Consistency of recommendations of clinical practice guidelines in periodontology: a systematic review

Abstract The aim of this systematic review was to evaluate the methodological quality and the consistency of recommendations of clinical practice guidelines (CPGs) in Periodontology. An electronic search was conducted in two databases, MEDLINE and EMBASE, eight CPGs databases, and home pages of scientific societies in Periodontology up to April 2022. Three reviewers independently assessed methodological quality using the AGREE II instrument. In addition, we evaluated the consistency of the recommendations. Eleven CPGs were included, and the topics developed focused on prevention, diagnosis, risk factors, surgical and non-surgical periodontal treatment, antimicrobial therapy, root coverage, and maintenance. We found that the AGREE domains 2 (Stakeholder involvement) and 5 (Applicability) obtained the lowest scores. Domains 1 (Scope and purpose), 3 (Rigor of development) and 4 (Clarity of presentation) obtained the highest scores among the evaluated CPGs. The clinical recommendations for treatment of periodontal diseases were mostly consistent. Overall, the quality of CPGs used in periodontics was high. There was consistency of recommendations in specific fields. These findings may help researchers to promote CPGs focused on different fields of periodontics that have not yet been developed. Furthermore, the clinician will be able to make better clinical decisions.

摘要 本系统综述旨在评价牙周病学领域临床实践指南（Clinical Practice Guidelines，CPGs）的方法学质量与推荐意见一致性。截至2022年4月，本研究在MEDLINE、EMBASE两大数据库、8个临床实践指南数据库以及牙周病学相关学术学会官网中开展电子检索。由3名评价者独立采用AGREE Ⅱ工具对纳入指南的方法学质量进行评价，并同步评估其推荐意见的一致性。最终纳入11篇临床实践指南，其研究主题涵盖预防、诊断、危险因素、手术与非手术牙周治疗、抗菌药物治疗、根面覆盖术以及牙周维护治疗等方向。结果显示，在本次评价的临床实践指南中，AGREE Ⅱ的领域2（利益相关方参与）与领域5（适用性）得分最低；而领域1（范围与目的）、领域3（开发严谨性）与领域4（表述清晰度）得分最高。牙周疾病治疗相关临床推荐意见整体一致性较好。总体而言，当前牙周病学领域所使用的临床实践指南质量较高，且在特定领域内的推荐意见具有一致性。本研究结果可为研究者推动尚未开发的牙周病学不同领域临床实践指南的制定提供参考，同时也有助于临床医师做出更合理的临床决策。