THE EDITOR'S CORNER

There is an old saying in orthodontics--"Put your plaster on the table". This is an inelegant way of saying, "Let's see your cases". Unfortunately, when cases are shown in publications, at lectures and clinics, to satisfy requirements for Boards and for certain meetings, they are usually near-perfect results, achieved in phenomenal time, with an uneventful treatment procedure. You don't learn much from them, but there are many cases which are teaching cases from which we could all learn a great deal.

I commiserate with anyone who does not wish to expose these cases because they are not always our best or easiest or most successful ones. They are more often the problem cases, the trouble cases, the difficult cases. I do not want to imply that there is nothing to be learned from well-treated, successful cases. There is and, if they have something to teach, I welcome them. I suspect that there is more to be learned from the less-than-successful cases.

We have to overcome our reticence about publishing our losing bouts with perfection. There is no question about it, when a case takes much too long, when things get out of control, when we do not achieve our goals, it hurts. It hurts and, most of the time, we'd like to walk away from the case with a reasonably successful result and not look back. I find no fault with the first part. It is the second that I think is an error. We can often learn from these cases if we do look back.

Teaching cases are more than just wallowing in our imperfections. A study of our cases can turn up things that you never did suspect and, sometimes, never would suspect about the very cases with which you were intimately concerned over some period of time. At that point they become interesting and instructive. We can learn a great deal from each other if we take the trouble to learn for ourselves from our cases and then share our findings with our fellows. JPO will print case reports anonymously on request to encourage the submission of the kind of case that may be unkind to its mentor.

I have decided to inaugurate a feature which I call "The Editor's Casebook" in order to act as a catalyst to others and also to demonstrate what I mean by teaching cases. The first of these appears in this issue.

Adequate Records

If anyone has been taking less than complete records before, during, and after treatment, I strongly urge that he start now taking complete records. Without models, photos and x-rays before and after treatment, you may ponder your cases, but you have no impartial evidence to study for yourself and none to show.

Models should show soft tissue approaching the muco-buccal fold. They should have trimmed bases for standard orientation. When they are photographed, they should be taken at right angles to the trimmed back. This standardizes the photographs of models. I have heard arguments which favor a view perpendicular to the lateral trim of the model. This is not a standardized view.

Intraoral and extraoral photographs should be standardized and of decent quality. In the absence of the patient, before and after portraits personalize the case and often show something of interest in the face and profile. Intraoral photographs should record anything of special interest about the case. I would particularly encourage the taking of intraorals when something goes wrong. Techniques used to recover are frequently lost in our haste to right the wrong.

X-rays include lateral jaw x-rays until third molars can be forgotten and cephalometric x-rays at least before and after treatment. Whatever else one can say about cephalometric x-rays, serial cephs are instructive. They are interesting and often surprising. I think you have to superimpose in order to get the full significance of serial cephs. I know that many men compare the numbers. I feel that the qualitative analysis from superimposition is at least as important as a quantitative analysis.

Case Study

Assuming that one has the records, he needs to develop a routine for examining them on case completion with the kind of constructively critical approach which asks what have I done? did it work out the way I planned? if not, why not? what should have been done differently? what can I learn from this case to help me treat future cases better?

To do this properly takes time. A great many men do not have the time during office hours and they have fallen into a pattern of closing the office door at the end of the day and leaving the office behind. I do not blame them for that. When an orthodontist leaves his office at the end of a busy day, he has made a significant contribution to mankind and he is entitled to his recreation and rest. Strange as it may sound, I am suggesting that case study is recreational. It so often results in discovery, that it can be exciting. Sometimes the discovery may be trivial and sometimes it can be mind-cracking. The funny thing is that it isn't boring. The serious thing is that you can learn a lot from doing it. If there is no office time available for case study and you don't want to go back to the office after hours, have a set-up at home for tracings and measurements. Once you try it, I think that you will find that it is more interesting than many another recreational activity and it has a bonus in what can be learned from it.

Which brings me around full-circle. If there is something that you learn from a case, publish it, and let us all learn from each other.

I would like to create an atmosphere in which it is no flaw to a professional reputation to expose these teaching cases, in which we do not blame ourselves for every case that is less than perfect, in which we recognize that we are dealing with a mechanism that is often quite imperfect and sometimes defies perfection, in which all that anyone will ask of an orthodontist is his 100% effort and his 100% interest in improvement of the treatment of his cases.

Once we start showing these teaching cases, I think we will have acquired a new tool. I hope that their presentation will stimulate some discussion on the part of the reader. I certainly hope that it stimulates a continued flow of this kind of case report from the profession to the profession. Watch for these cases but, more important, contribute to these teaching cases.