- Analysis and Selection of the Clinical Questions (CQ)
-
M. Hideshima, Y. Igarashi, T. Ichikawa, J. Tanaka,
T. Kochi, T. Ishigami, T. Andoh,* A. Nishiyama**
Dental Care Council, the Japanese Society of
Magnetic Applications in Dentistry,
Section of Removable Prosthodontics,* Temporomandibular Joint and Occlusion,**
Graduate
Introduction
In the era of
evidence-based medicine, clinical practice guidelines (CPG) have become an
integral task of each academic society, and the Japanese Society of Magnetic
Applications in Dentistry (JSMAD) has also formed a dental care council that
has discussed the formulation of clinical practice guidelines (CPG) for
magnetic applications in dentistry according to the directions of the Japanese
Association for Dental Science.
The council developed
a preliminary questionnaire survey dealing with the subject of magnetic
attachments and distributed it to the board members in order to analyze what
kind of clinical questions (CQ) they and their co-workers of their offices
have.
According to the
preliminary survey, the council distributed the questionnaire survey to attendees
of the 19th annual meeting of JSMAD and general practitioners belonged
to the academic section of the dental associations who were
not members of JSMAD.
As a result, 117
answers were returned and a total of 147 clinical questions (CQs) were divided into 5 categories according to their applications. The
numbers of CQs in each category was implants;21, type
of defect;51, occlusion and periodontics;17, arrangement and configuration;27
and management or others;31 respectively. And 14 typical CQs for CPG were
selected.
Objective
The objective of this survey was to analyze the
kinds of clinical questions that arise among general practitioners with regard
to the use of magnetic attachments and to encourage them to develop and to refer them to formulate
clinical practice guidelines (CPG).
Materials and Methods
For a preliminary study, 30 present and former council members of the Japanese Society of Magnetic Applications in Dentistry (JSMAD)
were surveyed by e-mail with a questionnaire attachment.
The recipients of the questionnaire were instructed to
answer the survey and distribute it among the pertinent professional members of
their offices. According to the preliminary survey,
the council members distributed the survey among attendees of the 19th
annual meeting of JSMAD at
The survey contained questions regarding clinical
experience, the work place, and affiliation of the individual answering the
questions (Table 1). A procedure that we refer to as gPICOh was used to categorize the
Clinical Questions (CQ). The acronym uses gPh to represent the gproblemh or
gpatient,h gI,h gintervention,h gC,h gcomparison,h and gO,h goutcome (Table 2).
The completed questionnaires were returned by e-mail, FAX
or letters, and they were also hand-collected at the
19th annual meeting.
Results
A total of 117
participants completed the questionnaire, and 147 CQs were collected.
The tables below show the clinical experience
and affiliation of the participants.
Clinical experience
and affiliation
Clinical questions (CQ)
A
total of 147 CQs were divided into 5 categories shown below according to their
applications.
1) Applying MAs to abutments of dental
implants
(Implant):
21CQs
2)
Compared to other type of retainers when applying in certain type of
defects
(Defects): 51CQs
3) Compared to
other type of retainers when applying in certain type of occlusion or
concerning periodontal disease
(Occlusion/Periodontics): 17CQs
4) Arrangement
of MAs in the remaining dentition or configuration of MA
(Arrange / Form): 27CQs
5)
Management
of MA or others
(Manage/etc):
31CQs
The figures below show the distribution of each
categorized CQ classified by workplace (Fig. 1) and
member/non-member of JSMAD(Fig. 2).
27 24
A
total of 14 typical CQs in 5 categories were selected from the 147 CQs as
follows.
1) Implant
(1)In
case of implant-supported overlay dentures, are magnetic attachments(MAs) more effective than applying other type of retainers?
(2)In
case of implant-supported overlay dentures, are applying MAs to
implant abutments more successful than applying them to natural teeth?
(3)When
applying magnetic MAs to implant-supported
overlay dentures, are maxillary
cases more successful than mandibular ones?
(4)When
applying magnetic MAs to implant-supported
overlay dentures, are multiple
abutments with MAs more effective than a single abutment?
2)
Defects
(5)In
case of few remaining mandibular teeth, are applying MAs more effective compared to other type of retainers?
