Abstract
An 11-year-old girl visited her general dentist for a routine check up. Upon clinical and radiographic examination, no signs of dental caries were observed, but the dentist noticed that her maxillary canines may have been impacted and referred the patient to the or -thodontist. After clinical and radiographic examina-tion, the orthodontist concluded that the teeth were palatally displaced and needed to make a decision for a course of action. The orthodontist suggested extracting the deciduous canines. The parents were hesitant and wanted to wait for the deciduous teeth to exfoliate and the permanent teeth to erupt. The or-thodontist then decided to look into published litera -ture for the best evidence available for the treatment of impacted canines. The orthodontist decided to use the five steps of Evidence-based practice: Ask, Ac-quire, Appraise, Apply and Assess (Table 1). » Ask a focused question: Use the PICOT (Popu-lation, Intervention, Comparison, Outcome, Time) acronym to create a focused question. The clinical question was: In an 11-year-old female patient with suspected palatally displaced maxillary canines, does the extraction of the deciduous canine, compared to no treatment or watchful waiting, result in successful eruption of canines after 4 years? » Acquire the evidence: The orthodontist performed a “Narrow scope” search in Pubmed Clinical Queries
Highlights
» Ask a focused question: Use the PICOT (Population, Intervention, Comparison, Outcome, Time) acronym to create a focused question
The cohort study, does have a comparison group, but the decision on whether to extract or not the deciduous canines was based on the clinician’s preference and may be biased if the reasons for providing treatment were based on better prognosis, for instance
Were participants allocated appropriately to groups? If a trial, were they randomized? If randomized, was allocation concealed? Did participants remain in the groups they were initially allocated to? Were completeness of follow-up, compliance, contamination and co-intervention acceptable? Were outcome assessors unaware if participants were in exposure or comparison groups (Blinding)? And/or Were outcomes objectively measured? Were intention-to-treat analyses done? If exposure and comparison groups were not similar at baseline, was this adjusted for the analyses? Were estimates of intervention effects correctly calculated? Were measures of the amount of random error in estimates of intervention effects correctly calculated?
Summary
4 years the PICOT question (tooth impaction, canines, extraction). Of the studies retrieved in the search, the orthodontist selected three. After 4 years, they assessed how many patients in each group had erupted permanent canines. Patients were randomly allocated by the investigators to have deciduous canines extracted or to have no treatment at all; patients were followed up for 4 years. The cohort study, does have a comparison group, but the decision on whether to extract or not the deciduous canines was based on the clinician’s preference and may be biased if the reasons for providing treatment were based on better prognosis, for instance. When the permanent canine showed impairment or no change in its position at the 12-month follow-up examination, combined therapy associating surgical exposure and orthodontic treatment was performed, regardless of the group to which the patient belonged (14 teeth from the extraction group and 27 in the control group). The orthodontist pondered what lessons were learned that could be incorporated into practice so as to make a better
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