NEWS
ARCHIVE
November
11, 1998
TOPIC:
Orthodontic Controversies
CITATION:
Controversies in orthodontics Dent Clin North Am 1990
Jan;34(1):91-102 Bramante MA, Graduate School of Orthodontics,
Columbia University School of Dentistry, New York, New
York.
Three
controversial interrelated aspects of orthodontics have
been reviewed: retention, the effect of third molars
on lower anterior crowding, and extraction and nonextraction
orthodontic treatment. Recent studies have shown that
unacceptable lower anterior crowding occurs in 90 per
cent of well-treated extraction cases. The implication
is that nonextraction cases should be 90 per cent or
higher. In view of our present general inability to
identify the 10 per cent that will remain acceptable,
some form of indefinite retention is advised. A literature
review of the effect of third molars on lower anterior
crowding finds strong opinions on both sides of the
issue. Similar studies often show dissimilar conclusions,
particularly when observing cases of third molar extraction
or agenesis. Certainly the problem is multifactorial;
however, the vast bulk of the evidence indicates that
the third molars play an insignificant role in lower
anterior crowding. Extraction of teeth for orthodontic
treatment prior to 1900 was prevalent and indiscriminate.
From the turn of the century to the mid-thirties Angle
moved the specialty away from extractions to a relatively
rigid nonextraction treatment philosophy. Dissatisified
with relapsing Class II cases, recurrence and aggravation
of crowding, and what he felt were bimaxillary full
faces, Tweed and others, circa 1935, redirected the
profession back to extractions with a more disciplined
approach to treatment by the removal of four first premolars.
Fifty years later we have found that extraction treatment
and uprighting lower incisors does not prevent long-term
postretention crowding and that flattened profiles are
not always esthetically desirable. Earlier treatment
of maxillomandibular basal discrepancies by old and
new treatment philosophies and mechanics have produced
more stable nonextraction corrections. Better control
of leeway space and a reduction in caries has helped
reduce the amount of lower anterior flaring that was
seen in the nonextraction cases in the first third of
the century. These reasons have moved the specialty
of orthodontics to a mixed but more nonextraction-oriented
approach to treatment.
DISCUSSION:
There have been a number of highly contested philosophical
approaches to moving teeth the past few decades. Fortunately
for patients, orthodontic treatment modalities are shifting
more and more away from "traditional orthodontics"
and toward Functional Jaw Orthopedics....a progressive
form of orthodontics and orthopedics with the similar
emphasis on straight teeth, but more emphasis on balanced
JAWS and the orthopedic effects of treatment and treatment
goals. Why is this important? Because the Jaws surround
the gateway to the human cardiopulmonary system, the
upper airway.
What
does this all mean to you?
FUTURE:
Even as "traditional orthodontics" moves towards
Functional Jaw Orthopedic modalities, a new medical
frontier is unfolding. And that frontier starts as early
as birth in evaluating the structural surroundings of
the gateway to the airway.
Take
Care,
Dr. David Page
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