Evidence-Based Orthodontics E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 508

Veröffentlichungsjahr: 2018

Beschreibung

Evidence-Based Orthodontics, Second Edition retains important elements of the First Edition, with several new sections to improve its use as a quick and comprehensive reference. * New updated edition of a landmark text that surveys the principles and practice of evidence-based orthodontics * Offers practical strategies for professionals to incorporate EBO in their daily practices * Presents brief summaries of the best evidence for a wide range of clinical topics * Incorporates information from over 400 systematic reviews, listed by topic

Leseprobe

Table of Contents

Cover

Foreword

1 Evidence‐Based Orthodontics – Its Evolution and Clinical Application

Introduction

Archie Cochrane and the development of evidence‐based medicine

The influence of an evidenced‐based approach

The influence of David Sackett and medical clinical trials

The application of evidence‐based dentistry to orthodontics

The Cochrane Oral Health Group/ Collaboration

Evidence‐based dentistry in education: Commission on Dental Accreditation guidelines

Making rational decisions in orthodontic practice

The American Dental Association website

The future of an evidence‐based approach in orthodontics

References

2 Clinical Research Design

Introduction

The scientific method

Research designs

Systematic reviews and meta‐analysis

Translational research

Clinical practice guidelines

References

3 Electronic Searching for Clinical Trials Information

Introduction

Where to search: choosing databases

How to search: constructing a search strategy

Summary

Useful resources

References

4 Making Sense of Randomized Clinical Trials and Systematic Reviews

How to interpret a randomized controlled trial

How to read a systematic review

The interpretation of “negative” findings

Final comments

References

5 Understanding and Improving our Evidence

Introduction

Maximizing value in clinical trials

Orthodontic randomized controlled trials: methodology and reporting

Systematic reviews and meta‐analyses for orthodontic interventions

Metaepidemiological findings from orthodontics

Improving research reporting in orthodontics

Core outcomes in orthodontics

Integration of evidence into daily practice

Collaboration/multicenter research and funding

Conclusions

References

6 Factors Influencing Facial Shape

Introduction

Biological basis of facial variation and heritability

Environmental influences on facial shape

Assessment of normal facial variation

Pubertal timing

Observing facial growth velocities in two different population groups

Determining differences in population groups using a multilevel principal component analysis

Multiple comparison tests

Conclusions

References

Summaries of Selected Systematic Reviews

Preface to Summaries

Summaries

S1 Curing lights for orthodontic bonding: a systematic review and meta‐analysis

S2 Self‐etch primers and conventional acid‐etch technique for orthodontic bonding: a systematic review and meta‐analysis

S3 Adhesives for bonded molar tubes during fixed brace treatment

S4 Adhesives for fixed orthodontic brackets

S5 Determinants for success rates of temporary anchorage devices in orthodontics: a meta‐analysis (n >50)

S6 The effectiveness of laceback ligatures during initial orthodontic alignment: a systematic review and meta‐analysis

S7 Mini‐implants in orthodontics: a systematic review of the literature

S8 Initial arch wires for tooth alignment during orthodontic treatment with fixed appliances

S9 Initial orthodontic alignment effectiveness with self‐ligating and conventional appliances: a network meta‐analysis in practice

S10 Systematic review of self‐ligating brackets

S11 Impacted and transmigrant mandibular canines incidence, aetiology, and treatment: a systematic review

S12 Effectiveness of early orthopaedic treatment with headgear: a systematic review and meta‐analysis

S13 Early orthodontic treatment for Class II malocclusion reduces the chance of incisal trauma: results of a Cochrane systematic review

S14 Efficacy of molar distalization associated with second and third molar eruption stage

S15 Orthodontic treatment for prominent upper front teeth (Class II malocclusion) in children

S16 Efficacy of orthopedic treatment with protraction facemask on skeletal Class III malocclusion: a systematic review and meta‐analysis

S17 Orthodontic treatment for prominent lower front teeth (Class III malocclusion) in children

S18 Effectiveness of pre‐surgical infant orthopedic treatment for cleft lip and palate patients: a systematic review and meta‐analysis

S19 Prevalence of dental anomalies in nonsyndromic individuals with cleft lip and palate: a systematic review and meta‐analysis

S20 Long‐term effects of presurgical infant orthopedics in patients with cleft lip and palate: a systematic review

S21 Secondary bone grafting for alveolar cleft in children with cleft lip or cleft lip and palate

S22 The effectiveness of non‐surgical maxillary expansion: a meta‐analysis

S23 Orthodontic treatment for posterior crossbites

S24 Long‐term dental and skeletal changes in patients submitted to surgically assisted rapid maxillary expansion: a meta‐analysis

S25 Long‐term dental arch changes after rapid maxillary expansion treatment: a systematic review

S26 Stability of deep‐bite correction: a systematic review

S27 Treatment and stability of Class II Division 2 malocclusion in children and adolescents: a systematic review

S28 Stability of Class II fixed functional appliance therapy – a systematic review and meta‐analysis

S29 Treatment effects of fixed functional appliances in patients with Class II malocclusion: a systematic review and meta‐analysis

S30 Effectiveness of orthodontic treatment with functional appliances on maxillary growth in the short term: a systematic review and meta‐analysis

S31 The effectiveness of the Herbst appliance for patients with Class II malocclusion: a meta‐analysis

S32 Enamel roughness and incidence of caries after interproximal enamel reduction: a systematic review

S33 Prevalence of peg‐shaped maxillary permanent lateral incisors: a meta‐analysis

S34 Craniofacial and upper airway morphology in adult obstructive sleep apnea patients: a systematic review and meta‐analysis of cephalometric studies

S35 Myofunctional therapy to treat obstructive sleep apnea: a systematic review and meta‐analysis

S36 CPAP vs mandibular advancement devices and blood pressure in patients with obstructive sleep apnea: a systematic review and meta‐analysis

S37 Orthodontic and orthopaedic treatment for anterior open bite in children

S38 Stability of treatment for anterior open‐bite malocclusion: a meta‐analysis

S39 Pharmacological interventions for pain relief during orthodontic treatment

S40 Pharmacological management of pain during orthodontic treatment: a meta‐analysis

S41 Factors associated with patient and parent satisfaction after orthodontic treatment: a systematic review

S42 The effects of orthodontic therapy on periodontal health: a systematic review of controlled evidence

S43 Retention procedures for stabilizing tooth position after treatment with orthodontic braces

S44 Performance of clear vacuum‐formed thermoplastic retainers depending on retention protocol: a systematic review

S45 A meta‐analysis of mandibular intercanine width in treatment and postretention

S46 Radiologically determined orthodontically induced external apical root resorption in incisors after non‐surgical orthodontic treatment of Class II division 1 malocclusion: a systematic review

S47 Root resorption of endodontically treated teeth following orthodontic treatment: a meta‐analysis

S48 Radiographic comparison of the extent of orthodontically induced external apical root resorption in vital and root‐filled teeth: a systematic review

S49 Root resorption associated with orthodontic tooth movement: a systematic review

S50 Influence of orthodontic treatment, midline position, buccal corridor and smile arc on smile attractiveness

S51 Systematic review and meta‐analysis of randomized controlled trials evaluating intraoral orthopedic appliances for temporomandibular disorders

S52 The role of mandibular third molars on lower anterior teeth crowding and relapse after orthodontic treatment: a systematic review

