Evidence based dentistry started 20 years ago (1). Most Cochrane Systematic Reviews still end with the conclusion that recommendations for clinical practice cannot be made based only on the results of these trials and that more randomised controlled trials are needed to elucidate the interventions for treating a certain kind of malocclusion. Turning the Cochrane reviews into a tool that is more relevant in clinical practice will require implementation of a methodology allowing inclusion of non-RCTs while controlling for possible bias.(2)
1.. Richards D, Lawrence A. Evidence based dentistry. Br Dent J. 1995;179(7):270–3.
2. Teich ST, Lang LA, Demko CA. Characteristics of the Cochrane Oral Health Gro up Systematic Reviews. J Dent Eduacation. 2015;79(1):5–15.
No. Well-designed observational studies, analytical, prospective (cohort) and low probability of bias are a valid alternative to support the possible causal relationship of orthodontic treatment with the modification of the occlusion. Strengthening research groups in implementation of the methodology for selecting, monitoring and measurement of the variables of interest is absolutely necessary. While a robust statistical analysis is used.
http://www.gradeworkinggroup.org/publications/Grading_evidence_and_recommendations_BMJ.pdf
http://www.sobracil.org.br/revista/jv030303/bjvs030303_105.pdf
Do you agree with Meikle`s statement that If one asks whether RCTs have achieved their objective, or provided knowledge not previously available from retrospective studies or animal experimentation, then the answer would have to be no; it is also hard to justify the cost. What is particularly interesting is that knowledge based on years of clinical experience has been disregarded and then announced as if it was something completely new?
1. Meikle MC. What do prospective randomized clinical trials tell us about the treatment of class II malocclusions? A personal viewpoint. Eur J Orthod. 2005;27(2005):105–14.
I do agree with Carlos Humberto Martinez-Cajas. The bottom line is as much foolproof as possible in the study design (follow proper guidelines for each type of study) and execute the same meticulously.
http://cccrg.cochrane.org/sites/cccrg.cochrane.org/files/uploads/Study_design_guide2013.pdf
I am sorry but all your arguments do not answer the question. Even a simple question concerning the treatment effects of various aligning archwires can not be answered by current evidence based research of renowned scientists (Papageorgiou SN, Konstantinidis I, Papadopoulou K, Jäger A, Bourauel C. A systematic review and meta-analysis of experimental clinical evidence on initial aligning archwires and archwire sequences. Orthod Craniofac Res. 2014 May 29;(April).). So where do we stand after 20 years of evidence based orthodontics?
Sir
Non RCTs if included , will include a lot of bias in the study structure so in any case, no clinical recommendations could be based on such trials. In fact, focus should be more on designing studies that are randomized and with strict protocols so that in years to come we may generate evidence free of bias and fit for clinical implementation. As for now, evidence can just be collected from studies with least bias and if no definite outcomes are achieved based on such studies, we can recommend future work in this regard. No scientific work goes waste, it can be a stepping stone for future well designed studies on the same topic.
kindly go through this: it might be helpful for assessment of strength of evidence
J Evid Based Dent Pract. 2007 Dec;7(4):147-50.
JEBDP improves grading system and adopts strength of recommendation taxonomy grading (SORT) for guidelines and systematic reviews.
Newman MG1, Weyant R, Hujoel P.
Because of the poor quality of the systematic reviews and/or evidence available, systematic reviews may not provide the best available evidence for clinical decision making. Clinicians should critically appraise all available literature when making clinical decisions.
No. Non-RCTs provide useful information. They have been condemed because they have the potential for introducing bias which may inflate the treatment response. In orthodontics prospective RCTs appear to give the same results as retrospective non-RCTs. This is demonstrated by the recent prospective RCT twin-block study by Trenouth & Desmond (1,2,3) which confirmed the results of the two previous retrospective studies in this field.
The only way to find out if bias is a significant problem in retrospective studies is to test if they give different results to prospective studies. This does not appear to be the case as Trenouth (4) compared four prospective twin-block studies with four retrospective ones and found no statistically significant difference.
It therefore seems inappropriate to disregard all previous knowledge simply because it is not based on an RCT. It would seem reasonable to include non-RCTs provided they can be validated (5).
1. Trenouth M J, Desmond S. A randomized clinical trial of two alternative designs of Twin-block appliance. J Orthod 2012;39:17-24.
2. Trenouth M J, Desmond S. The influence of clasp design on twin block appliance outcome - a prospective randomised, controlled clinical trial. Cranio-View 2013;22:18-34.
3. Trenouth M J, Desmond S. An alternative to angle ANB in the assessment of sagittal discrepancy: A case for W angle, M-axis and G-axis based on a secondary analysis of clinical trial data. Int J Dentistry Oral Sci 2015;S4:001:1-9.
4. Trenouth M J. Design flaws in some randomized controlled trials. Letter to the Editor. Am J Orthod Dentofacial Orthop 2009;135:141.
5. Trenouth M J. Evidence - based orthodontics and the Twin-block appliance. Letter to the Editor. Am J Orthod Dentofacial Orthop 2002;121:13A -14A.
Question could be, Can dentistry continue to not conduct non-biased, not manufacturer supported RCTs? There is a dearth of real dental RCTs and non-biased evidence for dentistry and oral health. Check out guidelines at AHRQ, final conclusions missing evidence for dentistry. We are light years behind medicine.
- Badges
- Science topic
- Similar topics
- Physical Sciences
- Materials Science
- Materials
- Inorganic Materials
- Metals
- Alloys
- Steel