LETTER: PREDOCTORAL ORTHODONTIC EDUCATION

Fixing the problem of predoctoral orthodontic education

Congratulations on the superb editorial in the May 2013 issue of the AJO-DO concerning predoctoral orthodontic education. It is spot-on, and it effectively describes the curriculum that I have developed and delivered for the past 17 years!

May 2013; 143(5):595

I frequently describe the orthodontist and general dentist as being team members in terms of diagnostic and restorative decision-making and treatment. I have several pertinent lectures specifically describing "smile design" and the protocols that the restorative dentist/prosthodontist follow, and I emphasize how these criteria and diagnostic parameters mirror those found in orthodontic literature and practice. In my predoctoral orthodontic lectures, I draw upon my own clinical orthodontic cases, since a significant number of them have been multidisciplinary in nature, and I complement these lectures with my experience as a general dentist, curriculum director in temporomandibular disorders, as well as occlusion, instructor in fixed prosthodontics, and my fellowship in the Academy of General Dentistry. My undergraduates and the AEGD and GPR residents to whom I lecture receive a strong curriculum in everything from the biology of tooth movement and growth and development to comprehensive orthodontic records, including ABO-quality casts, cephalometric tracings and interpretation, advanced Bolton tooth size (and shape) discrepancy analysis, and limited tooth movement, including anterior alignment and molar uprighting. The students are also exposed to a comprehensive laboratory experience beginning with wire bending, advancing to the fabrication of a Hawley appliance, and ending with a "clinical case problem" in which a retainer is not adequately stabilizing several teeth and the student must solder an auxiliary stabilization wire to the existing Hawley in order to satisfy the "patient's" chief complaint. All of these experiences have been and will continue to be complemented by the predocs providing limited orthodontic treatment to patients as a part of their 3rd year clinical “experience."

It is the general opinion of the students as well as participating faculty that this program clearly meets the needs of our students as well as patients, and greatly benefits both in the short and long terms.

I apologize for the thesis, but it is so refreshing to see someone as respected as the Editor-in-Chief of the AJO-DO declare that this sort of predoctoral orthodontic curriculum is appropriate, valuable, and certainly capable of "…fix(ing) the problem with predoctoral orthodontic education." 

With sincerest and best personal regards,

John Stockstill
East Carolina University
Greenville, NC    

RESIDENTS' JOURNAL REVIEW

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May 2013; 143(5):599-601.

Residents' Journal Review

Articles from the current orthodontic literature, selected and reviewed by Senior Orthodontic Residents, Marquette University, Milwaukee, Wis, Thomas G. Bradley, Department Chair, and Jose A. Bosio, Acting Program Director

Edited by Dan Grauer,Associate Editor for Residents' Journal Review

This month’s reviewers include Michael Payne, Manika Patwari, Syrah Quraishi, Jake Spendlove, and Nicholas Valeri. Read their reviews in the May issue.

LETTER: Mandibular incisor extraction

Mandibular incisor extraction

We read with great interest the case report on absence of maxillary canines treated with mandibular incisor extraction by Simão et al.¹ We congratulate the authors for their efforts in treatment of the case and the preparation of this article. We would like to share our opinion about this paper and our clinical experiences on mandibular incisor extraction.

One of the most critical decisions in treatment planning is whether to extract or not.² Another essential factor is removal of which teeth in the case of a decision to extract. Treatment with premolar extraction has been the most common method in patients with severe crowding for many years. Although single lower incisor extraction is a less common approach, it can be a therapeutic alternative in certain malocclusions. Mandibular incisor extraction is advised for cases of anterior tooth size discrepancies², or to harmonize with an absent or peg-shaped maxillary lateral incisor.^4,5 In the case report by Simão et al,¹ the authors demonstrate a new indication or a new phenomenon with a successful treatment of the iatrogenic absence of maxillary canines.

In our clinic, we add mandibular incisor extraction in the treatment plan for patients with tooth-size excess, peg or missing maxillary lateral incisor, mild Class III malocclusion with mild open bite tendency, moderately crowded mandibular incisors. Finally, we obtain an ideal occlusion and a pleasant facial profile, with maybe sometimes a slightly increased overjet and overbite. We advise clinicians to add mandibular incisor extraction to their treatment plans more often to obtain a stable result in less time. However a diagnostic set-up is required to predetermine the precise occlusal possibilities, as recommended by Simão et al¹.

