Date: Wed, 18 Jul 2007 00:16:26 -0500
From: "ESCO automatic digest system" <LISTSERV@LISTSERV.UIC.EDU>
Subject: ESCO Digest - 12 Jul 2007 to 17 Jul 2007 (#2007-59)

There is 1 message totalling 119 lines in this issue.

Topics of the day:
1. Response to Peter Miles on Damon


Date: Fri, 13 Jul 2007 10:05:40 -0400
From: "Oppenhuizen" <doctoro@MACATAWA.COM>
Subject: Response to Peter Miles on Damon


Thank you for taking the time to respond to my post.

It is self evident that we can treat the spectrum of cases to a fine end result without ever touching a Damon bracket. My background is 018 for 23 years. Before using the Damon system I only finished transfers in 022.

What intrigues me is how experienced clinicians can have a range of sincere and rational responses from abject failure with some approach to treatment, to success at a level that it seems as though the pearly gates have opened and you have been given the keys to the universe.

How can this be? Is it real and testable? Is it perception which is hopelessly subjective by a myriad of influences present and past? Does our attitude affect the outcome?

I think we need good data and good studies to attempt to extract as much repeatable information as we can. But even still, personal interaction with a system will vary due to the near limitless nuance we all bring to doing orthodontics (or anything else in life). I respect good data, but I still have to take it home and make something work for me. More than that, the information to be gleaned from the data must reliably improve what I personally do and experience. It still comes down to personal perception of personal interaction with the variables which is not as easy to test using the scientific method as the scientifically minded would often like to think.

On narrow arches: I said I prefer the 022 Damon system for these situations. Yet I can affect arch shape with an 018 system. I know how to kick it up with steel wires and arch shaping because I have done it many times. Nevertheless, my perception is that the Damon system pulls this off in a repeatable way for me with less finesse of the system. Is this perception and delusion? How do I test this? Will case A ever be exactly like case B? If I treated 100 cases of perceived similarity would the end be the same? Would the path to the end result be identical using either approach? What is the value to me in working with either system if either the end or the path is not quite the same? What does it take to affect my behavior this way or that?

In terms of application to the orthodontic community as a whole: How many orthodontists would perceive a difference as I have stated? I don't know, but I am sure that some, if not many, would concur if they ever tried it. On space closure in extraction cases: As is so often the case, published studies don't universally agree. Sivakumar Srinivas in a thesis split mouth study found cuspid retraction to be I month faster in Damon brackets on average to complete retraction. My experience using closing coils and identical application of technique as I do it suggests to me more rapid space closure and somewhat easier control of the anchorage. Perhaps the difference is wire stiffness along and/or slot size to wire size interaction. I use 016x022 steel in 018x025 versus 019x025 steel in 022x028. It seems reasonable that the size issues alone could explain all my perceived differences. But do they? I am aware of your studies on anterior alignment. I won't quibble with what you found versus my experience but I feel that there is more to the issue than just lining up the incisal edge of the front teeth in an acceptable arch form. The age old problem of flaring incisors is an integral part of my clinical assessment as well as finesse to the system.

What is acceptable?
Why is it acceptable?
When is it acceptable?
If a tooth is blocked out, how do all the teeth respond to aligning that tooth?
What do you have to do to make that work?

I would agree with you up to a point on alignment and time but working the case always has more variables that influence my perception of success. It's somewhat like aligning teeth with small diameter stainless steel wires, braided wires, twisted wires, or the myriad of NiTi wires.

What is the difference?
Why do we do what we do?

I once heard David Sarver respond to a question in the crowd about why he doesn't use the Damon system. He gave several responses about arch shapes and this and that but what he also said was simply this: Dwight Damon is a fine clinician. I take that to mean he pulls it off because of who he is and how he does it. Somewhat intangible but highly significant. Peter the water is muddy indeed. There are lots of testable hypotheses that need to be tested. Let's test them. Even still there's more to it.

I see the approach to treatment that the Damon system presents as worthy of understanding by one and all. It's more than brackets and wire sequences and there's more than one pearl to be gleaned. I, for one, appreciate always challenging what I believe and why.

I think an open minded exposure to the Damon system will benefit a lot of orthodontists even if you never place a Damon bracket. The hard part is the open mind - for innumerable /good/ reasons. There's much, much more than brackets going on here. PS: To prevent the gnashing of teeth, the D3 hybrid bracket should be scrupulously avoided everywhere but the maxillary anterior. :-)

Greg Oppenhuizen
Holland MI USA