S53 Coronectomy vs. total removal for third molar extraction: a systematic review

S54 How long does treatment with fixed appliances last? A systematic review

S55 Surgically facilitated orthodontic treatment: a systematic review

S56 Fluorides for the prevention of early tooth decay (demineralised white lesions) during fixed brace treatment

Additional References

Summary 3 Additional References

Summary 7 Additional References

Summary 19 Additional References

Summary 20 Additional References

Summary 23 Additional References

Summary 24 Additional References

Summary 29 Additional Reference

Summary 30 Additional References

Summary 33 Additional References

Summary 36 Additional References

Summary 38 Additional References

Summary 42 Additional References

Summary 43 Additional References

Summary 47 Additional References

Summary 50 Additional References

Summary 52 Additional References

Summary 54 References

Summary 55 Additional References

Systematic Reviews in Orthodontics

Accelerated tooth movement

Activator

Adherence

Adhesives and bonding agents

Agenesis and anomalies

Airway

Aligners

Alternating rapid maxillary expansion and constriction (ALT RAMEC)

Anchorage/temporary anchorage devices (TADs)

Anterior crossbite

Anterior openbite

Antimicrobial agents

Appliances

Arch width

Arch‐wires

Auto transplantation

Biology of tooth movement

Bionator

Bisphosphonates

Bond strength

Botulinum toxin

Brackets

Bruxism

Canine impaction and transmigration

Caries

CBCT

Cephalometry

Chin cup

Class II

Class III

Clear aligners

Cleft lip and palate

Compliance

Cone beam computed tomography (CBCT)

Continuous positive airway pressure (CPAP)

Corticotomy

Coronectomy

Crossbites (anterior)

Crossbites (posterior)

Crowding

Curing lights

Deep bite

Demineralization

Dental trauma

Diagnostic records

Digital models

Distraction osteogenesis

Early treatment

Education

Elastics

Electric toothbrush

Enamel

Endodontically treated teeth

Epidemiology

Essix retainer

Extraction

Extrusion

Face mask

Fluoride

Force levels

Frankel function regulator

Frenum

Functional and orthopedic appliances

Genetics

Gingival recession

Gingival display

Growth prediction

Habits

Headgear

Herbst appliance

Imaging

Impaction

Implant site development

Interdisciplinary orthodontics

Interproximal reduction

Intra‐arch width

Intraoral scanners

Intrusion

Invisalign

Juvenile idiopathic arthritis

Laceback ligatures

Lateral incisors

Lingual orthodontics

Lip bumper

Low level laser therapy and pain

Low level laser therapy and tooth movement

Maxillary expansion

Medications affecting tooth movement

Mini‐implants and mini‐plates

Mixed dentition

Molar distalization

Mouthguards

Myofunctional therapy

Nickel hypersensitivity

Obstructive sleep apnea

Oligodontia

Open bite

Oral health promotion

Orthognathic surgery

Osteoarthritis

Overlay retainer

Pain

Peg lateral incisors

Patient‐centered outcomes

Periodontal health

Pharmacological agents

Piezocision

Posterior crossbite

Powered toothbrush

Premature loss of deciduous teeth

Profile

Pulpal health

Quality of life

Recession

Retention and relapse

Remineralizing agents

Root damage/repair

Root resorption

Scanners, intraoral

Self‐ligating brackets

Smile esthetics

Soft tissue profile

Space maintenance

Speech

Stability

Surgically assisted maxillary expansion

Surgery first approach

Temporary anchorage devices (TADs)

Temporomandibular joint

Third molars

Transposition of teeth

Trauma

Treatment time

Vacuum formed thermoplastic retainers

White spot lesions

Index

End User License Agreement

List of Tables

Chapter 02

Table 2.1 Hill’s viewpoints on the aspects of an association to be considered when deciding on causality.

Table 2.2 Research designs ordered from least potential for bias (top) to greatest potential for bias (bottom).

Chapter 03

Table 3.1 Example of a MeSH tree: orthodontic appliances.

Chapter 04

Table 4.1 Forest plot of the amount of distal movement with intraoral appliances versus headgear.

Table 4.2 An example forest plot from the temporary anchorage devices review.

Table 4.3 An example forest plot from the temporary anchorage devices review with summary data from each study highlighted.

Table 4.4 An example forest plot from the temporary anchorage devices review with effect size and 95% confidence intervals for each study highlighted.

Table 4.5 An example forest plot from the temporary anchorage devices review graphics dispersed around the line of no effect highlighted.

Table 4.6 An example forest plot from the temporary anchorage devices review with effect size and confidence intervals highlighted.

Chapter 05

Table 5.1 Intention to treat (ITT) versus per protocol (PP) analysis. The extreme assumption is made here that lost patients failed to comply. Other assumptions during missing data imputations are sensible.

Table 5.2 When the answer to the six questions in the table are all “yes” then qualitative differences in treatment effects between subgroups from subgroup analyses are likely.

Table 5.3 Forest plot for halogen versus plasma, halogen versus led and halogen versus plasma and LED curing lights.

Table 5.4 Compliance with Consolidated Standards of Reporting Trials (CONSORT) subitems within a sample of dental journals.

Table 5.5 Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) profile (American College of Chest Physicians, ACCP) table from the systematic review comparing bond failure of brackets bonded with halogen versus plasma curing lights.

Chapter 06

Table 6.1 Currently reported phenotype‐genotypes for various facial features for the normal population.

Table 6.2 Environmental influences on facial growth and development.

Chapter S1

Table S1.1 Risk of bond failure comparing halogen to (A) plasma and (B) light emitting diode (LED) curing lights.

Chapter S2

Table S2.1 Comparison of self‐etching primer versus acid etch (A) bracket failure and (B) difference in time.

Chapter S3

Table S3.1 Bonded molar tubes versus bands (A) failure at tooth level, (B) failure at participant level and (C) decalcification.

Chapter S5

Table S5.1 Temporary anchorage devices (TADs) failure rates (A) associated with healthy and inflamed tissues and (B) in maxilla or mandible.

Chapter S6

Table S6.1 The use of lacebacks and their effect on (A) incisor and (B) molar positions.

Chapter S7

Table S7.1 Success rates of orthodontic mini‐implants.

Chapter S10

Table S10.1 The effect of self‐ligating brackets on (A) total treatment time and (B) rate of incisor alignment.

Chapter S11

Table S11.1 The incidence of impacted and transmigrant mandibular canines.

Table S11.2 Treatment success and outcome of impacted and transmigrant mandibular canines.

Chapter S12

Table S12.1 Outcome measures for use of headgear versus controls for (A) phase 1 and (B) phase 2 treatments.

Chapter S13

Table S13.1 The incidence of trauma (A) early treatment and adolescence only and (B) headgear or functional appliance.

Chapter S14

Table S14.1 Molar movement (distalization and distal crown tip) at various stages of second and third molar eruption.

Chapter S15

Table S15.1 Outcomes for orthodontic treatment of prominent teeth (A) two‐phase (early) and (B) one‐phase (adolescent) in terms of OJ, ANB, PAR score and self‐concept.

Chapter S16

Table S16.1 The effect of the facemask on the ANB angle (degrees) (A) facemask alone and (B) facemask and rapid maxillary expansion (RME).

Chapter S17

Table S17.1 Comparison of ANB for facemask and untreated controls (A) 1 year follow‐up and (B) 2–3 year follow‐up.

