Meta-analyses and Evidence-Based Orthodontic Practice

  • Moschos A. Papadopoulos


Evidence-based medicine has been defined by Rosenberg as the process of “systematically finding, appraising and using contemporary research as the basis for clinical practice” [1]. This definition can also be applied to dentistry and, in turn, to orthodontics [2]. According to Bader [3], “Evidence-based Dentistry is not simply a new name for an old practice. The process is designed to answer specific questions, and it includes systematic and qualitative search of all available evidence.”


Obstructive Sleep Apnea Syndrome Orthodontic Treatment Primary Dentition Source Study Mandibular Growth 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The author wish to thank the publishing houses “Wiley” and “Elsevier,” for granting permission to use various parts of the text and images from the papers entitled “Papadopoulos MA, Gkiaouris I. A critical evaluation of meta-analyses in orthodontics.Am J Orthod Dentofacial Orthop 2007;131:589–599” and “Papadopoulos MA. Meta-analysis in evidence-based orthodontics.Orthod Craniofac Res 2003;6:112–126,” respectively.


  1. 1.
    Rosenberg W, Donald A (1995) Evidence based medicine: an approach to clinical problem-solving. Br Med J 310:1122–1126CrossRefGoogle Scholar
  2. 2.
    Harrison JE (2003) Clinical trials in orthodontics II: assessment of the quality of reporting of clinical trials published in three orthodontic journals between 1989 and 1998. J Orthod 30:309–315; discussion 297–298PubMedCrossRefGoogle Scholar
  3. 3.
    Bader JD (2003) Is the term “evidence-based” a new name for an old process? First international conference on evidence-based dentistry. Atlanta, 7–9 Nov 2003Google Scholar
  4. 4.
    Oxman AD, Cook DJ, Guyatt GH (1994) Users’ guides to the medical literature. VI. How to use an overview. Evidence-Based Medicine Working Group. J Am Med Assoc 272: 1367–1371CrossRefGoogle Scholar
  5. 5.
    Greenhalgh T (1997) How to read a paper: the basis of evidence based medicine. British Medical Journal Publishing Group, LondonGoogle Scholar
  6. 6.
    Proffit WR (2000) Contemporary orthodontics. Mosby, St. LouisGoogle Scholar
  7. 7.
    Harrison JE (2000) Evidence-based orthodontics – how do I assess the evidence? J Orthod 72:189–197CrossRefGoogle Scholar
  8. 8.
    Green SB, Byar DP (1984) Using observational data from registries to compare treatments: the fallacy of omnimetrics. Stat Med 3:361–370PubMedCrossRefGoogle Scholar
  9. 9.
    O’Brien K, Craven R (1995) Pitfalls in orthodontic health service research. Br J Orthod 22:353–356PubMedGoogle Scholar
  10. 10.
    Glenny AM, Harrison JE (2003) How to interpret the orthodontic literature. J Orthod 30:159–164PubMedCrossRefGoogle Scholar
  11. 11.
    Deeks JD, Sheldon TA (1995) Guidelines for undertaking systematic reviews of effectiveness, 4th edn. York Center for Reviews and Dissemination, YorkGoogle Scholar
  12. 12.
    Guyatt GH, Sackett DL, Sinclair JC, Hayward R, Cook DC (1995) User’s guide to the medical literature: IX. A method for grading healthcare recommendations. J Am Med Assoc 274:1800–1804CrossRefGoogle Scholar
  13. 13.
    Harrison JE, Ashby D, Lennon MA (1996) An analysis of papers published in the British and European journals of Orthodontics. Br J Orthod 23:203–209PubMedGoogle Scholar
  14. 14.
    Antczac-Bouckoms A (1998) The anatomy of clinical research. Clin Orthod Res 1:75–79Google Scholar
  15. 15.
    Glass G (1976) Primary, secondary and meta-analysis of research. Educ Res 5:3–8Google Scholar
  16. 16.
    Ackerman M (2004) Evidence-based orthodontics for the 21st century. J Am Dent Assoc 135:162–167PubMedGoogle Scholar
  17. 17.
    Egger M, Davey Smith G (1997) Meta-analysis: potentials and promise. Br Med J 315:1371–1374CrossRefGoogle Scholar
  18. 18.
    Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. Br Med J 315:629–634CrossRefGoogle Scholar
  19. 19.
    Huque MF (1988) Experiences with meta-analysis in NDA submissions. Proc Biopharm Sect Am Stat Assoc 2:28–33Google Scholar
  20. 20.
    Dickersin K, Berlin JA (1992) Meta-analysis: state-of-the-science. Epidemiol Rev 14:159–176Google Scholar
  21. 21.
    Kassirer JP (1992) Clinical trials and meta-analysis. What do they do for us? N Engl J Med 327:273–274PubMedCrossRefGoogle Scholar
  22. 22.
    Cooper HM, Rosenthal R (1980) Statistical versus traditional procedures for summarizing research findings. Psychol Bull 87:442–449PubMedCrossRefGoogle Scholar
  23. 23.
    Bailar JC (1995) The practice of meta-analysis. J Clin Epidemiol 48:149–157PubMedCrossRefGoogle Scholar
  24. 24.
    Bailar JC (1997) The promise and problems of meta-analysis. N Engl J Med 337:559–561PubMedCrossRefGoogle Scholar
  25. 25.
    Cook DJ, Sackett DL, Spitzer WO (1995) Methodologic guidelines for systematic reviews of randomized control trials in health care from the Potsdam Consultation on Meta-analysis. J Clin Epidemiol 48:167–171PubMedCrossRefGoogle Scholar
  26. 26.
    Feinstein AR (1995) Meta-analysis: statistical alchemy for the 21st century. J Clin Epidemiol 48:71–79PubMedCrossRefGoogle Scholar
  27. 27.
    Slavin RE (1995) Best evidence synthesis: an intelligent alternative to meta-analysis. J Clin Epidemiol 48:9–18PubMedCrossRefGoogle Scholar
  28. 28.
    Naylor CD (1997) Meta-analysis and the meta-epidemiology of clinical research. Br Med J 315:617–619CrossRefGoogle Scholar
  29. 29.
    Editorial (1997) Meta-analysis under scrutiny. Lancet 350:675Google Scholar
  30. 30.
    Borzak S, Ridker PM (1995) Discordance between meta-analyses and large-scale randomized, controlled trials. Examples from the management of acute myocardial infarction. Ann Intern Med 123:873–877PubMedGoogle Scholar
  31. 31.
    Wolf FM (1986) Meta-analysis. Quantitative methods for research synthesis. Sage Publications, Beverly HillsGoogle Scholar
  32. 32.
    Jones DR (1992) Meta-analysis of observational epidemiological studies: a review. J R Soc Med 85:165–168PubMedGoogle Scholar
  33. 33.
    Cook T, Leviton L (1980) Reviewing the literature: a comparison of traditional methods with meta-analysis. J Pers 48:449–472CrossRefGoogle Scholar
  34. 34.
    Green B, Hall J (1984) Quantitative methods for literature review. Ann Rev Psychol 35:37–53CrossRefGoogle Scholar
  35. 35.
    Light RJ, Pillemer DB (1984) Summing Up: the science of reviewing research. Harvard University Press, CambridgeGoogle Scholar
  36. 36.
    Victor N (1995) The challenge of meta-analysis: discussion. Indications and contra-indications for meta-analysis. J Clin Epidemiol 48:5–8PubMedCrossRefGoogle Scholar
  37. 37.
    Instructions for preparing structured abstracts (1993) J Am Med Assoc271:162–164Google Scholar
  38. 38.
    Wilson A, Henry DA (1992) Meta-analysis. Part 2: assessing the quality of published meta-analyses. Med J Aust 156:173–187PubMedGoogle Scholar
  39. 39.
    Felson DT (1992) Bias in meta-analytic research. J Clin Epidemiol 45:885–892PubMedCrossRefGoogle Scholar
  40. 40.
    Easterbrook PJ, Berlin JA, Gopalan R, Matthews DR (1991) Publication bias in clinical research. Lancet 337:867–872PubMedCrossRefGoogle Scholar
  41. 41.
    Dickersin K, Min YI, Meinert CL (1992) Factors influencing publication of research results. Follow-up of applications submitted to two institutional review boards. J Am Med Assoc 267:374–378CrossRefGoogle Scholar
  42. 42.
