Cover
Foreword
1 Evidence‐Based Orthodontics – Its Evolution and Clinical Application
1. Introduction
2. Archie Cochrane and the development of evidence‐based medicine
3. The influence of an evidenced‐based approach
4. The influence of David Sackett and medical clinical trials
5. The application of evidence‐based dentistry to orthodontics
6. The Cochrane Oral Health Group/ Collaboration
7. Evidence‐based dentistry in education: Commission on Dental Accreditation guidelines
8. Making rational decisions in orthodontic practice
9. The American Dental Association website
10. The future of an evidence‐based approach in orthodontics
11. References
2 Clinical Research Design
1. Introduction
2. The scientific method
3. Research designs
4. Systematic reviews and meta‐analysis
5. Translational research
6. Clinical practice guidelines
7. References
3 Electronic Searching for Clinical Trials Information
1. Introduction
2. Where to search: choosing databases
3. How to search: constructing a search strategy
4. Summary
5. Useful resources
6. References
4 Making Sense of Randomized Clinical Trials and Systematic Reviews
1. How to interpret a randomized controlled trial
2. How to read a systematic review
3. The interpretation of “negative” findings
4. Final comments
5. References
5 Understanding and Improving our Evidence
1. Introduction
2. Maximizing value in clinical trials
3. Orthodontic randomized controlled trials: methodology and reporting
4. Systematic reviews and meta‐analyses for orthodontic interventions
5. Metaepidemiological findings from orthodontics
6. Improving research reporting in orthodontics
7. Core outcomes in orthodontics
8. Integration of evidence into daily practice
9. Collaboration/multicenter research and funding
10. Conclusions
11. References
6 Factors Influencing Facial Shape
1. Introduction
2. Biological basis of facial variation and heritability
3. Environmental influences on facial shape
4. Assessment of normal facial variation
5. Pubertal timing
6. Observing facial growth velocities in two different population groups
7. Determining differences in population groups using a multilevel principal component analysis
8. Multiple comparison tests
9. Conclusions
10. References
Summaries of Selected Systematic Reviews
1. Preface to Summaries
2. Summaries
  1. S1 Curing lights for orthodontic bonding: a systematic review and meta‐analysis
  2. S2 Self‐etch primers and conventional acid‐etch technique for orthodontic bonding: a systematic review and meta‐analysis
  3. S3 Adhesives for bonded molar tubes during fixed brace treatment
  4. S4 Adhesives for fixed orthodontic brackets
  5. S5 Determinants for success rates of temporary anchorage devices in orthodontics: a meta‐analysis (n >50)
  6. S6 The effectiveness of laceback ligatures during initial orthodontic alignment: a systematic review and meta‐analysis
  7. S7 Mini‐implants in orthodontics: a systematic review of the literature
  8. S8 Initial arch wires for tooth alignment during orthodontic treatment with fixed appliances
  9. S9 Initial orthodontic alignment effectiveness with self‐ligating and conventional appliances: a network meta‐analysis in practice
  10. S10 Systematic review of self‐ligating brackets
  11. S11 Impacted and transmigrant mandibular canines incidence, aetiology, and treatment: a systematic review
  12. S12 Effectiveness of early orthopaedic treatment with headgear: a systematic review and meta‐analysis
  13. S13 Early orthodontic treatment for Class II malocclusion reduces the chance of incisal trauma: results of a Cochrane systematic review
  14. S14 Efficacy of molar distalization associated with second and third molar eruption stage
  15. S15 Orthodontic treatment for prominent upper front teeth (Class II malocclusion) in children
  16. S16 Efficacy of orthopedic treatment with protraction facemask on skeletal Class III malocclusion: a systematic review and meta‐analysis
  17. S17 Orthodontic treatment for prominent lower front teeth (Class III malocclusion) in children
