The 20 Principles of the Alexander Discipline, Volume 2. R.G. "Wick" Alexander

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СКАЧАТЬ has taught us certain truths about where and how best to place the teeth. These facts cannot be disputed. They might be ignored, but they cannot be disputed. For the private practitioner, it can be difficult to resist the urge to compromise. The challenge before us is to apply new technology to create results that good science has already proven.

      The benchmarks have now been established. Until science changes these benchmarks, isn’t it our responsibility as professionals to strive to achieve them? By combining knowledge from our forefathers, clinical experience, and research, specific guidelines can be followed to consistently produce quality, stable results.

      The Room of Truth

      After a few years in practice, almost every orthodontist has the problem of storing patients’ diagnostic records. In addition to the growing amount of space required, there is also an added burden of finding time to take these final records. With the combination of time, space, and cost involved, virtually all orthodontists stop taking final records as they become busy.

      Certain advantages regarding records evolved early in my professional career without my realizing it. In graduate school, we were all taught to take complete pretreatment and posttreatment diagnostic records. Upon entering private practice, because I was teaching, I continued this sequence, and I have continued it to this day. More than 15,000 patients have been treated in our office, and we have full initial and final records for at least 10,000 of them.

One of the few advantages of my age is that many patients I treated years ago have since brought their children in for treatment. When we discover this former relationship, the first thing our staff does is to look into the Room of Truth (Figs 1-1a and 1-1b). This is the room where many of these records are stored. If we have complete records on the parent, we ask to take new postretention records. We have about 300 to 400 of these T3 records (postretention), and the number is growing monthly.

      From this room, more than 50 master theses have been written. The majority of students have come from Baylor, but other schools include the University of Texas, University of Alabama, University of Southern California, New York Univeristy, Loyola University, and other schools in Canada, Germany, Mexico, Brazil, and other countries. A large number of these theses have been published. An open-door policy concerning these records has always been in force. Any student in the world is welcome to come study these diagnostic records (Fig 1-1c). The only stipulation is that no records be removed from the office.

      Throughout this book, I quote many statements from these research studies that changed some of our concepts on long-term stability from anecdotal to evidence-based information.

      In volume one of this series, I attempted to identify the 15 keys to orthodontic stability. Although the keys have not changed, I have consolidated them into six guidelines. Hopefully this book presents to the reader a more precise approach to identifying the goals for long-term stability.

      Six Guidelines to Building Facial Harmony and Stability

      1 Surrounding tissuesPeriodontal healthTMJ

      2 Anterior torque controlIMPANasolabial angleInterincisal angle

      3 Skeletal controlVerticalSagittal

      4 Transverse controlMandibular 3 × 3 widthMaxillary 6 × 6 widthArch form

      5 OcclusionRoot positionLeveled mandibular archInterproximal reductionFinal occlusion

      6 Soft tissue profile and smile

      Presented with most guidelines are:

       Evidence: As often as possible, research from graduate orthodontic students using the author’s diagnostic records directly addresses the question related to the specific subject.

       Mechanics: Throughout my 45-year practice of treating more than 15,000 patients with full orthodontic appliances, specific mechanical techniques have been created to address specific issues. These mechanics are explained and demonstrated. More detailed explanations can be found in volume one of this series.

       Exceptions: Someone once said, “There is an exception to every rule.” In orthodontics, this statement is partially true; I attempt to distinguish the differences.

      During a presentation on posttreatment changes during and after retention, Dr Asai (Crazyhorse) Yasuhiko, one of Japan’s outstanding orthodontists, said the following: “It has been said that the biggest cause of relapse is inappropriate treatment, above all other factors causing posttreatment changes, such as growth, jaw position, function, and habits. This is a matter of common sense.”¹²

      Conclusions

      1 The human body grows, matures, and ages; none of its parts stay unchanged. The dentition is no exception. It will continue to change little by little, even during retention.

      2 There are many possible causes of orthodontic relapse that preclude us from accurately predicting long-term posttreatment changes with the current scientific standards in orthodontics.

      3 The current difficulties facing orthodontics should be no excuse for poor treatment. Orthodontic treatment makes an important contribution to patient quality of life through marked esthetic enhancement, various functional improvements, and creation of an environment conducive to more favorable jaw growth and oral hygiene.

      4 Minor changes occurring after quality orthodontic treatment seem to be mostly unavoidable and should therefore be tolerated. In reality, these changes are unlikely to develop into major problems.

      5 The orthodontist should inform the patient of relapse potential prior to treatment and raise patient awareness of sharing responsibility for stability of treatment results. Based on this shared responsibility approach, it is desirable for the orthodontist to be flexible to retreatment needs.

      In an article about the future of orthodontics, Mark Hans made the following statement: “A disturbing trend in the last few years has been the willingness of the specialty to accept that the treated case is less stable than the original. If we as a specialty give up on stability as a treatment goal, then it is likely the specialty will not survive. So, we must embrace stability as a treatment goal.”^13p1 This statement is quite appropriate to the purpose of this book. Yes, I agree that we should embrace stability as a goal. Continued evaluations and studies on future patients will bring us closer to creating accurate diagnoses, treatment planning, and treatment results that demonstrate long-term stability.

      References

      1 Little RM. The irregularity index: A quantitative score of mandibular anterior alignment. Am J Orthod 1975;68:554–563.

      2 Turpin, DL. The case for treatment guidelines. Am J Orthod Dentofacial Orthop 2007;131:159.

      3 Glenn G, Sinclair PM, Alexander RG. Nonextraction orthodontic therapy: Posttreatment dental and skeletal stability. Am J Orthod Dentofacial Orthop 1987;92:321–328.

      4 Alexander JM. A Comparative Study of Orthodontic Stability in Class I Extraction Cases [thesis]. Dallas: Baylor Department of Orthodontics, 1995.

      5 Elms TN, Buschang PH, Alexander СКАЧАТЬ