In this issue of JCO, we present the third and final installment of our series on the 2015 JCO Orthodontic Practice Study. It seems fitting, as I write this during the holiday season, to proclaim some glad tidings. The good news is a marked rise in the percentages of practices reporting increases in both case starts and gross income compared to the previous year - even higher than respondents to the 2013 Study had predicted, reaching a level of growth we have not seen since the 2001 Study.
This book provides valuable information about the academic, research, and clinical elements of postgraduate orthodontic programs worldwide. Of the 20 chapters, the first two outline the history of postgraduate education and various attempts to establish a standardized curriculum. The third focuses on the undergraduate orthodontic curriculum and addresses the shortage of specialists in some regions. Of particular interest are chapters 4 through 12, which break down postgraduate education throughout the world. The similarities and differences discerned by the authors among Europe, the United States, and Asia (to name a few) are incredibly informative, pointing toward a more universal curriculum.
In the two previous two installments of this series on the 2015 JCO Orthodontic Practice Study, we examined trends in economics and practice administration since our first survey was conducted in 1981 (Part 1, JCO, October 2015) and factors that seem to be associated with practice success, as reflected in net income and case starts (Part 2, JCO, November 2015). This final part will cover practice growth in case starts and gross income over the two years since the 2013 Study, as well as staff employment patterns, salaries, and benefits. The methodology for this Study, which was the second to be conducted online rather than by mail, was detailed in Part 1. The full tables and questionnaire are available to JCO subscribers in the Online Archive at www.jco-online.com; select the contents for the October 2015 issue and click on the listing for "Complete Tables".
Orthodontists are constantly looking for ways to improve the ease of treatment, patient comfort, and "throughput". Prescription bonded brackets and nickel titanium wires are just two examples of these efforts. In our Cutting Edge column this month, Dr. Timothy Shaughnessy explores another trend in orthodontic treatment: accelerated orthodontics. During my five decades in the profession, various methods for speeding up treatment, including electrical stimulation and hormonal and chemical applications, have occasionally surfaced. None of these has gained widespread acceptance. Now gaining some traction, however, are both invasive procedures that stimulate the body's reparative process and noninvasive vibratory stimulation of the periodontal membrane.
The advantages of a rapid maxillary expander (RME) anchored to the deciduous teeth in the mixed dentition have been described in the literature, as has the use of a cast-metal Haas-type RME bonded to six deciduous teeth.[ref]1-4[/ref] If the upper first permanent molar remains impacted against the second deciduous molar, however, the distal root of the deciduous molar may experience early resorption, leaving the permanent molar unable to erupt spontaneously. It then becomes impossible to band the deciduous second molar, especially considering the poorly retentive coronal anatomy of the deciduous teeth. The use of bands could not only increase the risk of appliance failure, but create another obstacle to first-molar eruption. An alternative approach would be to extract the deciduous second molars and expand the permanent teeth, but this could lead to early loss of the leeway space, with the consequent need to regain space by distalizing the upper molars or by using extraoral traction in a second treatment phase, or to wait for full eruption of the first molars. It might also require a transpalatal bar to be used before expansion to correct a buccal molar inclination or molar rotation.
The introduction of temporary anchorage devices (TADs) has facilitated orthodontic management of complex dentofacial problems. TADs have also elicited the creativity of orthodontists in designing new appliances and approaches for treating different malocclusions. One such approach involves delivering orthodontic forces directly from mini-implants in the buccal segments without bonding the posterior teeth. Introduced by Chung and colleagues, this "biocreative therapy" obtains skeletal anchorage from sandblasted and acid-etched miniscrews, called C-implants, which are placed interdentally between the first molars and second premolars. The archwire is inserted in the anterior brackets and secured posteriorly in the slots of the C-implants to retract the anterior teeth during space closure. Because the implants are partially osseointegrated, they can resist these torsional forces without failing. Chung and colleagues have indicated that biocreative therapy was especially appropriate for cases of bimaxillary dentoalveolar protrusion and Class II cases with good buccal occlusion. Advantages of their method include three-dimensional control of the active units, a minimal need for patient compliance, and significantly reduced risks of root resorption or white-spot lesions in the posterior segments.
Three-dimensional radiographic studies have found root resorption in 38% of the lateral incisors and 23% of the central incisors associated with impacted canines. Although such damage can occur even when canines erupt normally, the key to success in treating an impacted canine is to achieve correct positioning in the dental arch without causing periodontal defects. A combined surgical-orthodontic approach called the tunnel traction procedure enables physiological eruption of a deeply impacted upper canine while preserving long-term periodontal health. Introduced by Crescini and colleagues, the technique is based on the concept of infracrestal guided eruption. It is recommended for use in cases where the corresponding deciduous teeth provide sufficient space for eruption of the impacted canines.
Click here to download a PDF of the printed questions from the journal for reference. CE tests must be taken online. See the link to continuing education on the menu bar at the top of the screen.
2015 Author Index*ABELA, S., TEWSON, D., PRINCE, S., SIDEBOTTOM, A., and BISTER, D., Total TMJ Reconstruction in Cases of Advanced Idiopathic Condylysis, 263ADABI, S., NANDA, R., URIBE, F.A., and JANA...
Click here to download a PDF of the Product News column for December 2015. See also the Online Product News page of our website for a searchable data base of published Product News items for the past ...
(Editor's Note: The Readers' Corner is a regular feature of JCO in which orthodontists share their experiences and opinions about treatment and practice management. Questions are sent periodically to JCO subscribers selected at random, and the responses are summarized here. This month's column is the first in a series revisiting past Readers' Corner topics to examine changes in the profession over the intervening years; in this case, the same questions on fees and retention appeared in the April and July 2004 issues, respectively.)
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