  18. S18 Effectiveness of pre‐surgical infant orthopedic treatment for cleft lip and palate patients: a systematic review and meta‐analysis
  19. S19 Prevalence of dental anomalies in nonsyndromic individuals with cleft lip and palate: a systematic review and meta‐analysis
  20. S20 Long‐term effects of presurgical infant orthopedics in patients with cleft lip and palate: a systematic review
  21. S21 Secondary bone grafting for alveolar cleft in children with cleft lip or cleft lip and palate
  22. S22 The effectiveness of non‐surgical maxillary expansion: a meta‐analysis
  23. S23 Orthodontic treatment for posterior crossbites
  24. S24 Long‐term dental and skeletal changes in patients submitted to surgically assisted rapid maxillary expansion: a meta‐analysis
  25. S25 Long‐term dental arch changes after rapid maxillary expansion treatment: a systematic review
  26. S26 Stability of deep‐bite correction: a systematic review
  27. S27 Treatment and stability of Class II Division 2 malocclusion in children and adolescents: a systematic review
  28. S28 Stability of Class II fixed functional appliance therapy – a systematic review and meta‐analysis
  29. S29 Treatment effects of fixed functional appliances in patients with Class II malocclusion: a systematic review and meta‐analysis
  30. S30 Effectiveness of orthodontic treatment with functional appliances on maxillary growth in the short term: a systematic review and meta‐analysis
  31. S31 The effectiveness of the Herbst appliance for patients with Class II malocclusion: a meta‐analysis
  32. S32 Enamel roughness and incidence of caries after interproximal enamel reduction: a systematic review
  33. S33 Prevalence of peg‐shaped maxillary permanent lateral incisors: a meta‐analysis
  34. S34 Craniofacial and upper airway morphology in adult obstructive sleep apnea patients: a systematic review and meta‐analysis of cephalometric studies
  35. S35 Myofunctional therapy to treat obstructive sleep apnea: a systematic review and meta‐analysis
  36. S36 CPAP vs mandibular advancement devices and blood pressure in patients with obstructive sleep apnea: a systematic review and meta‐analysis
  37. S37 Orthodontic and orthopaedic treatment for anterior open bite in children
  38. S38 Stability of treatment for anterior open‐bite malocclusion: a meta‐analysis
  39. S39 Pharmacological interventions for pain relief during orthodontic treatment
  40. S40 Pharmacological management of pain during orthodontic treatment: a meta‐analysis
  41. S41 Factors associated with patient and parent satisfaction after orthodontic treatment: a systematic review
  42. S42 The effects of orthodontic therapy on periodontal health: a systematic review of controlled evidence
  43. S43 Retention procedures for stabilizing tooth position after treatment with orthodontic braces
  44. S44 Performance of clear vacuum‐formed thermoplastic retainers depending on retention protocol: a systematic review
  45. S45 A meta‐analysis of mandibular intercanine width in treatment and postretention
  46. S46 Radiologically determined orthodontically induced external apical root resorption in incisors after non‐surgical orthodontic treatment of Class II division 1 malocclusion: a systematic review
  47. S47 Root resorption of endodontically treated teeth following orthodontic treatment: a meta‐analysis
  48. S48 Radiographic comparison of the extent of orthodontically induced external apical root resorption in vital and root‐filled teeth: a systematic review
  49. S49 Root resorption associated with orthodontic tooth movement: a systematic review
  50. S50 Influence of orthodontic treatment, midline position, buccal corridor and smile arc on smile attractiveness
  51. S51 Systematic review and meta‐analysis of randomized controlled trials evaluating intraoral orthopedic appliances for temporomandibular disorders
  52. S52 The role of mandibular third molars on lower anterior teeth crowding and relapse after orthodontic treatment: a systematic review
  53. S53 Coronectomy vs. total removal for third molar extraction: a systematic review
