Evidence Based Care

This is the beginning of a regular feature of our website. An informational collection aimed at what I would call the “informed orthodontic consumer”. Many of our patients who arrive via the website have really done their homework. They are looking for a true specialist, not a general dentist who dabbles in orthodontics; an experienced practitioner (25 years and counting), and solid academic credentials (3 year Masters Degree program in orthodontics at Ohio State after dental school and a hospital residency). Most of our patients value a conservative approach to orthodontics that provides a great outcome without feeling like they were rushed into treatment.

Other patient’s heads are swirling with questions induced by corporate advertising or from a conflicting treatment plan offered by another practitioner. Achieving great outcomes in orthodontics means blending art and science; function and esthetics. It’s no wonder that the options appear confusing from a patient’s point of view. That is why I rely on what is referred to in the medical literature as “evidence based care”. Although orthodontics is the oldest dental specialty, traditionally most treatment methods were based on opinion gained from experience or relying on gurus within the profession. Over the years this led to hot arguments with little scientific underpinning. The most animated of these discussions within the profession centered on the appropriateness of permanent tooth extractions and our ability to affect the growth of the face to mask defects. More recently, companies such as InvisAlign and Damon stimulated interest in their products with direct marketing to consumers with multi-million dollar budgets and funded research geared to their products. In the last 20-some years the quality of orthodontic research has progressed as a much more reliable tool to assess treatment options. I like to have confidence in the methods that I prescribe and dental research provides that test.

Evidenced based care relies on a hierarchy of evidence to support claims. Rigorous study design helps to eliminate chance occurrences that may look like success. A classic case in point is the controversy over stimulating growth of deficient mandibles with functional appliances. A big overbite (overjet) is a common problem in orthodontic patients and is most often due to a short mandible. There are a myriad of options to correct this problem from headgear, extractions or surgery to the aforementioned functional appliances. As they say in Missouri “even a blind pig finds an acorn once in awhile.” Every orthodontist can show a picture of a patient with a huge overbite who turned out beautifully. Pictures can show that a functional appliance worked great on one particular patient. This is referred to as a Case Report in the literature and is a very weak method of advancing knowledge. Was it lucky growth or did the appliance really work? Recent well designed, prospective, controlled research1 shows that the appliances don’t work in a predictably effective manner to increase mandibular growth.

Practitioners who disparage scientific methods often utilize a case report to show that a particular method works. Their cry is that “it works in my hands”, implying that the reason the research does not confirm the efficacy is that the rest of us are not so well gifted. Some orthodontic cases may be treated successfully by several different methods and some cases may be difficult no matter the method. Paying attention to good research tips the balance in our favor when choosing mechanics for the most predictable outcomes.

The first topics to be covered in this upcoming series are: Growth Modification - Fact or Fantasy; Extractions – Friend or Foe to a Beautiful Face; Early Orthodontic Treatment – What’s to be Gained or Lost; Damon Braces – how do manufacturers claims stand up to unbiased scrutiny?; General dental practice orthodontics – a comparison of education and training; “I have TMJ” we all do and why that’s not such a bad thing

Hopefully this series will give you the dental consumer a good resource for intelligent decision making and it will force me to review some of the most controversial topics for the latest information.

1) American Journal of Orthodontics and Dentofacial Orthopedics Vol. 128, Issue 3, Pages 271-272

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Montebello Drive West
2575 Montebello Drive West,
Suite 101, Colorado Springs, CO 80918
Tel: (719) 268-7138
Fax: (719) 599-5107
Woodland Park
791 W Kelley's Rd,
Woodland Park, CO 80863
Tel: (719) 687-6129
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What our patients say...

We went to an evaluation at an orthodontist before this one and the price seemed kind of high so then I came to an evaluation here & not only was the price lower but immediately we felt very comfortable and loved the atmosphere of the office. The staff is wonderful, always on time & Dr. Bentele is a great Dr. - very knowledgeable, friendly & with excellent communication. I would recommend this practice to everyone!

We highly recommend Dr. Bentele and his practice. He is honest, friendly, skilled & timely - you name it. He and his staff are wonderful! Angela at the front desk is especially kind and helpful. Best of all - Dr. Bentele creates a wonderful outcome of beautiful teeth. I've experienced two other orthodontists with other children and Dr. Bentele definitely outshines all - in every way - even in cost! I can't speak highly enough about Bentele Orthodontics!

This office is extremely thorough in explaining all aspects of orthodontics from finances to procedures. I'm very confident in this office.

Dr. Bentele makes the patient feel comfortable with his skill and calm confidence. He's honest about the treatment needed and tries to keep the patient informed of the treatment.

Dr. Bentele is our orthodontist for our two children. He provided clear treatment plans with a practical approach. Dr. Bentele does all of the banding and bonding himself and the office appointments are appropriately scheduled. Our children get in and out quickly and the office is never overscheduled, resulting in short waits and unhurried treatment. We're very satisfied and would recommend our friends to see Dr. Bentele!

Dr. Bentele and all staff have been very professional and the cost was reasonable. The approach of not having braces on longer than necessary is one area where I have seen other children suffer (children who went to other orthodontists). The way Dr. Bentele explains what he is doing and why has been good for my daughter to learn the importance of her treatment. I appreciate Dr. Bentele's patience with us as we experienced a difficult financial time during the beginning of our process.