This document discusses evidence-based dentistry and randomized controlled trials (RCTs) in orthodontics. It defines evidence-based dentistry as integrating systematic assessments of scientific evidence with clinical expertise and patient preferences. RCTs are described as the gold standard for testing hypotheses as they minimize bias through randomization and blinding. However, RCTs can be challenging to conduct in orthodontics due to long treatment times and variability between patients. Recommendations for improving RCT quality include clearly defining the research question, proper randomization, sufficient sample sizes, and using valid and reliable methods.
This presentation is all about restoration of endodontically treated teeth, prefabricated post and core, cast post and core, direct and indirect technique.
Gingival Index comes under the chapter of Dental Indices. Gingival Index is used to determine the severity of Gingivits/Gingival Inflammation in a patient.
Oral Health Assessment Form, CPI, DMFT
Copyright by Department of Preventive & Community Dentistry
University of Dental Medicine, Yangon
Feel free to request to take it down this slide if you are copyright owner.
Caries risk assessment and management in infant, children and adolescent
Introduction
Definition
Changing Paradigms for Dealing with Dental Caries
Advantages
Caries Balance/Imbalance
Risk Indicators
Caries Risk Assessment Methods
Caries Questionnaire in combination with Clinical Observations
AAPD's Caries-risk Assessment Form
The Cariogram Model
Caries Assessment and Risk Evaluation (CARE) test
Caries management by risk assessment (CAMBRA)
Traffic Light Matrix (TLM).
Caries management protocol for infants and children
Conclusion
References
DEAN’S FLUOROSIS INDEX 1943 (PUBLIC HEALTH DENTISTRY)Jeban Sahu
INTRODUCTION
INDEX:“A NUMERICAL VALUE DESCRIBING THE RELATIVE STATUS OF A POPULATION ON A GRADUATED SCALE WITH DEFINITE UPPER AND LOWER LIMITS, WHICH IS DESIGNED TO PERMIT AND FACILITATE COMPARISION WITH OTHER POPULATIONS CLASSIFIED BY THE SAME CRITERIA AND METHODS.”
-RUSSELL A.L.
INDICES USED TO MEASURE FLUOROSIS
DEAN’S FLUOROSIS INDEX
Introduced by TRENDLEY H. DEAN in 1934.
Devised an index for assessing the presence and severity of mottled enamel.
It is also known as ‘DEAN’S CLASSIFICATION SYSTEM FOR DENTAL FLUOROSIS.’
DEAN’S FLUOROSIS INDEX- Modified Criteria (1942)
SCORING CRITERIA
COMMUNITY FLUOROSIS INDEX (CFI)
SUMMARY
This presentation is all about restoration of endodontically treated teeth, prefabricated post and core, cast post and core, direct and indirect technique.
Gingival Index comes under the chapter of Dental Indices. Gingival Index is used to determine the severity of Gingivits/Gingival Inflammation in a patient.
Oral Health Assessment Form, CPI, DMFT
Copyright by Department of Preventive & Community Dentistry
University of Dental Medicine, Yangon
Feel free to request to take it down this slide if you are copyright owner.
Caries risk assessment and management in infant, children and adolescent
Introduction
Definition
Changing Paradigms for Dealing with Dental Caries
Advantages
Caries Balance/Imbalance
Risk Indicators
Caries Risk Assessment Methods
Caries Questionnaire in combination with Clinical Observations
AAPD's Caries-risk Assessment Form
The Cariogram Model
Caries Assessment and Risk Evaluation (CARE) test
Caries management by risk assessment (CAMBRA)
Traffic Light Matrix (TLM).
Caries management protocol for infants and children
Conclusion
References
DEAN’S FLUOROSIS INDEX 1943 (PUBLIC HEALTH DENTISTRY)Jeban Sahu
INTRODUCTION
INDEX:“A NUMERICAL VALUE DESCRIBING THE RELATIVE STATUS OF A POPULATION ON A GRADUATED SCALE WITH DEFINITE UPPER AND LOWER LIMITS, WHICH IS DESIGNED TO PERMIT AND FACILITATE COMPARISION WITH OTHER POPULATIONS CLASSIFIED BY THE SAME CRITERIA AND METHODS.”
