Winter 2009 Southern Association of Orthodontists
SAO Annual Meeting
September 23-27, 2009
Hot Springs, VA
AAO TRUSTEE’S REPORT
have enjoyed serving as your AAO Trustee for the – Consumer Education
last six years. I continue to represent the AAO in – Volunteer Leadership
the following areas: Development
• AAO Executive Committee – Recruitment and Retention
• Chairman of the Budget Advisory Committee of Orthodontic Educators
• Chairman of the AAO Investment Committee
– Relationships with the ADA
• Investment Advisory RPF Committee
and other related Healthcare
• Board Liaison to the Rapid Response Committee Mike Rogers, DDS
on Legislative Matters Augusta, Georgia
• AAO BOT representative on the AAOF – International Orthodontic
• Board of Trustees’ Liaison to the Council on Issues: accreditation, certification and educa-
Orthodontic Health Care tion/research
• AAO/ABO Committee Advocacy: i.e. Government Affairs, Access to Care
• Chairman of AAO Disaster Relief Fund • Practice management webinars will be launched in
• ADA Advisory Committee early 2009 for all members. The AAO will be survey-
• Chairman of Board Committee A ing members on how the current economic situation is
The AAO will continue to be your number one advo- impacting individual practices. The survey will gener-
cate, and your input to help stay on top of the issues is ate topics for the webinars.
always welcome and needed . Please feel free to contact • DiMeo Schneider was selected as the new investment
me with any advice or concerns. advisor for the AAO. The AAO Board of Trustees
identified three advantages for the selection of this
Highlights of AAO from recent Board of Trustees company:
Meetings: – Philosophical approach ensures diversified portfolio
• BOT added a new “critical issue” for HOD approval and use of passive investments
that deals with practice management.
• The other “critical issues” are as follows: – Historical performance shows exceptional returns and
In This Issue
TRUSTEE’S REPORT Michael Rogers, DDS 2
A LOOK BACK
History 101: SAO Style 7
HOW WOULD YOU TREAT THIS PATIENT? Mark Yanosky, DMD 10
Graduate Program Spotlight-University of Kentucky Jeremy Albert, DMD 12
Class III Camouflage Treatment: What Are the Limits? Nikia R. Burns, DMD 17
AAO Task Force on Recruitment and Retention of Faculty 20
How Do You Handle Appointments in Your Office? Jeff Rickabaugh, DDS 15
NEW AND YOUNG MEMBERS Mark Dusek, DDS 16
PIONEER OF THE SPECIALTY 19
SAO Winter 2009
minimization of loss in down market membership make up? Are we helping our members
– Investment Policy Statement and effective Asset Alloca- deal with an increasingly diverse patient base?
tion plans focus on providing a sound basis for investment ENCOURAGING ECONOMIC DIVERSITY
management and committee/board education Is the AAO governance and programs/services reflec-
• The Board approved discontinuing the sale of AAO pro- tive of the growing diversity of orthodontists?
duced Superbills when the current inventory is exhausted. KEY TRENDS OVER THE NEXT 1-3 YEARS
Purchasers will be informed that the insurance industry THE AAO AND FUTURE FINANCIAL
prefers electronic claims submission or use of the ADA CONSIDERATIONS
Claim Form over use of Superbills. Purchasers will be
• Economic Trends – Sluggish economy, rising
further advised that the use of Superbills delays the pro-
unemployment, costs of goods and services (potential
cessing of claims.
• Upon approval by PARC and the AAO Board liaisons to • Revenue Considerations – Will the AAO revenue
the AAOF, the AAO will provide a restricted gift of decline?
$100,000 for preliminary Access to Care studies for the • Expense Considerations – Consider small cuts now
funding round of 2009-2010 to the AAOF. Additional rather than waiting until major cuts may needed
funding will be considered for the 2010-2011 funding
round, if responses to the initial foundation supported Update on SCHIP
studies and additional related proposals warrant continu- The AAO Board of Trustees and the AAO Council on
ing this project. Governmental Affairs (COGA) have been monitoring
• The Board approved the updated 2008 version of the SCHIP Legislation. New legislation concerning expansion
Clinical Practice Guidelines for Orthodontics and Dento- of SCHIP has passed the House of Representatives, adding
facial Orthopedics and will present it to the 2009 House four million children to the program.
of Delegates for approval. Every member should read this The AAO’s position on SCHIP is as follows:
online. One thing to note is the need for complete begin- The AAO believes SCHIP funding for oral health should
ning records as outlined on page 17. I have noticed that focus on ensuring all impoverished children in America
some consultants advocate not making complete beginning have (1) access to primary, preventative dental care
records. Diagnostically these records are needed. Not hav- (checkups twice a year, cleanings, fluoride treatments,
ing them leaves the member in a precarious situation if a etc.), (2) access to responsive care on an as-needed basis
legal question is raised. (fillings, tooth extractions, root canals, etc.), and (3)
• In response to a Communications Task Force recommen- access to medically necessary procedures such as cleft
dation, the Board has formed a Logo Task Force made up palate repairs. The AAO believes that scarce federal
of three trustees (Drs. Varner, Phillis, and Rogers) along healthcare resources like SCHIP should not be spent on
with one representative from each AAO Constituent Dele- elective dental services such as orthodontic care.
gation to explore the possibility of adopting a new AAO
logo. If a logo change is recommended, the proposal will
AAO Investment Committee Evaluates Portfolio
be presented to the 2009 AAO House of Delegates.
The stewardship of member funds and preservation of
• Revisions to the 2001 AAO Glossary of Orthodontic Terms member benefits are priorities of the AAO Board of
were approved. The copyright date on the glossary will be Trustees. Due to strong financial performance over the
changed to 2008 and posted on www.aaomembers.org. past several years, the AAO Reserve Funds have grown to
a level which would enable the AAO to continue member
The Board designates time at each meeting for benefits during a brief period of economic downturn, if
scanning. Recent issues that we have considered: necessary. In addition, the current reserve level can sup-
WHAT DOES THE FUTURE HOLD? port efforts to advance the specialty of orthodontics. In
recent years, these funds have been leveraged to increase
U.S. POPULATION DIVERSIFICATION
the scope of the AAO consumer awareness campaign and
We first looked outside our organization before taking
to address the shortfall of orthodontic faculty.
a hard look at issues that could impact the AAO and
our members. For example, several questions were Though investment returns are currently volatile, the man-
discussed: Is the AAO governance reflective of our agement of reserve funds is focused on long-term positive
SAO NEWS SAO
A publication of the Southern
Association of Orthodontists
32 Lenox Pointe
Atlanta, GA 30324-3169 returns that will benefit the membership through expanded programs and services.
(404) 261-5528 or (800) 261-5528 The AAO trustees have initiated several tactics to ensure appropriate oversight is
Fax: (404) 261-6856 in place for fund management and that prudent investment practices are in place:
e-mail: saortho@Bellsouth.net • The AAO Investment Committee was formed in November, 2006. This five
Web site: www.saortho.org
member committee works directly with the AAO investment advisor to review
OFFICERS portfolio performance on a regular basis as well as to review other aspects of
President AAO investments.
Tim Trulove (AL)
email@example.com • During 2008, the AAO Investment Committee—along with colleagues from
President-Elect the investment committees of the AAO Foundation and the AAO Insurance
R. R Reed, Jr. (FL) Company—solicited information from and met with several investment advi-
firstname.lastname@example.org sors. These efforts were made to ensure that all aspects of AAO investment
Secretary-Treasurer practices were managed in the most appropriate manner.
Rodney Klima (VA)
email@example.com • Recently, an in-depth analysis of AAO cash flow and the portfolio was per-
formed. This analysis will provide the basis for asset allocation decisions
Mark Johnston (GA) aligning AAO’s goals of capital preservation and net positive returns on
• Currently, the AAO Investment Policy is under review. This policy provides
the guideposts for staff and advisors to follow which will ensure that prudent
First Senior Director
Dr. Robert Calcote (SC) investment practices are used at all times.
Second Senior Director AAO Trustees and the members of the AAO Investment Committee are committed
Jay Whitley (LA)
firstname.lastname@example.org to maximizing portfolio performance while maintaining a conservative, low-risk
Third Senior Director
investment approach. Safeguarding these funds for the future benefit of AAO
Henry Zaytoun, Jr. (NC) members is an important responsibility.
AAO TRUSTEE BACKGROUND:
Michael B. Rogers (GA)
All of the dental specialties use the National Board Exam to quantitatively
evaluate applicants to the specialty programs. Several dental schools already
EDITOR have eliminated class rankings; and if the National Boards report only pass/fail,
James Vaden (TN) it would be difficult or impossible for graduate residency programs to evaluate
email@example.com applicants. Seven of the eight dental specialties joined the AAO initiative.
