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Class II Skeletal Growth Modification Treatment: Has Hope Triumphed Over Evidence?

  • Marc Ackerman1

1Boston Children’s Hospital, 300 Longwood Avenue, Hunnewell 416, Mailstop BCH3071, Boston, MA 02115, USA

DOI: 10.22514/1053-4625-46.4.1 Vol.46,Issue 4,July 2022 pp.257-261

Published: 01 July 2022

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Abstract

The hierarchy of evidence in the health sciences is primarily determined by study methodology and avoidance of systematic bias. As such, the systematic review and meta-analysis of randomized controlled trials sits at the top of the evidence pyramid while case studies, anecdotes, and personal opinions are located at its base. Ideally, clinical practice guidelines and reference manuals should be developed with this hierarchy in mind and clearly state what level of evidence supports any given clinical recommendation. When there is inadequate evidence to guide a clinical recommendation, we need to clearly state that. Unfortunately, many clinicians do not differentiate between the levels of evidence and consequently elevate highly biased studies to the level of the randomized controlled trial. Nowhere is this more evident than in the American Academy of Pediatric Dentistry Councils on Clinical Affairs’ and Scientific Affairs’ Reference Manual of Pediatric Dentistry best practice statement on the management of the Class II malocclusion.


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Marc Ackerman. Class II Skeletal Growth Modification Treatment: Has Hope Triumphed Over Evidence?. Journal of Clinical Pediatric Dentistry. 2022. 46(4);257-261.

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https://www.jocpd.com/articles/10.22514/1053-4625-46.4.1

References

1. American Academy of Pediatric Dentistry. Management of the devel-oping dentition and occlusion in pediatric dentistry. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pedi-atric Dentistry; 2021:408-25.

2. Keeling SD, Wheeler TT, King GJ, et al. Anteroposterior skeletal and dental changes after early Class II treatment with bionators and headgear. Am J Orthod Dentofacial Orthop 1998;113(1):40-50.

3. Chen JY, Will LA, Niederman R. Analysis of efficacy of functional appliances on mandibular growth. Am J Orthod Dentofacial Orthop 2002;122(5):470-6.

4. O’Brien K, Wright J, Conboy F, et al. Effectiveness of early orthodontic treatment with the twin-block appliance: A multicenter, randomized, controlled trial. Part 1: Dental and skeletal effects. Am J Orthod Dentofa-cial Orthop 2003;124(3):234-43.

5. McNamara JA, Bookstein FL, Shaughnessy TG. Skeletal and dental changes following regulatory therapy on Class II patients. Am J Orthod Dentofacial Orthop 1985;88 (2):91-110.

6. Toth LR, McNamara JA Jr. Treatment effects produced by the twin-block appliance and the FR-2 appliance of Frankel compared with untreated Class II sample. Am J Orthod Dentofacial Orthop 1999;116(6):597-609.

7. Ackerman M. Evidence-based orthodontics for the 21st century. J Am Dent Assoc. 2004 Feb;135(2):162-7; quiz 227-8.


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