i have not included the search methodology i.e. how to search articles in pubmed, embase etc..

1. False facts are highly injurious
to the progress of science, for
they often endure long but false
views, if supported by some
evidence, do little harm, for
everyone takes a salutary
pleasure in proving their
falseness.
– Charles Robert Darwin

2. Evidence Based Orthodontics
Presented by – Parag S. Deshmukh

3. Contents:
• Introduction
• Definition
• History
• Need for evidence based orthodontics
• Evidence based orthodontic practice
• Advantages and disadvantages
• Clinical implications
• Conclusion
• References

4. Learning objective:
Will learn what is EBO
Will be familiar with EBO search tools and different types of
studies used
Will Understand the previlages of EBO approach
Will know the stages in Evidence Based Practice

5. Orthodontists are challenged to manage
sophisticated patient needs and demands. On
the other hand keeping the advances in
orthodontics and medical dental sciences up
to date, following the current techniques and
relevant literature and applying knowledge to
daily practice is practicioner’s priority.

6. Glossary Relating to EBD:
Best evidence is a term that
refers to information
obtained from randomized
controlled clinical trials,
non-randomized controlled
clinical trials, cohort
studies, case-control
studies, crossover studies,
cross-sectional studies, case
studies or, in the absence of
scientific evidence, the
consensus opinion of
experts in the appropriate
fields of research or clinical
practice.
Case-control study involves
identifying subjects with a
clinical condition (cases)
and subjects free from the
condition (controls), and
investigating if the two
groups have similar or
different exposures to risk
indicator(s) or factor(s)
associated with the disease.
Case-series is a report on a
series of patients with an
outcome of interest. No
control group is involved.

7. Clinical practice guideline
(parameter of care) is a
systematically developed
statement designed to assist
both practitioner and patient
with decisions about
appropriate health care for
specific clinical circumstances.
Clinical protocol is a step-by-
step decision-making tool that
describes how a health
condition is diagnosed and
managed.

8. Randomized controlled clinical
trial is a study in which
participants are randomly (i.e., by
chance) assigned to either an
experimental group or control
group. The experimental group
receives the new intervention and
the control group receives a
placebo or standard intervention.
These groups are followed up for
the outcomes of interest.
Systematic review is a process of
systematically locating, appraising
and synthesizing evidence from
scientific studies in order to obtain
a reliable overview. The aim is to
ensure a review process that is
comprehensive and unbiased.
Findings from systematic reviews
may be used for decision-making
about research and the provision
of health care

9. Controlled clinical trial
is a study that uses the
same design features
of a randomized
controlled clinical trial,
but, for reasons
beyond the control of
the investigators, the
subjects are assigned
using a non-random
process into control or
experimental groups.
Cross-sectional study
is the observation of a
defined population at a
single point in time or
in a specified time
interval. Exposure and
outcome are
determined
simultaneously.
Meta-analysis is a
review that uses
quantitative methods
to combine the
statistical measures
from two or more
studies and generates a
weighted average of
the effect of an
intervention, degree of
association between a
risk factor and a
disease, or accuracy of
a diagnostic test.

10. Includes everything
that is used to
reveal and
determine the truth,
and therefore is
presumed to be
true.
In scientific
research, evidence
is accumulated
through
observations of a
phenomena or
which are created
as experiments in
a laboratory or
other controlled
conditions.
Scientific
evidence usually
goes towards
supporting or
rejecting a
hypothesis.
Evidence based practice

11. What is Evidence Based Dentistry?
• Evidence-based dentistry is the
practice of dentistry that
integrates the best available
evidence with clinical experience
and patient preference in making
clinical decisions.
Sutherland S., J Can Dent Assoc 2001; 67:204-6
• Evidence-based dentistry is an
approach to oral health that
requires the judicious integration
of systematic assessments of
clinically relevant scientific
evidence, relating to the patient’s
oral and medical condition and
history, with the dentist’s clinical
expertise and the patient’s
treatment needs and
preferences.
ADA Policy on Evidence-Based Dentistry

12. “a conscientious, explicit, and judicious use of
current best evidence in conjunction with clinical
experience to make decisions regarding patient care”
- David Sackett

13. Evidence based orthodontic practice is all about -
Doing
the
right
thing
to the
right
patient
in the
right
way
at the
right
time
at the
right
cost
in the
right
place

15. History:
The Cochrane Legacy
Professor Archibald Leman Cochrane
(1909–1988)
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.

