Hi Frank,
As a Dentist I think that it is acceptable to compare surgical to
non-surgical treatment for any periapical problems, if I was in an Ethic
Committee I would approve. It would be unacceptable a "no treatment" group.
The problem may be that in some areas there are dogmas about some old
treatments.
On the other hand, if there is strong biological reasons for people to
believe that it is unethical any non-surgical treatment (because of the size
of the lesion), you have to show that this reason is wrong. Try to start
from the very beginning, that is, to prove that surgery is ineffective in
animal models and show strong biological reasons for this.
Piantadossi discuss the ethical problems of unproven treatments. He
ilustrates from cancer field.
Best whises
Roger Keller, CD, MSc
Prof. Depto Epidemiologia e Bioestatística - ISC/UFF
Departamento de Epidemiologia - IMS/UERJ (PhD student)
Rua São Francisco Xavier, 524 7o ANDAR
Rio de Janeiro - Brasil
----- Original Message -----
From: "Olive Goddard" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, June 18, 2007 5:38 AM
Subject: Re: Guideline and Evidence / Help needed
Dear Colleagues,
If anyone can help Frank I should be grateful if they would respond to him
directly.
All good wishes,
Olive
Olive Goddard
Centre and Editorial Manager
Centre for Evidence-Based Medicine
Department of Primary Health Care
Old Road Campus, Headington
Oxford, OX3 7LF
.....................................................................
Tel: +44 (0)1865 289337 email: [log in to unmask]
Fax: +44 (0)1865 289336 web: www.cebm.net
Mobile: 07804 625002 web: www.cebmh.com ( http://www.cebmh.com )
>>> "Frank u Patricia Sanner" <[log in to unmask]> 17/06/2007 19:02 >>>
Dear Ms. Goddard,
I was member of a german Consensus conference in Dentistry for developing a
clinical guideline for the indications for Endodontic surgery compared to
non-surgical retreatment of teeth with periapical peridontitis.
The problem was, that there are no Level 1 RCT to show the benefit of
non-surgical treatment, but two older studies (1996and 1999) that show
similar success rates for both treatment modalities. Nowadays it is
ethically not possible to randomize patients into the surgical and
non-surgical group, so the two existing studies cannot be repeated with
modern methodology, which would probably favour the modern non-surgical
strategy. What to do with this dilemma. Can well documented cohort studies
have more evidence than RCT?
Who could help me with this question?
Is there anyone in Germany to help with this question?
Many greetings from Germany
Dr. Frank Sanner
<http://www.praxis-sanner.de/> www.praxis-sanner.de
[log in to unmask]
|