Evidence-Based Orthodontics

Modern orthodontic practice does not only aim to straighten the crowed or crooked teeth, but more importantly to restore an esthetic appeal of soft tissue and establish a functional occlusion.

Facial Esthetics

The primary goal of treatment becomes soft tissue relationships and adaptations, not Angle’s ideal occlusion. Soft tissue relationships, both the proportions of the soft tissue integument of the face and the relationship of the dentition to the lips and face, are the major determinants of facial appearance. Soft tissue adaptations to the position of the teeth help determine the orthodontic plan and whether the orthodontic result will be stable.

For example, the patient in the picture below originally had crowded teeth with excessive incisor protrusion, upper and lower lips could not close in the rest position. Theoretically, both premolar extraction and palate expansion can solve this problem. In this case premolar extraction is the one that should be chosen because palate expansion cannot help with the closure of lips, while extraction can help retract the incisors, thus lips can close, improving facial esthetics.

Functional Occlusion

Temporomandibular (TM) dysfunction, to the extent that it relates to the dental occlusion, is best thought of as the result of injury to the soft tissues around the TM joint caused by clenching and grinding of the teeth. Given that, an important goal of treatment is to arrange the occlusion to minimize the chance of injury. A stable occlusion can also prevent relapse in the future.

Practice Based on Evidence

The era of expert-based orthodontic practice is over, and now we are entering into the era of evidence-based practice. Evidence-based orthodontics uses the relevant literature to determine the benefits and risks of alternative patient management strategies and to weigh those benefits and risks in the context of the individual patient’s predicament, helping dentists know the degree of uncertainty for particular clinical decisions. Practicing evidence-based orthodontics requires dentists with strong research and reading ability. Practitioners should know how to frame a clinical quandary to facilitate use of the latest English articles in its resolution, to evaluate the strength of the methods of the studies and to extract the clinical message, apply it back to the patient, and store it for retrieval when encountering similar cases in the future.

For example, with the popularity of invisible orthodontic practice, enamalplasty is being used more and more often. Whether enamalplasty could cause decay was always controversial. But, according to evidence-based view, the clinical results demonstrate that enamalplasty does not increase the risk of developing cavities. Therefore, enamalplasty with careful polishing is an optional method to solve teeth crowding problems.