CAO BULLETIN - Fall 2009 by LS Graphics

Fall 2009

Bulletin

CANADIAN ASSOCIATION OF ORTHODONTISTS / ASSOCIATION CANADIENNE DE ORTHODONTISTES

Message from the President Message from the Outgoing President Report on the 2009 CAO Scientific Session Committee Reports CFAO Graduate Student Posterboards - Part 1 of 2 Component Society Reports From the Editor

Message from the President Canadian Association of Orthodontists Association canadienne des orthodontistes 2175 Sheppard Avenue East, Suite 310 Toronto, Ontario M2J 1W8 Telephone (416) 491-3186 / 1-877-CAO-8800 Fax (416) 491-1670 E-mail cao@taylorenterprises.com Website www.cao-aco.org AND www.canadabraces.ca

2009/2010 Board of Directors OFFICERS President President Elect Past President 1st Vice President 2nd Vice President Secretary/Treasurer

Dr. Gerry Zeit Dr. Howard Steiman Dr. Robert Cram Dr. Ritchie Mah Dr. Paul Major Dr. Garry A. Solomon

REGIONAL DIRECTORS British Columbia Alberta Saskatchewan Manitoba Ontario Quebec Atlantic

Dr. Rick Odegaard Dr. Phil Williamson Dr. Ross Remmer Dr. Susan Tsang Dr. Helene Grubisa Dr. Jean-Marc Retrouvey Dr. Stephen Roth

COMMITTEES Communications Nominations President CFAO CAO/AAO Liaison Insurance Planning & Priorities

Dr. Dan Pollit Dr. Robert Cram Dr. Gordon Organ Dr. Howard Steiman Dr. Robert Cram Dr. Gerry Zeit Dr. Howard Steiman Dr. Paul Major

Membership

Dr. Paul Major

Policy & Procedures

Dr. Amanda Maplethorp

Sponsorship

Dr. Garry A. Solomon

World Federation of Orthodontics

Dr. Robert Cram Dr. Ritchie Mah

National Scientific Meeting Coordinator

Dr. Richard Marcus

CAO/CDA Liaison CCOE New & Younger Members Rep

Dr. Ritchie Mah Dr. Don Robertson Dr. Susan Tsang

CAO Web Master Assistant Web Master Bulletin Editor Directory Editor Historian/Archivist Media Relations Task Force CAO Helpline Task Force GST Advisor

Dr. Daniel Pollit Dr. Jules Lemay III Dr. James Posluns Dr. Stephen Roth Dr. Garry A. Solomon TBA Dr. Howard Steiman Dr. Garry A. Solomon

Dr. Gerry Zeit, [Email: gzeit@sympatico.ca]

Thank you CAO members, attendees, dental staff, speakers, exhibitors, local orthodontic community, CAO Scientific Session Committee and CAO staff, (whew!) for arguably the best Canadian Association of Orthodontic Specialists Annual Session ever. If you had the chance to be in Kelowna this year, you know first-hand what a great success it was. The sun shone, the speakers were polished, the exhibitors illuminating, the social programs exhilarating. Look out Whistler, here we come! It is a great honour to be elected President of our national organization. Our profession is filled with talented, intelligent, creative individuals that make one proud to call oneself an orthodontic specialist. Sometimes it makes me wonder how exactly I got here. How, indeed? Groucho Marx, the famous comic actor, once quipped: “I do not care to belong to a club that accepts people like me as members.” I shudder to think what he would have said about a group that would have taken him as their President. And yet…here I am. I attended my first CAO board meeting in 2001. Ken Glover, then chairman of the orthodontic specialty program at the University of Alberta, was president. Ken had been the CAO Bulletin Editor (‘tis a noble profession! Ed.) for several years and, was looking to relieve himself of some of those duties upon assuming his new role. As the newly appointed Bulletin Editor, I attended board meetings. I listened and reported to the membership. I also learned how much work our association was doing on behalf of the membership and came to realize how much my own practice was the recipient of these efforts. After four years it was time to move on (Thanks! Ed.) to Chair of the Membership Committee. Immersed in the technicalities of processing memberships, I regularly and dutifully reported statistics to the Board. Once, when asked what fraction of Canadian orthodontic specialists were members of the CAO, I had no answer. But the question did start me thinking. While it was confirmed that a strong majority of the orthodontic specialists in Canada are members, why do some refrain? It is interesting to note that, according Dr. Arthur Brooks, author and President of the American Enterprise Institute, Continued… Consider supporting the advertisers and service providers referred to in this Newsletter, recognizing that they have been supporters of the CAO. Advertisements are paid advertising and do not imply endorsement of or any liability whatsoever on the part of the CAO with respect to any product, service or statement. The authors, the Canadian Association of Orthodontists, and its representatives will not be held liable in any respect whatsoever for any statement or advice contained herein. Authors’ views expressed in any article are not necessarily those of the Canadian Association of Orthodontists.

Fall 2009 • CAO Bulletin

among professionals, members of associations report 45 percent greater job satisfaction and higher levels of personal happiness than do non-members. But the CAO wanted specifics; we’re orthodontists! In a recent survey, a common reason cited for not joining was non-attendance at the CAO Annual Scientific Session. The Scientific Session is a major benefit of CAO membership, and getting better every year but it is far from the whole CAO. How exactly does one’s practice benefit from collective CAO efforts? One needn’t spend very long watching a patient sift through a dental fee guide trying to decipher the intricate details of his or her plan to realize how fortunate we are not to rely on insurance codes. This simple yet powerful decision has made an inestimable contribution to maintaining the integrity of the orthodontist-patient relationship. Think about our standard orthodontic form, our CAO transfer form and our directory. Our website has both a public section with information on oral hygiene, orthodontic emergencies and the ‘find an orthodontist’ engine, as well as a members-only section containing a wealth of valuable news and information. The CAO-CRA agreement on GST may have generated ITC collections on your behalf. Canadian orthodontists enjoy a reduced rate on membership with the AAO, and benefit from the close collaborative relationship between our two associations.

CAO Bulletin • Fall 2009

When public concerns such as bisphenol-A or recycled brackets arise in the media, the CAO speaks for us. The CAO has assisted in coordinating communication among educators at the five Canadian universities, initially as an effort to help cope with the crisis in recruitment and retention of orthodontic educators but recently, provided the forum to promote a united approach to recent policy decisions made by Align Technology. The CAO has helped to fund the Canadian Foundation for the Advancement of Orthodontics in support of Canadian orthodontic residents and critical projects such as the Burlington Growth Centre and computer- based orthodontic education modules being developed at the McGill University. The CAO is your organization, here to support you and to support a professional environment that allows us to be the best orthodontists we can be. The CAO is the voice of orthodontic specialists in Canada; it is dedicated to excellence in orthodontic education and to excellence in orthodontic care. The CAO’s ‘voice’ is your voice. The association will never treat an orthodontic patient, but through its efforts, every orthodontic specialist in Canada is better able to provide care to his or her patients in one of the best professional environments in the world. It makes me proud to play my part. Thank you and best wishes for a healthy, successful and fulfilling year.

Rapport du président Merci, membres de l’AOC, à vous tous, de l’auditoire, au personnel dentaire, aux conférenciers, aux exposants, aux orthodontistes de la région et au personnel de l’AOC (ouf!), pour avoir permis la tenue de la Séance annuelle des spécialistes sans doute la plus réussie de l’histoire de l’Association canadienne des orthodontistes. Si vous avez eu la chance de vous trouver à Kelowna cette année, vous avez constaté de visu à quel point cet événement a remporté un succès remarquable. Le soleil s’était paré de tous ses feux, les conférenciers rayonnaient, les exposants brillaient et les activités sociales étaient vivifiantes. Attention Whistler! Nous voici! Être élu président de notre association nationale constitue un grand honneur. En effet, notre profession fourmille de personnes douées, intelligentes et créatives qui suscitent la fierté chez quiconque figure parmi les des orthodontistes. Parfois, je me demande comment je suis parvenu jusqu’ici. Je me le demande vraiment. Groucho Marx, ce fameux acteur fantaisiste, a déjà dit : « Jamais je ne voudrais faire partie d’un club qui accepterait de m’avoir pour membre. » Je frissonne à l’idée de ce qu’il aurait dit à propos d’un groupe qui l’aurait nommé président. Cela dit, je me trouve devant vous. J’ai assisté à ma première réunion du Conseil de l’AOC en 2001. Ken Glover, alors président du conseil du programme d’études en orthodontie de l’Université de l’Alberta, était notre président. Ayant présidé à la rédaction du Bulletin de l’AOC (noble tâche, que celle de rédacteur en chef!) durant plusieurs années, Ken cherchait à se délester de certaines de ses responsabilités au moment d’accéder à son nouveau poste. À titre de nouveau rédacteur en chef, j’assistais aux réunions du conseil. J’ouvrais les oreilles et je livrais mon compte rendu aux membres. De plus, j’ai pu mesurer le travail d’envergure que notre association abattait au nom des membres, au point où j’ai pris conscience de la mesure dans laquelle ma propre pratique bénéficiait du résultat des efforts déployés. Au terme d’une période de quatre ans, il était temps de passer à autre chose (Merci!) pour présider le Comité de l’Affiliation. Enseveli sous les modalités techniques du traitement des affiliations, j’ai fait part régulièrement et fidèlement de statistiques au conseil. Un jour, je suis resté sans réponse quand on m’a demandé quel était le pourcentage des orthodontistes canadiens membres de l’AOC. Mais cette question a déclenché chez moi une réflexion. S’il est ressorti qu’une forte majorité des orthodontistes au Canada sont membres de l’ACO, pourquoi les autres ne le sont-ils pas? Constat intéressant, selon le Dr Arthur Brooks,

