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Table 5 Evaluation of the level of certainty of the evidence by the GRADE PRO tool

From: Allergies/asthma and root resorption: a systematic review

Certainty assessment Impact Certainty Importance
№ of studies Study design Risk of bias Inconsistency Indirectness Imprecision Other considerations
Predisposition of allergic patients to orthodontically induced root resorption
4 Observational studies Serious a Not serious Not serious Not serious All plausible residual confounding would suggest spurious effect, while no effect was observed. Of the 4 studies included, one has a high RoB [17] and one a moderate risk [16]. Studies have limitations in the identification and control of confounding factors. Three studies state that allergy is not a risk factor for root resorption [16, 17], while a study with a low RoB states that allergy is a risk factor for orthodontically induced root resorption [11]
LOW
IMPORTANT
Predisposition of asthmatic patients to orthodontically induced root resorption
3 Observational studies Serious b Serious c Not serious Not serious Strong association. All plausible residual confounding would suggest spurious effect, while no effect was observed Among the 3 studies evaluated, one has a moderate RoB [16] and the others have a low RoB [11, 15]. In addition to the lack of control of confounding variables, there is inconsistency between the results demonstrated by the value of the methodological heterogeneity between the studies. All studies conclude that asthma is not a risk factor for root resorption.
LOW
IMPORTANT
  1. aOne study has high RoB [17], one has moderate [16], while the others have low [11, 19]. All studies are deficient in the identification and control of confounding factors
  2. bTwo studies have low RoB [11, 15], while one study has moderate RoB [16]. All are deficient in the identification and control of confounding factors
  3. cThere is considerable methodological heterogeneity between the studies, concerning the teeth evaluated for root resorption, the sample unit, and the methods of diagnosis of resorption