text: 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: firstname.lastname@example.com • The AAO Investment Committee was formed in November, 2006. This five Web site: www.saortho.org member committee works directly with the AAO investment advisor to review OFFICERS portfolio performance on a regular basis as well as to review other aspects of President AAO investments. Tim Trulove (AL) email@example.com • During 2008, the AAO Investment Committee—along with colleagues from President-Elect the investment committees of the AAO Foundation and the AAO Insurance R. R Reed, Jr. (FL) Company—solicited information from and met with several investment advi- email@example.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) email@example.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 email@example.com 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. firstname.lastname@example.com Second Senior Director AAO Trustees and the members of the AAO Investment Committee are committed Jay Whitley (LA) firstname.lastname@example.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. firstname.lastname@example.com ADA Issues AAO TRUSTEE BACKGROUND: Michael B. Rogers (GA) email@example.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 firstname.lastname@example.com 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 firstname.lastname@example.com 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 email@example.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 firstname.lastname@example.com. 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 firstname.lastname@example.com. 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 firstname.lastname@example.com. THE AAO COUNCIL ON NEW AND YOUNGER MEMBERS Dr. Preston D. Miller III, 2008-09 Council Chair members free of charge upon request through The Council on New and Younger Members (CONYM) is the www.AAOmembers.org. The brochure features the AAO- AAO council dedicated to the interests of orthodontic stu- approved logo. Also, members may download the brochure dents/residents and orthodontists in practice eight years or from the AAO member web site for self printing. The Coun- less. A member of the AAO Board of Trustees serves as a liai- cil encourages use of the I Keep Safe program at local, state, son to the Council. and constituent orthodontic meetings. The Council's responsibilities are: • The Council's idea to provide family centered services, • Promote the importance of AAO membership to particularly child care services, during the AAO Annual Ses- new/younger orthodontists and students. sions will be continued the 2009 Annual Session in Boston. This service was planned but could not be provided at the • Represent and promote the interests of new/younger mem- 2008 Annual Session in Denver due to registration numbers. bers and students to the AAO. Safety and security of children are the concerns that instigat- • Provide a means of open communication and interaction ed this service. among new/younger members and students. • New and Younger Members Online Newsletter (NYMO): • Develop and recommend member services directed at This is an ongoing Council communication service which new/younger and student members. consists of a quarterly publication sent to students/residents • Develop and monitor interactive communication with and new/younger members via email and the AAO member new/younger members and students. Web site. Articles are written and solicited by Council members on a range of practice management topics. • Promote the development of future AAO leaders. • CONYM Resident/New Orthodontist Conference and • Provide information to the Board of Trustees and existing Reception at Annual Session: This program is targeted at councils, committees and task forces about issues involving students/residents and new/younger members and provides a new/younger and student members. different speaker each year. The speaker topics are practice The Council's Key Initiatives include: management, finances, starting out after graduation, and • Develop a debt consolidation program to be presented for practical business solutions. Spouses of registered members consideration by the AAO; or as an alternative, research who attend the program are also invited to attend by register- other programs available to the public and develop ways to ing for the Conference. The program concludes with a provide that information to our new/younger members. Q&A session with the speaker, and is followed by a cocktail • Develop ideas to encourage and promote increased atten- reception which provides valuable networking and an oppor- dance at annual meetings, and to increase awareness of a tunity for conversation about the various aspects of having a constituent's leadership development programs for practice. new/younger members. • The 2009 Speaker for the New Orthodontist/Resident • Through CONYM's efforts, the I Keep Safe program, an Conference is Charlene White, speaking on "A Step by Step internet safety program directed to young children and their Guide to Developing a Winning Team." parents, received AAO approval. A brochure is available to 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 SAO FUTURE MEETINGS September 22-26, 2010 The Broadmoor Colorado Springs, CO September 28-October 2, 2011 Boca Raton Resort & Club Boca Raton, FL September 26-30, 2012 Grove Park Inn Asheville, NC October 2-6, 2013 Marriott Hilton Head Resort Hilton Head Island, SC


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More Sixers injury woes? Holiday to have MRI on foot.
