Evidence-based practice and the evidence pyramid: A 21st century orthodontic odyssey

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Organized evidence-based practice is said to have started in the medical field in the late 20th century. Its principles and usage eventually spread to other health sciences, including orthodontics. Although the conceptual foundations and basic tenets of evidence-based orthodontics are based on the classical approach of testing medical interventions, differences unravel as we encounter the ground realities in orthodontics, which are unique due to the length, complexity, and diversity involved in orthodontic treatment and research. How has this led to the evolution of evidence-based orthodontics and changes in its applications? Is it being translated to better clinical answers, treatment strategies, patient satisfaction, and information for orthodontists? What more needs to be done, considering the rapidly changing orthodontic scenario? This article aims to explore these questions to evaluate how evidence-based orthodontics has played itself out so far, so that it can continue to grow strong and stand up to the challenges of 21st century orthodontics.HighlightsEvolution of evidence-based practice in response to unique issues in Orthodontics is a necessity.Classical evidence pyramid variants, may provide solutions relevant to the field of Orthodontics.Quality refinement and standardization of primary research will strengthen evidence base.Pre-appraised, easily accessible formats of evidence enhance usability and clinical application.Symbiotic “evidence” and “expert” aligned with patients' values or preference ensure best care.

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