Joseph G. Ghafari

Changes of arch width in the early treatment of Class II, division 1 malocclusions.

Changes in arch width during the early correction of Class II, Division 1 malocclusions with either the Fränkel functional appliance or headgear are compared in an ongoing prospective randomized clinical trial. The data were collected from 43 children, ages 7.5 to 12.85 years, who met strict dental and cephalometric criteria for inclusion in the study. They were assigned at random to treatment with either a headgear (n = 21) or a Fränkel appliance (n = 22). Occlusal measurements included the maxillary and mandibular intermolar distances (buccal and palatal/lingual) and intercanine distances. Measurements (millimeters) were performed on casts taken every 2 months, with digital calipers accurate to 0.01 mm. Four months after the initiation of treatment, the mean maxillary intermolar distance was larger in the Fränkel group (palatal: 1.58, SE: 0.22; buccal: 1.58, SE: 0.20) than the headgear group (palatal: -0.39, SE: 0.21; buccal: 0.26, SE: 0.23), and the difference was statistically significant (palatal: p < 0.0001 and buccal: p = 0.0001). The mean maxillary intercanine distance increased more with the headgear (1.62, SE: 0.19) than the Fränkel appliance (0.62, SE: 0.23) p = 0.003. As treatment progressed, the average intermolar distance in the headgear group increased, but was still higher in the Fränkel group by more than 1 mm. The intercanine distance remained larger in the headgear group. The mandibular intermolar and intercanine distances were higher after Fränkel therapy than with headgear.(ABSTRACT TRUNCATED AT 250 WORDS)

Identification of condylar anatomy affects the evaluation of mandibular growth: Guidelines for accurate reporting and research

Mandibular length is measured on cephalographs to depict changes during growth and after orthodontic treatment, and is often defined between condylion (Co, most posterior superior point on the condylar outline) and pogonion (Pog, most anterior point on the chin). The aim of this study was to assess the accuracy of identifying condylar anatomy, thus the validity of using Co-Pog to evaluate mandibular growth. The sample included 34 children from a prospective study on the early treatment of distoclusions. Two lateral head films were taken of each child, the first with the mouth closed (MC), the second with the mouth open (MO). Three examiners, two orthodontists (U.H. and K.H.) and a dental radiologist (R.B.), rated the condyle as identifiable, nonidentifiable, and interpreted. The rating was applied to the left (L) and right (R) condyles, or to only one outline (O) when the R and L structures appeared superimposed and were not distinguished separately. Besides Co-Pog, the orthodontists traced sella-nasion (SN) and incisor tip-menton (I-Me) to evaluate variability in measurements that do not include Co. One operator (J.G.) measured all distances. Agreement among the three examiners was best in rating the MO radiographs (50%): 4.1% identifiable, 5.9% nonidentifiable or interpreted; in the MC films, they agreed in 32.3% of the cases, but only one of the ratings was identifiable (2.9%). The highest agreement was in identifying the left condyle on the MO film (35.3%). Intraclass correlation coefficients for CO-Pog ranged from r = 0.73 (L side) to r = 0.92 (O) for one orthodontist, and for the other from r = 0.76 (O) to r = 0.85 (L). Both orthodontists had high correlations for SN and I-Me between MC and MO (0.94 < r < 0.98). The variability between examiners in recognizing condylar anatomy, particularly on radiographs taken with the mouth closed, suggests that the identification of condylar anatomy must be rated in studies of mandibular growth. Researchers measuring mandibular length in investigations of mandibular growth after orthodontic therapy should differentiate between cases where the condyle is readily identified, and those where condylar anatomy is interpreted.

Centennial inventory: the changing face of orthodontics.

The American Journal of Orthodontics and Dentofacial Orthopedics celebrates its centennial, safeguarded by the nearly 115-year-old American Association of Orthodontists. This journey witnessed the rise and demise of various developments, concepts, and procedures, while basic knowledge is still needed. Various periods can be defined in the past century, but the goals remain to obtain more accurate diagnosis through precise anatomic imaging, more controlled and faster tooth movement, more discreet appliances, and the balance of esthetics, function, and stability. The most recent technologic advances have buttressed these goals. Cone-beam computed tomography has brought 3-dimensional assessment to daily usage, albeit the original enthusiasm is tempered by the risk of additional radiation. Temporary anchorage devices or miniscrews have revolutionized orthodontic practice and loom as a solid cornerstone of orthodontic science. Decortication and microperforation promise to speed up tooth displacement by stimulating vascularization. The concept of the regional acceleratory phenomenon has touched upon even the timing of orthognathic surgery. The burden of esthetic appliances remains, with the demand for cosmetic appliances and clear aligners. Have these developments changed the face of orthodontics? Have we engaged in another turn wherein certain treatment modalities may fade, while others join mainstream applications? These questions are addressed in this essay on the challenges, promises, and limitations of current orthodontic technology, enhancement of biologic response, and personalized treatment approaches.

Coenraad F. A. Moorrees: Journey to the top of Mons Scolaris (Mount Scholar)

Coenraad F. A. Moorrees was a pioneer in orthodontic education and research. He was the first academic leader to merge clinical and research requirements in a 3-year residency. Beyond his lifelong association with the Harvard School of Dental Medicine and the Forsyth Dental Center (now the Forsyth Institute), his scholarly impact has reached worldwide through his multifaceted publications, but perhaps more potently through his postdoctoral fellows, 52% of whom achieved professorial ranks at academic institutions, and 15% became heads of orthodontic departments. His scholarly productivity cut across various components of facial growth and development, including the critical consideration of the soft tissue profile in evaluating the total face and the assessment of constitutional and psychobiologic panels in diagnosis and treatment of the individual patient. His investigations on dental development yielded cornerstone knowledge that was readily transferred to clinical applications. His contributions in various organizations included extended service for the prestigious National Institute for Dental Research, which oversees the most important research output in the United States. Numerous national and international recognitions were bestowed on him. He combined in his person the attributes of renaissance educator and citizen of the world, reflecting a unique combination of science and humanity.