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Mapping risk of bias criteria in systematic reviews of in vitro endodontic studies: an umbrella review

Evidence-Based Dentistry volume 26, pages 179–180 (2025)Cite this article

Subjects

Abstract

Aims

The risk of bias (RoB) assessment is a critical aspect of systematic reviews, yet a lack of standardization in RoB criteria persists in the endodontic literature. This study aimed to evaluate the RoB tools used in systematic reviews (SRs) of in vitro endodontic studies to synthesize the most commonly employed criteria.

Methods

A comprehensive search of five databases (PubMed, Embase, Web of Science, Scopus, and Cochrane Library) was conducted, identifying SRs with RoB evaluation. Data were extracted independently by two reviewers, focusing on the criteria used for RoB assessment. All SRs were categorized by main objective and the evaluation test. The study protocol was registered in the Open Science Framework (https://osf.io/azd8u/).

Results

Of the 10,409 records initially identified, 142 systematic reviews (SRs) published between January 2018 and September 2024 met the inclusion criteria. These SRs employed 36 distinct RoB criteria, with the most common being blinding (40.9%), sample size (34.5%), adequate statistical analysis (31%), randomization (30.3%), and standardized sample preparation and handling (21.8%).

Discussion

Inconsistencies in the application of RoB criteria were evident, with many SRs employing tools adapted from clinical studies that were not fully suitable for the unique methodological requirements of in vitro research. Although some SRs attempted to adapt criteria from other studies, these adaptations often fell short of addressing the specific needs of in vitro studies. The absence of standardized tools compromises the reliability of current SRs and limits their comparability with future research.

Conclusions

The observed inconsistencies in RoB assessments across SRs of in vitro endodontic studies highlight the critical need for a standardized tool specifically designed for this context. Such a tool should account for the methodological nuances of in vitro research, including the relevance of criteria like blinding and sample size calculation, to enhance the reliability, reproducibility, and overall relevance of future SRs.

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Data availability

Data is available upon request from the corresponding author.

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Acknowledgements

RRG and LPA are equally contributed to this work.

Funding

This study was partially supported by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) – Finance code 001.

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Authors and Affiliations

  1. Graduate Program in Dentistry, Federal University of Pelotas (UFPel), Pelotas, RS, Brazil

    Rafaella Rodrigues da Gama

  2. Clinical Assistant Professor, School of Dentistry, Department of Cariology, Restorative Sciences & Endodontics, University of Michigan, Ann Arbor, MI, USA

    Lucas Peixoto de Araújo

  3. Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas (UFPel), Pelotas, RS, Brazil

    Evandro Piva, Adriana Fernandes da Silva & Wellington Luiz de Oliveira da Rosa

  4. Laboratory Technician, Federal University of Pelotas (UFPel), Pelotas, RS, Brazil

    Leandro Perello Duro

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RRG and LPA conceived the work, performed the search, and wrote the manuscript. WLOR and LPD have collected data and performed the statistical analysis. AFS and EP are project administrators and have contributed to the accuracy and integrity of the study. WLOR has revised the final version of the manuscript and supervised the whole process.

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Rodrigues da Gama, R., de Araújo, L.P., Piva, E. et al. Mapping risk of bias criteria in systematic reviews of in vitro endodontic studies: an umbrella review. Evid Based Dent 26, 179–180 (2025). https://doi.org/10.1038/s41432-025-01186-9

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