Jeremy Albert The AAO was instrumental in passing the following ADA Resolution which
Mark Dusek urges JCNDE to report National Board scores in the present manner. This
Jeff Rickabaugh will enable our residency programs to continue the National Boards as
criteria for acceptance.
70RCS-1. Resolved, that the ADA House of Delegates urges the Joint Commis-
Sharon Hunt, CAE
sion on National Dental Examinations (JCNDE) to modify or replace the current
saortho@Bellsouth.net examination, to make it secure and to validate its use for quantitative scoring on or
Founded in 1921 before November 1, 2011, and be it further
Fostering the Ethical Delivery of
Quality Orthodontic Care
Resolved, that the ADA House of Delegates urges the JCNDE to retain its current
SAO News is published four times a year
by the Southern Association of system of reporting standard scores from the National Board of Dental Examina-
Orthodontists. The opinions expressed tions until the new examination is available.
in articles and editorials are those of
the authors and not necessarily
those of the Association.
SAO Winter 2009
Consumer Awareness Campaign Update New guidelines make it easier for members to use
In May the 2008 House of Delegates approved the exten- More Than a Smile marketing materials
sion of the Consumer Awareness Campaign More Than a • It’s now easier for members, constituents and compo-
Smile. This will be the third year of the campaign that is nents to make use of AAO materials to educate the public
designed to educate the consumer about the unique quali- and promote orthodontic treatment in local communities.
fications of an orthodontist. New guidelines approved by the AAO Board of Trustees
Schupp Company, marketing communications agency, is in explain how members may use AAO materials to promote
the process of evaluating the effectiveness of the campaign their practice, as long as the practice is solely comprised
which is expected to be completed before the House of of AAO-member orthodontists.
Delegates meets in May. • For step-by-step instructions on how to use the
Many times members state that they have not seen the More Than a Smile Campaign materials, visit
advertisements. In part, that fact is due to the target audi- www.AAOmembers.org and click on the More
ence – women ages 25 to 54 who have children in the Than a Smile consumer awareness campaign.
household. Obviously these television and print ads are
run and placed in media viewed and read by mothers, and RECOGNITION:
it is likely that many orthodontists do not have the same In this issue I would like to recognize a hard-working SAO
interest as this target group. member whom most of you have known since 2005-2006
when he served since he served as the SAO President.
The following report was prepared by Linda Gladden,
Richard McClung has
Director of Communications and Marketing, for the
been active in dental orga-
nizations for over 30
Last summer, the AAO launched the 2008-09: More Than years. He started as presi-
A Smile® Consumer Awareness Campaign, which was a dent of the Greenbrier Val-
mix of print, online and cable television advertising. It ley Dental Association
targeted mothers of children age 5 to 17. So far, the AAO while practicing general
has received preliminary data quantifying the impact of dentistry. He entered his
the Association’s online presence. The data indicates con- orthodontic residency in
sumers are being driven to www.braces.org where they can the early 1980’s and
learn more about orthodontic care and the unique qualifi- became involved with
cations of AAO-member orthodontists, as well as find orthodontic organizations,
AAO-member orthodontists in their community. but remained in touch
As of October 30, the AAO’s Google and Yahoo keyword with general dentists in
search results have prompted consumers to visit the West Virginia Dental
www.braces.org almost 160,000 times since July 1. The Association. Richard McClung, DDS
data indicate AAO is on track to meet its annual goal of Rick has served on the Executive Council of the West Vir-
456,000 search-engine generated visits to www.braces.org. ginia Dental Association and president of the SAO. While
The AAO’s print, national cable television and online dis- president, his vision led to conducting the SAO Futures
play banner advertisements are also driving consumers to study to help grasp the direction of orthodontics in the
www.braces.org. A report on these media outlets will be next decade. This work received nationwide acclaim from
included in a future issue of The Bulletin. the orthodontic community. He also helped to design the
The AAO offers consumers the “Find an Orthodontist” SAO Leadership Program which has received high marks
service on www.braces.org. During the first portion of the from participants.
2008-09 campaign, from August 11 to October 31, names He currently serves as chair of the SAO Investment Com-
and contact information of AAO members were furnished mittee (he served in the same role for the WV United
approximately 375,000 times. In order to determine how Methodist Foundation.); and at the request of the Execu-
many times your name has been given to consumers since tive Committee, he agreed to serve on the AAO Council
the AAO’s Consumer Awareness Campaign launched on Membership, Ethics, and Jurisprudence.
October 1, 2006, use the online real-time counter at Rick continues to give to others in his profession and in
http://www.aaomembers.org/namesgiven.cfm. the community. He is a Board Certified Examiner for the
Winter 2009 SAO
Mock ABO Phase III Examination at West Vir-
Have an idea? Have a comment? ginia University. He has served as high school
Want to make a suggestion? soccer referee for almost 20 years and is also
Contact Mike Rogers at firstname.lastname@example.org. active in his church.
(706) 733-1182, (706) 733-2501 fax Those who have served with Rick value his coun-
3545 Wheeler Road, Augusta, GA 30909. sel, common sense, analytical ability, and practice
I am happy to announce that during my presiden-
cy Rick along with his wife, Ann, will serve as
my 2012 Annual Session Chair in Hawaii.
– Mike Rogers
Interested in Serving as AAO Trustee?
he 2009 General Assembly will be charged with electing the next Trustee to the AAO Board of Trustees
from the Southern Association of Orthodontists. This position has been filled since 2001 by Dr. Michael
Rogers of Augusta, Georgia. While Mike makes it seem easy, it is anything but.
The duties of the Trustee can be found in the AAO Bylaws. Dr. Rogers listed the number of duties that have been
assigned to him on page 1.
The commitment is daunting and includes the following meetings where preparation is required:
• AAO Annual Session (minimum of 10 days)
• Four board meetings (approximately 2 days each)
• ADA meeting (approximately 5 days)
• SAO Annual Meeting (approximately 4 days) AAO Presidents from the SAO:
• SAO Executive Committee and Board Meetings 1930 Dr. Oren Oliver (TN)
(1 day each) 1951 Dr. Joseph Johnson (KY)
• Other meetings (e.g. AAO Council meetings) 1957 Dr. A. Claude Broussard (LA)
In addition there are numerous conference calls and daily 1966 Dr. Frank Bowyer (TN)
emails requiring a response.
1971 Dr. Harold Terry (FL)
As Dr. Rogers says: It is a part-time job….The AAO and
1980 Dr. John Faust (MS)
SAO have to become your hobby.
1988 Dr. Russell Greer (KY)
It is an 11-year commitment from beginning Trustee
through the officer positions to Past President. 1996 Dr. Clifford Marks (FL)
You will meet many great leaders from around the country 2004 Dr. James Caveney (WV)
and help to shape the future of the specialty. Dr. Michael Rogers (President in 2012)
If you are interested in serving as Trustee, contact the SAO
Office at (800) 261-5528 or email email@example.com.
A LOOK BACK
History 101: SAO Style
n two past issues of the SAO News, occlusion you can’t extract teeth, who
we featured two articles “woven among you has the temerity in a
around” the 9th Annual Meeting of patient over 16 to attempt to move the
the Southern Association of Orthodon- whole maxillary denture backward,
tists which was held at the Hotel remembering the condition of the third
Dempsey in Macon, GA on January 31 molar and the second molar, which are
through February 2, 1929. Some of you usually impacted. Then what are you
who read these articles have expressed an going to do about it? Are you going to
interest in our history. Sharon wrote two treat it at all? It seems to me on this
articles on the history of orthodontic edu- proposition, we are blocked in every
cation which were in the past two issues direction. Not only in my experience,
of the SAO News. These also received but it has been reported in the experi-
favorable reviews. ence of many men that in distocclu-
The 1929 Dewey lecture (see Fall, 2007 sion, if you widen the maxillary arch
Dr. Martin Dewey
SAO News) created a discussion at the slightly and do what has been
1929 meeting about two topics: 1) expressed as harmonizing the sizes of
condylar position (which we described in the arches so the mandible can come
the Fall 2007 issue) and 2) maxillary forward without interference, it often
expansion and mandibular growth. does it without any intermaxillary
elastics at all. [Underline added-
This article will feature this second topic.
