The Journal of the American Dental

Association
Volume 135, Issue 2, February 2004, Pages 162-167

Cover Story

Evidence-based orthodontics for the 21st century

MARC ACKERMAN D.M.D.

Available online 29 December 2014.

Show less

Share Cite

https://doi.org/10.14219/jada.archive.2004.0147
Get rights and content

ABSTRACT

Background
This article examines some of the data-driven advances in clinical orthodontics and how they might
influence the decision-making process in the specialty.

Types of Studies Reviewed

Nearly 100 years of orthodontic study has focused on two issues: one-phase versus two-phase treatment of
Class II malocclusion and extraction versus nonextraction treatment of arch perimeter deficiencies. The
author addresses these issues by presenting data from the first randomized clinical trial in orthodontics and
from a survey of the current literature.

Results
The clinical trial involved subjects who had Class II malocclusion. The researchers who conducted the trial
found no difference in the quality of the dental occlusion between the children who had early treatment and
those who did not, as judged by both an occlusal index (Peer Assessment Rating scores) and the percentages
of the subjects with excellent and less-than-optimal outcomes. Early treatment did not reduce the eventual
need for orthognathic surgery. In a separate study, a researcher reported that the maxillary arch perimeter
could be increased by 3 to 4 millimeters by using rapid palatal expansion, or RPE, providing space for incisor
alignment to resolve crowding. The author concluded that any added benefit of RPE treatment in patients
without a crossbite might be “challenging to define.”
Clinical Implications
The challenge facing orthodontists in the 21st century is the need to integrate the accrued scientific
evidence into clinical orthodontic practice.

Section snippets

DEFINING AND REDEFINING ORTHODONTICS

The American Association of Orthodontists defines orthodontics, or dentofacial orthopedics, as the area of
dentistry concerned with the supervision, guidance and correction of the growing and mature dentofacial
structures. This definition includes conditions that require movement of teeth or correction of mal-
relationships and malformations of related structures by adjusting relationships between and among teeth
and facial bones by applying forces or by stimulating and redirecting the…

MYTHOLOGY REGARDING NEED FOR TREATMENT

It would appear logical that malocclusion would have a causal relationship with both dental decay and
periodontal disease. Theoretically, satisfactory oral hygiene for a maloccluded dentition would be more
difficult to achieve than it would with a dentition that boasts an ideal occlusion. Recent data suggest that a
person's willingness and motivation to maintain oral hygiene have a greater impact on the occurrence
of dental disease than does tooth alignment.5

Two studies conducted in the…

MYTHOLOGY REGARDING TREATMENT OUTCOME

Nearly 100 years of orthodontic study has focused on the issues of one-phase versus two-phase treatment
of Class II malocclusion and extraction versus nonextraction treatment. With greater emphasis on data-
driven dental treatment, there is good evidence in the orthodontic literature to put to rest these age-old
debates. It would appear that some of the most strongly held orthodontic treatment strategies are severely
flawed when viewed in light of efficiency and efficacy.

Proffit9 stated:

In the…

COMMUNICATION: PARAMOUNT IN ORTHODONTIC CARE

A shift that has occurred in the last 15 years of dental practice is the evolution of patient autonomy and
informed consent and the departure from paternalism in the decision-making process. A conflict for
today's orthodontist is, on the one hand, to adhere to the obligation set forth in the American Dental
Association Principles of Ethics and Code of Professional Conduct15 to perform the highest quality service
within his or her power to perform, yet, on the other hand, to observe the…

THE SCOPE OF CONTEMPORARY ORTHODONTICS

Contemporary orthodontic practice can be summarized as interactive problem-oriented diagnosis and
treatment planning between clinician and patient, with the goal of defining mutually desirable treatment
objectives coupled with the selection of the most appropriate mechanotherapy to achieve these ultimate
goals (Figure 2). The first key to a successful outcome in orthodontic therapy is to follow a systematized
method of clinical examination and data collection, which should aid in eliciting the…

CONCLUSION: THE FUTURE

It is conceivable in 2004 that if a patient seeks orthodontic opinions from 10 orthodontists, he or she may
receive 10 different treatment plans. It also is conceivable that all 10 treatment plans could achieve
satisfactory results. However, when viewed in light of the principles of effectiveness and efficiency, there
might be only one or two treatment alternatives that best satisfy the patient's esthetic, functional and
psychosocial needs. The challenge facing orthodontists in the 21st…

REFERENCES (18)

WC Shaw
The influence of children's dentofacial appearance on their social attractiveness as judged
by peers and lay adults
Am J Orthod (1981)

