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Editorial |
In recent months, the Journal of Orthodontics has published another scientific paper which has subsequently won the prestigious FEO (European Federation of Orthodontics) award (Figures 1
and 2). The Journal has also awarded its own prize for a scientific paper (Figures 3 and 4), but what do such prizes actually mean to practising orthodontists? Indeed, do they mean anything at all to practising orthodontists, whether in the clinic or for those undertaking research?
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Manning N, Chadwick SM, Plunkett D, Macfarlane TV. A randomized clinical trial comparing ‘one-step’ and ‘two-step’ orthodontic bonding systems. J Orthod 2006; 33(4): 276–83
Clinicians constantly strive to seek quicker ways of bonding fixed appliances to the teeth. Among possible advantages, it would certainly make bonding more comfortable for the patient. Manufacturers are also keen to support clinicians’ desires to improve what they do but this can lead to problems when multiple, superficially similar products arrive on the market at the same time. However, any new method must be at least as good as the method it replaces since otherwise (for example) constant breakages or damage to teeth will compromise patient care and treatment outcomes.
This study carried out a randomized, controlled, clinical trial to compare the standard two-stage etch and bond technique with a new, one-stage self-etch primer. This approach utilizes the ‘gold standard’ of evidence-based, clinical research.
In this study, the authors:
In addition to this,
The study concluded that there was no statistically significant difference found between the clinical bond failure rates for brackets bonded using a self-etching primer or a conventional acid-etch and resin technique. Both systems had low overall failure rates and the decision to use a particular adhesive system may come down to individual preference.
However, there is perhaps more to this paper than at first meets the eye and there are a number of aspects that make it stand out relative to other, seemingly similar papers. For example, this paper randomizes patients to one or other bonding technique, i.e. it does not utilize a split mouth design. This makes it far more relevant to actual clinical practice, since randomization cannot itself affect the technique being tested. Furthermore, this paper reports results to the end of treatment (not just six- or twelve-month results) and, significantly, demonstrates that in this case, failure rates changed (increased) over this time. This directly relates to recommendations made in a systematic review of bonding studies,1,2 so this is a demonstration of high-level evidence being used to directly enhance and influence the work undertaken.
In summary then, before this study was undertaken, clinicians would probably have opted to use self-etch primers based on manufacturers’ claims, cost, or word of mouth. Now clinicians have some evidence that suggests that this specific type of self-etch primer can reasonably be used in their patients without risking increased debond rates. This is actual, evidence-based decision-making directly impacting patient care.
What about the Journal of Orthodontics Scientific Paper of the Year, sponsored by Maney Publishing?
Benson PE, Douglas CWI. Decontamination of orthodontic bands following size determination and cleaning. J Orthod 2007; 34(1): 18–24.
This was a laboratory-based study but before you think, ‘not relevant to me,’ consider the importance of cross-infection matters. Also consider whether it is possible to assess all clinically relevant cross-infection matters purely on the clinic. I suspect you would conclude that it is not: one has to use laboratory techniques to assess the success or otherwise of cross-infection procedures.
This study is therefore directly relevant to clinicians, as it assesses decontamination procedures which are relevant to the health of patients, to the health of clinical staff and, may also influence practice costs and actual clinical practice. For example, as pointed out by the authors: ‘Preformed stainless steel bands of varying sizes are commonly placed around posterior teeth during fixed appliance treatment. It frequently takes several attempts to achieve the correct size. Orthodontic bands are expensive; therefore, it is not financially viable to consider these as single-use, disposable items if they have been tried in the mouth and found to be the wrong size. As a result, the practice of re-use and re-circulation is widely accepted and carried out ...’
This study aimed to answer the following questions:
The authors indicate some limitations of their work but use careful laboratory techniques. The authors concluded that:
In other words, practising clinicians need to watch this space since such findings may well affect clinical practice in the future. For example, when the risks and benefits are weighed up, such work may influence whether bonding supersedes banding of teeth.
The Journal of Orthodontics aims to publish high quality, valuable research which will answer important clinical questions that really matter to patients, clinicians and researchers. I hope that such awards will encourage and inspire more authors, from around the world, to submit their work to the Journal. To answer the question then: award winning papers. So what? So good.
In Memoriam: Thomas M. Graber, DMD, MSD, PhD. 27 May 1917 – 26 June 2007
It is with regret that we learned of the sad passing of Dr Tom Graber on 26 June 2007. Among his many achievements, he was former Editor-in-Chief of the American Journal of Orthodontics and Dentofacial Orthopedics and Editor-in-Chief of the World Journal of Orthodontics.
References
1 Mandall NA, Millett DT, Mattick CR, Hickman J, Worthington HV, Macfarlane TV. Orthodontic adhesives: a systematic review. J Orthod 2002; 29(3): 205–10.
2 Mandall NA, Millett DT, Mattick CR, Hickman J, Macfarlane TV, Worthington HV. Adhesives for fixed orthodontic brackets. Cochrane Database Syst Rev 2003; issue 2: CD002282.
This article has been cited by other articles:
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  P. Huntley Letters to the Editor J. Orthod., September 1, 2008; 35(3): 215 - 216. [Full Text] [PDF]
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