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Field of dreams
SPECIAL ARTICLE
Field of dreams Malcolm Meister, DDS, MSM, JD,a and Richard S. Masella, DMDb Fort Lauderdale, Fla
A
s it entered the 20th Century, New York City experienced an explosion of growth. In 1916, the city enacted a setback law to reduce the effect of towering new buildings on the light and air at street level. The law required that a specific angle of light be preserved. To comply, architects altered the design of the buildings to include proportionate setbacks at specific heights. This shape, created by a functional need, became the traditional design of the pre-World War II skyscraper. This is a prime example of the adage, “form follows function.” Another example can be found in the construction of art museums. The function of an art museum is to display works of art in an attractive and comfortable environment with proper lighting and space. As a result, for generations, the form of museums has followed their function. The Metropolitan Museum of Art in New York City is an excellent example of the evolution of the museum form in response to functional needs. The renowned architect Frank Lloyd Wright, in his desire to break with the past and imprint his own unique and brilliant talent on the world of architecture, decided that form was more important than function, and that once the form was created, function would follow. He reversed the mantra to “function follows form.” Wright’s creation, the Guggenheim Museum of Art, is a remarkable architectural site and a pleasure to see. But inside, inadequate lighting, narrow and slanted viewing ramps, and art that is mounted perpendicularly on walls creates discord for the viewer. The form of the museum is beautiful, but function follows with difficulty. The environment of the Guggenheim does not encourage relaxed, restful viewing of art but, rather, produces an unsettling, rushed onslaught of colors and shapes. The question in architecture is, “How well does From the College of Dentistry, Nova Southeastern University, Fort Lauderdale, Fla. a Professor and chairman, Department of Orthodontics. b Associate professor and assistant Dean of Education. Reprint requests to: Malcom Meister, DDS, MSM, JD, Department of Orthodontics, Nova Southeastern University, College of Dental Medicine, 3200 South University Dr, Fort Lauderdale, FL 33328; e-mail, [email protected]. Submitted, May 2002; revised and accepted, August 2002. Am J Orthod Dentofacial Orthop 2003;123:352-3 Copyright © 2003 by the American Association of Orthodontists. 0889-5406/2003/$30.00 ⫹ 0 doi:10.1067/mod.2003.82
352
function follow?” We might also ask this question of orthodontics. Orthodontics, during its evolution as a science, has enthusiastically embraced the concept of form following function. However, in the past, only constant repetition of this mantra in the orthodontic literature constituted the evidence to justify the attempted exclusion of genetics from the morphogenesis of the orofacial complex. Only in recent years has the 100-year-old debate about genetics versus environmental influences on growth and development of the craniofacial structures elucidated a sensible blending of causative factors. Although a legitimate controversy might exist regarding which is dominant— genetics or epigenetic modification— denying the significance of genetic factors in light of recent discoveries is reckless. Despite the abundance of evidence for genetic influence, there are still those among us who treat the head as if it exists in a vacuum—a separate entity ruled by different laws of nature. The size of the nose and ears, the length of the fingers and toes, and the various ratios of foot and leg size to each other and to total body size silently testify to genetic influence independent of functional modification. The particular celebrity of Tommy Lee, Eddie Fisher, and Milton Berle that shadows their show business personae is reputed to be the envy of the male world. We would speculate that genetics rather than functional modification is responsible for their heralded measure of fame; if the reverse were true, the streets of our cities would be empty and the bedrooms full, as men increased their function to change their form. Recently, Dr Sydney Brenner decoded the genome of a distant relative of humans, the fugu, or puffer fish. The 2 vertebrates shared an ancestor 450 million years ago. Three-fourths of the fish’s genes have human counterparts. Because of this, Dr Brenner and his team identified another 961 human genes. Obviously, the gene is extremely durable; the passage of millions of years and uncountable numbers of environmental-modifying experiences have failed to greatly alter the shared genes of fish and human. Genetic predisposition, in some orthodontic circles, has been presented as readily attenuated and unreasonably dismissed as an insignificant contributing factor in
American Journal of Orthodontics and Dentofacial Orthopedics Volume 123, Number 3
the development of malocclusion; if not dismissed completely, it has at best been relegated to the back shelf of etiologic factors. Dismissing genetics and depending on mechanical alteration of form to influence the epigenetic internal regulatory mechanism in orofacial development and malocclusion have encouraged a “New Wave” approach to differential diagnosis and treatment. This approach is not based on the evolving cross-pollination of genomic and epigenetic factors but, instead, ignores this confluence of concepts in favor of a convenient contrivance housed in the fear of litigation and the unfounded fears of patients, and in orthodontic clinical incompetence, inventive rationales, and marketing techniques. Disregard for genetic dominance and the supporting role of epigenetic regulation in favor of the form-function relationship have encouraged the denial of an individual normal. Furthermore, it has invited to orthodontics the “Wrightian reversal” of function following form and the indiscriminate belief that a mechanical change of form will automatically trigger a compatible internal regulatory reaction to significantly diminish genetic predisposition. Most orthodontists recognize and accept that malocclusion is a relatively stable equilibrium resulting from a collision of disparate forces. In other words, the genetic and environmental factors in conjunction with the function of the dentition are the source of the disparate forces that collide and establish the malocclusion. On the contrary, the New Wave theory rejects these influences and proposes that, with arbitrary arch form changes, function will follow and stabilize the new form. This should be defined as the “Field of Dreams theory” for its similarity to the baseball motion picture, Field of Dreams, in which a mysterious voice tells actor Kevin Costner, “If you build it, they will come.” The equivalent orthodontic proposition would be to build an arbitrary dental arch form and then to expect the colliding factors that contributed to the
Meister and Masella 353
malocclusion to magically disappear or adapt and a new harmony to appear to support the arbitrary arch design. The Field of Dreams theory proposes to support arbitrary corrective parameters for inadequate palate width (the thickness of a thumb or the length of a cotton roll) or to create unlimited mandibular arch width (a rejection of 60 years of studies reported in the literature). This approach to orthodontic treatment dismisses differential diagnosis as irrelevant and analysis of variables as insignificant; it makes a mockery of orthodontic records and analysis. It suggests that all patients should be treated identically. The arguments to dismiss differential diagnosis as an integral part of analysis are suspect. New Wave practitioners have discarded the treatment goal of relative stability of the dentition and treatment within the abstract of an envelope of tolerance. This concept is erroneously based on mythology and convenient misinterpretation of the literature. Furthermore, excessively full smiles, wide arches, and procumbent lips are promoted as the standards of beauty for all patients, regardless of their individuality and their chief complaints. There was movie magic in Field of Dreams. Costner built the baseball field, and the ghost heroes of the past did come, but that was fantasy; orthodontics presumes to be science. As scientists, we should respect evidence and leave the dreams for the movies. The “Wrightian reversal” and the New Wave approach to orthodontics defy genetic predisposition and the individual normal, and rely on function and stability following arbitrary changes in form. Doesn’t this deserve critical examination and supportive evidence? The German aphorist Georg Christoph Lichtenberg (1742-1799) noted that “Nowadays, we everywhere seek to propogate wisdom: Who knows whether in a couple of centuries there may not exist universities for restoring the old ignorance?”
Field of dreams Malcolm Meister, DDS, MSM, JD,a and Richard S. Masella, DMDb Fort Lauderdale, Fla
A
s it entered the 20th Century, New York City experienced an explosion of growth. In 1916, the city enacted a setback law to reduce the effect of towering new buildings on the light and air at street level. The law required that a specific angle of light be preserved. To comply, architects altered the design of the buildings to include proportionate setbacks at specific heights. This shape, created by a functional need, became the traditional design of the pre-World War II skyscraper. This is a prime example of the adage, “form follows function.” Another example can be found in the construction of art museums. The function of an art museum is to display works of art in an attractive and comfortable environment with proper lighting and space. As a result, for generations, the form of museums has followed their function. The Metropolitan Museum of Art in New York City is an excellent example of the evolution of the museum form in response to functional needs. The renowned architect Frank Lloyd Wright, in his desire to break with the past and imprint his own unique and brilliant talent on the world of architecture, decided that form was more important than function, and that once the form was created, function would follow. He reversed the mantra to “function follows form.” Wright’s creation, the Guggenheim Museum of Art, is a remarkable architectural site and a pleasure to see. But inside, inadequate lighting, narrow and slanted viewing ramps, and art that is mounted perpendicularly on walls creates discord for the viewer. The form of the museum is beautiful, but function follows with difficulty. The environment of the Guggenheim does not encourage relaxed, restful viewing of art but, rather, produces an unsettling, rushed onslaught of colors and shapes. The question in architecture is, “How well does From the College of Dentistry, Nova Southeastern University, Fort Lauderdale, Fla. a Professor and chairman, Department of Orthodontics. b Associate professor and assistant Dean of Education. Reprint requests to: Malcom Meister, DDS, MSM, JD, Department of Orthodontics, Nova Southeastern University, College of Dental Medicine, 3200 South University Dr, Fort Lauderdale, FL 33328; e-mail, [email protected]. Submitted, May 2002; revised and accepted, August 2002. Am J Orthod Dentofacial Orthop 2003;123:352-3 Copyright © 2003 by the American Association of Orthodontists. 0889-5406/2003/$30.00 ⫹ 0 doi:10.1067/mod.2003.82
352