16. • Using evidence from the medical
literature to answer questions, direct
clinical action and guide practice was
pioneered at McMaster University,
Ontario, Canada in the 1980’s.

17. • The group was formed to organize medical research information in a systematic way to
facilitate the choices that health professionals, patients, policy makers and others face
in health interventions according to the principles of evidence-based medicine.
• The group conducts systematic reviews of randomized controlled trials of health-care
interventions and diagnostic tests, which it publishes in The Cochrane Library.

18. The Cochrane Oral Health Group
• Part of The Cochrane Collaboration
• Established in the USA in 1994
• Comprises an international network of researchers involved
in producing and disseminating systematic reviews of
controlled RCTs in the field of oral health.
• Publishes summaries of the best quality research available
to help people (patients, carers, clinicians, researchers and
funders) make better informed decisions about oral
healthcare choices.

19. The Graph shows
the progress of the
Oral Health Group
since 1998, in terms
of published
reviews, protocols
and review updates.
There are now 118
published reviews,
61 updates and 78
published protocols
as of the Cochrane
Library
Evidence-Based Care in Context : William Shaw Evidence-Based Orthodontics, First Edition.

20. Need for evidence based orthodontics???
“Simply because we, as health care
professionals, owe it to our patients, to
provide the currently best care available”

21. How does the Evidence based approach differ
from what you already practice???
• Accessing new evidence on a regular basis
• Identification of new risk factors, analysis,
continuous improvement in efficacy of
care
• Patient centered approach

23. Systematic review:
It is a process of systematically locating, appraising and
synthesizing evidence from scientific studies in order to
obtain a reliable overview.
The aim is to ensure a review process that is comprehensive
and unbiased.
Findings from systematic reviews may be used for decision-
making about research and the provision of health care.

24. STEPS IN PERFORMING SYSTEMATIC
REVIEW
• FIRST STEP : Framing an important and well defined
question that is relevant to patient care.
• Framing a question in a proper format and identifies four
crucial “ PICO” elements. These elements are:
• Population or patient type
• Intervention
• Comparison
• Outcome

25. SECOND STEP:
• Determining inclusion and exclusion to select the
eligible studies.
• Subcategory of outcome, exposure, confounder, effect
modifiers, intermediates, type of control as well as
type of study design and other consideration.

26. THIRD STEP:
• Design a search strategy.
• Employed to search available studies include both electronic
databases such as MEDLINE, EMBASE, Web of science,
Cochrane, databases and manual searches.

27. Type I
Resources:
• Resources that give you background and factual information
Examples - Text books, dictionaries, handbooks, drug information
resources
These are the resources that you study to get your basic degrees
Type II
Resources
• Resources related to current and old research
Examples - Journals, Indexes to Journals, Theses and
Dissertations, Conference abstracts
Type III
Resources:
• Resources that summarize Research Information from Type II
resources and give you an analysis, evidence of what works,
directions for patient management, information to compile
guidelines or taking public health decisions

28. FOURTH STEP:
• Involves application of the selection criteria identified in
step Two to the potential studies retrieved from both
electronic and manual search strategies determined in
step Three.
• This action will result in selection of the eligible studies
for the review and appraising these studies.

