Home > Research > Cranio-facial & Oral-health Evidence-based Practice Group (COEPG)

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One of the current lines of research in our program is evidence-based dentistry. It is amazing to realize that a large part of our current knowledge in dentistry is empirical and circumstantial. Following the trend initiated in medicine years ago, a progressive number of new evidence-based reviews continue to appear in orthodontic literature.

In the last 30 years an exponential amount of information has become available in every field of human knowledge. The practice of health care has not escaped this phenomenon. Evidence-based decision making is an emerging concept developed to deal with all this plethora of new knowledge.

Nowadays, as in any usual clinical environment clinicians will need to rely on their clinical experience, experts' opinions, and the limited available evidence to make their treatment decisions. Therefore the application of evidence into clinical practice has to be related to professional expertise and patient value needs. A combination of values (clinical, personal and social) is required and needs to be analyzed before making the procedure selection, to determine if the benefits are worth the costs of the intervention.  The evidence-based practice concept arose with an aim to provide the best possible treatment based on sound evidence. 

There are different levels of evidence. The highest level is represented by the randomized controlled trials, then the non-randomized controlled trials or quasi-experimental studies, then non-experimental descriptive studies, and finally expert opinions. In the absence of the highest level of evidence, clinicians have to make decisions based on lower levels of evidence. Because lower levels of evidence are more prone to confounding and selection bias, a careful analysis of their results considering their limitations is therefore required.

Systematic reviews (if possible meta-analysis) arose as reviews of the literature about specific topics that have been prepared using a systematic approach to minimize biases and random errors. 

COEPG has already published a number of systematic reviews and meta-analyses:

