THE EDITOR'S CORNER
If I were asked to list the seven cardinal sins of orthodontic treatment mechanics, I would name them, not necessarily in the order of their importance:
Loss of anchorage to me means forward movement of the posterior segments that you didn't want to come forward. The extent of the forward movement prevents you from achieving uprightness of the anterior teeth by whatever standard you have set for yourself. Apart from poor growth patterns, it results from poor treatment planning, poor mechanics, and/or poor patient cooperation. It may result because the orthodontist does not consider it to be important. Or because he does not recognize that it is occurring. Or because he may be prejudiced against methods and adjuncts such as headgear which can prevent or reduce loss of anchorage. Since the special population that we see includes a great many cases in which teeth are already forward, it seems to me to be of prime importance to at least see that we do not place any further strain on their functional or esthetic embarrassment. Also, if teeth are extracted to correct a malocclusion, there is an obligation to use the space in a most economical manner.
Rabbiting upper anterior teeth is a frequent sequel to indiscriminate tipping in retracting without adequate anterior torque. It creates a poor appearance. It can create a poor anterior relationship. Morris Stoner shows that it frequently can cause a foreshortening of the upper arch and prevent correct posterior cusp interdigitation. It is inexcusable, especially with so many torquing auxiliaries available on the market today.
Tenting cuspids and second bicuspids in closing first bicuspid extraction spaces is in the same category as rabbiting anteriors. It is the result of indiscriminate tipping and a failure to use torquing auxiliaries that are available. The periodontal significance of the tented position is potentially grave. Vertical slot brackets have made this condition easy to avoid.
Creating a bimaxillary protrusion or increasing one through expansion without extraction would almost seem to be a relic of the past. Some of these can be attributed to a lack of orthodontic training, some to borderline non-extraction treatment, and some, unfortunately because the parents will not agree to extraction and the orthodontist will not refuse the case.
Relapse to a Class II relationship I consider to be incomplete treatment most of the time. This is seen either when excessive force is used in Class II mechanics or when inadequate cooperation in wearing Class II elastics extends over a long period of time. You can get a repositioning of the mandible that is transient. Another type is that in which the Class II was not corrected completely for one reason or another. They can get worse when treatment is stopped. On the first type, the answer is to stop and test--to stop using Class II elastics for a week or two and see if the Class I correction holds. If it has been truly corrected and interdigitated, it holds.
Molar rotations are one of the hidden villains in orthodontic results. I think they are responsible for a great many poor results and relapses. Rotated molars can rarely occupy a position that will be functionally correct, stable, or allow a perfect interdigitation. They setup cuspal relapses and periodontal problems. They are functionally unsound. They occur often enough, especially when light round wires are used throughout treatment. I think they are as bad in a mesio-distal direction as in a bucco-lingual one and I am puzzled when I see a mesial axial inclination of upper first molars advocated.
Deep overbite due to a failure to open the bite correctly in treatment should be a thing of the past. There are so many technique systems that can open the bite efficiently and early in treatment, that it is inexcusable to neglect this most important step in treatment. This does not mean that all overbite reduction is stable. Far from it. However, opening the bite early in treatment makes a very significant contribution to the success of treatment, to the health of the teeth, and to the degree of overbite reduction that can be maintained.
Everyone can compose his own list. I selected these "cardinal sins" because they are important factors in the quality of an orthodontic result and they are, in large measure, controllable. They do not require superior skill. They require only a certain vigilance and the use of the most fundamental treatment procedures and adjuncts.
Orthodontic treatment is such a variable item quantitatively that, sometimes, it is good to look at it qualitatively. In my list are some of the qualities that I believe should be invested in an orthodontic result. I believe that the advantage that exists in the so-called numbers game is that the establishment of quantitative goals is a guide to qualitative goals. The numbers game sets up some kind of a target. If you are a good shot you will hit the target most of the time. You may often get a bullseye. Having a target establishes your aim.
We are all aware that we are often trying to make something perfect that is quite imperfect; that we are often trying to make something precise using systems that are relatively imprecise. We are the handmaidens of growth and patient cooperation over both of which we have questionable control. Yet, within the framework that we work, attention to details of occlusion are what orthodontics is all about. And that is what my seven cardinal sins were all about. 