  54. S54 How long does treatment with fixed appliances last? A systematic review
  55. S55 Surgically facilitated orthodontic treatment: a systematic review
  56. S56 Fluorides for the prevention of early tooth decay (demineralised white lesions) during fixed brace treatment
3. Additional References
  1. Summary 3 Additional References
  2. Summary 7 Additional References
  3. Summary 19 Additional References
  4. Summary 20 Additional References
  5. Summary 23 Additional References
  6. Summary 24 Additional References
  7. Summary 29 Additional Reference
  8. Summary 30 Additional References
  9. Summary 33 Additional References
  10. Summary 36 Additional References
  11. Summary 38 Additional References
  12. Summary 42 Additional References
  13. Summary 43 Additional References
  14. Summary 47 Additional References
  15. Summary 50 Additional References
  16. Summary 52 Additional References
  17. Summary 54 References
  18. Summary 55 Additional References
Systematic Reviews in Orthodontics
1. Accelerated tooth movement
2. Activator
3. Adherence
4. Adhesives and bonding agents
5. Agenesis and anomalies
6. Airway
7. Aligners
8. Alternating rapid maxillary expansion and constriction (ALT RAMEC)
9. Anchorage/temporary anchorage devices (TADs)
10. Anterior crossbite
11. Anterior openbite
12. Antimicrobial agents
13. Appliances
14. Arch width
15. Arch‐wires
16. Auto transplantation
17. Biology of tooth movement
18. Bionator
19. Bisphosphonates
20. Bond strength
21. Botulinum toxin
22. Brackets
23. Bruxism
24. Canine impaction and transmigration
25. Caries
26. CBCT
27. Cephalometry
28. Chin cup
29. Class II
30. Class III
31. Clear aligners
32. Cleft lip and palate
33. Compliance
34. Cone beam computed tomography (CBCT)
35. Continuous positive airway pressure (CPAP)
36. Corticotomy
37. Coronectomy
38. Crossbites (anterior)
39. Crossbites (posterior)
40. Crowding
41. Curing lights
42. Deep bite
43. Demineralization
44. Dental trauma
45. Diagnostic records
46. Digital models
47. Distraction osteogenesis
48. Early treatment
49. Education
50. Elastics
51. Electric toothbrush
52. Enamel
53. Endodontically treated teeth
54. Epidemiology
55. Essix retainer
56. Extraction
57. Extrusion
58. Face mask
59. Fluoride
60. Force levels
61. Frankel function regulator
62. Frenum
63. Functional and orthopedic appliances
64. Genetics
65. Gingival recession
66. Gingival display
67. Growth prediction
68. Habits
69. Headgear
70. Herbst appliance
71. Imaging
72. Impaction
73. Implant site development
74. Interdisciplinary orthodontics
75. Interproximal reduction
76. Intra‐arch width
77. Intraoral scanners
78. Intrusion
79. Invisalign
80. Juvenile idiopathic arthritis
81. Laceback ligatures
82. Lateral incisors
83. Lingual orthodontics
84. Lip bumper
85. Low level laser therapy and pain
86. Low level laser therapy and tooth movement
87. Maxillary expansion
88. Medications affecting tooth movement
89. Mini‐implants and mini‐plates
90. Mixed dentition
91. Molar distalization
92. Mouthguards
93. Myofunctional therapy
94. Nickel hypersensitivity
95. Obstructive sleep apnea
96. Oligodontia
97. Open bite
98. Oral health promotion
99. Orthognathic surgery
100. Osteoarthritis
101. Overlay retainer
102. Pain
103. Peg lateral incisors
104. Patient‐centered outcomes
105. Periodontal health
106. Pharmacological agents
107. Piezocision
108. Posterior crossbite
109. Powered toothbrush
110. Premature loss of deciduous teeth
111. Profile
112. Pulpal health
113. Quality of life
114. Recession
115. Retention and relapse
116. Remineralizing agents
117. Root damage/repair
118. Root resorption
119. Scanners, intraoral
120. Self‐ligating brackets
121. Smile esthetics
122. Soft tissue profile
123. Space maintenance
124. Speech
125. Stability
126. Surgically assisted maxillary expansion
127. Surgery first approach
128. Temporary anchorage devices (TADs)
129. Temporomandibular joint
130. Third molars
131. Transposition of teeth
132. Trauma
133. Treatment time
134. Vacuum formed thermoplastic retainers
135. White spot lesions
Index
End User License Agreement

