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Evidence-Based OrthodonticsGreg J. Huang, Stephen Richmond & Katherine W.L. Vig

Evidence-Based Orthodontics satisfies the educational demands of orthodontics, which calls for the integration of the best research evidence with the clinicians expertise and the patients unique values and circumstances.

This landmark text is the first to be devoted to the methodology, principles, and practice of evidence-based practice in orthodontics. It aims to serve as a reference for those wishing to understand the principles of evidence-based practice, including the foundation for clinical study design, epidemiology, and the statistical inferences from data. The ability to define a search strategy from established databases and to identify relevant clinical and translational research in the scientific published literature requires a new approach in orthodontic education. Evidence-Based Orthodontics provides a contemporary approach to those strategies in clinical orthodontic practice. The growing ability to translate critical appraisals of evidence into clinical practice and evaluate clinical evidence for its validity and potential usefulness requires an understanding of basic elements in epidemiology and biostatistics.

Evidence-Based Orthodontics provides its readers with a cogent, clear resource with which to navigate and understand this important subject area. It provides students and practitioners of orthodontics with an indispensible guide to this vital tenet of education, research, and clinical practice.

Key Features

Landmark text surveys the principles and practice of evidence-based orthodontics

Covers clinical study design, epidemiology, and understanding of statistical data

Equips readers with critical apparatus for understanding orthodontic literature

Reviews the available evidence and studies in orthodontics

Clear and cogent approach to clarify this vital area of study, research, and practice

Greg J. Huang, DMD, MSD, MPH is Associate Professor and Chair of the Department of Orthodontics at the University of Washington.

Stephen Richmond, BDS, DOrth RCS, MScD, FDSRCS, PhD is Professor of Orthodontics and Head of Applied Clinical Research and Public Health, Department of Applied Clinical Research and Public Health, at the University Dental Hospital at Cardiff University.

Katherine W. L. Vig, BDS, MS, DOrth RCS, FDSRCS is Professor Emeritus and former Chair of Orthodontics at The Ohio State University, College of Dentistry.

Cover design: Meaden Creative

9 780813 806143

ISBN 978-0-8138-0614-3

Evidence-Based OrthodonticsHuang, Richm

ond & Vig

Evidence-Based Orthodontics

huang_9780813806143_pb.indd 1 25/2/11 10:08:11

Evidence-Based Orthodontics

Evidence-Based Orthodontics

Edited by

Greg J. Huang, DMD, MSD, MPH

Stephen Richmond, BDS, DOrth RCS, MScD, FDSRCS, PhD, FHEA

Katherine W.L. Vig, BDS, MS, DOrth RCS, FDSRCS

A John Wiley & Sons, Inc., Publication

This edition fi rst published 2011 2011 by Blackwell Publishing, Ltd.

Blackwell Publishing was acquired by John Wiley & Sons in February 2007. Blackwells publishing program has been merged with Wileys global Scientifi c, Technical and Medical business to form Wiley-Blackwell.

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Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold on the understanding that the publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional should be sought.

Library of Congress Cataloging-in-Publication Data

Evidence-based orthodontics / edited by Greg J. Huang, Stephen Richmond, Katherine W.L. Vig. p. ; cm. Includes bibliographical references and index. ISBN 978-0-8138-0614-3 (paperback : alk. paper) 1. Orthodontics. 2. Evidence-based dentistry. I. Huang, Greg J., editor. II. Richmond, Stephen, editor. III. Vig, Katherine W.L., editor. [DNLM: 1. Orthodontics. 2. Evidence-Based Dentistry. 3. Malocclusiontherapy. WU 440] RK521.E975 2011 617.6'43dc22 2010048237

A catalogue record for this book is available from the British Library.

This book is published in the following electronic formats: ePDF [9780470959749]; ePub [9780470959756]

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The publisher and the author make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifi cally disclaim all warranties, including without limitation warranties of fi tness for a particular purpose. No warranty may be created or extended by sales or promotional materials. The advice and strategies contained herein may not be suitable for every situation. This work is sold with the understanding that the publisher is not engaged in rendering legal, accounting, or other professional services. If professional assistance is required, the services of a competent professional person should be sought. Neither the publisher nor the author shall be liable for damages arising herefrom. The fact that an organization or Website is referred to in this work as a citation and/or a potential source of further information does not mean that the author or the publisher endorses the information the organization or Website may provide or recommendations it may make. Further, readers should be aware that Internet Websites listed in this work may have changed or disappeared between when this work was written and when it is read.

1 2011


Table of Contents

Foreword viiGordon Guyatt

Contributor List ix

Part 1 Principles 3

Chapter 1 A Historical Perspective of Evidence-Based Orthodontics 5Katherine W.L. Vig

Chapter 2 Clinical Research Designs 15Robert J. Weyant

Chapter 3 Electronic Searching for Clinical Trials Information 31Anne Littlewood

Part 2 Selected Topics 47

Chapter 4 The Treatment of Class II MalocclusionHave We the Evidence to Make Decisions? 49Kevin OBrien and Jonathan Sandler

Chapter 5 External Root Resorption and Orthodontic TreatmentAssessment of the Evidence 63Belinda J. Weltman

Chapter 6 Malocclusion, Orthodontic Treatment, and Periodontal HealthAn Assessment of the Evidence 89Anne-Marie Bollen

Chapter 7 Stability of Anterior Open Bite CorrectionAn Assessment of the Evidence 97Greg J. Huang and Geoffrey M. Greenlee

Chapter 8 Orthodontics and Temporomandibular Joint (TMJ) Disorders 119Friederike Luther and Fraser McDonald

Chapter 9 Self-Ligation 135Padhraig S. Fleming



Chapter 10 Prevention of Demineralization During Orthodontic Treatment with Fluoride-Containing Materials or Casein Phosphopeptide-Amorphous Calcium Phosphate 149Philip E. Benson

Chapter 11 Invisalign TherapyA Systematic Review of Lower Quality Evidence 167Jason M. Bressler, Stefanie Hamamoto, Gregory J. King, and Anne-Marie Bollen

Chapter 12 Retention 181Simon J. Littlewood, Declan T. Millett, David R. Bearn, Bridget Doubleday, and Helen V. Worthington

Chapter 13 Quality of Outcome 191Stephen Richmond and Alexei Zhurov

Chapter 14 Stability of Orthognathic Surgery 217Donald R. Joondeph

Chapter 15 Orthodontic Treatment of the Transverse DimensionAssessment of the Evidence 233Steven D. Marshall

Chapter 16 Class III MalocclusionThe Evidence on Diagnosis and Treatment 247Joseph G. Ghafari, Ramzi V. Haddad, and Maria E. Saadeh

Part 3 Evidence-Based Orthodontics in Perspective 281

Chapter 17 Evidence-Based Care in Context 283William Shaw

Chapter 18 Playing Doctor: Evidence-Based Orthodontics 293Lysle E. Johnston, Jr.

Chapter 19 Refl ections on a Decade of Evidence-Based Dentistry 301David L. Turpin

Index 307



Evidence - based medicine (EBM) or evidence - based surgery, or evidence - based ortho-dontics (EBO) is about solving clinical problems. In particular, EBO provides tools for using the relevant literature to determine the benefi ts and risks of alternative patient man-agement strategies and to weigh those benefi ts and risks in the context of the individual patient s predicament