Chapter S18

Table S18.1 Study details on which the outcomes have been based.

Table S18.2 Outcome for the angle (degrees) between the midpoint of the tuberosities, tuberosity, and the most occlusal point on the cusp of the canine M‐T‐C (5).

Chapter S19

Table S19.1 The prevalence of (A) tooth agenesis, (B) supernumerary teeth, and (C) irregularities of crown morphology.

Chapter S20

Table S20.1 The outcome measures for PSIO in patients with cleft lip and palate.

Chapter S22

Table S22.1 Outcome measures for slow maxillary molar width expansion compared to control (mm).

Chapter S23

Table S23.1 Comparison of different appliances and outcomes to correct lateral crossbites.

Chapter S24

Table S24.1 Comparison of three outcome measures for surgically assisted rapid maxillary expansion (SARME) for at least 1‐year follow‐up.

Chapter S25

Table S25.1 Long‐term expansion based on rapid maxillary expansion versus control groups.

Chapter S27

Table S27.1 Number of patients evaluated according to study types.

Chapter S28

Table S28.1 Outcome of (A) ANB angle using a fixed functional appliance.

Chapter S29

Table S29.1 Outcomes of fixed functional appliances versus controls (A) SNA, (B) SNB, and (C) ANB angles.

Chapter S30

Table S30.1 Outcomes for removable functional appliances versus controls for (A) SNA angle and (B) anterior maxillary displacement.

Chapter S31

Table S31.1 Sensitivity analysis for Herbst appliance versus control.

Chapter S32

Table S32.1 Forest plot and confidence intervals (CI) for the incidence of caries after interproximal enamel reduction (IER) on tooth surfaces compared with untreated tooth surfaces (clinical and radiographic assessments).

Chapter S33

Table S33.1 Prevalence of peg‐shaped lateral in differenta populations.

Tables S33.2 Prevalence of peg‐shaped laterals by gender in different ethnic groups.

Chapter S34

Table S34.1 Effect of obstructive sleep apnea on two craniofacial measurements.

Chapter S35

Table S35.1 Outcomes for pre‐ and postmyofunctional therapies in terms of Apnea‐Hypopnea Index (AHI), low oxygen levels, and Epworth sleepiness scale (ESS) (9 studies).

Chapter S36

Table S36.1 Treatment effect for change in Systolic Blood Pressure (SBP) in the included trial of continuous airway pressure (CPAP) versus Inactive control.

Table S36.2 Treatment effect for change in systolic blood pressure (SBP) in the included trials of mandibular advancement device (MAD) versus continuous positive airway pressure (CPAP) and versus inactive controls.

Chapter S37

Table S37.1 Treatment effects of two interventions on open bite (mm) versus no treatment.

Chapter S38

Table S38.1 Long‐term overbite status in surgical studies.

Table S38.2 Long‐term overbite status in nonsurgical studies.

Chapter S40

Table S40.1 Meta‐analysis results: standardized treatment effect, calculated as Hedges’ g, 95% confidence interval (CI) using random effects model, and I

2

values.

Chapter S41

Table S41.1 Summary of timing of data collection, surveying methods, response rate and risk of bias for the included studies.

Chapter S42

Table S42.1 Summary estimate and individual results of cohort and cross‐sectional studies reporting on the effect of orthodontic therapy on periodontal health: (A) alveolar bone loss, (B) periodontal pocket depth, and (C) gingival recession.

Chapter S43

Table S43.1 Comparison of different retention regimes after orthodontic tooth movement (based on Little’s Irregularity index for the lower labial segment).

Chapter S44

Table S44.1 Comparisons between various clear vacuum‐formed thermoplastic retainers based of wear regime (

p

values).

Chapter S45

Table S45.1 Comparison of mean intercanine widths pre‐ and post‐treatment for various types of malocclusion and interventions.

Chapter S46

Table S46.1 Root resorption related to treatment duration, sex, appliance type, and incisors affected.

Chapter S47

Table S47.1 Comparison of root resorption during orthodontic treatment: endodontically treated teeth versus teeth with vital pulps.

Chapter S48

Table S48.1 Outcome of radiographic assessment of root resorption.

Chapter S49

Table S49.1 Orthodontic tooth movement and associated root resorption.

Chapter S50

Table S50.1 The conclusions of the 20 studies regarding midline position, buccal corridor and smile arc on smile attractiveness.

Chapter S51

Table S51.1 Comparison of intervention outcomes (A) two appliances and (B) stabilization appliance versus control.

Chapter S52

Table S52.1 The influence of third molars on lower anterior crowding.

Chapter S53

Table S53.1 Risk ratios for (A) coronectomy versus total removal and (B) postoperative infections.

Chapter S54

Table S54.1 Treatment times for orthodontic treatment.

Chapter S55

Table S55.1 Outcomes for tooth movements in respect of (A) distraction and (B) corticotomy.

Chapter S56

Table S56.1 Relative risk ratios for intervention and control/comparison groups.

List of Illustrations

Chapter 01

Figure 1.1 Professor Archibald Leman Cochrane CBE, FRCP, FFCM (1909–1988). The Cochrane Collaboration is named in honor of Archie Cochrane, a British medical researcher who contributed greatly to the development of epidemiology as a science.

Figure 1.2 The Cochrane Collaboration logo. The outer blue semicircles represent the Cochrane Collaboration and the inner circle the globe to represent international collaborations. The forest plot of clinical trials represents the effectiveness of administering corticosteroids to pregnant women delivering prematurely; the diamond to the left of the “no effect” line indicates the meta‐analysis favored the intervention.

Figure 1.3 David Lawrence Sackett, OC, MD, MMSc, FRSC, FRCP (Canada, England, and Scotland).

Chapter 03

Figure 3.1 The AND command – “orthodontic appliances” AND “crowded teeth” will only retrieve articles containing both terms (the shaded area).

Figure 3.2 The OR command – “crowded teeth” OR “class I malocclusion” OR “class II malocclusion” will retrieve all articles with these terms, whether they appear together in the article or not. This is useful for finding synonyms.

Chapter 05

Figure 5.1 Evidence‐based orthodontics amalgamating the best evidence with clinical expertise and individual patient values.

Figure 5.2 Main steps of a systematic review. Abbreviations: PICO, participants, intervention(s), comparators, outcome measures.

Figure 5.3 Relationship between reporting quality, methodological quality–risk of bias, and interpretation of trial results.

Figure 5.4 Benefits of reporting guidelines. Abbreviations: RCT, randomized controlled trial; SR, systematic review.

Figure 5.5 The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) process for assessing the evidence from systematic reviews and making recommendations. Abbreviations: PICO, participants, intervention(s), comparators, outcome measures; RCT, randomized controlled trial.

Chapter 06

Figure 6.1 Comparison of narrow‐sense heritability h

2

for a range of facial features and medical conditions. Abbreviation: HDL, high density lipid.

Figure 6.2 Standard deviation ellipsoids for 21 facial landmarks, highlighting facial morphology variation revealed by the first three principal components (PCs): PC1 explains 29% of total variance (red); PC2 10% (yellow); PC3 7% (green); PC4 5% (blue). Facial landmarks: 1, glabella; 2, nasion; 3 and 4, endocanthion (left and right); 5 and 6, exocanthion (left and right); 7 and 8, palpebrale superius (left and right); 9 and 10, palpebrale inferius (left and right); 11, pronasale; 12, subnasale; 13 and 14, alare (left and right); 15, labiale superius; 16, labiale inferius; 17 and 18, crista philtri (left and right); 19 and 20, cheilion (left and right); 21, pogonion.

