Larry P. Tadlock

Prevalence of gingival recession after orthodontic tooth movements

Introduction: This study was designed to evaluate the long‐term prevalence of gingival recession after orthodontic tooth movements, focusing on the effects of mandibular incisor proclination and expansion of maxillary posterior teeth. Methods: Records of 205 patients (162 female, 43 male) were obtained from 2 private practice orthodontists. Using pretreatment (age, 14.0 ± 5.9 years) and posttreatment (age, 16.5 ± 6.0 years) lateral cephalograms and dental models, mandibular incisor proclination and maxillary arch widths were measured. Gingival recession was measured based on posttreatment and postretention (age, 32.3 ± 8.5 years) intraoral photographs and models. Associations between tooth movements and gingival recession were evaluated statistically. Results: Only 5.8% of teeth exhibited recession at the end of orthodontic treatment (only 0.6% had recession >1 mm). After retention, 41.7% of the teeth showed recession, but the severity was limited (only 7.0% >1 mm). There was no relationship between mandibular incisor proclination during treatment and posttreatment gingival recession. Incisors that finished treatment angulated (IMPA) at 95° or greater did not show significantly more recession than did those that finished less than 95°. There were weak positive correlations (r = 0.17‐0.41) between maxillary arch width increases during treatment and posttreatment recession. Conclusions: Orthodontic treatment is not a major risk factor for the development of gingival recession. Although greater amounts of maxillary expansion during treatment increase the risks of posttreatment recession, the effects are minimal. HighlightsSmall amounts of gingival recession are seen immediately after orthodontic treatment.Recession increases somewhat from end of treatment to long‐term follow‐up.Similar amounts of recession occur in untreated subjects.Mandibular incisor proclination during treatment is not related to gingival recession.The association between maxillary expansion and gingival recession is weak.

American Board of Orthodontics: Time for change

The American Board of Orthodontics (ABO) works to certify orthodontists in a fair, reliable, and valid manner. The process must examine an orthodontists knowledge, abilities, and critical thinking skills to ensure that each certified orthodontist has the expertise to provide the highest level of patient care. Many medical specialty boards and 4 American Dental Association specialty boards use scenario-based testing for board certification. Changing to a scenario-based clinical examination will allow the ABO to test more orthodontists. The new process will not result in an easier examination; standards will not be lowered. It will offer an improved testing method that will be fair, valid, and reliable for the specialty of orthodontics while increasing accessibility and complementing residency curricula. The ABOs written examination will remain as it is.

Common errors observed at the American Board of Orthodontics clinical examination

&NA; The American Board of Orthodontics has developed tools to help examinees select patients to be used for the Board examination. The Case Management Form can be used to evaluate aspects of a patient’s treatment that cannot be measured by other tools. The Case Management Form is a structured treatment‐neutral assessment of orthodontic objectives and outcomes associated with a patient’s treatment. Despite the availability of this form, examiners continue to see problems, including lack of attention to finishing details, inappropriate treatment objectives, excessive proclination of mandibular incisors due to treatment mechanics, excessive expansion of mandibular intercanine width, closing skeletal open bite with extrusion of anterior teeth leading to excessive gingival display, and failure to recognize the importance of controlling the eruption or extrusion of molars during treatment. In addition, some examinees exhibit a lack of understanding of proper cephalometric tracing and superimposition techniques, which lead to improper interpretation of cephalometric data and treatment outcomes. HighlightsThe ABO Case Management Form (CMF) helps examinees prepare a case for Board certification.Some errors seen in the clinical examination could be avoided by using the CMF.

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.