    Stern JM, Simes RJ (1997) Publication bias: evidence of delayed publication in a cohort study of clinical research projects. Br Med J 315:640–645CrossRefGoogle Scholar
  43. 43.
    Dickersin K (1990) The existence of publication bias and risk factors for its occurrence. J Am Med Assoc 263:1385–1389CrossRefGoogle Scholar
  44. 44.
    Angell M (1989) Negative studies. N Engl J Med 321:464–466PubMedCrossRefGoogle Scholar
  45. 45.
    Cook DJ, Guyatt GH, Ryan G, Clifton J, Buckingham L, Willan A, McIlroy W, Oxman AD (1993) Should unpublished data be included in meta-analyses? Current convictions and controversies. J Am Med Assoc 269:2749–2753CrossRefGoogle Scholar
  46. 46.
    West RR (1993) A look at the statistical overview (or meta-analyses). J R Coll Physicians Lond 27:111–115PubMedGoogle Scholar
  47. 47.
    Villar J, Piaggio G, Carroli G, Donner A (1997) Factors affecting the comparability of meta-analyses and largest trials results in perinatology. J Clin Epidemiol 50:997–1002PubMedCrossRefGoogle Scholar
  48. 48.
    Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50: 1088–1101PubMedCrossRefGoogle Scholar
  49. 49.
    Dwan K, Altman DG, Arnaiz JA, Bloom J, Chan AW, Cronin E, Decullier E, Easterbrook PJ, Von Elm E, Gamble C, Ghersi D, Ioannidis JP, Simes J, Williamson PR (2008) Systematic review of the empirical evidence of study publication bias and outcome reporting bias. PLoS One 3: e3081Google Scholar
  50. 50.
    Rosenthal R (1979) The ‘file drawer problem’ and tolerance for null results. Psychol Bull 86: 638–641CrossRefGoogle Scholar
  51. 51.
    Duval S, Tweedie R (2000) Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 56: 455–463Google Scholar
  52. 52.
    Kleinbaum DG (2002) Epidemiologic methods. The “art” in the state of the art. J Clin Epidemiol 55:1196–1200PubMedCrossRefGoogle Scholar
  53. 53.
    Downs SH, Black N (1998) The feasibility of creating a checklist for the assessment of the methodological quality both of randomized and non-randomized studies of health care interventions. J Epidemiol Community Health 52: 377–384Google Scholar
  54. 54.
    Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds JM, Gavaghan DJ, McQuay HJ (1996) Assessing the quality of reports of randomized clinical trials: Is blinding necessary? Control Clin Trials 17: 1–12PubMedGoogle Scholar
  55. 55.
    Higgins JPT, Green S, editors (2011) Cochrane handbook for systematic reviews of interventions 5.1.0 (updated March 2011). Available from: PubMedGoogle Scholar
  56. 56.
    Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 62: e1–34PubMedCrossRefGoogle Scholar
  57. 57.
    Review manager (RevMan) [computer program]. Version 5.1. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration 2011; Available at PubMedCrossRefGoogle Scholar
  58. 58.
    Glass G, McGraw B, Smith ML (1981) Meta-analysis in social research. Sage Publications, Beverly HillsGoogle Scholar
  59. 59.
    Strube MJ, Hartman DP (1983) Meta-analysis: techniques, applications, and functions. J Consult Clin Psychol 51:14–27CrossRefGoogle Scholar
  60. 60.
    Cooper HM (1984) The integrative research review: a social science approach. Sage Publications, Beverly HillsGoogle Scholar
  61. 61.
    Rosenthal R (1984) Meta-analytic procedures for social research. Sage Publications, Beverly HillsGoogle Scholar
  62. 62.
    Hedges LV, Olkin I (1985) Statistical methods for meta-analysis. Academic, OrlandoGoogle Scholar
  63. 63.
    Henry DA, Wilson A (1992) Meta-analysis. Part 1: an assessment of its aims, validity and reliability. Med J Aust 156:173–187PubMedGoogle Scholar
  64. 64.
    Walter SD (1995) Methods of reporting statistical results from medical research studies. Am J Epidemiol 141:896–906PubMedGoogle Scholar
  65. 65.
