Do orthodontists recommend Class II treatment according to evidence-based knowledge?

AbstractIntroductionThe adequate indications for the timing of treatment for Class II malocclusion are mandatory for the ethical and efficient practice of orthodontics, but clinicians are reluctant to accept new information that contradicts their preferred method of treatment.ObjectiveThe aim of this investigation was to assess the agreement regarding the indications for Class II malocclusion interceptive therapy between a group of international opinion-makers on early treatment and a group of orthodontists and to compare their treatment indications with the current evidence-based knowledge.Material and methodAn electronic survey containing photographs of mild, moderate and severe Class II malocclusions in children was sent to two panels of experts. Panel 1 (n=28) was composed of international orthodontists who had authored world-class publications on early orthodontic treatment, and Panel 2 (n=261) was composed of clinical orthodontists. Based on a 5-point Likert-type scale, the orthodontists selected their therapy option for each of the 9 Class II malocclusion cases.ResultThe Class II malocclusion treatment recommendations of Panel 2 were significantly different from those offered by Panel 1 with a skew of at least 1 scale point toward earlier treatment. The Class II malocclusion treatment recommendations of the members of Panel 1 members were in accordance with contemporary evidence-based knowledge.ConclusionClass II malocclusion overtreatment appears to be the tendency among clinical orthodontists but not among orthodontists who are academically involved with early treatment. There is a gap between the scientific knowledge and the practices of orthodontists.

摘要及引言：安氏II类错𬌗畸形（Class II malocclusion）治疗时机的适宜适应证，是正畸临床实践遵循伦理原则并实现高效诊疗的必要条件，但临床医师往往不愿接受与其既定治疗方案相悖的新认知。
研究目的：本研究旨在评估早期正畸治疗国际权威专家与普通正畸医师群体，在安氏II类错𬌗畸形阻断性治疗（interceptive therapy）适应证上的共识程度，并将两类群体的治疗适应证与当前循证医学知识进行对比。
材料与方法：本研究向两组专家群体发放包含儿童轻、中、重度安氏II类错𬌗畸形照片的电子问卷。专家组1（n=28）由在早期正畸治疗领域发表过国际顶尖学术成果的正畸医师组成；专家组2（n=261）为临床在岗正畸医师。参与者需基于5级李克特量表（5-point Likert-type scale），为9例安氏II类错𬌗畸形病例分别选择治疗方案。
结果：专家组2提出的安氏II类错𬌗畸形治疗建议与专家组1存在显著差异，其推荐的治疗时机平均早于专家组1至少1个量表等级。专家组1的治疗建议与当前循证医学知识相符。
结论：临床在岗正畸医师群体存在过度治疗安氏II类错𬌗畸形的倾向，但专注于早期正畸治疗的学术型正畸医师则无此倾向。正畸临床实践与科学认知之间仍存在一定差距。