16A
Am. J. Ortho,I. Dentofiw. Orthop. July 1992
Letters to the editor
"Aberrent Mandibular Growth: Theoretical Implications." The authors seem to have overlooked our publications of 1947 and 1949 in which we reported on a series of patients with condylar defects, including juvenile rheumatoid arthritis. '"~ In many of these instances serial cephalometric records and laminagrams were included, and some significant angular and linear measurements were recorded. Is there a statute of limitations on literature citations? Milton B. Engel Professor, Orthodontics attd ltistology University of lllinois College of Dentistry REFERENCES I. Engel MB, Brodie AG. Condylar growth and mandibular deformities. Surgery 1947;22:976. 2. Engel MG, Richmond J, Brodie AG. Mandibular growth disturbance in rheumatoid arthritis of children. Am J Dis Child 1949;78:728-43.
A letter of thanks to Dr. Koester, AAOF Dear Roa: On behalf of many orthodontic educators, I want to express my gratitude to you and the work being done on behalf of the AAO Foundation. It has become increasingly clear in recent years that continuation of high standards and technical superiority of American orthodontics depends on the quality of young people becoming orthodontic educators. Support for these people and their research activities must come increasingly from our specialty, since government and school support is constantly dwindling. The AAOF is certainly the way to do this, and I only hope that support will come soon enough to allow orthodontics to maintain its leadership. DonaM R. Poulton, DDS Professor attd Clmirperson Department of Orthodontics
Special TMJ issue comment To the Editor:
I did not like the overall tone of this issue. It appeared to me that we were falling all over ourselves trying to prove a lack of correlation between orthodontics and TMD in a reactionary manner. Temporomandibular disorders are without question multifactoral in nature. Any person who treats these problems clinically knows that in some cases correction of the occlusal scheme can be enough to reduce the sum of a patient's problems below the clinical symptom threshold; sometimes not. Clearly, one cannot "blame" orthodontics and occlusion in general for being sole etiologic factors. However, the overall tone of this issue would seem to promote the attitude of "Hey, orthodontics isn't related, so I don't have to pay attention to occlusion!" rather than promoting clinical excellence and knowledge of gnathologic concepts so that we improve our diagnostic and treatment methods. For example, most studies seemed to focus on anterior-posterior condylar position, and in general paid little attention to vertical and, more importantly, transverse relationships. It is only a small percentage of cases in any given practice that develop problems, and I would not have expected any of the studies in this issue, even without a number of design and conceptual problems in some of them, to have shown any definitive correlations because of this fact. However, it is this small number that causes the majority of practitioner stress, and we should be working to improve our understanding so that we can take every measure possible to recognize potential prob.lems, identify them to the patient in advance, and design our treatment with those problems in mind. It is in this area that this issue and the specialty in general is missing the target. Mark Antosz, DMD, D.Ortho., MRCD(C) Calgary, Alberta
More comments on the Special TMJ issue To the Editor: As a clinician who has treated many patients in the last 15 years who exhibit both TMJ pain-dysfunction problems, as well as a history of premolar extraction type traditional orthodontics, I read your January 1992 "Special TMJ Issue" with great interest. I found some of the material to be excellent work. Yet I also found some conclusions that appeared in this issue to be flawed. Some of the material prt:sented represents sound scientific data capable of standing alone. Ironically, much of the material supports many of the basic tenets of the "functional jaw orthopedics" viewpoint. Other material, unfortunately, clearly reflects an apparent bias and lack of total understanding of the malocclusion/orthodontics/TMJ connection in the minds of some of the researchers. In addition, although a number of the conclusions drawn throughout the issue are either totally valid, or could be with certain qualifications, some other important ones are in the realm of the deceptively misleading! The proof for this opinion, to me, lies right in the pages of this same issue. As a result, the erroneous propositions could leave some of the contributing researchers who produced them, and possibly the entire orthodontic discipline as well, in a vulnerable and compromised position. This issue does not represent a medicolegal "safety net" for premolar extraction techniques. The "Viewpoint" article by Behrents and White sets the tone for the entire issue, or so it would seem at first. They list several conclusions they contend "the good scientific evidence" of this issue supports. Among them are (1) there are no relationships shown between the occlusion (structure) and TMJ disorders, (2) such relationships that might exist are not simple, frequent, nor
Am. J. Ortho,I. Dentofiw. Orthop. July 1992
Letters to the editor
"Aberrent Mandibular Growth: Theoretical Implications." The authors seem to have overlooked our publications of 1947 and 1949 in which we reported on a series of patients with condylar defects, including juvenile rheumatoid arthritis. '"~ In many of these instances serial cephalometric records and laminagrams were included, and some significant angular and linear measurements were recorded. Is there a statute of limitations on literature citations? Milton B. Engel Professor, Orthodontics attd ltistology University of lllinois College of Dentistry REFERENCES I. Engel MB, Brodie AG. Condylar growth and mandibular deformities. Surgery 1947;22:976. 2. Engel MG, Richmond J, Brodie AG. Mandibular growth disturbance in rheumatoid arthritis of children. Am J Dis Child 1949;78:728-43.
