Papers on the application of evidence-based medicine in orthodontics

1 Overview of evidence-based orthodontics

Evidence-based medicine It is a problem-based medical education model. Compared with the traditional medical education model, evidence-based medicine pays more attention to the cultivation of innovation ability and lifelong self-learning ability. It takes solving practical clinical problems as the starting point and proposes a set of problems discovered in clinical practice. , search for the best existing evidence, evaluate and comprehensively analyze the evidence and application results to guide the theory and methods of disease diagnosis, treatment and prognosis. As an important branch of evidence-based medicine, evidence-based orthodontics aims to apply the principles and methods of evidence-based medicine to the field of orthodontics and guide the clinical practice of orthodontists, emphasizing both clinical experience and the use of the best practices. Based on the best research, only by perfectly combining experience and evidence can we continue to provide more effective and safer correction methods for patients with malocclusions. For example, how to choose between tooth extraction and non-extraction correction during orthodontic treatment? Should skeletal Class II malocclusions in adolescents be treated with growth modification, fixed orthodontics, or surgical treatment in adulthood? What is the relationship between orthodontic treatment and temporomandibular joint disease and periodontal disease? These are clinical issues that orthodontists face every day. On the one hand, the choice of treatment plan depends on the analysis of the patient's clinical data, such as models and cephalometric analysis; on the other hand, it must be combined with the patient's subjective wishes and the doctor's clinical experience. However, these factors may produce certain biases and lack scientific verification. Only by conducting randomized clinical controlled experiments under feasible conditions and then making a systematic evaluation can the conclusions drawn and the correction plan formulated be relatively scientific and effective. Finding the most valuable evidence in the vast sea of ??information, judging the authenticity and quality of the evidence, and formulating appropriate treatment plans for patients based on this is the only way for postgraduates with a degree in orthodontics to cultivate their independent thinking and innovative thinking abilities. , and evidence-based orthodontics provides us with a new clinical teaching concept that can effectively guide students to solve clinical problems in order to provide high-quality medical services.

2. Characteristics of postgraduate training for orthodontic degree

Orthodontics is an oral medicine clinical discipline that studies the etiology, diagnosis, analysis and preventive treatment of malocclusions. It is a recent Stomatology has been one of the most dynamic disciplines in the past 30 years, with relative independence and particularity. In the undergraduate study stage of oral medicine, the orthodontic course has few hours, and the teaching content is mainly the theory and application of specific treatment techniques. The experimental teaching has less connection with theory and clinical practice, and clinical internships are generally not arranged. Therefore, it is unlikely for undergraduate students to master the treatment of orthodontic malocclusion cases and be able to independently carry out routine clinical work. They need to further study orthodontics through further education or postgraduate education after graduation, mainly through Postgraduate education develops clinical and basic research capabilities in orthodontics. In 2009, in order to change the traditional graduate training model based on theoretical knowledge, the country adjusted the enrollment structure of master's degree students and increased the enrollment ratio of professional master's degree students. The purpose is to cultivate more high-level applied talents to adapt to society. need. Orthodontics is a highly practical discipline that requires high clinical abilities. The training goal of graduate students with a professional degree in orthodontics is to cultivate orthodontic professionals with clinical practical work ability, innovative thinking ability and analytical problem-solving ability. In this context, only by adopting new learning methods and introducing an evidence-based medical education model can we cultivate qualified graduate students with a professional degree in orthodontics and continuously promote the sustainable development of orthodontic clinical professionals.

3 Evidence-based Orthodontic Education Model under the New Learning Method

The new learning method emphasizes independent learning, cooperative learning and inquiry learning. Independent learning is the foundation, and true cooperative learning And inquiry learning must also be independent learning. The way of thinking of evidence-based medicine can be summarized as follows:

(1) Based on the patient’s medical history, physical signs, and various auxiliary examinations, problems that need to be solved related to the diagnosis, treatment, and prognosis of the disease are raised;

(2) Search existing relevant evidence as needed to solve the problem;

(3) Strictly evaluate the authenticity and authenticity of the research evidence according to the principles of clinical epidemiology and evidence-based medicine evaluation of literature. Clinical value;

(4) Use research evidence combined with clinical expertise and patient selection to guide medical decisions;

(5) Conduct a comprehensive evaluation of the above measures. The evidence-based medicine way of thinking can fully mobilize students' enthusiasm and initiative, allowing students to truly become the subject, protagonist and master of learning, break away from passive acceptance, and think about problems proactively and logically. For graduate students with a professional degree in orthodontics, under the new learning method, the evidence-based orthodontic education model can follow the following steps.

3.1 Raise clinical questions

The instructor asks clear questions based on clinical cases, for example, will functional correction cause damage to the temporomandibular joint and cause temporomandibular joint disorder? When it comes to the evidence-based practice process, asking the right questions can be the most difficult. A good question usually follows the PICO principle.

P (Patient) refers to the patient, we need to clarify the specific patient group to be studied; I (Intervention) refers to clinical intervention, what diagnostic and treatment measures we take; C (Comparison) refers to clinical control, which control we compare with Comparatively evaluate the efficacy of the implemented intervention; O (Outcome) refers to the outcome selection, which clinical or laboratory indicators we use to evaluate the efficacy of the intervention. The questions raised through the PI-CO principle are very clear, which helps us search all clinical trials within a specific scope, and then derive answers to specific questions that can be applied to patients with specific conditions.

3.2 Retrieve relevant evidence

Guide graduate students to systematically search relevant literature. "FunctionalAppliances" "Orthodontic" "TemporomandibularJointDisorders". Use Pubmed, MEDLINE or Cochrane databases and Chinese full-text databases to search and establish corresponding sites.

3.3 Evaluate the evidence

Guide students to evaluate the authenticity, reliability and practicality of the obtained literature. Generally, clinical studies designed according to RCT principles are of high quality and reliable. For example, regarding the topic of "whether functional correction is a risk factor for TMD", we reviewed relevant literature, graded the level of clinical evidence, and conducted a systematic review to draw useful information and data from it, and analyzed different diagnostic criteria for TMD. The advantages and disadvantages of functional appliances and the reasons why functional appliances affect TMJ can be used to determine whether functional appliances will become a risk factor for TMD.

3.4 Formulate correction strategies

Guide students to re-integrate the information obtained, evaluate the current situation, propose corresponding countermeasures for the problems to be solved, and finally form a valuable written summary, which can be A review on a certain topic.

3.5 Guide clinical practice

Using the summarized results to guide clinical practice is the most important step in the practice of evidence-based medicine. The principle is to make the best clinical decisions based on examining the scientific nature, importance and feasibility of the evidence, combined with personal experience and patient treatment needs, which will help students broaden their clinical and scientific research ideas. In short, under the new learning method, the application of the evidence-based medical education model breaks the authoritative position of the instructor in traditional teaching, changes the previous simple "teaching-receiving" teaching model, and teaches students to actively acquire knowledge. At the same time, during case preparation, question design, participating in discussions, answering questions and other activities, tutors encourage themselves to continuously learn, consult literature, update knowledge, and receive useful inspiration from discussions with students, so as to truly achieve mutual learning through teaching.

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