M - Dentistry Spring 2023

A Century of Orthodontics

Program celebrates 100 years of leadership and excellence

After 100 years of growth from a fledgling specialty to a world-class educational enterprise, it’s still the people that make the University of Michigan School of Dentistry orthodontic program special.

Dr. Nan Hatch, Chair of the Department of Orthodontics and Pediatric Dentistry, says residents in the program and new graduates may not understand or appreciate the quality of their educational experience while they are in the program, but they soon find out after they graduate and begin their careers.

Adjunct orthodontics professor Dr. Steven Lash shares guidance with second-year resident Dr. Sara Tinawi (left) as he examines her young patient.

“A year or so later, alumni will come up at meetings and say things like: ‘Oh, my goodness, I knew we were good,” Hatch says, paraphrasing the common conversations, “but I didn’t realize how much I learned here compared to my peers until I got out and started talking to my friends who went to other programs.’”

That sort of revelation is a testament to the dedication that all members of the program – faculty, staff, alumni and residents – put into the program, Hatch said. “As chair, my primary objective is to maintain the excellence and innovation that is known to be University of Michigan Orthodontics, such that our alumni will continue to bleed maize and blue.”

Such perspective is especially meaningful during this special year that marks 100 years since the program was established at Michigan, when it became the first such graduate degree-granting program in the United States.

Dr. Hera Kim-Berman, the current Graduate Orthodontic Program Director, said student applicants who visit the program usually want to see the clinic – where the knowledge is created, and where the “magic” happens. She said U-M residents will reply with words to the effect of: “Well, it’s just the clinic. It’s just dental chairs. In a relative sense, there’s really nothing to see.”

And, indeed, it’s not about the facility, Kim-Berman says. “It’s the interaction of the people, the back and forth, and all the hard work that people put in at all levels here. Many people who came right out of this program are giants in their field. And I think that really creates this aura of excellence.”

Interim Dean Jan Hu, in her welcome at this year’s Moyer’s Symposium, said the orthodontics centennial is an opportunity to reflect on the incredible amount of learning and progress over the course of 100 years. “Imagine the culture of dentistry in 1923 as Dean Marcus Ward directed Dr. Leroy Johnson to start a new program without any models to follow,” she said. “A year later, the job of chair was given to Dr. George Moore, who just that spring had graduated from our school as one of the first two students to receive the new Master’s of Science degree in Orthodontics. From those early days, a model of excellence was gradually built, year by year, decade by decade, research advancement by research advancement. It is truly remarkable how far orthodontics and orthodontics at the University of Michigan have come.”

In the beginning

Orthodontic training was available at U-M prior to the establishment of the Graduate Program, but the training was at the level of dental students and was limited in its extent and focus. Dr. William Dorance, a U-M faculty member in prosthetics and dental metallurgy from 1877-1902, was identified as the first faculty member to teach orthodontics, from 1883-1902. “Lectures in Orthodontia” were first mentioned in the 1893 U-M College of Dental Surgery Announcements.

Three decades later came a galvanizing event for dental specialties. Dr. William Gies, a Columbia University professor of biochemistry and widely credited as founder of modern dental education, published The Gies Report, “Dental Education in the United States and Canada.” This landmark report in 1926 established the importance of dentistry as a healing science, and as an essential component of higher education within the health professions.

The Gies philosophy that was the foundation for the report struck a chord with Dr. Marcus Ward, who was Dean of the dental school. He decided the school should have an orthodontic program at the graduate student level. Ward named Dr. Leroy Johnson as the first “Chair of Orthodontia,” initiating the program in 1923.

At its September meeting that year, the U-M Board of Regents authorized the “sum of $1,500 to provide equipment and quarters for the use of Dr. A. Leroy Johnson, Professor of Orthodontia in the College of Dental Surgery.” The Graduate Degree, a Master of Science in Orthodontia, was first offered in the academic year 1923-24. Drs. George Moore and Frank Cartwright are granted the first degrees in 1924.

While Dr. Johnson quit in 1924 after just one year, in part because he did not see eye to eye with Ward on some matters, the die had been cast. A Graduate Orthodontic Program at the University of Michigan was born and a distinguished 100-year history was set in motion.

