Practicing evidence-based Orthodontics: How to critically appraise a randomized controlled trial

An 11-year-old girl visited her general dentist for a routine check up. Upon clinical and radiographic examination, no signs of dental caries were observed, but the dentist noticed that her maxillary canines may have been impacted and referred the patient to the orthodontist. After clinical and radiographic examination, the orthodontist concluded that the teeth were palatally displaced and needed to make a decision for a course of action. The orthodontist suggested extracting the deciduous canines. The parents were hesitant and wanted to wait for the deciduous teeth to exfoliate and the permanent teeth to erupt. The orthodontist then decided to look into published literature for the best evidence available for the treatment of impacted canines. The orthodontist decided to use the five steps of Evidence-based practice: Ask, Acquire, Appraise, Apply and Assess (Table 1). » Ask a focused question: Use the PICOT (Population, Intervention, Comparison, Outcome, Time) acronym to create a focused question. The clinical question was: In an 11-year-old female patient with suspected palatally displaced maxillary canines, does the extraction of the deciduous canine, compared to no treatment or watchful waiting, result in successful eruption of canines after 4 years? » Acquire the evidence: The orthodontist performed a “Narrow scope” search in Pubmed Clinical Queries1, category “Therapy”, using some of the terms defined in