-RUSSELL A.L.
INDICES USED TO MEASURE FLUOROSIS
DEAN’S FLUOROSIS INDEX
Introduced by TRENDLEY H. DEAN in 1934.
Devised an index for assessing the presence and severity of mottled enamel.
It is also known as ‘DEAN’S CLASSIFICATION SYSTEM FOR DENTAL FLUOROSIS.’
DEAN’S FLUOROSIS INDEX- Modified Criteria (1942)
SCORING CRITERIA
COMMUNITY FLUOROSIS INDEX (CFI)
SUMMARY
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Module 2: Evidence-Based Dental Public HealthKelley Minars
The updated version of this tutorial is available here: http://www.slideshare.net/uthsclib/module-2-evidencebased-dental-public-health-1724938
Module 2 of the Oral Health Tutorial, a production of UT HSC Libraries.
This module focuses on evidence-based dental health. View this tutorial to learn how to define evidence-based dental public health, learn effective retrieval strategy, be able to critique the literature and apply it to public health dental practice.
This tutorial is copyright Lara Sapp and Julie Gaines. Uploaded with permission.
Evidence based dentistry/certified fixed orthodontic courses by Indian dental...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Evidence based dentistry strategies for new diagnostic and treatment methodol...devicharan11
If you think that you are facing difficulties covering your course on oral pathology, then it is high time to opt for lectures offered by Professor Dr. Devi Charan Shetty at ITS Dental College. He can help you understand the toughest concepts with his interactive approach.
Slow maxillary expansion /certified fixed orthodontic courses by Indian dent...Indian dental academy
Description :
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
A Power Point Presentation of 10 Selected Jokes with 10 Reflections on the Lessons one can learn from the jokes. Can be used as a motivational English Lesson.
Jan Hrabal: Evaluation of medical information quality #bcs2015KISK FF MU
Talk given at the BOBCATSSS 2015 conference - http://www.bobcatsss2015.com/.
The paper deals with the concept of quality of health-related information in the internet environment. It brings definitions of indicators of medical information quality, which are set into the methodics for evaluation of medical information quality on Czech websites. The methodics is divided in two parts: one for non-expert sources in common online environment designed for laymen and one extended version designed for experts, which includes also criteria for evaluation of research papers and reviews.
This ppt will help dentists in taking Evidence Based decision in daily practice and will also help researchers to categorized result of research on the basis of hierarchy of Evidence Based Dentistry
Elaboración de recomendaciones en GPC. Sistema GRADEGuíaSalud
Presentación realizada por Nicola Magrini, Director del Centro de evaluación de efectividad de cuidados en salud del Sistema Nacional de Salud de Italia, sobre el uso del Sistema GRADE para la elaboración de guías de práctica clínica. Presentación realizada en la Jornada Cienfífica de GuíaSalud 2011 "Avances en el desarrollo de Guías de Práctica Clínica".
Portal GuíaSalud http://www.guiasalud.es
Evidence based decision making in periodonticsHardi Gandhi
INTRODUCTION TO EVIDENCE BASED DENTISTRY
EVIDENCE BASED PERIODONTOLOGY
NEED, PRINCIPLES, GOALS AND ADVANTAGES OF EBDM
SKILLS NEEDED FOR EBDM
ASSESING THE EVIDENCE
INCORPORATING INTO THE PRACTICE
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
4. Evidence-based Dentistry
ADA Definition - an approach to oral health care 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 preference
6. Why is evidence-based dentistry
important?
To improve quality of health-care delivery
7. Why is evidence-based dentistry
important?
To improve quality of health-care delivery
By incorporating effective practices
8. Why is evidence-based dentistry
important?
