Unraveling Periradicular Pathology: An In-Depth Analysis of an 18-Year Long Retrospective Study
- Dr Ajmal Zubair
- Nov 29, 2023
- 4 min read
Introduction:
The study of periradicular pathology, a crucial aspect of dental health, has been profoundly advanced by Tadkamol Krongbaramee and colleagues' recent publication, "Retrospective Evaluation of Periradicular Biopsies: An 18-Year Study," in the Journal of Endodontics. Spanning nearly two decades, this study provides groundbreaking insights into the prevalence and nature of non-endodontic lesions in periradicular tissues, a topic of immense importance in endodontics and oral pathology.
The Study at a Glance:
The researchers meticulously analysed 10,031 lesions from 72,055 pathology reports, uncovering that about 8% of periradicular lesions were non-endodontic. This finding is pivotal, highlighting the need for dentists to consider a broader spectrum of diagnoses in periradicular diseases.
Comprehensive Analysis Using the ROBINS-I Tool:
1. Bias due to Confounding:
- The retrospective design inherently carries the risk of confounding bias. Important confounding factors like patient demographics, oral hygiene practices, and systemic health conditions, although mentioned, are not fully controlled for in the analysis (Vandenbroucke, 2007).
- Confounding variables such as environmental factors and genetic predispositions, which might influence oral health outcomes, are not addressed in the study.
2. Bias in Selection of Participants:
- Selection bias in retrospective studies can significantly impact findings. The study’s selection criteria for including specific cases from numerous pathology reports are not comprehensively outlined, which might introduce bias (Rothman, 2008).
- The demographic and geographic representativeness of the selected cases remains unclear, potentially affecting the generalisability of the study’s findings.
3. Bias in Classification of Interventions:
- The classification of lesions as endodontic or non-endodontic is crucial in this study. The lack of a detailed description of the classification criteria raises concerns about potential misclassification bias (Brennan and Silman, 1992).
4. Bias due to Deviations from Intended Interventions:
- Not directly applicable to this observational study. However, variations in pre-biopsy treatment approaches are not accounted for, which could influence histopathological outcomes.
5. Bias due to Missing Data:
- In long-term retrospective studies, missing data is a significant concern. The study does not elaborate on how missing or incomplete records were handled, potentially leading to information bias (Little and Rubin, 2002).
6. Bias in Measurement of Outcomes:
- The study relies on histopathological examinations, the accuracy and consistency of which are paramount. The potential variability in diagnostic criteria over the 18-year period and differences in pathologists’ expertise could introduce measurement bias (Fletcher, 2012).
7. Bias in Selection of the Reported Result:
- The possibility of selective reporting, a common issue in retrospective studies, cannot be ignored. Without access to the original study protocol, it’s challenging to determine if certain outcomes were preferentially reported (Chan et al., 2004).
Additional Considerations in Study Design:
Temporal Bias: The span of 18 years in the study introduces the risk of temporal bias. Diagnostic criteria and techniques evolve over time, which may affect the study's outcomes (Fletcher, 2012).
- Geographical Bias: Conducted in a single institution, the study's findings may not accurately represent the diversity of oral health issues globally. Geographical bias limits the generalizability of the results to different populations with varied oral health profiles (Glick et al., 2014).
- Technological Advancements: Over the 18-year period, advancements in diagnostic technology and histopathological techniques could have significantly influenced the study's outcomes. The evolution in diagnostic precision over time is a crucial factor to consider in interpreting the results (Sørensen et al., 2013).
Further Exploration of the Study's Findings and Impact:
- Implications for Clinical Practice: This study's findings have significant implications for clinical practice. The revelation that a considerable percentage of periradicular lesions are non-endodontic necessitates a broader diagnostic approach and highlights the importance of considering systemic conditions that may manifest in oral health (Segura-Egea et al., 2017).
- Future Research Directions: The study paves the way for future research to explore the underlying causes and systemic correlations of non-endodontic periradicular lesions. This could lead to more holistic treatment approaches and improved patient outcomes (Chung et al., 2016).
- Educational Impact: The study underscores the importance of continuous education for dental professionals. Understanding the evolving nature of oral pathology and staying abreast of the latest research findings are crucial for accurate diagnosis and effective treatment (Kassebaum et al., 2015).
Conclusion:
The study by Tadkamol Krongbaramee and colleagues is a milestone in dental research, offering invaluable insights into periradicular pathology. The overall risk of bias, considering the factors discussed above, appears to be moderate to high. This level of bias should be carefully considered when interpreting the study's findings.
While the study's retrospective design introduces several biases, the meticulous analysis of an extensive dataset provides a foundation for future research and clinical practice enhancements. As we delve deeper into the mysteries of oral health, studies like this remind us of the dynamic and evolving nature of dental science, urging us to continually question and expand our understanding.
Bibliography:
1. Krongbaramee, T., et al. (2023). "Retrospective Evaluation of Periradicular Biopsies: An 18-Year Study." Journal of Endodontics.
2. Sterne, J.A.C., et al. (2016). "ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions." BMJ, 355, i4919.
3. Vandenbroucke, J.P. (2007). "Observational research, randomised trials, and two views of medical science." PLoS Medicine, 5(3), e67.
4. Rothman, K.J. (2008). "Epidemiology: An Introduction." Oxford University Press.
5. Brennan, P., and Silman, A. (1992). "Statistical methods for assessing observer variability in clinical measures." BMJ, 304(6840), 1491-1494.
6. Little, R.J.A., and Rubin, D.B. (2002). "Statistical Analysis with Missing Data." John Wiley & Sons.
7. Fletcher, R.H. (2012). "Clinical Epidemiology: The Essentials." Lippincott Williams & Wilkins.
8. Chan, A.W., et al. (2004). "Empirical evidence for selective reporting of outcomes in randomized trials." JAMA, 291(20), 2457-2465.
9. Glick, M., et al. (2014). "A Global Perspective on Oral Health Care Practice." Journal of Dental Education, 78(3), 343-349.
10. Sørensen, H.T., et al. (2013). "The Danish National Patient Registry: a review of content, data quality, and research potential." Clinical Epidemiology, 7, 449-490.
11. Segura-Egea, J.J., et al. (2017). "Endodontic medicine: connections between apical periodontitis and systemic diseases." International Endodontic Journal, 48(10), 933-951.
12. Chung, M.P., et al. (2016). "A systematic review of systemic diseases manifested in the jawbones and their oral management strategies." Journal of Clinical Periodontology, 43(10), 815-825.
13. Kassebaum, N.J., et al. (2015). "Global burden of untreated caries: a systematic review and metaregression." Journal of Dental Research, 94(5), 650-658.