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Bone remodeling orthodontics by jaw repositioning and alveolar growth
DEPARTMENT
OF REVIEWS AND ABSTRACTS
Edited by Alex Jacobson, D.M.D., M.S., M.D.S., Ph.D. Birmingham,
Ala.
All inquiries regarding information on reviews and abstracts should be directed to the respective authors. Articles or books for review in this department should be addressed to Dr. Alex Jacobson, University of Alabama School of Dentistry, University StationlBirmingham, Alabama 35294.
Clinical Aspects the Jaws
and Treatment
of Cysts of
Herbert Harnisch (Translated by J. Buck) Berlin: Quintessenz, 1974
This well-illustrated, attractive book probably represents the definitive work on both odontogenic and nonodontogenic cysts of the oral and maxillofacial regions. The pictures and illustrations are first-rate as are the reproductions of x-ray films and clinical material. The subject matter ranges from a definitive historical perspective of cysts through pathogenesis, histopathology, and treatment. The material is complete and upto-date. It is a must for the serious student of pathology. For the average clinician, however, the book is perhaps overwhelming. There are many very short chapters that do not add significantly to the book. The same criticism could be leveled at illustrative cases. Thus, aside from editorial comments, the book is complete and a worthy addition to the library of the academically inclined pathologist or surgeon. Victor J. Matukas Bone Remodeling Orthodontics by Jaw Repositioning and Alveolar Growth Leon Kussick Chicago: Quintessence Publishing Co., 1987
Having practiced orthodontics for almost 30 years, the author claims that he has developed and perfected “bone remodeling,” a technique that changes jaw relationships and encourages alveolar growth in young patients by stimulating the periosteum/muscle adjustment phenomenon, harnessing young jaw and bone growth potential usually well before adolescent growth has started. In essence, the bone remodeling appliance described is a tightly retained simple acrylic removable appliance with a steep inclined plane worn for 2 to 3 hours each night. The contention is that the appliance repositions the mandible anteriorly, distally relocates the maxilla, permits arch expansion, creates a stable
opening of the bite, corrects overjet and achieves “uncrowding of even severe lower mandibular anterior teeth.” The claims are made on the basis of clinical observations of 2500 cases, serial photographs, study models, and cephalometric radiographs. Condylar growth, encouraged by distal [reviewer’s comment-distal should possibly read mesial] relocation of the mandible, is based on a normal adaptive mechanism that occursafter changestake place in the soft tissuematrix. The condyle is temporarily displaced from its usual position in the fossa when the mandible is held downward and forward under more than usual prolonged jaw muscle tension by the steep incline of the BR. The condyle then elongates distally and superiorly into a temporary space created in the fossa. The fossaprobably remodels as well. A newly remodeled and relocated condylar process is soon seen deep in the fossa, usually within three months. . . . These clinical results have been confirmed consistently in treated casessince 1959 and are well documented.
The book is replete with photographs of successfully treated cases (or partially successful); no tables, statistics, or incidence figures are cited. Whereas cephalometric radiographs are recommended when taking basic records at the beginning of treatment, the text does not include a single lateral cephalometric head film tracing. Exactly why lateral cephalometric head films are advocated remains unclear particularly since the author states that, “Cephalometric growth prediction analysis, often used as a diagnostic tool with FJO or traditional banded techniques, is not needed in bone remodeling diagnosis and therapy.” He further states: Analysisof cephalometric radiographsmay be a possibletool for revealing some post treatment changesor may show abnormal growth patterns indicating congenital or pathological problems. In many casesit confuses the clinician and may keep him or her from treating many patients properly. (page 31)
Throughout the book references are made to the premaxillary bone: “underdevelopment of the premaxillary bone, ” “treatment involves extending the pre173
Am. J. Orthod.
174 Reviews and abstracts
maxillary bone slowly, laterally and labially . . .” (page 154), “There is a limit to the extent to which the premaxillary bone can be developed” (page 55 and elsewhere). Unlike anthropoids, man does not possess a premaxillary bone, neither embryologically nor anatomically. The causes, diagnosis, and treatment of temporomandibular joint dysfunction are covered in three pages; the remainder of the chapter (6) contains photographs of jaws and accompanying anecdotal legends of “treated” cases-if only TMJ problems were that easily resolved. To establish credibility, particularly for those claiming originality of purpose or who are sincere in promoting an idea, technique, or procedure, it is essential that the material be presented in a way that is scientific and amenable to scrutiny. Anecdotal evidence, however impressive, is no substitute for scientific endeavor. The author is clearly an experienced clinician and has enjoyed considerable success in treating various orthodontic problems, particularly in younger patients, with the appliance described. It would be to the author’s advantage and to the advantage of the profession as a whole, if an in-depth controlled study of sequentially treated cases could be conducted to determine precisely what occurs during treatment, the changes that are a result of growth, and the amount of correction that can be attributed directly to treatment. Alex Jacobson
Die Straight-Wire Technik-Ein Behandlungsinstrument fur Einsteiger? (The Straight-Wire Technique-Is It Right for Beginners?) Rolf Koch Prakt.
