Evidence based orthodontics

www.indiandentalacademy.comwww.indiandentalacademy.com

Fasten your seatFasten your seat
belts for thebelts for the
bumpy ride tobumpy ride to
evidence basedevidence based
practice.practice.

Never discuss divergentNever discuss divergent
views concerning religionviews concerning religion
and politics with friends,and politics with friends,
you could lose a friend andyou could lose a friend and
create an enemy.create an enemy.

Generally, an article published in aGenerally, an article published in a
scientific journal- reporting resultsscientific journal- reporting results
of a clinical trial- is considered asof a clinical trial- is considered as
evidence.evidence.
EVIDENCEEVIDENCE

EVIDENCE BASED DENTISTRYEVIDENCE BASED DENTISTRY
 Webster’s dictionary:Webster’s dictionary: judicious asjudicious as
exercising sound judgment.exercising sound judgment.
 DefinedDefined : “ a conscientious explicit ,: “ a conscientious explicit ,
and judicious use of current bestand judicious use of current best
evidence in conjunction with clinicalevidence in conjunction with clinical
experience to make decisions regardingexperience to make decisions regarding
patient care.”patient care.”
 In other words, it is using evidence toIn other words, it is using evidence to
base one’s therapeutic decision –base one’s therapeutic decision –
making, rather than whim, instinct , ormaking, rather than whim, instinct , or
hearsay.hearsay.

 ADAADA: “ an approach to oral health care: “ an approach to oral health care
that requires the judicious integrationthat requires the judicious integration
of systematic assessments of clinicallyof systematic assessments of clinically
relevant scientific evidence , relating torelevant scientific evidence , relating to
patient’s oral and medical conditionpatient’s oral and medical condition
and history, with the dentist’s clinicaland history, with the dentist’s clinical
expertise and patient’s treatmentexpertise and patient’s treatment
needs and preferences.needs and preferences.

 Our literature is oftenOur literature is often
inconclusive, inconsistent orinconclusive, inconsistent or
even contradictory. This leaveseven contradictory. This leaves
clinicians frustrated, confusedclinicians frustrated, confused
and skeptical of all researchand skeptical of all research
 EBO is not a cook book approachEBO is not a cook book approach
to orthodontics.to orthodontics.

An approach to oral health care thatAn approach to oral health care that
requires the judicious integration ofrequires the judicious integration of
systemic assessments of clinicallysystemic assessments of clinically
relevant scientific evidence, relatingrelevant scientific evidence, relating
to the patients oral and medicalto the patients oral and medical
condition and history, with thecondition and history, with the
dentist’s treatment needs anddentist’s treatment needs and
preferencespreferences
EVIDENCE BASEDEVIDENCE BASED
DENTISTRYDENTISTRY

PROCESS INTEGRATESPROCESS INTEGRATES
1.1. Clinical expertiseClinical expertise
2.2. Best research evidenceBest research evidence
3.3. Patient treatment needsPatient treatment needs

HISTORY OF EBDHISTORY OF EBD
 Origin in the middle of 19Origin in the middle of 19 thth
century in Paris,century in Paris,
when young graduates started challengingwhen young graduates started challenging
the validity of clinical decisions based solelythe validity of clinical decisions based solely
upon personal experience.upon personal experience.
 Mc Master University in Canada in 1985 ,Mc Master University in Canada in 1985 ,
introduced some concepts in its curriculum.introduced some concepts in its curriculum.
 American College of Physicians followed.American College of Physicians followed.
 Establishment of Center for Evidence- basedEstablishment of Center for Evidence- based
Medicine in Oxford, UK in 1995.Medicine in Oxford, UK in 1995.
 The litigious nature of society further fueledThe litigious nature of society further fueled
the need for practicing evidence basedthe need for practicing evidence based
health carehealth care www.indiandentalacademy.comwww.indiandentalacademy.com