auteur et président de l’American Enterprise Institute, chez les membres d’une profession libérale, ceux appartenant à une association se déclarent plus satisfaits, dans une proportion de 45 %, plus heureux au travail que les autres et ils sont également plus heureux dans leur vie personnelle. Mais l’AOC voulait des données particulières; ne sommes-nous pas orthodontistes, après tout? Selon les résultats d’un sondage récent, un des motifs fréquents invoqués pour ne pas s’affilier à l’AOC était de ne pas participer à son Assemblée scientifique annuelle. Cette assemblée représente un avantage considérable aux yeux des membres de l’AOC, qui s’améliore chaque année, sans toutefois réunir l’ensemble de l’Association. De quelle manière, précisément, la pratique de l’orthodontiste peut-elle tirer avantage des efforts collectifs de l’AOC? Il n’est pas nécessaire d’observer un patient explorer un guide des honoraires tout en tentant de déchiffrer les particularités complexes de son régime de soins pour constater à quel point nous sommes fortunés de ne pas dépendre de codes d’assurance. Cette décision simple, mais aux répercussions énormes, a constitué un apport inestimable au maintien de l’intégrité du rapport orthodontiste-patient. Songez à nos formulaires orthodontiques standard, à notre formulaire de transfert de l’AOC et à notre répertoire. Notre site Web est doté d’une section informative destinée au public aux chapitres de l’hygiène buccale, des urgences orthodontiques et d’un outil de recherche d’un orthodontiste, de même qu’une section réservée aux membres qui regorge de nouvelles et d’informations précieuses. L’entente AOC-ARC sur la TPS vous a éventuellement amenés à percevoir des crédits de taxe sur intrants. Les orthodontistes canadiens peuvent bénéficier d’une réduction des frais d’adhésion à l’AAO et de la collaboration étroite qui prévaut entre nos deux associations. Lorsque des préoccupations publiques telles que celles suscitées par le bisphenol A ou le recyclage des boîtiers orthodontiques sont soulevées dans les médias, l’AOC se prononce pour nous. L’AOC a participé à la coordination de la communication entre les professeurs des cinq grandes universités canadiennes, tout d’abord en vue de contribuer à faire face à la crise du recrutement et de la fidélisation de professeurs en orthodontie, puis, dernièrement, pour constituer le forum en vue de promouvoir une approche concertée à l’endroit des décisions en matière de politique d’Align Technology. L’AOC a contribué au financement de la Fondation canadienne pour l’avancement de l’orthodontie à l’appui des résidents canadiens en orthodontie et de projets essentiels tels que le Burlington Growth Centre et l’élaboration, à l’Université McGill, de modules informatisés de formation en orthodontie. L’AOC est votre organisation, dont le rôle est de vous soutenir, de même que de promouvoir un cadre professionnel qui nous permet d’atteindre notre plein potentiel en qualité d’orthodontistes. L’AOC est la voix des spécialistes en orthodontie au Canada; elle a à cœur l’excellence au chapitre de l’enseignement de l’orthodontie et des soins orthodontiques. La « voix » de l’AOC est votre voix. Si l’Association ne traitera jamais un patient, grâce à ses efforts, chaque spécialiste en orthodontie Fall 2009 • CAO Bulletin

au Canada est en mesure de mieux traiter ses patients dans un des meilleurs cadres professionnels du monde. Le rôle que je joue dans ce contexte me remplit de fierté.

to their Canadian counterparts never ceases to amaze me. We are indeed fortunate to be considered such close members of the AAO family.

Merci et puissiez-vous passer une année marquée au coin de la santé, de la réussite et de l’épanouissement.

The CAO continues to liaise with the Royal College of Dentists of Canada (RCDC). While there is no news to report as of late, Hugh Lamont remains as orthodontic councillor for orthodontics, taking over from Don Taylor who previously held the post for many years.

Message from the Outgoing President Dr. Robert Cram [Email: drbob@reddeerortho.com] I extend a heartfelt thank-you to the members of the Canadian Association of Orthodontists for the opportunity to serve as your president over the past year. And what a year it’s been! Support is the key. As all Past Presidents of late are aware, the only way one can maintain any sense of sanity throughout the length of one’s term is through the Herculean efforts of Ms. Diane Gaunt, and Ms. Alison Nash; the quarterbacks of the CAO staff. These two fine ladies held my hand every step of the way. Without their input, patience and tolerance for missed deadlines, no doubt the CAO would have difficulty functioning! Traveling from the Atlantic to the Pacific Coast to attend all provincial meetings was the highlight of my term. I kicked-off with the Saskatchewan meeting in October, followed by Ontario in November (including attendance at the Toronto Study Club meeting and a 2-day media training session given by Tripp Frohlichstein), Alberta in March and BC in early May. Then it was home to wash and change my clothes, walk the dog and give the wife a peck on the cheek before heading off to the Quebec and the Atlantic meetings to close out the season. Through all of these provincial meetings I realized just how many orthodontists I have come to know over the short period of time that I have been in practice in Canada. Organized orthodontics represents a small association in absolute number, but many of its members remain heavily involved and attend local meetings on a regular basis. In addition to the provincial meetings, I was fortunate to attend the AAO leadership conference in Orlando and the joint AAOCAO executive meeting at the AAO Annual Scientific Session in Boston. The bond Canadian orthodontists have established with the leadership of the AAO continues to pay dividends north of the 49th. The special attention that the AAO extends

CAO Bulletin • Fall 2009

The AAO media campaign will continue for one more year without significant change. Several provincial associations have taken the opportunity to dove-tail their local campaigns with the AAO program utilizing materials obtained from the AAO and easily adapted for local use. Incorporated provincial associations are now members of the Canadian Dental Association. Individual dentists remain members of their provincial associations and become indirect members of CDA. A separate and influential body comprised of the provincial presidents and CEOs, has been formed and will be providing input to the CDA governing body. The role of COSA and specialists still appears to be somewhat obscure. Align Technology indicated earlier this year that only practitioners who met certain provider criteria (ie.10 or more patients with Invisalign appliances each year) would be allowed to obtain Invisalign appliances in the future. Individual Orthodontists, as well as provincial and state and national organizations have written to Align Technology to express concerns over the new policy. ESI will be taking over from FCH as the payment agency for the aboriginal dental program, starting in December 09. The ‘provider information’ form has again raised concerns about the relationship between orthodontic providers and FNIHB. We have alerted our membership to these concerns. The CAO has acted as a conduit for information for our provincial organizations in regards to the AAO’s request to sign official AAO affiliation agreements. The focus of this particular issue is provincial in nature. I have had been interviewed three times over the past year, but have only seen one of the articles published thus far in What’s Up Kids Family Magazine. The training session with Tripp provided me with the tools to be better prepared and to better control the flow of information. Although not an entirely gentle process, media training remains a valuable and highly recommended experience for all. I extend a gracious thank-you to the Board of Directors, the Committee Members, and especially to the Line Officers and the Past Presidents of the CAO. The job was tough but the tremendous support was greatly appreciated.

Rapport du le président sortant Je remercie du fond du cœur les membres de l’Association canadienne des orthodontistes de l’occasion qu’ils m’ont offerte de les servir en qualité de président au cours de la dernière année. Et que dire de cette année! Le soutien est la clé de toutes les portes. Comme les ex-présidents récents le savent bien, la préservation ne serait-ce que d’une once de bon sens durant un mandat n’est possible que grâce aux efforts herculéens de Mmes Diane Gaunt et Alison Nash, véritables quarts-arrières du personnel de l’ACO. Ces deux dames merveilleuses m’ont apporté leur soutien tout au long du parcours. Sans leur apport, leur patience et leur tolérance à l’endroit des échéances non respectées, l’ACO aurait certes des difficultés à fonctionner! Mes déplacements d’un océan à l’autre pour assister à toutes les réunions provinciales ont indubitablement constitué le point culminant de mon mandat. J’ai amorcé le tout sur la réunion en Saskatchewan, en octobre, pour me rendre ensuite en Ontario en novembre (notamment pour assister à la rencontre du Toronto Study Club et à une séance de formation sur les médias d’une durée de 2 jours placée sous l’égide de Tripp Frohlichstein), puis, ce fut l’Alberta en mars et la Colombie-Britannique au début de mai. Ensuite, retour à la maison le temps de me rafraîchir et de changer de garderobe, de promener le chien et de faire la bise à ma femme avant de me diriger vers les réunions tenues au Québec et des provinces de l’Atlantique pour clore la saison. Au fil de ces réunions provinciales, j’ai pris conscience du nombre considérable d’orthodontistes dont j’ai fait la connaissance durant la courte période pendant laquelle j’ai exercé au Canada. Si formés en organisation, les orthodontistes constituent une petite association en termes absolus, nombre des membres poursuivent leur participation massive et assistent aux réunions locales régulièrement. Outre les réunions provinciales, j’ai eu le bonheur d’assister au congrès sur le leadership de l’AAO, à Orlando, et à la réunion de direction conjointe de l’AAO-ACO à l’Assemblée scientifique annuelle de l’AAO tenue à Boston. Le lien que les orthodontistes canadiens ont noué avec les dirigeants de l’AAO continue de porter ses fruits au nord du 49e parallèle. L’attention particulière que l’AAO porte à ses confrères canadiens ne cesse de nous étonner. Nous sommes certes choyés d’être considérés comme des membres si rapprochés de la famille de l’AAO. L’ACO continue de communiquer avec le Collège royal des chirurgiens-dentistes du Canada (CRCDC). Si, dernièrement, il n’y a aucune nouvelle à signaler, Hugh Lamont demeure au poste de conseiller des orthodontistes

après avoir pris la relève de Don Taylor qui a assumé ce rôle durant de nombreuses années. La campagne médiatique de l’AAO se poursuivra durant encore un an sans changement important. Plusieurs associations provinciales ont profité de l’occasion pour faire coïncider leurs campagnes locales avec le programme de l’AAO en utilisant du matériel provenant de cette association et en l’adaptant facilement à leur région. Des associations provinciales dûment constituées ont adhéré à l’Association dentaire canadienne (ADC). Des dentistes demeurent membres de leur association provinciale tout en devenant des membres indirects de l’ADC. Une organisation distincte et influente, composée des présidents et des présidents-directeurs généraux, a été formée; elle fournira des renseignements aux instances dirigeantes de l’ADC. Le rôle du Comité des affaires reliées aux spécialistes (CARS) et des spécialistes demeure cependant quelque peu obscur. Align Technology a indiqué plus tôt cette année que seuls les orthodontistes satisfaisant à certains critères (soit au moins 10 patients utilisant les appareils Invisalign chaque année) devraient avoir la possibilité d’obtenir les produits Invisalign à l’avenir. Des orthodontistes, de même que des organismes provinciaux, nationaux et étatiques ont exprimé par écrit leurs préoccupations à Align Technology à l’endroit de cette nouvelle politique. À compter du 9 décembre, ESI Canada remplacera FCH à titre d’agence de règlement des coûts des régimes dentaires des Autochtones. Le formulaire de « renseignements sur le fournisseur » a encore soulevé des préoccupations au chapitre de la relation entre les fournisseurs de soins orthodontiques et la Direction générale de la santé des Premières Nations et des Inuits. Nous avons fait part de ces préoccupations à nos membres. L’ACO a fait office de canal de liaison pour nos organisations provinciales en ce qui a trait à la demande de l’AAO aux fins de signature d’ententes officielles d’affiliation avec cette association. Dans ce cas particulier, l’enjeu est provincial. Au cours de l’année écoulée, j’ai été interviewé trois fois pour ne voir qu’un seul article publié jusqu’à présent dans le magazine familial What’s Up Kids Family Magazine. La séance de formation avec Tripp m’a doté des outils qui m’ont permis de mieux me préparer au flux d’information et de mieux le contrôler. S’il s’agit d’un exercice parfois rude, la formation sur les médias demeure une expérience précieuse que je recommande à tous. Je remercie gracieusement le conseil d’administration, le Comité des membres et, surtout les gestionnaires et les précédents présidents pour le soutien exceptionnel qu’ils m’ont apporté tout au long de l’année. Si le travail était exigeant, j’apprécie énormément le soutien remarquable que j’ai reçu. Avec mes respectueuses salutations,

Fall 2009 • CAO Bulletin

Highlights of the 2009 Scientific Session

Passing the Gavel at the Annual General Meeting

Drs. Bob Cram and Cliff Moore at the Annual General Meeting

The Kettle Valley Rail Trail Tour.