To improve quality of health-care delivery
By incorporating effective practices
While eliminating those that are ineffective or inappropriate
10. The five steps of evidence-based
dentistry practice
1. Developing a clear, clinically focused
question
11. The five steps of evidence-based
dentistry practice
1. Developing a clear, clinically focused
question
2. Identifying, summarizing, and
synthesizing all relevant studies that
directly answer the formulated question
12. The five steps of evidence-based
dentistry practice
1. Developing a clear, clinically focused
question
2. Identifying, summarizing, and
synthesizing all relevant studies that
directly answer the formulated question
3. Appraising evidence in terms of validity
and applicability
13. The five steps of evidence-based
dentistry practice
1. Developing a clear, clinically focused
question
2. Identifying, summarizing, and
synthesizing all relevant studies that
directly answer the formulated question
3. Appraising evidence in terms of validity
and applicability
4. Combining research evidence with
clinical expertise and patients
characteristics
14. The five steps of evidence-based
dentistry practice
1. Developing a clear, clinically focused
question
2. Identifying, summarizing, and
synthesizing all relevant studies that
directly answer the formulated question
3. Appraising evidence in terms of validity
and applicability
4. Combining research evidence with
clinical expertise and patients
characteristics
5. Assessing the successful
implementation of previous steps
15.
16. Level Evidence
1++ High-quality meta-analyses, systematic reviews of RCTs, or RCTs with a very low risk of bias
1+ Well-conducted meta-analyses, systematic reviews of RCTs, or RCTs with a low risk of bias
1- Meta-analyses, systematic reviews or RCTs, or RCTs with a high risk of bias
2++
High-quality systematic reviews of case-control or cohort studies or high-quality case-control or
cohort studies with a very low risk of confounding, bias, or chance and a high probability that
the relationship is causal
2+
Well-conducted case-control or cohort studies with a low risk of confounding, bias, or chance
and a moderate probability that the relationship is causal
2-
Case-control or cohort studies with a high risk of confounding, bias, or chance and a significant
risk that the relationship is not causal
3 Non-analytic studies, e.g., case reports, case series
4 Expert opinion
Scottish Intercollegiate Guidelines Network (SIGN)
Revised grading system for recommendations in
evidence-based guidelines
17. Level Evidence
1++ High-quality meta-analyses, systematic reviews of RCTs, or RCTs with a very low risk of bias
1+ Well-conducted meta-analyses, systematic reviews of RCTs, or RCTs with a low risk of bias
1- Meta-analyses, systematic reviews or RCTs, or RCTs with a high risk of bias
2++
High-quality systematic reviews of case-control or cohort studies or high-quality case-control or
cohort studies with a very low risk of confounding, bias, or chance and a high probability that
the relationship is causal
2+
Well-conducted case-control or cohort studies with a low risk of confounding, bias, or chance
and a moderate probability that the relationship is causal
2-
Case-control or cohort studies with a high risk of confounding, bias, or chance and a significant
risk that the relationship is not causal
3 Non-analytic studies, e.g., case reports, case series
4 Expert opinion
Scottish Intercollegiate Guidelines Network (SIGN)
Revised grading system for recommendations in
evidence-based guidelines
18. Level Evidence
1++ High-quality meta-analyses, systematic reviews of RCTs, or RCTs with a very low risk of bias
1+ Well-conducted meta-analyses, systematic reviews of RCTs, or RCTs with a low risk of bias
1- Meta-analyses, systematic reviews or RCTs, or RCTs with a high risk of bias
2++
High-quality systematic reviews of case-control or cohort studies or high-quality case-control or
cohort studies with a very low risk of confounding, bias, or chance and a high probability that
the relationship is causal
2+
Well-conducted case-control or cohort studies with a low risk of confounding, bias, or chance
and a moderate probability that the relationship is causal
2-
Case-control or cohort studies with a high risk of confounding, bias, or chance and a significant
risk that the relationship is not causal
3 Non-analytic studies, e.g., case reports, case series
4 Expert opinion
Scottish Intercollegiate Guidelines Network (SIGN)
Revised grading system for recommendations in
evidence-based guidelines
19. Level Evidence
1++ High-quality meta-analyses, systematic reviews of RCTs, or RCTs with a very low risk of bias
1+ Well-conducted meta-analyses, systematic reviews of RCTs, or RCTs with a low risk of bias
1- Meta-analyses, systematic reviews or RCTs, or RCTs with a high risk of bias
2++
High-quality systematic reviews of case-control or cohort studies or high-quality case-control or
cohort studies with a very low risk of confounding, bias, or chance and a high probability that
the relationship is causal
2+
Well-conducted case-control or cohort studies with a low risk of confounding, bias, or chance
and a moderate probability that the relationship is causal
2-
Case-control or cohort studies with a high risk of confounding, bias, or chance and a significant
risk that the relationship is not causal
3 Non-analytic studies, e.g., case reports, case series
4 Expert opinion
Scottish Intercollegiate Guidelines Network (SIGN)
