Volume 99 Number 1

stable, and free of symptoms. As with the work of many others who employ physiologic as opposed to mechanistic concepts in their treatment, the questions raised in this review have long since been settled. Successful treatment requires that we follow the anatomic requirements of our patients; conventional orthodontics mandates that treatment structure the patient's dentition to conform to arbitrary manmade standards, often at the expense of the TMJ and associated neuromusculature. It is ironic, but predictable, that the void created by the orthodontists' abdication and denial of his role and responsibility in TMJ disorders would be filled by others less equipped. At the present time most treatment is directed to palliative symptom removal. Patients who have this affliction and are treated by other than a function-oriented orthodontist can at best expect a lifetime of pain management rather than cure. The basic sciences have long since discredited the fixed-jaw hypothesis in all areas of dentistry (e.g., P.H. Levy, guest editor "An Alterable Centric Relation in Dentistry") Dental Clinics of North America, July 1975.) The real question of Dr. Reynders is "How much longer can those who control the dental school curriculum and the major professional publications suppress the truth in a rising tide and awareness of iatrogenic disease?" Philip H. Levy, DDS 1359 Bellmore Ave. North Bellmore, NY 11710

Reply To the Editor:

Thank you for the opportunity to respond to Dr. kevy's viewpoint on the relationship between orthodontics and temporomandibular disorders. There is always some degree of tension between the beliefs and practice of the clinician and the findings from scientific studies. Therefore it is not surprising when a clinician feels angry toward both the message and the messenger of a published study. However, despite the charges of bias and preconceived results, my study was not done to prove any specific point. Rather, it was an attempt to classify the available literature on this topic according to the methods underlying each paper. I stand by the major conclusion that was drawn from my findings, namely, the few well-controlled studies done so far have shown little or no relationship between orthodontics and temporomandibular disorders, while the majority of viewpoint publications and case reports have presented an opposing view.

Letters to the editor

23A

One of the characteristics of a good and thoughtful clinician is the willingness to abandon old myths and incorporate new information into his practice. I hope Dr. Levy will be able to reconsider his personal viewpoint, as well as the findings from the well-designed sample studies cited in my paper, before he reaches any final conclusions. Reint M. Reynders, DDS, MSc Via M. Bandello 2 20123 Milan Italy

Ceramic brackets tested in study no longer in circulation To the Editor:

I would like to address the readers of your JOURNAL in reference to the article entitled "Bond Strength of Ceramic Brackets Under Shear Stress: An In Vitro Report" by A.D. Viazis, G. Cavanaugh, and R.R. Bevis (AM J ORTHOD DENTOFAC ORTHOP 1990;98:214-21). It should be noted and clearly emphasized that the Transcend (Unitek/3M) and Gem (Ormco Corp.) ceramic brackets tested in this study 2 years ago are no longer in circulation; therefore clinicians should not confuse the appliances presented in the article with the new generation of brackets that these companies are introducing to the orthodontists. Current investigation is under way to assess the clinical application of the new brackets. Caution would be justified if clinicians are using the old brackets. It is wise to be critical of every new material. Thorough, in-depth investigation is absolutely necessary to assess the biocompatibility of all materials. Comprehensive research endeavors initiated at the dental schools, academic institutions, and research laboratories of various companies provide a sound, solid, critical, and nonbiased evaluation of the performance of all innovative ideas. It is crucial, for the good of the profession, our patients, the quality of our work, and our commitment to excellence that we constantly search for new and better modes of treatment. We have certainly come a long way from the time we banded every single tooth. Good research has kept us on the path of constant knowledge. As the great Greek philosopher of the ancient world once said: "No one will be able to learn a thing if he is convinced he already knows it" (Socrates). Anthony D. Viazis, DDS, MS Assistant Professor Orthodontic Department Bto'lor College of Dentistry

Ceramic brackets tested in study no longer in circulation.

Volume 99 Number 1 stable, and free of symptoms. As with the work of many others who employ physiologic as opposed to mechanistic concepts in their t...
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