To replace Johnson, Ward turned to one of the two first graduates that year, Dr. George Moore, naming him chair in 1924. He served in that capacity for 28 years and is credited with fully establishing the program at a time when U-M stood nearly alone in offering dental specialty training to graduate students leading to an MS degree. Moore gained recognition for strong and focused leadership that proved essential for creating the fundamental program tenets that still hold true today, including a vision for excellence in education, patient care and research. Moore served as chair until his death in 1952.

The Moyers Impact

In 1953, a remarkable figure came to Ann Arbor, a leader and researcher whose footprint remains firmly implanted in the spirit of Michigan Orthodontics today. U-M recruited Dr. Robert E. Moyers from the University of Toronto to chair the Department of Orthodontics at Michigan.

Moyers had received his orthodontic training and a PhD from the University of Iowa, then became a highly regarded faculty member at the University of Toronto, where he was the founding Chair of Orthodontics in 1949, the first such program in Canada. Among his many other accomplishments in Toronto, he established the Burlington Growth Center in a town 30 miles from Toronto, and the Craniofacial Anomalies Clinic at the Hospital for Sick Children in Toronto.

Moyers carried that developmental perspective to U-M, where he brought the U-M Center for Human Growth and Development to fruition in 1964. The center was established as a university-wide interdisciplinary unit to better understand childhood growth and development, including many aspects of dental and craniofacial growth. Under Moyers’ leadership, the Center drew distinguished scholars from all over the world and gained international prominence. He served as the Chair of Orthodontics until 1966 and directed the Center for Human Growth and Development until 1980.

The memory of Moyers, who died in 1996, is honored annually during the Orthodontic Program’s annual Moyers Symposium, which celebrated its 50th anniversary this year.

The James Harris Years

The appointment of Dr. James Harris as Chair of Orthodontics in 1966 began an extended run through 1981 in which the program focused on offering residents excellence in patient-centered clinical training in addition to research. Harris came steeped in the U-M experience, having graduated from its dental school in 1954, completed an MS in genetics followed by an MS in orthodontics in 1963.

Despite the fact he had a research-focused background, Harris wanted the department to emphasize the clinical aspects of orthodontics. He went to Dean William Mann and together they put together a program aimed at hiring the best orthodontic practitioners they could find in Michigan to become faculty members. Inclusion of this group brought increased time for clinical teaching and patient care at the university.

“I wanted (external faculty) to have half a day to prepare their lectures, so that when they were at our school, they gave seminars in the morning, and then went over cases with patients in the clinic during the afternoon,” Harris said in an interview at his Ann Arbor home last year. Thus, each faculty member from the clinical practice realm spent a whole day with the graduate students, teaching the challenging aspects of Tweed orthodontics, that is, the bending of wires, a process Harris calls the “grandfather of orthodontics.”

Harris said he also sought to develop a broader understanding of the variations between patient groups. To that end, he brought a fulltime professor of anthropology, Dr. Mel Baer, from the University of Chicago, to the department. The move reflected Dr. Harris’ deep appreciation for the fact that, in addition to working with teeth, orthodontists are dealing with skulls, growth and development, and human variability and diversity. “The big thing was to look at each individual as an individual, and not as a mean, on a curve of a population,” Harris said.

When Harris retired in 1981 after 16 years of leadership, he was followed by two interim leaders who served shorter stints. Dr. Surender Kumar Nanda was acting department chair from 1981-82. He was followed by Dr. Peter Vig from 1983-87. Under Vig’s leadership, the curriculum content was further standardized, and the department continued to grow.

Jim McNamara’s many roles

Few people have cast a more varied and positive shadow on U-M Orthodontics than Dr. James McNamara. He has long been a key fixture, having played myriad roles, including interim chair from 1987-91, faculty member, long-time local practitioner, world-renown researcher and lecturer, and co-organizer for two of the program’s marquee events – the Moyers Symposium and the Graduate Orthodontic Resident Program, or GORP.

