Evidence and clinical decisions: Asking the right questions to obtain clinically useful answers

Orthodontists need to know the effectiveness, efficiency and predictability of treatment approaches and methods, which can be learned only by carefully studying and evaluating treatment outcomes. The best data for outcomes come from randomized clinical trials (RCTs), but retrospective data can provide satisfactory evidence if the subjects were a well-defined patient group, all the patients were accounted for, and the percentages of patients with various possible outcomes are presented along with measures of the central tendency and variation. Meta-analysis of multiple RCTs done in a similar way and systematic reviews of the literature can strengthen clinically-useful evidence, but reviews that are too broadly based are more likely to blur than clarify the information clinicians need. Reviews that are tightly focused on seeking the answer to specific clinical questions and evaluating the quality of the evidence available to answer the question are much more likely to provide clinically useful data

The hierarchy of stability and predictability in orthognathic surgery with rigid fixation: an update and extension

A hierarchy of stability exists among the types of surgical movements that are possible with orthognathic surgery. This report updates the hierarchy, focusing on comparison of the stability of procedures when rigid fixation is used. Two procedures not previously placed in the hierarchy now are included: correction of asymmetry is stable with rigid fixation and repositioning of the chin also is very stable. During the first post-surgical year, surgical movements in patients treated for Class II/long face problems tend to be more stable than those treated for Class III problems. Clinically relevant changes (more than 2 mm) occur in a surprisingly large percentage of orthognathic surgery patients from one to five years post-treatment, after surgical healing is complete. During the first post-surgical year, patients treated for Class II/long face problems are more stable than those treated for Class III problems; from one to five years post-treatment, some patients in both groups experience skeletal change, but the Class III patients then are more stable than the Class II/long face patients. Fewer patients exhibit long-term changes in the dental occlusion than skeletal changes, because the dentition usually adapts to the skeletal change

Short-term and long-term stability of surgically assisted rapid palatal expansion revisited

The purpose of this article is to present further longitudinal data for short-term and long-term stability, following up our previous article in the surgery literature with a larger sample and 2 years of stability data

Closer Look at the Stability of Surgically Assisted Rapid Palatal Expansion

To assess the amount of dental and skeletal expansion and stability following surgically assisted rapid maxillary expansion,

Stability After Mandibular Setback: Mandible-Only Versus 2-Jaw Surgery

The objective of this study was to evaluate whether changes in the technique for mandibular setback surgery since the introduction of RIF have improved postsurgical stability in Class III correction with setback alone and 2-jaw surgery

Extraction frequencies at a university orthodontic clinic in the 21st century: Demographic and diagnostic factors affecting the likelihood of extraction

The aims of this study were 1) to report contemporary orthodontic extraction frequencies at a university center and 2) to investigate what patient-related factors might influence the likelihood of extraction

Long-term follow-up of Class II adults treated with orthodontic camouflage: A comparison with orthognathic surgery outcomes

Thirty-one adults who had been treated with orthodontics alone for Class II malocclusions were recalled at least 5 years posttreatment to evaluate cephalometric and occlusal stability and also their satisfaction with treatment outcomes. The data were compared with similar data for long-term outcomes in patients with more severe Class II problems who had surgical correction with mandibular advancement, maxillary impaction, or a combination of those. In the camouflage patients, small mean changes in skeletal landmark positions occurred in the long term, but the changes were generally much smaller than in the surgery patients. The percentages of patients with a long-term increase in overbite were almost identical in the orthodontic and surgery groups, but the surgery patients were nearly twice as likely to have a long-term increase in overjet. The patients’ perceptions of outcomes were highly positive in both the orthodontic and the surgical groups. The orthodontics-only (camouflage) patients reported fewer functional or temporomandibular joint problems than did the surgery patients and had similar reports of overall satisfaction with treatment, but patients who had their mandibles advanced were significantly more positive about their dentofacial images

Long-term outcome of surgical Class III correction as a function of age at surgery

In this study, we assessed whether the likelihood of a positive overjet 5 to 10 years after Class III surgery was affected by age at the surgery or the type of surgery and evaluated the amount and pattern of postsurgical growth

Long-term Soft Tissue Changes after Orthodontic and Surgical Corrections of Skeletal Class III Malocclusions

To evaluate long-term soft tissue changes after orthodontic and surgical corrections of skeletal Class III malocclusions

Changes in the pattern of patients receiving surgical-orthodontic treatment

The characteristics of patients who seek and accept orthognathic surgery appear to be changing over time but have not been well documented in the 21st century