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Abstract
Lucena C, Lopez JM, Pulgar R, Abalos C,
Valderrama MJ. Potential errors and misuse of statistics in
studies on leakage in endodontics. International Endodontic
Journal, 46, 323331, 2013.
Aim To assess the quality of the statistical methodology used in studies of leakage in Endodontics, and
to compare the results found using appropriate versus
inappropriate inferential statistical methods.
Methodology The search strategy used the descriptors root filling microleakage, dye penetration,
dye leakage, polymicrobial leakage and fluid filtration for the time interval 20012010 in journals
within the categories Dentistry, Oral Surgery and
Medicine and Materials Science, Biomaterials of the
Journal Citation Report. All retrieved articles were
reviewed to find potential pitfalls in statistical
methodology that may be encountered during study
design, data management or data analysis.
Results The database included 209 papers. In all
the studies reviewed, the statistical methods used
Introduction
The practice of Endodontics involves decision-making
on materials, techniques, procedures and treatment
options. Today, in the era of evidence-based dentistry,
many of these decisions are based on the review of
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these deficiencies are encountered in the areas of Epidemiology, Periodontology, Implantology and Orthodontics (Galgut & OMullane 1998, BeGole 2000,
Galgut 2003, Tu et al. 2004, 2005), but until now,
little has been published on the prevalence of flawed
statistical analysis in Endodontics.
The inappropriate application of statistical methods
to research data is an error of sufficient magnitude to
raise serious questions about the validity of the
conclusions reached (Elenbaas et al. 1983). Nevertheless, in dentistry, most of the papers published on this
question have listed only the types of statistical mistakes committed, but have made no attempt to determine whether both the correct and incorrect statistical
tests lead the investigators to the same conclusions.
Fardi et al. (2011) identified the 100 top-cited articles
published in journals dedicated to Endodontics, analysing
the subject areas to highlight noteworthy trends and to
reflect major advances during the last 50 years. This
review shows that one of the main topics covered is leakage. Although the number of citations that an article
receives is not necessarily a measure of its quality, it does
reflect recognition by the scientific community and the
influence of the article in generating changes in dental
practice or further research (Fardi et al. 2011).
Given the importance of the statistical methodology in
terms of the validity of the findings of any research and
the fact that the subject of leakage represents an area of
significant interest within endodontics, the goals of the
present study were to analyse the quality of statistical
methodology used in the literature with respect to leakage in Endodontics, and to compare the results using
appropriate versus inappropriate inferential statistical
methods.
324
The records were imported to the bibliography-management program ProCite, version 5 for Windows,
eliminating all duplicates. Two researchers from the
Conservative Dentistry Department of the University of
Granada (Spain) independently screened the database,
selecting only the documents related to leakage in
Endodontics. Doubtful cases were decided by consensus.
A detailed evaluation was made of the articles to
assess the quality of the statistical methodology used
and to find potential pitfalls in the implementation and
reporting of research methodology that may be
encountered during the study design, data management, statistical analysis or documentation of the
statistical tests applied. For this purpose, we used guidelines specified in previous studies (Strasak et al. 2007,
Baccaglini et al. 2010, Clark & Mulligan 2011).
Documentation stage
All statistical methods applied were checked to confirm
whether they were described clearly and correctly, and
ascertained whether the raw data were presented to
enable a reader to recalculate the results presented
(Strasak et al. 2007, Clark & Mulligan 2011). In addition, whether the magnitude of the effect had been
estimated was also considered (by means of confidence
intervals CIs-, odds ratios, etc.).
Statistical re-analysis
For all the studies that, according to the standards
mentioned, had employed inappropriate methods to
analyse their data, and in which the authors had
provided raw data, statistical methods were applied
that were more appropriate to the nature of the data
presented. Finally, to estimate the magnitude of the
effect, the odds ratios or CIs were calculated in all the
studies in which it was possible to apply them.
Results
The search strategy applied retrieved 371 papers, 209 of
which adhered to the predetermined criteria. Therefore,
the final database consisted of 209 original research articles on leakage in Endodontics, published between 2001
Frequency
Percentage
209
209
209
209
209
209
178
205
1
198
43
15
85.2
98.0
0.5
94.7
20.6
7.2
192
209
158
4
82.3
1.9
209
209
181
6
86.1
2.9
209
204a
182
26
90
66
114
16
2
1
31.6
55.9
8.8
7.7
1.1
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Leakage measurement
Qualitative
01 scale (success or failure)
02 scale
03 scale
04 scale
05 scale
13 scale
Total
Quantitative
Millimetres, micrometers
or nanometres
Percentages or ratios
Fluid movement (in mL min 1,
lL min 1, etc.)
Bacterial or glucose concentrations
(in mmol mL 1, UI mL 1, etc.)
Mean of days without leakage
Filtration area (in mm2)
Electrical conductance (in k)
Total
21
7
2
4
4
2
40
56
10
79
12
20
2
3
182
N = 222
Leakage
measurement
Outcome
variable
Conditions
of application
Ordinal scale
(n = 40)
As a categorical variable
(n = 26)
As a continuous variable
(n = 14)
Expected number
in a cell 5 (n = 26)
Variables without normal
approximation (n = 14)
Quantitative
measurement
(n = 182)
As a continuous variable
(n = 182)
Test of
significance
used
Fisher
Chi-square
Parametric
test
Nonparametric
test
Parametric
test
Nonparametric
test
Parametric
test
Nonparametric
test
Number
of works
11
15
1
13
15
1
74
88
4
Numbers in italics refer to studies that used the appropriate test of statistical inference.
a
In nine studies more than one type of evaluation was used.
