It is an absolute pleasure to write this editorial. I have been in orthodontic practice for over 53 years and have thoroughly enjoyed the opportunity to be part of a great profession.
I was raised in a family of 10 children. My father was a physician in North Dakota, and he enjoyed presenting problems at the dinner table for each of us to resolve. However, he would intentionally lead us to the wrong answers, which caused all of us to laugh. But we were expected, at the next dinner, to explain why we were wrong and then to provide the correct answer to the problem. It led me to become a cause-and-effect oriented person and helped me to realize that one should not fear being wrong but, rather, consider it to be a valuable learning process.
For this reason, from my student years onward, I have always enjoyed asking “why?” As I passed through my 53-plus years of practice, I became known to many, including my wife, as “the why person.” Although many people are willing to accept anything taught as being reliable, it was my nature to first analyze the cause-and-effect relationships involved. For many orthodontists, unexpected side effects were overcome by using various methods for prevention: transpalatal arches, lingual arches, elastics, and so on. I wanted to know the cause of these side effects rather than to simply resort to methods of prevention. As many of us know today, it has become common to use full appliances in orthodontic treatment to correct various malocclusions; this means including normally positioned teeth already in the neutral zone. Partial appliances, round wires, and other devices were said to result in undesirable tooth movements in unexpected directions. I have always said that teeth move in unexpected directions when the operator is unaware of the total force systems involved. This was a common experience when I first entered orthodontic practice, but after analyzing the cause-and-effect relationships, I made many changes in commonly applied biomechanics.
After being introduced to the Arizona technique, which was known to produce excellent results, I looked for unexpected movements, and this led me to look into the cause-and-effect relationships involved in such movements. Again, I made major changes in my biomechanics as I began to discover that what was considered undesirable could be very desirable if the force systems were understood at both ends of the archwire. For example, using terminology such as “intrusive arches” can lead one to concentrate on that aspect of the force system involved in overbite correction and ignore other movements that might be taking place because of forces and moments present because of the requirements for static equilibrium.
So, gradually I began making what many at the time considered to be objectionable changes. Because I was in my younger years then, it was completely understandable why quality-oriented orthodontists would think that I was moving in the wrong direction. But I have always had great respect for the requirements of static equilibrium, because they offer each of us the opportunity to know and understand the entire force system, something that introduced opportunities not considered possible at the time.
As I approach the end of my professional career, I am most happy that I did not retreat from making major changes in my early years, because I have had the opportunity to lecture throughout the world while presenting an approach to biomechanics that eliminates the need for cervical headgear during Class II treatment in patients when growth and headgear cooperation would indicate a successful outcome. This cannot be accomplished with intra-arch mechanics in a full appliance but can readily be accomplished with a partial appliance. Space does not allow the details, but with a partial appliance, 8 distinct force systems can be easily created in a matter of seconds with intraoral activation in all 3 planes of space—frontal, sagittal, and occlusal. The Class II, arch length, overbite, and crossbite corrections can all be accomplished with a single wire—no headgear and no elastics. Never in over 53 years have I used a crossbite elastic, since I have never seen a patient who required such. Midline elastics are minimized because of the opportunities a partial appliance presents for intra-arch correction. Thus, the requirements in my practice with a partial appliance have been “Brush your teeth and keep your appointments. I will do the rest.” In a world where cooperation seems so often to be a problem, this has been very rewarding.
Today, there are tremendous increases in the variety of brackets, wire types, temporary anchorage devices, interarch appliances, and so on. If the specialty could fully appreciate the use of horizontal forces applied with partial appliances, we could return to the fundamentals that seem to be disappearing to a rather great degree. When horizontal forces are used for crossbite correction, we would discover that occlusal plane problems will not result, whereas today, such problems are a result of the vertical forces necessary to balance a net moment. Horizontal forces are balanced with zero effect on the occlusal plane.
In summary, let me simply say that regardless of the malocclusions—dental or dental-skeletal—I start treatment for the vast majority of my patients with partial appliances. Although many teach that second molars should be included in the appliance, this gives the faulty impression that first molars are not displaced because the central grooves would then be in nice alignment. However, terminating the appliance at the first molars most often causes them to move slightly to the buccal or the lingual aspect because of the balancing forces at the end of the archwire required by static equilibrium. Alignment of the central grooves gives the impression of control, but if the appliance is terminated at the first molars, the central grooves frequently are not aligned, whether the second molars are already present or in the process of erupting. This is rarely due to faulty second molar eruption but, rather, to buccal or lingual displacements or rotations of the first molars before second molar eruption, thus creating the illusion upon second molar eruption that including the first molars would have resulted in central groove alignment without displacing the first molars. Including the second molars simply permits alignment of the central grooves while at the same time altering the functional curves of Monson and Wilson to some degree, since they no longer harmonize as intended. As a result, there are reductions in axial loading and the stability to follow. There is so much more that could be said!
Thank you for the joy you have brought not only to me, but to my family. I can truly say that God has blessed me.