(6)
In case of free-end saddle removable partial dentures, are
applying MAs more effective compared to other type of retainers?
(7) In case of overlay dentures, are applying MAs effective than applying
other type of retainers?
3) Occlusion/Periodontics
(8) In case of partially edentulous patients without occlusal contact,
are MAs more successful than other type of retainers?
(9) In case of partially edentulous with undulating occlusal planes,
are applying MAs more effective compared to other type of retainers?
(10)
When remaining abutments are with periodontal disease, are applying MAs more successful compared to other type of retainers?
4)
Arrange / Form
(11)When
applying MAs to multiple abutment teeth, are symmetrical arrangements
more effective than asymmetrical ones?
(12)When
applying MAs to remaining abutment teeth, are flat type keepers more
effective than dome-shaped keepers for stability of the denture?
5) Manage/etc
(13)
When undergoing MRI examination, do applying MAs cause more artifacts in the examined
graphic images compared to other type of retainers?
(14)When
setting MAs to removable partial dentures, is the applied pressure
method more successful than the minimum pressure ones?
Discussion
The results of this survey indicate that two third of the participants had more than
10 years of clinical experience and one half of them had used MAs at least 10
times. Fifty
eight percent of the participants were general clinicians at dental offices,
and 56 percent of them were non-members of the Japanese Society for Magnetic
Applications in Dentistry(JSMAD). Although in the preliminary
survey, the ratio of dental office workers and non-members of JSMAD were quite
low, the ratio of them were more than 50 percent. In
order to develop clinical guidelines universally prevalent, it would be
valuable to seek a greater consensus and collect many CQs among individuals new
to the clinical practice of dentistry, dental office workers, and those who are
not members of JSMAD.
The PICO procedure is an effective way to
answer clinical questions. First, the PICO question is formulated; next, the
relevant domain (therapy/prevention, diagnosis, etiology/risk, or prognosis) is
established, along with the type of research by means of which the question
will have to be answered.
According to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) group system, PICO format CQ and corresponding answers which should be synthetically recommended by evidences from the concerning articles, doctorsf skill and patients conditions. It might be difficult to search enough evidence-based articles for the answers to some of the CQs. But it would be covered by another questionnaire survey to multiple expert clinicians such as Delphi Method.
Approximately
one third of the 147 collected CQs were classified according to the type of
defect; e.g.: lower few remaining dentition or free-end saddle cases, and 53%
of them were from university hospital practitioners and 62% were from the
members. As for implants, 14%
of the 147 CQs were dealt and 62% of those were received from dental office
practitioners of whom 50% were members of JSMAD.
Affiliation of the participants reflected differences
in their clinical interest.
Fourteen
typical CQs in 5 categories were finalized and the committee is planning to ask some
experts in each organization to conduct the literature search related to the
CQs and write the systematic reviews.
This questionnaire survey also inquired on the issue of whether social health
insurance should cover treatment with magnetic attachments. Results of the
distribution of agree, agree with
reservations and disagree were dispersed and the committee could not develop a
process of advanced medical care of MAs which the Japan Dental Society
advocates.
JSMAD currently lacks sufficient information to make a
recommendation regarding health insurance coverage for MAs and should take
cautious steps referring to general practitioners opinion when applying MAs to
social health insurance.
Conclusion
EA questionnaire survey
for Clinical Questions (CQs) was conducted, and 117 answers and 147 CQs were collected.
EHalf of the participants
were clinicians with more than 10 years of experience
who averaged 10 cases each involving MAs.
ECQs were classified into 5
categories: (applying to) Implant 21, (compared to other retainers when
applying certain type of) Defects 51, (ditto; type of)Occlusion/Periodontics 17, Arrange/Form (arrangement
in dentition and configuration of MA) 27 and Manage/etc.(management
of MA or others) 31.
EA total of 14 typical CQs ; Implant 4, Defects 3, Occlusion/Periodontics 3, Arrange/Form 2
and Manage/etc 2 were selected.
Acknowledgement
Members of the
council are grateful to the participants for their cooperation with this study
and hopeful that they will participate in the continuation of this effort.
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