Figure 6.3 (a) Association of adult height, pubertal timing, and fat levels. (b) Height and weight growth charts. (c) Early and late patterns of pubertal growth (height velocities). (d) Soft and skeletal facial height growth velocities from 5 to 20 years of age.

Figure 6.4 Growth of the face for Finnish and Welsh males and females based on three different landmarks. Abbreviations: men, midendocanthion; g, glabella; n, nasion; sn, subnasale; prn, pronasale; ls, labiale superius; li, labiale inferius; pg, pogonion.

Figure 6.5 (a) Component scores from standard (single‐level) principal component analysis (PCA) (PC1 against PC2). (b) Component scores from between‐group multilevel PCA (PC1 against PC2). The filled circles indicate the centroids, and results for females and males from the same country are linked by a line, all following a similar trajectory. (c) Eigen vectors for three‐level model: subject, sex and ethnicity. (d) Three‐dimensional facial scans averaged over all subjects in each group (country and gender).

Chapter S9

Figure S9.1 Bar plot of the SUCRA (surface under the cumulative ranking) values for the outcome “overall efficacy”.

Chapter S26

Figure S26.1 Weighted averages for overbite at various follow‐up times from (a) Class I, (b) Class II Division I, and (c) Class II Division 2 studies. Abbreviations: NE, nonextraction, EXT, extraction; MIX, mixed.

Guide

Cover

Table of Contents

Begin Reading

Pages

iii

iv

vii

viii

ix

x

xi

xii

1

2

3

4

5

6

7

8

9

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66

67

69

70

71

72

73

74

75

76

77

78

79

80

81

83

91

92

93

94

95

96

97

98

99

100

101

102

103

104

105

106

107

108

109

110

111

112

113

114

115

116

117

118

119

120

121

122

123

124

125

126

127

128

129

130

131

132

133

134

135

136

137

138

139

140

141

142

143

144

145

146

147

148

149

150

151

152

153

154

155

156

157

158

159

160

161

162

163

164

165

166

167

168

169

170

171

172

173

174

175

176

177

178

179

180

181

182

183

184

185

186

187

188

189

190

191

192

193

194

195

196

197

198

199

200

201

202

203

206

207

208

209

210

211

212

213

214

215

216

217

218

219

220

221

222

223

224

225

226

227

228

229

230

231

232

233

234

235

236

237

238

239

240

241

242

243

244

245

246

247

248

249

250

251

252

253

254

255

256

257

258

259

261

262

263

264

265

266

267

268

269

270

271

272

Evidence‐Based Orthodontics

Second Edition

Edited by

Greg J. Huang

School of DentistryUniversity of WashingtonSeattleWashington, USA

Stephen Richmond

School of DentistryCardiff UniversityCardiffWales, UK

Katherine W. L. Vig

Harvard School of Dental MedicineBostonMassachusetts, USA

This edition first published 2018© 2018 John Wiley & Sons, Inc.

Edtion History:Blackwell Publishing Ltd. (1e, 2011)All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by law. Advice on how to obtain permission to reuse material from this title is available at http://www.wiley.com/go/permissions.

The right of Greg J. Huang, Stephen Richmond and Katherine W. L. Vig to be identified as the author(s) of the editorial material in this work has been asserted in accordance with law.

Registered Office(s)John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, USA

Editorial Office111 River Street, Hoboken, NJ 07030, USA

Limit of Liability/Disclaimer of WarrantyThe contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting scientific method, diagnosis, or treatment by physicians for any particular patient. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. While the publisher and authors have used their best efforts in preparing this work, they make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives, written sales materials or promotional statements for this work. The fact that an organization, website, or product is referred to in this work as a citation and/or potential source of further information does not mean that the publisher and authors endorse the information or services the organization, website, or product may provide or recommendations it may make. This work is sold with the understanding that the publisher is not engaged in rendering professional services. The advice and strategies contained herein may not be suitable for your situation. You should consult with a specialist where appropriate. Further, readers should be aware that websites listed in this work may have changed or disappeared between when this work was written and when it is read. Neither the publisher nor authors shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.

Library of Congress Cataloging‐in‐Publication Data

Names: Huang, Greg J., editor. | Richmond, Stephen, editor. | Vig, Katherine W. L., editor.Title: Evidence‐based orthodontics / edited by Greg J. Huang, Stephen Richmond, Katherine W.L. Vig.Description: 2nd edition. | Hoboken, NJ : Wiley, 2018. | Includes bibliographical references and index. |Identifiers: LCCN 2018010564 (print) | LCCN 2018011366 (ebook) | ISBN 9781119289920 (pdf) | ISBN 9781119289951 (epub) | ISBN 9781119289913 (paperback)Subjects: | MESH: Orthodontics | Malocclusion | Evidence‐Based DentistryClassification: LCC RK521 (ebook) | LCC RK521 (print) | NLM WU 400 | DDC 617.6/43–dc23LC record available at https://lccn.loc.gov/2018010564

Cover Design: WileyCover Images: (Dental images) Courtesy of Greg J. Huang; (Pyramid) Courtesy of Wiley

List of Contributors

Azrul Safuan Mohd Ali, BDSApplied Clinical Research and Public HealthSchool of DentistryCollege of Biomedical and Life SciencesCardiff UniversityCardiff, UK

Matina V. Angelopoulou, DDS, MSDepartment of Developmental SciencesMarquette University School of DentistryMilwaukee, WI, USA

Philip Benson, BDS, PhD, FDS(Orth)Academic Unit of Oral Health, Dentistry and SocietySchool of Clinical DentistryUniversity of SheffieldSheffield, UK

Niko Bock, DMDDepartment of OrthodonticsUniversity of GiessenGiessen, Germany

Anne‐Marie Bollen, DDS, MS, PhDDepartment of OrthodonticsUniversity of WashingtonSeattle, WA, USA

Macario Camacho, MDOtolaryngology‐Head and Neck SurgeryDivision of Sleep Surgery and MedicineTripler Army Medical CenterHonolulu, HI, USA

Stephanie Shih‐Hsuan Chen, DDS, MSDTaipei CityTaiwan

Domenico Dalessandri, DDS, MS, PhDDepartment of OrthodonticsSchool of DentistryUniversity of BresciaBrescia, Italy

Scott Deacon, BDS, MSc, MFDS, MOrth, FDS(Orth)South West Cleft ServiceUniversity Hospitals Bristol NHS Foundation Trust and University of BristolBristol, UK

Damian Farnell, BSc, PhDApplied Clinical Research and Public Health School of DentistryCollege of Biomedical and Life SciencesCardiff UniversityCardiff, UK

Camilo Fernandez‐Salvador, MDOtolaryngology‐Head and Neck SurgeryTripler Army Medical CenterHonolulu, HI, USA

Padhraig Fleming, BDent Sc (Hons), MSc, PhD, FDS RCS, MFDS RCS, FDS RCS, MOrth RCS, FDS (Orth) RCS, FHEABarts and The London School of Medicine and DentistryQueen Mary University of LondonLondon, UK

