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.

安氏II类错𬌗（Class II malocclusion）治疗时机的恰当指征，是正畸学实现伦理化与高效临床实践的必要前提，但临床医师往往不愿接受与其偏好的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领域的国际学术权威群体与普通临床正畸医师群体，在安氏II类错𬌗阻断性治疗（interceptive therapy）指征上的共识差异，并将二者的治疗指征与当前循证医学知识进行对比。
材料与方法：本研究向两组专家发放了包含儿童轻、中、重度安氏II类错𬌗病例照片的电子调查问卷。第一组专家（n=28）为在早期正畸治疗领域发表过世界级学术成果的国际正畸医师；第二组专家（n=261）为执业临床正畸医师。所有受试者需基于李克特5级量表（5-point Likert-type scale），为9例安氏II类错𬌗病例分别选择对应的治疗方案。
结果：第二组专家针对安氏II类错𬌗的治疗建议与第一组存在显著差异，其推荐的治疗时机平均比第一组早至少1个量表等级。第一组专家的治疗建议符合当代循证医学认知。
结论：临床正畸医师群体存在过度治疗安氏II类错𬌗的倾向，但专注于早期正畸治疗的学术型正畸医师则无此倾向。正畸医师的临床实践与科学认知之间仍存在差距。