The timely and thoughtful editorial by Dr Turpin sheds light on challenges encountered by orthodontic journal editors and reviewers when appraising the design, conduct, and reporting of research to facilitate the assessment of the study’s quality. Progress has certainly been made with the AJO-DO ‘s adoption of the Consolidated Standards of Reporting Trials (CONSORT) statement to promote transparency and reporting quality of randomized controlled trials. This is critical because high-quality randomized controlled trials contribute greatly to the strength of a body of evidence assessed in systematic reviews, informing decisions by practitioners and practice guidelines. As Dr Turpin noted, adoption of the CONSORT does not guarantee compliance; I argue further that relying on this approach may enable a false sense of security to reviewers and readers, that good reporting is sufficient for meeting methodologic quality standards, including a low risk of bias. Transparent reporting would, for example, fail to safeguard against recognizing important risks of bias such as selective outcome reporting by trial authors (ie, preferential reporting of beneficial results) who have failed to document their primary outcomes and analyses in an a priori fashion. Another bias that is fundamental to determining the strength of a body of evidence is publication bias, whereby studies having large beneficial effect sizes are published sooner and in journals with higher impacts. These biases have been shown to overestimate the magnitude of the treatment effects of the clinical trials and can skew the overall conclusions in meta-analyses. The most effective and efficient way to detect either of them is to review the trial registries.

To optimize methodologic quality assessment, promote submissions of clinical trials having a low risk of bias, and assist systematic review authors in the dental field in assessing publication bias, I urge the AJO-DO to consider the recommendations of the International Committee of Medical Journal Editors by implementing mandatory trial registration. This action was taken 10 years ago by 11 leading medical journals, lately by over 300 medical journals and recently by a leading dental journal. It was recently reported that only 23% of the randomized controlled trials published in 15 dental journals were registered.

Although Dr Turpin’s stated concern of the challenge of conflicts of interest is appreciated, given the nature of orthodontic interventions, I suggest that bias should be considered the main challenge encountered and in need of more reflection.