Colleagues say that throughout his 50-plus year association, McNamara retained a powerful enthusiasm for the U-M Orthodontic Program, for his private practice in Ann Arbor and for the education in and profession of orthodontics. After a long period serving as the Graber Endowed Professor in Orthodontics, he is now a Professor Emeritus of Dentistry, Professor Emeritus of Cell and Developmental Biology, and Research Professor Emeritus of the Center for Human Growth and Development.

McNamara was educated in California, earning his dental and orthodontic degrees at the University of California at San Francisco. He earned his PhD in anatomy from U-M in 1972 and began teaching in the U-M Orthodontics Program as professor in 1984.

Beginning in 1971, McNamara maintained a practice in Ann Arbor, which he eventually shared with his daughter, Dr. Laurie McNamara McClatchey. “Being able to move seamlessly between the university laboratory and clinical practice has been a hallmark of his career,” wrote a colleague, Rolf Behrents, in an article announcing that McNamara had received the Lifetime Achievement Award for Orthodontic Research from the American Association of Orthodontists, one of many prestigious awards McNamara has received.

The GORP event was born, as McNamara recalls it, when he and two residents, Drs. Pat Nolan and Gary Starr, were talking about such an event after a holiday departmental gathering involving faculty, residents and staff. In 1989, the discussion led to a program that now draws orthodontic residents from the United States and Canada for a long weekend of networking, professional education and fun in Ann Arbor every other year.

Lysle Johnston’s quest for best

Dr. Lysle Johnston, who served more than a dozen years as Chair of the Department of Orthodontics and Pediatric Dentistry from 1991-2004, focused on managing and successfully running a department whose graduates excelled in both research and in patient care. “Running an orthodontics department was like a game,” he said in an interview last year. “The ways you can tell you have won include good research, good faculty and good clinicians. We built a clinical faculty that was absolutely fabulous.”

Johnston grew up in the small town of East Jordan, Michigan. He entered the University of Michigan School of Dentistry in 1957, for both his DDS (1961) and MS (1964). After graduation, his academic and career stops included Queen’s University of Belfast in Ireland, Case Western Reserve University and then St. Louis University as Department Chair.

In 1991 he was recruited to Michigan, where he was appointed as the Robert W. Browne Professor of Dentistry and Chair of the U-M Department of Orthodontics and Pediatric Dentistry, serving until his retirement. Under his direction, the Graduate Orthodontic Program produced more than 300 orthodontists. He and his students won numerous research awards over the years and Johnston presented at numerous national and international conferences. Among his honors is the AAO Lifetime Achievement Award.

Dr. Nan Hatch, chair of the Department of Orthodontics and Pediatric Dentistry, welcomes alumni and friends to the Centennial Celebration Reception on March 4 at Michigan Stadium. More than 450 people attended the event.

McNamara describes Johnston’s career this way: “Whether as a department chair, mentor, lecturer, or researcher, his focus never has strayed much beyond the day-to-day concerns of the clinician. He has served as a key spokesman who has questioned, scolded, asked for data, and generally served as resident skeptic when new (and often unproved) techniques and protocols had been advocated. Lysle Johnston has served our profession and our specialty well. … His work has made and continues to make a difference to orthodontics, to craniofacial biology, and to dentistry.”

Faculty emphasis by Sunil Kapila

Recruiting exceptional faculty was one emphasis for the next Chair, Dr. Sunil Kapila, who served in that role for a decade from 2004-14. In addition to hiring the current chair, Dr. Nan Hatch, as a postdoctoral research fellow, he recruited world renowned researcher Dr. Lucia Cevidanes from the University of North Carolina along with Dr. Hera Kim-Berman, who currently serves as the U-M Graduate Orthodontic Program Director.

Kapila was educated as a dentist at the University of Nairobi in Kenya. He received his MS degree in orthodontics from the University of Oklahoma and his PhD in Oral Biology from the University of California at San Francisco. His research focused on the hormonal basis of TMJ degeneration and periodontal bone biology. He published many peer-reviewed papers, chapters and proceedings on these topics, and on orthodontic biomaterials, biomechanics and 3-D imaging.