Faulty arguments against evidenceFaulty arguments against evidence
based decision makingbased decision making
 Dogmatic approachDogmatic approach
 Influence of drug companiesInfluence of drug companies
 Academics Vs clinical researchAcademics Vs clinical research
 ““Galileo ploy”Galileo ploy”

UNTESTEDUNTESTED
HYPOTHESESANDHYPOTHESESAND
THEORIES VsTHEORIES Vs
SCIENCE ANDSCIENCE AND
EVIDENCE – BASEDEVIDENCE – BASED
CARECARE

CONFOUNDINGCONFOUNDING
EFFECTSEFFECTS A goal of sound experimental research andA goal of sound experimental research and
design is the control of confoundingdesign is the control of confounding
factors.factors.
 When factors are not controlled, theWhen factors are not controlled, the
effects of treatment are clouded with theeffects of treatment are clouded with the
outside influence of extrinsic factors andoutside influence of extrinsic factors and
the treatment effects cannot be isolatedthe treatment effects cannot be isolated
and analyzed.and analyzed.
 If the findings of confounded studies areIf the findings of confounded studies are
accepted ,there is a strong possibility thataccepted ,there is a strong possibility that
this will negatively impact patientthis will negatively impact patient
care.i.e.beneficial treatment will becare.i.e.beneficial treatment will be
ignored and useless treatment adopted.ignored and useless treatment adopted.

CONTROLLING GROUPCONTROLLING GROUP

Research does lend itself to the use of a control.Research does lend itself to the use of a control.
nonetheless ,when controls are required andnonetheless ,when controls are required and
used, the liability and validity of a study areused, the liability and validity of a study are
improved. with observational research vis-à-visimproved. with observational research vis-à-vis
experimental research, the group not havingexperimental research, the group not having
treatment is often called the comparison ortreatment is often called the comparison or
matched group rather than the control group.matched group rather than the control group.
Through the use of a control group inThrough the use of a control group in
experimentally designed studies, a researcherexperimentally designed studies, a researcher
can assert with confidence that the treatment orcan assert with confidence that the treatment or
condition introduced is directly responsible for thecondition introduced is directly responsible for the
findings obtained, instead of due to chance orfindings obtained, instead of due to chance or
some other extraneous variable.some other extraneous variable.

HAWTHORNE EFFECTHAWTHORNE EFFECT
 Despite the effectiveness of experimentDespite the effectiveness of experiment
design, potential threats can directlydesign, potential threats can directly
impact validity ,a time management studyimpact validity ,a time management study
in 1930 at western electrics Chicago basedin 1930 at western electrics Chicago based
Hawthorne plant desired to improveHawthorne plant desired to improve
employee morale and particularlyemployee morale and particularly
productivity.productivity.
 Reverse Hawthorne effect- resentment orReverse Hawthorne effect- resentment or
apathy developing in control group whichapathy developing in control group which
does not receive treatment. This producesdoes not receive treatment. This produces
poor behavior or improvement in controlpoor behavior or improvement in control
groups.groups. www.indiandentalacademy.comwww.indiandentalacademy.com

TYPES OF STUDIESTYPES OF STUDIES
STUDIES
EXPERIMENTAL OBSERVATIONAL
RCT COHORT CASE
CONTROL
CASE
REPORT

LEVELS OF EVIDENCELEVELS OF EVIDENCE
To judge the quality of studies a “hierarchy ofTo judge the quality of studies a “hierarchy of
evidence” exists the relative strength ofevidence” exists the relative strength of
various studies.various studies.
The evidence that is most likely to be useful forThe evidence that is most likely to be useful for
making decisions regarding patientmaking decisions regarding patient
management:management:
1.Systematic Review (Meta-analysis)
2.Randomized Controlled Trials (RCTs)
3.Cohort Studies
4.Case-control Studies
5.Cross-sectional Surveys
6.Case Series/ Reportwww.indiandentalacademy.comwww.indiandentalacademy.com