WC Shaw et al.
The influence of dentofa-cial appearance on the social attractiveness of young
adults
Am J Orthod (1985)

C Sadowsky et al.
Long-term effects of orthodontic treatment on periodontal
health
Am J Orthod (1981)

AM Polson et al.
Long-term periodontal status after orthodontic treatment
Am J Orthod Dentofac Orthop (1988)

CS Greene
Etiology of temporomandibular
disorders
Semin Orthod (1995)

AA Gianelly
Rapid palatal expansion in the absence of crossbites: added
value?
Am J Orthod Dentofacial Orthop (2003)
M Brennan et al.
The use of the lingual arch in the mixed dentition to resolve incisor
crowding
Am J Orthod Dentofacial Orthop (2000)

American Association of Orthodontists

Glossary of dentofacial orthopedic terms(1996)

WR Proffit et al.
Prevalence of malocclusion and orthodontic treatment need in the United States: estimates
from the NHANES III survey
Int J Adult Orthodon Orthognath Surg (1998)

There are more references available in the full text version of this article.

Cited by (42)

Do malocclusion and orthodontic treatment impact oral health? A systematic review and meta-
analysis
2020, American Journal of Orthodontics and Dentofacial Orthopedics

Citation Excerpt :
…Therefore, relevant study designs were randomized controlled trials and prospective cohorts with 2 time points
(before and after treatment) with an untreated control group. For both parts of the review, we identified outcomes that
fell into 2 broad categories, which included change in dental disease state and sociodental impact.14 We recorded the
following data: (1) caries outcomes: decayed, missing, and filled teeth; (2) periodontal outcomes: basic periodontal
examination and loss of attachment; (3) plaque; (4) incidence of dental trauma; and (5) any oral health–related quality
of life (OHRQOL) outcome.…

Show abstract

Temporomandibular Disorders: Effects of Occlusion, Orthodontic Treatment, and Orthognathic

Surgery
2013, Orthognathic Surgery: Principles and Practice

Orthodontic Considerations in the Evaluation and Treatment of Dentofacial

Deformities
2013, Orthognathic Surgery: Principles and Practice

Maxillomandibular Expansion and Advancement for the Treatment of Sleep-Disordered

Breathing in Children and Adults
2012, Seminars in Orthodontics

Citation Excerpt :
…In 1996, Palmisano et al69 reported the first use of RME to successively treat snoring and SDB (the AHI went from 22/h
 to 4/h) in a 22-year-old man with a Class I malocclusion and maxillary constriction. However, some have questioned the
therapeutic benefit of RME for SDB.70 To date, several studies have shown the effectiveness of RME in treating both
children and adults with SDB, maxillary narrowing, and high-arched palates.71-74…

Show abstract

3D Diagnosis and Treatment Planning in Orthodontics

2009, Seminars in Orthodontics

Show abstract

Early orthodontic treatment need in paediatric age: a prospective observational study in Italian
school-children
2023, European Journal of Paediatric Dentistry

View all citing articles on Scopus

Recommended articles (6)

Research article

Association of orthodontic force system and root resorption: A systematic

review
American Journal of Orthodontics and Dentofacial Orthopedics, Volume 147, Issue 5, 2015, pp. 610-626

Show abstract

Research article

How long does treatment with fixed orthodontic appliances last? A systematic review
American Journal of Orthodontics and Dentofacial Orthopedics, Volume 149, Issue 3, 2016, pp. 308-318

Show abstract

Research article

An evidence-based comparison of headgear and functional appliance therapy for the correction
of Class II malocclusions
Seminars in Orthodontics, Volume 19, Issue 3, 2013, pp. 174-195

Show abstract

Research article

Evolving concepts of heredity and genetics

in  orthodontics
American Journal of Orthodontics and Dentofacial Orthopedics, Volume 148, Issue 6, 2015, pp. 922-938

Show abstract
Research article

Clinical applications and treatment outcomes with modified C-palatal plates

Seminars in Orthodontics, Volume 24, Issue 1, 2018, pp. 45-51

Show abstract

Research article

Early orthodontic treatment for Class II malocclusion reduces the chance of incisal trauma:
Results of a Cochrane systematic review
American Journal of Orthodontics and Dentofacial Orthopedics, Volume 148, Issue 1, 2015, pp. 47-59

Show abstract

View full text

Copyright © 2004 American Dental Association. Published by Elsevier Inc. All rights reserved.

Copyright © 2023 Elsevier B.V. or its licensors or contributors.

ScienceDirect® is a registered trademark of Elsevier B.V.