John E. Grubb

Clinical and scientific applications/advances in video imaging

This paper discusses the current capabilities and limitations of video imaging. Probable future applications are suggested, including the use of video imaging as an adjunct for esthetic diagnosis and treatment planning and as a means of providing realistic representations to patients of probable treatment outcomes. The widespread use of video imaging to facilitate interactive informed consent and rapid interspecialty communication and transfer of data is predicted and discussed.

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-

The role of computerized video imaging in predicting adult extraction treatment outcomes.

The purpose of this study was to evaluate the accuracy of computerized video imaging in predicting the soft tissue outcome of extracting four premolars in adults. The pretreatment and posttreatment cephalometric and facial photographic records of 31 previously treated, nongrowing patients were digitized and computer-generated cephalometric VTOs and video images were compared with the known outcomes. The results showed that both the VTOs and video images were accurate enough to be used for patient education and communication, as well as for diagnosis and treatment planning. While lay people found that the predicted video images adequately resembled the actual outcomes, orthodontists were more critical, particularly of the lower lip area where variable soft tissue responses to treatment were noted.

The accuracy of video imaging for mixed dentition and adolescent treatment

The purpose of this study was to evaluate the accuracy of computerized video imaging in predicting the soft tissue outcome of growth modification treatment for skeletal Class II malocclusions. Pretreatment and posttreatment cephalometric and facial photographic records of 22 mixed dentition (8 to 10 years old) and 20 adolescent (12 to 14 years old) patients were digitized, and the known outcomes were compared with computer-generated VTOs and video images. The predicted video images were found to be reasonably accurate for the mixed dentition group, but unacceptable for the adolescent group. When graded by a panel of judges, orthodontists were far more critical of the findings than their lay counterparts. These results emphasize the potential of video imaging as a communication medium, rather than as a diagnostic tool for growing patients.

Case Report: Treatment for a patient with a history of TMJ disorder

Establishing a knowledge-based protocol for the treatment of orthodontic patients who report a history of temporomandibular dysfunction can alert the practitioner to potential treatment pitfalls before they happen. While the joints can be extremely adaptive, some individuals are subject to painful and/or limited function. Others have acquired condylar positions that, if not recognized, could lead to serious alterations in the original treatment plan. Combining a thorough diagnostic protocol with a therapeutic regimen that seeks to establish a stable condylar and occlusal position-prior to initiating treatment- is essential.

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-

The role of the American Board of Orthodontics in advanced dental education.

From its inception, the American Board of Orthodontics (ABO) has attempted to elevate the standard of orthodontic care. In 1929, one of the board’s first directors, the eminent Dr Martin Dewey, stated that the ABO’s primary objective was to “stimulate and promote the spirit of research and self-improvement among students and practitioners of orthodontics.” The ABO has always believed that the education of proficient clinicians originates at the most basic level—that of the student. Yet a distinct boundary between the board and the autonomy of the advanced dental education programs has been historically respected by the ABO. For example, in 1964, when the Council on Dental Education of the American Dental Association (ADA) approached ABO President Frank Bowyer for “guidance in matters pertaining to orthodontic education,” Dr Bowyer declined and emphasized that the ABO would limit its educational influence to assessing the results of education rather than developing educational requirements. This philosophy within the ABO has endured and remains respected today. Via liaisons with the American Association of Orthodontists’ (AAO) Council on Orthodontic Education and the ADA Council on Dental Education, the ABO’s input to quality of education is both solicited and offered. As present and former members of both committees will attest however, the ABO intentionally makes no attempt to modify program duration or content. Although the ABO offers a list of recommended publications in preparation for its written examination, the board believes that specifics of educational programs are not within its domain and are best left to other special-interest groups in organized dentistry and dental education. Concurrent with the ABO’s restructuring of its certi-