29. FIFTH STEP:
• Performing a statistical summary of the abstracted data, or
Meta- analysis.
• Data from different study designs are summarized with the
purpose of the following six tasks:
i. Deciding whether to combine the data or defining what to
combine
ii. Evaluating the statistically heterogeneity of the data
iii. Estimating a common effect
iv. Exploring an explained heterogeneity
v. Assessing the potential for bias
vi. Presenting the results in the form of a table

30. FINAL STEP:
• INTERPRET THE EVIDENCE TO ANSWER THE RESEARCH
QUESTION

31. Meta-analytic Procedures (MAPs)
It is a review that uses quantitative methods to
combine the statistical measures from two or more
studies and generates a weighted average of the
effect of an intervention, degree of association
between a risk factor and a disease, or accuracy of a
diagnostic test.

32.  Consequently, the evidence produced by MA can be considered
the strongest possible.
Randomized control trials.
+ = (MAPs)
Randomized control trials.

33. Meta-analyses are often, but not always, important components of a
systematic review procedure.
Meta-analysis has the capacity to contrast results from different
studies and identify patterns among study results, sources of
disagreement among those results, or other interesting relationships
that may come to light in the context of multiple studies.

34. Conducting meta-analyses…
Location
of studies
Quality
assessment
Calculating
effect sizes
Checking
for
publication
bias

35. Calculating effect sizes
Clinical trials commonly present their results as the frequency of some outcome in the
intervention groups and the control group.
These are usually summarized as a ratio of the frequency of the events in the intervention
to that in the control group.
In the past the most common summary measure of effect size was the odds ratio, but
now the risk ratio (relative risk) can be given.
A ratio of 2 implies that the defined outcome happens about twice as often in the
intervention group as in the control group; an odds ratio of 0.5 implies around a 50%
reduction in the defined event in the treated group compared with the controls.
The findings from individual studies can be combined using an appropriate statistical
method.

36. Checking for publication bias:
A key concern is publication bias, as clinical trials that obtain negative findings (that is, no
benefit of treatment) are less likely to be published than those that conclude the treatment
is effective.
To examine a funnel plot.
Display the studies included in the meta analysis in a plot of effect size against sample size
In the absence of publication bias, it assumes that the largest studies will be plotted near the
average, and smaller studies will be spread evenly on both sides of the average, creating a
roughly funnel-shaped distribution. Deviation from this shape can indicate publication bias

38. Presenting the findings:
Forest plots:
 It is a graphical display of estimated results from a number of scientific
studies addressing the same question, along with the overall results.

39. Heterogeneity:
A major concern about meta-analyses is the extent to which they mix
studies that are different in kind.
‘a statistical analysis which combines or integrates the results of
several independent clinical trials considered by the analyst to be
“combinable”
To get a precise answer to a specific question, only studies that exactly
match the question should be included.
Meta-analyses should test for the existence of heterogeneity.

40. Meta-regression
When heterogeneity is detected, it is important to investigate what may have
caused it.
Meta-regression is a technique which allows researchers to explore which types of
patient-specific factors or study design factors contribute to the heterogeneity.
The simplest type of metaregression uses summary data from each trial, such as
the average effect size, average disease severity at baseline, and average length of
follow-up.
It struggles to identify which patient features are related to the size of treatment
effect.

41. Advantages:
• Results can be generalized to a larger population
• The precision and accuracy of estimates can be improved as
more data is used. This, in turn, may increase the statistical
power to detect an effect.
• Inconsistency of results across studies can be quantified and
analyzed.
• Moderators can be included to explain variation between
studies.
• The presence of publication bias can be investigated

42. Disadvantages:
• Over simplifying the results of a research area
• Errors in classifying the studies and estimating effect sizes
• The small number of studies available in certain research
topics
• The low quality and heterogeneous results

43. • Published MAs in medical research are 8418 articles,
• Only 13 orthodontic-related MAs were cited in
Cochrane library for the same period!!
Few Facts…
1966 to 2002

44. RANDOMISED CONTROL TRIALS
• An experimental study on patients with a particular disease or
disease free subjects in which the individuals are randomly
assigned to either an experimental intervention or a control
group to determine the ability of an agent or a procedure to
diminish symptoms, to decrease risk of disease during follow
up period.
• Provide strongest evidence causation of evidence.
• The RCT is often considered the gold standard for a clinical
trial.