List of Tables

Chapter 02
1. Table 2.1 Hill’s viewpoints on the aspects of an association to be considered when deciding on causality.
2. Table 2.2 Research designs ordered from least potential for bias (top) to greatest potential for bias (bottom).
Chapter 03
1. Table 3.1 Example of a MeSH tree: orthodontic appliances.
Chapter 04
1. Table 4.1 Forest plot of the amount of distal movement with intraoral appliances versus headgear.
2. Table 4.2 An example forest plot from the temporary anchorage devices review.
3. Table 4.3 An example forest plot from the temporary anchorage devices review with summary data from each study highlighted.
4. Table 4.4 An example forest plot from the temporary anchorage devices review with effect size and 95% confidence intervals for each study highlighted.
5. Table 4.5 An example forest plot from the temporary anchorage devices review graphics dispersed around the line of no effect highlighted.
6. Table 4.6 An example forest plot from the temporary anchorage devices review with effect size and confidence intervals highlighted.
Chapter 05
1. Table 5.1 Intention to treat (ITT) versus per protocol (PP) analysis. The extreme assumption is made here that lost patients failed to comply. Other assumptions during missing data imputations are sensible.
2. Table 5.2 When the answer to the six questions in the table are all “yes” then qualitative differences in treatment effects between subgroups from subgroup analyses are likely.
3. Table 5.3 Forest plot for halogen versus plasma, halogen versus led and halogen versus plasma and LED curing lights.
4. Table 5.4 Compliance with Consolidated Standards of Reporting Trials (CONSORT) subitems within a sample of dental journals.
5. Table 5.5 Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) profile (American College of Chest Physicians, ACCP) table from the systematic review comparing bond failure of brackets bonded with halogen versus plasma curing lights.
Chapter 06
1. Table 6.1 Currently reported phenotype‐genotypes for various facial features for the normal population.
2. Table 6.2 Environmental influences on facial growth and development.
Chapter S1
1. Table S1.1 Risk of bond failure comparing halogen to (A) plasma and (B) light emitting diode (LED) curing lights.
Chapter S2
1. Table S2.1 Comparison of self‐etching primer versus acid etch (A) bracket failure and (B) difference in time.
Chapter S3
1. Table S3.1 Bonded molar tubes versus bands (A) failure at tooth level, (B) failure at participant level and (C) decalcification.
Chapter S5
1. Table S5.1 Temporary anchorage devices (TADs) failure rates (A) associated with healthy and inflamed tissues and (B) in maxilla or mandible.
Chapter S6
1. Table S6.1 The use of lacebacks and their effect on (A) incisor and (B) molar positions.
Chapter S7
1. Table S7.1 Success rates of orthodontic mini‐implants.
Chapter S10
1. Table S10.1 The effect of self‐ligating brackets on (A) total treatment time and (B) rate of incisor alignment.
Chapter S11
1. Table S11.1 The incidence of impacted and transmigrant mandibular canines.
2. Table S11.2 Treatment success and outcome of impacted and transmigrant mandibular canines.
Chapter S12
1. Table S12.1 Outcome measures for use of headgear versus controls for (A) phase 1 and (B) phase 2 treatments.
Chapter S13
1. Table S13.1 The incidence of trauma (A) early treatment and adolescence only and (B) headgear or functional appliance.
Chapter S14
1. Table S14.1 Molar movement (distalization and distal crown tip) at various stages of second and third molar eruption.
Chapter S15
1. Table S15.1 Outcomes for orthodontic treatment of prominent teeth (A) two‐phase (early) and (B) one‐phase (adolescent) in terms of OJ, ANB, PAR score and self‐concept.
Chapter S16
1. Table S16.1 The effect of the facemask on the ANB angle (degrees) (A) facemask alone and (B) facemask and rapid maxillary expansion (RME).
Chapter S17
1. Table S17.1 Comparison of ANB for facemask and untreated controls (A) 1 year follow‐up and (B) 2–3 year follow‐up.
Chapter S18
1. Table S18.1 Study details on which the outcomes have been based.
2. Table S18.2 Outcome for the angle (degrees) between the midpoint of the tuberosities, tuberosity, and the most occlusal point on the cusp of the canine M‐T‐C (5).
Chapter S19
1. Table S19.1 The prevalence of (A) tooth agenesis, (B) supernumerary teeth, and (C) irregularities of crown morphology.
Chapter S20
1. Table S20.1 The outcome measures for PSIO in patients with cleft lip and palate.
