Eladio DeLeon

Complications and Solutions in Presurgical Nasoalveolar Molding Therapy

Objective: To outline three main categories of nasoalveolar molding complications, describe their etiologies and manifestations, and prescribe preventive and palliative therapy for their proper management. Estimates of the incidence of each complication also are provided. Materials and Methods: Data were collected retrospectively from the charts of 27 patients with complete unilateral cleft lip and palate treated by the first author (D.L.-B.) at the University of Puerto Rico (n  =  12) and the Medical College of Georgia (n  =  15). Confidence intervals for the true incidence of each complication were calculated using exact methods based on the binomial distribution. A significance level of .05 was used for all statistical tests. Results: Of the soft and hard tissue complications considered, only one (tissue irritation) had an estimated incidence greater than 10%. Compliance issues were of greater concern, with an estimated incidence of 30% for broken appointments and an estimated incidence of 26% for removal of the nasoalveolar molding appliance by the tongue. Conclusions: Although benefits outnumber the complications, it is important to address all complications in order to prevent any deleterious outcomes.

Posttreatment tooth movement: for better or for worse.

P osttreatment tooth movement is inevitable, but its degree depends on a variety of factors that are both iatrogenic and innate to each patient. Although various retention techniques have been developed to minimize posttreatment movement, it is unrealistic to believe that the entire dentition can be retained in all dimensions. Relapse is usually considered an adverse phenomenon, but some dimensions of posttreatment tooth movement might actually enhance occlusal function and esthetics. Favorable movement is often considered as ‘‘settling’’ if that aspect of the occlusion is improved over time. In 1998, the American Board of Orthodontics (ABO) published an objective method of evaluating posttreatment results by using 7 cast measurements and 1 radiographic measurement. Formerly called the Objective Grading System, the ABO now refers to this as the Cast Radiograph Evaluation (C-R Eval). This evaluation technique is used to score final casts and the panoramic radiograph produced within 12 months of debanding. The 8 scoring parameters are alignment/rotations, marginal ridges, buccolingual inclination, overjet, occlusal contacts, occlusal relationships, interproximal contacts, and root angulation. The C-R Eval was developed to increase objectivity in evaluation of treatment results; it uses a point system with precise criteria for cast and radiographic grading to score the case result in terms of finishing and detailing. Each case is scored after individual and group calibration of examiners in an effort to secure equity in grading among all examiners. Hence, 8 aspects of the

Radiographic and periodontal requirements of the American Board of Orthodontics: a modification in the case display requirements for adult and periodontally involved adolescent and preadolescent patients.

The increased number of adults undergoing orthodontic treatment is one of the most dramatic changes in our specialty, at least partially due to the population’s elevated awareness of dental esthetics. Studies have shown an 800% increase in the number of adult orthodontic patients starting treatment between 1970 and 1990. In conjunction with the rise in the adult patient pool, orthodontic treatment complexity has likewise increased. Periodontal involvement in adults as young as 18 years has been documented in over 50% of subjects and in most adult patients over 45 years of age. Documentation of advanced periodontal disease has been shown to affect approximately 8% to 30% of the adult population, and many of these patients are unaware of it. It is logical that some patients who are prone to periodontal involvement will proceed with orthodontic therapy. Periodontal disease is site specific and usually occurs cyclically over the lifetime of a susceptible person. This site specificity is most common in the interdental areas, which are readily seen on appropriate radiographs. Studies have shown that over two-thirds of adults have radiographic bone loss even before orthodontic therapy, indicating an elevated susceptibility toward periodontal involvement. In a 2-year adult treatment course, it is therefore probable that exacer-

Common errors in preparing for and completing the American Board of Orthodontics clinical examination.

Attaining Board Certification should be a goal of every orthodontic resident, orthodontic educator, and practicing orthodontist. The Board Certification process requires commitment, persistence, firmness of purpose, and sacrifice. Procrastination is the first error along the way to becoming certified. There are many reasons in support of achieving Board Certification,butundoubtedly themost salient isthe inner satisfaction of knowing that one has done his or her best. From a practical perspective, certification will become increasingly important in the eyes of the public we serve. As directors of the American Board of Orthodontics (ABO), we receive ample testimonies to the value of the certification process from newly certified and recertified orthodontists. Many of these diplomates reflect their gratitude for the assistance of the ABO staff throughout the process, the information on the ABO Web site, and the preparation courses provided by the College of Diplomates. The value of the examination as a self-evaluation and self-improvement tool is probably the most frequent comment the ABO receives each year.

Certification renewal process of the American Board of Orthodontics

The American Board of Orthodontics was established in 1929 and is the oldest specialty board in dentistry. Its goal is to protect the public by ensuring competency through the certification of eligible orthodontists. Originally, applicants for certification submitted a thesis, 5 case reports, and a set of casts with appliances. Once granted, the certification never expired. Requirements have changed over the years. In 1950, 15 cases were required, and then 10 in 1987. The Board has continued to refine and improve the certification process. In 1998, certification became time limited, and a renewal process was initiated. The Board continues to improve the recertification process.

Banking cases for the American Board of Orthodontics' initial certification examination.

B oard certification has been widely accepted as a means of improving the quality of medical and dental care. Yet, certification of most practicing orthodontists has historically remained elusive at best. Traditional certification percentages of American Association of Orthodontists (AAO) members before 2005 did not exceed 25% and was only between 13% and 17% in the late 1970s. In 2005, to motivate more members of the specialty to become certified, the American Board of Orthodontics (ABO) established a new certification process to increase the numbers of certified orthodontists and yet maintain its standards. This process was called ‘‘Early Certification’’ and included the concept of mandatory, periodic recertification to maintain the level of care throughout an orthodontist’s career. The ABO’s vision was that early certification, followed by repeated recertification, initiates a lifelong process of learning and self-evaluation. The ABO later renamed the Early Certification process the ‘‘InitialCertificationExamination’’ (ICE). Among various specific requirements, the ICE uses cases treated in an orthodontist’s residency with precise stipulations. The specifics of the requirements can be found on the ABO website at www.americanboardortho.com. As the ICE process was used, it became apparent that residents in shorter orthodontic specialty programs had more difficulty in satisfying the ICE requirements than those from longer programs. Yet, studies showed that younger orthodontists, regardless of program length, valued certification. After the July 2007 conclu-