function follow?” We might also ask this question of orthodontics. Orthodontics, during its evolution as a science, has enthusiastically embraced the concept of form following function. However, in the past, only constant repetition of this mantra in the orthodontic literature constituted the evidence to justify the attempted exclusion of genetics from the morphogenesis of the orofacial complex. Only in recent years has the 100-year-old debate about genetics versus environmental influences on growth and development of the craniofacial structures elucidated a sensible blending of causative factors. Although a legitimate controversy might exist regarding which is dominant— genetics or epigenetic modification— denying the significance of genetic factors in light of recent discoveries is reckless. Despite the abundance of evidence for genetic influence, there are still those among us who treat the head as if it exists in a vacuum—a separate entity ruled by different laws of nature. The size of the nose and ears, the length of the fingers and toes, and the various ratios of foot and leg size to each other and to total body size silently testify to genetic influence independent of functional modification. The particular celebrity of Tommy Lee, Eddie Fisher, and Milton Berle that shadows their show business personae is reputed to be the envy of the male world. We would speculate that genetics rather than functional modification is responsible for their heralded measure of fame; if the reverse were true, the streets of our cities would be empty and the bedrooms full, as men increased their function to change their form. Recently, Dr Sydney Brenner decoded the genome of a distant relative of humans, the fugu, or puffer fish. The 2 vertebrates shared an ancestor 450 million years ago. Three-fourths of the fish’s genes have human counterparts. Because of this, Dr Brenner and his team identified another 961 human genes. Obviously, the gene is extremely durable; the passage of millions of years and uncountable numbers of environmental-modifying experiences have failed to greatly alter the shared genes of fish and human. Genetic predisposition, in some orthodontic circles, has been presented as readily attenuated and unreasonably dismissed as an insignificant contributing factor in
American Journal of Orthodontics and Dentofacial Orthopedics Volume 123, Number 3
the development of malocclusion; if not dismissed completely, it has at best been relegated to the back shelf of etiologic factors. Dismissing genetics and depending on mechanical alteration of form to influence the epigenetic internal regulatory mechanism in orofacial development and malocclusion have encouraged a “New Wave” approach to differential diagnosis and treatment. This approach is not based on the evolving cross-pollination of genomic and epigenetic factors but, instead, ignores this confluence of concepts in favor of a convenient contrivance housed in the fear of litigation and the unfounded fears of patients, and in orthodontic clinical incompetence, inventive rationales, and marketing techniques. Disregard for genetic dominance and the supporting role of epigenetic regulation in favor of the form-function relationship have encouraged the denial of an individual normal. Furthermore, it has invited to orthodontics the “Wrightian reversal” of function following form and the indiscriminate belief that a mechanical change of form will automatically trigger a compatible internal regulatory reaction to significantly diminish genetic predisposition. Most orthodontists recognize and accept that malocclusion is a relatively stable equilibrium resulting from a collision of disparate forces. In other words, the genetic and environmental factors in conjunction with the function of the dentition are the source of the disparate forces that collide and establish the malocclusion. On the contrary, the New Wave theory rejects these influences and proposes that, with arbitrary arch form changes, function will follow and stabilize the new form. This should be defined as the “Field of Dreams theory” for its similarity to the baseball motion picture, Field of Dreams, in which a mysterious voice tells actor Kevin Costner, “If you build it, they will come.” The equivalent orthodontic proposition would be to build an arbitrary dental arch form and then to expect the colliding factors that contributed to the
Meister and Masella 353
malocclusion to magically disappear or adapt and a new harmony to appear to support the arbitrary arch design. The Field of Dreams theory proposes to support arbitrary corrective parameters for inadequate palate width (the thickness of a thumb or the length of a cotton roll) or to create unlimited mandibular arch width (a rejection of 60 years of studies reported in the literature). This approach to orthodontic treatment dismisses differential diagnosis as irrelevant and analysis of variables as insignificant; it makes a mockery of orthodontic records and analysis. It suggests that all patients should be treated identically. The arguments to dismiss differential diagnosis as an integral part of analysis are suspect. New Wave practitioners have discarded the treatment goal of relative stability of the dentition and treatment within the abstract of an envelope of tolerance. This concept is erroneously based on mythology and convenient misinterpretation of the literature. Furthermore, excessively full smiles, wide arches, and procumbent lips are promoted as the standards of beauty for all patients, regardless of their individuality and their chief complaints. There was movie magic in Field of Dreams. Costner built the baseball field, and the ghost heroes of the past did come, but that was fantasy; orthodontics presumes to be science. As scientists, we should respect evidence and leave the dreams for the movies. The “Wrightian reversal” and the New Wave approach to orthodontics defy genetic predisposition and the individual normal, and rely on function and stability following arbitrary changes in form. Doesn’t this deserve critical examination and supportive evidence? The German aphorist Georg Christoph Lichtenberg (1742-1799) noted that “Nowadays, we everywhere seek to propogate wisdom: Who knows whether in a couple of centuries there may not exist universities for restoring the old ignorance?”