    Laupacis A, Sackett DL, Roberts RS (1988) An assessment of clinically useful measures of the consequences of treatment. N Engl J Med 318:1728–1733PubMedCrossRefGoogle Scholar
  66. 66.
    Horwitz RI (1995) Large-scale randomized evidence: large, simple trials and overviews of trials: discussion a clinician’s perspective on meta-analyses. J Clin Epidemiol 48:41–44PubMedCrossRefGoogle Scholar
  67. 67.
    Higgins J, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21: 1539–1558PubMedCrossRefGoogle Scholar
  68. 68.
    L’Abbé KA, Detsky AS, O’Rourke K (1987) Meta-analysis in clinical research. Ann Intern Med 107:224–233PubMedGoogle Scholar
  69. 69.
    Beecher HK (1955) The powerful placebo. J Am Med Assoc 159:1602–1606PubMedCrossRefGoogle Scholar
  70. 70.
    Rosenthal R (1968) Experimenter expectancy and the reassuring nature of the null hypothesis decision procedure. Psychol Bull Monogr 70(Suppl):30–47Google Scholar
  71. 71.
    Rosenthal R (1969) Interpersonal expectations. In: Rosenthal R, Rosnow RL (eds) Artifact in behavioral research. Academic, New York, pp 181–277Google Scholar
  72. 72.
    Rosenthal R, Rubin DB (1978) Interpersonal expectancy effects: the first 345 studies. Behav Brain Sci 3:410–415CrossRefGoogle Scholar
  73. 73.
    Smith ML, Glass G (1977) Meta-analysis of psychotherapy outcomes. Am Psychol 32:752–760PubMedCrossRefGoogle Scholar
  74. 74.
    Clagett GP, Reisch JS (1988) Prevention of venous thromboembolism in general surgical patients. Results of meta-analysis. Ann Surg 208:227–240PubMedCrossRefGoogle Scholar
  75. 75.
    Yusuf S, Peto R, Lewis J, Collins R, Sleight P (1985) Beta blockade during and after myocardial infarction: an overview of the randomized trials. Prog Cardiovasc Dis 17:335–371CrossRefGoogle Scholar
  76. 76.
    Oldridge NB, Guyatt GH, Fisher ME, Rimm AA (1988) Cardiac rehabilitation after myocardial infarction: combined experience of randomized clinical trials. J Am Med Assoc 260:945–950CrossRefGoogle Scholar
  77. 77.
    Longnecker MP, Berlin JA, Orza MJ, Chalmers TC (1988) A meta-analysis of alcohol consumption in relation to risk of breast cancer. J Am Med Assoc 260:652–656CrossRefGoogle Scholar
  78. 78.
    Early Breast Cancer Trialists’ Collaborative Group (1988) Effects of adjuvant tamoxifen and of cytotoxic therapy on mortality in early breast cancer. An overview of 61 randomized trials among 28,896 women. N Engl J Med 319:1681–1692CrossRefGoogle Scholar
  79. 79.
    Chalmers I, Enkin M, Keirse M (1989) Effective care during pregnancy and childbirth. Oxford University Press, OxfordGoogle Scholar
  80. 80.
    Greenland S (1987) Quantitative methods in the review of epidemiologic literature. Epidemiol Rev 9:1–30PubMedGoogle Scholar
  81. 81.
    Office General Accounting (1992) Cross design synthesis: a new strategy for medical effectiveness research. G.A.O., Washington, D.CGoogle Scholar
  82. 82.
    Cross design synthesis: a new strategy for studying medical outcomes? (1992) Lancet 340:944–946Google Scholar
  83. 83.
    Tulloch JFC, Antzack AA, Tuncay OC (1989) Review of clinical research in orthodontics. Am J Orthod Dentofacial Orthop 95: 499–504PubMedGoogle Scholar
  84. 84.
    Petren S, Bondemark L, Soderfeldt B (2003) A systematic review concerning early orthodontic treatment of unilateral posterior crossbite. Angle Orthod 73:588–596PubMedGoogle Scholar
  85. 85.
    Papadopoulos MA (2003) Meta-analysis in evidence-based orthodontics. Orthod Craniofac Res 6:112–126PubMedGoogle Scholar
  86. 86.