45. The first published RCT in medicine appeared in the 1948 paper
entitled "Streptomycin treatment of pulmonary tuberculosis",
which described a Medical Research Council investigation.
One of the authors of that paper was Austin Bradford Hill, who is
credited as having conceived the modern RCT.
As of 2004, more than 150,000 RCTs were in the Cochrane
Library.

46. Classification
By study design:
Parallel group – each
participant is
randomly assigned to
a group, and all the
participants in the
group receive (or do
not receive) an
intervention.
Crossover – over
time, each
participant receives
(or does not receive)
an intervention in a
random sequence.
Cluster – pre-existing
groups of
participants (e.g.,
villages, schools) are
randomly selected to
receive (or not
receive) an
intervention.
Factorial – each participant
is randomly assigned to a
group that receives a
particular combination of
interventions or non-
interventions (e.g., group 1
receives vitamin X and
vitamin Y, group 2 receives
vitamin X and placebo Y,
group 3 receives placebo X
and vitamin Y, and group 4
receives placebo X and
placebo Y).
• An analysis of the 616 RCTs indexed in PubMed during December 2006 found that
78% were parallel-group trials, 16% were crossover, 2% were cluster, and 2% were
factorial.

47. By outcome of interest (efficacy vs. effectiveness)
Explanatory RCTs test efficacy in a
research setting with highly
selected participants and under
highly controlled conditions.
Pragmatic RCTs test effectiveness in
everyday practice with relatively
unselected participants and under
flexible conditions; in this way,
pragmatic RCTs can "inform
decisions about practice."
RCTs can be classified as "explanatory" or "pragmatic.“

48. Superiority trials, in
which one intervention
is hypothesized to be
superior to another in a
statistically significant
way.
Noninferiority trials "to
determine whether a
new treatment is no
worse than a reference
treatment."
Equivalence trials in
which the hypothesis is
that two interventions
are indistinguishable
from each other.
By hypothesis (superiority vs. noninferiority vs. equivalence)
Superiority trials, noninferiority trials and equivalence trials, which differ in methodology
and reporting.

49. Randomization:
Choosing a randomization procedure to generate an unpredictable sequence of
allocations; this may be a simple random assignment of patients to any of the
groups at equal probabilities, it may be "restricted," or may be "adaptive."
Allocation concealment, which refers to the stringent precautions taken to
ensure that the group assignment of patients are not revealed prior to
definitively allocating them to their respective groups.
Non-random "systematic" methods of group assignment, such as alternating
subjects between one group and the other, can cause "limitless contamination
possibilities" and can cause a breach of allocation concealment.

50. Blinding:
An RCT may be blinded, (also called "masked") by "procedures that prevent study
participants, care givers, or outcome assessors from knowing which intervention was
received.“
Sometimes inappropriate or impossible to perform in an RCT.

51. Advantages:
RCTs are considered by most to be the most reliable form of
scientific evidence in that they influences healthcare policy
and practice because RCTs reduce spurious causality and bias.

52. Drawbacks:
• Raise ethical concerns in control groups
• Costly and time consuming to implement
• Because of the strict eligibility criteria and loss to
follow-up, RCT sample size requirements are difficult
to attain and maintain.

