Authors’ response

We thank Dr Aichinger for her interest in our article. It appears that she is clutching at any possible excuse to support and justify a long-held orthodontic gnathologic view that does not fit well with the current best evidence—ie, evidence-based orthodontics. Dr Aichinger used the classic sympathy line of what would practitioners do when it comes to treating their own children and then goes on to say, “Why so much emotion about adding 1 additional tool [articulator mountings] in diagnosing orthodontic patients?” This has nothing to do with emotion and everything to do with evidence. If there is no outcome benefit after the routine use and incorporation of articulators in orthodontics, then what is the point of the exercise? Why should patients be put through additional procedures when there is no benefit in the long term? The bottom line here is that external measuring devices such as condylar position indicators, centric relation bite registrations, and articulators cannot accurately measure internal joint orthopedic positions or disorders. Furthermore, if there is no convincing evidence to support a particular centric relation position, what is the point of spending unproductive effort and time to place the condyles in a specific centric relation position that ultimately is not where clinicians actually think they are placing them?

What about Dr Aichinger’s question, “Is there convincing evidence that placing condyles in centric relation will harm patients?” Regarding centric relation, as a specialty, we cannot even agree on the definition of centric relation, and it has changed many times over the years. Recall that, in the 1970s, the orthodontic gnathologists, led by Dr Roth, advocated a retruded (posterosuperior) centric relation position, and then they changed their opinion in favor of the more popular anterosuperior centric relation position (and both were considered the correct “seated centric relation” positions of their era). So whatever happened to all those orthodontic patients (including Dr Aichinger’s) who were treated to a retruded centric relation position? Are they all now suffering from postcentric-relation-opathy? Were they retreated to anterosuperior centric relation? This was certainly a blemish for the orthodontic gnathologists who blindly followed a fallacious treatment philosophy. So, contrary to Dr Aichinger’s thinking, there are actually real problems, and harm can come from ignoring the best available evidence in favor of unsupported conjectures and claims. Unfortunately, in orthodontics, our patients pay the price for these unfounded techniques and philosophies.

And this finally leads us to Dr Aichinger’s statement, which we have heard many times before, “We . . . cannot wait for future research when we treat our patients today.” We have always thought of this statement more as an excuse for ignoring the current best evidence, rather than waiting for future research. Of course, practitioners must treat patients before all the research has been performed, but does this mean that we simply do what “feels” right: some kind of free-for-all attitude toward diagnoses and treatments? Before we get the answers from future research, we must rely on the best available evidence, which currently points away from articulator mountings in orthodontics.

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Apr 8, 2017 | Posted by in Orthodontics | Comments Off on Authors’ response
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