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Dr.Vijay apparaju
PG student(2013-14 batch)
EVIDENCE BASED DENTISTRY
EVIDENCE BASED
PERIODONTOLOGY
CONTENTS
• Introduction
• Evidence Based Medicine
• Why is EBD required??
• Role of EBD
• Principles of EBD
• Goals of EBD...
• Levels of evidence
• Basic concepts of research design
• Searching for the best evidence…. Where is the evidence found??...
• Components of Evidence Based Periodontology
• Study design
• Critical appraisal of different study designs
• Conclusion
• Evidence Based Medicine-
"the integration of best research evidence with clinical expertise
and patient values.“
Gordon ...
WHY IS EVIDENCE BASED DENTISTRY
REQUIRED??
To reduce the variation in patient care & outcomes which is associated
with:
1....
PRINCIPLES
• Finding the best information quickly when it is required.
• Assessing its quality & deciding whether it is re...
PROBLEMS OF INDUCING EVIDENCE
BASED DENTISTRY
• Amount of evidence
• Quality of evidence
• Dissemination of evidence
• Pra...
ADVANTAGES
• Improves the effective use of research evidence in clinical practice
• Uses resources more effectively
• Reli...
FOUR BASIC PHASES OF EVIDENCE
BASED DENTISTRY
• Asking evidence based questions
• Searching for the best evidence
• Review...
PICO PROCESS
• P= Patient Problem or Population
• I= Intervention
• C= Comparison
• O= Outcome
Asking evidence based quest...
Formulate a search protocol
In a systematic review, the search protocol is a search strategy that is
developed and strictl...
SEARCHING FOR BEST EVIDENCE….
• Ask someone
• Consult a textbook
• Finding a relevant article in your own reprint rile
• U...
EVIDENCE CYCLE
Searching for the best evidence
EVIDENCE LADDER
SUB LEVELS OF EVIDENCE LADDER
DRAW A CONCLUSION
CLINICAL RELEVANCE
• Number needed to treat (NNT) - This is the number of patients that
would need to be treated to achiev...
CRITICAL APPRAISAL
GUIDELINES TO HELP PUBLICATION OF
CLINICAL RESEARCH
• CONSORT (Consolidated Standards of Reporting Trials) for RCT
• STARD...
CONSORT CHECKLIST
CONSORT FLOW CHART
EVIDENCE BASED PERIODONTOLOGY
• Efficient use of research & scholarship needs to be a part of
periodontal practice.
• Aims...
DEVELOPMENT OF EVIDENCE BASED
PERIODONTOLOGY
• Built upon developments in clinical research design throughout 18,
19 & 20 ...
• 1996 – World Workshop in Periodontology (AAP) included
elements of evidence based healthcare, supported by Micheal
Newma...
EVIDENCE BASED PERIODONTOLOGY
V/S TRADITIONAL PERIODONTOLOGY
COMPONENTS OF EVIDENCE BASED
PERIODONTOLOGY
Step 6
extract clinical message and apply it to solve the patients periodontal problem
step 5
present efficiently the cont...
CONCLUSION
• Clinicians need to continually update on treatment options,
modalities and rationale as new research emerges....
References
Clinical periodontology, carranza, 10th ed, 213-244
Periodontology 2000, Vol. 37, 2005, 12–28
Periodontology 20...
Evidence based dentistry
Evidence based dentistry
Evidence based dentistry
Evidence based dentistry
Evidence based dentistry
Evidence based dentistry
Evidence based dentistry
Evidence based dentistry
Evidence based dentistry
Evidence based dentistry
Evidence based dentistry
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Evidence based dentistry

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  • Hi Dr. Vijay, that was indeed a very beautiful & informative presentation. It is quiet impressive with all the relevant and required information. I want to present something like this under the title "EVIDENCE BASED ENDODONTICS ". It would be great if you could guide and help me regarding this. I would be glad to hear from you. My email id - harikasayz@gmail.com
       Antworten 
    Sind Sie sicher, dass Sie …  Ja  Nein
    Ihre Nachricht erscheint hier
  • Hi Dr. Vijay. I very much liked your presentation on EBD. It is really a step by step guide on how to use EBD in periodontology. i was going through a lot of material on the net, but your work really impressed me as it is exactly how i want to put it to undergraduate students. I want to use your presentation as a source to teach EBD practically , in 1-2 hrs time allotted to me. Its a long fascinating process, but i just need to give them an overview of it. Please allow me to download the full ppt or mail it to me at arpitjpatel2@gmail.com
       Antworten 
    Sind Sie sicher, dass Sie …  Ja  Nein
    Ihre Nachricht erscheint hier

Evidence based dentistry

  1. 1. Dr.Vijay apparaju PG student(2013-14 batch) EVIDENCE BASED DENTISTRY EVIDENCE BASED PERIODONTOLOGY
  2. 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. 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. 4. • Components of Evidence Based Periodontology • Study design • Critical appraisal of different study designs • Conclusion
  5. 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. 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. 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. 8. PROBLEMS OF INDUCING EVIDENCE BASED DENTISTRY • Amount of evidence • Quality of evidence • Dissemination of evidence • Practice based on authority rather than evidence
  9. 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. 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. 11. PICO PROCESS • P= Patient Problem or Population • I= Intervention • C= Comparison • O= Outcome Asking evidence based questions
  12. 12. 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
  13. 13. 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/
  14. 14. EVIDENCE CYCLE Searching for the best evidence
  15. 15. EVIDENCE LADDER
  16. 16. SUB LEVELS OF EVIDENCE LADDER
  17. 17. DRAW A CONCLUSION
  18. 18. 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).
  19. 19. CRITICAL APPRAISAL
  20. 20. 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)
  21. 21. CONSORT CHECKLIST
  22. 22. CONSORT FLOW CHART
  23. 23. 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.
  24. 24. 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
  25. 25. • 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
  26. 26. EVIDENCE BASED PERIODONTOLOGY V/S TRADITIONAL PERIODONTOLOGY
  27. 27. COMPONENTS OF EVIDENCE BASED PERIODONTOLOGY
  28. 28. 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
  29. 29. 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.
  30. 30. 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.

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