Speaker William Hiltz at the Annual General Meeting.

AAO President Dr. Robert Bray and CAO President Dr. Bob Cram.

Drs. Bus Haryett and Amanda Maplethorp celebrate the publication of “A History of Orthodontics in Canada”.

Doctor’s Roundtable

Student Posterboards

Presentation by Rosemary Bray

CAO Bulletin • Fall 2009

Catching up at the Welcome Reception.

Enjoying the Welcome Reception.

Drs. Earl Haltrecht, Richard Marcus and Howard Tile at the Welcome Reception.

Exhibitors at the Trade Show

AAO Trustee Dr. John Buzzatto and AAO President, Dr. Robert Bray at the Taste of Kelowna.

A great time was had by all at the Tailgate party.

Attendees were treated to a fantastic fire and light show a the Taste of Kelowna. Fall 2009 â&#x20AC;˘ CAO Bulletin

Highlights of the 2009 Scientific Session

Trade Show Raffle Prize Winners Ms. Sheila Rae Sonicare Flexcare System

Dr. Rob Strasdin 2 Cases Brackets RMO

Many thanks to “Cliff and Team”- Hosts of 2009 Scientific Session

A time to see new and old friends.

Ms. Valerie Hall Signed Lucky Charms Box ORMCO / Michelle Kelly

Dr. Jay Winburn Signed Cheerios Box ORMCO / Michelle Kelly

Dr. Vohn Rosang Damon Forum Registration

Ms. Sue Leong GPS

Dr. Perry Unruh Digital Models/iPod

Ms. Jodi Bradford-Cherver Leather Bag

Dr. Tim Dumore Digital Camera

Ms. Luci Kurceba $750 Travel Gift Certificate

Congratulations to all our winners and a special thank you to those companies that donated prizes!

CAO Bulletin • Fall 2009

Committee Reports Treasurer’s Report Report Dr. Garry Solomon Treasurer [Email: hellener@lks.net]

Treasurer’s Report - CAO 2008 General operations of the CAO created net revenues of $58,168.70. The Winnipeg Scientific Session created net revenues of $9,644.32. The total operations net revenue for the CAO was $ 67,813.02 for 2008.

Treasurer’s Report - CFAO The CFAO showed net losses of $50,124.18 for 2008, a result of the $30,000 grant to McGill University, $10,353 in legal expenses arising from the CRA audit and $9,239 in CDSPI Market losses. The CFAO CDSPI Investment balance for 2008 was $ 380,604.60, representative of a 0.24 percent decrease in comparison to 2007.

Insurance Report Dr. Richard Marcus Chair, Insurance Committee [Email: richard.marcus@utoronto.ca] It has been a pleasure to be the Acting Chair of the Insurance Committee, whilst Bob Cram ascended to the Presidency of the Canadian Association of Orthodontists. Clerical errors remain the greatest insurance concern, yet are easily rectified once insurance company senior staff is involved. For example, a major hospital had a plan which required procedure codes for the taking of diagnostic records. Through discussions with the hospital administrator and the insurance company, the CAO modified the plan to be consistent with similar dental benefit plans that, for orthodontic treatment, remain independent of procedure codes.

Select CAO members continue to include procedure codes and use forms other than the CAO Standard Information Form. Certain members still accept assignment by taking monies from the insurance companies and then holding the patient or parent responsible for paying the difference or the full amount should the claim not be accepted by the insurance company within a specified time frame. Some members continue to use rubber signature stamps, against the advice of the CAO. The Insurance Committee is aware of at least five cases of fraud arising from the use of stamps. Insurance guidelines are readily available on the CAO website. All staff and doctors are welcome to attend a lunch-time primer on how to deal with orthodontic benefit plans presented at every Annual Scientific Session. The CAO guidelines recommend the following: • No procedure codes for any aspect of orthodontic therapy • No Angle classifications, nor millimetre measurements of overbite or overjet • The exclusive use of the CAO Standard Information Form no need to use the CDA, provincial or private insurance forms. • No need for the orthodontist to provide any insurance form of any type for initial, monthly or quarterly payments. An office receipt which clearly indicates the date of payment and the month or the quarter to which the payment relates is all that is needed to satisfy third-party continuation of treatment requirements. • Never use rubber signature stamps. Health Canada has informed dentists and orthodontists of the change in claims administrator, from First Canadian Health (FCH) to Express Scripts Incorporated (ESI) Canada. Some CAO members have expressed concern that registering as a provider with ESI and then using the Dent 29 Form will obligate them to the terms and conditions of Health Canada and ESI, even though the terms and conditions appear to be unclear under this plan. Health Canada remains unprepared to fundamentally modify their program. CAO members are advised to examine the policies of Health Canada, and to make a personal determination as to whether he or she wishes to register as a ‘provider’ for this preferred provider plan. It is possible to treat First Nations and Inuit peoples without registering as a ‘provider’ with ESI, but patients must submit diagnostic records (preferably a duplicate set) on their own behalf to the Orthodontic Screening Centre in Ottawa, along Fall 2009 • CAO Bulletin

Committee Reports with a CAO Standard Information Form. The patient makes payments directly to the orthodontist (especially advised in cases of co-insurance) with reimbursement to the patient by ESI (or FCH). It has been my pleasure to have acted as Interim Chair of the Insurance Committee over this past year and gladly return said chairmanship into the capable hands of Immediate Past- President Bob Cram.

GST Report Dr. Garry Solomon GST Advisor [Email: hellener@lks.net] Over the last six months two of our western members have had GST audits. The auditors were unaware of the agreements signed between the CRA and the CDA. CRA headquarters was contacted and initially relayed that they were unaware of any change to established policy and that they would investigate. Following said investigation, CRA confirmed that there was no change in official policy and that they would once again contact all district offices to restate the CRA & CDA position.

COSA Report Dr. Ritchie Mah CDA/COSA Liaison [Email: ritchiemah@yahoo.ca] The Canadian Dental Association General Assembly (CDA GA) and the Committee on Specialist Affairs (COSA)/National Dental Specialties Organization (NDSO) meetings were held concurrently April 23rd to 25th, 2009. In attendance were CDA staff, the new President, Dr. Don Friedlander, and the CDA/COSA liaison, Dr. Robert Sutherland. COSA members were updated on the new CDA GA composition proposed as part of the CEO/President’s meeting in March, 2009. Following discussion, the composition was voted in by the GA for implementation in 2011 reducing the size of both the CDA Board of Directors and the GA. The number of specialist votes has been reduced from 2 to 1. Academic, armed forces members and student members will continue to have one vote each. The current CDA GA voted in the new GA and Board of Director structure as recommended by the Presidents/CEOs working group. COSA members were reassured that any future specialist issues similar to dental anesthetists seeking specialty recognition would be raised in a manner that provides time for adequate consideration. In a related matter, dental anesthetists in Ontario have requested that the CDA introduce new unique identification numbers to allow insurance companies to recognize them as specialists.

DIRECTORY UPDATE

The CDA is updating its 1992 position on guidelines for patient referrals to dental specialists. The ADA guidelines from 2007 are being used as a reference.

The CAO is switching to an on-line membership directory to provide for accurate, instantly available information. The directory will be secure, easily accessible and simple to use, all-the-while reducing our impact on the environment. The launch date is anticipated for mid-2010.

The Canadian Association of Oral and Maxillofacial Surgeons (CAOMFS) indicated the need for procedure codes for the placement and removal of temporary anchorage devices (ie. mini-implants) for reimbursement by insurance companies. The Canadian Association of Oral and Maxillofacial Radiologists identified several dental schools that seem unconcerned about the lack of oral radiologists on faculty.

Please feel free to contact stephenfroth@mac.com with any comments or suggestions.

CAO Bulletin • Fall 2009

CDA discussion and examination workshops are held in conjunction with the General Assembly in order to maximize participation. This year, participants were asked to re-examine the relevance and accuracy of several of the 27 Position Statements with regards to the CDA’s official statements on a variety of issues such as dental amalgam, funding of health and dental care, tooth bleaching and whitening.

Committee Reports \

In 2008 Canada recognized 19,336 dentists of which 11,500 (59.5 percent) were identified as CDA members. General Practitioners made up 17,159 of the population. There are 2,177 recognized dental specialists in Canada, with 1,433 (65.8 percent) included as Dental Specialist CDA members.

CAO/AAO Report Dr. Howard Steiman CAO/AAO Liaison [Email: straightsmile@sympatico.ca]

Details on the November 2009 CDA and COSA meetings will be reported on in the next issue.

New and Younger Members Dr. Helene Grubisa, New and Younger Members Representative [Email: drgrubisa@sympatico.ca] The keynote speaker at this year’s NYM luncheon was Mr. John McGowan, a Toronto-based lawyer specializing in employment law. Mr. McGowan addressed the principles of employee hire and dismissal, as well as the rights of employees and employers as per the Employment Standards Act (ESA). Dr. Susan Tsang attended the GORP Conference last August, where she welcomed four new Canadian student CAO members currently enrolled in American orthodontic programs. Residents remain under the misconception that if they check the ‘Canadian’ box on their student AAO forms, their information is automatically sent to the CAO on their behalf. This unfortunately is not the case. Further, students are reticent to fill out an additional form, fearing duplication of personal data. The AAO could potentially remove the tick box, or add a line instructing Canadian residents to submit their information directly to the CAO. The CAO Welcome Dinners involving a number of Canadian programs were well received by the residents. The Université of Montréal and the University of Alberta will be visited for dinners this fall. This is my final report as the representative of the New and Younger Members. Over the past very enjoyable seven years, I have become ‘less-young’ and hopefully, ‘less -new’ as an orthodontist. This is THE group to watch and to nurture at the CAO. As I pass the torch to Dr. Susan Tsang at this year’s meeting, I remain a committee member forever ready to offer assistance when requested.

A meeting of inquiring minds took place at the AAO Annual Session on May 3rd, 2009. A re-enactment of the Boston Tea Party was postponed in order that the CAO and AAO Executives could meet behind closed doors. AAO President-Elect Dr. Bob Bray and his henchmen, Secretary-Treasurer Dr. Lee Graber and Great Lakes Trustee Dr. John Buzzatto were present along with the AAO Communication and Marketing Director Ms. Linda Gladden and Executive Director Mr. Chris Vranas. Not to be out numbered, Drs. Cram, Organ, Zeit, Mah, Marcus, Maplethorp and Yours Truly were present spreading the gospel of the CAO. Gospel means music and I have once again, called on some of my many friends to lend their titles to our subject issues: 1) “It takes Two” - Rod Stewart Canada kicks butt at the AAO! Dr. John Buzzatto is now the inaugural AAO-CAO liaison until his coronation three years from now. Sounds familiar: Momma always told me that imitation is the sincerest form of flattery. There is now a direct link between the two Boards, improving communication and continuity. The CAO wishes John the best of luck in trail-blazing this new portfolio. If he promises not continued…

Holiday Greetings! On behalf of everyone at the CAO office, we wish all of our readers a wonderful Holiday Season and a Healthy and Successful 2010!

