TADS are effective: The results of a trial
TADS are effective! More published evidence….
The World Cup is now moving to the final stages and I have begun the slow migration away from my television to return to the world of orthodontic research. This has allowed me to put together a blog post for this week. This is concerned with a recently published trial of temporary anchorage devices in the AJO-DDO.
Jonathan Sandler et al. North of England, UK
AJO-DDO 2014: 146: 1: 10-20
The more observant of you will have spotted that I am a co-author of the paper, and I know a lot about this study. So here is my unbiased review!
This project was carried out by Jonathan Sandler and a team from the North of England. It was a very straightforward investigation, but it took a lot of work, and Jonathan is describing it here.
We attempted to answer a simple question
“Is there a difference in the effectiveness of TADS, Nance button palatal arch and headgear”?
What did they do?
This was a three arm parallel sided randomized trial. Seventy eight patients aged 12-18 years, requiring absolute anchorage were randomized to be treated with (i) TADS, (ii) Nance palatal arch and (iii) headgear. As with all trials reported in the AJO-DDO the paper was written according to CONSORT guidelines and, therefore, it was fairly clear to read and check for quality. The randomization, blinding and concealment was good, a sample size calculation was carried out and the statistics were relevant.
The primary outcome was the amount of molar tooth movement. The secondary outcomes were the quality of the final finish result (PAR) and the patients opinions on their treatment. We collected data at the start of treatment, at the end of anchorage reinforcement and at the end of treatment.
We also measured tooth movement from 3D scans of casts that were superimposed on the palatal rugae. This allowed us to accurately measure tooth movement in three dimensions and avoid the many errors involved with cephalometric measurement.
What did they find?
When we looked at tooth movement we found that no method of anchorage reinforcement was any better than another. There were also no differences in the number of attendances and duration of treatment.
We also found that the final occlusal result of treatment was better for the TAD group when compared to headgear.
Another, and perhaps the most important finding, was that the patients reported less problems and concerns with TADS than Headgear.
What did I think?
I hope that you feel that this was a good study that answered a straightforward clinical question using relevant methods. While we found that there were no differences in the effectiveness of the methods of anchorage reinforcement, there were differences in the patient’s perceptions. The addition of this important information suggests that the method of choice of anchorage reinforcement for both the clinicians and patients is the use of TADS.
It is also worth pointing out that if we had not collected the patient information , this would have been “another trial finding no difference” and illustrates the importance of moving away from “orthodontic” measures to collect information that is relevant to our patients.
Finally, it is great to see a clinical trial reporting on an orthodontic innovation is proving to be effective. We are currently in the final stages of finishing a Cochrane review on methods of anchorage reinforcement. I will publish a blog on this as soon as it is published, so watch this space!
Emeritus Professor of Orthodontics, University of Manchester, UK.