Using the Best Available Evidence to Support Clinical Decisions in Implant Dentistry

Purpose: The number of clinicians performing dental implant treatment has increased in recent years. Evidence-based information is necessary to support dentists' decision making. This study was undertaken to present a strategy for searching, selecting, and appraising scientific literature and applying the information in the clinical setting. Materials and Methods: A focused question in the PICO format (patient, intervention, comparison, and outcome) was developed to optimize the literature search process. Systematic reviews (SRs) of randomized controlled trials (RCTs) on the treatment of peri-implantitis were retrieved from the PubMed and Cochrane electronic databases on January 1, 2009. The methodologic quality of the two SRs selected was assessed by two referees using three checklists (CASP, QUOROM, and AMSTAR). The level of agreement between the referees was determined by use of the intraclass correlation coefficient. The evidence retrieved served as the basis for development of a treatment algorithm. Results: The selected SRs reported that subgingival debridement, subgingival debridement plus use of antibiotics, and regenerative procedures can be effective treatments for peri-implantitis. Although the RCTs included in both SRs had several limitations, the checklists demonstrated that the SRs were methodologically rigorous. Intraclass correlation coefficients ranged from substantial to good, indicating that reviewers agreed in their assessment. The evidence-based algorithm visually illustrated the options for the management of peri-implantitis of different severity. Conclusions: This scheme may help clinicians to understand research evidence and to apply it directly in a clinical setting. Palabras clave: decision making, dental implants, evidence-based dentistry, model, peri-implantitis