Quality assessment of clinical practice guidelines and position statements on vital pulp therapy: a systematic review

To evaluate different Clinical Practice Guidelines (CPGs) and Position Statements (PS) on Vital Pulp Therapy (VPT) using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) and Appraisal of Guidelines for Research and Evaluation-Recommendation EXcellence (AGREE-REX) tools.

Two authors performed the initial search using a set of keywords in six databases. Only CPGs and PS on VPT published during the past five years were included. The included CPGs were appraised independently by six appraisers. AGREE II tool was used to evaluate the methodological quality, and AGREE REX was used to evaluate the quality of recommendations. Intraclass correlation coefficient was used as a reliability indicator among assessors.

Four published CPGs were shortlisted. Guidelines established by the European Society of Endodontology (ESE, 2019), German Society of Endodontology and Dental Traumatology (GSEDT, 2019), American Association of Endodontists (AAE, 2021), and Australian Dental Association (ADA, 2021) were analyzed. The ESE PS obtained the highest average score overall.

Endodontists must adhere to clinical practice guidelines established by specialty associations or societies. Improving the domains "Rigour of Development" and "Applicability" is necessary to enhance the overall strength of the guidelines. It is imperative to prevent discouragement and confusion among practitioners regarding VPT procedures by ensuring cohesiveness among various endodontic associations.

This assessment aids in determining the standard of CPGs among different specialized societies and associations. It also highlights the essential future actions and initiatives needed to establish robust evidence-based standards on VPT.

The protocol of this systematic review was registered in PROSPERO (ID: CRD42023429673).