We are living in an exciting scientific era, one in which our basic understanding of treatment capabilities and biological responses is rapidly expanding and changing. However, the American Dental Association’s “Evidence-based dentistry” edict¹ leaves the practical clinical application of EBD in constant balance by individual practitioners, between what we think has been proven in the past and what is in the process of being proven now. I firmly believe that within our specialty, we are in the midst of a paradigm shift, from the heavy forces of the past to the appropriate gentle forces optimum for cellular response.

The late Thomas Kuhn at MIT observed that pre-paradigm periods (read: Paradigm shifts) are “…revealed in textbooks, lectures and laboratory exercises. By studying them and by practicing with them, the members of the corresponding community learn their trade.”²   Unfortunately, in our professional journals, there are two areas where I take umbrage. One is categorically dismissing information attributed to corporately sponsored data; the other, just as disturbing, is clinical research that is based on inadequate understanding or lack of information by the researcher, leading to a faulty protocol that is then deemed true based on statistical confirmation.

First, let us consider privately funded data. Sir Francis Bacon said that “Truth emerges more readily from error than confusion.” Our society needs to reward those dedicated scientists who contribute to the Baconian “what it is not” as much as “what it is.” Turpin³ cautioned us against falling into the same privately funded research trap that our medical colleagues have in the past. Realistically, however, since 2003 we have been faced with a decline in U.S. government grant funding by both the National Institutes of Health⁴ and the National Science Foundation.⁵ A foreboding reality check and further complication permeates government funding. As the Director of Stanford University’s “Stem cells in Society Program” Christopher Thomas Scott⁶ stated “Presidents and Congresses, both liberals and conservatives, have used their authority to guide, redirect, and limit funds. In this aspect, the fate of science funding is no different than funding for Interstate highway systems, municipal police departments, or the National Endowment of the Arts.” It is probably not coincidental that only 1 of 26 research articles in the September 2009 issue of the Angle Orthodontist was written entirely by authors from the United States.  Where does that leave orthodontics on the funding totem pole?

We are caught in a conundrum for which I feel there is a partial answer: we need to allow more dialogue and research by corporately supported doctors. I am talking about our professional journals and not the marketing publications of individual companies. Revealing the relationship should be a requirement for publication, not rejection. The research garnered and published by Orgill, et al^7-9 about the clinical and cellular effects of WoundVac therapy wasn’t less outstanding because it was funded by the corporate entity KCI.

I am not currently, nor have I ever been, the recipient of financial remuneration from the Ormco Corporation. We should all be obliged by professional ethics to reveal monetary relationships. However, to pre-judge any speaker or researcher’s information and data as tainted before we have personally listened and analyzed it for ourselves is a disservice to our patients and our profession. We need to read articles and Forum letters from the people on the “cutting edge,” followed by independent evaluation of that data by the rest of the profession following the initial protocols. Otherwise, it is useless evaluation or a change in the initial published approach.

 My second objection is the researcher who attempts to do research in an area in which he or she is not adequately trained or experienced. If, for example, a clinical researcher tried to publish research that placed a single Begg bracket in the middle of a fully banded edgewise arch, and worse, added an .018” stainless steel arch, rather than Australian wire to evaluate the claims and effectiveness of the Begg Technique to level the arch, I would expect this protocol to be severely critiqued and rejected. I would have to assume that the researching clinician (in an honest attempt to control surrounding parameters in his methodology and materials) created a clinical situation that was self-limiting by its very nature.

The Damon System evolved, conceptually, into a new technique. It uses the 4-walled, passive ligation aspect of the Begg appliance and the pre-torqued, rectangular control of the edgewise appliance in the same enlarged bracket lumen, which is never fully engaged by the archwire. As a new “hybrid” technique, it should be examined and studied as a separate appliance that has evolved naturally from our past treatment modalities. My scientific definition would read:

  “The Damon System of treatment is a technique which utilizes passively- ligated, large lumen, four-walled rectangular brackets on every tooth combined with extremely low force arch wires with specific, expanded arch forms, sequenced during treatment to stay within the lowest forces necessary at every phase of treatment to elicit optimum tooth movement through enhanced physiological response of the PDL and surrounding supportive hard and soft histological structures.”

Notice that the term “self-ligated” appears nowhere in my definition. Why? Because whether by arduous insertion of a free-standing rectangular “pin” or the convenient click of the manufacturer’s provided self-ligation, once the fourth wall is provided, the passive ligation system is totally operational. However, I cannot emphasize enough that the adjective “passive” refers to the application (or in this case non-application) of a component of active moments of force within the bio-mechanical system, which alters the biomechanical effects of the wire and ultimately the biological response of tissues. All of this occurs simply to retain the archwire in the slot!

I look forward to the coming research by clinicians, cellular biologists, biochemists, metallurgists and all our esteemed colleagues who provide the foundation for our enhanced clinical treatment. I hope to see our profession confirm or reject a new paradigm for treating our patients. In the meantime…I’ll just have to continue doing the best I can do and enjoy every moment of it.

 Richard M. Bach

Riverhead, NY

References

1. American Dental Association. Policy on Evidence Based Dentistry. ADA Publications. 2008, Feb. 28

2. Kuhn T. The Structure of Scientific Revolution, 3rd ed. University of Chicago Press. 1996 Pg. 43

3. Interview with David L.Turpin. Hellenic Orthodontic Review 2005; 8:1-9.

4. NIH Office of Extramural Research.  Office of Research Information Services. Table#304-NIH Research Grants, Current and Constant Dollars: Fiscal Years 2008-1950

5. National Science Foundation. Division of Science Resources Statistics FY 2008, Data Show Downward Trend in Federal R&D Funding, Arlington, VA (NSF 09-309) [January 2009]

6. Scott CT. Stem Cell Now. Plume Publishing. Penguin Group, New York, 2006

7. Orgill DP, Bayer LR. Advancing the treatment options of chest wounds with negative pressure wound therapy. Ostomy Wound Management 2005; 51(2A Suppl):39S-43S

8. Scherer SS, Pietramaggiori G, Mathews JC, Prsa MJ, Huang S, Orgill DP. The mechanism of action of the vacuum-assisted closing device. Plast Reconstr Surg. 2008; 122:786-97.

9. Orgill DP, Manders EK, Sumpio BE, Lee RC, Attinger CE, Gurtner GC, Ehrlich HP. The mechanism of action of the vacuum-assisted closing device-more to Learn. Surgery. 2009; 146:40-51.

The article discusses the differences among different types of orthodontic problems and why some patients benefit more from early treatment than others. The recommendation for all children to have an orthodontic check-up no later than age 7 is included. Because the story is from the Associated Press, it may appear in numerous daily newspapers nationally.

View the article at http://www.msnbc.msn.com/id/33434473/ns/health-kids_and_parenting/