Kindly note that the CAO offices will be closed from 5:00 pm on December 23rd and reopening on Monday, January 4th, 2010 at 9:00 am.

Fall 2009 • CAO Bulletin

Committee Reports to spill anything on it, I will lend him my copy of the ‘Liaison for Dummies’ handbook.

plateaued and the focus now shift towards advocacy and /or hard sales.

2) “I’ve Gotta get a Message to You” - The Bee Gees The AAO Consumer Awareness campaign is now in its second run. Any print or online banner advertising coming into Canada will contain the CAO logo with reference to the Canadian members of the AAO. The success of the campaign has been strong. Traffic to the AAO website has tripled and over 6 million orthodontists’ names and contact information have been distributed via the locator section. Recognized success and future recommendations were contained in the Adams Report, as presented to the AAO Board in April 2009. The membership fallout from the campaign has been less than ten. At least four states, as well as Puerto Rico, have used the AAO materials for localized media campaigns. Furthermore, the AAO has received significant interest from individual offices wishing to make use of their materials. Linda Gladden reported that the next phase of the campaign will not be as ‘soft’; the ‘awareness’ concept has likely

The CAO has addressed the issue of a national campaign a number of times in the past and the Board has voted the idea down repeatedly. Since Ontario, Alberta and Manitoba have elected to run provincial media campaigns, some with associated levies, it is unlikely that the CAO will run a national campaign involving assessments. Linda Gladden has offered to review the Shupp Co. recommended media materials.

CAO Bulletin • Fall 2009

3) “Go Your Own Way” - Fleetwood Mac Just when you thought the AAO knew everything about everything, your bubble gets burst! Were their eyes ever opened during the discussion on the Agreement on Internal Trade (AIT)? The up-and-coming Canadian approach to job mobility was of great interest to our American friends. Even though licensure is a state-by-state process, there remains significant reciprocity between states.

Committee Reports Of greater importance to both our groups is the importation of practitioners outside North America. The World Federation of Orthodontists (WFO) is preparing guidelines which, if adopted, will ensure global orthodontic standards. These standards are expected to be presented at the upcoming European Orthodontic Society meeting in Helsinki. 4) “Say What You Need to Say” - John Mayer There is nothing like a good old fashion fireside chat (sans the fire) to bring the CAO up to snuff on the juicy AAO happenings. Many AAO members are utilizing AAO endorsed staff training programs to increase the overall productivity of their employees and the quality of patient care. Staff members are cross-trained to acquire skills beyond their primary job functions and to assist wherever needed. The AAO endorses two programs whereby a staff member can become ‘certified’ in orthodontic assisting. The Academy of Orthodontic Assisting (AOA) is a 14-part competency-based course including oral and dental anatomy, wire selection, diagnostic record taking and patient management. A 30 minute timed test follows each lesson. The International Training Institute (ITI) has more than 40 online courses incorporating photography, impressions, bonding, cephalometrics and new-patient exams. Each course features professionally narrated videos, pre-and post-examinations as well as summaries with detailed checklists for review. Highly recommended by the AAO Board, these programs would not be of significant value in Ontario and Quebec, the only provinces still requiring hygienists to perform third party orthodontic duties. As a national certification program, both the AOA and ITI do not apply in Canada. The AAO Brass continue to build their relationships with other dental organizations, both general and specialty, through consistent attendance at meetings, orthodontic involvement on their respective Boards and stakeholder involvement. This approach takes a tremendous amount of time and manpower. The CDA has been informed of the CAO’s desire to improve our relationship, but the CAO has identified the bureaucratic stumbling blocks continually confronted (See Richie Mah’s CDA Report). With the new CDA/ODA merger and with the realignment of the CDA Board, the CAO endeavours to meet with individuals and groups within the CDA in the hopes of fostering new positive working relations…..Wish us luck!

5) “We are the Champions” - Queen Both the CAO and AAO are in full support of our candidates Dr. Amanda Maplethorp, Dr. David Turpin and Dr. Thomas Ahman for the WFO Executive Committee 20102015. Watch for joint campaign fundraisers coming soon including the Sports Logo Stomach Painting Contest, the McIntosh Apple eating Marathon and the always popular General Motors Charity Car Wash (proudly supported in part by the Obama/Harper Administrations).

Canadian Orthodontic Educators Report Dr. Donald Robertson Chair, Conference of Canadian Orthodontic Educators [Email: mouthtraps@shaw.ca] Prior to the meeting in Kelowna, the CCOE / CCGOPD (Educators Group) met most recently as part of the 3M Unitek Annual Ski Seminar in Whistler BC in April, 2009. Agreement for Internal Trade (AIT) There was a concern that AIT could override the recently developed MOU as a route to licensure for foreign-trained specialists. Ms. Heather Mackay, Registrar of the BC College of Dentists confirmed the ‘possibility’ cited above, but confirmed that the January 2009 meeting of Regulators/Registrars secured the agreement of all provinces and regions to abide with the terms of the MOU as being the only route to licensure/mobility or foreign-trained dental specialists. Since the AIT is a Federal initiative and dental regulation remains a Provincial matter, there is no way to ‘bind’ provinces and regions to an agreement of national scope. It is theoretically possible for a single region to allow registration under different terms than those agreed-to previously. If such a ‘back-door’ route were to happen, such a registrant would have mobility within Canada. The agreement among regulators will ultimately depend on their collective goodwill. There is consensus amongst the DRA’s that should an underserviced province act unilaterally, such a move would not be in the province’s best interest, as registrants once licensed would be free to move to a preferred location. Ms. Mackay further indicated that the government is not simply shoving the AIT initiative through, but is respectful of the health professions’ efforts to maintain Fall 2009 • CAO Bulletin

Committee Reports reasonable standards to the benefit of all Canadians. The government objects to ‘barriers’, not ‘standards’. Confirmation of Process leading to Accreditation and Licensure of foreign-trained Specialists: • Credentialing Equivalency of orthodontic training program to be eligible to write the DSCKE (Dental Specialty Core Knowledge Examination). • Gap-Training Depending on the outcome of the DSCKE, the candidate may apply for Gap-Training of not more than 12 months leading to a Certificate of Completion enabling candidate to challenge the RCDC examination. • RCDC Examination Successful completion of the RCDC examination will enable licensure /mobility.

In Memoriam

Jerry Giblon Long time CAO member Jerry Giblon passed away suddenly on May 6, 2009. Jerry was a 1957 and 1960 University of Toronto graduate in dentistry and orthodontics respectively. He was a fixture in Toronto, regularly attending Orthodontic Study Club meetings, OAO business dinners and U of T Alumni Days. Considered the ‘Iron Man’ of orthodontics, he continued to practice well into his eighth decade even following extensive knee replacement surgery. Jerry practiced in a number of locations throughout the GTA, including Leaside, North York, Scarborough and Pickering. Always a conversationalist, Jerry had a story for every occasion. On a personal note, one never tires of hearing how ‘un-lawyer-like’ was one’s late father, assuming that, this is in fact, a good thing. Thank-you for all of your kind words Jerry. You will be missed. The CAO Board extends its heartfelt condolences to Dr. Giblon’s children and extended family during this difficult time.

CAO Bulletin • Fall 2009

Graduate Orthodontic Program at UBC: It is not clear at the time of writing, when or if UBC will initiate its planned graduate orthodontic program. UBC’s plans had been understood to depend somewhat on Gap Training foreign-trained specialists. Since the MOU requires GapTraining to occur only in institutions with established graduate orthodontic departments, it is unclear how the development of a graduate orthodontic program at UBC will ultimately proceed. AAO and WFO Educational Taskforces: An AAO taskforce is looking at ways to provide financial support for mid-level and senior faculty. A WFO taskforce is attempting to create a template for international accreditation and standards. This group is recommending that all graduate orthodontic programs should be 36 months in duration. The U.S. is opposed to this recommendation because of its remaining accredited 22-24 month programs. Graduate Department Updates: Alberta: - Fully staffed - New Dean of the Faculty of Medicine & Dentistry Manitoba: - Fully staffed - New President of the university – David Barnard - Provincial tuition freeze ended – 40 percent increase foreseen Western Ontario: - New President of the University – Amit Chakma - Staff changes results in incomplete, but marginally adequate staffing. Toronto: - Fully staffed - New dental school ‘on hold’ due to ongoing location (building) selection Montreal: - One full-time faculty position open - Facility cannot accommodate Gap-Training - New Dean is Gilles Lavigne CURRENT ISSUES: Align Technologies: Based on extensive discussions with Bill Oldman of Align Technologies, it is the understanding of the CCGOPD that the rationale for Invisalign’s requirement of completing ten Invisalign cases, plus completing ten hours of Invisalign-produced continuing education per year, is that this would be the minimum requirement on an ongoing basis required by Invisalign to establish and maintain competency for providing Invisalign treatment, by certified specialists in orthodontics as well as general practitioners.

Committee Reports It is the unanimous decision of the CCGOPD that such requirements cannot realistically be accommodated within the Canadian Graduate Orthodontic programs. Accordingly, those programs are therefore compelled to withdraw the option of providing Invisalign instruction and treatment in Canadian Graduate Orthodontic Programs. Furthermore, the Canadian Graduate Orthodontic Educators believe their programs provide a full scope of education in diagnosis and care; and are confident the graduates of their programs will have a strong foundation in the elements of all orthodontic treatments, including Invisalign, should they choose to use it. Ad-Interim Educators Meetings – 3M Unitek: The annual 3M-Unitek meeting at Whistler will not occur in 2010. Suggestions have been made by 3M Unitek that it may be possible to convene an ad-interim meeting of the Educators at an alternative venue, possibly in the United States. Funding will be available to the five Department Heads only and not to the CAO facilitators. Depending on whether the implied changes are temporary or permanent, a number of alternatives need to be considered before a decision is made with respect to the ad-interim Educators meeting plans for 2010 and beyond.

Communications Report Dr. Daniel Pollit, CAO Web Master [Email: dpollit@sympatico.ca]

The new Canadian Association of Orthodontists Discussion Forum is up and running, located in the Members Only section of the website. To use this forum you must first register as a user. Many interesting discussion threads should take shape over time and the forum is anticipated to become a valued tool used by the entire membership. All that’s left is a name. So we’re holding a CONTEST! First prize is one free registration to the upcoming Scientific Session in Whistler BC. To enter, simply e-mail you suggestions to cao@taylorenterprises.com. Include your name, phone number and e-mail address. The winner will be chosen by the Board of Directors at the Ad Interim Meeting held in February 2010 and will be announced in the spring 2010 edition of the Bulletin. Good luck! This is not the first discussion forum hosted by the CAO; previously located in Yahoo Groups, it was used primarily by the New and Younger members. Those who tried the old site are requested to place future comments on the new forum. If you haven’t experienced a discussion forum before, take your time and have a good look around.

