Evidencebased Decisions

Evidence-based dentistry can be defined as: 'the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients'.1 The 'gold standard' is strong evidence from at least one published systematic review of multiple well-designed randomised controlled trials. Meta-analysis is a form of systematic review looking at all the relevant literature whether good, bad or indifferent and producing a single estimate of the clinical effectiveness. The advantage of meta-analysis is that it summarises the available evidence and because of its systematic nature it can be appraised rapidly and applied to patient care.2

There are various levels of evidence beneath the 'gold standard', of which the weakest is anecdotal evidence. In the field of orthodontics there are few well-designed randomised controlled trials which lend themselves to a systematic review. Currently there are two such reviews, namely the change of intercanine width following orthodontic treatment and the treatment of posterior crossbites.3,4

Recently, media attention has focused on views made by a small number of orthodontists and general dental practitioners on the adverse effects of conventional orthodontic treatment. Much of this has centred on the role of extracting teeth as part of orthodontic therapy to align teeth, retract protrusive incisors and to camouflage dentally any skeletal disharmonies between the mandible and the maxillae.

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