NARRATIVE LITERATURE
SYSTEMATIC REVIEW
QUANTITATIVE
(Meta analysis)
QUALITATIVE

SYSTEMATIC REVIEWSSYSTEMATIC REVIEWS
 Systematic reviews are a synopsis of theSystematic reviews are a synopsis of the
existing evidence on a specific topic.existing evidence on a specific topic.
 Provides means to keep up with numerousProvides means to keep up with numerous
articles published annually in every field.articles published annually in every field.
 Concentrates on a very specific andConcentrates on a very specific and
narrow, clinically relevant question.narrow, clinically relevant question.
 Team of expertsTeam of experts
 Inclusion and exclusion criteria is usedInclusion and exclusion criteria is used
 Bias unlikely to happenBias unlikely to happen

STEPS IN PERFORMINGSTEPS IN PERFORMING
SYSTEMATIC REVIEWSYSTEMATIC REVIEW
 FIRST STEPFIRST STEP : framing an important and: framing an important and
well defined question that is relevant towell defined question that is relevant to
patient care.patient care.
 Framing a question in a proper formatFraming a question in a proper format
and identifies four crucial “ PICO”and identifies four crucial “ PICO”
elements. These elements are:elements. These elements are:
1.1. PPopulation or patient typeopulation or patient type
2.2. IInterventionntervention
3.3. CComparisonomparison
4.4. OOutcomeutcome

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

 THIRD STEP:THIRD STEP: design a searchdesign a search
strategy.strategy.
 Employed to search available studiesEmployed to search available studies
include both electronic databasesinclude both electronic databases
such as MEDLINE, EMBASE, Web ofsuch as MEDLINE, EMBASE, Web of
science and Cochrane, databasesscience and Cochrane, databases
and manual searches.and manual searches.

 FOURTH STEP:FOURTH STEP: involves applicationinvolves application
of the selection criteria identified inof the selection criteria identified in
step Two to the potential studiesstep Two to the potential studies
retrieved from both electronic andretrieved from both electronic and
manual search strategies determinedmanual search strategies determined
in step Three.in step Three.
 This action will result in selection ofThis action will result in selection of
the eligible studies for the reviewthe eligible studies for the review
and appraising these studies.and appraising these studies.

 FIFTH STEP:FIFTH STEP: Performing a statisticalPerforming a statistical
summary of the abstracted data, orsummary of the abstracted data, or
Meta- analysis.Meta- analysis.
 Data from different study designs areData from different study designs are
summarized with the purpose of thesummarized with the purpose of the
followingfollowing six taskssix tasks::
1.1. Deciding whether to combine the data orDeciding whether to combine the data or
defining what to combinedefining what to combine
2.2. Evaluating the statistically heterogeneityEvaluating the statistically heterogeneity
of the dataof the data
3.3. Estimating a common effectEstimating a common effect
4.4. Exploring and explained heterogeneityExploring and explained heterogeneity
5.5. Assessing the potential for biasAssessing the potential for bias
6.6. Presenting the results in the form of aPresenting the results in the form of a
tabletable www.indiandentalacademy.comwww.indiandentalacademy.com

 FINAL STEP:FINAL STEP: INTERPRET THEINTERPRET THE
EVIDENCE TO ANSWER THEEVIDENCE TO ANSWER THE
RESEARCH QUESTIONRESEARCH QUESTION

META ANALYSISMETA ANALYSIS
 It identifies the major varying factorsIt identifies the major varying factors
for their significance, and reportsfor their significance, and reports
that studies match their definedthat studies match their defined
standardization criteriastandardization criteria

RANDOMISED CONTROLRANDOMISED CONTROL
TRIALSTRIALS
 An experimental study on patients with aAn experimental study on patients with a
particular disease or disease –freeparticular disease or disease –free
subjects in which the individuals aresubjects in which the individuals are
randomly assigned to either anrandomly assigned to either an
experimental intervention or a controlexperimental intervention or a control
group to determine the ability of an agentgroup to determine the ability of an agent
or a procedure to diminish symptoms, toor a procedure to diminish symptoms, to
decrease risk of death from disease duringdecrease risk of death from disease during
follow up period.follow up period.
 Provide strongest evidence causation ofProvide strongest evidence causation of
evidence.evidence.