CFAO Donations

What’s In A Name?

(Since February, 2009)

That which we call a Discussion Forum by any other name would inform as sweet

Ms. Krista Knorr In honour of Drs. Robert Hatheway and Susette Instrum for use of their meeting space Dr. Douglas Eisner In Memoriam of Dr. Wallace Donald Dr. Mark Mahler

(With sincerest apologies to Mr. Shakespeare!)

Help us come up with a name for our new Discussion Forum. FIRST PRIZE - One Free registration for the 2010 Scientific Session in Whistler BC.

In honour of Dr. Jeffrey S. Corbett

Send your suggestion along with your name, phone number and e-mail to cao@taylorenterprises.com.

Cerum Ortho Organizers

Winner to be announced in the Bulletin, Spring 2010

Fall 2009 • CAO Bulletin

Committee Reports Visit the forum frequently to follow a thread of interest or choose to have the messages on that thread e-mailed to you. If a posting does not belong, push the Ouch Button and the identified posting will be eliminated in due course.

members on WFO Council, and is entitled to send two people to the meeting in Sydney. Bob Cram and the newest Member-at-Large, Ritchie Mah will represent Canada at the WFO meeting in February.

The Forum is a work in progress; feel free to offer feedback at any time.

The WFO has requested use of the CAO logo in Sydney and has requested the names of the orthodontic educators in Canada. Jack Dale’s name was put forward for Honorary Membership in the WFO.

RCDC Report Dr. Robert Cram RCDC Liaison [Email: drbob@reddeerortho.com] The Royal College of Dentists (RCDC) has hired Alison Brodie as their new Executive Director. Ms. Brodie previously owned and managed a consulting firm that served mainly clients mainly in the health and social service sectors. The Royal College orthodontic examination has undergone a number of recent improvements. The OSCE has been incorporated into the written examination that now consists of only short answer questions. The candidate must successfully pass the written examination to be eligible to register for the two 1-hour oral examinations. While individual case submission is no longer a requirement, two case analyses are completed as part of the oral examination. Following the completion of the fall 2009 session, examinations in orthodontics will be held in the spring only. Thank you to Hugh Lamont, past Chief Examiner, for all of his current efforts as the RCDC Councillor for Orthodontics.

WFO Report Dr. Amanda Maplethorp WFO Committee [Email: a_maple@shaw.ca] Drs. Thomas Ahman, David L. Turpin and Amanda Maplethorp are the official nominations to the WFO Executive for 2010-2015. Congratulations to all. Dr. Maplethorp’s appointment will begin in February in Sydney Australia at which time she will no longer be eligible to act as the CAO Member at Large. The CAO is entitled to two

CAO Bulletin • Fall 2009

Historian Report Dr. Garry Solomon Historian, Archivist [Email: hellener@lks.net] The long-awaited CFAO-funded chronicle entitled ‘History of Orthodontics’ is finally a reality. 150 copies were available at the Scientific Session for distribution at no additional cost to the CAO membership, other than the $20 handling and shipping charge. The CFAO will donate one copy to the libraries of each of the five Canadian programs. On behalf of the membership, the CAO and CFAO Boards of Directors thanks Drs. Bus Haryett and Amanda Maplethorp for the countless hours they have dedicated in researching, compiling and editing the manuscript. Congratulations on a project that will be valued by all for years to come.

Congratulations! The CAO wishes to extend our congratulations to the Quebec Orthodontists Association/Association Orthodontistes du Quebec on their recent fundraising efforts. At a recent event, the group raised $85,000 which they donated to Children’s Hospitals of Montreal. Their huge show of charitable support should inspire others.

ESI Canada...an update from President Dr. Gerry Zeit On November 5th , 2009 representatives of the CAO met, via teleconference, with representatives of Health Canada and ESI Canada. ESI Canada is the new administrator of claims for Health Canada’s NIHB program. Information regarding enrollment with ESI is available on the ESI Canada website. Members are advised to read the terms of the agreement carefully before signing as enrollment may involve certain commitments on the part of the provider. The CAO has confirmed that it is not necessary to enroll with ESI in order to treat patients who are eligible for benefits under the NIHB program. Indeed, it is only necessary to enroll in the case where a member would like to accept assignment of benefits from the NIHB program. Non-enrolled members may treat NIHB eligible patients as any other patients in their practice, requiring payment directly from the patient. Patients would then be free to request re-imbursement directly from the program. Non- enrolled members should not sign any Dent 29 or other forms from NIHB. It is our understanding that Health Canada and ESI will require predetermination for all orthodontic cases. This can be accomplished in a non- assigned scenario by providing the patient with a CAO Standard Information Form and a duplicate set of records, which the patient can then send to:

Orthodontic Review Centre Non-Insured Health Benefits First Nations and Inuit Health Branch Health Canada 55 Metcalfe Street, 5th Floor Postal Locator 4005A Ottawa, Ontario K1A 0K9 It should be noted that, although CAO has no particular position with regard to whether members should enroll with ESI or not, we have always recommended against accepting assignment of benefits as we feel that it violates the appropriate relationships between doctor, patient and benefits provider. CAO supports a clear distinction between the doctor-patient relationship on the one hand, and the separate and distinct relationship between the patient and the benefits provider on the other. For more information, please feel free to contact me, our insurance representative, Dr. Bob Cram, or any member of the CAO board.

In Memoriam

Dr. Wallace (Wally) Donald Dr. Wallace "Wally" Owen Donald was born on Prince Edward Island April 9, 1942. Following high school, he graduated from Dalhousie University with a degree in pharmacy in 1962. After working for three years as a pharmacist, he returned to Dalhousie, graduating with a D.D.S. in 1970. He served as a dental officer with the Canadian Armed Forces until 1975. In 1977, he completed his specialty training in orthodontics at the University of Alberta. Wally returned east shortly thereafter, setting up private practice in Dartmouth, Nova Scotia. He was an assistant professor with the Division of Orthodontics, Faculty of Dentistry, Dalhousie University until the late 1990’s. Wally served as a past-president of the Atlantic Orthodontic and the Halifax County Dental Societies, a director of the Canadian Association of Orthodontists, and as a member of the American Association of Orthodontists, the Canadian Dental Association as well as the Nova Scotia Dental Society. He retired from private practice in 2002. Wally loved travelling, getting together with family and friends, playing cards, making wine, dancing, and enjoying life to the fullest. He was also an avid sports fan, who loved golf and curling. He is survived by his wife Mary Elizabeth, two sons Ross and Neil, daughter Beth, Ross’s wife Susan and grandchildren Chase and Kathleen. The CAO Board extends its sincerest condolences to the Donald family on behalf of the entire membership.

Fall 2009 • CAO Bulletin

CFAO Graduate Student

Posterboards Abstracts from the 2009 CAO Annual Scientific Session – Part 1 of 2 part series

University of Alberta ACCURACY OF COMPUTER PROGRAMS IN PREDICTING ORTHOGNATHIC SURGERY SOFT AND HARD TISSUE RESPONSE Authors: Neelambar Kaipatur*, DMD, MSc, Yousef Al-Thomali BDS, Cert. Ortho, Paul Major DDS, MSc., Carlos Flores-Mir, DDS, DSc, FRCD(C) PURPOSE: The aim of the present systematic reviews is to investigate the accuracy of computer programs in predicting hard and soft tissue responses following orthognathic surgery. Materials and methods: A systematic computerized database search was conducted using several electronic databases. The reference lists of all the selected articles were also searched for any potential articles that might have been missed in the electronic search and additional information not available through the articles was obtained directly from the source (by contacting the author). RESULTS: Out of the 40 and 79 initially identified articles only 7 and 9 articles fulfilled the final selection criteria for soft tissue and hard tissue changes respectively. All 7 articles, in general, showed accurate prediction outcomes of soft tissue response (less than 2 mm) when compared to actual post surgical results in both horizontal and vertical directions. The most significant area of error in soft tissue prediction was the lower lip. The computer programs were unable to precisely predict all the skeletal changes. Most of the prediction inaccuracies with skeletal changes were within 2 mm/degrees except for Witts analysis possibly due to difficulty in locating the functional occlusal plane on cephalograms. CONCLUSIONS: These systematic reviews demonstrated that computer programs cannot consistently predict the skeletal or soft tissue changes following orthognathic surgery but their results may be considered inside a clinically acceptable range. Although the individual errors are almost always minimal (less than 2 mm or degrees); the composite addition of these minimal errors could have clinical implications. (*Presenter)

CAO Bulletin • Fall 2009

University of Alberta EFFECT OF LOW INTENSITY PULSED ULTRASOUND ON A HUMAN TOOTH SLICE ORGAN CULTURE Authors: Saleh Al-Daghreer*, Michael Doschak, Alastair J Sloan, Paul Major, Giseon Heo, Yeng Tsui and Tarek El-Bialy AIM: To investigate the effect of therapeutic Low Intensity Pulsed Ultrasound effect on the human dentin pulp complex in an in vitro tissue culture model. MATERIALS AND METHODS: Ninety-two premolars were extracted from 23 adolescent orthodontic patients [mean age was 14y-5m ± (2y-3m)] whose orthodontic treatment required premolar extraction. All the premolars were cut transversely into 600 µm thick slices (8-11 slices per tooth). The slices were divided into two main groups according to the frequency at which LIPUS was applied (single application and daily application). The groups were further subdivided into five subgroups (5, 10, 15 and 20 minutes and one control group). The tooth slices were cultured at 37°C in an atmosphere of 5% CO2 in air, in a humidified incubator, with the medium changed after 24 hours and then every 48 hours. LIPUS was applied using a 2.5 cm2 transducer that produces incident intensity of 30 mW/cm2 of the transducer’s surface area. After 5 days of culture tooth slices were fixed, demineralised and processed for histomorphometrical analysis (to measure the Predentin layer thickness PD, and odontoblast cell numbers OD) and real time PCR to investigate changes in expression of genes of interest (Collagen I, DMP1, DSPP, TGF β1, RANKL and OPG). RESULTS: The histomorphometric analysis revealed that the predentin thickness was higher in the single application group (10, 5 and 15 minutes) respectively than in the daily application LIPUS treatment group and the control groups. These 3 groups (10, 5 and 15 minutes/ single application) were not significantly different from each other. The odontoblast cell count was higher also in the single application groups mainly in the 5, 10 and 15 minutes respectively than in the control and other treatment groups. Also, they were significantly different from each other. Real time PCR demonstrated no

CFAO Graduate Student Posterboards statistical significant difference between the groups in the expression of Collagen I, DMP1 and TGF β1. All groups expressed DSPP, RANKL and OPG at a low level which were not significantly different. CONCLUSIONS: • LIPUS appeared to increase in the predentin layer thickness and odontoblast cell numbers following a single application for 5, 10 and 15 minutes. • No significant difference in expression of Collagen I, DMP1 and TGF β1 was observed in these LIPUS stimulated cultures when compared to controls. • Very low expression of DSPP, RANKL and OPG from cells within dentin pulp complex in this in-vitro model after 5 days of culture.

term expansion at the upper premolar crown and upper premolar root than the bone-borne expansion appliance. CONCLUSION: Both expanders presented similar results. Greatest changes happened in the transverse dimension while changes in the vertical and antero-posterior dimension were negligible. Dental expansion was also greater than skeletal expansion.

