Effectiveness and efficiency in clinical orthodontic practice

Proffitt et al. have described “effectiveness and efficiency” (E&E) as achieving desired results without wasting the orthodontist's and patients' time. In 1972, Archibald Cochrane published a monograph entitled “Effectiveness and Efficiency,” which challenged the medical community to use medical protocols that were evidence-based. As a possible starting point for E&E, the orthodontist could consider an “Evidence-based clinical practice” (EBCP) model, which integrates the best research evidence with clinical expertise and patient values. This model considers scientific or evidence-based orthodontics (EBO) together with patient preferences and patient autonomy, clinical or patient circumstances, and clinical experience and judgment. In this paper, therefore, E&E will be discussed from an EBCP perspective which, for our purposes, includes relevant evidence but also our clinical experience and rationale. We will discuss: wire sequence; NiTi Wire types; space closure by sliding; canine retraction versus en masse retraction, 18” slot versus 22” slot, the Bidimensional System; self-ligating brackets (SL); vertical slot; economic aspects.