Revised grading system for recommendations in
evidence-based guidelines
22. Features of RCT’s
Rarticipants are randomly assigned
Comparative - Treatment group compared with
control group with similar characteristics
23. Features of RCT’s
Rarticipants are randomly assigned
Comparative - Treatment group compared with
control group with similar characteristics
Allocation concealment
24. Features of RCT’s
Rarticipants are randomly assigned
Comparative - Treatment group compared with
control group with similar characteristics
Allocation concealment
Blinding
25. Features of RCT’s
Rarticipants are randomly assigned
Comparative - Treatment group compared with
control group with similar characteristics
Allocation concealment
Blinding
Is the most scientifically rigorous method of
hypothesis testing gold standard
26. Bias in RCT’s
Type of bias Prevention / elimination of bias
Selection bias Proper randomization
Performance bias
Blinding of participants and people
administering treatment
Detection bias Blinding of outcome assessors/analyzers
Attrition bias Intention-to-treat analysis
Publication bias Trial registration, no selective reporting
27. Bias in RCT’s
Type of bias Prevention / elimination of bias
Selection bias Proper randomization
Performance bias
Blinding of participants and people
administering treatment
Detection bias Blinding of outcome assessors/analyzers
Attrition bias Intention-to-treat analysis
Publication bias Trial registration, no selective reporting
28. Bias in RCT’s
Type of bias Prevention / elimination of bias
Selection bias Proper randomization
Performance bias
Blinding of participants and people
administering treatment
Detection bias Blinding of outcome assessors/analyzers
Attrition bias Intention-to-treat analysis
Publication bias Trial registration, no selective reporting
29. Bias in RCT’s
Type of bias Prevention / elimination of bias
Selection bias Proper randomization
Performance bias
Blinding of participants and people
administering treatment
Detection bias Blinding of outcome assessors/analyzers
Attrition bias Intention-to-treat analysis
Publication bias Trial registration, no selective reporting
30. Bias in RCT’s
Type of bias Prevention / elimination of bias
Selection bias Proper randomization
Performance bias
Blinding of participants and people
administering treatment
Detection bias Blinding of outcome assessors/analyzers
Attrition bias Intention-to-treat analysis
Publication bias Trial registration, no selective reporting
31. Bias in RCT’s
Type of bias Prevention / elimination of bias
Selection bias Proper randomization
Performance bias
Blinding of participants and people
administering treatment
Detection bias Blinding of outcome assessors/analyzers
Attrition bias Intention-to-treat analysis
Publication bias Trial registration, no selective reporting
34. Systematic Review
A research article that,
o Identify relevant studies
o Appraises their quality
35. Systematic Review
A research article that,
o Identify relevant studies
o Appraises their quality
o Summarizes their results
using scientific methodology
37. Meta-analysis
The use of statistical techniques to combine the results of studies
addressing the same question into a summary measure
Systematic
Review Systematic ReviewMeta-Analysis
38. Meta-analysis
The use of statistical techniques to combine the results of studies
addressing the same question into a summary measure
Increases the size of the `overall sample’ enhances statistical power
Systematic
Review Systematic ReviewMeta-Analysis
39. Meta-analysis
The use of statistical techniques to combine the results of studies
addressing the same question into a summary measure
Increases the size of the `overall sample’ enhances statistical power
Quantitative synthesis only when the studies to be combined are
clinically and statistically homogeneous
Systematic
