Where does evidence-based medicine sit with real world (clinical) medicine - Is it time to invert the Pyramid?

Abstract

As basic orthodontic principles and proven concepts integrate with modern technologies, the time has come to re-evaluate how to report and present Evidence Based Medicine (EBM) for the betterment of clinical outcomes and patient satisfaction in Real World Settings. In the last three decades there has been an overemphasis on scientific research publications, and particularly on the results of randomized clinical trials (RCTs) which are mostly performed under idealistic research conditions in patient populations meeting stringent eligibility criteria which can lead to difficulties in applicability for daily clinical practice. Instead, true patient centered orthodontic care requires a comprehensive amalgamation of scientific and clinical data. The respect for each patient’s individual biology, specific individual autonomous self-determination, along with application of clinical common sense and clinical expertise are fundamental to improving outcomes. Only the symbiosis of scientific and clinical evidence can lead to consistent, high-level, individualized, nuanced care. This article highlights some core proposals in the hope of igniting a debate and a resurgence in clinical excellence as a primary driver for quality orthodontics. Is it therefore time to invert the hierarchy of the evidence pyramid?