to identify studies
with sound methodology. The studies are
reviewed, assessed, and the results
summarized according to pre-determined
criteria of the review question.
• Meta-Analysis takes a systematic review one
step further by combining all the results using
accepted statistical methodology.
 Example
Top 100 cited systematic reviews and
meta-analyses in dentistry
Christos Gogos 1, Konstantinos Kodonas 1, Anastasia Fardi 2, Nikolaos Economides
Acta Odontol Scand . 2020 Mar;78(2):87-97. doi:10.1080/00016357.2019.1653495. Epub 2019
Aug 16
Abstract
Objective: The purpose of the present study was to
identify the 100 top cited systematic reviews and
meta-analyses on dental journals so as to gain
insight into the influential publications in dentistry.
Material and methods: The Web of Science was
used to comprehensively identify the 100 most
cited papers without year and language
restriction. Specific parameters regarding the title,
journal, publication year, authors, country of
origin, institution and university, collaborations,
keyword analysis and field of study of each
manuscript were retrieved
.
Results: The citations ranged from 642 to 140. The
most productive years were 2008 and 2009. The
majority of top cited papers were published in
Clinical Oral Implants Research and Journal of
Clinical Periodontology. The leading countries
were United States, followed by Switzerland. The
University of Zurich was the most productive
institution with 8 articles. Major topics of interest
in the top 100 most-cited papers were dental
implants and periodontology. The most
frequently occurring keywords were systematic
review, dental implants and meta-analyses.
Conclusions: Systematic reviews published in
high impact factor Dental journals focused on
implantology and periodontology had the
highest citation rates. Obviously, the top cited
list is dynamic, as scientific interests and
research tendencies evolve over the years.
• Keywords: Bibliometrics; citation analysis;
meta-analysis; systematic review.
Thank you
Best of luck