Readers Respond By Taking Issue With Letter Writers` Published Statements Regarding Preferred Orthodontic Treatment Modalities
As an orthodontist, Dr. Keller`s letter in the September 1996 issue was one I simply cannot ignore. While I agree that many orthodontists would probably prefer not to see general dentists and pedodontists doing orthodontics, most of us recognize that this has and will be the case for the foreseeable future, and the majority of these patients will be treated competently. However, many of the statements that Dr. Keller makes ignore facts present in the orthodontic literature and his assumptions on preferred treatment modalities of orthodontists are, at best, misinformed.
The vast majority of orthodontists have recognized the value of early intervention in selected cases for many years. Additionally, it is doubtful that most orthodontists utilize extraction of permanent teeth in more than 20-25 percent of their patients. I hardly think that these doctors would concur with Dr. Keller that the remaining 75 percent of their practices should be referred to a general dentist or pedodontist for competent nonextraction treatment.
If Dr. Keller would take the time to evaluate current clinical orthodontic research, he would find a growing body of evidence suggesting that lack of stability associated with expansion of cuspid widths is still a problem; that functional orthopedics has more to do with dentoalveolar change than stimulation of increased mandibular growth, and that early intervention, in some cases, provides little or no benefit to the patient and merely prolongs treatment. As with any health-care treatment, case selection based on proper diagnosis and treatment planning is the key to a successful outcome.
The tone of his letter resonates with an attitude that I have dealt with over my 13 years of practice among some other fellow professionals-that extraction of teeth in orthodontics is bad treatment. Unfortunately, many orthodontists have abandoned the use of extraction to avoid the disapproval of referring dentists and the potential rejection by patients. Consequently, some patients end up with over-expanded results that threaten the supporting tissues and stability of the orthodontic treatment. This fact is now being rediscovered as the new nonextraction treatment modalities are followed after completion. Any treatment can be unsuccessful or inappropriate when case selection is incorrect. This includes nonextraction as well and extraction treatment. Most experienced orthodontists have the perspective to see both sides of these issues. Based on Dr. Keller`s commentary as to how orthodontists treat their patients, I question whether he has the same capability.
Gary J. Romeo, DMD
Norwalk, CT