Kapila supported departmental growth in the area of education in the treatment of patients with craniofacial anomalies such as cleft lip/palate. In collaboration with Dr. Katherine Kelly, and through a generous patient family donation, an endowed fellowship in Craniofacial Orthodontics was created.

When Kapila left to return to UCSF, two interim chairs, Dr. R. Scott Conley in 2014 and Dr. Jan Hu in 2015, each led the Orthodontics and Pediatric Dentistry Department for a year.

At the centennial celebration at Michigan Stadium, Jim McNamara (center) poses with members of the 2005 orthodontics class, including his daughter. From left are Drs. Marsha Beattie, Laurie McNamara McClatchey, Heather Gietzen and Steven Charchut.

Hatch: ‘You have to lead’

Dr. Nan Hatch, who had been at the U-M dental school for more than 10 years, was chosen as Chair in 2016 after the School of Dentistry conducted a competitive national search to fill the position.

Originally from Massachusetts, Hatch received her DMD from the Harvard School of Dental Medicine with honors in research. She then moved across the country to pursue clinical orthodontic training in combination with research training at the University of Washington in Seattle. After completing her PhD in Cell and Molecular Biology in 2005, she was recruited to U-M, where she advanced from postdoctoral research fellow to a full-time orthodontic faculty position.

As an internal candidate for Chair, she knew the dental school well. She initiated the Orthodontic Faculty Practice within the orthodontic clinic; treated patients in the faculty practice; taught predoctoral dental students and orthodontic residents in clinical and didactic arenas; served as the Orthodontic Research Director, developing a course and specific milestones to promote successful achievement of MS research projects by the orthodontic residents; ran her research lab; and provided service to the program, department and school.

Today, she brings a management approach that emphasizes empathetic faculty and staff leadership, technology, patient care, research and professional service. “I just wanted to make sure that we had a Chair who really was going to put their heart into it. To put their head into it, yes, but also their heart …This is very much a leadership position. This isn’t just about clinical practice or your particular expertise in the field. You’ve got to lead.”

One of her goals is to incorporate new clinical technologies balanced with traditional techniques to create well-rounded and highly versed orthodontic residents ready to become master clinicians. “Our students are going to be treating with clear aligners, and they’re going to be using intraoral scanners and digital software to visualize and manipulate those scans, so they need to learn those skills.”

Hatch provides strong support for both faculty and resident research, making sure faculty can protect research time and receive department resources. To support resident research, she developed a formal course and a scheduled list of milestones as residents work to develop and write their master’s research projects. “There is no expectation that orthodontic residents will become researchers, but successful completion of an MS project provides critical thinking skills that will enable them to distinguish real data from opinion, which will be useful throughout their orthodontic careers as new techniques and philosophies continue to arise.”

Hatch cites what she calls the “Michigan knowledge base,” a strong understanding of diagnosis, treatment planning and mechanics. “Not everybody is taught the way these residents are taught,” she said. “I’m not saying that we’re the only good program, but when alumni go teach at another orthodontic program, they’ll be teaching from their Michigan knowledge base, which is deep and comprehensive.”

That knowledge is also paired with an expectation of service to the profession, to the community, and to orthodontic education.

“The reality is that these people are going to be much more fortunate than many others in their community,” Hatch says. “And they’re highly capable, highly skilled, highly intelligent, typically with good people skills. And we just really want them to remember how fortunate they are and that it’s important to give back and also to spread the Michigan knowledge.”

Lysle Johnston greets well-wishers during the centennial reception at Michigan Stadium. Here he chats with his classmate Dr. Daniel (DDS 1961, MS 1965) and Barbara Balbach. At left is Dr. Jay Bowman and in the background is Dr. Fedon Livieratos (MS 1993).

The Department History Project

This article by Geoff Larcom is excerpted from the book, “100 Years of Graduate Orthodontics at the University of Michigan School of Dentistry,” which he wrote to mark the centennial. Larcom is a writer who lives in Ann Arbor. To read the entire book online, go to this web address https://myumi.ch/m7JP3 or use the QR code.

To see a short video of the Ortho 100 reception at the Big House, go to https://myumi.ch/EPpx5