DrawbacksDrawbacks::
 Raise ethical concerns in controlRaise ethical concerns in control
groupsgroups
 Costly and time consuming toCostly and time consuming to
implementimplement
 Because of the strict eligibilityBecause of the strict eligibility
criteria and loss to follow-up, RCTcriteria and loss to follow-up, RCT
sample size requirements are difficultsample size requirements are difficult
to attain and maintain,to attain and maintain,
 Result becomes in limited externalResult becomes in limited external
validity of results for the generalvalidity of results for the general
populationpopulation

COHORT STUDIESCOHORT STUDIES
 An observational study that follows anAn observational study that follows an
exposed cohort compared to anexposed cohort compared to an
unexposed cohort to determine theunexposed cohort to determine the
incidence of given outcome.incidence of given outcome.
 Well designed cohort study providesWell designed cohort study provides
strong support for causationstrong support for causation
 Non concurrent cohort studies areNon concurrent cohort studies are
relatively weaker because they rely onrelatively weaker because they rely on
existing records.existing records.
 Disadvantages : require large sample sizeDisadvantages : require large sample size
 Length of the studies result inLength of the studies result in
misclassification in outcome statusmisclassification in outcome status
 Continuous assessment of the exposureContinuous assessment of the exposure
and outcome results.and outcome results.

CASE CONTROLCASE CONTROL
STUDIESSTUDIES These are observational studies whereThese are observational studies where
in cases with a particular outcome andin cases with a particular outcome and
controls that donot have the samecontrols that donot have the same
outcome are first selected andoutcome are first selected and
exposure assessment is doneexposure assessment is done
retrospectively.retrospectively.
 Quick, relatively inexpensiveQuick, relatively inexpensive
 Appropriate in studying rare diseasesAppropriate in studying rare diseases
 Assessment of multiple risk factors forAssessment of multiple risk factors for
a particular disease within the samea particular disease within the same
studystudy www.indiandentalacademy.comwww.indiandentalacademy.com

CASE REPORT ANDCASE REPORT AND
CASE SERIESCASE SERIES
 Document unusual occurrences ofDocument unusual occurrences of
outcomesoutcomes
 First clues of a new diseases orFirst clues of a new diseases or
adverse effects of exposureadverse effects of exposure
 Case series are an extension of caseCase series are an extension of case
reportsreports

HISTORYHISTORY Early part of 19 century ushered inEarly part of 19 century ushered in
evidence based decision making forevidence based decision making for
health care.health care.
 1920 Geis1920 Geis report- Medical and Dentalreport- Medical and Dental
schools to be scientific in their teaching.schools to be scientific in their teaching.
 Dentistry and Orthodontics have laggedDentistry and Orthodontics have lagged
behind medicine in the quest tobehind medicine in the quest to
incorporate science in to clinical practice.incorporate science in to clinical practice.
 Perhaps, the art in the practice ofPerhaps, the art in the practice of
dentistry has overshadowed the need fordentistry has overshadowed the need for
science.science.

Making sense of EvidenceMaking sense of Evidence
 The evidence gathered is checked forThe evidence gathered is checked for
its scientific validity, and applicabilityits scientific validity, and applicability
in patients.in patients.
 Why article not published inWhy article not published in
prestigious journal ?prestigious journal ?
 The RCT is considered to be ‘deThe RCT is considered to be ‘de
rigueur’ for arriving at a scientificallyrigueur’ for arriving at a scientifically
valid conclusion.valid conclusion.