    Popowich K, Nebbe B, Major PW (2003) Effect of Herbst treatment on temporomandibular joint morphology: a systematic literature review. Am J Orthod Dentofacial Orthop 123: 388–394PubMedCrossRefGoogle Scholar
  87. 87.
    Bergstrand F, Twetman S (2003) Evidence for the efficacy of various methods of treating white-spot lesions after debonding of fixed orthodontic appliances. J Clin Orthod 37:19–21PubMedGoogle Scholar
  88. 88.
    Ren Y, Maltha JC, Kuijpers-Jagtman AM (2003) Optimum force magnitude for orthodontic tooth movement: a systematic literature review. Angle Orthod 73:86–92PubMedGoogle Scholar
  89. 89.
    Chen JY, Will LA, Niederman R (2002) Analysis of efficacy of functional appliances on mandibular growth. Am J Orthod Dentofacial Orthop 122:470–476PubMedCrossRefGoogle Scholar
  90. 90.
    Kim MR, Graber TM, Viana MA (2002) Orthodontics and temporomandibular disorder: a meta-analysis. Am J Orthod Dentofacial Orthop 121:438–446PubMedCrossRefGoogle Scholar
  91. 91.
    Schiffman PH, Tuncay OC (2001) Maxillary expansion: a meta-analysis. Clin Orthod Res 4:86–96PubMedCrossRefGoogle Scholar
  92. 92.
    Jager A, Braumann B, Kim C, Wahner S (2001) Skeletal and dental effects of maxillary protraction in patients with angle class III malocclusion. A meta-analysis. J Orofac Orthop 62:275–284PubMedCrossRefGoogle Scholar
  93. 93.
    Nguyen QV, Bezemer PD, Habets L, Prahl-Andersen B (1999) A systematic review of the relationship between overjet size and traumatic dental injuries. Eur J Orthod 21:503–515PubMedCrossRefGoogle Scholar
  94. 94.
    Kim JH, Viana MA, Graber TM, Omerza FF, BeGole EA (1999) The effectiveness of protraction face mask therapy: a meta-analysis. Am J Orthod Dentofacial Orthop 115:675–685PubMedCrossRefGoogle Scholar
  95. 95.
    Orthlieb JD, Girardeau A, Laplanche O (1998) Occlusion and dysfunction: the paradox of dentofacial orthopedics. Orthod Fr 69:69–78PubMedGoogle Scholar
  96. 96.
    Burke SP, Silveira AM, Goldsmith LJ, Yancey JM, Van Stewart A, Scarfe WC (1998) A meta-analysis of mandibular intercanine width in treatment and post-retention. Angle Orthod 68:53–60PubMedGoogle Scholar
  97. 97.
    Trpkova B, Major P, Prasad N, Nebbe B (1997) Cephalometric landmarks identification and reproducibility: a meta analysis. Am J Orthod Dentofacial Orthop 112:165–170PubMedCrossRefGoogle Scholar
  98. 98.
    Miles PG, Vig PS, Weyant RJ, Forrest TD, Rockette HE Jr (1996) Craniofacial structure and obstructive sleep apnea syndrome–a qualitative analysis and meta-analysis of the literature. Am J Orthod Dentofacial Orthop 109:163–172PubMedCrossRefGoogle Scholar
  99. 99.
    Fox NA, McCabe JF, Buckley JG (1994) A critique of bond strength testing in orthodontics. Br J Orthod 21:33–43PubMedGoogle Scholar
  100. 100.
    Tuncay OC, Tulloch JF (1992) Apparatus criticus: methods used to evaluate growth modification in class II malocclusion. Am J Orthod Dentofacial Orthop 102:531–536PubMedCrossRefGoogle Scholar
  101. 101.
    Mills JR (1991) The effect of functional appliances on the skeletal pattern. Br J Orthod 18:267–275PubMedGoogle Scholar
  102. 102.
    Harrison JE, Ashby D (2004) Orthodontic treatment for posterior crossbites (Cochrane review). In: The Cochrane Library, vol 1. Wiley, ChichesterGoogle Scholar

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Authors and Affiliations

  1. 1.Department of OrthodonticsSchool of Dentistry, Aristotle University of ThessalonikiThessalonikiGreece

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