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Split-mouth and cross-over designs in dental research
A A Antczak-Bouckoms1, J F Tulloch, C S Berkey
1Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts 02115.
Journal of Clinical Periodontology
|August 1, 1990
Summary
Split-mouth and cross-over research designs offer efficiency in dental studies but require strict adherence to assumptions. Many studies fail to fully utilize these designs in statistical analysis or account for potential biases like order effects.
Area of Science:
- Dental Research
- Clinical Trial Design
- Biostatistics
Background:
- Split-mouth and cross-over designs are suitable for paired/multiple organs and chronic dental diseases.
- These designs can save resources but depend on specific scientific and statistical assumptions.
- Prerequisites include stable, uniformly distributed disease and localized or reversible treatment effects.
Purpose of the Study:
- To review dental research journals for the application of split-mouth and cross-over designs.
- To assess how underlying assumptions of these designs are considered and applied in practice.
- To identify common shortcomings in the utilization of these research methodologies.
Main Methods:
- Systematic review of studies employing split-mouth or cross-over designs across three dental journals.
- Evaluation of methodology concerning treatment allocation, sequencing, statistical analysis, and bias reduction.
- Assessment of adherence to design-specific prerequisites and considerations.
Main Results:
- Most studies adequately employed treatment allocation and sequencing methods.
- A significant number of studies did not leverage the designs effectively in statistical data analysis.
- Few studies addressed order effects or implemented blinding to minimize bias.
Conclusions:
- While treatment allocation is often appropriate, statistical analysis in split-mouth and cross-over dental studies requires improvement.
- Greater attention to order effects and blinding procedures is necessary for robust research.
- Optimizing the use of these designs can enhance the validity and efficiency of dental research.