 Necessary to know the type ofNecessary to know the type of
randomization done, by goingrandomization done, by going
through the methodology of study.through the methodology of study.
 Element of blinding too should beElement of blinding too should be
apparent in the study.apparent in the study.
 Even though the study is determinedEven though the study is determined
to be valid , still may not beto be valid , still may not be
applicable to one’s patient.applicable to one’s patient.
1.1. Different characteristics of patientDifferent characteristics of patient
2.2. Results may be weakResults may be weak
3.3. Statistical analysis may not beStatistical analysis may not be
adequateadequate www.indiandentalacademy.comwww.indiandentalacademy.com

Face mask protraction therapy in earlyFace mask protraction therapy in early
skeletal Class IIIskeletal Class III
AJO DO 2005 128; 299-309AJO DO 2005 128; 299-309
 Does RME enhance the efficiency ofDoes RME enhance the efficiency of
maxillary protraction with face mask inmaxillary protraction with face mask in
developing Class III malocclusion?developing Class III malocclusion?
 Results: Face mask therapy effective inResults: Face mask therapy effective in
early Class III MOearly Class III MO
 The need for palatal expansion in theThe need for palatal expansion in the
absence of a transverse discrepancy or aabsence of a transverse discrepancy or a
skeletal/ dental cross bite is not supported.skeletal/ dental cross bite is not supported.
 Correction due to combined skeletal andCorrection due to combined skeletal and
dental change.dental change.

Critical appraisalCritical appraisal
EBD 2006:7,16-17.EBD 2006:7,16-17.
 First prospective RCT of the subjectFirst prospective RCT of the subject
 Inclusion of control group to quantifyInclusion of control group to quantify
growth before recruiting participants.growth before recruiting participants.
 Results are conclusive.Results are conclusive.
 The skeletal change followingThe skeletal change following
protraction is significant, but has noprotraction is significant, but has no
correlation with expansion.correlation with expansion.

Skeletal and dental changes with fixed slowSkeletal and dental changes with fixed slow
maxillary expansion treatment. Systematicmaxillary expansion treatment. Systematic
reviewreview..
JADA Feb 2005JADA Feb 2005
 Eight studies were selected, eachEight studies were selected, each
lacked a control group, and four alsolacked a control group, and four also
did not have a measurement errordid not have a measurement error
treatment.treatment.
 A control group is necessary to factorA control group is necessary to factor
out normal growth changes in theout normal growth changes in the
dental arch and cranio facial structure.dental arch and cranio facial structure.
 No strong conclusion could be made onNo strong conclusion could be made on
dental and skeletal changes after SME.dental and skeletal changes after SME.www.indiandentalacademy.comwww.indiandentalacademy.com

Meta analysis of immediate changesMeta analysis of immediate changes
with RME treatmentwith RME treatment
JADA Jan 2006JADA Jan 2006
 Results: Of the 31 selected abstracts, 12Results: Of the 31 selected abstracts, 12
were rejected b coz they failed to reportwere rejected b coz they failed to report
immediate changes after the activationimmediate changes after the activation
phase of RME and instead reportedphase of RME and instead reported
changes only after the retention phase.changes only after the retention phase.
 The greatest changes were in theThe greatest changes were in the
maxillary transverse plane in which themaxillary transverse plane in which the
width gained was caused more by dentalwidth gained was caused more by dental
expansion than true skeletal expansion.expansion than true skeletal expansion.
Few vertical and anteroposterior changesFew vertical and anteroposterior changes
were statistically significant, and none waswere statistically significant, and none was
clinically significant.clinically significant.www.indiandentalacademy.comwww.indiandentalacademy.com

A systematic review concerning earlyA systematic review concerning early
orthodontic treatment of unilateralorthodontic treatment of unilateral
posterior cross biteposterior cross bite
Angle Orthod 2003;73:588-596Angle Orthod 2003;73:588-596
The aim of this study was to assess theThe aim of this study was to assess the
orthodontic treatment effects on unilateralorthodontic treatment effects on unilateral
posterior cross bite in primary and earlyposterior cross bite in primary and early
mixed dentition by systematically reviewingmixed dentition by systematically reviewing
the literature. Two RCT’s of early treatment ofthe literature. Two RCT’s of early treatment of
cross bite have been found and these twocross bite have been found and these two
studies support grinding as treatment in thestudies support grinding as treatment in the
primary dentition. There is no scientificprimary dentition. There is no scientific
evidence to show which of the treatmentevidence to show which of the treatment
modalities, grinding, quad helix, expansionmodalities, grinding, quad helix, expansion
plates or RME is most effectiveplates or RME is most effectivewww.indiandentalacademy.comwww.indiandentalacademy.com