It was Dr. Martin Dewey’s opinion that
the position of the condyle in the fossa This statement of Dr. Hawley’s will be
could not be permanently altered. Dr. the subject of this short article. The
Dewey’s summation of his paper was: comments and discussion of this con-
In various types of malocclusion, your cept are very interesting:
greatest change and variation of develop- Dr. Dewey: You said the mandible
ment is a maxillary bone and in the comes forward.
mandible anterior attachments of the Dr. Hawley: Well, it appears to.
Dr. C.A. Hawley
muscles of mastication, but this part
Dr. Dewey: That is different.
remains the same anteroposteriorly in Class I, Class II
and Class III Malocclusions. Any plan of treatment Dr. Hawley: The occlusion is corrected without any
which has for it’s object changing the condyle into intermaxillaries. Haven’t many of you seen that condi-
either an anterior or posterior occlusion is anatomical- tion? What takes place? It stays there too. I have a
ly incorrect and will only lead to changes which are case which I am treating now. A girl, 23 years old, who
anatomically incorrect, if you finally accomplish it. I some three years ago, I treated. I used no intermaxil-
thank you. laries and the mandible apparently came forward in the
proper occlusion and I retained it and thought every-
At early SAO meetings, there was always discussion of
thing was fine. She wore a retainer for a couple years
a paper. As we have stated in past issues of the SAO
and then lost it, and I thought it wouldn’t be necessary
News, the discussion was often heated. One of the
to put another one on because the occlusion was so
discussers of Dr. Dewey’s paper was Dr. C.A. Hawley
close and tight. She came in about six months ago and
(yes, the Hawley retainer is named for him!). Dr. Haw-
the mandible was back in its posterior position again. I
ley offered the following comments: It seems to me we
measured the maxillary teeth and they had contracted
are getting into the stage, if all of these things are true,
due to no retention. I widened the maxilla and the
of being passé. If you can’t move a mandible forward
mandible came forward again, and that is the condition
because it is affixed by evolution, and if you have distal
Winter 2009 SAO
of it now. What happens in these cases and Dr. Harry E. Kelsey: I, myself, am
what are we going to do about it? inclined to believe that the condyle never
After reading these comments, have we permanently remains anterior to its nor-
heard this before? This concept has been mal relation with the structure surround-
“rediscovered” in the past ten years. And ing it, but I do believe that the mandible
many in orthodontics think it is a “new con- often moves forward during treatment.
cept.” In an article entitled, “Evidence- And then there is reconstruction of the
based Therapy: An Orthodontic Dilemma,”1 ramus and the neck of the condyle which
Dr. Anthony Gianelly discusses this very permits the condyle to reassume its nor-
concept. Dr. Gianelly sites two articles 2, 3 mal position in the fossa. I am also not
and a case report4 in which expansion of the unmindful of Dr. Dewey’s statement that
mandibular inter-canine dimension is development in the body of the jaw could
described and illustrated in conjunction with take place to correct this condition.
rapid palatable expansion that widens the Dewey was then asked by President
maxillary arch. Dr. Gianelly describes this Dr. Anthony Gianelly Childs to close the discussion. Dr.
concept as one of our current and ongoing Dewey: Now my good friend Lourie says
“conundrums” in orthodontics. He states in here today, and I understood Hawley to say
his article that: no study has shown that practically the same thing, that they believe
mandibular arch width, particularly the inter- the mandible could be moved forward. Dr.
canine dimension, can be expanded and yet Kelsey practically answered their state-
there are two articles and one case report in ments: It can not be moved forward. And
our peer reviewed literature that contend that what they get when they think they have
maxillary expansion allows the mandible to moved it forward is development of the
expand and come forward. It is difficult to body of the mandible which allows the
explain why the mandibular arch expansion condyle again to assume its normal posi-
was done and why it is apparently condoned tion (What would Lysle Johnston say about
since it was published in a peer reviewed this?8 He would agree). That is perfectly
journal without the obvious caveat that feasible and possible. The body of the
established data do not support the changes mandible can be developed and a proper
in the inter-canine zone. plan of orthodontic treatment is the plan
Dr. Harry E. Kelsey which develops the body of the mandible.
Dr. Gianelly further states: These circum-
The muscle training men, to my mind, have
stances also raise a treatment issue that requires an expla-
misinterpreted the results and have become centered upon
nation. In a round-table concerning treatment planning,
the action of the muscles which is the part that has the
Rickets noted that “We all accept that Tweed was correct in
least to do and does the wrong thing. When they widen the
building his plan around the lower incisor segment.”5 This
maxillary arch, as Dr. Hawley suggests, and the patient
statement which reflects the traditional attitude toward
bites forward, then if you could get the patient to masticate
treatment planning is now contrasted with an approach
in that position, plus the functions of the muscles of deglu-
that makes a centerpiece of treatment planning the width
tition and expression, then the mandible would slide back
of the maxillary arch.6 Presumably, the mandibular arch
despite the fact the body of the mandible has been length-
will spontaneously expand when the maxillary arch is
ened. If the patient doesn’t masticate as he should in that
expanded in order to maintain transverse relationships.
muscular relation, the body of the mandibular does not
Gryson7 tested the hypothesis that the mandibular arch
develop and pretty soon the mandible slides back in its old
would expand spontaneously after rapid maxillary expan-
position, and the case is a failure.
sion and noted that “the use of RME to increase mandibu-
lar arch length cannot be justified.” Gentlemen, why in the world would you start out with a
treatment which is fundamentally incorrect? Why not
It seems that our specialty is having the same discussion
leave that condyle and mandible where it belongs and use
that members of the Southern Society of Orthodontists had
a method of treatment which leaves the mandible and
in Macon, GA in 1929! Further discussion of Dr. Dewey’s
condyle in its fundamental position. In those cases where
paper about the irrevocable positions of the condyle and
you get good results, where the mandible does not slide
the fossa ensued.
back, the mandible was never forward. The patient has
SAO Winter 2009
simply gotten a growth spurt in the body of the mandible.
The mandible with the lower teeth has swung outward and
forward due to the action of the muscles of mastication, CAST OF CHARACTERS
deglutition and expression. The mandible has sloped for-
The cast of characters who took part in this very interesting dis-
ward and the patient has gotten a nice profile. I am sold cussion in 1929 at the SAO meeting in Macon, GA and those
on normal muscular action and function, but I am not sold from today’s world of orthodontics who are “taking part.”
that with muscular action you can keep the mandible for- CHARLES A. HAWLEY (1861 – 1929) was born in Milan, OH.
ward. The temperomandibular articulation, owing to the He was an 1893 graduate of the University of Michigan Col-
fact that you have those intra-elastic ligaments and lege of Dentistry and a 1905 graduate of the Angle School.
because of other anatomical facts, is fixed anteroposteri- He served as a Professor of dentistry and orthodontics at Ohio
Medical University (now The Ohio State University) until
orly. Anything which is changing the antero-posterior
1910. In 1910 he moved to Washington, DC and practiced
position of it is going to materially interfere with the func- there until his death in 1929. He was the first orthodontic
tion. I thank you. specialist in our nation’s capital and it was there that he
invented the removable retainer that continues to bear his
It seems that in 1929 the “argument” was not settled to an
name. Among his other contributions are: 1) a system of geo-
conclusion acceptable to everyone. The argument still metrical charts that can be used to determine arch form, 2) a
rages as is evidenced by Dr. Gianelly’s Evidence-Based gold annealer, and 3) various instrument inventions. Dr. Haw-
Orthodontics’ article. We at the SAO News thought that ley was the President of the American Society of Orthodontia
the discussion was interesting and appropriate to the dis- in 1908 and was the President-Elect of the SSO (Southern
Society of Orthodontists) in 1929 at the time of his death.
cussions some circles in orthodontics have today. Isn’t it
interesting that the same issue was controversial approxi- MARTIN DEWEY (1881-1933) was born in Kingman, IA, son
mately 80 years ago! And many of us thought our current of a pioneer dentist. DDS, Keokuk, IA 1902, MD; Keokuk
discussion was something new! President Childs summed Medical College 1904, Angle School 1902 – taught on the
faculty of the Angle School until 1911 when he opened the
up the discussion in 1929 in a manner which can be
Dewey School Orthodontics in Kansas City, MO. In 1914 he
applied to today’s discussion. In closing he stated: Some- founded, along with C.V. Mosby and Dr. Pollock, the Interna-
one has said that the clash of great minds makes sparks of tional Journal of Orthodontics which is now the American
truth fly. We certainly are indebted to you gentlemen for Journal of Orthodontics and Dentofacial Orthopedics. He
this interesting discussion. President Childs gave us a was the journal’s Editor until 1913. He had a “rift” with
Edward Angle because he lobbied against Angle’s efforts to
proper focus to the same discussion that we’re having in establish state specialty boards. In 1917 he moved his school
today’s world of orthodontics. to Chicago, then to New York in 1919, where it remained until
closing in the mid 20th century. He helped organize the
References American Board of Orthodontics in 1929 and served as one of
1 Gianelly Arthur. Am. J of Orthod: Dentofacial Orthopedics, vol. 129 its first directors.
#5, p 596–598.