53. COHORT STUDIES
An observational study that follows an exposed cohort compared to an unexposed
cohort to determine the incidence of given outcome.
Obtain evidence to try to refute the existence of a suspected association between
cause and effect; failure to refute a hypothesis often strengthens confidence in it.
The study groups follow a group of people who do not have the disease for a
period of time and see who develops the disease.
It is a longitudinal observation of the individual through time

54. • A "prospective cohort" defines the groups before the study is done

55. A “Retrospective cohort", defines the grouping after the data is collected.

56. • Well designed cohort study provides strong support for causation
• Non concurrent cohort studies are relatively weaker because
they rely on existing records.
Disadvantages :
• Require large sample size
• Take a long follow-up time to generate useful data. Length of the
studies result in misclassification in outcome status
• Expensive to conduct.
• Are sensitive to attrition

57. CASE CONTROL STUDIES
An observational epidemiological study of persons with the disease (or another outcome
variable) of interest and a suitable control group of persons without the disease
(comparison group, reference group) [Porta’s dictionary of epidemiology]
These are observational studies where in cases with a particular outcome and controls that
do not have the same outcome are first selected and exposure assessment is done
retrospectively.
Quick, relatively inexpensive
Appropriate in studying rare diseases
Assessment of multiple risk factors for a particular disease within the same study

58. Advantages:
 Quick and cheap.
 Excellent for rare condition.
Disadvantages:
 Potential recall bias.
 Confounding of exposure variable.
 Matching control to cases is challenge.

59. CASE REPORT AND CASE SERIES
• Document unusual occurrences of outcomes
• First clues of a new diseases or adverse effects of exposure
• Case series are an extension of case reports

60. Decision making….
EBDM is the formalized process and structure for
learning these skills with the purpose of closing the
gap between what is known and what is practiced in
order to improve patient care based on informed
decision-making.
Evidence Based Decision Making(EDBM)

61. Clinical decision making will be based on:
• CLINICAL EXPERTISE = Knowledge + Experience
• May be out of
date
• Increasingly
difficult to
keep up with
New ideas and
concepts
• Acquisition of
new
knowledge is
slow and
haphazard
• May be limited
Subject to
personal bias
• May out weigh
knowledge
Drawbacks

62. Evidence based decision making

63. The Need for EBDM
• Forces driving the need to improve the quality of
care include:
Variations in practice,
Slow translation and
assimilation of the
scientific evidence
into practice.
Managing the information
overload, and changing
educational competencies
that require students to
have the skills for lifelong
learning

64. • Convert information needs/problems into clinical questions
so that they can be answered
• Conduct a computerized search with maximum efficiency for
finding the best external evidence with which to answer the
question
• Critically appraise the evidence for its validity and usefulness
(Clinical applicability).
• Apply the results of the appraisal, or evidence, In Clinical
practice.
• Evaluate the process and your performance.
Skills needed to apply the EBDM
Process

66. Surgically facilitated orthodontic treatment: A
systematic review
Eelke J. Hoogeveen, Johan Jansma, and Yijin Ren; April 2014; Vol 145; Issue 4.
• A systematic review was performed to evaluate the evidence supporting that the
corticotomy and dental distraction shorten orthodontic treatment duration in
adolescent and adult patients.
• MATERIAL AND METHODS:
Articles regarding corticotomy -facilitated orthodontics or dental distraction in
healthy adolescent or adult patients without periodontal disease were
considered.
Randomized controlled trials (RCT), controlled clinical trials (CCT), and case
series (CS) with sample sizes of 5 or more patients were eligible for inclusion in
this review.
Studies needed to focus on the velocity of tooth movement or treatment time
reduction, tissue health or complications, or comparisons between different
surgical techniques to be included.
Only full-length articles were considered.

68. • The studies were assessed for eligibility and graded by 2 observers
• A 3-point grading system, as described by the Swedish Council on Technology
Assessment in Health Care and the Centre for Reviews and Disseminations
(York), was used to rate the methodologic quality of the articles

69. • Surgically facilitated orthodontics is characterized by a temporary phase of accelerated
tooth movement; this might effectively shorten the duration of treatment, but careful
treatment planning, early activation of appliances, and short intervals between
checkups are recommended.
• Surgically facilitated orthodontics is not associated with complications such as loss of
tooth vitality, periodontal problems, or severe root resorption.
• However, the level of evidence is limited owing to shortcomings in methodologies and
the small numbers of patients in the studies.
• Due to a lack of comparative data, it is unclear which surgical protocol is preferable
regarding treatment efficiency and safety.

