Evidence-Based Orthodontics

In a September 12, 2010 New York Times editorial entitled “ Is Newer Better? Not Always”, the comparative effectiveness aspects of the Obamacare legislation are examined. While there is much to debate about this bill, there can be little doubt that together, evidence based healthcare and comparative effectiveness studies are complimentary strategies which if implemented should benefit patients by making it easier to identify high quality and cost effective treatments that work as compared to other choices that may be available.

Evidence based healthcare (EBH) in Orthodontics means that for a given procedure, material or technique, valid studies confirm its effectiveness…in other words, it should work if used in the intended way. Comparative effectiveness studies (CES) determine how a given procedure, material or technique performs relative to others with respect to several factors like: time effectiveness, quality of the result, cost effectiveness and undesirable side effects. There is a consensus that not all of our treatment choices meet both criteria but in a perfect world, they would. That is, the treatments we select should be shown to work reliably and they are better in most respects than the alternatives with fewer side effects.

When we evaluate new methods and materials for use on our patients at Ziman Orthodontics, the primary question we ask is whether or not the new method or material being promoted is proven to be better than what we are currently doing. Manufacturers are continuously updating materials and entrepreneurs compete to bring the next big thing to market. Regulators can pass on the safety of materials that we use but don’t consider either EBH or CES in their approvals. As a consequence, new techniques and materials USUALLY come to market with the barest of supporting data exposing busy providers to sometimes jaded sales people and talking heads with undisclosed financial relationships with the manufacturer. In many cases with the passage of time, research reveals that a material or method previously touted as newest and best was not any better than what was in conventional use at the time. In Orthodontics, we’ve seen it with self ligating braces , early intervention multiple phase therapy and Invisalign tm therapy. Payers, you, me, insurance companies and government should all be interested in materials and methods which meet criteria supporting EBH and CES.

To the extent that the Obamacare legislation fosters this type of analysis, we should be in support of its CES mandate as long as departures are allowed for unusual circumstances that a provider determines are necessary for the welfare of their patient(s). The politics of the day should have no influence on what materials, methods or techniques are selected in treating patients. At Ziman Orthodontics, we are continuously evaluating the latest and greatest products and techniques at the same time searching the literature for validation before using them on our patients.