1. Korayem M, Flores-Mir C, Nassar U, Olfert K. Implant site development by orthodontic extrusion. Angle Orthod 2008 Jul;78(4):752-60.
2. Barnett GA, Higgins DW, Major PW, Flores-Mir C. Immediate skeletal and dentoalveolar effects of the crown- or banded type Herbst appliance on Class II division 1 malocclusion. Angle Orthod 2008 Mar;78(2):361-9. 
3. Hussain AM, Pakota G, Major PW, Flores-Mr C. Role of different imaging modalities in assessment of temporomandibular joint erosions and osteophytes: a systematic review.  Dentomaxillofacial Radiol 2008 Feb;37(2):63-71.
4. Rappoport K, Muller R, Flores-Mir C. Dental and skeletal changes during pressure garment use in facial burns: a systematic review. Burns. 2008 Jul;78(4):752-60. [Epub ahead of print 2007 Oct 4]
5. Major MP, Major PW, Flores-Mir C. Benchmarking of reported search and selection methods of systematic reviews by dental speciality. Evid Based Dent 2007;8(3):66-70.
6. Armijo-Olivo S, Gadotti I, Kornerup M, Lagravère MO, Flores-Mir C. Quality of reporting masticatory muscle electromyography in 2004: a systematic review. J Oral Rehabil 2007;Jun;34(6):397-405.
7. Lou L, Lagravère MO, Major PW, Compton S, Flores-Mir C.  Accuracy of measurements and reliability of landmark identification with computed tomography (CT) techniques in the maxillofacial area: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;Sep;104(3):402-11.
8. Flores-Mir C, Ayeh A, Goswani A, Charkhandeh S.  Skeletal and dental changes in Class II division 1 malocclusions treated with splint-type Herbst appliances: a systematic review. Angle Orthod 2007;Mar;77(2):376-81.
9. Armijo Olivo S, Magee DJ, Parfitt M, Major P, Thie NM. The association bhetween the cervical spine, the stomatognathic system, and craniofacial pain: a critical reivew. J Orofac Pain 2006;Fall;20(4):271-87.
10. Major MP, Flores-Mir C, Major PW. Assessment of lateral cephalometric diagnosis of adenoid hypertrophy and posterior upper airway obstruction: a systematic review. Am J Orthod Dentofacial Orthop. 2006 Dec;130(6):700-8.
11. Ng J, Major PW, Flores-Mir C. True molar intrusion attained during orthodontic treatment: a systematic review. Am J Orthod Dentofacial Orthop. 2006 Dec;130(6):709-14.
12. Flores-Mir C, Major PW. A systematic review of cephalometric facial soft tissue changes with the Activator and Bionator appliances in Class II Division 1 subjects. Eur J Orthod 2006;Dec;28(6):586-93.
13. Major MP, Major PW, Flores-Mir C. An evaluation of search and selection methods used in dental systematic reviews published in English. J Am Dent Assoc 2006;Sep;137(9):1252-1257. 
14. Major MP, Major PW, Flores-Mir C. Search and selection methodology of systematic reviews in orthodontics (2000-2004). Am J Orthod Dentofacial Orthop 2006;Aug;130(2):214-217.
15. Flores-Mir C, Major PW. Cephalometric facial soft tissue changes with the Twin Block appliance in Class II Division 1 malocclusion patients. Angle Orthop 2006;76(5):876-881. 
16. Orellana MF, Major PW, Lagravère M, Boychuk DG, Flores-Mir C. Prevalence of xerostomia in population-based samples: a systematic review. J Public Health Dent 2006;66(2):152-158.
17. Lagravère Mo, Major PW, Flores-Mir C. Dental and skeletal changes following surgically assisted rapid maxillary expansion. Int J Oral M Surg 2006 Jun;35(6):481-87. 
18. Oshasi E, Pecho O, Moron M, Lagravère MO. Implant vs. screw loading protocols in orthodontics. A systematic review. Angle Orthod 2006;76:721-727. Epub 2006 March 1.
19. Flores-Mir C, Major MP, Major PW. Soft tissue changes with fixed functional appliances in Class II division I cases: a systematic review. Angle Orthod 2006;76(4):712-720. Epub 2006 March 1.
20. Olivo SA, Bravo J, Magee DJ, Thie NMR, Major PW, Flores-Mir C. The association between head and cervical posture with  intra-articular and muscular temporomandibular disorders: a systematic review. J Orofac Pain 2006; 20:9-23.
21. Lagravère MO, Heo G, Major PW, Flores-Mir C. Meta-analysis on immediate changes with rapid maxillary expansion treatments J Am Dent Assoc 2006;137:44-53.
22. Lagravère MO, Flores-Mir C. The treatment effects of Invisalign orthodontic aligners: a systematic review. J Am Dent Assoc 2005;136:1724-1729.
23. Ng J, Major PW, Heo G, Flores-Mir C. True incisor intrusion attained during orthodontic treatment: a systematic review and meta-analysis. Am J Orthod Dentofac Orthop 2005;128:212-9.
24. Lagravère MO, Major PW, Flores-Mir C. Long-term skeletal changes with rapid maxillary expansion treatments: a systematic review. Angle Orthod 2005 Nov;75:1046-52. Epub 2005 June 27.
25. Lagravère MO, Major PW, Flores-Mir C. Long-term dental arch changes after rapid maxillary expansion treatment: a systematic review. Angle Orthod  2005 Mar;75:155-161.
26. Lagravère MO, Major PW, Flores-Mir C. Skeletal and dental changes with fixed slow maxillary expansion treatment: a systematic review. J Am Dent Assoc  2005;136:194-199.
27. Flores-Mir C, Nebbe B, Major PW. Use of skeletal maturation based on hand-wrist radiographic analysis as a predictor of facial growth velocity:  a systematic review. Angle Orthod 2004; 74: 118-124.
28. Major PW, Grubisa HS, Thie NM. Triptans for treatment of acute pediatric migraine: a systematic literature review. Pediatr Neurol 2003; 29: 425-9.
29. Popowich K, Nebbe B, Major PW. Effect of Herbst treatment on temporomandibular joint morphology: a systematic literature review. Am J Orthod Dentofacial Orthop 2003; 123: 388-94.
30. Kersey ML, Nebbe B, Major PW. Temporomandibular joint morphology changes with mandibular advancement surgery and rigid internal fixation: a systematic literature review. Angle Orthod 2003; 73: 79-85.
31. Trpkova, B, Major P, Prasad N, Nebbe B.  Cephalometric landmarks identification and reproducibility: a meta analysis. Am J Orthod Dentofacial Orthop 1997; 112:165-70.

Dr. Carlos Flores-Mir
Director, COEPG
Associate Professor
Orthodontic Graduate Program
Faculty of Medicine and Dentistry
University of Alberta

Mr. Michael P. Major
Member, COEPG
DMD Student
Goldman School of Dental Medicine
Boston University
Boston, USA 

Dr. Paul W. Major
Member, COEPG
Professor, Orthodontic Graduate Program
Faculty of Medicine and Dentistry
University of Alberta

Dr. Sharon M. Compton
Collaborator, COEPG
Associate Professor & Director, Dental Hygiene Program
Faculty of Medicine and Dentistry
University of Alberta

Dr. Manuel Lagravère
Collaborator, COEPG
PhD Graduate Student
Orthodontic Graduate Program
Faculty of Medicine and Dentistry
University of Alberta 

Susan Armijo Olivo
Collaborator, COEPG
PhD Graduate Student
Faculty of Rehabilitation Medicine
University of Alberta