Orthodontics and Temporo-mandibularOrthodontics and Temporo-mandibular
Disorders – A meta-analysisDisorders – A meta-analysis
AJO DO 2002;121:438-446AJO DO 2002;121:438-446
Orthodontists are blamed for causing TMD.Orthodontists are blamed for causing TMD.
Epedemiologic studies show that TMDEpedemiologic studies show that TMD
symptoms are most prevalent amongsymptoms are most prevalent among
patients between 15-25 years of age.patients between 15-25 years of age.
Orthodontists may encounter patients whoOrthodontists may encounter patients who
complain about TMD during or aftercomplain about TMD during or after
treatment.treatment.
Does traditional orthodontic treatmentDoes traditional orthodontic treatment
change the prevalence of TMD?change the prevalence of TMD?
No study indicated that traditional applianceNo study indicated that traditional appliance
increased the prevalence of TMD, exceptincreased the prevalence of TMD, except
for mild or transient signsfor mild or transient signswww.indiandentalacademy.comwww.indiandentalacademy.com

The effect of topical fluorides onThe effect of topical fluorides on
decalcification in patients with fixeddecalcification in patients with fixed
orthodontic appliances: A systematic revieworthodontic appliances: A systematic review
AJO DO 2005; 128: 601-606AJO DO 2005; 128: 601-606
Decalcification is a significant problem duringDecalcification is a significant problem during
fixed orthodontic treatment. Topical fluoridesfixed orthodontic treatment. Topical fluorides
can reduce or eliminate the problem, but thecan reduce or eliminate the problem, but the
relative effectiveness of different orrelative effectiveness of different or
combinations of topical fluoride preparations iscombinations of topical fluoride preparations is
unknown.unknown.
Results:Results: The use of topical fluorides in addition toThe use of topical fluorides in addition to
fluoride toothpaste reduced the incidence offluoride toothpaste reduced the incidence of
decalcification in populations with bothdecalcification in populations with both
fluoridated and non fluoridated water supplies.fluoridated and non fluoridated water supplies.
Different preparations and formats appear toDifferent preparations and formats appear to
decrease decalcification but there was nodecrease decalcification but there was no
evidence that any one method was superior.evidence that any one method was superior.www.indiandentalacademy.comwww.indiandentalacademy.com

Incremental versus maximum biteIncremental versus maximum bite
advancement during Twin block therapy:advancement during Twin block therapy:
A randomized controlled clinicalA randomized controlled clinical trialtrial..
AJO-DO 2004;126:583-8AJO-DO 2004;126:583-8
•Experimental patients had 2mm initial bite advancement and
subsequent 2mm advancements at 6 weekly intervals with a Twin
block appliance incorporating advancement screws.
•The aim of this study was to evaluate the effectiveness of
incremental and maximum bite advancement during treatment of
class II div 1 malocclusion with the Twin-block appliance in the
permanent dentition.
•The use of incremental advancement of the twin block did not
confer any advantage in terms of process and outcome of the
treatment.

Outcomes in a 2-phase RCT of earlyOutcomes in a 2-phase RCT of early
class II treatmentclass II treatment
AJO DO 2004;125:657-667AJO DO 2004;125:657-667
This study was a randomized control trial designed to examine the
2 major strategies used to treat class II malocclusion:early
treatment in mixed dentition before adolescence,followed by a
second phase of comprehensive treatment in permanent
dentition;and 1-phase treatment during the adolescent growth
spurt and early permanent dentition.
Results: there was no differences in the findings between the
‘intent to treat’(ITT) sample,who had completed phase 1,and an
‘efficacy analyzable’(EA)sample(n=137),which comprised only
patients who completed phase 2.During phase 2 of the trial,the
advantage created during phase 1 treatment in the 2 early
treatment group was lost,and by the end of fixed appliance
treatment,there was no significant difference between any of the 3
groups for all anteroposterior and vertical skeletal and dental
measures.

