Easy Street, is that the right place for us?

Easy Street is a fictional place where life is carefree. Many doctors and patients are finding simplified, less demanding treatments more appealing, especially in these infectious times that encourage approaches involving minimal contact. In orthodontics, the move to perform more clear aligner therapy may be a faulty step toward Easy Street. A case is made against further trivialization of our specialty.

Redesigning Dentistry-A Perspective Based in History.

Why is dentistry set up separately from mainstream medicine? It seems unnatural. The reason is embedded in historical shadows, as for centuries, dental disease and its treatments were accompanied by excruciating pain and human misery. Early itinerant dentists were in demand because the need for relief was so urgent and great, resulting in dentistry became an independent profession. However, toothache may no longer be a significant public health problem. Despite some pressures from present-day interlopers such as osteopathy schools, dental and oral medicine can and should fold back into mainstream medicine as one of the natural units of medical care. While undoing the existing educational and organizational infrastructure may be a nearly impossible task, there may be a way these perceived obstacles can be circumvented. Those responsible for the administration of medical education should be encouraged to create pathways for their Doctor of Medicine (Medicinae Doctor ­ M.D.) -seeking students to pursue dental/oral medicine as a bona fide specialty of medicine. The time appears right for this redirection in dental education.

Whither orthodontics?

What is the destiny, the future, for orthodontics and its specialists? It is disappointing that industry is leading our thinking these days. Much of our professional life centers around the device- and machine-based techniques, claims, and marketing of manufacturers. When did our passive role as followers happen and why? We may begin to reclaim control of our specialty by revising some aspects of our training programs and journal formats. Meanwhile, we may go back several decades in the literature and find useful insights from clinical sages-applied scientists-who were clearheaded, truthful, and science-based observers, writing before the industrial manipulation and noise we now have to compete with.

Space conditions, palatal vault height, and tooth size in patients with and without palatally displaced canines: A prospective cohort study.

OBJECTIVES:: To assess palatal vault height, tooth size, and dental arch dimensions in patients with unilateral and bilateral palatally displaced canines compared with a control group. MATERIALS AND METHODS:: A sample of 66 patients (mean age: 11.5 ± 1.0 years) with 22 unilateral palatally displaced canines (UPDCs), 22 bilateral palatally displaced canines (BPDCs), and 22 controls (C) were consecutively recruited. All three groups had dental casts that were scanned digitally using the OrthoX three-dimensional model scanner. Tooth size, palatal vault height, dental arch width, dental arch depth, dental arch length, and dental arch space were measured by the same examiner using the GOM software. Remeasurements were made in 10 randomly identified patients. RESULTS:: The palatal vault height was significantly lower in the BPDC group compared with controls. A significantly smaller mesial-distal crown width and, in general, more spacing in the maxilla were found in the UPDC and BPDC groups. No differences in arch length or arch width at the molar region were seen between the groups, while the arch length at the canine region was smaller in the UPDC and BPDC groups. However, this was observed in BPDC patients with both deciduous canines present and in most UPDC patients where the deciduous canine was present, compared with the control group, who had more permanent canines present. CONCLUSIONS:: Patients with PDC had greater reduction in tooth size compared with the control group. The arch length and arch width were similar in patients with and without PDC.

Extractions, retention and stability: the search for orthodontic truth.

Background and objectives: From the beginnings of modern orthodontics, questions have been raised about the extraction of healthy permanent teeth in order to correct malocclusions. A hundred years ago, orthodontic tooth extraction was debated with almost religious intensity by experts on either side of the issue. Sheldon Friel and his mentor Edward H. Angle both had much to say about this controversy. Today, after significant progress in orthodontic practice, similar arguments are being voiced between nonextraction expansionists and those who see the need for tooth extractions in some orthodontic patients. Furthermore, varying concepts of mechanical retention of treatment results have evolved over the years which have been misinterpreted as enhancing natural orthodontic stability. Materials and methods: In this essay, representing the Ernest Sheldon Friel Memorial Lecture presented in 2016 at the 92nd Congress of the European Orthodontic Society, a full spectrum of evidence from biology, anthropology and history is critically discussed in the search for truth among highly contested orthodontic variables: extraction versus nonextraction, fixed retention versus limited retention, and rationalized stability versus biological homeostasis. Conclusions and implications: Conscientious clinicians should try to develop individualized treatment plans for their patients, and not be influenced by treatment 'philosophies' with untested claims in clinical orthodontics.

The Modern Value of Early Writings in Medicine and Dentistry.

This article illustrates three examples supporting the modern value of early writings in dentistry and medicine. First, by studying cases described in works published long before the era of genetic science, we are able to develop new hypotheses about familial conditions and their genetic roots. Tooth transposition is presented as an example. Second, old writings may lead us to valuable historical insights and perspectives in medicine that can be revealed only in retrospective analysis. An example of this kind of historical analysis uncovers why dentistry became unnaturally separated from mainstream medicine in the 19th century. Third, early writings become keys to unlocking forgotten knowledge that enriches our understanding of historically significant people and events. The discovery of Norman Kingsley's long forgotten pyrographic paintings after Rembrandt portraits is used as an example. Libraries, the traditional custodians of these valued old texts, must continue to be supported, and not undermined by the paperless digital revolution.

Setting the stage for the AJO-DO: the haphazard times before orthodontic specialty journals.