2 Brust EW, McNamara JA Jr. Arch dimensional changes concurrent HARRY KELSEY (1872-1946) was born in Pamona, KS, he
with maxillary expansion in the mixed dentition. In: Trotman CA, received his dental degree from Baltimore College of Dental
McNamara JA Jr, editors. Orthodontic treatment: outcomes and effec- Surgery. He was a 1908 graduate of the Angle School. He
tiveness. Craniofacial Growth Series. Ann Arbor: Center for Human had a private practice in Baltimore for 32 years and was the
Growth and Development; University of Michigan; 1995. p. 377-86. chair of John Hopkins Hospital’s Orthodontic Department from
3 McNamara JA. Early intervention in the transverse dimension: is it 1913 to 1940. He was president of the AAO in 1931 and was
worth the effort? Am J Orthod Dentofacial Orthop 2002; 121: 572-4. an ABO director from 1938 to 1941. He published over 57
4 Lima RMA, Lima AL. Case report: long-term outcome of Class II papers and received many honors in orthodontics.
Division 1 malocclusion treated with rapid palatal expansion and cer-
vical traction. Angle Orthod 2000;70:89-94. ANTHONY GIANELLY, DMD, PHD, MD is Chairman Emeritus
5 Creekmore TD, Cetlin NM, Ricketts RM, Root TL, Roth RH. Diagno- of Orthodontics at Boston University School of Dental
sis and treatment planning. J Clin Orthod 1992;26:585-606. Medicine. He received his DMD and his orthodontic training
6 Brust EW, McNamara JA Jr. Arch dimensional changes concurrent from Harvard School of Dental Medicine. His PhD and MD
with maxillary expansion in the mixed dentition. In: Trotman CA, degrees are from Boston University. He is a member of many
McNamara JA Jr, editors. Orthodontic treatment: outcomes and effec- organizations, has published more than 90 articles and three
tiveness. Craniofacial Growth Series. Ann Arbor: Center for Human books and has given more than 200 lectures and continuing
Growth and Development; University of Michigan; 1995. p. 377-86. education courses nationally and internationally. He received
7 Gryson JA. Changes in mandibular interdental distance concurrent many awards including the Dewel Award for the best clinical
with rapid maxillary expansion Angle Orthod 1977;47:186-92. article in the American Journal of Orthodontics and the best
8 Johnson, Lysle E. Jr. “Functional Appliance: A Mortgage on paper in the Angle Orthodontist, a Lifetime Achievement
Mandibular Position,” Australian Orthodontic Journal, 1996; vol. 14, p. Award and the A.H. Ketcham Award.
HOW WOULD YOU TREAT THIS PATIENT?
Mark Yanosky, DMD
Patient SM: II canine relationship. On her left side, the patient
exhibits a Class I molar relationship. Overbite is mini-
History mal, and the patient is missing the maxillary right later-
This 12-year-old patient initially presented at age 10 for al incisor, has a peg shaped maxillary left lateral incisor
correction of a bilateral posterior crossbite. The cross- and an unerupted maxillary left canine. The maxillary
bite was corrected with a banded rapid palatal expan- occlusal view reveals leeway space remaining on the
sion appliance. A Hawley retainer was delivered and the right side, the missing maxillary lateral incisor, the
patient was placed on observation. The patient returned unerupted canine, and the remaining primary maxillary
at age 12 and presented in the late mixed dentition for left second molar. The maxillary molars are rotated
“Phase II” treatment. The medical history was normal. mesially. The mandibular occlusal view reveals an arch
How would you treat this patient? that is nicely aligned with some space remaining in the
Her malocclusion is complicated by a unilateral missing arch. The panoramic film shows the missing maxillary
maxillary lateral incisor. Although the prevalence of right lateral incisor, the unerupted canine and the
missing teeth is quite low, orthodontists are called upon unerupted second molar. There is evidence of third
to not only treat the patient, but to advise the patient, molar development on the panoramic film. The
patient’s parents, and our restorative colleagues about cephalometric tracing reveals slight bimaxillary retru-
all the options available. sion, a high mandibular plane angle, and protrusive
Pretreatment Records Problems that exist are:
The patient’s facial photographs reveal normal facial 1.) The missing maxillary right lateral incisor
height relationships, slight bimaxillary retrusion on pro-
file view, an obtuse nasolabial angle, and a consonant 2.) The peg shaped maxillary left lateral incisor
smile arc. The maxillary mid-line shift is also evident 3.) The impacted maxillary left canine.
on the frontal smiling picture. On the right side, the
patient has an end to end molar relationship and a Class
Pretreatment Facial Photos Pretreatment Tracing
Pretreatment Pretreatment Pretreatment
right buccal center left buccal
SAO Winter 2009
Pretreatment Maxillary Pretreatment Mandibular Pretreatment Panorex
Discussion of the Treatment Plan 2) Extraction of teeth in the
Most patients that present to the orthodontic office with a mandibular arch, and in the
missing maxillary lateral incisor are very informed about maxillary left quadrant would
one treatment option, the osseointegrated implant, but they have resulted in unesthetic flat-
often have no idea of the option of dental substitution. Due tening of the patient’s lips. For
to the patient’s minimal overjet and significant maxillary this reason, this option was not
arch spacing, opening space for the missing maxillary lat- seriously considered.
eral and restoration with a dental implant was the pre- 3) The fact that the patient is
ferred treatment option. Like so many families, however, missing only one of her maxil-
this patient’s mother expressed concern about the financial lary lateral incisors makes the
obligation of both orthodontics and restorative treatment. dental substitution plan one that
The concerns with dental substitution were as follows: requires management of an
1) If we attempt space closure for patients like this we asymmetric extraction. This
might finish the patient with negative overjet unless there plan would increase the difficulty Pretreatment Ceph.
is excellent cooperation. Surgical correction may be need- of achieving optimal esthetics.
ed to advance the maxilla into positive overjet. Temporary The need for cosmetic dentistry at
anchorage devices may also be needed for complete space the end of this treatment plan has
closure. to be discussed with the patient’s family.
To see the treatment plan that was utilized for this patient and
the post-treatment records, please go to page 22.
oc i ation of Or
rn Hospitality September 23-27, 2009
Insight Elegance Doctor Program: Staff Program:
TH: Mr. John McGill TH: Dr. Eric Ploumis
Dr. Greg Huang
Dr. David Turpin
FR: Dr. David Turpin FR: Mr. Ed Horrell
Th Dr. Greg Huang
e H omeste ad Dr. John Casko
Sep t 9 SA: Dr. Mark Hans SA: Dr. Anissa Anderson
ember 23-27, 200
Dr. David Sarver
GRADUATE PROGRAM SPOTLIGHT
University of Kentucky
Jeremy M. Albert, DMD, MS
To keep current with orthodontic programs within the region of the Southern Association of Orthodontists, we will run
a series of articles on the constituent orthodontic programs, with each issue highlighting one selected department.
he University of Kentucky (UK) Graduate
Orthodontic Program graduated its first class of
four orthodontists in 1970 under the leadership
of Dr. William Proffit. The graduate program began as
a 24-month program, but in 1987 became a 34-month
curriculum which required successful completion of a anism to reduce the overall number of orthodontic
Masters thesis project. Since 1991, UK has graduated graduates in the Commonwealth of Kentucky,” said
over 40 orthodontists. In our spotlight on UK, we will Associate Professor Dr. Preston Hicks.
take a look at its history (which involved a unique loca- However, by 1987, both universities agreed that the
tion move) and its focus on the future of orthodontic consolidation plan was not succeeding and, in fact, the
research and education. specific loss of the graduate orthodontic program at
After 15 years in Lexington, the program was trans- UK College of Dentistry had caused serious deficien-
ferred from UK to the University of Louisville. This cies in the educational and service programs for
move was part of a plan devised by the Council of oral/orthognathic surgery, pediatric dentistry, and cleft
Higher Education and respective university presidents palate and orofacial anomalies. “Along with clinical
to combine various graduate programs at both universi- service, a reduction in the quality and quantity of
ties in order to consolidate and reduce programmatic teaching in the undergraduate DMD curriculum was
costs. There was also a concern at the time with gener- felt as well,” said Dr. Hicks.
ating excess orthodontic manpower. “The hope was Therefore, in 1987, with the approval of the Council
that programmatic consolidation would provide a mech- of Higher Education and the respective university
UK orthodontic residents at work on a typical day in the graduate orthodontic clinic.
