Supplementary Material for: Risk of bias and methodological critical appraisal in systematic reviews of non- and micro-invasive caries management for primary and permanent teeth

Introduction: Paediatric dentistry should rely on evidence-based clinical decisions supported by high-quality, unbiased systematic reviews (SRs). Therefore, the purpose of this study was to systematically evaluate the methodological quality and risk of bias of SRs focused on non- and micro-invasive treatment for caries lesions in primary and permanent teeth.
Methods: A comprehensive search was conducted in multiple databases, including MEDLINE/PubMed, Scopus, Web of Science, EMBASE, Epistemonikos, and ProQuest, up to March 2023 to identify relevant systematic reviews (SRs) focused on non- and micro-invasive caries treatment. Two independent reviewers extracted data from the included SRs and assessed the methodological quality and risk of bias using the AMSTAR 2 and ROBIS tools, respectively.
Results: A total of 39 SRs were included in the analysis. Among these, 27 SRs (69.2%) were assessed as having critically low methodological quality, 11 SRs (28.2%) were considered to have low methodological quality and only one SR was rated as high-quality. The primary concern identified was the absence of protocol registration before the commencing the study, observed in 33 SR when using the AMSTAR 2 tool. According to the ROBIS tool, 21 studies (53.8%) were categorised as low risk of bias, 10 (25.6%) as high risk and eight (20.5%) as unclear risk of bias.
Conclusion: Our analysis revealed that SRs focused on non- and micro-invasive treatment for caries in children and adolescents had critically low methodological quality according to the AMSTAR 2 tool but demonstrated a low risk of bias based on the ROBIS tool. These findings highlight the importance of emphasizing prospective protocol registration, clear reporting of statistical analyses, and addressing potential bias implications within this topic. By addressing these issues, we can enhance the quality of SRs and ensure that clinical decisions rely on unbiased and trustworthy evidence.
Registry DOI: 10.17605/OSF.IO/AR4MS

引言：儿童牙科学应依托高质量、无偏倚的系统评价（systematic reviews, SRs）所支撑的循证临床决策。因此，本研究旨在系统评价针对乳牙与恒牙龋损的非侵入性及微侵入治疗相关系统评价的方法学质量与偏倚风险。
方法：本研究于2023年3月前在MEDLINE/PubMed、Scopus、Web of Science、EMBASE、Epistemonikos及ProQuest等多个数据库中开展全面检索，以筛选聚焦龋病非侵入性与微侵入治疗的相关系统评价。由两名独立的评价者从纳入的系统评价中提取数据，并分别采用AMSTAR 2工具与ROBIS工具评价其方法学质量及偏倚风险。
结果：本分析共纳入39项系统评价。其中，27项（69.2%）被评定为极低级方法学质量，11项（28.2%）被评定为低级方法学质量，仅1项被评为高质量。采用AMSTAR 2工具评估发现，主要问题为33项系统评价未在研究启动前进行方案注册。依据ROBIS工具评级，21项研究（53.8%）被归为低偏倚风险，10项（25.6%）为高偏倚风险，8项（20.5%）为偏倚风险不确定。
结论：本研究分析显示，针对儿童及青少年龋病非侵入性与微侵入治疗的系统评价，依据AMSTAR 2工具评定结果为极低级方法学质量，但基于ROBIS工具评估结果则显示其偏倚风险较低。本研究结果凸显了在该研究领域强化前瞻性方案注册、清晰报告统计分析过程以及规避潜在偏倚影响的重要性。通过解决上述问题，可提升系统评价的质量，确保临床决策依托无偏倚且可信的证据。
注册DOI：10.17605/OSF.IO/AR4MS