Chapter S22
1. Table S22.1 Outcome measures for slow maxillary molar width expansion compared to control (mm).
Chapter S23
1. Table S23.1 Comparison of different appliances and outcomes to correct lateral crossbites.
Chapter S24
1. Table S24.1 Comparison of three outcome measures for surgically assisted rapid maxillary expansion (SARME) for at least 1‐year follow‐up.
Chapter S25
1. Table S25.1 Long‐term expansion based on rapid maxillary expansion versus control groups.
Chapter S27
1. Table S27.1 Number of patients evaluated according to study types.
Chapter S28
1. Table S28.1 Outcome of (A) ANB angle using a fixed functional appliance.
Chapter S29
1. Table S29.1 Outcomes of fixed functional appliances versus controls (A) SNA, (B) SNB, and (C) ANB angles.
Chapter S30
1. Table S30.1 Outcomes for removable functional appliances versus controls for (A) SNA angle and (B) anterior maxillary displacement.
Chapter S31
1. Table S31.1 Sensitivity analysis for Herbst appliance versus control.
Chapter S32
1. Table S32.1 Forest plot and confidence intervals (CI) for the incidence of caries after interproximal enamel reduction (IER) on tooth surfaces compared with untreated tooth surfaces (clinical and radiographic assessments).
Chapter S33
1. Table S33.1 Prevalence of peg‐shaped lateral in differenta populations.
2. Tables S33.2 Prevalence of peg‐shaped laterals by gender in different ethnic groups.
Chapter S34
1. Table S34.1 Effect of obstructive sleep apnea on two craniofacial measurements.
Chapter S35
1. Table S35.1 Outcomes for pre‐ and postmyofunctional therapies in terms of Apnea‐Hypopnea Index (AHI), low oxygen levels, and Epworth sleepiness scale (ESS) (9 studies).
Chapter S36
1. Table S36.1 Treatment effect for change in Systolic Blood Pressure (SBP) in the included trial of continuous airway pressure (CPAP) versus Inactive control.
2. Table S36.2 Treatment effect for change in systolic blood pressure (SBP) in the included trials of mandibular advancement device (MAD) versus continuous positive airway pressure (CPAP) and versus inactive controls.
Chapter S37
1. Table S37.1 Treatment effects of two interventions on open bite (mm) versus no treatment.
Chapter S38
1. Table S38.1 Long‐term overbite status in surgical studies.
2. Table S38.2 Long‐term overbite status in nonsurgical studies.
Chapter S40
1. Table S40.1 Meta‐analysis results: standardized treatment effect, calculated as Hedges’ g, 95% confidence interval (CI) using random effects model, and I² values.
Chapter S41
1. Table S41.1 Summary of timing of data collection, surveying methods, response rate and risk of bias for the included studies.
Chapter S42
1. Table S42.1 Summary estimate and individual results of cohort and cross‐sectional studies reporting on the effect of orthodontic therapy on periodontal health: (A) alveolar bone loss, (B) periodontal pocket depth, and (C) gingival recession.
Chapter S43
1. Table S43.1 Comparison of different retention regimes after orthodontic tooth movement (based on Little’s Irregularity index for the lower labial segment).
Chapter S44
1. Table S44.1 Comparisons between various clear vacuum‐formed thermoplastic retainers based of wear regime (p values).
Chapter S45
1. Table S45.1 Comparison of mean intercanine widths pre‐ and post‐treatment for various types of malocclusion and interventions.
Chapter S46
1. Table S46.1 Root resorption related to treatment duration, sex, appliance type, and incisors affected.
Chapter S47
1. Table S47.1 Comparison of root resorption during orthodontic treatment: endodontically treated teeth versus teeth with vital pulps.
Chapter S48
1. Table S48.1 Outcome of radiographic assessment of root resorption.
Chapter S49
1. Table S49.1 Orthodontic tooth movement and associated root resorption.
Chapter S50
1. Table S50.1 The conclusions of the 20 studies regarding midline position, buccal corridor and smile arc on smile attractiveness.
Chapter S51
1. Table S51.1 Comparison of intervention outcomes (A) two appliances and (B) stabilization appliance versus control.
Chapter S52
1. Table S52.1 The influence of third molars on lower anterior crowding.
Chapter S53
1. Table S53.1 Risk ratios for (A) coronectomy versus total removal and (B) postoperative infections.
Chapter S54
1. Table S54.1 Treatment times for orthodontic treatment.
Chapter S55
1. Table S55.1 Outcomes for tooth movements in respect of (A) distraction and (B) corticotomy.
Chapter S56
1. Table S56.1 Relative risk ratios for intervention and control/comparison groups.

