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The Role of Orthodontic Experience

In an era of evidence-based dentistry, how easy is it to ensure that orthodontic treatments are based on sound and up-to-date research? Not at all easy was a key message to speakers at the British Orthodontic Conference (BOC) 2017 in Manchester.

But if gold standard research cannot always deliver conclusive results, then orthodontic experience comes to the fore, according to several speakers, who emphasised that orthodontists can draw confidence and insight from their long years of training and clinical practice. And where better to build knowledge than at BOC which this year was the 30th conference for a united orthodontic profession. More than 1100 delegates attended and had their pick of 64 presentations spread across three parallel sessions on each of the three days. With a theme of Back to the Future, many of the speakers were inspired to reflect on the past but also predict what might be on the horizon, whether discussing supplies, techniques, equipment or materials.

Research themes underpinned most of the three days with Professor Tony Ireland, winner of the prestigious Chapman Prize, setting the trend by presenting the results of his multi site collaborative study in the South West of England, examining the comparative impact of sugar free chewing gum and ibuprofen in reducing pain in orthodontic patients.

The conclusion of the study was that chewing gum can reduce the discomfort of archwires once braces have been placed and at the first archwire change. Funded by the British Orthodontic Society Foundation, the patient-focused research cost less than £33k, regarded as great value for money in an era when many trials cost over £1m. Professor Ireland explained the large and very lengthy logistical difficulties involved in conducting this prospective trial and the endurance required to gather top level evidence.

A double act by Professors Sabine Ruf and David Bearn entitled The Great Research Debate examined research methodologies and the value of orthodontic research. Professor Ruf said: “Each and every clinician needs to find the best research to support their practice but how is this possible when it’s now appreciated that Random Controlled Trials do not eliminate bias?”

Professor Bearn was more optimistic about the value of random prospective trials, believing that study design is challenging but critical. He also maintained that Cochrane Reviews set the bar high and eliminate commercial bias. “The challenge in the next 10 years is for us to design and deliver RCTs that can answer bigger questions.” While Professor Ruf praised observational data, Professor Bearn said that collaborative research such as the work undertaken by Professor Ireland and colleagues is the way forward.

An eagerly awaited highlight of the conference was Nigel Harradine’s talk “40 years in orthodontics, what has changed?” He identified some landmark innovations which had moved the science and practice of orthodontics forward but which had frequently been scorned when first advocated.. Sometimes early versions of a new product or concept were not fully convincing, at other times, orthodontists didn’t want to leave their comfort zone and current skill set.

“For example, the biggest change in orthodontic archwires has been the introduction of nickel titanium archwires. However, they were not an instant wonder, having a high breakage rate initially and being considered expensive,” he said, “and no RCT has shown them to be better than other archwires, but I bet everyone in this room uses them because they know they are better.” He urged his audience “not to be imprisoned by your competence” but to be open to change.

Digital Technology is another area where research is slow to catch up with innovation. The three speakers in the Great Digital Debate were Asif Chatoo, Lars Christensen and Bjorn Ludwig. Dr Chatoo told his audience that there were times when it was necessary to trust your experience as an orthodontist. Safe in the knowledge that you could not do harm, you should be ready to provide your patients with new treatments that you know to be effective.

In her talk “Tooth Eruption: One step forward in order to be seen” Karin Becktor made a passionate defence of specialist training and all it represents. She opened by saying that the specialty of orthodontics was under threat. Tooth eruption and cranio-facial growth was a hot topic, she said. “I think we should be taking a step forward as a specialty, defining ourselves as specialists in biologically driven orthodontics and not just teeth-straightening.”

Professor Dirk Wiechmann, an orthodontist from Bad-Essen in Germany with the biggest lingual practice in the world, delivered the Northcroft Memorial Lecture. His approach was respectful, acknowledging that to be invited to deliver the Northcroft lecture was a very great honour. His talk, Quality or Compromise, the fork in the road, picked up from the theme explored by Nigel Harradine – that it was very easy to operate well in a comfort zone. But to be a specialist, he argued, means avoiding the route of compromise and seeking out quality. He presented interesting research to support his argument and chided the previous speaker, an Invisalign champion, for suggesting it was possible to achieve torque in Class III cases. “Torque is much more a movement of the root than the incisor edge,” he said. He presented pictures to demonstrate his successful use of lingual braces with Herbst appliances.

Retention was another important theme with both Professor Sabine Ruf and Simon Littlewood, the BOS authority on orthodontic retention, speaking in a combined session. The conference was also the opportunity for BOS to launch its retention campaign - Hold that Smile, supported by a video and animation.

Other speakers who impressed included:

  • the irrepressible Chris Chang, renowned for his generosity in publishing his research and superb clinical cases on open forums but always worth seeing in person
  • Peter Huntley on the role of the third molar which he argued can be retained and used for anchorage
  • Michael Chasklalson, the country’s leading authority on mindfulness, who induced a state of meditation among hundreds of delegates in the main auditorium
  • Stefano Troiano, who spoke on orthodontic finishing and was also one of the leading lights on the Orthodontic Technicians’ Association programme
  • John Scholey, also delivering superb cases and discussing the boundary between orthodontic and surgical treatment.
  • A double act of Trevor Hodge and Professor Toru Inami speaking in the lingual session
  • The academic rising stars, Julie Williams, Sarah Bell and Jennifer Galloway, showcasing the future of orthodontic research

Next year’s BOC is in London from the 27th-29th September and key speakers have already been lined up.

Author: Caroline Holland

 

Posted by Gemma

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