University of Manitoba ORTHODONTIC TREATMENT TIMING – A SURVEY OF ORTHODONTISTS AND PEDIATRIC DENTISTS IN CANADA Authors: Eileen Lo, Charles Lekic, William Wiltshire

University of Alberta LONG-TERM CHANGES USING A BONE-ANCHORED MAXILLARY EXPANDER (BAME) IN ADOLESCENTS – RANDOMIZED CONTROL TRIAL Authors: Manuel O. Lagravère Vich*, Jason Carey, Giseon Heo, and Paul W. Major OBJECTIVE: The purpose was to compare skeletal and dental long-term changes assessed by digital volumetric images produced after maxillary expansion between a bone-anchored expansion appliance and a conventional tooth borne RME. METHODS: A sample of 62 patients ranging between 11-16 years of age, all needing maxillary expansion were randomly allocated to either of three groups (traditional Hyrax tooth borne expander, bone-anchored expander and control). BAME consisted of two stainless steel onplants (8.0 mm x 3.0 mm), two miniscrews (12.0 mm length, 1.5 mm diameter), and an expansion screw. Records (CBCT) were taken at baseline and at 12 month follow-up. A repeated measure MANOVA was applied to the distances and angles measured to determine the statistical significance in time. Bonferroni post-hoc tests were used to identify specific significant differences between the treatment groups. RESULTS: Long term changes showed that none of the three groups presented statistically significant differences in symmetry angle. Both treatment groups had significant long-term expansion at the level of the upper first molar crown and root apex, upper first premolar crown and root, maxilla alveolus in the first molar and premolar regions and central incisor root. The tooth-borne expansion resulted in significantly more long-

INTRODUCTION: The ideal timing to initiate orthodontic treatment is an important, yet controversial issue. The purpose of this study was to investigate the provision of orthodontic care for 7 types of skeletal dysplasia by paediatric dentists and orthodontists in Canada. METHODS: A questionnaire was distributed to randomly selected orthodontists (N=140) and paediatric dentists (N=132) throughout Canada. Surveys returned within 8 weeks were included for c2 statistical analysis. RESULTS: The response rate was 59% for orthodontists and 54% for pediatric dentists. Orthodontists and pediatric dentists differed significantly in the timing of their first orthodontic consultation (p < 0.01). More pediatric dentists used to the dental age to determine the appropriate time to initiate treatment (p < 0.01), whereas more orthodontists relied on the pubertal indicators (p < 0.01). More orthodontists would intervene in the early mixed dentition for moderate mandibular prognathia (p < 0.01); mid-mixed dentition for severe mandibular retrognathia (p < 0.01), late mixed dentition for moderate mandibular retrognathia (p < 0.01) and permanent dentition for skeletal openbite and severe mandibular prognathia (p < 0.01). Most pediatric dentists would intervene in the early and mid-mixed dentition for the specified cases of skeletal malocclusions (p < 0.05). CONCLUSIONS: The results of this investigation indicate both consistencies and variation between orthodontic and paediatric practitioners with regard to preference in treatment timing, and the factors that influence these decisions.

Fall 2009 • CAO Bulletin

CFAO Graduate Student Posterboards University of Montreal SKELETAL AND DENTOALVEOLAR EFFECTS OF SARPE: A CONE BEAM COMPUTERIZED TOMOGRAPHY EVALUATION Authors:

Olivier Quintin*, DMD, Athena Papadakis, BDS (Hons), FDS RCS (Eng), MSc, FRCD(C) Manon Paquette, MSc, DMD, MS Claude Remise, DDS, MS Pierre Rompré, MSc

INTRODUCTION: Few research projects have evaluated the effects of surgically assisted rapid palatal expansion (SARPE) on hard tissues, and most of these projects suffer from significant methodological flaws. The objective of this clinical prospective comparative study was to evaluate the effects of SARPE three-dimensionally on the maxillary teeth, their supporting alveolar bone as well as the basal bone of both maxillae. MATERIALS AND METHODS: The sample consisted of 14 subjects (mean age: 23.0 ± 1.9 years). The patients were treated using a Hyrax expansion appliance and a retention period of one year without any other orthodontic treatment was observed. A cone-beam computed tomography (CBCT) evaluation was performed before and 6 months after the end of expansion. Thirty-seven hard tissue parameters were measured on the three-dimensional volumes. RESULTS: Radiological results have demonstrated a significant increase in dento-alveolar inclination and in dental, alveolar and skeletal widths of the maxilla, with a tendency towards a gradually increasing expansion supero-inferiorly and posteroanteriorly. No significant sagittal displacement of anatomic landmarks located of the maxillae, nor any significant correlation between expansion screw activation and radiological parameters were found. CONCLUSIONS: SARPE causes buccal dentoalveolar tipping in the posterior superior region and significant transverse expansion on all hard tissues of the maxilla. However, SARPE does not induce any relevant sagittal movement of the maxilla and the mandible. The changes that were observed do not have a correlation with expansion screw activation.

CAO Bulletin • Fall 2009

University of Montreal COMPARISON OF MANDIBULAR ARCH DIMENSIONS BEFORE AND AFTER NON EXTRACTION ORTHODONTIC TREATMENT Author:

Cédric Cardona*, Athéna Papadakis, Claude Remise and Pierre Rompré

One of the objectives during orthodontic treatment is to make every effort to minimize the phenomenon of post-treatment relapse. Many scientific articles have hypothesized that one of the cornerstones of post-orthodontic treatment stability is the maintenance of the original arch form. It has been suggested that of all the dimensions characterizing the arch form, mandibular inter-canine distance is the one that should be changed the least during treatment. In our study, we compared the dimensions of 45 pairs of mandibular plaster models before and after non extraction orthodontic treatment. For our group of patients whose mandibular crowding was less than 5 mm, we found that the inter-canine distance was modified less than either the intermolar distance or arch length. It would be interesting, in future studies, to assess the post-retention stability of this group of patients. Key words: Plaster study models, Inter-canine distance, Mandibular expansion, Stability

Thanks to GAC for their support of the CFAO Posterboards

CFAO Graduate Student Posterboards University of Toronto INTERCENTER COMPARISON OF TREATMENT OUTCOME IN PATIENTS WITH COMPLETE UNILATERAL AND BILATERAL CLEFT LIP AND PALATE: ANALYSIS OF CRANIOFACIAL FORM Authors:

Gregory S. Dugas*, John Daskalogiannakis, Bryan Tompson, Ross E. Long, Jr.

BACKGROUND: Several different surgical treatment protocols have been advocated for the management of patients with complete unilateral cleft lip and palate (CUCLP) and complete bilateral cleft lip and palate (CBCLP), and little evidence exists on comparison of the outcomes of each protocol. OBJECTIVES: 1) To compare craniofacial morphology among individuals with repaired CUCLP treated at four North American centers, through cephalometric analysis. 2) To compare craniofacial morphology among individuals with repaired CBCLP treated at three North American centers, through cephalometric analysis. This is meant to serve as a means of treatment outcome assessment, as well as an effort to provide cleft lip and palate (CLP) teams with a basis from which to perform clinical audits. METHODS: A retrospective study was conducted examining the lateral cephalometric radiographs of 148 individuals with repaired CUCLP (average age = 8y 8m, M/F = 99/49, cleft L/R = 106/42) as well as the lateral cephalometric radiographs of 93 individuals with repaired CBCLP (average age = 8y 10m, M/F = 61/32). Main outcome measures included 16 angular, 7 linear and 2 ratio cephalometric parameters. The group means for the different centers per cephalometric measurement were compared using analysis of variance to assess statistical significance. Specifically, pairwise comparisons of means were performed using the Tukey-Kramer method. RESULTS: For the CUCLP sample, significant differences were found in the sagittal maxillary prominence among the four centers. The most significant differences were seen between centers 1 (largest maxillary prominence) and 3 (lowest maxillary prominence). The differences between the two centers in the mean SNA and ANB angles were highly statistically significant (p<0.001); whereas for the mean Ba-N-ANS’, and ANS’-N-Pg angles the differences were significant at the p<0.01 and p<0.05 level, respectively. Similarly, for the CBCLP sample, the most significant differences were observed between center 1 (largest maxillary

prominence), and center 3 group A (lowest maxillary prominence), and center 4. The differences between the three centers in the mean SNA and Ba-N-ANS’ angles were highly statistically significant (p<0.001); whereas for the mean ANB and ANS’-N-Pg angles and WITS appraisal the differences between center 1 and center 3 group A, and center 1 and center 4 were significant at the p<0.001 and p<0.01 level, respectively. CONCLUSIONS: 1) Significant differences in craniofacial morphology, specifically hard and soft tissue maxillary prominence, exist among patients with CUCLP treated according to different surgical protocols at the centers investigated in this study; 2) Significant differences in craniofacial morphology, specifically hard and soft tissue maxillary prominence, exist among patients with CBCLP treated according to different surgical protocols at the centers investigated in this study; 3) For both the CUCLP and CBCLP groups, center 1 patients had the greatest hard-tissue maxillary prominence and soft-tissue convexity; 4) Patients from center 3 and center 3 group A, the only center to perform primary alveolar bone grafting, had the least prominent maxilla and straightest soft-tissue profile for both the CUCLP and CBCLP groups, respectively.

University of Toronto CONE BEAM CT STUDY OF RELATIONSHIP BETWEEN FACE HEIGHT AND DENTOALVEOLAR POSITION. Authors:

Bn Laski*, BD Tompson, A Metaxas, EWN Lam

BACKGROUND: The intraoral findings of patients presenting with differing lower anterior face heights are variable. Cephalometric and model studies on the subject have elicited contradictory results. By analyzing the pre-treatment cone beam computed tomography (CBCT) records of orthodontic patients, it is possible to assess dental and skeletal features of interest that are relevant to orthodontic treatment planning. OBJECTIVE: To determine differences between the dentoalveolar positions of maxillary and mandibular central incisors and first molars in subjects classified into three groups: long, normal and short lower anterior face height. METHODS: Upper anterior face height/lower anterior face height Fall 2009 • CAO Bulletin

CFAO Graduate Student Posterboards ratios (UAFH/LAFH) were determined from 111 pretreatment iCAT® (Imaging Sciences International, Pennsylvania) CBCT scans and analyzed with AMIRA® (Mercury Computer Systems, Germany) imaging software. Upper and lower central incisor and first molar vertical heights and buccolingual inclinations were measured relative to fixed reference planes. Mean differences in tooth heights and inclinations between the groups were assessed using an analysis of variance. Results: Clinically significant differences in dentoalveolar heights, but not buccolingual inclinations, between the three face height groups were found. CONCLUSIONS: Face height and dentoalveolar position can be determined using cbCT image data. Vertical height, not buccolingual inclination, contributes to differences in lower anterior face height.

rotation, and tip. Dentists found the closed technique led to unsatisfactory tip, rotation, attached gingiva and crown height when comparing treatment to control. Lay persons were unsatisfied with tip, torque, and rotation in both treatment groups when compared to control, while attached gingiva and crown height were less satisfactory for closed surgical exposure vs. controls. CONCLUSION: Closed surgical exposure of palatally impacted maxillary canines led to less satisfactory esthetic outcomes than open surgical exposure. Although the difference was statistically significant, no clinical significance was established between open and closed treatment groups or between treatment and control canines.