A letter of thanks to Dr. Koester, AAOF Dear Roa: On behalf of many orthodontic educators, I want to express my gratitude to you and the work being done on behalf of the AAO Foundation. It has become increasingly clear in recent years that continuation of high standards and technical superiority of American orthodontics depends on the quality of young people becoming orthodontic educators. Support for these people and their research activities must come increasingly from our specialty, since government and school support is constantly dwindling. The AAOF is certainly the way to do this, and I only hope that support will come soon enough to allow orthodontics to maintain its leadership. DonaM R. Poulton, DDS Professor attd Clmirperson Department of Orthodontics
Special TMJ issue comment To the Editor:
I did not like the overall tone of this issue. It appeared to me that we were falling all over ourselves trying to prove a lack of correlation between orthodontics and TMD in a reactionary manner. Temporomandibular disorders are without question multifactoral in nature. Any person who treats these problems clinically knows that in some cases correction of the occlusal scheme can be enough to reduce the sum of a patient's problems below the clinical symptom threshold; sometimes not. Clearly, one cannot "blame" orthodontics and occlusion in general for being sole etiologic factors. However, the overall tone of this issue would seem to promote the attitude of "Hey, orthodontics isn't related, so I don't have to pay attention to occlusion!" rather than promoting clinical excellence and knowledge of gnathologic concepts so that we improve our diagnostic and treatment methods. For example, most studies seemed to focus on anterior-posterior condylar position, and in general paid little attention to vertical and, more importantly, transverse relationships. It is only a small percentage of cases in any given practice that develop problems, and I would not have expected any of the studies in this issue, even without a number of design and conceptual problems in some of them, to have shown any definitive correlations because of this fact. However, it is this small number that causes the majority of practitioner stress, and we should be working to improve our understanding so that we can take every measure possible to recognize potential prob.lems, identify them to the patient in advance, and design our treatment with those problems in mind. It is in this area that this issue and the specialty in general is missing the target. Mark Antosz, DMD, D.Ortho., MRCD(C) Calgary, Alberta
More comments on the Special TMJ issue To the Editor: As a clinician who has treated many patients in the last 15 years who exhibit both TMJ pain-dysfunction problems, as well as a history of premolar extraction type traditional orthodontics, I read your January 1992 "Special TMJ Issue" with great interest. I found some of the material to be excellent work. Yet I also found some conclusions that appeared in this issue to be flawed. Some of the material prt:sented represents sound scientific data capable of standing alone. Ironically, much of the material supports many of the basic tenets of the "functional jaw orthopedics" viewpoint. Other material, unfortunately, clearly reflects an apparent bias and lack of total understanding of the malocclusion/orthodontics/TMJ connection in the minds of some of the researchers. In addition, although a number of the conclusions drawn throughout the issue are either totally valid, or could be with certain qualifications, some other important ones are in the realm of the deceptively misleading! The proof for this opinion, to me, lies right in the pages of this same issue. As a result, the erroneous propositions could leave some of the contributing researchers who produced them, and possibly the entire orthodontic discipline as well, in a vulnerable and compromised position. This issue does not represent a medicolegal "safety net" for premolar extraction techniques. The "Viewpoint" article by Behrents and White sets the tone for the entire issue, or so it would seem at first. They list several conclusions they contend "the good scientific evidence" of this issue supports. Among them are (1) there are no relationships shown between the occlusion (structure) and TMJ disorders, (2) such relationships that might exist are not simple, frequent, nor