SAO Winter 2009
UK residents and faculty (L to R): Dr. Dave Kujak, Dr. Preston Hicks, Dr. John Turner, Dr. Thomamiso Moremi, Dr. Michael Pratt,
Dr. Cindy Beeman, Dr. Jennifer Sullivan, Dr. Jim Hartsfield, Dr. Megan McHugh,
Dr. Albert Pascual, Dr. Tom Kluemper and Dr. Sally Holliday.
presidents, the graduate program was moved back to UK. Hartsfield. Part-time faculty instruction and coverage is
Additionally, the program at UK became a 34-month pro- provided by Dr. Melvin Dean, Dr. Judson Knight, Dr.
gram in order to provide more time for resident research Charles Pritchett, Dr. Michael Stansbury, Dr. Paul Tran,
projects and a broader scope of patient experiences. To Dr. Philip Wahle, and Dr. Sonny Long. The most recent
re-establish the program at UK, provisional approval of the “addition” to the program is Dr. Hartsfield, whom Dr.
revised curriculum had to be obtained from the ADA Beeman notes “brings research expertise to our program,
Commission on Dental School Accreditation. In August which has been building its research initiative over the last
of 1988, two students were admitted. two decades.”
Currently, there are a total of eight graduate students “Our residents benefit from this range of experience, and
enrolled in the UK orthodontic program. Residents must understand the validity of different approaches to clinical
successfully investigate and defend an independent practice,” added Dr. Beeman. “We have a great cadre of
research project before they graduate. They are encour- outstanding faculty, staff and graduate students. Our pro-
aged to identify a topic and select an advisor by the com- gram boasts an outstanding faculty/student ratio, around
pletion of their first year. Orthodontic residents are also 1:2 full-time faculty.” First year resident Dr. John Wallace
involved as teaching assistants in the DMD curriculum Turner agreed that “the faculty to student ratio was better
during their second and third year. Division Chief and than anywhere else I interviewed.”
Associate Professor Dr. Thomas Kluemper said, “They Residents are quickly introduced to clinical orthodontic
take an active part in all three components of the courses treatment. “We take multiple didactic courses as well as
by preparing some lectures, directing small group discus- getting started in the clinic during our first week,” said
sions and by providing clinical coverage for the dental stu- first year resident Dr. David Kujak. Residents are in clinic
dents. Residents receive a stipend for this effort.” five days a week and work up to treating 80-100 active
The faculty comes from diverse training backgrounds, but patients. Patient treatment, in particular treatment plan-
all faculty members share a common philosophy of educa- ning and diagnosis, is viewed by the residents as a strength
tion and practice. The full-time faculty includes Dr. of the program. “Each patient’s needs are broken down
Kluemper, Dr. Hicks, Program Director Dr. Cynthia Bee- into planes of space using the orthogonal analysis. These
man, and the E. Preston Hicks Endowed Chair, Dr. James needs are then organized into a prioritized problem list that
Winter 2009 SAO
is used to determine the best method of treating the
patient,” said first year resident Dr. Michael Pratt.
When assessing the strengths of their educational experi-
ence at UK, residents also noted a strong didactic compo-
nent with an emphasis on biomechanics, the chance to
experience lingual appliance treatment, and interdisci-
plinary treatment with their cleft lip/palate team and
orthognathic surgery clinic. Residents also appreciate the
opportunity to work closely with other specialties such as
periodontics, oral surgery, and pediatric dentistry, both in
the clinic and in the classroom.
In addition to an orthodontic residency, UK is developing a
craniofacial fellowship program under the guidance of Dr.
Hartsfield. The Continuing Education Fellowship Program
in Craniofacial Research will be a one-year program that
Dr. Preston Hicks received the UK Great Teacher Award for
gives the Fellow exposure to basic and clinical research 2008. Pictured with Dr. Hicks are the orthodontic residents
that focuses primarily in the areas of genetics and/or who nominated him, Dr. Joe Petrey (Class of 2008) and
orthodontics (e.g. external apical root resorption associated Dr. Megan McHugh (Class of 2009).
with orthodontic treatment, facial growth, Class III and
Class II division 2 malocclusion, and the use of Cone- • Dr. Megan McHugh on “Performance of Kim’s Overbite
Beam (CT) in clinical research). Along with the research Depth Indicator in diagnosis and treatment in vertical dis-
component, “approximately 50 percent of the Fellow’s crepancies”
scheduled time will be spent on the clinical management
of orthodontic patients,” remarked Dr. Hartsfield. Fellows Looking at the future of orthodontics, the faculty and resi-
will also be required to write a review article on a topic dents have several areas that intrigue them, particularly
related to craniofacial biology, and will have the opportu- TADs and the use of soft tissue lasers as an adjunct to
nity to participate in ongoing research efforts in that area. orthodontic treatment. UK’s recent acquisition of a CT
This program will admit its first participants in the Fall of imaging machine opens the door to improved treatment
2009. planning and diagnosis, as well as research opportunities
in its utilization. “We have started implementing this tech-
Current research at UK is progressive and diverse. It nology (CT) into our diagnosis,” Dr. Pratt remarked. “I
ranges from evaluating the association between hypodontia also believe that lingual braces are going to be a large part
and ovarian cancer to temporary anchorage devices of the future of orthodontics. Here at UK, we have the
(TADs) to DNA genotyping. “Probably the newest clinical chance to treat many patients with lingual braces.”
gadgets that we are currently focusing on and researching
are the acceptance, efficacy and placement of temporary The charge of educating the orthodontists of the future is
anchorage devices (TADS),” said Dr. Kluemper. “In addi- not one taken lightly by the University of Kentucky’s fac-
tion, we are re-exploring the cost/benefit ratio of indirect ulty. A great deal of commitment to the specialty of
bonding with prescription appliances and the use of CT orthodontics is continually demonstrated by the UK facul-
imaging in orthodontic and multi-discipline treatment.” ty. “The single greatest challenge in educating and train-
ing students is inculcating a sincere commitment to
Residents are also actively involved in research, with third professionalism against the increasing influences of con-
year residents nearing completion of their thesis projects in sumerism in our culture,” said Dr. Hicks. “Professionalism
the following areas: is a calling to service above self. In contrast, consumerism
• Dr. Albert Pascual on “Fracture behavior of different is a pattern of behavior that seeks to serve self; a preoccu-
thermoplastic retainer materials exposed to various oral pation with possessions which undermines these ideals of
cleansing agents” professionalism. In my estimation, consumerism is thus a
• Dr. Sally Holliday on “Examining the influence of verti- powerful and difficult influence to overcome in our educa-
cal and transverse relationships on perceived facial attrac- tional process.”
How Do You Handle This in Your Office?
Jeff Rickabaugh, DDS
t was fortunate that the clinical and business staff that constantly changing appointments may prolong
of many offices attended the annual SAO meeting treatment. Morgan Smith in Dr. Brad Porter’s office
held November 6-9, 2008. Undoubtedly a lot of scripted the response to patients as follows:
arm twisting was used to convince this valued work- I’m happy to change your appointment. Dr. Porter has
force to spend a few days in Orlando at the Gaylord estimated your treatment time at xx. If you need a cer-
Palms Resort to further their training. The SAO staff tain time of day, it may be sometime before I have an
seized upon this opportunity to gather responses from available appointment. Please be advised that the
a seasoned crowd of auxiliaries who deal with patients number of weeks we go out may be time added to xx
and parents day in and day out. treatment. Would you prefer my first available?
