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The Alexander Discipline: Long-Term Stability

208 pages, 1,000 illustrations. $152. 2011.
Quintessence Publishing, 4350 Chandler Drive, Hanover Park, IL 60133.
(800) 621-0387; 

With so few scientific or clinical articles, textbooks, or seminars devoted to long-term retention and stability of treated orthodontic cases, the orthodontic specialty should welcome a book devoted entirely to the subject. Here, Dr. Alexander shares more than 45 years of experience, critical introspection, and assessment of individual patients, cohorts, and orthodontic records, having followed them many years after orthodontic treatment was rendered. His meticulous record keeping has also served as the basis of numerous investigations by orthodontic colleagues that have confirmed the efficacy of his treatment principles. 

This text is written in the most clear, concise, and understandable manner possible, using "case-based learning" as a pedagogical tool. It begins with six important guidelines on building facial harmony and stability, including the surrounding tissues, anterior torque control, skeletal control, transverse control, occlusion, and the soft-tissue profile and smile. Subsequent chapters detail clinical concerns in all these areas. In addition to principles for diagnosis and treatment planning, the reader receives numerous clinical tips on case management and other useful treatment pearls developed by the author. 

Topics such as mandibular intercanine width, mandibular incisor boundaries, the role of incisor torque, and dental arch width and form are covered in great depth. Dr. Alexander thoroughly debunks unsubstantiated attacks on properly diagnosed, well-planned, and appropriately managed extraction therapy with respect to overall stability, facial and smile esthetics, and periodontal and TMJ health. His philosophy is to base the extraction decision on treatment principles, rather than other less-worthy criteria. Clearly, Dr. Alexander uses nonextraction treatment as a strategy rather than a goal in itself. 

While the text describes the rationale behind the design of the Alexander Discipline, each and every point can be applied to any modern orthodontic appliance design. Leveling the curve of Spee without flaring the mandibular incisors is among many useful techniques described in this book. The references and case studies presented at the end of each chapter will also be significant learning tools for any clinician. 

Dr. Alexander's text is a brilliant compilation of time-honored clinical principles, melded with modern orthodontic goals that are empirically derived, evidence- based, or evidence-bolstered. This text might do more than any other I have read to prevent yet another generation of needless orthodontic "retreatments". Yes, it is that important. 



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