More on straight wire appliances

LETTERS TO THE EDITOR Orthodontics and TMD To the Editor: I read with interest the letter to the editor by Philip H. Levy in the January 1991 issue of the AM J OFITHOD DENTOFAC ORTHOP (pages 21A-23A) in response to the literature review paper of Dr. Reynders (AM J ORTHOD DENTOFAC ORTHOP, June 1990). Even though two papers, which I coauthored, appeared to be an issue in Dr. Levy's mind, I was initially reluctant to enter this debate. I am, however, acutely aware of how documented research is sometimes misinterpreted and misrepresented to further the biases of certain persons or groups as I feel Dr. Levy has done. In addition, he has criticized unfairly American orthodontic education. A couple of years ago at the Chicago midwinter meeting, I heard one of the leaders of the "functionally oriented" orthodontic groups completely misrepresent another of my coauthored publications to further his ideas and mislead the audience; I was compelled to set the record straight during the question period. Once again, I suppose it is my duty to respond specifically to Dr. Levy's flippancy in reference to the two papers in question (Sadowsky and BeGole, AM J ORTHOD 1980;80:156-72; Sadowsky and Polsen, AM J ORTHOO 1984;86:386-90). The 1980 Illinois study reported on the findings with respect to the initial 75 adults who underwent orthodontic treatment and the 75 adults who had untreated malocclusions from an N'.I.D.R. sponsored research contract on the long-term effects of orthodontic treatment. A similar research contract was also awarded to the Eastman Dental Center and was conducted completely independently. The 1984 report used the data collected by the Eastman group (112 orthodontic patients and 112 controls) under Alan Polsen and compared the Eastman findings with the total Illinois sample of 96 orthodontic patients and 104 controls. The studies are therefore not "essentially repeats" and were conducted independently. Our research groups were surprised at the similarity of findings; regrettably Dr. Levy has a problem when wellmeaning unbiased efforts are made to attempt to answer important questions and suggest conclusions that are not to his liking. I take strong exception to his statement that "these studies were intended to exonerate the orthodontic community... "The gobbledygook that foIIows in parts of Dr. Levy's letter is impossible to understand and is the jargon we often hear on the subject of "functionally oriented orthodontics." A lot of what Dr. Levy may be referring to is the treatment of patients with TMD and the part that tooth movements and jaw orthopedics may have rather than indicting orthodontic therapy per se. Furthermore, the cases evaluated in the Illinois and Eastman studies were treated in the 1940s to 1960s by wellrespected, conscientious orthodontists according to the concepts of those times. Dr. Levy makes many of his own vague assumptions and generalizations as to the treatment objectives and dentoskeletal relationships

achieved in those cases, which are completely unfounded. On a more positive note, Dr. Levy's statement that "orthodontic treatment does not cause or cure TMJ disorder" is well taken and has been supported by several more recent studies. His point that orthodontic therapy "does "have the potential to do either... "is an important one. I suspect that modern day orthodontists, and most certainly modern day orthodontic education, are acutely aware of iatrogenic possibilities. With the many years of experience that Dr. Levy has and the criticism he has of other documented studies, it is his responsibility, and that of others who espouse his ideas, to have large samples of their cases documented and reported on as objectively as possible for the profession to scrutinize. After all, we all wish to be able to provide the best possible care to our patients. Dr. Cyril Sadowsky Associate Professor Department of Orthodontics College of Dentistry University of lllino.is at Chicago 801 S. Paulina St. Chicago, IL 60612

More on straight wire appliances To the Editor: The letter written by Arthur L. Wool to the editor in the December 1990 issue of the AJO-DO titled "A Further Word on Straight Wire Appliances" is excellent for teaching purposes. It reflects much of the confusion that prevails about the straight wire concept and appliance. The first matter of concern is whether Dr. Wool actually uses the straight wire appliance or is incorrectly labeling the appliance he uses. For correct terminology regarding the matter, please refer to the book Straight Wire--The Concept and Appliance by L. F. Andrews (published by LA Wells, 1989, 2025 Chatsworth Blvd., San Diego, CA 92107). If Dr. Wool is not using the straight wire appliance, then the poor bracket-to-crown fit and the incorrect slot alignment he is experiencing is typical for appliances tha.t are only partially programmed. If, in fact, Dr. Wool is using the straight wire appliance, then he is not siting the brackets as prescribed. Any claim I have every made about saving chair time has not included the time spent bracketing, with or without bands. If Dr. Wool would like a first-hand experience of seeing how effective the straight wire appliance is with little or no wirebending, I invite him to spend several days in my office if he, as a quid pro quo, would report the experience with another letter to the editor. Dr. Lawrence F. Andrews 2025 Chatsworth Bh'd. San Diego, CA 92107 25A