List of Illustrations

Chapter 01
1. Figure 1.1 Professor Archibald Leman Cochrane CBE, FRCP, FFCM (1909–1988). The Cochrane Collaboration is named in honor of Archie Cochrane, a British medical researcher who contributed greatly to the development of epidemiology as a science.
2. Figure 1.2 The Cochrane Collaboration logo. The outer blue semicircles represent the Cochrane Collaboration and the inner circle the globe to represent international collaborations. The forest plot of clinical trials represents the effectiveness of administering corticosteroids to pregnant women delivering prematurely; the diamond to the left of the “no effect” line indicates the meta‐analysis favored the intervention.
3. Figure 1.3 David Lawrence Sackett, OC, MD, MMSc, FRSC, FRCP (Canada, England, and Scotland).
Chapter 03
1. Figure 3.1 The AND command – “orthodontic appliances” AND “crowded teeth” will only retrieve articles containing both terms (the shaded area).
2. Figure 3.2 The OR command – “crowded teeth” OR “class I malocclusion” OR “class II malocclusion” will retrieve all articles with these terms, whether they appear together in the article or not. This is useful for finding synonyms.
Chapter 05
1. Figure 5.1 Evidence‐based orthodontics amalgamating the best evidence with clinical expertise and individual patient values.
2. Figure 5.2 Main steps of a systematic review. Abbreviations: PICO, participants, intervention(s), comparators, outcome measures.
3. Figure 5.3 Relationship between reporting quality, methodological quality–risk of bias, and interpretation of trial results.
4. Figure 5.4 Benefits of reporting guidelines. Abbreviations: RCT, randomized controlled trial; SR, systematic review.
5. Figure 5.5 The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) process for assessing the evidence from systematic reviews and making recommendations. Abbreviations: PICO, participants, intervention(s), comparators, outcome measures; RCT, randomized controlled trial.
Chapter 06
1. Figure 6.1 Comparison of narrow‐sense heritability h² for a range of facial features and medical conditions. Abbreviation: HDL, high density lipid.
2. Figure 6.2 Standard deviation ellipsoids for 21 facial landmarks, highlighting facial morphology variation revealed by the first three principal components (PCs): PC1 explains 29% of total variance (red); PC2 10% (yellow); PC3 7% (green); PC4 5% (blue). Facial landmarks: 1, glabella; 2, nasion; 3 and 4, endocanthion (left and right); 5 and 6, exocanthion (left and right); 7 and 8, palpebrale superius (left and right); 9 and 10, palpebrale inferius (left and right); 11, pronasale; 12, subnasale; 13 and 14, alare (left and right); 15, labiale superius; 16, labiale inferius; 17 and 18, crista philtri (left and right); 19 and 20, cheilion (left and right); 21, pogonion.
3. Figure 6.3 (a) Association of adult height, pubertal timing, and fat levels. (b) Height and weight growth charts. (c) Early and late patterns of pubertal growth (height velocities). (d) Soft and skeletal facial height growth velocities from 5 to 20 years of age.
4. Figure 6.4 Growth of the face for Finnish and Welsh males and females based on three different landmarks. Abbreviations: men, midendocanthion; g, glabella; n, nasion; sn, subnasale; prn, pronasale; ls, labiale superius; li, labiale inferius; pg, pogonion.
5. Figure 6.5 (a) Component scores from standard (single‐level) principal component analysis (PCA) (PC1 against PC2). (b) Component scores from between‐group multilevel PCA (PC1 against PC2). The filled circles indicate the centroids, and results for females and males from the same country are linked by a line, all following a similar trajectory. (c) Eigen vectors for three‐level model: subject, sex and ethnicity. (d) Three‐dimensional facial scans averaged over all subjects in each group (country and gender).
Chapter S9
1. Figure S9.1 Bar plot of the SUCRA (surface under the cumulative ranking) values for the outcome “overall efficacy”.
Chapter S26
1. Figure S26.1 Weighted averages for overbite at various follow‐up times from (a) Class I, (b) Class II Division I, and (c) Class II Division 2 studies. Abbreviations: NE, nonextraction, EXT, extraction; MIX, mixed.

List of Contributors

Azrul Safuan Mohd Ali, BDS
Applied Clinical Research and Public Health
School of Dentistry
College of Biomedical and Life Sciences
Cardiff University
Cardiff, UK

Matina V. Angelopoulou, DDS, MS
Department of Developmental Sciences
Marquette University School of Dentistry
Milwaukee, WI, USA

Philip Benson, BDS, PhD, FDS(Orth)
Academic Unit of Oral Health, Dentistry and Society
School of Clinical Dentistry
University of Sheffield
Sheffield, UK

Niko Bock, DMD
Department of Orthodontics
University of Giessen
Giessen, Germany

Anne‐Marie Bollen, DDS, MS, PhD
Department of Orthodontics
University of Washington
Seattle, WA, USA

Macario Camacho, MD
Otolaryngology‐Head and Neck Surgery
Division of Sleep Surgery and Medicine
Tripler Army Medical Center
Honolulu, HI, USA

Stephanie Shih‐Hsuan Chen, DDS, MSD
Taipei City
Taiwan

Domenico Dalessandri, DDS, MS, PhD
Department of Orthodontics
School of Dentistry
University of Brescia
Brescia, Italy