Carlos Flores Mir, DDS, DSc, FRCDDepartment of DentistryUniversity of AlbertaEdmonton, Alberta, Canada

James Fricton, DDS, MSSchool of DentistryUniversity of MinnesotaMinneapolis, MN, USA

Jennifer Galloway, BDS, BMSc, MDSc, MFDS RCPSApplied Clinical Research and Public Health School of DentistryCollege of Biomedical and Life SciencesCardiff UniversityCardiff, UK

Geoff Greenlee, DDS, MSD, MPHDepartment of OrthodonticsUniversity of WashingtonSeattle,WA, USA

Gordon Guyatt, MD, MSc, FRCP, OCDepartment of MedicineMcMaster UniversityHamilton, Ontario, Canada

Jayne Harrison, BDS, MDentSci, PhD, MOrth RCSEd, FDS(Orth)RCPS, FDTFEdOrthodontic DepartmentLiverpool University Dental HospitalLiverpool, UK

Hong He, MDS, PhDDepartment of OrthodonticsSchool and Hospital of StomatologyWuhan UniversityWuhan, Hubel, China

Fang Hua, BDS, MSc, PhDDepartment of Orthodontics and Center for Evidence‐Based StomatologySchool and Hospital of StomatologyWuhan UniversityWuhan, Hubei, China

Greg J. Huang, DMD, MSD, MPHDepartment of OrthodonticsUniversity of WashingtonSeattle,WA, USA

Guilherme Janson, DDS, MSc, PhD, MRCDCDepartment of OrthodonticsBauru Dental SchoolUniversity of São PauloBauru, São Paulo, Brazil

Eleftherios G. Kaklamanos, DDS, Cert, MSc, MA, Dr MedHamdan Bin Mohammed College of Dental MedicineMohammed Bin Rashid University of Medicine and Health SciencesDubai, United Arab Emirates

Visnja Katic, PhD, DMDResearch AssistantDepartment of OrthodonticsFaculty of MedicineUniversity of RijekaRijeka, Croatia

O. P. Kharbanda, BDS, MDS, M Orth RCS, M MEd, FDS RCS, Hon, FAMSDivision of Orthodontics and Dentofacial DeformitiesCentre for Dental Education and ResearchAll India Institute of Medical SciencesNew Delhi, India

Malcolm Kohler, MDDepartment of PulmonologyUniversity Hospital ZurichZurich, Switzerland

Vasiliki Koretsi, DDS, Dr Med DentDepartment of OrthodonticsUniversity Hospital Regensburg RegensburgGermany

Eleni Koumpridou, DDS, DOrthDepartment of OrthodonticsCenter for Dental and Maxillofacial HealthMedical FacultyUniversity of WuerzburgWuerzburg, Germany

Wenli Lai, DDS, PhDState Key Laboratory of Oral Diseases and Department of OrthodonticsWest China Hospital of StomatologySichuan UniversityChengdu, China

Débora A. Lentini‐Oliveira, DDS, MScNeuro‐Sono Sleep CenterDepartment of NeurologyFederal University of São PauloSão Paulo, Brazil

Anne Littlewood, BA(Hons), MA, MPhilCochrane Oral HealthUniversity of ManchesterManchester, UK

Simon J. Littlewood, BDS, FDS(Orth)RCPS, MDSc, MOrth RCSOrthodontic DepartmentSt Luke’s HospitalBradford, UK

Claudia Trindade Mattos, DDS, MSD, PhDDepartment of OrthodonticsSchool of DentistryUniversidade Federal FluminenseNiterói, Brazil

Marcello Melis, DMD, PharmDPrivate PracticeCagliari, Italy

Reint Meursinge Reynders, DDS, MS, MSc, PhDMilanItaly

Declan Millett, BDSc, DDS, FDSRCPS, FDSRCS, DOrthRCSEng, MOrthRCSEng, FHEAOral Health and DevelopmentCork University Dental School and HospitalUniversity CollegeCork, Ireland

Peter Ngan, DMDDepartment of OrthodonticsWest Virginia UniversityMorgantown, WV, USA

Riccardo Nucera, DDS, PhD, MScDepartment of Biomedical and Dental Sciences and Morphofunctional ImagingSection of OrthodonticsSchool of DentistryUniversity of MessinaMessina, Italy

Kevin O’Brien, BDS, FDS, DOrth RCS, PhDSchool of DentistryUniversity of ManchesterManchester, UK

S. H. Ong, DDSDepartment of OrthodonticsUniversity Medical Center GroningenUniversity of GroningenGroningen, The Netherlands

Nikolaos Pandis, DDS, MS dr. Med Dent MSc, DLSHTM, PhDDepartment of Orthodontics and Dentofacial OrthopedicsDental School/Medical FacultyUniversity of BernBern, Switzerland

Moschos Papadopoulos, DDS, Dr Med DentDepartment of OrthodonticsSchool of DentistryAristotle University of ThessalonikiThessaloniki, Greece

Spyridon N. Papageorgiou, DDS, Dr Med DentClinic of Orthodontics and Pediatric DentistryCenter of Dental MedicineUniversity of ZurichZurich, Switzerland

Pertti Pirttiniemi, DDS, PhDProfessor and ChairOral Development and OrthodonticsInstitute of DentistryUniversity of OuluOulu University HospitalMedical Research CenterFinland

Lauren K. Reckley, MDOtolaryngology‐Head and Neck SurgeryTripler Army Medical CenterHonolulu, HI, USA

Yijin Ren, DDS, MSc, PhDDepartment of OrthodonticsUniversity Medical Center GroningenUniversity of GroningenGroningen, The Netherlands

Stephen Richmond, BDS, D'Orth, RCS, MScD, FDS, RCS (Ed & Eng), PhD FHEAApplied Clinical Research and Public Health School of DentistryCollege of Biomedical and Life SciencesCardiff UniversityCardiff, Wales, UK

Anibal M. Silveira, DDSDepartment of Orthodontics, Pediatric Dentistry and Special CareSchool of DentistryUniversity of LouisvilleLouisville, KY, USA

Badri Thiruvenkatachari, BDS, MFDS RCS, MDS, MOrth RCS, FDS RCS, PhDSchool of DentistryUniversity of ManchesterManchester, UK

Alessandro Ugolini, DDS, PhD, Spec. OrthodonticsOrthodontics DepartmentUniversity of GenoaGenoa, Italy

Aslıhan Uzel, DDS, PhDDepartment of OrthodonticsFaculty of DentistryÇukurova UniversityBalcalı, Turkey

Alexandre R. Vieira, DDS, MS, PhDUniversity of PittsburghSchool of Dental MedicinePittsburgh, PA, USA

Katherine W. L. Vig, BDS, MS, D. Orth, FDS RCSDepartment of Developmental BiologyHarvard School of Dental MedicineBoston, MA, USA

Yan Wang, DDS, PhDDepartment of OrthodonticsLaboratory of Oral DiseasesWest China Hospital of StomatologySichuan UniversityChengdu, Sichuan, China

Belinda Weltman, HBSc, MSc, DMD, MS, FRCD(C)University of British ColumbiaVancouver, British Columbia, Canada

Robert J. Weyant, MS, DMD, DrPHDepartment of Dental Public HealthSchool of Dental MedicineUniversity of PittsburghPittsburgh, PA, USA