Kieferorthop.
1987;l.W
:5
For the well-trained practitioner, the use of the straight-wire technique represents a significant simplification of treatment. However, the original concept of using only straight wires is severely limited mostly to nonextraction cases. Modifications to the arch wire must be added to compensate for individual tooth forms and positions. The extent of such modifications is dependent on the bracket system used. In some systems the necessary alterations and overcorrections needed during certain phases of treatment to compensate for the angulations built into the brackets are more complex than if a standard edgewise bracket had been used. This requires the practitioner to have exceptional compe-
Orthop. February 1988
Dentofac.
tence and understanding of the biomechanical principles of the multiband technique. The straight wire technique cannot be viewed as an ideal method for the inexperienced. Rather, it must be seen as an advanced method of treatment that is built on complete mastery of the standard edgewise technique. Alex Jacobson
Gaumennahtsprengung bei Einer Erwachsenen Patientin Trotz Torus Palatinus (To Open the Suture of the Palate in a Female Adult Despite a Torus Palatinus) Somchai Satravaha Prakt.
Kieferorthop.
1987;1:97-100
In spite of an existing torus palatinus, rapid maxillary expansion, using the orthodontic appliance described by Rakosi, was successfully carried out in the case of a 23-year-old Chinese woman. Within 1 week a substantial effect of expansion was achieved. The torus palatinus did not prove to be an impediment to the expansion of the median palatal suture. The uncomfortable appliance designed for the active phase of treatment was replaced by a Hawley retainer after 1 month. The retainer was worn for an additional 2 months until bony healing of the suture as evidenced by radiographs was complete. The accomplished therapeutic result remained stable. Alex Jacobson
Vergleich Verschiedener Neuer Retentionsmechanismen fur Metallbracketbasen J. Weibenberg and P. Diedrich Fortschr.
Kieferorthop.
1987;48:1321/4
Direct bracket bonding failures usually occur at the resin bracket base interface. In a study using physical (tensile bond strength) and scanning electron microscopic methods, the adhesion of orthodontic resin to new types of bracket bases was investigated. Conventional mesh bases were compared with electrolytically etched bases, with glass-coated bases (Silicoater technique), and with porous metal powder-coated bases. The glass-coated bases were shown to have superior retentive capacity. The bases coated with spherical metal powder and the electrolytically etched bases were
OF REVIEWS AND ABSTRACTS
Edited by Alex Jacobson, D.M.D., M.S., M.D.S., Ph.D. Birmingham,
Ala.
All inquiries regarding information on reviews and abstracts should be directed to the respective authors. Articles or books for review in this department should be addressed to Dr. Alex Jacobson, University of Alabama School of Dentistry, University StationlBirmingham, Alabama 35294.
Clinical Aspects the Jaws
and Treatment
of Cysts of
Herbert Harnisch (Translated by J. Buck) Berlin: Quintessenz, 1974
This well-illustrated, attractive book probably represents the definitive work on both odontogenic and nonodontogenic cysts of the oral and maxillofacial regions. The pictures and illustrations are first-rate as are the reproductions of x-ray films and clinical material. The subject matter ranges from a definitive historical perspective of cysts through pathogenesis, histopathology, and treatment. The material is complete and upto-date. It is a must for the serious student of pathology. For the average clinician, however, the book is perhaps overwhelming. There are many very short chapters that do not add significantly to the book. The same criticism could be leveled at illustrative cases. Thus, aside from editorial comments, the book is complete and a worthy addition to the library of the academically inclined pathologist or surgeon. Victor J. Matukas Bone Remodeling Orthodontics by Jaw Repositioning and Alveolar Growth Leon Kussick Chicago: Quintessence Publishing Co., 1987
Having practiced orthodontics for almost 30 years, the author claims that he has developed and perfected “bone remodeling,” a technique that changes jaw relationships and encourages alveolar growth in young patients by stimulating the periosteum/muscle adjustment phenomenon, harnessing young jaw and bone growth potential usually well before adolescent growth has started. In essence, the bone remodeling appliance described is a tightly retained simple acrylic removable appliance with a steep inclined plane worn for 2 to 3 hours each night. The contention is that the appliance repositions the mandible anteriorly, distally relocates the maxilla, permits arch expansion, creates a stable
opening of the bite, corrects overjet and achieves “uncrowding of even severe lower mandibular anterior teeth.” The claims are made on the basis of clinical observations of 2500 cases, serial photographs, study models, and cephalometric radiographs. Condylar growth, encouraged by distal [reviewer’s comment-distal should possibly read mesial] relocation of the mandible, is based on a normal adaptive mechanism that occursafter changestake place in the soft tissuematrix. The condyle is temporarily displaced from its usual position in the fossa when the mandible is held downward and forward under more than usual prolonged jaw muscle tension by the steep incline of the BR. The condyle then elongates distally and superiorly into a temporary space created in the fossa. The fossaprobably remodels as well. A newly remodeled and relocated condylar process is soon seen deep in the fossa, usually within three months. . . . These clinical results have been confirmed consistently in treated casessince 1959 and are well documented.