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

Damian Farnell, BSc, PhD
Applied Clinical Research and Public Health School of Dentistry
College of Biomedical and Life Sciences
Cardiff University
Cardiff, UK

Camilo Fernandez‐Salvador, MD
Otolaryngology‐Head and Neck Surgery
Tripler Army Medical Center
Honolulu, HI, USA

Padhraig Fleming, BDent Sc (Hons), MSc, PhD, FDS RCS, MFDS RCS, FDS RCS, MOrth RCS, FDS (Orth) RCS, FHEA
Barts and The London School of Medicine and Dentistry
Queen Mary University of London
London, UK

Carlos Flores Mir, DDS, DSc, FRCD
Department of Dentistry
University of Alberta
Edmonton, Alberta, Canada

James Fricton, DDS, MS
School of Dentistry
University of Minnesota
Minneapolis, MN, USA

Jennifer Galloway, BDS, BMSc, MDSc, MFDS RCPS
Applied Clinical Research and Public Health School of Dentistry
College of Biomedical and Life Sciences
Cardiff University
Cardiff, UK

Geoff Greenlee, DDS, MSD, MPH
Department of Orthodontics
University of Washington
Seattle,
WA, USA

Gordon Guyatt, MD, MSc, FRCP, OC
Department of Medicine
McMaster University
Hamilton, Ontario, Canada

Jayne Harrison, BDS, MDentSci, PhD, MOrth RCSEd, FDS(Orth)RCPS, FDTFEd
Orthodontic Department
Liverpool University Dental Hospital
Liverpool, UK

Hong He, MDS, PhD
Department of Orthodontics
School and Hospital of Stomatology
Wuhan University
Wuhan, Hubel, China

Fang Hua, BDS, MSc, PhD
Department of Orthodontics and Center for Evidence‐Based Stomatology
School and Hospital of Stomatology
Wuhan University
Wuhan, Hubei, China

Greg J. Huang, DMD, MSD, MPH
Department of Orthodontics
University of Washington
Seattle,
WA, USA

Guilherme Janson, DDS, MSc, PhD, MRCDC
Department of Orthodontics
Bauru Dental School
University of São Paulo
Bauru, São Paulo, Brazil

Eleftherios G. Kaklamanos, DDS, Cert, MSc, MA, Dr Med
Hamdan Bin Mohammed College of Dental Medicine
Mohammed Bin Rashid University of Medicine and Health Sciences
Dubai, United Arab Emirates

Visnja Katic, PhD, DMD
Research Assistant
Department of Orthodontics
Faculty of Medicine
University of Rijeka
Rijeka, Croatia

O. P. Kharbanda, BDS, MDS, M Orth RCS, M MEd, FDS RCS, Hon, FAMS
Division of Orthodontics and Dentofacial Deformities
Centre for Dental Education and Research
All India Institute of Medical Sciences
New Delhi, India

Malcolm Kohler, MD
Department of Pulmonology
University Hospital Zurich
Zurich, Switzerland

Vasiliki Koretsi, DDS, Dr Med Dent
Department of Orthodontics
University Hospital Regensburg Regensburg
Germany

Eleni Koumpridou, DDS, DOrth
Department of Orthodontics
Center for Dental and Maxillofacial Health
Medical Faculty
University of Wuerzburg
Wuerzburg, Germany

Wenli Lai, DDS, PhD
State Key Laboratory of Oral Diseases and Department of Orthodontics
West China Hospital of Stomatology
Sichuan University
Chengdu, China

Débora A. Lentini‐Oliveira, DDS, MSc
Neuro‐Sono Sleep Center
Department of Neurology
Federal University of São Paulo
São Paulo, Brazil

Anne Littlewood, BA(Hons), MA, MPhil
Cochrane Oral Health
University of Manchester
Manchester, UK

Simon J. Littlewood, BDS, FDS(Orth)RCPS, MDSc, MOrth RCS
Orthodontic Department
St Luke’s Hospital
Bradford, UK

Claudia Trindade Mattos, DDS, MSD, PhD
Department of Orthodontics
School of Dentistry
Universidade Federal Fluminense
Niterói, Brazil

Marcello Melis, DMD, PharmD
Private Practice
Cagliari, Italy

Reint Meursinge Reynders, DDS, MS, MSc, PhD
Milan
Italy

Declan Millett, BDSc, DDS, FDSRCPS, FDSRCS, DOrthRCSEng, MOrthRCSEng, FHEA
Oral Health and Development
Cork University Dental School and Hospital
University College
Cork, Ireland

