title: How meta-analytic evidence impacts clinical decision making in oral implantology: a Delphi opinion poll.
abstract: OBJECTIVE
  To investigate the impact of meta-analytic evidence in scientific literature on clinical decision making in the field of oral implantology.
  
  
  METHODS
  A Delphi opinion poll was performed at the meeting of the "Next Generation" Committees of the Austrian, German and Swiss Societies for Implantology (ÖGI, DGI and SGI). First, the experts gave their opinion on 20 questions regarding routine implant treatment (uninformed decisions), then they were confronted with up-to-date Level I evidence from scientific literature on these topics and again asked to give their opinion (informed decisions) as well as to rate the available evidence as satisfactory or insufficient. Topics involved surgical issues, such as immediate implant placement, flapless surgery, tilted and short implants and bone substitute materials, as well as opinions on prosthodontic paradigms, such as immediate loading, abutment materials and platform switching.
  
  
  RESULTS
  Compared to their uninformed decisions prior to confrontation with recent scientific literature, on average, 37% of experts (range: 15-50%) changed their opinion on the topic. When originally favoring one treatment alternative, less than half were still convinced after review of meta-analytic evidence. Discrepancy between uninformed and informed decisions was significantly associated with insufficient evidence (P = 0.014, 49% change of opinion vs. 26% on topics rated as sufficiently backed with evidence). Agreement regarding strength of evidence could be reached for eight topics (40%), in three issues toward sufficiency and in five issues toward lack of evidence.
  
  
  CONCLUSIONS
  Confrontation with literature results significantly changes clinical decisions of implantologists, particularly in cases of ambiguous or lacking meta-analytic evidence.
authors.affiliation: Academy for Oral Implantology, Vienna, Austria.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Pommer
authors.affiliation: Department of Oral Surgery, Heinrich Heine University, Düsseldorf, Germany.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Becker
authors.affiliation: Division of Oral Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Christoph
authors.initials: C
authors.lastname: Arnhart
authors.affiliation: Department of Oral Surgery and Radiology, Medical University of Graz, Graz, Austria.
authors.forename: Ferenc
authors.initials: F
authors.lastname: Fabian
authors.affiliation: Private dental praxis Dr. Markus Schlee, Forchheim, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Rathe
authors.affiliation: Department of Oral and Maxillofacial Surgery, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Stigler
mesh_terms: D001317:Austria; D000066491:Clinical Decision-Making; D003226:Congresses as Topic; D003697:Delphi Technique; D003758:Dental Implantation, Endosseous; D055094:Evidence-Based Dentistry; D005858:Germany; D006801:Humans; D012196:Review Literature as Topic; D013557:Switzerland
keywords: decision making; dental implant; evidence-based dentistry; expert opinion; implant-supported dental prosthesis; patient preference