The book is replete with photographs of successfully treated cases (or partially successful); no tables, statistics, or incidence figures are cited. Whereas cephalometric radiographs are recommended when taking basic records at the beginning of treatment, the text does not include a single lateral cephalometric head film tracing. Exactly why lateral cephalometric head films are advocated remains unclear particularly since the author states that, “Cephalometric growth prediction analysis, often used as a diagnostic tool with FJO or traditional banded techniques, is not needed in bone remodeling diagnosis and therapy.” He further states: Analysisof cephalometric radiographsmay be a possibletool for revealing some post treatment changesor may show abnormal growth patterns indicating congenital or pathological problems. In many casesit confuses the clinician and may keep him or her from treating many patients properly. (page 31)
Throughout the book references are made to the premaxillary bone: “underdevelopment of the premaxillary bone, ” “treatment involves extending the pre173
Am. J. Orthod.
174 Reviews and abstracts
maxillary bone slowly, laterally and labially . . .” (page 154), “There is a limit to the extent to which the premaxillary bone can be developed” (page 55 and elsewhere). Unlike anthropoids, man does not possess a premaxillary bone, neither embryologically nor anatomically. The causes, diagnosis, and treatment of temporomandibular joint dysfunction are covered in three pages; the remainder of the chapter (6) contains photographs of jaws and accompanying anecdotal legends of “treated” cases-if only TMJ problems were that easily resolved. To establish credibility, particularly for those claiming originality of purpose or who are sincere in promoting an idea, technique, or procedure, it is essential that the material be presented in a way that is scientific and amenable to scrutiny. Anecdotal evidence, however impressive, is no substitute for scientific endeavor. The author is clearly an experienced clinician and has enjoyed considerable success in treating various orthodontic problems, particularly in younger patients, with the appliance described. It would be to the author’s advantage and to the advantage of the profession as a whole, if an in-depth controlled study of sequentially treated cases could be conducted to determine precisely what occurs during treatment, the changes that are a result of growth, and the amount of correction that can be attributed directly to treatment. Alex Jacobson
Die Straight-Wire Technik-Ein Behandlungsinstrument fur Einsteiger? (The Straight-Wire Technique-Is It Right for Beginners?) Rolf Koch Prakt.
Kieferorthop.
1987;l.W
:5
For the well-trained practitioner, the use of the straight-wire technique represents a significant simplification of treatment. However, the original concept of using only straight wires is severely limited mostly to nonextraction cases. Modifications to the arch wire must be added to compensate for individual tooth forms and positions. The extent of such modifications is dependent on the bracket system used. In some systems the necessary alterations and overcorrections needed during certain phases of treatment to compensate for the angulations built into the brackets are more complex than if a standard edgewise bracket had been used. This requires the practitioner to have exceptional compe-
Orthop. February 1988
Dentofac.
tence and understanding of the biomechanical principles of the multiband technique. The straight wire technique cannot be viewed as an ideal method for the inexperienced. Rather, it must be seen as an advanced method of treatment that is built on complete mastery of the standard edgewise technique. Alex Jacobson
Gaumennahtsprengung bei Einer Erwachsenen Patientin Trotz Torus Palatinus (To Open the Suture of the Palate in a Female Adult Despite a Torus Palatinus) Somchai Satravaha Prakt.
Kieferorthop.
1987;1:97-100
In spite of an existing torus palatinus, rapid maxillary expansion, using the orthodontic appliance described by Rakosi, was successfully carried out in the case of a 23-year-old Chinese woman. Within 1 week a substantial effect of expansion was achieved. The torus palatinus did not prove to be an impediment to the expansion of the median palatal suture. The uncomfortable appliance designed for the active phase of treatment was replaced by a Hawley retainer after 1 month. The retainer was worn for an additional 2 months until bony healing of the suture as evidenced by radiographs was complete. The accomplished therapeutic result remained stable. Alex Jacobson
Vergleich Verschiedener Neuer Retentionsmechanismen fur Metallbracketbasen J. Weibenberg and P. Diedrich Fortschr.
Kieferorthop.
1987;48:1321/4
Direct bracket bonding failures usually occur at the resin bracket base interface. In a study using physical (tensile bond strength) and scanning electron microscopic methods, the adhesion of orthodontic resin to new types of bracket bases was investigated. Conventional mesh bases were compared with electrolytically etched bases, with glass-coated bases (Silicoater technique), and with porous metal powder-coated bases. The glass-coated bases were shown to have superior retentive capacity. The bases coated with spherical metal powder and the electrolytically etched bases were