I want to thank all the authors who participated in the interesting and thought-provoking Point/Counterpoint on the use of articulators by orthodontists. Several points seem worthy of mention.
Drs Martin and Cocconi listed 8 reasons for mounting casts. Apparently Drs Rinchuse and Kandasamy saw no reason to disagree with 7 of them. Good, something perhaps both sides can concur on.
Drs Rinchuse and Kandasamy acknowledged that articulators are useful in prosthodontics, restorative dentistry, and orthognathic surgery. Assumably, this is because these specialties do significant or full-mouth reconstructions. Is that not most of what we do in orthodontics?
If “proper attention to an orthodontic patient’s centric records is an important consideration in orthodontics and all of dentistry,” what practical, in-office alternatives to mounted models do Drs Rinchuse and Kandasamy recommend?
We all routinely take perfunctory cephalometric radiographs of all our patients. I ask my colleagues, “in what percentage of your patients does the information from these radiographs significantly direct the eventual treatment plan?” I do not mount all my cases, but I do look for orthopedic instability using bilateral guidance and routinely mount those with significant discrepancies or interdisciplinary needs. The percentage of my patients in whom the information from these mounted casts significantly influences my final treatment plan is far greater than that of the cephalometric radiographs in my office, especially in my growing numbers of adult patients. I think we all could agree that we find cephalometric radiographs worthy of irradiating our patients. Do we not have room in our “diagnostic tool chest” for another item, either to help out in special situations or even as a routine contributor? Cephalometric radiographs and mounted models are just diagnostic tools. Some of our colleagues use detailed or multiple cephalometric analyses to help them determine the most predictable treatment plan. Are they any different from a colleague who wants the additional information that mounted casts provide?
In the periodontal discussion cited by all, there were indeed disagreements on interpretations of the data. There also were several points of agreement on both sides in that debate. The antiocclusal side even gave a detailed description of how occlusal trauma negatively affected periodontal tissues. They also stated, “Like most long-standing controversies, no one now believes that excessive occlusal force initiates periodontal disease, nor does any credible person believe that occlusal force is incapable of causing periodontal injury.” Oh, how I wish those leading the debate on the role of occlusion in orthodontics also could recognize the areas of agreement. In the quest to root out perceived “heresies,” we end up paralyzing any possibility of finding practical answers to everyday questions.