Zehra Ileri
Mehmet Akin
Faruk Ayhan Basciftci
Selcuk Univesity
Faculty of Dentistry, Department of Orthodontics
Konya, Turkey

References

1.     Simão TM, Valladares-Neto J, Rino-Neto J, de Paiva JB. Iatrogenic absence of maxillary canines: Bolton discrepancy treated with mandibular incisor extraction. Am J Orthod Dentofacial Orthop 2013;143:713-23.

2.     Bayram M, Ozer M. Mandibular incisor extraction treatment of a class I malocclusion with bolton discrepancy: a case report. Eur J Dent 2007;1:54-9.

3.     Canut JA. Mandibular incisor extraction: indications and long-term evaluation. Eur J Orthod 1996;18:485-9.

4.     Owen AH. Single lower incisor extractions. J Clin Orthod 1993;27:153-60.

5.     Ileri Z, Basciftci FA, Malkoc S, Ramoglu SI. Comparison of the outcomes of the lower incisor extraction, premolar extraction and non-extraction treatments. Eur J Orthod 2012;34:681-5.

LETTER: The time is now

April 2013; 143(4):449

The time is now

An outstanding Ethics in Orthodontics column,  “The time is now,” by Peter Greco, in the April 2013 issue. It's a courageous commentary and a breath of intellectually honest fresh air, desperately needed in today's orthodontic culture where gadgetry, hucksterism, and manufactured treatment have already made too many inroads. Peter is right on spot: “As competition increases, the possibility of transgression from appropriate ethical behavior increases.” And so all morality and ethical values goes out the window in order to make ends meet! And thus the orthodontic profession continues to exhibit a slow inexorable descent of an honorable profession to the depths of crass commercialism.

The genesis of this loss of control of our destiny and the over-supply of practitioners began with the Carter/Califano strategy in the 1970s of flooding the market with health care providers to lower the costs of heath care. It was a very specious economic policy, representing another contrived intrusion into the market place.

There’s nothing wrong with the orthodontic profession that being left alone won't fix, as long as we rely on the genius of the market place with it’s law of supply and demand, and without social do-gooders, politicians, bureaucrats, and dental leaders getting in the way! And as long as we differentiate practice management expedients from biological imperatives!

Robert D Helmholdt
Fort Lauderdale, FL

MAY LITIGATION AND LEGISLATION

May 2013; 143(5): 745-6.

So let it be written, so let it be done

By Laurance Jerrold

When Yul Brenner banishes Charlton Heston from Egypt in the movie The Ten Commandments, he utters the words that are the title of this month's article: So let it be written, so let it be done. When you set something down in writing, it is plain and unambiguous, and meant to be followed to the letter: no hemming and hawing; no ifs, ands, or buts; it is to be as it is written. 

In any case, that's the theory behind an employment contract. Read Larry Jerrold's May column for more.

CASE OF THE MONTH

May 2013; 143(5):713-23

Iatrogenic absence of maxillary canines: Bolton discrepancy treated with mandibular incisor extraction

By Tassiana Mesquita Simão, José Valladares-Neto, José Rino-Neto, and João Batista de Paiva 
A 47-year-old man had a Class II malocclusion with lateral incisor crossbites and significant mandibular crowding. The maxillary canines were extracted previously because of crowding. How would you treat this patient? The authors extracted one mandibular incisor. Read the May Case of the Month and see the excellent results achieved for this patient.
More excellent case reports are available in the Case of the Month Collection page.

LETTER: Pre-Doc Orthodontic Education

May 2013; 143(5):595.

Predoctoral orthodontic education

Once again, I must comment on the timely editorial in the May 2013 issue and the appropriateness of the comments (Kokich VG. The problem with predoctoral orthodontic education. Am J Orthod Dentofacial Orthop 2013; 143[5]:595). Educating the pre-docs thoroughly about the subject will only fertilize their interest in referring cases to their specialist colleagues because:
 

1. They will possess advanced diagnostic skills
 

2. They will recognize the quality of well treated cases.
 

3. They will have had an opportunity to work in a team-like approach correcting malocclusions.
 

Well done!
John Grubb

Chula Vista, Calif.