GRANTS: Alpha Omega Foundation of Canada.

University of Western Ontario IMPACTED CANINES TREATED WITH CLOSED VS OPEN SURGICAL-ORTHODONTIC APPROACH: A SUBJECTIVE EVALUATION Authors: Dr. Nadia Nizam, Dr. Lesley Short, Dr. Antonios Mamandras, Dr. Bruce Hill, Dr. Sahza Hatibovic-Kofman, Dr. David Banting, Dr. Alison Stefanuto*

PURPOSE: This study examined differences in esthetic outcome of palatally impacted maxillary canines treated with either open or closed surgical exposure techniques. MATERIALS AND METHODS: Sixteen subjects in each group had a unilateral impacted maxillary canine of equal severity. The contralateral untreated canine was used as a control. Final esthetic outcome was assessed by orthodontists, dentists, and lay persons using a 100mm visual analog scale. Features evaluated included crown height, attached gingiva, mesiodistal tip, buccolingual torque, rotation, and overall esthetics.

Canadian Association of Orthodontists UPCOMING ORTHODONTIC MEETINGS 2010 Feb. 6-9 . . . . . . . . . .7th International Orthodontic Congress (WFO), Sydney Australia Apr 30-May 4 . . . . .AAO Annual Session, Washington, DC August 6-8 . . . . . . .Graduate Orthodontic Residents Program (GORP), Ann Arbor, MI Sept. 23-25 . . . . . .Joint CAO-CAOMS Scientific Session, Whistler, BC Sept 30-Oct 3 . . . .GLAO/MASO Joint Annual Session, Palm Beach, FL Oct 9-13 . . . . . . . . .PCSO Annual Session, Honolulu, HI Nov 11-14 . . . . . . . .NESO Annual Session, Montreal, QC 2011

RESULTS: No statistical or clinical difference in overall esthetics between the closed and open surgical techniques was found, as rated by each examiner group. Orthodontists and dentists found torque unsatisfactory regardless of surgical exposure technique. Orthodontists found the amount of attached gingiva unsatisfactory for both surgical techniques compared to the untreated side, although open exposure results were generally preferred over closed exposure. Orthodontists also found the closed technique led to unsatisfactory crown height,

CAO Bulletin • Fall 2009

May 13-17 . . . . . . . .AAO Annual Session, Chicago, Illinois Sept 23-25 . . . . . . .CAO Annual Session, Halifax, NS 2012 May 1-4 . . . . . . . . . .AAO Annual Session, Hawaii

Component Society Reports British Columbia Dr. Rick Odegaard [Email: dr.odegaard@shawcable.com]

The Annual General Meeting of the BCSO was held Friday, May 8th, 2009 at the University of British Columbia Golf Club. Prior to the AGM, Dr. Brahm Miller, a Vancouver prosthodontist gave an excellent presentation on interdisciplinary care focusing on the placement and restoration of implants. CAO President Dr. Robert (Western Bob) Cram was in attendance. Obviously intimidated by the skill of his Western colleagues, Bob somehow managed to duck out on joining us for the postmeeting golf tournament. The meeting focused on advertising and the promotion of the specialty. Piggy-backing of a provincial campaign with that of the AAO was discussed but no consensus was reached. Dr. Cram spoke on the ongoing challenges of funding when working with First Nations Health Insured Benefits. With Tom Moonen completing his term as BCSO President, the BCSO Executive for the upcoming year is Bernie Lim, President, Robert Elliot, Vice-President, and Ryan Bulat, Secretary Treasurer. The Executive thanks Tom for his leadership this past year. With the success of the CAO Scientific Session in Kelowna behind us, all in BC anticipate seeing our Canadian friends at the joint meeting with the oral surgeons in Whistler in September 2010. Mark it down now!

Alberta Dr. Paul Major [Email: major@ualberta.ca]

The Alberta Society of Orthodontists (ASO) Annual General Meeting was held March 7, 2009. The current executive consists of Immediate Past- President Biljana Trpkova, President Keith King, Vice-President Mike Bleau and Secretary-Treasurer Cory Liss.

CAO Bulletin • Fall 2009

The ASO is pleased to have the CAO host a central website, with a link to our component society’s individual page. Anticipated expenses were budgeted at $5,000. The ASO remains committed to the current dispute resolution process managed by the CAO, with Gary Stauffer acting as the ASO disputes resolution officer. The ASO is continuing its media advertising campaign with a budget of $20,000 for the upcoming year. The Alberta Dental Association and College have drafted new sterilization guidelines which have now been forwarded to the provincial government. The ASO made representation regarding the orthodontic perspective as it is anticipated that the new guidelines will increase the burden on orthodontic practices in Alberta. The 2010 ASO Annual Scientific Session will be held on April 15-17 at the Rimrock Hotel in Banff Alberta, featuring the wellknown and well-respected Dr. Bill Proffit as keynote speaker. Specific topics for presentation are to be determined in the next few months.

Saskatchewan Dr. Ross Remmer [Email: dr.remmer@sasktel.net] Following a threat from the College of Dental Surgeons of Saskatchewan to withdraw services if fee negotiations did not begin, meetings between the College and the Department of Health have begun. A delisting of surgical procedures from coverage under the provincial Medical Care Insurance Commission would have a profound effect on orthodontic treatment planning, to say nothing of the repercussions for the patients that have consented and have been waiting interminably for a surgical date. The prospect of an invoice in excess of $20,000 for orthognathic surgery and associated hospital costs would be prohibitive for a number of potential patients. Is that you Tommy Douglas I hear howling in protest? Orthodontics currently covered for children receiving social assistance and those qualifying for the Family Income Plan (the so-called ‘working poor’) also would be discontinued. Time will tell if a ‘strike’ will materialize into a withdrawal of services or if negotiations will permit coverage to continue.

Component Society Reports Labour unrest in Saskatchewan dentistry: Who would have thunk it? To meet the guidelines of the AAO and to remain a constituent of the PCSO, the Saskatchewan Society of Orthodontists is in the process of incorporating. Saskatchewan may hold the record of the smallest incorporated orthodontic organization in the world with only eleven (11!) certified orthodontists in the entire province. All members practice in either Saskatoon or Regina, but to have ‘Saskatchewan’ in the title the rules of incorporation dictate that there must be activity in a minimum of six centers. Fortunately, through the use of satellite offices, this requirement will be met.

Congratulations to Dr. Keith Levin, who has assumed the position of Speaker of the House of Delegates of the AAO until 2012. Keith has been a highly active member of the MOS, the Midwestern Society of Orthodontists (MSO), and the AAO House of Delegates. Congratulations also to two University of Manitoba full-time orthodontic faculty members, Dr. Sercan Akyalcin and Dr. Wellington Rody, who are both recent recipients of the AAO’s Full Time Faculty Teaching Fellowships. At the upcoming WFO meeting in Sydney, Australia, there will be nine research presentations from the Department of Orthodontics. Also, incoming residents are now required to complete a thirty-six instead of a thirty-five month program.

We may be small, but we are mighty!

Ontario Manitoba Dr. Susan Tsang

Dr. Helene Grubisa [Email: drgrubisa@sympatico.ca]

[Email: s_tsang2@hotmail.com]

The most recent Manitoba Orthodontic Society (MOS) dinner meeting was held in April 2009. The MOS was pleased to be joined by Dr. Bob Cram, who provided an update on recent CAO activities. The next meeting is November 2009. Last March, Manitoba orthodontists recently paid an advertising assessment to fund a media campaign on three major television networks. There was a 100 percent increase in web traffic, based on the number of visits, originating from Manitoba to the AAO’s braces.org website in comparison the previous year. It remains to be seen if the increased web traffic is a direct result of the MOS ad campaign, and/or the advertising will have a direct effect on the number of orthodontic office visits. The results of the campaign and how to best direct future advertising efforts will be a topic of discussion at the next meeting. Investigation is underway into the requirements for association incorporation in order to satisfy AAO affiliation agreements. There are changes underway to separate membership services from the dental regulatory body in Manitoba; both functions are currently carried out by the Manitoba Dental Association. The change will create the ‘College of Dentists of Manitoba’ and is being brought about by Bill 18, the Regulated Health Professions Act, standardizing the regulation of health professions in Manitoba.

The Ontario Association of Orthodontists (OAO) website will be revamped this fall. While the ‘find an orthodontist’ remains the most popular feature of the site, newer features and links to other orthodontic associations will be updated, as will the information about the OAO and its mission. The goal is to have the new website up and running in time for the Ontario media campaign in February of 2010. All constituent and component societies of the American Association of Orthodontists must be incorporated in order to sign the affiliation agreement. Since the OAO is formally recognized as a component of the AAO, it must sign the agreement if it wishes to remain as such. The process of incorporation has been investigated by the OAO Board through financial and legal consultation. After both legal and accounting consultation, the OAO is in the process of incorporating and the OAOA Executive has signed the AAO affiliation agreement. Ontario has had membership approval in principle to proceed with a provincial media campaign in early 2010. An assessment of 350 dollars per year per member will be levied only in the second and third years of the campaign. Television is considered to be the most cost effective method of delivering the message province-wide and will make use of the ‘AAO More Than a Smile’ campaign with the tag line modified to “Brought to you by the Ontario Association of Orthodontists” directing further inquires to the OAO’s website.

Fall 2009 • CAO Bulletin

Component Society Reports A Harmonized Sales Tax (combined GST and Provincial Sales tax) is coming to Ontario starting in July of 2010. The effect on the orthodontics has not yet been determined. The Ontario Dental Association has been looking into the matter and will be informing its members of changes to dental office procedures. The merger between the Ontario and Canadian Dental Associations is now a ‘fait accompli’. Membership in the ODA will automatically confer membership in the CDA. Membership dues will increase accordingly. Credit card companies charge higher percentages on ‘keyed’ rather than ‘swiped’ cards, due to the potential risk associated with payments processed without the card holder present. Further, as of last year, loyalty credit cards (i.e. Aeroplan, Avion, etc) charged a higher percentage than standard cards. With merchants remaining unaware, this increase in commission was initiated as of September 2008, with increases across the board by September of 2009. Even though the contracts between practitioners and their patients represent low risk, the CAO recognizes that credit card companies remain at liberty to charge what the market will bear.