70. Treatment effectiveness of Fränkel function regulator on the
Class III malocclusion: A systematic review and meta-analysis
Xianrui Yang, Chunjie Li, Ding Bai, Naichuan Su, Tian Chen, Yang Xu , Xianglong Han;
August 2014Volume 146, Issue 2, Pages 143–154
Aim:
To assess the effectiveness of the FR-3 in treating patients with Class III
malocclusion in the growth and development period.
Methods:
Medline (via PubMed), Cochrane Central Register of Controlled Trials, Embase,
Chinese Biomedical Literature Database, China National Knowledge Infrastructure,
VIP Database for Chinese Technical Periodicals, Scirus, Lilacs, Scopus, and World
Health Organization International Clinical Trials Registry Platform were searched
electronically. Relevant journals and reference lists of included studies were
manually searched. The quality of the included studies was assessed with the
Newcastle-Ottawa scale. The meta-analysis was carried out using RevMan (version
5.2; Nordic Cochrane Centre, Cochrane Collaboration, Copenhagen, Denmark).

71. Results:
• Seven high-quality cohort studies were included.
• The meta-analysis showed that SNA changes did not differ in the short (mean
difference, 0.43°; 95% CI, −0.52°-1.39°) and long (mean difference, 0.37°; 95%
CI, −0.29°-1.03°) terms. However, SNB changes significantly differed in the
short (mean difference, −1.62°; 95% CI, −2.62° to −0.62°) and long (mean
difference, −1.50°; 95% CI, −2.12° to −0.88°) terms.
• By contrast, MPA changes did not differ in the short term (mean difference,
0.55°; 95% CI, −0.74°-1.84°).
Conclusions:
Clinical evidence suggests that the FR-3 might restrict mandibular growth but not
stimulate forward movement of the maxilla. Further high-quality studies are
necessary to confirm the effectiveness of the FR-3.

72. • The objective of this randomized controlled trial was to investigate the effects of facemask
protraction combined with alternating rapid palatal expansion and constriction (RPE/C) vs rapid
palatal expansion (RPE) alone in the early treatment of maxillary retrusive patients.
Methods:
Patients with a midface deficiency were recruited and randomly allocated into either the control
group (RPE) or the intervention group (RPE/C).
Eligibility criteria =
 Age 7 to 13 years old,
 Class III malocclusion,
 Anterior crossbite,
 ANB less than 0°,
 Wits appraisal less than −2 mm and
 No cleft of lip or palate.
Effect of maxillary protraction with alternating rapid palatal
expansion and constriction vs expansion alone in maxillary retrusive
patients: A single-center, randomized controlled trial
Weitao Liu, Yanheng Zhou, Xuedong Wang, Dawei Liu, Shaonan Zhou; October 2015; Volume 148, Issue 4, Pages
641–651.

73. • The primary outcome was the degree of maxillary forward movement after treatment.
• The secondary outcomes were the changes of the other cephalometric variables after
treatment and the treatment time.
• Simple randomization was carried out using a random number table at the beginning
of the study.
• Envelopes containing the grouping information were used to ensure allocation
concealment from the researchers.
• Blinding was applicable for cephalometric analysis only.
• Hyrax palatal expanders and facemask maxillary protraction were used in all patients.
• Patients in the RPE group were treated with rapid palatal expansion for 1 week.
• Patients in the RPE/C group were treated with RPE/C for 7 weeks.
• The expansion or constriction rate was 1 mm per day.
• Comparison of the pretreatment and posttreatment cephalometric radiographs were
made.
• Independent t tests were used to compare the data between the 2 groups.