Dec 13, 2012, 1:40 PM EDT
Haven't the basketball gods already had enough fun with Sixers, dealt the enough of an injury woe for one season in the knees of Andrew Bynum?
Apparently not.
After racking up some heavy minutes recently, Jrue Holiday is getting an MRI on his sore foot and it sounds like he could miss at least the Friday game and maybe more, reports CSNPhilly.com.
Holiday did not practice Thursday and remains questionable for Friday night's game in Indianapolis because of soreness in the longitudinal arch of his left foot. Holiday had X-rays taken, which came back negative for a fracture. However, Holiday was still awaiting the results of an MRI on Thursday afternoon.
Holiday has taken on the role as the fulcrum of the offense with no Bynum and has had by far his best year — 18.6 points per game on 45.1 percent shooting overall, while dishing out 8.9 assists per game. All of those are career highs. He has a PER of 18.2.
The Sixers are 12-10 and playing over their head, winning more games than their point differential would suggest. They are still defending fairly well, but their offense is 24th in the NBA in points per possession. And without Holiday that would be far worse.
They can't really afford to be without him for a while, too.
Sixers GM says he never had conversations about acquiring Anthony Bennett
Aug 27, 2014, 9:51 AM EDT
Sixers value a pick in next year's draft more than they do Bennett at this time.
Report: Clippers plan to stretch Carlos Delfino, waive Miroslav Raduljica
Aug 27, 2014, 9:22 AM EDT
Clippers could sign Chris Douglas-Roberts, Ekpe Udoh with freed cap space
Charlotte offers to spend $33.5 million to upgrade Hornets' arena. Is that enough to get an All-Star Game?
Aug 27, 2014, 8:44 AM EDT
Reportedly 10 teams made bids so this helps
Anthony Davis was filling up the stat sheet vs. Slovenia (VIDEO)
Aug 27, 2014, 8:00 AM EDT
Davis had 18 points, nine rebounds, five blocks and three steals in 20 minutes of work.
Kyrie Irving, Goran Dragic threw some wicked moves at each other (VIDEO)
Aug 27, 2014, 12:25 AM EDT
The point guards made this blowout more fun to watch.
Boxing legend Manny Pacquiao drafts himself onto his own team to be player/coach
Aug 26, 2014, 11:30 PM EDT
I don't see what could possibly go wrong here.
Bucks sign No. 31 pick Damien Inglis
Aug 26, 2014, 10:30 PM EDT
Milwaukee's trade with Clippers cleared a roster spot
Serge Ibaka, Ricky Rubio remind of why Spain will be a problem in FIBA World Cup (VIDEO)
Aug 26, 2014, 9:30 PM EDT
Zydrunas Ilgauskas' agent denies comeback attempt
Aug 26, 2014, 8:35 PM EDT
Former Cavaliers center, 39, has been retired three years
Timberwolves owner: Kevin Love might regret trade because he'll be third banana with Cavaliers
Aug 26, 2014, 7:40 PM EDT
Glen Taylor also questions whether Cleveland should offer Love five-year contract
Jazz sign former Knick Toure' Murry to two-year contract
Aug 26, 2014, 6:45 PM EDT
Murry receives $250,000 guarantee
Anthony Davis and Kenneth Faried lead Team USA in final World Cup tune-up
Aug 26, 2014, 5:55 PM EDT
Derrick Rose struggles off the bench against Slovenia
Thunder trade Hasheem Thabeet to 76ers
Aug 26, 2014, 5:23 PM EDT
Oklahoma City will create trade exception, and Philadelphia will waive Thabeet
From late-arriving to a LeBron James favorite, Kevin Love comes full circle
Aug 26, 2014, 4:55 PM EDT
Kevin Love: 'My decision' swayed by LeBron James calling just after choosing Cavaliers in free agency
New NBA rule clears more space on baseline
Aug 26, 2014, 4:20 PM EDT
Number of camera positions behind baseline to be halved
Clippers trade Jared Dudley and first rounder to Bucks for Carlos Delfino and Miroslav Raduljica
Aug 26, 2014, 3:27 PM EDT
Clippers limit their present and future, and the Bucks gain an easy asset
Report: Cavaliers trying to trade for Nuggets' Timofey Mozgov
Aug 26, 2014, 2:28 PM EDT
Cleveland not offering assets as of yet, so Denver's not biting.
