In this issue, Dr. Diane Paxton’s (Seattle, WA) review of Evidence-based Treatment reminded me of an editorial I wrote in the Winter 1984 issue of the PCSO Bulletin. I am glad that Diane reviewed this presentation by Dr. Thomas Southard (Iowa City, IA). His message and my editorial both encouraged practitioners to be familiar with the literature and to use established facts when treating patients.

However, every day we make treatment decisions based only on our judgment and experience, because the final proof is not in. As Bertrand Russell said in Unpopular Essays, "The most savage controversies are those about matters as to which there is no good evidence either way."

In private practice, I sometimes find it difficult to apply the results of a study to my patient and the treatment plan. A successful study must have a narrow focus. My patient usually does not fit the criteria of the study. Since orthodontics is both art and science, and there are many treatment techniques available, each practitioner learns to apply a fairly individual solution to a given problem. While science may offer us a factual observation on a specific group of patients treated with a specific modality, we in the clinic must then try to understand what that factual observation means for our specialty.

The evidence card has become a common trump these days. Sometimes I find a colleague citing a study that proved a specific point, but using the study to support some entirely different conclusion. It becomes easy to dismiss all Phase I treatment, expansion treatment, wisdom teeth removal, etc. I caution that expanding the focus of a specific study to establish a general rule is risky business.

Sometimes a speaker will question the relevance of a study to his or her treatment protocol. Should we condemn such questions? No, because the complexities in making such judgments are major. How does your expansion treatment compare to the cases treated at the University of Washington? It would be very difficult to answer. You would have to compare different treatments, different patient groups, different tabulation techniques, and on and on.

To be honest, research does not provide all the answers. For example, studies won’t tell you how to predict. Orthodontics is a game of probabilities. A study may tell us what worked for a group of patients in 75% of the cases, but what about the patient in front of us? However, studies can guide us to favor both treatment modalities, which are likely to work, and to avoid those that are likely not to work.

The most meaningful research for any clinician is the study that is done on his or her own patients. When we review our own patients using pre- and post- treatment records we are looking at a group of patients treated with familiar methods. While we may not have a control group or double blind data, if we are willing to look objectively, our own treatment results will provide the most relevant information. Then, we can try to understand how the best studies compare to our work. Such effort is the essence of evidence-based orthodontic treatment. If you don’t take and analyze final records, your judgments about your treatment effects will remain more anecdote than evidence.

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