Topics of the day:
1. Putting orthodontics into perspective
If the questions you ask lead to paradox, I would suggest that you are asking the wrong questions. Perhaps the question may only clearly demonstrate that you fundamentally misunderstand on an intrinsic level.
I read Dr. Mollenhauer's FRO newsletter reprint with a smile on my face. I wonder how many of us waded through the article. I doubt that many of us spend much time with questioning the fundamentals which form the basis of the way we think. My perspective is that the scientific thinker, which is selected for in dental education, generally has little interest in deeply questioning the accepted underpinnings of their worldview. Perhaps I am mistaken.
Karl Rahner, a Catholic theologian concluded that there are two major groups of people in the world: those who demand certainty and those who seek understanding.
As muddy as the picture is that Dr. Mollenhauer presented, I would chime-in that he has introduced for discussion only the Western scientific world view analysis of the Western scientific/philosophical world view. The picture is much larger and even more ethereal.
As a primer a book that I would recommend to all is: Zen and the Art of Motorcycle Maintenance (An Inquiry into Values) by Robert Pirsig published about 40 years ago. It is a great story that incorporates an erudite treatise of the concept of ‘quality'. It brings in another world view to this discussion which sheds much light on the dark places that Dr. Mollenhauer has alluded to in his newsletter article. The book opens doors that you may have not known were even there.
A critique of scientific thought should step outside of the intellectual stew which spawned Western scientific thinking. You might be amazed, or perhaps, simply bored beyond words.
Anyway, science has much value for us, but creating aligned teeth and a beautiful face and smile is much more like being an outstanding sculptor than a scientist. Orthodontists prioritize their values, apply what they believe, and work to attain their goals. Even what anyone of us might consider to be outstanding may fall far short if assessed by a different set of parameters. Does that make what was done poor or inadequate? Is Picasso a better artist than Da Vinci? Could Picasso recreate the work of DaVinci or DaVinci the work of Picasso? Can Dr Joe Blow create Michelangelo's David if he just listens and applies what science tells us? What do you think?
Is it the right question or are we fundamentally missing something on a pretty basic level?
Re: Bonded lingual retainers
I agree with Charlie Ruff. At this moment, fixed retention offers a great deal in reducing post-treatment problems. And I agree with the lower canine to canine fixed retainer use and upper lateral to lateral placement as well. The "social six" or front porch (as they say down south) are the most visible areas and are frequently the cause of patient dissatisfaction and annoyance to the orthodontist.
We published an article in the JCO recently (Moskowitz, Park, and Maestre, October 2004)) on the use of the Ortho Flextech material from Reliance for lower lingual retainers. We have been using this material for several years and find that it is superior to other types of lower lingual retention arches.
As far as teeth shifting even with lingual arches in place? Many of these lingual arches (especially the rigid variety) are distorted over time by the patient. These lingual arches, intended to hold the teeth, actually become active orthodontic appliances. The teeth move, and with round types of wires, can actually "torque" around the lingual arch.
Where do retention efforts begin? I have always contended that they begin before the first orthodontic appliance is actually inserted. Additionally, a cursory look at the pre-treatment study casts prior to debanding (as well as other records) will actually give the clinician a pretty good idea of where to expect retention problems.
It appears that retention issues, especially in the lower incisor area, will be with us for quite some time. It is this area (as well as others) that the physiologic ageing process simply will not respect the clinicians "best intentions". Add to this decreased alveolar bone loss as a result of moderate to severe periodontal disease, discrete hormonal or endocrine changes as a result of either ageing or pathology, and you can see that we have our work cut out for us.
As an alternative to any suggestions from me or anyone else on this subject, I recommend a method of reducing retention problems almost 100%. This might be achieved by moving out of state about every 5 years. Such "geographical success cases" are priceless and far too rare.
At one time we bought hundreds of bulk sheets to use for indirect bonding, and as "slipcovers" over some bonded retainers. It was cheap, but not ideally accurate.
We switched to Raintree Essic C+ for retainers two years ago. This is durable, fits perfectly if you chill it immediately, and is the most appreciated advance in retention we have seen. If teeth are ideal when it's made, the thinness allows full arch retention without causing occlusal interferences. I don't know if it's the cheapest alternative, but for me it's the best and well worth it. I think I heard Jack Sheridan remark that the material is similar to Kevlar in bulletproof vests. We have lots of patients who have worn these faithfully, nights only, for two years and they look virtually new.
Dr Dick Carter
Re: New source for retainer material
I recently had a patient who is undergoing semiannual MRI's. Is there a contraindication for fixed appliance orthodontic treatment with patients undergoing regular MRI's. I honestly have never encountered this issue before last week and have not been able to contact the patient's radiologist to consult. Has anyone else faced this issue and what is the recommended course of action? The only thing that I would think would be a contraindication for having a MRI with fixed orthodontic appliances (stainless steel brackets) is that they would distort or interfere with imaging.
Anyone have any thoughts on having new patients sign a separate "arbitration agreement."?
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