Fact-checking some KOLs…
The buzzword at the moment is fact-check. So I thought that I would do this for two recent Key Opinion Leaders lectures from the Henry Schein webinars site. It was interesting!
One of the consequences of the pandemic is the availability of online lectures. I came across the HSO webinar website and watched two classes by their most prominent KOLs. As a result, I decided to be as objective as possible, and fact check their presentations against recently published research (or lack of research).
These are the recently published papers on the subject of the lectures. I have reviewed these on my blog and I have added my comments on the papers.
This paper was significantly flawed because they excluded cases whose treatment lasted too long, and they included a historical control group.
The flaws in this paper were that there was no control, and the study was confined to successfully treated patients.
This study was retrospective, and the patients were treated by three different operators with no data on the distribution of patients between the operators.
To be honest, if I had refereed these papers, I would have strongly recommended that they should be rejected. However, when we look at them, we must assume that they are the best that we have got. Furthermore, any biases may be towards the positive. Importantly, all the papers were published before these presentations. As a result, there should be no reason why the KOLs did not refer to them.
The Lectures and claims
I got the lectures from the HSO webinar website.
First up was Dr Dave Paquette. His presentation was:
A member of the HSO staff introduced the lecture. She told us that Dave was passionate about the education and science of orthodontics. Dave is the major KOL for HSO. Details of his yearly payments are on Open Payments.
This is the lecture preamble;
“Dr Dave Paquette is charting new territory with the ground-breaking SAGITTAL FIRST ™ Philosophy of correcting the Class II or Class III malocclusion at the beginning of treatment when patients are most compliant. It provides greater efficiencies, shorter treatment times, and long-term aesthetics results with minimal extractions.
“Dr Paquette will show you how to integrate the Carriere® MOTION 3D™ Appliance to correct the AP, reposition the mandible, and expand the airway while achieving average treatment times of 12 months or less. His clinical results will challenge your views on the traditional practice workflow”.
Anyway, what was the lecture about?
This lecture and questions were just under two hours long. He started with a lengthy discussion about the way that the “philosophy” enables same-day starts. I think that this is because it is easy and quick to bond a Carriere Motion appliance. I do not really understand this concept, but it may explain something that I am missing?
These were the claims he made;
Sagittal First corrects the A-P relationship early. This enables most treatment to start from a dental Class I relationship. The usual correction is done in 2-4 months.
Fact check: The mean times for A-P correction reported in the papers were:
Kim (5.2 months, 95% CI=4.2-6.1), Areeponga (4.9 months) and Yin (6.3 months, 95% CI= 5.2-7.3). None of these papers included 2-4 months in the 95% Confidence Intervals.
The use of this technique resulted in a 50% reduction in treatment time and a 75% reduction in chair time.
Fact check: Treatment time from Kim was 18.2 months (95% CI=16.5-19.8) and Yin reported 32 months (28.4-36.8). There is no published research on chair time.
He then showed some case reports. He stated that he informs patients that their treatment will be completed in a year. The intervals between treatment visits are shorter.
Fact check: I could not find any published research on intervals between treatment visits.
He also mentioned that the Motion re-positions the mandible. I am not sure what this means. Unless he means posture the mandible forwards? There is no proof that the Motion appliance produces more or less skeletal change than any other flexible Class II corrector.
He then moved onto Carriere self-ligating brackets.
They are better engineered than other brackets. This leads to better force distribution, leading to better predictability and reduced treatment times.
He mentioned two papers, one in the EJO and the other in the Angle. I think that I found these papers. They were both in vitro studies, and they generally showed that the Carriere bracket was nothing special. Specifically, it is just a passive self-ligating bracket. There is no clinical evidence suggesting benefit in terms of treatment duration or outcome over those achieved with conventional brackets.
He is the inventor of the Carriere Motion and the new self-ligating bracket. As he is based in the EU, there are no details of any funds he may receive as a KOL.
The aims of the webinar were:
- The benefits of correcting the AP at the beginning of treatment, before placing the brackets or aligners
- The benefits of the SAGITTAL FIRST Philosophy and SLX 3D passive self-ligation brackets and the new M-Series wires
- How to achieve average treatment times of 12 months or less progressive technologies and a minimal-touch, high-efficiency workflow.
This was a lengthy presentation based around a few case reports. The main aim of his treatment philosophy was to simplify treatment.
We can reduce treatment time by increasing the intervals between appointments. This is opposite to Dr Paquette’s suggestion?
See above on treatment time.
The Carriere Motion repositions the mandible forwards. Again, this concept of “re-positioning the mandible”.
Fact check: No evidence
It improves the airway.
Fact check: No evidence
It moves the condyle forwards and corrects TMD.
Fact check: No evidence
What did I think?
To be honest, I was surprised at the information that they presented, as nearly all their claims were not supported by research evidence. I also found this more concerning when we consider that they were aware of recent research publications.
This was also very similar to the self-ligating presentations that I saw many years ago. We know what happened there!
Finally, while it may currently be acceptable for politicians to be “economical with the truth”. Fortunately, this is not the case for clinicians, as we are bound by a code of ethics. As a result, I am genuinely concerned with the claims being made by these two KOLs. Perhaps, I have missed something here and misinterpreted their presentations. I am happy to let them have a blog post to state their case in the spirit of transparency and debate. Let’s have a good discussion about their approach in the comments section of this post?
Emeritus Professor of Orthodontics, University of Manchester, UK.