Review Systematic ReviewMeta-Analysis
40. Meta-analysis
The use of statistical techniques to combine the results of studies
addressing the same question into a summary measure
Increases the size of the `overall sample’ enhances statistical power
Quantitative synthesis only when the studies to be combined are
clinically and statistically homogeneous
Systematic Review ≠ Meta-Analysis
Systematic
Review Systematic ReviewMeta-Analysis
49. What are Cochrane reviews?
The Cochrane Collaboration is an international
organization that aims to organize medical research
information in a systematic way promoting the
accessibility of systematic reviews of the effects of health-
care interventions
50. What are Cochrane reviews?
The Cochrane Collaboration is an international
organization that aims to organize medical research
information in a systematic way promoting the
accessibility of systematic reviews of the effects of health-
care interventions
Systematic reviews of primary research in human health
care and health policy, undertaken by members of The
Cochrane Collaboration adhering to a specific
methodology
53. This article is the result of a debate at the European Journal of
Orthodontics Open Session in 2013 in Reykjavik, Iceland
54. Part I: RCTs are for orthodontics
Lars Bondemark
55. Part I: RCTs are for orthodontics
The first published RCT 1948 ‘Streptomycin treatment
of pulmonary tuberculosis’
Lars Bondemark
56. Part I: RCTs are for orthodontics
The first published RCT 1948 ‘Streptomycin treatment
of pulmonary tuberculosis’
Orthodontic RCTs per year between 1990 and 2013
Lars Bondemark
58. Randomization
Ensures both known and unknown
determinants are evenly distributed
among the different study groups
59. Randomization
Ensures both known and unknown
determinants are evenly distributed
among the different study groups
Minimizes bias in assessment of
differences in effects between two
or more treatment alternatives
Confounding factors equally
distributed
60. Randomization
Ensures both known and unknown
determinants are evenly distributed
among the different study groups
Minimizes bias in assessment of
differences in effects between two
or more treatment alternatives
Confounding factors equally
distributed
Idea with randomization is that the
treatment will be the only thing that
will constitute a significant
difference between the patient
groups
61. Randomization
Ensures both known and unknown
determinants are evenly distributed
among the different study groups
Minimizes bias in assessment of
differences in effects between two
or more treatment alternatives
Confounding factors equally
distributed
Idea with randomization is that the
treatment will be the only thing that
will constitute a significant
difference between the patient
groups
Best if done by an independent
person
65. Recommendations
Create a relevant question use PICO
• P - population
• I - intervention
• C - control
• O - outcome
66. Recommendations
Create a relevant question use PICO
• P - population
• I - intervention
• C - control
• O - outcome
e.g. Is Quad-helix treatment (intervention) more cost-effective (outcome) than platal
expansion (control) in 8–10 year-old patients with unilateral posterior crossbite
(population)?
67. Recommendations
Create a relevant question use PICO
• P - population
• I - intervention
• C - control
• O - outcome
e.g. Is Quad-helix treatment (intervention) more cost-effective (outcome) than platal
expansion (control) in 8–10 year-old patients with unilateral posterior crossbite
(population)?
Use proper randomization
68. Recommendations
Create a relevant question use PICO
• P - population
• I - intervention
• C - control
• O - outcome
e.g. Is Quad-helix treatment (intervention) more cost-effective (outcome) than platal
expansion (control) in 8–10 year-old patients with unilateral posterior crossbite
(population)?