Caryl Wilson‐Nagrani, BDS, MFDS(RCSEng), MOrth(RCSEd), FDSOrth(RCSEd), PhD, FHEAApplied Clinical Research and Public Health School of DentistryCollege of Biomedical and Life SciencesCardiff UniversityCardiff, UK

Anastasios Zafeiriadis, DDS, MSc, DrDentDepartment of OrthodonticsSchool of Dentistry, Faculty of Health SciencesAristotle University of ThessalonikiThessaloniki, Greece

Khalid H. Zawawi, BDS, DScDepartment of OrthodonticsFaculty of DentistryKing Abdulaziz UniversityJeddah, Saudi Arabia

Alexei Zhurov, BSc, MSc, PhDApplied Clinical Research and Public Health School of DentistryCollege of Biomedical and Life SciencesCardiff UniversityCardiff, UK

Vasileios F. Zymperdikas, DDSDepartment of OrthodonticsFaculty of DentistryAristotle University of ThessalonikiThessaloniki, Greece

Foreword

Evidenced based orthodontics (EBO) provides tools for using the relevant literature to determine the benefits and risks of alternative patient management strategies in the context of the individual patient’s presenting condition.

The term evidence‐based medicine (EBM) first appeared in the medical literature in 1991; it rapidly became something of a mantra. EBM is sometimes perceived as a blinkered adherence to randomized trials, or a health‐care manager’s tool for controlling and constraining recalcitrant physicians. In fact, EBM and EBO involve informed and effective use of all types of evidence, but particularly evidence from the medical literature, in patient care.

EBM's evolution has included outward expansion – we now realize that optimal health care delivery must include evidence‐based nursing, physiotherapy, occupational therapy, and podiatry – and specialization. We need evidence‐based obstetrics, gynaecology, internal medicine, and surgery – and, indeed, orthopedics and neurosurgery. And, of course, we need evidence‐based orthodontics.

Applying EBO to management decisions in individual patients involves use of a hierarchy of study design, with high‐quality randomized trials showing definitive results directly applicable to an individual patient at the apex, to relying on physiological rationale or previous experience with a small number of similar patients near the bottom rung. Ideally, systematic reviews and meta‐analyses summarize the highest quality available evidence. The hallmark of evidence‐based practitioners is that, for particular clinical decisions, they know the quality of the evidence, and therefore the degree of uncertainty.

What is required to practice EBO? Practitioners must know how to frame a clinical quandary to facilitate use of the literature in its resolution. Evidence‐based orthodontic practitioners must know how to search the literature efficiently to obtain the best available evidence bearing on their question, to evaluate the strength of the methods of the studies they find, extract the clinical message, apply it back to the patient, and store it for retrieval when faced with similar patients in the future.

Traditionally, neither dental schools nor medical schools or postgraduate programs have taught these skills. Although this situation is changing, the biggest influence on how trainees will practice is their clinical role models, few of whom are currently accomplished EBO practitioners. The situation is even more challenging for those looking to acquire the requisite skills after completing their clinical training.

This text primarily addresses the needs of both trainees and of this last group, orthodontic practitioners. Appearing over 25 years after the term EBM was coined, the text represents a landmark in a number of ways. The book represents a successful effort to comprehensively address the EBO‐related learning needs of the orthodontic community, and summarize the key areas of orthodontic practice.

To achieve its goals of facilitating evidence‐based orthodontic practice, the text begins with chapters that introduce the tools for evaluating the original orthodontic literature, including research designs, searching for relevant trials, and making sense of randomized trials and systematic reviews. Those interested in delving deeper into issues of how to evaluate the literature, and apply it to patient care, can consult a definitive text, the Users’ Guides to the Medical Literature (Guyatt G et al. 3rd edition, McGraw‐Hill Education, 2015).

The current text goes on to provide evidence summaries to guide each of the key common problems of orthodontic practice. Thorough and up to date at the time of writing, they provide a definitive guide to evidence‐based orthodontic practice today – with over 50 brief summaries of relevant evidence including self‐ligating versus conventional brackets, the impact of orthodontic treatment on apical root resorption, and the success rates for temporary anchorage devices.

That evidence will, of course, change – and in some areas change quickly. Clinicians must therefore use this book not only as a text for the present, but as a guide for updating their knowledge in the future. That future will hopefully hold the advent of an evidence‐based secondary journal for orthodontics, similar to those that have been developed in other areas, including evidence‐based mental health, evidence‐based nursing, and the ACP Journal Club, which does the job for internal medicine. These publications survey a large number of journals relevant to their area and choose individual studies and systematic reviews that meet both relevance and validity screening criteria. The results of these studies are presented in structured abstracts that provide clinicians with the key information they need to judge their applicability to their own practices, similar to the summaries that comprise the second section of this text. Fame and fortune await the enterprising group who applies this methodology to produce evidence‐based orthodontics.

Whatever the future holds for the increasing efficiency of evidence‐based practice, the current text provides an introduction to a system of clinical problem‐solving that is becoming a prerequisite for modern orthodontic practice.

Dr. Gordon Guyatt

1Evidence‐Based Orthodontics – Its Evolution and Clinical Application

Katherine W. L. Vig

Introduction

Health‐care information escalated towards the end of the twentieth century. This created a serious challenge for clinicians trying to make informed decisions for their patients concerning the relative effectiveness of alternative treatment interventions. The lack of systematic reviews from prospective well‐designed clinical trials led to delays in incorporating and testing new information while fostering the continuation of less‐effective, less‐efficient, and even harmful interventions; the proponents believing clinical experience, as the gold standard, for supporting and recommending treatment procedures and interventions.

Medicine pioneered an evidence‐based approach to clinical practice in the eighteenth century at a time when navigation was important for overseas trading in Britain. Long voyages to Australia and the Far East were undertaken with sailors deprived of fresh fruit and vegetables, resulting in scurvy and other medical problems. James Lind MD, surgeon to the British Navy, wrote a Treatise of the Scurvy which was ignored for many years but considered the first controlled clinical trial to be translated into clinical practice by equipping long‐distance trade ships with lemons and limes to avoid the ship’s crew succumbing to scurvy.

In 1971, the British epidemiologist, Archie Cochrane (Figure 1.1), in his influential monograph entitled Effectiveness and Efficiency (Cochrane 1971) introduced this “new” concept in clinical medicine that all treatment interventions must be proven to be effective. This was supported by an early example in which data were combined from multiple clinical trials investigating premature births and infant mortality. By 1974, all controlled trials in perinatal medicine had been systematically identified and entered into a clinical trials register. By 1987, the year before Archie Cochrane died, 600 systematic reviews on health‐care topics had been conducted. How one man, whose ideas were initially unacceptable to the medical community, had such a profound impact on medicine is recounted in the autobiographical monograph One Man’s Medicine (Cochrane and Blythe 1989). His revolutionary observations and convictions were fashioned by his experiences of growing up in Britain during the tumultuous years surrounding the two World Wars, and the death of his father in the First World War. The loss of his father had a profound effect on the young Archie Cochrane, with the responsibilities expected from the eldest son to take over as head of the family to care for his mother and siblings.

Figure 1.1 Professor Archibald Leman Cochrane CBE, FRCP, FFCM (1909–1988). The Cochrane Collaboration is named in honor of Archie Cochrane, a British medical researcher who contributed greatly to the development of epidemiology as a science.

