Newman and Carranza's Essentials of Clinical Periodontology Quiz

Essentials of Clinical Periodontology Study Guide

Evidence-Based Clinical Practice

• Blinding: process of concealing allocation of intervention(s) to one or multiple individuals involved in a clinical study
  • Single blinded study: allocation concealed only from study participant
  • Double blinded study: allocation concealed from two individuals in the research team
  • Triple blinded study: allocation concealed from three individuals in the research team
• Case-Control Study: comparing individuals with the primary endpoint of interest (cases) with those without it (controls) to identify exposure
• Cohort Study: monitoring individuals exposed to a specific exposure and comparing them with non-exposed individuals for the occurrence of the primary endpoint
• Confounding Variables: variables related to exposure and causally associated with the endpoint, masking the real effect of the exposure
• Evidence: synthesis of all valid research conducted earlier that answers a specific PICO question
• PICO Format: formulating a clinical question containing information on problem/population, intervention, comparison group, and outcomes
• Randomization Methods: methods used to randomize study participants in RCTs
• Randomized Clinical Trial (RCT): clinical study design for testing the efficacy of interventions, minimizing bias
• Temporality: establishing that the cause preceded the effect in studies looking into causality

Fast Facts

• Components of Evidence-Based Dentistry: patient values/preferences, clinical experience/judgment, and scientific evidence
• Steps in Evidence-Based Clinical Decision-Making: formulate a clinical question, search for and acquire evidence, appraise the evidence, apply the evidence in a given clinical scenario, and evaluate the outcomes
• Advantages of Evidence-Based Dentistry: efficient way for clinicians to stay current, maximizes potential for successful clinical outcomes
• Research Design Types: randomized controlled trials, case-control, cohort, preclinical (animal), case series, and case reports
• Sources of Evidence: primary (original research studies and publications), secondary (combination of multiple original studies)
• High Levels of Clinical Evidence: clinical practice guidelines, systematic reviews, and meta-analysis
• Low Levels of Clinical Evidence: case reports, case series, and expert opinions
• Systematic Review vs. Meta-Analysis: systematic reviews are qualitative, while meta-analysis is quantitative, both identifying and combining studies to answer a specific research question

Core Knowledge

• Introduction to Evidence-Based Decision-Making: a formalized process that allows clinicians to search for the best current scientific evidence and integrate it into practice

• Key Advantage of Systematic Reviews and Meta-Analysis: combining multiple studies increases the effective sample size and power of the study### EBDM (Evidence-Based Decision-Making) Process

• The EBDM process involves five steps to achieve a high level of clinical competence

• The five steps are: Ask, Acquire, Appraise, Apply, and Assess & Adjust

Step 1: Ask (PICO Format)

• Ask the right question using the PICO format, which requires defining four components to a clinical problem
• The four components are: Problem/Population, Intervention, Comparison, and Outcome

Step 2: Acquire (Filtered and Unfiltered Information)

• Use biomedical databases like PubMed, EMBASE, DARE, and NCG to find filtered and unfiltered information
• Use Boolean operators like AND and OR to search efficiently for relevant literature
• Use PubMed's "Clinical Queries" feature to quickly find relevant citations

Hierarchy of Evidence

• Hierarchies exist among types of experimental and observational studies, guiding clinical decision-making
• The quality/level of evidence is directly related to the type of clinical question asked
• For example, clinical questions on therapy would consider clinical practice guidelines (CPGs) based on meta-analyses and systematic reviews of RCT studies as the highest levels of evidence

Types of Studies and Sources of Evidence

• Best scientific evidence: systematic reviews (SR), meta-analyses (MA), randomized controlled trials (RCT), cohort studies, and clinical practice guidelines (CPGs)
• Secondary sources: valid studies and publications synthesizing and generating clinically applicable information
• Primary sources: original peer-reviewed research studies and publications

Step 3: Appraise (Critical Appraisal)

• Critically appraise all the evidence collected using checklists and forms to guide the appraisal process
• Common appraisal tools used are: CONSORT statements for reviewing RCTs, PRISMA for reviewing SRs, and CASP for reviewing other types of studies

Step 4: Apply (Integrating Evidence with Clinical Judgment)

• Integrate the results of the best scientific evidence with good clinical judgment and patient preferences
• Apply the evidence to the clinical scenario to make competent clinical decisions

Step 5: Assess & Adjust

• Evaluate the effectiveness of the intervention in achieving a good clinical outcome
• Share the results with other care providers or make adjustments to interventions to provide better patient care### Evidence-Based Decision-Making Process
• The process involves five A's: ask, acquire, appraise, apply, and assess
• It is structured to achieve desired clinical outcomes

Clinical Performance and Outcome

• The goal is to determine if the evidence-based intervention achieved the desired outcome
• The process involves assessing the outcome during follow-up visits

Case-Based Learning Exercise

• A 13-year-old female patient suffered dental trauma from a softball
• The patient's teeth were replanted, and a stable and accurate Ribbond and flowable composite splint were used to stabilize the teeth
• The clinician evaluated the outcome of the rendered treatment during follow-up visits

Study Designs

• A systematic review represents the highest level of evidence
• It involves a comprehensive search of the literature to identify all relevant studies on a specific topic

Anatomy, Structure, and Function of the Periodontium

• The periodontium consists of the alveolar bone, periodontal ligament, cementum, and gingiva
• The alveolar bone proper is the inner socket wall of thin, compact bone with the cribriform plate
• Ankylosis is the fusion of the cementum and the alveolar bone with obliteration of the periodontal ligament
• Bone cells include osteogenic cells, osteoblasts, osteocytes, and osteoclasts
• Bone marrow is the red hematopoietic marrow of the newborn that becomes fatty or yellow inactive marrow with aging
• Bundle bone contains a great number of Sharpey fibers and resorbs after tooth extraction
• Cancellous bone is trabeculae enclosing marrow spaces and is predominantly found in interdental and interradicular spaces

Relevant Terminology

• Alveolar bone: the inner socket wall of thin, compact bone with the cribriform plate
• Ankylosis: fusion of the cementum and the alveolar bone with obliteration of the periodontal ligament
• Bone cells: cells seen within bone, including osteogenic cells, osteoblasts, osteocytes, and osteoclasts
• Bundle bone: bone adjacent to the periodontal ligament that contains a great number of Sharpey fibers
• Cancellous bone: trabeculae enclosing marrow spaces
• Cemental aplasia: absence of cementum
• Cemental hyperplasia/hypercementosis: excessive deposition of cementum
• Cemental hypoplasia: paucity of cementum
• Cemental resting lines: incremental lines parallel to the long axis of the root viewed in microscopic sections, separating lamellae of cementum
• Cemental reversal line: a deeply staining irregular line that demarcates newly formed (reparative) cementum from the root, delineating the border of a previous cemental resorption