Peter Ngan, DMD
Department of Orthodontics
West Virginia University
Morgantown, WV, USA

Riccardo Nucera, DDS, PhD, MSc
Department of Biomedical and Dental Sciences and Morphofunctional Imaging
Section of Orthodontics
School of Dentistry
University of Messina
Messina, Italy

Kevin O’Brien, BDS, FDS, DOrth RCS, PhD
School of Dentistry
University of Manchester
Manchester, UK

S. H. Ong, DDS
Department of Orthodontics
University Medical Center Groningen
University of Groningen
Groningen, The Netherlands

Nikolaos Pandis, DDS, MS dr. Med Dent MSc, DLSHTM, PhD
Department of Orthodontics and Dentofacial Orthopedics
Dental School/Medical Faculty
University of Bern
Bern, Switzerland

Moschos Papadopoulos, DDS, Dr Med Dent
Department of Orthodontics
School of Dentistry
Aristotle University of Thessaloniki
Thessaloniki, Greece

Spyridon N. Papageorgiou, DDS, Dr Med Dent
Clinic of Orthodontics and Pediatric Dentistry
Center of Dental Medicine
University of Zurich
Zurich, Switzerland

Pertti Pirttiniemi, DDS, PhD
Professor and Chair
Oral Development and Orthodontics
Institute of Dentistry
University of Oulu
Oulu University Hospital
Medical Research Center
Finland

Lauren K. Reckley, MD
Otolaryngology‐Head and Neck Surgery
Tripler Army Medical Center
Honolulu, HI, USA

Yijin Ren, DDS, MSc, PhD
Department of Orthodontics
University Medical Center Groningen
University of Groningen
Groningen, The Netherlands

Stephen Richmond, BDS, D'Orth, RCS, MScD, FDS, RCS (Ed & Eng), PhD FHEA
Applied Clinical Research and Public Health School of Dentistry
College of Biomedical and Life Sciences
Cardiff University
Cardiff, Wales, UK

Anibal M. Silveira, DDS
Department of Orthodontics, Pediatric Dentistry and Special Care
School of Dentistry
University of Louisville
Louisville, KY, USA

Badri Thiruvenkatachari, BDS, MFDS RCS, MDS, MOrth RCS, FDS RCS, PhD
School of Dentistry
University of Manchester
Manchester, UK

Alessandro Ugolini, DDS, PhD, Spec. Orthodontics
Orthodontics Department
University of Genoa
Genoa, Italy

Aslıhan Uzel, DDS, PhD
Department of Orthodontics
Faculty of Dentistry
Çukurova University
Balcalı, Turkey

Alexandre R. Vieira, DDS, MS, PhD
University of Pittsburgh
School of Dental Medicine
Pittsburgh, PA, USA

Katherine W. L. Vig, BDS, MS, D. Orth, FDS RCS
Department of Developmental Biology
Harvard School of Dental Medicine
Boston, MA, USA

Yan Wang, DDS, PhD
Department of Orthodontics
Laboratory of Oral Diseases
West China Hospital of Stomatology
Sichuan University
Chengdu, Sichuan, China

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

Robert J. Weyant, MS, DMD, DrPH
Department of Dental Public Health
School of Dental Medicine
University of Pittsburgh
Pittsburgh, PA, USA

Caryl Wilson‐Nagrani, BDS, MFDS(RCSEng), MOrth(RCSEd), FDSOrth(RCSEd), PhD, FHEA
Applied Clinical Research and Public Health School of Dentistry
College of Biomedical and Life Sciences
Cardiff University
Cardiff, UK

Anastasios Zafeiriadis, DDS, MSc, DrDent
Department of Orthodontics
School of Dentistry, Faculty of Health Sciences
Aristotle University of Thessaloniki
Thessaloniki, Greece

Khalid H. Zawawi, BDS, DSc
Department of Orthodontics
Faculty of Dentistry
King Abdulaziz University
Jeddah, Saudi Arabia

Alexei Zhurov, BSc, MSc, PhD
Applied Clinical Research and Public Health School of Dentistry
College of Biomedical and Life Sciences
Cardiff University
Cardiff, UK

Vasileios F. Zymperdikas, DDS
Department of Orthodontics
Faculty of Dentistry
Aristotle University of Thessaloniki
Thessaloniki, Greece

Foreword

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

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

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

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

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

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

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

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

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

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

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

Dr. Gordon Guyatt