Pacific Coast Society of Orthodontists Bulletin Spring 2013 - (Page 30)

SUMMARIES ANNUAL SESSION CONTROVERSIES IN ORTHODONTICS Presented by Dr. Terry McDonald, DDS, MS, at the PCSO Annual Session, October 5, 2012. Summarized by Dr. Douglas Hom, PCSO Bulletin Southern Region Editor. N umerous controversies persist in contemporary orthodontics. Issues such as extraction vs. nonextraction therapy, “jaw-growing”, timing of class II correction, arch form and arch development, and the relationship of TMJ to occlusion and malocclusion are only a few of the disputed topics. In his presentation at the 2012 PCSO Annual Session, Dr. Terry McDonald addressed two related questions: “Why do such controversies continue to exist?” and “Should current orthodontic therapy be evidence-based?” If the orthodontist’s treatment goals consist of only one or two of the items at the top of the list, then treatment planning can be a relatively straightforward task. Maintaining the patient’s original arch form is largely ignored as a goal today, due to the emphasis on arch development as well as the use of pre-formed archwires. Dr. McDonald referenced recent research demonstrating that facial bone does not develop with arch expansion, thus negating the goal of maintaining periodontal health. Therefore, the dentition must be kept Dr. McDonald within the bony housing during orthodontic treatment. For long-term stability, the original arch form, The presentation began with a discussion of the orthodoninter-canine width, and pre-treatment lower incisor positic patient-doctor process. The usual sequence begins tion must be maintained throughout treatment. with the initial examination. This is followed by the The difficulty increases as one moves down the list and compilation of records, the diagnostic process, treatment ultimately attempts to achieve all of the goals while using planning, treatment, and follow-up. Although controcurrent scientific evidence. Dr. McDonald referenced versies can exist at any of these stages, the treatment several orthodontic leaders in regard to evidence-based planning stage offers the most opportunities for differtreatment. ences to arise. It is Dr. McDonald’s contention that a lack of goals in the treatment planning stage is the primary Dr. Greg Huang believes that many orthodontists find cause of today’s major controversies. evidence-based orthodontics difficult to accept and see the concept as a threat to their practices. Evidence-based data There are many possible treatment goals in orthodontics. is not a cookbook approach, but rather should provide the These can include: guidelines for treatment. • • Maintaining or improving facial balance • Correcting the static and functional occlusion • Maintaining the patient’s original arch form • Maintaining periodontal health • Achieving long-term stability • 30 Straightening teeth Accomplishing all of the above using current scientific evidence Dr. William Proffit contends that the orthodontic profession has no choice but to become a data-based specialty sooner rather than later, willingly rather than unwillingly. The late Dr. Anthony Gianelly believed that a dilemma exists in the orthodontic profession in that evidence is often ignored. Contrary to endodontics, oral surgery, pedodontics, and other disciplines, there is no short-term health penalty for treatment that discounts the evidence when the specialty is not disease-based. Our mistakes do not cause death. Dr. McDonald closed his presentation by asking if there are currently any “doable” answers to this dilemma. His answer was a reluctant “no,” because the profession as a whole lacks the will to change. His closing words were a somber “I don’t have any good news...”. S PCSO BULLETIN • SPRING 2013

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Spring 2013

Dental Ethics
Save a Little and Invest a Lot
Plan for Ongoing Success
AAO Trustee's Report
PCSO Business
AAOF Report
Component Report
PCSO at a Glance
Dr. Terry McDonald Interviews Dr. Harry (Hap) Doughterty, Jr.
Case Report Pre-Treatment
Dr. John Ive
3-D Image-Aided Treatment of Impacted and Transposed Teeth
Controversies in Orthodontics
DIY Technology Upgrades on a DIY Budget
Accelerated Osteogenic Orthodontic (AOO) System -- Physiological Benefits and Increased Range of Movement
Case Report Post-Treatment
Pearls from Idaho: Holding 3-3 Retainers While Bonding

Pacific Coast Society of Orthodontists Bulletin Spring 2013