The professional distinction of "surgeon-dentist," created in France in the 18th century, stimulated dentistry's early advance as a learned profession. By 1841, Pierre-Joachim Lefoulon coined the term "orthodontosie," which was the root of "orthodontics and dentofacial orthopedics" as a distinct academic field and a specialty. In 1907, the American Orthodontist became the first scientific journal in the world completely devoted to orthodontics. Its failure after 5 years of publication prompted former editor Martin Dewey to find a new publisher for an orthodontic specialty journal. In 1915, the International Journal of Orthodontia was created with Dewey as editor. After some years, its name was changed to the American Journal of Orthodontics, which later became the American Journal of Orthodontics and Dentofacial Orthopedics, or AJO-DO. Today, the AJO-DO at 100 years is a mainstay of scientific advancement in orthodontics.

Is missing maxillary lateral incisor in complete cleft lip and palate a product of genetics or local environment?

OBJECTIVE: To test the null hypothesis: Subjects with isolated complete unilateral cleft lip and palate (UCLP) show no differences in overall frequency of tooth agenesis (hypodontia), comparing a subsample with cleft-side maxillary lateral incisor (MxI2) agenesis to a subsample without cleft-side MxI2 agenesis. Findings could clarify the origins of cleft-side MxI2 agenesis. MATERIALS AND METHODS: Tooth agenesis was identified from dental radiographs of 141 subjects with UCLP. The UCLP cohort was segregated into four categories according to the status and location of MxI2 in the region of the unilateral cleft: group M: subjects with one tooth, located on the mesial side of the alveolar cleft; group D: subjects with one tooth, located on the distal side of the alveolar cleft; group MD: subjects with two teeth present, one mesial and one distal to the cleft; and group ABS: subjects with lateral incisor absent (agenesis) in the cleft area. RESULTS: The null hypothesis was rejected. Among UCLP subjects, there was a twofold increase (P < .0008) in overall frequency of tooth agenesis outside the cleft region in a subsample with cleft-side MxI2 agenesis (ABS), compared to a subsample presenting with no agenesis of the cleft-side MxI2 (M+D+MD). CONCLUSIONS: Cleft-side MxI2 agenesis in CLP subjects appears to be largely a genetically controlled anomaly associated with cleft development, rather than a collateral environmental consequence of the adjacent cleft defect, since increased hypodontia involving multiple missing teeth observed remote from a cleft clearly has a significant genetic basis.

Dentist, artist, pioneer: orthodontic innovator Norman Kingsley and his Rembrandt portraits.

BACKGROUND AND OVERVIEW: Norman W. Kingsley (1829-1913) was one of the most inventive contributors to the early development of orthodontics and cleft palate therapy. Gifted not only in dentistry but also in art, he was a sculptor and painter of considerable renown in his day. The author reports the rediscovery of two Kingsley paintings--exacting copies of Rembrandt self-portraits. Kingsley created them by using pyrography, a rare and difficult wood-charring artistic technique that he helped perfect.

Biographical chronology and selected bibliography of Norman William Kingsley, pioneer in orthodontics.

Norman W. Kingsley (1829- 1913) of New York City was one of the great contributors to the early development of orthodontics and cleft palate therapy. His biographical chronology is presented, based largely on a little-known autobiography published in 1907 when he was 77 years old. Also presented is a Kingsley bibliography with key publications by and about this remarkable pioneer in orthodontics.

Increased occurrence of dental anomalies associated with infraocclusion of deciduous molars.

OBJECTIVE: To test the null hypothesis that there is no relationship between infraocclusion and the occurrence of other dental anomalies in subjects selected for clear-cut infraocclusion of one or more deciduous molars. MATERIALS AND METHODS: The experimental sample consisted of 99 orthodontic patients (43 from Boston, Mass, United States; 56 from Jerusalem, Israel) with at least one deciduous molar in infraocclusion greater than 1 mm vertical discrepancy, measured from the mesial marginal ridge of the first permanent molar. Panoramic radiographs and dental casts were used to determine the presence of other dental anomalies, including agenesis of permanent teeth, microdontia of maxillary lateral incisors, palatally displaced canines (PDC), and distal angulation of the mandibular second premolars (MnP2-DA). Comparative prevalence reference values were utilized and statistical testing was performed using the chi-square test (P < .05) and odds ratio. RESULTS: The studied dental anomalies showed two to seven times greater prevalence in the infraocclusion samples, compared with reported prevalence in reference samples. In most cases, the infraoccluded deciduous molar exfoliated eventually and the underlying premolar erupted spontaneously. In some severe phenotypes (10%), the infraoccluded deciduous molar was extracted and space was regained to allow uncomplicated eruption of the associated premolar. CONCLUSION: Statistically significant associations were observed between the presence of infraocclusion and the occurrence of tooth agenesis, microdontia of maxillary lateral incisors, PDC, and MnP2-DA. These associations support a hypothesis favoring shared causal genetic factors. Clinically, infraocclusion may be considered an early marker for the development of later appearing dental anomalies, such as tooth agenesis and PDC.

A biographical portrait of Edward Hartley Angle, the first specialist in orthodontics, part 1.

Much of what is known about Edward Hartley Angle, MD, DDS (1855-1930), the acknowledged "father" of modern orthodontics, has been derived from secondary sources, accounts written by his contemporaries and others. New historical research using primary sources, largely the recently published four-volume sourcebook of Angle's correspondence and business transactions from 1899 to 1910, gives a broad view of the personality, interests, and activities of this prime mover in the evolution of orthodontics. This three-part article highlights aspects of Edward H. Angle's life and persona, based on new findings culled from his letters and other personal documents. Part 3 presents a biographical chronology of Angle's remarkable life.