Questionnaire Survey for Formulating Clinical Practice Guidelines for Magnetic Attachments Applications

- 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 School of Medical and Dental Sciences, Tokyo Medical and Dental University


 

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 Morioka, Iwate Prefecture and sent the survey by letter to general practitioners belonged to the academic section of the dental associations who were not members of JSMAD. The council members also published the questionnaire survey in the annual journal and the web homepage of JSMAD.

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 gPICOh was used to categorize the Clinical Questions (CQ). The acronym uses gPh to represent the gproblemh 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, doctorsf 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.

 

References

1.       Hideshima M, Igarashi Y, Ichikawa T, Tanaka J, Kochi T, Ishigami T, Andoh T, Nishiyama A: Preliminary questionnaire survey for formulating clinical practice guidelines for magnetic attachments applications. - Analysis and Selection of the Clinical Questions (CQ) -, J J Mag Dent 19. 29-34.2010.

2.       Pagliaro U. Nieri M, Rotundo R, Cairo F, Carnevale G, Esposito M, Cortellini P, Pini-Prato G : Clinical guidelines of the Italian society of periodontology for the reconstructive surgical treatment of angular bony defects in periodontal patients. J Periodontol 79: 2219-2232, 2008.

3.       Grant W. An evidence-based journal club for dental residents in a GPR program. J Dent Educ. 69: 681-686, 2005.

4.       Iacono V J, Cochran D L. State of the science on implant dentistry: A workshop developed using an evidence-based approach. Int J Oral Maxillofac Implant 22: 7-10, 2007.

Discussion Board