Source: courtesy of the Cochrane Collaboration.

Archie Cochrane and the development of evidence‐based medicine

The early years

Archie Cochrane was born in a small town in Scotland in 1909 to a privileged and wealthy family. His successful grandfather and great‐grandfather pioneered the textile industry and benefited from the textile manufacture of the popular Scottish tweeds. As a young boy with an elder sister, two younger brothers, and devoted parents, he lived an affluent but disciplined life in a large house with multiple servants. His youthful world was disrupted in 1914 when the First World War was declared. His father joined a Scottish regiment and was killed in 1917 while attempting to rescue a wounded brother officer. Archie Cochrane was 8 years old and now carried the responsibilities of being the eldest son with three siblings and a grieving mother. The desolation accompanying the loss of his father was followed by the death of his younger brother to tuberculosis during the severe wartime restrictions.

Archie Cochrane was educated in the traditional upper‐class prerogative of “building character” by sending young boys to preparatory boarding school, followed by a prestigious and expensive “public” school, before entering University. Archie Cochrane excelled in athletics and mathematics, and his aptitude for literature resulted in his successful admittance to King’s College, Cambridge. A rugby football accident curtailed the time he devoted to acting, riding, tennis, and golf but made him focus on his studies. He graduated with a double first‐class honors degree. His grandfather’s death, while he was at Cambridge, resulted in his becoming independently wealthy early in his adult life, which he believed contributed to his later success. However, this was also the time of another family tragedy when his remaining younger brother died in a motorcycle accident. Archie was now the eldest and only son of his family, and he undertook responsibility for his widowed mother and elder sister.

The influences in developing an evidence‐based approach

Archie Cochrane was a man of the turbulent 1930s who witnessed the events leading to the Second World War. His emotional and intellectual independence and conviction of moral values caused him to often reject political solutions. When he was a medical student at University College Hospital, in London, the Spanish civil war broke out, and Archie Cochrane risked his life and career by volunteering to join the Spanish Medical Aid Unit following Franco’s invasion. A year later he returned to England to complete his medical training while believing fascism a menace to Western civilization.

His experience of seeing the consequences of war prepared him for joining the British Army during the Second World War and serving overseas. His fluency and aptitude for languages, including German, French, and Spanish, resulted in his joining a commando regiment that included 70 Spanish refugees from the civil war who had enlisted in the British Army. The regiment was deployed to Crete where Archie was captured by the invading Germans. He spent the next 4 years as a prisoner of war (POW), serving as the medical officer to a camp of 20 000 POWs from diverse cultures and countries, whom he cared for with compassion and fortitude (Doll 1997).

This ordeal resulted in his abiding beliefs in patient care and that medical interventions should be available for all individuals whatever their circumstance. As the medical officer in the POW camp he shared the same diet and conditions as his fellow prisoners. His courage and endurance as a compassionate medical officer resulted in his first clinical trial. He was emaciated and jaundiced himself, with pitting edema above the knees, but he set up a trial with yeast he had acquired from the German prison guards. He describes this as “my first, worst, and most successful clinical trial” (Cochrane 1984).

Having survived the Second World War, he subsequently spent time in the United States before returning to England with a mission and commitment to change the imperfect British medical system. His firm belief in finding evidence for the effectiveness of medical interventions resulted in the development of randomized clinical trials (RCTs) and systematic reviews of the scientific literature. This initiated a new era in medicine – one that would ultimately influence dentistry. A new evidence‐based approach to patient care was destined to revolutionize clinical practice, and the methodology had its roots in his experiences as a POW medical officer with limited medical supplies, never knowing what might or might not work. This uncertainty proved to be fertile ground for Archie to test his theories, as it allowed him to ethically randomize patients to alternative treatments. This randomization usually resulted in well‐matched groups that received different interventions, thus allowing the investigation to determine the most effective treatment.

The Cochrane legacy

The Cochrane Collaboration was established a year after Archie Cochrane’s death and is recognized in the twenty‐first century as an international organization that prepares, maintains, and promotes accessible systematic reviews of the effectiveness of health‐care interventions from which well‐informed decisions emerge (Antes and Oxman 2001).

The familiar logo of the Cochrane Collaboration (Figure 1.2) exemplifies and recognizes the impact of Archie Cochrane’s life. The circle, representing the global and international collaboration, encircles the forest plot, which depicts the results of a quantitative meta‐analysis. This forest plot represents one of the earliest systematic reviews and meta‐analyses of the literature on the therapeutic intervention of corticosteroids in women who were to deliver their babies prematurely. By a statistical combination of data from the clinical trials, the highest evidence, and ultimately the gold standard for clinical practice in caring for pregnant women delivering prematurely, was established. The benefits of the effectiveness of administering perinatal corticosteroids were undeniably correlated with the outcome of perinatal and neonatal survival with a consequent reduction in mortality and morbidity.

Figure 1.2 The Cochrane Collaboration logo. The outer blue semicircles represent the Cochrane Collaboration and the inner circle the globe to represent international collaborations. The forest plot of clinical trials represents the effectiveness of administering corticosteroids to pregnant women delivering prematurely; the diamond to the left of the “no effect” line indicates the meta‐analysis favored the intervention.

The Cochrane Collaboration

The Cochrane Collaboration (Cochrane Collaboration 2017) has influenced and driven the science and methodology of systematic reviews and has been compared to the revolutionary Human Genome Project in its potential implications for contemporary health care (Naylor 1995). Nevertheless, changing the standard of care in clinical practice does not move quickly, and information gained from research experience has a long gestation period and time lag before it becomes incorporated into clinical practice.

Historically, medical and dental regimens have remained unchanged even when well‐designed clinical trials have provided counterevidence. Treatment decisions based on clinical experience and beliefs are difficult to change, and it has been shown to take an average of 17 years for the findings from clinical trials to be implemented into clinical practice. For example, there were clinical trials in 1960 of thrombolytic therapy and the administration of streptokinase. By 1975, 40 RCTs had been conducted, and by 1985 there were 50 000 patients enrolled, with evidence that thrombolytic therapy was effective. When a systematic review and meta‐analysis conclusively showed the effectiveness of thrombolytic agents, it was finally accepted as a standard of care in 1990. If the contemporary methodological approach to evidence‐based practice had been established 30 years previously, many lives could have been saved. Unfortunately, even in the twenty‐first century, when evidence is convincing, clinicians may still find it difficult to relinquish their beliefs based on their clinical experience.

The influence of an evidenced‐based approach

The establishment of the evidence‐based approach resulted in rapid changes in the health‐care system and in the education of students and residents in the health‐care professions. A paradigm shift had occurred from the paternalistic choice of a treatment intervention by doctors for their trusting patients to a partnership in which the doctor and patient make choices together to determine the “best” treatment. It was therefore incumbent on the health‐care provider to have knowledge of the best available evidence pertaining to the risks, costs, benefits, burden of care, and probability of success for alternative treatment interventions. The caveat was that if evidence exists to support the effectiveness and efficiency of treatment interventions, an integration of the best research evidence with clinical expertise and patient values and preferences should occur (Sackett et al. 1991, 2000). Although the new movement of Evidence Based Medicine and Clinical Trialists was flourishing in Britain with the leadership of the Cochrane Collaboration, other influences were playing their part on the other side of the Atlantic. Alvan Feinstein MD, Professor of Medicine and Epidemiology at Yale, promoted “clinical care as science,” and advanced knowledge with clinimetrics. The term clinimetrics, as its name suggests, embraced science, technology, and clinical care with reproducible consistency as the basic science underlying clinical decision making. During his formative years, in 1963 David Sackett read a paper by Alvan Feinstein on Boolean algebra and taxonomy and wrote Feinstein a fan letter, following which Alvan Feinstein became a mentor to Sackett (Smith 2015). Clinicians and academics interested in evidence‐based medicine consider Cochrane, Feinstein, and Sackett as the “fathers” of a new and currently flourishing movement of evidence‐based medicine. Dentistry has embraced an evidence‐based approach and has ridden on the coattails of medicine in teaching and practicing an evidence‐based approach, and conducting systematic reviews and meta‐analysis of treatment interventions with well‐defined, reliable, and valid outcomes.