CONCLUSIONCONCLUSION
 Currently, researchers and facilitatingCurrently, researchers and facilitating
organizations disseminate best evidence inorganizations disseminate best evidence in
the forms perceived logical for clinicalthe forms perceived logical for clinical
practice .These forms are standard topractice .These forms are standard to
research reporting. Once reported,research reporting. Once reported,
evidence must be read,analyzed,andevidence must be read,analyzed,and
accepted for its statisticalaccepted for its statistical
significance.Then,findings need to besignificance.Then,findings need to be
integrated with other types of evidence tointegrated with other types of evidence to
provide statistically componentprovide statistically component
comparisons and measures of decisioncomparisons and measures of decision
making.making.

REFRENCESREFRENCES
1. Incremental versus maximum bite advancement during twin
block therapy : A randomized controlled clinical trail- Phil
Banks, Jean Wright & Kevin O’Brein (AJODO 2004; 126: 583-8)
2. Outcomes in a 2-phase randomized clinical trail of early Class
II treatment- J.F.Camilla Tulloch, William R. Proffit & Ceib
Phillips (AJODO 2004; 125: 657-67)
3. Essential elements of evidenced- based endodontics: Steps
involved in conducting clinical research- Mahmoud Torabinejad
& Khaled Babjri (JOE 2005; 35: 563-8)
4. The effect of topical fluorides on decalcification in patients with
fixed orthodontic appliances: A systematic review- Barbara L
Chadwick, Jayne Roy, Jeremy Knox & Elizabeth T Treasure
(AJODO 2005; 128: 601-6)
5. Orthodontics & temporomandibular disorder: A meta- analysis-
Myung- Rip Kim, Thomas M Graber & Marlos A Viana (AJODO
2002; 121: 438-46)

6. Making the case for evidence- based orthodontics- Greg J
Huang (AJODO 2004; 125: 405-6)
7. Putting the evidence first- David L Turpin (AJODO 2005; 128:
415)
8. Effect of Herbst treatment on temporomandibular joint
morphology: A systematic literature review- Kurt Popowich,
Brain Nebbe & Paul w Major (AJODO 2003;123: 388-94)
9. Evidence - based versus experience- based views on occlusion
& TMD- Donald J Rinchuse, Daniel J Rinchuse & Sanjivan
Kandasamy(AJODO February 2005,Volume 127,Number 2)
10. Fasten your seat belts for the bumpy ride to evidence-based
practice.Greg J.Huang(AJODO,Volume 127,Number 1)
11. 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)
12. 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)www.indiandentalacademy.comwww.indiandentalacademy.com

14.A Systematic Review Concerning Early Orthodontic Treatment
Of Unilateral Posterior Crossbite-Sofia Petren,Lars
Bondemark,Bjorn Soderfeldt,Med Sc(Angle Orthodontist,Volume
73, Number 5,2003)
15. Face mask protraction therapy in early skeletal class III
malocclusion-Anmol S Kalha(EBD 2006:7.1)
16.Skeletal and dental changes with fixed slow maxillary
expansion treatment-Manuel Lagravere,Paul Major,Carlos Flores-
mir(JADA,Volume-136,February 2005)
17. Meta-analysis of immediate changes with rapid maxillary
expansion treatment-Manuel Lagravere,Giseon Heo,Paul Major,Carlos
Flores Mir(JADA,Vol.137,January 2006)
13.Evidence-Based therapy:An Orthodontic dilemma-
Anthony Gianelly(AJODO,Volume 129,Number 5)

Evidence based orthodontics

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Viewers also liked

Viewers also liked (20)

Similar to Evidence based orthodontics

Similar to Evidence based orthodontics (20)

More from Indian dental academy

More from Indian dental academy (20)

Recently uploaded

Recently uploaded (20)

Evidence based orthodontics