Questions were directed to those who schedule
patients, treat the patients, market the practice and How do you handle patients who want only
manage the financial aspects. This issue will focus appointments after school?
on the scheduling coordinators and subsequent Several offices met this head-on at
articles will view the responses from the other the initial visit when policies are
areas mentioned. discussed. Elaine Pucciano
(Atlanta) at Dr. Moody Williams
How do you handle patients who are habitually office tells them at the initial visit
late for appointments? their policy is to alternate morning
All the offices that responded stat- and afternoon appointments. Other
ed that the patient would be seen. offices advised that certain proce-
The patients/parents are advised dures could not always be done
that they are late, but would be during the hectic afternoon ses- Elaine Pucciano
seen if they were willing to wait. sions. One office reports it “stays Atlanta, GA
The “on time” patients are seen late” on Tuesdays to accommodate
first, then the others worked in as those who need late appointments while another office
Angie Williams time allowed. If the patient is over opens early before school two days per week to see
Decatur, AL 15-20 minutes late, he/she are these patients.
offered the opportunity to resched-
ule their appointment if they could not wait to be How do you schedule long procedures?
worked in. As Angie Williams from Dr. Penny Taylor’s Most offices responded that long
office said, “If they are over 15 minutes late, we procedures are staggered through-
reschedule at a later date unless we have time to go out the morning and right after
ahead and treat them.” One office noted that it is more lunch. Another office states that
accommodating because it is a newer office. initial bandings are staggered 20
minutes apart for enough ‘doctor’
How do you handle patients time. Samantha Smith in Dr. David
who constantly change Wemmer’s office put it like this:
appointments? Stagger like procedures throughout Samantha Smith
This seemed to be less of a prob- the day, bondings and bracket Okeechobee, FL
lem in the offices than tardiness. removal in a.m. AW changes and
Patients are rescheduled to fit their reforms in p.m.
schedule or the first available If you feel that you have other solutions, please send
Morgan Smith appointment. When appropriate, it your comments to the Editor.
Altamonte is mentioned to the patient/parent
Winter 2009 SAO
Council on New and Younger Members
Mark Dusek, DDS
e are fortunate to have a member of the SAO, Preston Miller, as chair of the AAO Council on New and Younger
Members (CONYM). Dr. Miller is a native of Memphis, TN and a graduate of Washington and Lee University,
the University of Tennessee College of Dentistry, and the University of Tennessee Department of Orthodontics.
He is currently in private practice in Jackson, TN, and is an Assistant Professor at the University of Tennessee Department
Dr. Miller was asked to write a summary of the roles and responsibilities of CONYM. If you have questions about the
Council, you may contact Dr. Miller at firstname.lastname@example.org. Future articles in this section will relate to the interests of
the “young” orthodontist. If there are topics you would like to see featured, please contact me at email@example.com.
THE AAO COUNCIL ON NEW AND YOUNGER MEMBERS
Dr. Preston D. Miller III, 2008-09 Council Chair members free of charge upon request through
The Council on New and Younger Members (CONYM) is the www.AAOmembers.org. The brochure features the AAO-
AAO council dedicated to the interests of orthodontic stu- approved logo. Also, members may download the brochure
dents/residents and orthodontists in practice eight years or from the AAO member web site for self printing. The Coun-
less. A member of the AAO Board of Trustees serves as a liai- cil encourages use of the I Keep Safe program at local, state,
son to the Council. and constituent orthodontic meetings.
The Council's responsibilities are: • The Council's idea to provide family centered services,
• Promote the importance of AAO membership to particularly child care services, during the AAO Annual Ses-
new/younger orthodontists and students. sions will be continued the 2009 Annual Session in Boston.
This service was planned but could not be provided at the
• Represent and promote the interests of new/younger mem- 2008 Annual Session in Denver due to registration numbers.
bers and students to the AAO. Safety and security of children are the concerns that instigat-
• Provide a means of open communication and interaction ed this service.
among new/younger members and students. • New and Younger Members Online Newsletter (NYMO):
• Develop and recommend member services directed at This is an ongoing Council communication service which
new/younger and student members. consists of a quarterly publication sent to students/residents
• Develop and monitor interactive communication with and new/younger members via email and the AAO member
new/younger members and students. Web site. Articles are written and solicited by Council
members on a range of practice management topics.
• Promote the development of future AAO leaders.
• CONYM Resident/New Orthodontist Conference and
• Provide information to the Board of Trustees and existing
Reception at Annual Session: This program is targeted at
councils, committees and task forces about issues involving
students/residents and new/younger members and provides a
new/younger and student members.
different speaker each year. The speaker topics are practice
The Council's Key Initiatives include: management, finances, starting out after graduation, and
• Develop a debt consolidation program to be presented for practical business solutions. Spouses of registered members
consideration by the AAO; or as an alternative, research who attend the program are also invited to attend by register-
other programs available to the public and develop ways to ing for the Conference. The program concludes with a
provide that information to our new/younger members. Q&A session with the speaker, and is followed by a cocktail
• Develop ideas to encourage and promote increased atten- reception which provides valuable networking and an oppor-
dance at annual meetings, and to increase awareness of a tunity for conversation about the various aspects of having a
constituent’s leadership development programs for practice.
new/younger members. • The 2009 Speaker for the New Orthodontist/Resident
• Through CONYM's efforts, the I Keep Safe program, an Conference is Charlene White, speaking on “A Step by Step
internet safety program directed to young children and their Guide to Developing a Winning Team.”
parents, received AAO approval. A brochure is available to
SAO Winter 2009
Class III Camouflage Treatment:
What are the Limits?
Editor’s Note: Each year the SAO supports graduate student education in our constituent by awarding monetary grants to student
research projects that are selected by the SAO’s Scientific Affairs Committee. This paper is the summary of a research project that
was supported by an SAO research grant to Dr. Nikia Burns, a graduate student at West Virgina University who is now in private
practice in Pittsburgh, Pennsylvania. Her research was supervised by Drs. Peter Ngan, Chris Martin, Dave Musich and the faculty of
the Department of Orthodontics at West Virginia University.
The incidence of Class III malocclusion in the United films and measurements on study casts. Results were
States population is approximately 1%.1 However, approxi- compared to a group of untreated subjects taken from the
mately 16% of patients ages 4-10 years of age who are Bolton-Brush Study who were matched by age, sex, and
referred to an orthodontic practice have a diagnosis of craniofacial morphology to the experimental sample. Data
Class III malocclusion.2 were analyzed using a repeated measures analysis and
Developing Class III malocclusion can be camouflaged by matched t tests.
orthopedic or orthodontic treatment.3-5 Orthodontic treat- Results of the study showed the average WITS appraisal of
ment to procline the maxillary incisors and retrocline the the Class III sample that could be successfully camou-
mandibular incisors can improve the dental occlusion but flaged with fixed appliances was -7.3 + 2.7 mm with a
will not correct the underlying skeletal problem or facial range from -12.7 to 1.0 mm. The average PAR index score
profile. The literature does not clearly define the limit of before treatment was 33.5 and after treatment was 4.1, an
camouflage treatment is without compromising the peri- indication of successful treatment with good occlusion.
odontium. The objective of this study was to provide No significant differences were found in gingival attach-
information on the range of tooth movements, the peri- ment change after orthodontic treatment between the treat-
odontal health and soft tissue response to camouflage ment group (0.67 + 0.05 mm) and the control group (0.47
treatment of Class III skeletal malocclusions and to com- + 0.02 mm). This finding confirms that treatment does not
pare these findings to an untreated Class III sample. compromise the periodontium. Significant differences
Thirty-four patients with skeletal Class III malocclusions were found in the skeletal, dental and soft tissue changes
whose comprehensive orthodontic treatment was rendered between the treatment and control groups. The average
by David Musich were included in the study. The average change in WITS appraisal was 1.2 + 0.1 mm in the treat-
age of the patients was 12.4 + 1.0 years. The selection cri- ment sample as compared to -0.2 + 0.3 mm in the control
teria included patients with 1) a skeletal Class III maloc- sample. The average change in overjet in the treatment
clusion and a WITS >-1.5 mm; 2) a Class III molar group was 0.1 + 0.8 mm as compared to -0.5 + 0.4 mm in
relationship or a mesial step terminal plane in the mixed the control group. However, large variations were found in
dentition; 3) comprehensive extraction or non-extraction both the treatment and control samples (Figures 1-8). The
orthodontic treatment to camouflage the skeletal malocclu- change in maxillary base ranged from 2 to 8 mm in the
sion; 4) quality pre- and post treatment orthodontic treatment group and the mandibular base from 3 to 9 mm.
records. Lateral cephalometric radiographs were taken Similar range and distribution were found in the control
before and after orthodontic
treatment. Skeletal, dental and
soft tissue changes were deter-
mined using published
cephalometric analyses. The
quality of orthodontic treat-
ment was standardized by reg-
istering the PAR index on the
pre- and post treatment study
casts. Periodontal changes in
response to treatment were per- Figure 1: Changes in Maxillary Base in Figure 2: Changes in Maxillary Base in
formed on both the lateral head Treatment Group (mm) Control Group (mm)
Winter 2009 SAO
an average of 2.4 mm. The
position of the nose (Pn) in
relation to Nasion was
increased by 1.4mm. The
position of labrale superius
(Li) in relation to Nasion
was increased by 1.2 mm.
