(51) Trends in the Quality of Evidence in Oral and Maxillofacial Surgery: A 20-Year Systematic Review

Abstract: High-quality evidence is critical for guiding clinical decision-making,¹ yet it remains unclear whether methodological rigor in oral and maxillofacial surgery (OMS) research has improved over time. The purpose of this study was to systematically evaluate the trends in the levels of evidence (LOE) of OMS studies published in the years 2003, 2013, and 2023.

A systematic search was conducted in MEDLINE, Embase, and PubMed on October 10, 2024. Clinical studies were included if they were published in the Journal of Cranio-Maxillofacial Surgery, the International Journal of Oral and Maxillofacial Surgery, or the Journal of Oral and Maxillofacial Surgery in the years 2003, 2013, or 2023. Only studies written in English were considered. Studies were excluded if they did not qualify as clinical studies or were classified as study protocols, conference abstracts, letters to the editor, or editorials. Studies were evaluated using an adapted version of the Journal of Bone and Joint Surgery’s ‘Levels of Evidence for Primary Research Question’,² a framework applied across various healthcare specialties. This system ranks evidence quality from level 1 (highest) to level 5 (lowest). A data extraction spreadsheet was created a priori. Descriptive statistics and a Chi-Squared test were used to conduct an analysis of the data.

The search yielded 3,408 articles of which 1,153 clinical studies met the inclusion criteria. The leading countries contributing to OMS clinical research in the 3 analyzed journals were the United States of America (229, 19.9%), China (116, 10.2%), and Japan (88, 7.6%). A Chi-Squared test was performed to assess the change in the LOE over time. There was a statistically significant improvement in the LOE between 2003 and 2013 (P = .01) and between 2013 and 2023 (P < .001). Among the included studies, 189 were from 2003, 583 from 2013, and 381 from 2023. The percentage of LOE 1 clinical studies increased from 2.1% in 2003 to 7.0% in 2013 and 16.8% in 2023.

This study highlights a positive shift in the quality of OMS research over the past 2 decades, with an increase in high-level evidence studies. The rise in randomized controlled trials and systematic reviews indicates improved methodological rigor. Sustained focus on high-quality research is vital for the ongoing advancement of evidence-based practice in OMS.

References
1. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS: Evidence based medicine: what it is and what it isn't. BMJ. 312:71-72, 1996.
2. Marx RG, Wilson SM, Swiontkowski MF. Updating the assignment of levels of evidence. J Bone Joint Surg Am. 97:1-2, 2015.