Article: EVIDENCE AND CLINICAL DECISIONS: Asking the Right Questions to Obtain Clinically Useful Answers

Orthodontists need to know the effectiveness, efficiency and predictability of treatment approaches and methods, which can be learned only by carefully studying and evaluating treatment outcomes. The best data for outcomes come from randomized clinical trials (RCTs), but retrospective data can provide satisfactory evidence if the subjects were a well-defined patient group, all the patients were accounted for, and the percentages of patients with various possible outcomes are presented along with measures of the central tendency and variation. Meta-analysis of multiple RCTs done in a similar way and systematic reviews of the literature can strengthen clinically-useful evidence, but reviews that are too broadly based are more likely to blur than clarify the information clinicians need. Reviews that are tightly focused on seeking the answer to specific clinical questions and evaluating the quality of the evidence available to answer the question are much more likely to provide clinically useful data.

Citing Articles

The second molar dilemma in orthodontics: to bond or not to bond?.

Alshuraim F, Burns C, Morgan D, Jabr L, Rossouw P, Michelogiannakis D Angle Orthod. 2024; 94(3):320-327.

PMID: 38195055 PMC: 11050455. DOI: 10.2319/071223-487.1.

Assessment of masticatory efficiency based on glucose concentration in orthodontic patients: A methodological study.

Aiyar A, Shimada A, Svensson P J Oral Rehabil. 2022; 49(10):954-960.

PMID: 35899420 PMC: 9542905. DOI: 10.1111/joor.13359.

Reader's Forum.

Ahn H Korean J Orthod. 2016; 46(4):187-8.

PMID: 27478795 PMC: 4965589. DOI: 10.4041/kjod.2016.46.4.187.

Systematic review and meta-analysis: what are the implications in the clinical practice?.

Mattos C, Carlos de Oliveira Ruellas A Dental Press J Orthod. 2015; 20(1):17-9.

PMID: 25741820 PMC: 4373011. DOI: 10.1590/2176-9451.20.1.017-019.ebo.

References

1.

OBrien K, Wright J, Conboy F, Appelbe P, Davies L, Connolly I . Early treatment for Class II Division 1 malocclusion with the Twin-block appliance: a multi-center, randomized, controlled trial. Am J Orthod Dentofacial Orthop. 2009; 135(5):573-9. DOI: 10.1016/j.ajodo.2007.10.042. View

2.

Freeman C, McNamara Jr J, Baccetti T, Franchi L, Graff T . Treatment effects of the bionator and high-pull facebow combination followed by fixed appliances in patients with increased vertical dimensions. Am J Orthod Dentofacial Orthop. 2007; 131(2):184-95. DOI: 10.1016/j.ajodo.2005.04.043. View

3.

King G, McGorray S, Wheeler T, Dolce C, Taylor M . Comparison of peer assessment ratings (PAR) from 1-phase and 2-phase treatment protocols for Class II malocclusions. Am J Orthod Dentofacial Orthop. 2003; 123(5):489-96. DOI: 10.1067/mod.2003.S0889540603000453. View

4.

Lagravere M, Carey J, Heo G, Toogood R, Major P . Transverse, vertical, and anteroposterior changes from bone-anchored maxillary expansion vs traditional rapid maxillary expansion: a randomized clinical trial. Am J Orthod Dentofacial Orthop. 2010; 137(3):304.e1-12. DOI: 10.1016/j.ajodo.2009.09.016. View

5.

Adkins M, NANDA R, Currier G . Arch perimeter changes on rapid palatal expansion. Am J Orthod Dentofacial Orthop. 1990; 97(3):194-9. DOI: 10.1016/S0889-5406(05)80051-4. View

6.

Tortop T, Keykubat A, Yuksel S . Facemask therapy with and without expansion. Am J Orthod Dentofacial Orthop. 2007; 132(4):467-74. DOI: 10.1016/j.ajodo.2006.09.047. View

7.

Motoyoshi M, Hirabayashi M, Shimazaki T, Namura S . An experimental study on mandibular expansion: increases in arch width and perimeter. Eur J Orthod. 2002; 24(2):125-30. DOI: 10.1093/ejo/24.2.125. View

8.

Harrison J, OBrien K, Worthington H . Orthodontic treatment for prominent upper front teeth in children. Cochrane Database Syst Rev. 2007; (3):CD003452. DOI: 10.1002/14651858.CD003452.pub2. View

9.

Tulloch J, Proffit W, Phillips C . Outcomes in a 2-phase randomized clinical trial of early Class II treatment. Am J Orthod Dentofacial Orthop. 2004; 125(6):657-67. DOI: 10.1016/j.ajodo.2004.02.008. View

10.

Mattos C, Vilani G, SantAnna E, Ruellas A, Maia L . Effects of orthognathic surgery on oropharyngeal airway: a meta-analysis. Int J Oral Maxillofac Surg. 2011; 40(12):1347-56. DOI: 10.1016/j.ijom.2011.06.020. View

11.

Vaughn G, Mason B, Moon H, Turley P . The effects of maxillary protraction therapy with or without rapid palatal expansion: a prospective, randomized clinical trial. Am J Orthod Dentofacial Orthop. 2005; 128(3):299-309. DOI: 10.1016/j.ajodo.2005.04.030. View