Old Tricks for New Dogs
Holy writ admonishes readers to "forget not thine ancient landmarks." That is not bad advice for orthodontists seeking ways to handle difficult clinical problems.
With the constant introduction of new materials, products, and techniques, it is easy to form the opinion that an idea has less merit because it lacks a modern origin. Nevertheless, some of the best ideas are those that have stood the test of time and proven their usefulness over and over again. Universality is precisely what makes such concepts so valuable and allows them to serve as familiar and identifiable signposts that keep us from losing our way on our professional journeys.
The inadvisability of trying to move maxillary incisors beyond the palatal cortical plate comes to mind as one of those timeless ideas. Both Edwards1 and Ten Hoeve2 enlightened orthodontists about our biological limits years ago, but we need to remind ourselves now and again to temper our enthusiasm for radically retracting protruded maxillary teeth.
Of course, health-care professionals can survive simple and harmless notions that don't quite work out. Most orthodontists have cabinets full of gadgets whose performances never equaled their promises. Willingness to try new ideas can be an occupational and economic hazard that doctors have to recognize in their search for effective diagnoses and therapies.
What we should never support are the downright dangerous concepts that threaten patients' well being and health. For example, more rigorous questioning a few years ago about the new surgical promises of "recapturing" temporomandibular discs and the use of silastic disc replacements could have saved thousands of TMD patients from a great deal of agony and a future of painful uncertainty.
In this issue of JCO, Dr. Fred Schudy illustrates a technique that he used over a professional lifetime to correct the midlines of malocclusions. It was bequeathed to him by Dr. Andrew Jackson of Philadelphia, who had used the same method for many decades before. In addition, early in the century, Emil Herbst used his mandibular repositioning appliance to correct midline discrepancies as well as overbites and overjets.3 What Schudy, Jackson, and Herbst discovered experientially, others have confirmed scientifically.4,5 Orthodontists now realize they can enlist the TMJs in their quests for balanced faces and occlusions without fear of irreversible joint damage.
This is good news, because midline correction remains a top priority of orthodontists and their patients. Patients may not understand the anatomy and physiology of posterior occlusion, but they can and will discover midline asymmetries and request therapeutic remedies. Without the ability to reposition the mandible and the expectation of subsequent TMJ remodeling, such corrections become difficult enough that they can require unilateral extractions--a therapy few patients willingly accept and few orthodontists enthusiastically recommend.
From time to time, clinicians need to be reminded of old knowledge and technology that can help them deliver modern, first-class orthodontic care. The new and the old are not always at cross-purposes. In fact, they often complement one another and help expand professionals' therapeutic skills.