74. Results:
• A total of 44 patients were randomized to either the RPE group or the RPE/C group in
a 1:1 ratio.
• One subject in the RPE group was lost to follow-up during the treatment. Per-protocol
analysis was used. All the other 43 patients reached the treatment completion criteria
and were analyzed (RPE group: n = 21; RPE/C group: n = 22).
• The average protraction time was 10.84 months in the RPE group, which was
significantly longer than that in the RPE/C group (9.06 months).
• Maxillary forward movement increased by 3.04 mm in the RPE/C group, which was
significantly greater than that in the RPE group (2.11 mm).
• The counterclockwise rotation of the palatal plane was 1.73° in the RPE/C group,
which was significantly greater than that in the RPE group (0.83°).
• The degree of mandibular downward and backward rotation was significantly smaller
in the RPE/C group (P <0.05).
• No serious harm was observed during treatment and research.

75. • A survey consisting of 35 questions pertaining to the use of
scientific evidence in orthodontics was sent to 4771
members of the American Association of Orthodontists in
the United States.
• Each respondent’s age, attainment of a master’s degree,
and whether he or she was currently involved with teaching
were ascertained. To minimize bias, the survey questions
were phrased as an examination of the use of scientific
literature in orthodontics.
Asha Madhavji et al (Am J Orthod Dentofacial Orthop 2011;140:309-16)
Attitudes, awareness, and barriers toward
evidence-based practice in orthodontics

76. Results:
A total of 1517 surveys were received.
• Most respondents had positive attitudes toward, but a poor
understanding of, evidence-based practice.
• Younger orthodontists were more aware, had a greater understanding,
and perceived more barriers than did older orthodontists.
• Orthodontists involved in teaching were more aware, had a greater
understanding, and reported fewer barriers than those not involved
with teaching.
• Those with master’s degrees had a greater understanding of evidence-
based practice than those without degrees.

77. Differing view..
• PCSO ( Seattle Washington) member wrote at the
end of the survey that “evidence-based research
and treatment modalities are a joke in
orthodontics.” Well, that may be true, but the joke
is really on us.
• Orthodontics is dentistry’s first specialty, and yet
we have poor scientific support for many of our
treatments.
Making the case for evidence-based orthodontics, Greg J. Huang AJODO:2004:11.018

78. • A common criticism is that the findings of clinical
trials are not relevant to patients in private
practice, because the operators in trials are
working to such tight protocols that their
treatment bears no resemblance to the real world.
The excuse…

79. Dr. David L. Turpin
Editor Emeritus, Former editor in chief AJODO
“Every time I hear this statement, I nod my head and
say that is exactly why an evidence-based approach
was developed—to systematically evaluate
information from many studies to determine what
seems to be the best approach, treatment, or
intervention.”
In the land of no evidence, is the salesman king? AJO-DO September 2010

80. Take home message
Up till date, the American Association of Orthodontists has been very careful to state that
an evidence-based approach does not set a standard of care, and that the treatment for
each patient should be based on a combination of the doctor’s clinical expertise, the
patient’s needs and preferences, and the evidence.

81. It's not necessarily the amount of time you
spend at practice that counts; it's what you
put into the practice, which will be best
done bye doing Evidence Based Practice
- Eric londros.

82. REFRENCES
1. Making the case for evidence- based orthodontics- Greg J Huang (AJODO 2004; 125:
405-6)
2. Putting the evidence first- David L Turpin (AJODO 2005; 128: 415)
3. Fasten your seat belts for the bumpy ride to evidence-based practice. Greg
J.Huang(AJODO,Volume 127,Number 1)
4. Understanding science and evidence-based decision making in orthodontics-Donald J
Rinchuse,Emily M.Sweitzer,Daniel J.Rinchuse,Dara L.Rinchuse,AJODO,Volume
127,Number 5)
5. Model of Evidence-Based Dental Decision Making, Janet Baeuer, Sue Spackman,
Francesco Chiappelli, Paolo Prolo (Journal of Evidence-Based Dental Practice
2005;5:189-97)
6. Evidence-Based therapy: An Orthodontic dilemma- Anthony Gianelly (AJODO, Volume
129,Number 5)
7. Evidence-Based Care in Context : William Shaw

83. Thank You