J.R. Smith: 'I'm on pace to be one of the best shooters the game had ever seen'
Aug 26, 2014, 1:51 PM EDT
Career three-pointers made is the only category where this statement begins to make any sense.
Cavaliers, with LeBron James and Kevin Love, favored by oddsmakers to win 2015 NBA title
Aug 26, 2014, 1:09 PM EDT
Spurs, Bulls, Thunder next on the list.
Agent for Thanasis Antetokounmpo 'amazed' his client chose to play in D-League for $25K
Aug 26, 2014, 12:27 PM EDT
Brother of the Bucks' Giannis turned down a more lucrative offer to play overseas.
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From Pitch to Canvas: Pepsi Celebrates 'The Art of Football'
Pepsi today officially announced its global creative curation, uniting the exciting worlds of photography, street art and sport to celebrate "The Art of Football" as part of the brand's 2014 football campaign. Combining world-renowned photographer Danny Clinch, six of the world's leading street artists and some of the globe's best footballers, including Leo Messi, Robin van Persie, Jack Wilshere, David Luiz, Sergio Aguero and Sergio Ramos, Pepsi presents a truly bespoke art collection celebrating the artistry of football.
The resulting artwork six spectacular 10-foot by 10-foot canvases was created by emerging artistic talent chosen specifically to represent the vibrancy and spirit of the global players' home countries. Participating artists include the UK's professional doodle bomber, Hattie Stewart, Argentinean urban artist, Jaz, Brazilian illustrator and street artist Ricardo AKN, Barcelona, Spain-based visual artist Zosen, Merijn Hos, visual artists from the Netherlands and Argentinean street artist Ever.
"The Art of Football" collaboration brings the raw energy of street art onto permanent fixtures of art which depict the players who last month were announced as Pepsi's global 2014 football ambassadors in a clash of color, energy and movement to bring to life the beautiful game in a powerful, striking way.
To capture the athletes' passion and excitement for the game, Pepsi commissioned lensmen Danny Clinch, whose distinctive, stark, black and white imagery of iconic subjects have earned global accolades. Clinch's images were then enhanced by the six street artists, giving the photography an unbridled creative edge, urban rawness, bold color and sense of movement.
"Photographing some of the world's most rhythmic and energetic individuals in a pure and simple way was a really exciting opportunity. Their individual personalities truly come alive in front of the camera," said Clinch. "Coupled with the chance to collaborate with these amazing artists and have them integrate their art with mine and mine with theirs was so creative and inspiring. This project with Pepsi was a personal must do."
Steve Lazarides, gallerist and street art pioneer who discovered world-renowned street artist Banksy, co-hosted the first unveiling of the creative collection in the heart of London last night.
"Using street art over the stark black and white photos of these footballing icons creates a striking image," said Lazarides. "This project provided these artists with the perfect opportunity to showcase their unique styles to a global audience there's a huge difference between something on the street which a passerby might glance at for 20-seconds and canvases of this magnitude that are permanent pieces of art. This collection manages to fuse the two styles in a very innovative and organic way."
The innovative art collaboration is an important piece of the yearlong Pepsi football campaign.
Kristin Patrick, Pepsi Global Chief Marketing Officer, PepsiCo, commented: "There is an instinctive connection between artists and footballers in their energy, passion and creativity whether it's on a canvas or a pitch. We were passionate about creating a visual language that brought the energy and movement of football to life in powerful, unique pieces of art showcasing our players in the spirit of now. These are the hero images of this year's global Pepsi football campaign and wonderfully capture our Live for Now brand ethos."
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