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					Winter 2009                          Southern Association of Orthodontists




 SAO NEWS
                     Alabama
                    Florida
                  Georgia
                Kentucky
           Louisiana
        Mississippi
   North Carolina
  South Carolina
     Tennessee
       Virginia
West Virginia




              SAO Annual Meeting
             September 23-27, 2009
                The Homestead
                Hot Springs, VA
                                                                                                                    SAO

AAO TRUSTEE’S REPORT


  I
     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
                                                              Organizations
     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

  EDUCATION
     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

  STAFF CORNER
     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

                                                       2
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.
                                                                    patients, products/services)
• 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
                                                                 Finances
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


                                                             3
             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)
           tstrulove@aol.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-
          rrrortho@gmail.com                    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)
        rodklima@hotmail.com                    • Recently, an in-depth analysis of AAO cash flow and the portfolio was per-
          Past President
                                                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
    mwjohnston@smilemakers.net                  investments.

       SENIOR DIRECTORS
                                                • 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.
       drrdcalcote163@aol.com
        Second Senior Director              AAO Trustees and the members of the AAO Investment Committee are committed
           Jay Whitley (LA)
         jaywhitley@msn.com                 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.
 drhenryjr@zaytounorthodontics.com
                                            ADA Issues
           AAO TRUSTEE                      BACKGROUND:
        Michael B. Rogers (GA)
         bracesmbr@aol.com
                                            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
          jvaden@utmem.edu                  applicants. Seven of the eight dental specialties joined the AAO initiative.
        EDITORIAL BOARD
             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
              Terry Trojan
                                            criteria for acceptance.
             Mark Yanosky

     EXECUTIVE DIRECTOR
                                            70RCS-1. Resolved, that the ADA House of Delegates urges the Joint Commis-
          Sharon Hunt, CAE
           (800) 261-5528
                                            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.
                                                                 4
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-
SAO News:
                                                                    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


                                                                5
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 bracesmbr@aol.com.               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
                                                                   experience.
                                                                   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
                                                                     AAO Trustee




    Interested in Serving as AAO Trustee?
    T
          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 sharhunt@bellsouth.net.




                                                           6
SAO

                                                                                    A LOOK BACK

History 101: SAO Style

I
     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.
                                                                                Editor]
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

                                                               7
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
                                                             8
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.
154-156.

                                                                          9
                                                                                                                   SAO


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
                                                              maxillary incisors.
 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
                                                                           PRE TX
                                                                           SNA              78
                                                                           SNB              76
                                                                           ANB              2
                                                                           SN-GO-GN         38
                                                                           FMA              29
                                                                           U1-NA            4
                                                                           U1-SN            103
                                                                           L1-NB            6
                                                                           L1-MP            91

                   Pretreatment Facial Photos                                         Pretreatment Tracing




      Pretreatment                   Pretreatment                   Pretreatment
      right buccal                      center                       left buccal
                                                        10
SAO                                                                                                                Winter 2009




    Pretreatment Maxillary                           Pretreatment Mandibular                       Pretreatment Panorex
           Occlusals                                         Occlusals

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.




              Ass
                  oc i   ation of Or
                                       th o
                                                             The Homestead
         rn        Hospitality                                     September 23-27, 2009
                                         do
    th e




                                              nt i
  S ou




                                               sts




         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

                                                                     11
                                                                                                                          SAO

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.




  T
         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.

                                                           12
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

                                                               13
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.”
tiveness”


                                                                14
SAO

                                                                                   STAFF CORNER

How Do You Handle This in Your Office?
Jeff Rickabaugh, DDS



I
    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
   Springs, FL
                                                               15
Winter 2009                                                                                                                       SAO




W
 Council on New and Younger Members
 Mark Dusek, DDS




of Orthodontics.
                                           CONYM
          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 mill1170@bellsouth.net. 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 orthodusek@bellsouth.net.


 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




                                                                  16
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)

                                                                17
Winter 2009                                                                                                                   SAO

                                                                                                  (Ns-Sls/Sls-Pos) was
                                                                                                  reduced by
                                                                                                  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
                                                                   References
                                                                             .
                                                                   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

                                                              18
SAO

                                                              PIONEER OF THE SPECIALTY

Hubert “Puck” Kiser
Sharon Hunt, CAE




H
         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
                                                            19
Winter 2009                                                                                                           SAO



 Recruitment and Retention of Faculty

T
         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




TFRRF
                                                                           • 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-


                                                              20
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




                                                              21
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-
                                                                   Macroesthetic Elements
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
                                                                  22
SAO                                                                                                            Winter 2009




                                                     Posttreatment Casts




                                                 Posttreatment Photographs

 POST TX
 SNA              77
 SNB              75
 ANB              2                                                                                              Maxillary
 SN-GO-GN         41
 FMA              31
 U1-NA            4
 U1-SN            103
 L1-NB            4
 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.
                                                             23
 Southern Association of Orthodontists
 32 Lenox Pointe, NE
 Atlanta, GA 30324-3169


 Address correction requested




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