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Journal
J Endod
Oral Surg Oral Med
Oral Pathol Oral Radiol Endod
Int Endod J
Quintessence Int
Aust Endod J
J Appl Oral Sci
J Can Dent Assoc
Am J Dent
Dent Mater J
J Biomed Mater
Res B Appl Biomater
J Dent
J Oral Rehab
Dent Mater
Eur J Oral Sci
J Adhes Dent
J Biomater Appl
J Biomed Mater Res A
J Am Dent Assoc
J Prosthet Dent
Med Oral Patol
Oral Cir Bucal
Published
worksa
Correct
works
(%)b
96
40
47
55
37
5
4
4
4
3
2
2
84
60
75
75
50
100
50
0
2
2
1
1
1
1
1
1
1
1
100
0
100
0
100
0
0
0
0
100
a
Number of articles on leakage in Endodontics published in
the time interval 20012010.
b
Percentage of articles that used the appropriate test of statistical inference.
Documentation stage
Amongst the 91 cases that had selected an inappropriate test of statistic inference, only 16 provided
raw data enabling a statistical re-analysis to be performed. With respect to the presentation of the study
results, only three of the 209 articles reviewed provided a measure of the magnitude of the difference,
by means of an odds ratio (two articles) or CIs (one
case).
Statistical re-analysis
The change of the statistical methodology with
respect to the one previously applied (n = 16) gave
results that differed from those originally presented in
11 studies (69% of the sample) and represented a
substantial alteration of the final conclusions in three
of them (19% of the recalculated studies). In eight of
the recalculations (50%), a lower P-value was
obtained, although the initial conclusions remained
valid. In five cases (31% of the sample), it was not
possible to compare the results generated in the
Discussion
Studies of leakage in Endodontics have a long and
controversial history, with both supporters and
detractors (Oliver & Abbott 2001, Susini et al. 2006,
Editorial Board of the Journal of Endodontics 2007,
De-Deus 2008). Thus, the relationship of in vitro
leakage to clinical success or failure of endodontic
treatment has been widely debated (Oliver & Abbott
2001). Furthermore, the inconsistency apparent
amongst the results of different studies means that
the value of virtually any endodontic technique may
be supported or disputed (Editorial Board of the
Journal of Endodontics 2007).
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328
Conclusions
Statistical deficiencies found in studies of leakage in
Endodontics may affect their results and interpretation
and might be one of the reasons for the poor agreement
amongst the reported findings. The standardization of
statistical methodology should be more widely implemented and assistance from a statistical expert is highly
recommended.
Acknowledgements
We thank David Nesbitt and Glenn Harding for the
English version of the text. This research was supported
by Ministerio de Ciencia e Innovacion (Spain) grant
MAT2009:09795.
329
References
Abt E (2010a) Understanding statistics 1. Evidence-Based
Dentistry 11, 601.
Abt E (2010b) Understanding statistics 2. Evidence-Based
Dentistry 11, 934.
Abt E (2011) Understanding statistics 5. Evidence-Based
Dentistry 12, 578.
Altman DG (1991) Statistics in medical journals: developments in the1980s. Statistics in Medicine 10, 1897
913.
Altman DG (2002) Poor-quality medical research, what can
journals do? Journal of the American Medical Association
287, 27657.
Altman DG, Goodman SN, Schroter S (2002) How statistical
expertise is used in medical research. Journal of the
American Medical Association 287, 281720.
Baccaglini L, Shuster JJ, Cheng J et al. (2010) Design and
statistical analysis of oral medicine studies: common
pitfalls. Oral Diseases 16, 23341.
BeGole EA (2000) Interpreting the literature on the effectiveness of clinical procedures. Seminars in Orthodontics 6, 67
75.
Camps J, Pashley D (2003) Reliability of the dye penetration
studies. Journal of Endodontics 29, 5924.
Clark GT, Mulligan R (2011) Fifteen common mistakes
encountered in clinical research. Journal of Prosthodontic
Research 55, 16.
Cohen ME (2001) Analysis of ordinal dental data: evaluation
of conflicting recommendations. Journal of Dental Research
80, 30913.
De-Deus G (2008) New directions in old leakage methods.
International Endodontic Journal 8, 7201.
Eckert SE, Choi YG, Koka S (2003) Methods for comparing
results of different studies. International Journal of Oral &
Maxillofacial Implants 18, 697705.
Editorial Board of the Journal of Endodontics(2007) Wanted:
a base of evidence. Journal of Endodontics 33, 14012.
Elenbaas RM, Elenbaas JK, Cuddy PG (1983) Evaluating the
medical literature. Part II: statistical analysis. Annals of
Emergency Medicine 12, 61020.
Fardi A, Kodonas K, Gogos C, Economides N (2011) Topcited articles in endodontic journals. Journal of Endodontics
37, 118390.
Galgut PN (2003) A review of the limitations of statistical
analysis of treatment outcomes used in periodontal research.
Journal of the International Academy of Periodontology 5,
927.
Galgut PN, OMullane D (1998) Statistical analysis of data
derived from clinical variables of plaque and gingivitis.
Journal of Clinical Periodontology 25, 54953.
Gardner MJ, Altman DG (1986) Confidence intervals rather
than P values: estimation rather than hypothesis testing.
British Medical Journal (Clinical Research Ed.) 292, 746
50.
330
Tu YK, Clerehugh V, Gilthorpe MS (2004) Collinearity in linear regression is a serious problem in oral health research.
European Journal of Oral Sciences 112, 38997.
Tu YK, Kellet M, Clerehugh V, Gilthorpe MS (2005)
Problems of correlations between explanatory variables in
multiple regression analyses in the dental literature.
British Dental Journal 199, 45761.
331