Use proper randomization
Plan and coordinate the trial carefully - have patience since it takes time to run an RCT
69. Recommendations
Create a relevant question use PICO
• P - population
• I - intervention
• C - control
• O - outcome
e.g. Is Quad-helix treatment (intervention) more cost-effective (outcome) than platal
expansion (control) in 8–10 year-old patients with unilateral posterior crossbite
(population)?
Use proper randomization
Plan and coordinate the trial carefully - have patience since it takes time to run an RCT
Have sufficient sample size – if small, greater risk of unknown or confounding factors that
may interfere the outcomes
70. Recommendations
Create a relevant question use PICO
• P - population
• I - intervention
• C - control
• O - outcome
e.g. Is Quad-helix treatment (intervention) more cost-effective (outcome) than platal
expansion (control) in 8–10 year-old patients with unilateral posterior crossbite
(population)?
Use proper randomization
Plan and coordinate the trial carefully - have patience since it takes time to run an RCT
Have sufficient sample size – if small, greater risk of unknown or confounding factors that
may interfere the outcomes
Use valid and reliable methods
71. Recommendations
Create a relevant question use PICO
• P - population
• I - intervention
• C - control
• O - outcome
e.g. Is Quad-helix treatment (intervention) more cost-effective (outcome) than platal
expansion (control) in 8–10 year-old patients with unilateral posterior crossbite
(population)?
Use proper randomization
Plan and coordinate the trial carefully - have patience since it takes time to run an RCT
Have sufficient sample size – if small, greater risk of unknown or confounding factors that
may interfere the outcomes
Use valid and reliable methods
Follow the CONSORT statement
72. Recommendations
Create a relevant question use PICO
• P - population
• I - intervention
• C - control
• O - outcome
e.g. Is Quad-helix treatment (intervention) more cost-effective (outcome) than platal
expansion (control) in 8–10 year-old patients with unilateral posterior crossbite
(population)?
Use proper randomization
Plan and coordinate the trial carefully - have patience since it takes time to run an RCT
Have sufficient sample size – if small, greater risk of unknown or confounding factors that
may interfere the outcomes
Use valid and reliable methods
Follow the CONSORT statement
Use blinding if possible
73. Recommendations
Create a relevant question use PICO
• P - population
• I - intervention
• C - control
• O - outcome
e.g. Is Quad-helix treatment (intervention) more cost-effective (outcome) than platal
expansion (control) in 8–10 year-old patients with unilateral posterior crossbite
(population)?
Use proper randomization
Plan and coordinate the trial carefully - have patience since it takes time to run an RCT
Have sufficient sample size – if small, greater risk of unknown or confounding factors that
may interfere the outcomes
Use valid and reliable methods
Follow the CONSORT statement
Use blinding if possible
Use the Intention-to-treat (ITT)analysis to evaluate the results
76. Part II: RCTs are not for orthodontics
New EBM ideology - RCTs may minimize, but do not eliminate
bias
Sabine Ruf
77. Why RCTs are not ‘working’ for crucial
clinical orthodontic questions?
78. Why RCTs are not ‘working’ for crucial
clinical orthodontic questions?
Primary goal of RCT test whether an intervention works
by comparing it to a control condition
79. Why RCTs are not ‘working’ for crucial
clinical orthodontic questions?
Primary goal of RCT test whether an intervention works
by comparing it to a control condition
o No treatment
o A placebo treatment
o An alternative treatment
80. Why RCTs are not ‘working’ for crucial
clinical orthodontic questions?
Primary goal of RCT test whether an intervention works
by comparing it to a control condition
o No treatment
o A placebo treatment
o An alternative treatment
Orthodontics is a device-driven specialty not a series of
pills that can be administered at random and evaluated
blindly
81. Why RCTs are not ‘working’ for crucial
clinical orthodontic questions?
