Research Methodology, Evidence-Based Endodontics and Professional Ethics
This domain tests whether you can appraise endodontic evidence and apply it ethically.
Study design and levels of evidence
In vitro and animal studies sit low; case reports and case series above them; cross-sectional, case-control and cohort studies higher; randomized controlled trials highest for therapy; systematic reviews and meta-analyses of RCTs at the top. GRADE rates certainty across risk of bias, inconsistency, indirectness, imprecision and publication bias.
Measures of test performance
Sensitivity is the proportion of diseased teeth correctly detected; specificity is the proportion of healthy teeth correctly cleared. Positive predictive value depends on prevalence, so a test with good sensitivity and specificity can still have a modest PPV in a low-prevalence population. Likelihood ratios summarize both.
Reading a trial
Randomization with allocation concealment, blinding of outcome assessors, intention-to-treat analysis, and a prespecified primary outcome. Endodontic outcomes must distinguish success (clinical and radiographic healing, usually at least 1 year with a periapical index) from survival (tooth still present). Heterogeneity in meta-analysis is quantified by I-squared; funnel plots assess publication bias.
Worked example
A CBCT study of 100 teeth: 80 diseased, of which 70 are detected (sensitivity 87.5%); 20 healthy, of which 4 are falsely positive (specificity 80%). Report both; do not present PPV as if it were sensitivity.
Ethics
Informed consent, autonomy, beneficence, non-maleficence and justice; confidentiality; practising within competence and referring surgical or complex cases; declaring conflicts of interest and industry sponsorship; Helsinki declaration and institutional review board approval, with assent for children; no fabrication, falsification or plagiarism.
Traps
Treating survival as success; ignoring confidence intervals; quoting PPV without prevalence; failing to disclose a referral need or a financial interest.