[Orthodontics based on a new scientific method of evaluating results: "evidence-based"]

In the orthodontic literature, randomized clinical trials are used to establish standards for the comparison of different clinical approaches. The balancing effect produced in a randomized study makes it possible to attribute the differences in results achieved clearly to treatment and not to variations in the biological characteristics of the patients involved. Recently, most randomized studies in orthodontics have been devoted to testing the hypothesis that some orthodontic appliances exert orthopedic effects that modify dento-facial growth. The authors propose definitions of "orthopedic effects" and of "dento-alveolar changes" and discuss the difficulties encountered in measuring them. They also review clinical studies published over the past 10 years on the correction of Class II malocclusions, on the problems of expansion and also report on Class IIl disorders. In addition they assess the problems associated with these clinical studies such as the ethical requirement of assuring that control groups receive treatment as appropriate for their maladies as that delivered to patients under study, the high cost of carrying them out, the relatively long delay before results can be evaluated, the difficulties of measuring all the different parameters involved, and the need to assemble large enough samples. To sum up, one can conclude that, because of all these impediments, randomized clinical studies have not as yet delivered the hope for benefit of collecting enough "evidence based" information for the orthodontic profession to deliver better treatment to its patients.