Figure 3: Changes in Mandibular Base in Figure 4: Changes in the Mandibular Base
the Treated Sample (mm)
The upper lip thickness at
in the Control Sample (mm)
subnasale (Sn-A) was
increased by 1.6 mm and the superior labial
sulcus (Sls-A) was decreased in thickness by
1.4. Vertically, soft tissue upper and lower
facial height also showed a significant down-
ward movement during treatment. These
results suggest that significant skeletal, dental
and soft tissue changes can be expected from
patients are camouflaged by orthodontic
Figure 6: Lower Incisor Inclination tooth movement. A wide range of Class III
Changes Control Sample malocclusion can be successfully camou-
Figure 5: Lower Incisor Inclination flaged with tooth movement without causing
Treatment Changes deleterious effects to the periodontium.
While treating the Class III patient, the
orthodontist is strongly advised to monitor
growth changes during this period to be cer-
tain that the patient does not grow out of the
range of successful camouflage treatment. If
camouflage treatment is planned through the
irreversible step of extraction of premolars,
verification that the goals of treatment can be
Figure 8: Upper incisor Inclination achieved through a non-surgical treatment
of Control Sample approach is essential.
Figure 7: Upper incisor Inclination
Changes in Treated Sample
1. Ngan, P (2000). Treatment of Class III Malocclusion in the
groups. A wide range of tooth movement was found to Primary and Mixed Dentitions. In Textbook of Orthodontics, ed.
compensate for the skeletal changes. The change in lower Bishara SE, pp. 375-376. New York: WB Saunders Company.
incisors ranged from -10 to 15 mm in the treated group 2. Sugawara J, Mitani H. “Facial Growth of Skeletal Class III
and -10 to 6 mm in the control group. The change in Musich, DR, Busch, MJ: Early Orthodontic Treatment: Current
upper incisor ranged from -6 to 12 mm in the treated Clinical Perspectives: Alpha Omegan March 2007 Vol. 100, Issue
group and from -3 to 12 mm in the control group. The 1, Pages 17-24
molar relationship was improved to a more Class I rela- 3. Malocclusion and the Effects, Limitations, and Long-Term
tionship in the treated group (0.5 + 0.2mm) compared to Dentofacial Adaptations to Chincap Therapy”. Semin Orthod
the control group (0.1 + 0.1 mm). The occlusal plane was 1997;3:244-54.
rotated clockwise 0.8 + 0.5° in the treatment group as 4. Costa Pinho T, Torrent J, Pinto J. “Orthodontic Camouflage in
compared to an anti-clockwise rotation of 2.6 + 1.2° in the the case of a skeletal Class III malocclsuion” World J Orthod
control group. The mandibular plane was closed by 0.1 + 2004;5:213-223.
1.2° compared to 1.4 + 0.7° in the control group. Signifi- 5. Lin J, Gu Y. “Preliminary Investigation of Nonsurgical Treat-
cant differences in soft tissue changes were also found ment of Severe Skeletal Class III Malocclusion in the Permanent
between the treatment and control group with individual Dentition” Angle Orthod 2003; 73(4):401-10.
variation in response to treatment. The angle of convexity
PIONEER OF THE SPECIALTY
Hubert “Puck” Kiser
Sharon Hunt, CAE
ubert “Puck” Kiser has extra curricular activities, such
been a force in as writing a history of the SAO
orthodontics for from 1981-2000. He presented
decades. He has built a reputa- and organized programs for the
tion for integrity and ethics. SAO Annual Meeting. He
Accolades come from all over served on the SAO Future
the world. Directions Committee and as a
Dr. Kiser received the nick- guest examiner for the ABO.
name “Puck” from his 3 year- He has received the SAO Citi-
old sister who thought the new zenship Award and the Oren
baby looked like a puppy dog, Oliver Distinguished Service
but pronounced the word Award.
“pucky” and it stuck. He was Puck was active in community
extremely active as a high organizations. He helped orga-
school student, earning letters nize the Bluefield Rotary Club,
in 3 sports for 3 years. Puck was an active member of the
served as editor of the annual Bluefield Chamber of Com-
yearbook. He belonged to 5 merce, the Tazewell Communi-
clubs. He sang and acted in ty Hospital Foundation, and the
plays, and organized a boys Clinch Mountain Militia Chap-
club called “The Woman ter of the Sons of the American
Haters” with the motto “Hate to be Without ‘em.” Puck Revolution. He was awarded the DAR good Citizenship
did his dental training at MCV and his orthodontic resi- Award for his outstanding service to the community
dency at Columbia. He served two years in the Air through his practice and the many positions he has held
Force. A longtime Air Force friend Fred Thrasher, said in the community throughout the years.
“He doesn’t have a medal on his chest, but he has Puck’s personal code of behavior is religious, ethical and
always had one in his heart.” He opened his practice in fun-loving. Friends think of Puck as HAPPY. Puck’s
Bluefield, West Virginia in 1963. Thus began many practice philosophy was to obtain the best possible
years of service to dental and community organizations. results for each patient in his care in a minimum treat-
Puck believed that every year he should give something ment time at a fair and reasonable fee. He loved seeing
back to his profession. He has the distinction of serving changes in personality from unattractive and withdrawn
as President of the Virginia Orthodontic Society and the because of dental deformities to attractive with confi-
West Virginia Orthodontic Society. He was active for dence in his/her appearance—and receive appreciation
many years with specialty licensure testing for years after treatment. His advice for new practitioners
orthodontists in West Virginia. Puck moved on to the is to get established, live frugally, and expand by incur-
regional level and worked up to becoming SAO Presi- ring a minimum of debt so it is not necessary to pay for
dent in 1985-86. His theme was “We Need Each Other.” interest out of profits. He encouraged life long learning.
He explained the theme as follows: The student needs A friend compared Puck to Don Quixote and described
the school, the young orthodontist needs the mature him as a knight who goes about searching to do good
orthodontist, and the practicing orthodontist needs the deeds. Another described Puck as an “outstanding citi-
SSO [Southern Society of Orthodontists, changed to zen with the highest degree of attainment in education,
Southern Association of Orthodontists in 1988]. Serv- history, genealogy, patriotism and humanitarianism.”
ing as SAO President also required service in the AAO
We need more pioneers like Puck.
House of Delegates. Along the way he volunteered for
Winter 2009 SAO
Recruitment and Retention of Faculty
he orthodontic specialty has grappled with the By Task Force approval, the Academy of Academic Lead-
issues facing recruitment and retention of orthodon- ership Sponsor Program deadline has been extended to
tic educators for many years—even decades. In March 1, 2009 and is now open to faculty members of all
recent years the AAO House of Delegates began to proac- experience levels, including mid-career and senior faculty.
tively deal with the issues involved by developing a well The 2008-2009 Task Force members are: Chair, Dr. Don
conceived plan to augment the backbone of the specialty, Joondeph, University of Washington; Dr. Carla Evans,
orthodontic education. The message that the House of Del- University of Illinois at Chicago; Dr. Lee Graber, AAO
egates sent was that orthodontists care about educators Board of Trustees; Dr. Gayle Glenn, AAO Board of
and about education. Here is a report on the initiatives Trustees; Dr. Henry Fields, Ohio State University; Dr.
taken since 2006 when the Task Force on Recruitment and James Koelbl, Western University; Dr. Brent Larson, Uni-
Retention of Faculty was formed. versity of Minnesota; Dr. William Lobb, Marquette Uni-
versity; Dr. William Proffit, University of North Carolina
In the past three years $4 million has been distributed or at Chapel Hill; Dr. David Turpin, AJO-DO; Dr. James
allocated by the AAO in strategic response to the Vaden, University of Tennessee; Dr. Leslie Will, Tufts
orthodontic faculty shortage. The Task Force on Recruit- University; and Dr. William Wiltshire, University of Mani-
ment and Retention of Faculty (TFRRF) efforts are specif- toba.
ically focused on making academic careers appealing and Recent Task Force accomplishments and project updates
affordable for new and existing faculty members via a include:
range of long-term and sustainable programs. Dr. Don
Joondeph, Task Force Chair, currently oversees a dozen Full-time Faculty Teaching Fellowships
initiatives directed at addressing this critical AAO issue. • 2008-2009 (Year 2), Full-time Faculty Teaching Fellow-
In 2007 the Faculty Development Awards were given to ships, $600,000 will be awarded to junior faculty for
142 orthodontic faculty members who received financial two to five year fellowships with one year of teaching
grants that ranged from $4,250 to $30,000. During 2008, payback required in exchange for each year of funding;
eleven full-time Faculty Teaching Awards were awarded for 14 applications were received by the January 1, 2009
either two or three years each. The Academy of Academic deadline and are now being reviewed by committee.
