Similar to what we have seen with the ebb and flow of orthodontic products or techniques over the years, available methods of clinical investigation also follow cyclical curves of enthusiasm and disappointment. The usual rise in enthusiasm initially starts slowly; then there is an increase in interest followed by a period when “reality” sets in, and an adequate place for the product or technique in the clinical or methodological armamentarium of the orthodontist-researcher is determined.
After the widespread, and occasionally improper, use of “evidence-based dentistry,” Dr Pandis has been influenced most probably by the persistence of the high level of enthusiasm for certain investigative methods that put greater emphasis on statistical significance and much less on clinical utility. However, Fleming and Johal in a recent systematic review indicated that even the methodological efforts of Dr Pandis in his own orthodontic clinical investigations are associated with a medium to high risk of bias.
Regarding points 1 through 3, Dr Pandis might not be aware of the difficulties pertaining to conducting clinical studies of outcomes of Class III treatment, particularly in white populations. The prevalence of this type of malocclusion in white people is low (∼1%-2%). There also is a virtual lack of longitudinal data on a large number of untreated white Class III controls (with the main exception of those that our research group has collected during the last 2 decades).
Regarding points 4 and 6, the power calculation was performed with specific regard to the comparisons between treated and control subjects. The comparison with respect to the use of the quad-helix is a secondary, minor issue in the article, since the results remain scarcely significant clinically.
Regarding points 5 and 7, it appears that Dr Pandis has a problem with cephalometric studies and cephalometrics in general. We also are well aware of the limitations of the cephalometric method. Our research group has published an extensive series of nonconventional morphometric studies, with some specific examples of Class III treatment (thin-plate spline analysis and so on). However, while we wait for the expected revolution in the evaluation of treatment outcomes (3D?), the analysis of cephalometric films still can provide useful information.
Finally, some concerns expressed in the commentary by Dr Pandis might have been understandable if the conclusion of our study had been that therapy with the light-force chincup was recommended. On the contrary, in several parts of the article, we made it clear that the inconsistency and the limited amount of dentoskeletal change induced by this treatment regimen did not indicate that it would be a first-choice treatment approach in Class III patients. The reader is left to evaluate our article on the basis of its own merits and limitations.