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1. Dr.Vijay apparaju
PG student(2013-14 batch)
EVIDENCE BASED DENTISTRY
EVIDENCE BASED
PERIODONTOLOGY

2. CONTENTS
• Introduction
• Evidence Based Medicine
• Why is EBD required??
• Role of EBD
• Principles of EBD
• Goals of EBD
• Problems of inducing EBD in order to make clinical decisions
• Advantages of EBD
• 4 basic phases of EBD
• The evidence ladder

3. • Levels of evidence
• Basic concepts of research design
• Searching for the best evidence…. Where is the evidence found??
• The PICO process
• Finding evidence on Internet
• Evidence Based Periodontology
• Development
• What is it??
• Evidence based Periodontology v/s Traditional Periodontology

4. • Components of Evidence Based Periodontology
• Study design
• Critical appraisal of different study designs
• Conclusion

5. • Evidence Based Medicine-
"the integration of best research evidence with clinical expertise
and patient values.“
Gordon Guyatt and the Evidence-Based Medicine Working Group
at McMaster University in Ontario, Canada in the 1990s.
• Evidence Based Dentistry-
“It is an approach to oral health care that requires the judicious
integration of systematic assessments of clinically relevant
scientific evidence, relating to patient’s oral & medical condition
& history, with the dentists clinical expertise & the patient’s
treatment needs & preferences.”ADA

6. WHY IS EVIDENCE BASED DENTISTRY
REQUIRED??
To reduce the variation in patient care & outcomes which is associated
with:
1. The quality of science underlying clinical care.
2. The quality of clinical decision making.
3. Variation in the level of clinical skill.
4. The large & increasing volume of literature.

7. PRINCIPLES
• Finding the best information quickly when it is required.
• Assessing its quality & deciding whether it is relevant which will help
you to use research evidence in making everyday clinical decisions.
GOALS
• Best evidence research
• Transfer of this evidence to use in practice

8. PROBLEMS OF INDUCING EVIDENCE
BASED DENTISTRY
• Amount of evidence
• Quality of evidence
• Dissemination of evidence
• Practice based on authority rather than evidence

9. ADVANTAGES
• Improves the effective use of research evidence in clinical practice
• Uses resources more effectively
• Relies on evidence rather than authority for clinical decision making
• Monitor & develop clinical performance

10. FOUR BASIC PHASES OF EVIDENCE
BASED DENTISTRY
• Asking evidence based questions
• Searching for the best evidence
• Reviewing & critically appraising the evidence
• Applying this information in a way to best help clinical practice
• Evaluation of performance of the technique, procedure, or material.
(Carr & McGiveny)

11. PICO PROCESS
• P= Patient Problem or Population
• I= Intervention
• C= Comparison
• O= Outcome
Asking evidence based questions

13. Formulate a search protocol
In a systematic review, the search protocol is a search strategy that is
developed and strictly followed, so that the results can be standardized
and reproducible
The inclusion criteria should be broad enough to include the necessary
information but
narrow enough so that the screening process will not be too
complicated

16. SEARCHING FOR BEST EVIDENCE….
• Ask someone
• Consult a textbook
• Finding a relevant article in your own reprint rile
• Using a bibliographic database such a MEDLINE
www.ncbi.nlm.nih.gov ,
COCHRANE collabration,
www.ihs.ox.ac.uk/cebd
www.hiru.hirunet.mcmaster.co/
www.ottawahospital.on.ca/professionals/library
www.library.utoronto.co/medicine/ebm/
www.cche.net/

18. EVIDENCE CYCLE
Searching for the best evidence

19. EVIDENCE LADDER

20. SUB LEVELS OF EVIDENCE LADDER

24. DRAW A CONCLUSION

26. CLINICAL RELEVANCE
• Number needed to treat (NNT) - This is the number of patients that
would need to be treated to achieve a stated benefit (NNTb) or to
avoid a stated harm (NNTh).

27. CRITICAL APPRAISAL

30. GUIDELINES TO HELP PUBLICATION OF
CLINICAL RESEARCH
• CONSORT (Consolidated Standards of Reporting Trials) for RCT
• STARD (Standards for reporting of Diagnostic Accuracy) for
diagnostic tests
• For systematic reviews-
QUOROM (Quality of Reporting of Meta-analysis)
MOOSE (Meta-analysis of observational studies in epidemiology)
QUADAS (Quality Assessment of studies of Diagnostic Accuracy
included in Systematic reviews)

31. CONSORT CHECKLIST

33. CONSORT FLOW CHART

34. EVIDENCE BASED PERIODONTOLOGY
• Efficient use of research & scholarship needs to be a part of
periodontal practice.
• Aims to facilitate an approach, accelerating the introduction of the
best research in patient care.

35. DEVELOPMENT OF EVIDENCE BASED
PERIODONTOLOGY
• Built upon developments in clinical research design throughout 18,
19 & 20 centuries.
• Was coined by Alexia Antezak Bouckoms & colleagues in Boston,
USA in the Oral Health Group part of Cochrane Collabration in
1994

36. • 1996 – World Workshop in Periodontology (AAP) included
elements of evidence based healthcare, supported by Micheal
Newman
• 2001- First Cochrane systematic review in Periodontology
(researched the effect of GTR for intra-bony defects).
• 2002 - European Workshop on Periodontology- First
international workshop to use rigorous systematic reviews to
inform the consensus.
• 2003 - International Centre for Evidence-Based Oral Health was
launched to produce high quality, evidence based research with
an emphasis on, but not limited to Periodontology & implants

37. EVIDENCE BASED PERIODONTOLOGY
V/S TRADITIONAL PERIODONTOLOGY

38. COMPONENTS OF EVIDENCE BASED
PERIODONTOLOGY

39. Step 6
extract clinical message and apply it to solve the patients periodontal problem
step 5
present efficiently the content, strengths and weakness of the articles to colleagues
Step 4
apply rules of evidence to assess validity of the studies
Step 3
effeciently search the periodontal literature and select relevant studies
Step 2
identify needed information to answer the periodontal problem
Step 1
Clearly define patient's periodontal problem and specify it as a question

40. CONCLUSION
• Clinicians need to continually update on treatment options,
modalities and rationale as new research emerges.
• By following a systematic approach, evidence can be considered
and applied to clinical practice. This approach is standardized and
repeatable, and facilitates the practice of evidence-based dentistry.
• The application of evidence is essential in modern dentistry, and this
approach is the core of the evolution towards an evidence-driven
practice.

41. References
Clinical periodontology, carranza, 10th ed, 213-244
Periodontology 2000, Vol. 37, 2005, 12–28
Periodontology 2000, Vol. 37, 2005, 9-14
Periodontology 2000, Vol. 59, 2012, 61–74
Abitbol TE, Rosenfeld-Abitbol M. Surgical treatment of nifedipine-
induced gingival hyperplasia. A case report.
N Y State Dent J1996:62: 34–37.
American Dental Association. Center for Evidence-Based Dentistry.
Available at: http://ebd.ada.org/SystematicReviews.aspx. Accessed
March 1, 2012.
American Dental Association. Available at: http://ebd.
ada.org/About.aspx. Accessed March 1, 2012.
Barak S, Kaplan I. The CO2 laser in the excision of gingival
hyperplasia caused by nifedipine.J Clin Periodontol1988:
15: 633–635.
Barclay S, Thomason JM, Idle JR, Seymour RA. The incidence and
severity of nifedipine-induced gingival overgrowth.J Clin
Periodontol1992:19: 311–314.