Sir William Osler, considered the father of modern medicine, described the practice of medicine as “a science of uncertainty and an art of probability.” Evidence-based orthodontics reduces uncertainty in the decision-making process by promoting the generation, accessibility, and implementation of good-quality evidence, and it increases the probability of a successful outcome by integrating this evidence with the orthodontist’s clinical expertise and the patient’s treatment needs and preferences.
Mulimani, in her July 2017 editorial (Mulinani PS. Evidence-based practice and the evidence pyramid: a 21st century orthodontic odyssey. Am J Orthod Dentofacial Orthop 2017;152:1-8), suggested that evidence-based orthodontics must develop new approaches to improve the quality of orthodontic evidence. To design valid and useful clinical trials, the fundamental question is “which treatment in a real-world setting has the highest probability of being more beneficial for the least cost and inconvenience to both patient and provider?” Therefore, the selection of an appropriate outcome measure is a key element that affects the ultimate value of results from clinical studies.
The purpose of patient-centered clinical practice is “to improve the health outcomes for individual patients, within the context of everyday clinical practice, taking into account the objectives, preferences, and values of each patient, as well as the available economic resources.” Use of dental, skeletal, and biomarker changes produced by an intervention do not provide information about their economic, social, psychological, and emotional impact in the patient. Considering the patient as a key stakeholder in the decision-making process must be the basis of patient-centered orthodontics.
Continuous use of patient-reported outcome measures can help patients and clinicians make better decisions. The use of “surrogate outcome measures” only provides an incomplete representation of the treatment outcome in relation to its success. Likewise, to achieve better homogeneity in outcomes measured across studies, O’Brien suggested the need for the development of a “core outcome set.”
The integration of evidence-based orthodontics with appropriate patient-reported outcome measures should allow us to move toward patient-centered orthodontics. It is not possible to practice patient-centered orthodontics not based on evidence, nor is it possible to practice evidence-based orthodontics without considering the individual patient. The approaches complement each other; thus, both are necessary.