Leadership Sponsored Program Fellowships were given to • The Full-time Faculty Teaching (FFT) Fellowships are
four faculty members during the summer of 2008. for two to five years with a pay-back of an equal number
The Task Force continues to make progress on a range of of years of teaching with a minimum of $60,000 funding
projects: to a maximum of $150,000 funding contingent upon the
number of years awarded. The $600,000 in budgeted
(1) 2009 fellowship applications have been received;
funds will be divided between two to five year Fellow-
(2) A formal proposal was received to create an electronic ships and among as many recipients as the funding
library of teaching lectures by the Distance Learning will cover. Fellows must agree to requirements, e.g.,
Repository Committee; and educational courses, mentoring sessions and more.
(3) Recommendations have been written by the Compliance is monitored.
Mid-Career Faculty Committee.
Faculty First Awards
• New in 2008-2009, Faculty First Awards are
ten $30,000 awards ($300,000 total) for first-
time orthodontic junior faculty members
with one year of teaching payback required
in exchange for the year of funding; 12 appli-
SAO Winter 2009
cations were received by the January 1, 2009 deadline Resolution Review and Recommendation With
and are now being reviewed. COMEJC
With COMEJC, the Task Force reviewed and made recom-
Sponsor Participants to Attend the Academy of mendations on proposed bylaws changes and was in unani-
Academic Leadership mous agreement with COMEJC:
• 2008-2009 (Year 2), Academy of Academic Leadership
• 29-08 SWSO Assessment Relief for Orthodontists
Sponsor Program, education immersion program com-
Employed at Least Half-time as Faculty (approve)
prised of four faculty openings for 2009 with one year of
teaching required; the application deadline has been • 31-08 SWSO Consideration of Full-time Hospi-
extended to March 1, 2009; four completed applications tal/Institution Staff Orthodontists as Full-time Academic
were received as of January 1. The Task Force has Members (approve)
broadened the eligibility requirement to include mid- • 33-08 SWSO Dues Reduction for Active Orthodontic
career and senior faculty. Members Employed at Least Half-time as Faculty
• The teaching payback requirement is one year per fellow. (approve)
Compliance is monitored.
Available at AAOMEMBERS.ORG
Create a Repository of Material for the Purpose of • Academic Careers PowerPoint Presentation
Distance Learning • AAO Academic Career Center
• A proposal was submitted for BOT consideration at the • White Paper Guide for Orthodontic Education Mentors
February 2009 meeting recommending the 25 online
• White Paper on Government Grants and Fellowships
orthodontic lectures be made available for use by all
accredited orthodontic programs. • White Paper on Orthodontic Alumni Development
Mid-Level and Senior Faculty Support
• The sub-committee has investigated support for mid- ACTIONS OF THE HOUSE OF
level and senior faculty members. Their recommenda- DELEGATES
tions are now being reviewed by the Task Force.
Conduct Faculty Practices and Faculty Financial Resolution 27-06 Augmentation of Faculty
Models Survey Salaries and Benefits:
Surveys were conducted in fall 2008 and results are now RESOLVED, that the AAO allocate $2 million in
being analyzed. The committee will prepare a White the 2006-2007 budget to augment faculty salaries
Paper on Practice Models to be accompanied by a Power- and benefits at all accredited postgraduate
Point presentation. The survey results will ”dovetail” with orthodontic residency programs in the USA and
Dr. Rolf Behrents’ work on the topic and will be made Canada.
available as a resource for orthodontic graduate programs. In the 2007 House of Delegates, several resolu-
tions were referred to the TFRRF:
Conduct Orthodontic Educator Entry and
Exit Surveys (1) $374,250 unused by the Faculty Development
• The annual surveys that will be conducted in spring Awards Committee in 2006-2007 to recruit faculty
2009. The initial Orthodontic Faculty Trends Surveys, (2) $750,000 to augment 25 junior faculty
Faculty Entry and Faculty Exit Surveys were conducted (3) $900,000 for 6 orthodontic fellowships
in 2007-2008. Data from the faculty surveys will be
collected annually for comparison and analysis of longi-
In the 2008 HOD, $600,000 from excess reserves
tudinal data. was approved for the continuation of the Full-time
Faculty Teaching Fellowship Program
Winter 2009 SAO
How Would You Treat This Patient continued
After receiving consent from the family, the plan to sub- replacement of the
stitute the maxillary right canine for the maxillary right temporary bonding on
lateral incisor, build up the maxillary left lateral incisor to the maxillary left lat-
normal shape, disimpact the maxillary left canine and fin- eral incisor was rec-
ish treatment to a Class II occlusion on the right side was ommended.
chosen. A “close-up” pre-
restorative smile that
Treatment Sequence demonstrates connec-
Treatment was begun by placing fixed appliances in the tor disharmony and
maxillary and mandibular arches. Prior to bonding, the large mesio-incisal
maxillary left lateral incisor was temporarily bonded with embrasure between
composite to allow for bracket placement. The bracket the reshaped cuspid
was positioned on this tooth so that it would keep the and maxillary right
root of this tooth at a mesial angulation in order to avoid central incisor is
potential damage by the developing maxillary left canine. shown. An ideal
After leveling to a full dimension .017 X .025 archwire in embrasure and con-
the mandibular arch and a .016 stainless steel archwire in tact/connector rela-
the maxillary arch, Class III elastics were started on the tionships as
right side. Once the maxillary left canine was fully erupt- demonstrated by
ed and it was established that the patient had excellent Morley and Eubank is
elastic compliance, the maxillary right canine was shown.
reshaped to the appearance of a maxillary lateral incisor.
(Morley, J Eubank, J.
After reshaping and leveling into full dimension arch-
wires, the patient continued Class III elastics on the right of Smile Design. JADA.
side and Class II elastics on the left side. The curve of 2001; 132: 39-45)
Spee was maintained in the lower archwire to assist with
overbite closure. Posttreatment
Prior to debond, the patient was referred to her restorative Records
dentist for discussion of the restorative options. While Facial proportion, from both the frontal and profile rela-
there are many options for patients who are missing ante- tionships has remained relatively unchanged. Frontal
rior teeth- bonding, whitening, and/or veneers- this smile esthetics has improved immensely due to proper
patient’s family preferred to take a fairly conservative alignment of teeth, space closure, disimpaction of the
route. Examination of the debond close-up smile photo- maxillary left canine, and temporary composite bonding
graph reveals a couple of microesthetic details. First, the on the peg shaped maxillary left lateral incisor. The
patient certainly struggled with oral hygiene during treat- patient’s smile arc is consonant and incisor display on
ment as is evidenced by decalcification
present on several of her teeth. Second,
the substituted maxillary right canine
and its associated shape left the patient
with a large incisal embrasure between
this tooth and the central incisor. The
large incisal embrasure is also accom-
panied by a shortened connector
between the lateral and central incisor
which causes visual disturbance when
compared to the contra-lateral side.
For this reason, bonding of the mesio-
incisal embrasure on the canine and Posttreatment Facial Photos
SAO Winter 2009
ANB 2 Maxillary
L1-MP 80 Mandibular
Posttreatment Ceph Pre/Posttreatment Superimpositions
smile has improved. The final smile picture after restora- Final postrestorative photographs show improved embra-
tion shows the enhanced microesthetics created by the sim- sure, contact and connector relationships.
ple restorative additions to her treatment plan. The
patient’s posttreatment casts reveal a Class II molar rela- Summary
tionship on the right side, Class I (substituted premolar for In summary, the treatment of this patient illustrates one of
canine) canine relationship on the right side, and Class I the options available for patients who are missing one or
canine and molar relationships on the patients left side. both maxillary lateral incisors. Although there are inherent
The maxillary and mandibular midlines are coincident and disadvantages with asymmetric canine substitution,
the maxillary right canine has been reshaped and posi- patient/parent desires, financial constraints, and many
tioned in the lateral incisor position. The curve of Spee other factors must be considered when making the final
has been maintained to assist with bite closure. Superimpo- treatment plan for patients. Our job, as orthodontists, is to
sitions reveal that the ANB angle was maintained during advise them as to what is possible and appropriate for their
treatment despite slight opening of the mandibular plane individual situation. Good cooperation was coupled with
due to extrusion of the maxillary molar. The mandibular conservative restorative therapy in order to achieve a nice
incisor was uprighted, due to Class III elastic wear, into the result for this patient.
available mandibular arch space.
Southern Association of Orthodontists
32 Lenox Pointe, NE
Atlanta, GA 30324-3169
Address correction requested
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