Damon advertising is judged to breach a UK advertising code…
Damon advertising is judged to breach a UK advertising code…
I recently came across a ruling by the UK Advertising Standards Authority on Damon bracket advertising. They concluded that the evidence provided by Ormco was not adequate to demonstrate that Damon braces provided faster and less painful treatment than traditional braces.
I have cut and paste the whole ruling here for information for everyone to see and think about..I think that it is important to share this.
If anyone is asking, it was not me that raised the complaint….
A web page describing Damon dental braces, seen on www.15dental.com in December 2016, stated “Three key components, which when used together, deliver faster treatment, fewer appointments, greater comfort, and consistent high-quality results: 1. Damon passive self-ligating braces that eliminate the need for elastic or metal ‘ties’. With Damon tie-less braces you can experience treatment without tightening. 2. Light high-technology shape-memory wires that move teeth faster and require fewer adjustments. 3. A new clinically proven treatment approach that aligns your teeth and enhances your facial aesthetics-usually without extractions or rapid palatal expanders. Traditional braces … are tied in with elastics, which cause friction and pressure, making treatment slower and less comfortable. Damon braces use a slide mechanism to hold the wire, which allows teeth to move more freely, quickly and comfortably”.
The complainant, an NHS orthodontist, challenged whether the ad misleadingly implied the Damon brace system involved a faster process and one that was less painful than traditional braces.
Ormco Corporation, the manufacturer of Damon braces, replied on behalf of 15 Dental. They stated that Damon braces had been on the market for over 20 years, and they believed that their research confirmed that individuals wearing Damon braces experienced less “chairside time” (time spent in an appointment with their orthodontist) and experienced less pain compared with those wearing traditional braces. They had received a large volume of feedback from orthodontists around the world who stated that they used Damon braces because they provided quicker and less painful treatment than traditional braces.
Ormco stated that there were limitations on their ability to obtain meaningful evidence from randomised controlled clinical trials due to the nature of orthodontic treatments. They said that the majority of the evidence base in orthodontics was in vitro. They believed that a combination of in vitro and in vivo studies constituted a robust evidence base in which multiple methods complemented each other and overcame the intrinsic biases of single-method studies. Furthermore, they were of the view that claims relating to the application of braces would be seen as performance claims rather than health claims, and therefore should not be subject to the same standard of evidence under the CAP Code.
That notwithstanding, Ormco submitted a number of documents which they said supported the claims. These included clinical studies, articles, a discussion document, a survey of orthodontic practitioners and Masters theses.
The web page stated “Three key components … deliver faster treatment, fewer appointments, greater comfort”, “light high-technology shape-memory wires move teeth faster and require fewer adjustments” and “Traditional braces … are tied in with elastics, which cause friction and pressure, making treatment slower and less comfortable. Damon braces use a slide to hold the wire, which allows teeth to move more freely, quickly and comfortably”. The ASA considered that consumers were likely to understand these claims to mean that Damon braces provided faster and less painful treatment than traditional braces.
We noted Ormco’s assertion that there were difficulties associated with research into orthodontic practices and that therefore substantiation should not be based on clinical trials alone. We considered, however, that a body of evidence should include at least one independently and well-designed randomised controlled trial in order to ensure conclusions were unbiased and objective.
We reviewed the evidence submitted by Ormco. Several of the documents were unpublished Masters theses, or commercial surveys, which were not peer-reviewed. Four of the studies were conducted using models of the mouth rather than human subjects. While we acknowledged that in vitro studies could form an important part of orthodontic research and development, we did not consider that they were sufficient to support claims about the comparative performance of the braces in humans in the absence of adequate clinical trials.
Ormco provided a number of clinical trials comparing the effect of Damon and/or other self-ligating braces with traditional braces. However, many of these studies measured surrogate markers, such as microbial count or frictional forces, rather than measuring pain or rate of tooth movement directly as referenced by the claims in the ad. While several of the studies reported faster treatment times or reduced pain for participants using self-ligating braces compared to those using conventional braces, they all exhibited methodological issues. These included potential sample selection bias (in that participants were selected retrospectively from among the authors’ patients), per-protocol analysis of comparative results, conclusions drawn from one population subgroup, reporting errors and a lack of randomisation in treatment allocation. While single-blinding would be appropriate in this instance, none of the trials were blinded.
Given the above, we considered that the evidence provided by Ormco was not adequate to demonstrate that Damon braces provided faster and less painful treatment than traditional braces. We concluded that the claims had not been substantiated and were therefore misleading.
The ad breached CAP Code (Edition 12) rules 3.1 (Misleading advertising), 3.7 (Substantiation), 3.33 (Comparisons with identifiable competitors) and 12.1 (Medicines, medical devices, health-related products and beauty products).
The ad must not appear again in its current form. We told 15 Dental not to claim that Damon braces provided faster or less painful treatment than traditional braces in the absence of sufficient evidence to substantiate this.
The ruling can be found here https://www.asa.org.uk/rulings/15-dental-a16-365575.html
Emeritus Professor of Orthodontics, University of Manchester, UK.