Primary goal of RCT test whether an intervention works
by comparing it to a control condition
o No treatment
o A placebo treatment
o An alternative treatment
Orthodontics is a device-driven specialty not a series of
pills that can be administered at random and evaluated
blindly
Even ‘invisible’ appliances are visible to the pt & operator
82. Why RCTs are not ‘working’ for crucial
clinical orthodontic questions?
Primary goal of RCT test whether an intervention works
by comparing it to a control condition
o No treatment
o A placebo treatment
o An alternative treatment
Orthodontics is a device-driven specialty not a series of
pills that can be administered at random and evaluated
blindly
Even ‘invisible’ appliances are visible to the pt & operator
Excludes the possibility of orthodontic placebo treatments
at least for the majority of the questions
84. Effect of Informed Consent
RCT by Bergmann et al. in 1994,
shortly before informed consent
became mandatory in France
85. Effect of Informed Consent
RCT by Bergmann et al. in 1994,
shortly before informed consent
became mandatory in France
Aim: Effect of informed consent on
analgesic activity of pain killers
86. Effect of Informed Consent
RCT by Bergmann et al. in 1994,
shortly before informed consent
became mandatory in France
Aim: Effect of informed consent on
analgesic activity of pain killers
49 consecutively hospitalized patients
with mild to moderate cancer pain
87. Effect of Informed Consent
RCT by Bergmann et al. in 1994,
shortly before informed consent
became mandatory in France
Aim: Effect of informed consent on
analgesic activity of pain killers
49 consecutively hospitalized patients
with mild to moderate cancer pain
Uninformed group - 25 received both
treatments without any information
88. Effect of Informed Consent
RCT by Bergmann et al. in 1994,
shortly before informed consent
became mandatory in France
Aim: Effect of informed consent on
analgesic activity of pain killers
49 consecutively hospitalized patients
with mild to moderate cancer pain
Uninformed group - 25 received both
treatments without any information
Informed-consent group - 24 had a
complete information about the trial;
6 refused to participate 18 pt’s
89. Effect of Informed Consent
RCT by Bergmann et al. in 1994,
shortly before informed consent
became mandatory in France
Aim: Effect of informed consent on
analgesic activity of pain killers
49 consecutively hospitalized patients
with mild to moderate cancer pain
Uninformed group - 25 received both
treatments without any information
Informed-consent group - 24 had a
complete information about the trial;
6 refused to participate 18 pt’s
VAS score of pain before and 30, 60,
120 and 180 min after the intake of
naproxen and placebo were
recorded
90. Changes (mm) in VAS pain levels after naproxen or placebo intake in patients
with and without informed consent
91. Changes (mm) in VAS pain levels after naproxen or placebo intake in patients
with and without informed consent
Pain reduces with the drug in the
non-informed group
Pain increases after receiving the
placebo in the non-informed group
92. Changes (mm) in VAS pain levels after naproxen or placebo intake in patients
with and without informed consent
Pain reduces in both the
drug and placebo in the
informed consent group
93. First described in the 1950s by Henry A. Landsberger after experiments conducted at the
Hawthorne works electric company to determine if increasing or decreasing the amount of
light workers received would have an effect on worker productivity
Employee productivity seemed to increase due to the changes, but then decreased at
after the experiment was over
Researchers suggested that productivity increased due to attention from the research team
and not because of changes to the experimental variables
Lansdberger defined the Hawthorne effect as a short-term improvement in performance
caused by observing workers
94. All orthodontic treatment modalities requiring cooperation cannot be
tested reliably using a RCT design, at least not if we are seeking clinically
relevant truth. And that is maybe ‘why RCTs in orthodontics have not
achieved their intended objective
95. Drawbacks of RCT’s
High costs
Ethical problems
Informed consent
Bias problems
Clinicians/patients preference for certain treatment
Recruiting sufficient patients
96. Final Thoughts
Lack of evidence does not necessarily imply lack of effect
Instead, there is need for further relevant evaluations. Clearly,
new well-designed RCTs and non-randomized studies can
achieve important support to reliable evidence in orthodontics