CAO Bulletin • Fall 2009

Quebec Dr. Jean-Marc Retrouvey [Email: jmretrouvey@videotron.ca] In March of 2009, a CAO member from Quebec communicated his concerns to the CAO Board regarding the new enrolment guidelines for the NIHB. Discussions were held with Dr. Bob Cram and the Executives of the CAO. This issue was raised again at the General Assembly of the Quebec Orthodontists Association. On July 12th, 2009 Dr Marc Plante from Health Canada and the CAO President had an opportunity to discuss the role of NIHB further. Dr Cram reiterated that the CAO’s position at this time remains unchanged. During the Quebec General Assembly on May 25th, 2009 Dr Kondo, from Japan gave a wonderful presentation on Class III openbite non-surgical treatment. Dr Robert Cram updated Quebec orthodontists on the benefits of membership in the CAO and on the NIHB new enrolment forms. Questions were

Component Society Reports raised regarding the use of credit card billing and incorporation. Dr. Cram encouraged attendance to the CAO Annual Scientific Session in Kelowna. Dr Lee Erikson, the current President of the NESO, explained updated legal parameters adapted by the AAO. AOQ incorporation process is on its way and should be completed by September, 2009. Dr Erikson extended invitation to the NESO Annual Session in New York City from November 12th to 15th, 2009. The next Quebec AGM will be held on May 30th, 2010. Speakers have yet to be confirmed. The Quebec orthodontists, according to the president of the AOQ and the Ordre des Dentistes du Quebec, have concerns with the new CE requirements put forth by Align Technology. They plan to communicate their concerns to the company in the near future.

Rapport de la province de Québec En mars 2009, un membre québécois de l’ACO a fait part de ses inquiétudes au conseil d’administration au sujet des nouveaux critères d’admissibilité des Services de santé non assurés pour les Premières Nations et les Inuits. Des discussions s’ensuivirent avec le Dr Bob Cram et les représentants du comité exécutif. Le sujet fut de nouveau abordé lors de l’assemblée générale des Orthodontistes du Québec. Au mois de juillet, le docteur Marc Plante de Santé

Canada et le président de l’ACO se concertèrent de nouveau sur le sujet et Docteur Bob Cram réitéra que l’ACO n’avait aucunement modifié sa politique et n’avait nullement l’intention de le faire dans le futur. Au cours de la journée de l’assemblée générale des orthodontistes du Québec, le Dr Kondo du Japon a donné une conférence fort intéressante sur les approches non chirurgicales des malocclusions de Classe III présentant une béance antérieure. Durant le déjeuner, le Dr Cram a rappelé aux membres présents les avantages d’appartenir à l’ACO et a mis à jour le plus récent rapport des discussions tenues avec Santé Canada. Plusieurs questions furent soulevées au sujet de la facturation par carte de crédit et le droit à l’incorporation. Dr Cram a conclu son discours en invitant les orthodontistes québécois à se joindre à leurs confrères canadiens au congrès annuel à Kelowna. Le président actuel de la NESO, Dr Lee Erikson, nous a expliqué les nouveaux paramètres légaux adoptés par l’AAO. Le processus d’incorporation de l’AOQ est en bonne voie et devrait être complétée au mois de septembre 2009. Le Dr Erikson a invité tous les membres à la conférence annuelle de la NESO qui se tiendra à New York du 12 au 15 novembre 2009. La prochaine assemblée générale de l’AOQ aura lieu le 30 mai 2010. Les conférenciers ne sont pas encore connus.

University of Toronto Class Reunion

– Submitted by Dr. Gordie Organ

The U of T ortho class of 1979 celebrated our 30th reunion at the CAO meeting in Kelowna and naturally we had a picture of us taken for posterity’s sake. Thirty-one years ago, we had a similar picture taken during one of Drs. Ronnie Landsberg and Howard Tile's Sailing day (many thanks to Howard Tile for letting me have the picture). Unfortunately, Ed Pong (the fellow second from the right in 1978) was unable to attend the Kelowna meeting, but we had a drink on his behalf anyway. The motley crew’s names are: from left to right: Reijo Peltoniemi, Gordie Organ, Gerry Solomon, Paul Milne, Ed Pong and Paul Witt.

Fall 2009 • CAO Bulletin

Component Society Reports Selon le président de l’AOQ et de l’Ordre des dentistes du Québec, les orthodontistes québécois expriment de fortes réserves quant au programme d’éducation continue mis en place par la compagnie Align. Ils prévoient faire part de leurs inquiétudes à la compagnie Align sous peu.

Atlantic Report Dr. Stephen F. Roth

Despite the threat of rain, attendees awoke to near-perfect conditions for golf the next morning. The main discussion at the business meeting was the AAO Affiliation Agreement and the requirements for incorporation. The current benefit of continuing as a component of NESO was questioned. A committee was struck to examine the details of the agreement and to explore the issues involved with incorporation. The AOA is planning to hold a meeting during the NESO conference in New York City this November to reach a final consensus on this issue.

[Email: stephenfroth@mac.com]

The Atlantic Orthodontist’s Association (AOA) held its annual meeting at the Rodd Crowbush Resort on Prince Edward Island May 29th and 30th, 2009. Dr. Bob Cram, CAO President, and Dr. Leslie Will, President of the Northeastern Society of Orthodontists were both in attendance. A productive afternoon meeting was followed by an enjoyable reception and banquet that evening.

CAO Bulletin • Fall 2009

The Division of Orthodontics at Dalhousie University is proceeding with the elective program in advanced orthodontics for six of its senior students. The program commenced in September under the tutelage of Drs. Kathy Russell and Lee Erickson.

A HISTORY OF ORTHODONTICS IN CANADA After many years of hard work, we are pleased to announce the publication of “A History of Orthodontics in Canada”. Many years of hard work were lovingly undertaken by author Dr. Rowland Dalton Haryett to offer Orthodontic Specialists in Canada a comprehensive history of our profession. With much effort and assistance by Dr. Amanda Maplethorp to complete the editing and typesetting of this, it is finally ready for all Orthodontists. Look for more information regarding this exciting venture!

Fall 2009 • CAO Bulletin

Diversions and Distractions Due to circumstances beyond our control, the puzzle in the last bulletin, as it appeared in print, was unfortunately unanswerable. Rest assured, the person or persons responsible for such an outrage have been sacked. Well, maybe not sacked (as it is near impossible to sack oneself) but in the very least, the puzzle book previously used has been tossed aside and a new puzzle book has been contracted for reference. Again, the Editorial Team at the CAO is offering a prize for the first person to forward correct answers to the following puzzle: 1. On a visit to the park on a hot day, Mom bought each of her four children an ice cream, each selecting a different flavour. From the clues given below, can you a. Name each of the children numbered 1 to 4 b. Work out the age of each c. Say which flavour each chose Clues: • Steven, who is not sitting next to his mother on the bench, is the immediate senior of the child who went for the traditional vanilla ice cream. • The seven year old is on the same side of Mom as the child with the raspberry ripple, the former being the nearer to her. • As you look at the four children, the youngest is next left from Leo • Francis, who had chocolate ice cream, is farther right in our diagram than the child aged nine. • The child in position 2 is older than the one numbered 1. Names: Ages: Ice Creams:

Francis, Leo, Malcolm, Steven 6, 7, 9, 10 chocolate, raspberry ripple, strawberry, vanilla

[1]

[2]

[3]

[4]

Name Age Ice Cream

Clinical Tip Its time to call it a day when your bondable button position is off.

Fall 2009 • CAO Bulletin

From the Editor

Will Trade Braces For… Last Christmas, my daughter bought me a non-descript paperback about Kyle McDonald; a down-on-his-luck Canadian who transformed a red paper clip into a three-bedroom house through a series of strategically planned trade maneuvers. Kyle made use of the then newlylaunched Craigslist, what most of us now know as the wildly popular website that categorically lists a plethora of items for sale or trade. I couldn’t put the book down. Taking on a life of its own, Kyle’s master plan ultimately propelled this unemployed twenty-something with an unparalleled vision into a world-wide quasi-celebrity. McDonald was onto something. In sizing-up North American society, doesn’t life in the simplest of terms boil down to the acquisition and the disposal of stuff? From cars to clothes, kids to kittens, the dynamic balance of supply and demand applies across the board. I took a good look around. I have a lot of stuff. I could get rid of most of it and suspect that my life would change not one bit. So, with some trepidation, I logged on and listed my two items under ‘Barter’ true to the rules set forth in Kyle’s book. I ended up giving my things away, partly because I genuinely wanted these particular items gone and partly because what is the point of getting more stuff when stuff is exactly what you’re trying to rid yourself of in the first place? Even to a simpleton like me, trading for something, when there is nothing you really want or really need, makes little sense.

CAO Bulletin • Fall 2009

During the weeks that my items were listed, I became a certified Craigslist junkie. I checked back religiously, to get a real sense of what was out there in the nether regions of Gotham. Late one evening, before finally tearing myself away from the hypnotic glow of my sadly overworked laptop, I came across an ad that jolted me right back into the land of the living: ‘Looking to Trade Engagement Ring and Wedding Band for a Set of Braces’. Whoa! I couldn’t let this go. So I hit the return button and wrote a reply.

‘Hello,’ I composed. ‘This is one of the saddest things I have ever heard. No one should have to give up her wedding rings for a set of braces. I’m part of the orthodontic department at the Faculty of Dentistry (in Toronto). Would you be interested in a consultation? I’ll take a good look at your teeth and let you know what I think. This is absolutely legit, no strings attached and totally on the up and up’. Bam! Less than ten minutes later I received a response from what sounded like a very nice person who, really wanted to have her teeth straightened, but found herself without the means to do so. She told me a bit about her story, but honestly, she could have written anything. Anybody willing to trade an item of such sentiment for a set of mini-twins

must place significant value on what any one of us is willing and able to offer each and every day. So we arranged an appointment a few days hence and to my semi-surprise, she showed on-time. SP is a 31 year-old female, in good medical health, with harmonious facial features and moderate dentoalveolar crowding. She hates her teeth and doesn’t smile much. She’s not your typical mid-town Toronto patient of which I normally treat. A tad unconventional, SP is pleasant enough, but the sadness behind her eyes betrays what she wants the world to see. As we sat and talked, I found myself wanting to help this relative stranger and still can’t figure out exactly why. It’s not because I’m a particularly giving person or because I think I’m making the world a better place. Maybe the timing was right. Or perhaps it’s simply that I have the feeling that straightening her teeth will bring her a measure of happiness that will be equaled only by my own. I really don’t know. I’m sure she can’t believe her good fortune. What are the chances that she’d end up being treated and keep her prize possessions simply because out of desperation she posted an advertisement on a potentially sketchy website at precisely the moment some random orthodontist happened to be checking out the same? Pretty slim I would bet. But things do happen for a reason and hopefully two years from now (remember we’re talking orthodontic years here; kind of like dog-years, but less affectionate) when I remove the appliances from her teeth, the two of us will look back on this experience as the right move at the right time for both SP and for me. Pray for snow, kids. Go Canada Go (USA too!) in 2010 Jimmy