The impact of David Sackett and clinical epidemiology resonated with the orthodontic attendees when Bob Moyers invited David Sackett to participate in the Moyers Symposium on three occasions over a 30‐year period, starting in 1985. By 2015, when Sackett attended his third Moyers Symposium, he cited his comments from 1985 when he excoriated orthodontics, suggesting the trials in orthodontics was lagging behind “such treatment modalities as acupuncture, hypnosis, homeopathy and orthomolecular therapy and on a par with scientology, dianetics and podiatry” (Sackett 1995). There were no RCTs in orthodontics prior to 1967 and there was a rate of one trial every 2 years during the next decade. By 1994, when Sackett next participated in the Moyers Symposium, orthodontic trials had increased 18‐fold, and by 2005 had risen to 129 per year (Sackett 1995, 2014). David Sackett’s unique perspective and encouragement in the world of orthodontics had a major influence on the now classic orthodontic Class II RTCs funded by National Institutes of Health/ National Institute of Dental and Craniofacial Research. So who was the late David Sackett and what influenced his interest in an evidence‐based approach in medicine (Figure 1.3)?

Figure 1.3 David Lawrence Sackett, OC, MD, MMSc, FRSC, FRCP (Canada, England, and Scotland).

Source: Per Kjeldsen with permission of Dr. James McNamara.

The influence of David Sackett and medical clinical trials

David L. Sackett (1934–2015) was born in Chicago, the third son of “a bibliophile mother and artist‐designer father” (Smith 2015). His childhood was not without adversity as he was bedridden for months with polio, from which he recovered as a 12 year old. He became a voracious reader and as he recovered from polio he became an accomplished runner. He started his medical training at the University of Illinois in 1956 and in 1962 was drafted into the US Public Health service as a result of the Cuban missile crisis. He also had a Master of Science degree from the Harvard School of Public Health. He was diverted from a career in bench science by his love for clinical medicine, and was influenced by Walter Holland, Professor of Clinical Epidemiology at St Thomas’s Hospital Medical School in London, to have an enduring interest and career in clinical epidemiology. He was only 32 years old when he was recruited to the new Canadian Medical School at McMasters University, in Hamilton, Canada. This was a difficult decision as Sackett did not want to leave the United States. Nevertheless, the opportunity to develop a different way to educate medical students by finding evidence from systematic reviews rather than conventional teaching “in my clinical experience” was irresistible. This proved a new and exciting challenge, embraced by a new generation of medical students who flourished in the innovative educational methods, although these were not popular with the senior experienced clinicians. Sackett was not a man with a big ego and once considered an expert it was time to move on and let new talent emerge. This trait was exemplified by his decision, when he was 49 years old, to repeat his Medical Residency. He considered clinical practice had changed so much that he was no longer a “good enough doctor anymore”. It took courage to return to medical school but he believed he would become a better doctor if he adopted contemporary methods and became updated. Sackett believed that evidence‐based medicine went beyond critical appraisal by combining evidence from research with clinical skills and the values and preferences of patients (Sackett 2015). In 1994, Sackett became a clinician at the John Radcliffe Hospital in Oxford where he was the Director of the Center of Evidence‐based Medicine. Five years later, in 1999, he gave his last lecture on evidence‐based medicine in Krakow and retired from clinical practice. He returned to Canada to live with his wife and family in a wood cabin beside a lake and set up the Trout Research and Education Center (Smith 2015).

The application of evidence‐based dentistry to orthodontics

One method of achieving an evidence‐based approach in dentistry and its advanced specialty programs is to carry out a systematic review of all RCTs from which a quantitative analysis of the available data can be statistically included into a meta‐analysis. This approach was developed in medicine, with the benefit of patients and doctors making informed decisions on the most effective treatment intervention. The basis of a systematic review is that it provides a method of identifying all the available literature on a topic and synthesizing it into an easily accessible knowledge base. The clinician practicing in the twenty‐first century has the computer literacy to access electronic data bases to make informative choices and decisions. As this approach became accepted in dentistry, leaders in the field developed a Cochrane Oral Health Group.

The Cochrane Oral Health Group/ Collaboration

The Cochrane Collaboration is made up of over 50 review groups, of which the Cochrane Oral Health Group (COHG) is one (Shaw 2011). Originally, the COHG was established in 1994 in the United States by Alexia Antczak Bouckoms, based at Harvard University in Boston Massachusetts. In 1996, the editorial base of the COHG (COHG 2017) was relocated to the School of Dentistry, University of Manchester, in England, with Professors Bill Shaw and Helen Worthington as the coordinating editors (Shaw 2011). The COHG is part of the Cochrane Collaboration based in Oxford, England and the University of Dundee in Scotland, directed by Professor Jan Clarkson, and comprises an international network of researchers involved in producing and disseminating systematic reviews of controlled RCTs in the field of oral health. Searching for trials to include in a systematic reviews is a complex process; in order to avoid bias in the results of the review, it is important to include as many relevant trials as possible (see Chapter 3 of this text). The search process relies on initially defining the question, and this has been described in detail in Chapter 2. Finding the best available evidence from sources of published and unpublished studies requires a standardized systematic approach to avoid the different types of recognized bias (Eggar et al. 2001). The quality of data retrieved from a careful, systematic, and standardized review of the scientific literature may be quantitative and/or qualitative in nature (Glasziou et al. 2001). Therefore, discrete steps to find the relevant studies are required in searching computer databases to retrieve a body of literature that then requires careful selection and appraisal.

Evidence‐based dentistry in education: Commission on Dental Accreditation guidelines

Dentistry did not adopt this revolutionary concept in guiding clinical practice and the education of dental students and residents in the advanced specialty programs until the mid‐1990s. To a certain extent, it was forced on the profession by several events that occurred in 1995 owing to the publication of Dental Practice Parameters for Oral Health (McNeil et al. 1995). The American Dental Association practice parameters stressed the need to develop and implement aids to assist in clinical decision making, which stated the need for:

condition‐based parameters, not procedure‐based;

integrated oral health care in an interdisciplinary approach;

parameters to aid clinical decision making;

process of care to be emphasized as well as the outcome;

balancing patient needs with scientific soundness.

In the same year, the Institute of Medicine report (Field 1995) was published on the future of dental education. This had 22 recommendations, which among others emphasized the need to implement:

evidence‐based care;

patient‐centered treatment;

elimination of unnecessary/ineffective treatment interventions;

scientific evidence, outcome research, and formal consensus processes in clinical practice guidelines;

research to evaluate outcomes of alternative treatments.