Spring 2010
Bulletin
CANADIAN ASSOCIATION OF ORTHODONTISTS / ASSOCIATION CANADIENNE DE ORTHODONTISTES
Message from the President Committee Reports CFAO Graduate Student Posterboards - Part 2 of 2 Component Society Reports From the Editor Photo courtesy of of Dr. Sean Marcy, U of T Graduate Orthodontic Resident
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. Ritchie Mah 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 CAO Helpline Task Force GST Advisor
Dr. Daniel Pollit Dr. Jules Lemay III Dr. James Posluns Dr. Stephen Roth Dr. Garry A. Solomon Dr. Howard Steiman Dr. Garry A. Solomon
Dr. Gerry Zeit, [Email: gzeit@sympatico.ca]
With all the changes taking place in the world of health care recently, I continually ponder the question: ‘What does it mean to be a professional?’ When posed to a group of my daughter’s friends, the general reply is usually ‘A professional is someone who is really good at something.’ A professional is, essentially, an expert. The Oxford Dictionary defines ‘Professional’ both as ‘a person having impressive competence in a particular activity’ and ‘…engaged in an activity as a paid occupation.’ The distinction between amateur and professional may work in the world of sports but surely, in the field of health care, there is more to being a professional than merely receiving a fee for one’s service. Norman Mailer said that a professional is ‘someone who does a good day’s work, even on a bad day.’ Apparently simplistic, Mailer addresses the core of professionalism; the placement of the needs and the concerns of another above one’s own. Regardless of the province in which you reside, your dental regulatory body is sure to know what a professional is and what his or her responsibilities are. In 1964, U.S. Supreme Court justice Potter Stewart publicly struggled with a specific definition of obscenity. His concluding remark remains forever notable: ‘I shall not attempt to further define… (obscenity)…but I know it when I see it.’ In a similar vein, after working with orthodontic specialists for the last ten years – I know a professional when I work with one. Six months into my too-short presidential year, I am prouder than ever to call myself an orthodontic specialist. I have had the opportunity to make new friends, connect with old ones, have seen the CAO be active in a number of areas and am looking forward to the future. The CAO website has had a facelift, including a new URL; www.canadabraces.org and www.canadabraces.ca. The website continues to contain information regarding orthodontic emergencies and oral hygiene. In the members’ sections you will find downloadable and fill-in-able CAO Standard Information and transfer forms. The most exciting feature is our new discussion forum, poised to become a knowledge resource with posted questions or comments immediately forwarded to more than sixty orthodontists from across the country. The website is designed to ultimately contain our new online directory. The CAO Helpline is a true member benefit that you may know. The Helpline is a resource for patients with concerns regarding their orthodontic care. Trained CAO Continued…
CAO Mission Statement: The Canadian Association of Orthodontists is the national organization and official voice for registered orthodontic specialists and is dedicated to the promotion of the highest standards of excellence in orthodontic education and quality orthodontic care. 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.
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staff members receive input including questions and concerns via the Helpline from all parts of the country. Our staff does an excellent job dealing with these issues; it is a rare occurrence that a caller is unsatisfied with the outcome.
tatives from each of the provincial associations round out the group and, of course, nothing would ever get off the ground if it weren’t for our CAO staff, led by Ms. Diane Gaunt and Ms. Alison Nash.
If you believe in the old adage that you can’t know where you are going unless you know where you have been, then you may want to have a look at the recently printed History of Orthodontics in Canada. Dr. Bus Haryett’s compilation and Dr. Amanda Maplethorp’s skill in organization represents a huge effort by two of our members to bring this project to fruition.
Thank you for the opportunity to serve.
Health Canada has a new administrator, ESI, which is continuing to register orthodontists. Read any agreement carefully and understand fully the commitments you are about to make before signing. Registration is voluntary and is necessary only if you accept assignment (i.e. payment) of benefits directly from the government. The CAO has a longstanding recommendation against the direct acceptance of benefits. FNIHB patients make payments to the orthodontist; the orthodontist provides the patient with a Standard Orthodontic form along with a copy of their orthodontic records and the patient submits for re-imbursement on his/her own behalf. Consider yourself invited to the 62nd Annual CAO Scientific Session, to be held at the Fairmont Chateau Whistler, September 23-25th, 2010. This year’s meeting will be held in combination with the Canadian Association of Oral and Maxillofacial Surgeons Annual Session and it promises to be informative and entertaining. Expect a variety of excellent speakers, an ever-expanding line up of commercial exhibitors, round table breakfasts, student research posterboards, and an auxiliary program that gets better every year. Work aside, there’s the CFAO Golf tournament, an exciting Cougar Mountain aerial tree course and zip line adventure, and a hands-on cooking workshop with executive chef Melissa Craig. Be prepared to ‘Rock the Creekside’ with the Olympic-featured band the Hairfarmers at Dusty’s Bar and Grill on Thursday night. On Friday it is time to ‘Walk the Red Carpet’ at our Gala tribute to old Hollywood. Thank you to all our sponsors without whose support, none of this would be possible. Here’s looking at you, kid! This year’s Board is made up of a number of dedicated energetic individuals. Dr. Dan Pollit works unceasingly to maintain and improve our website. Dr. Jim Posluns continues to keep us informed through the bi-annual bulletin. Dr. Susan Tsang has taken over the New and Younger Members committee steering one of the most vibrant and active CAO portfolios. Dr. Ritchie Mah and Dr. Howard Steiman have maintained and nurtured our relations with CDA and AAO respectively, while Dr. Don Robertson continues to co-ordinate with the orthodontic educators. Dr. Richard Marcus and his team are the driving force behind our scientific sessions. Dr. Bob Cram has stepped back into his role as insurance point person and along with other past-presidents, provides that ‘sober second thought.’ Treasurer Dr. Garry Solomon keeps us all ‘accountable.’ The hard working and dedicated represen-
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CAO Bulletin • Spring 2010
Rapport du président Étant donné tous les changements qui surviennent dans le domaine des soins de santé en ce moment, je me demande constamment ce que signifie le mot « professionnel ». J’ai posé la question à un groupe d’amis de ma fille qui m’ont grosso modo fourni la réponse suivante : « Un professionnel est une personne qui excelle véritablement dans ce qu’elle fait ». Essentiellement, un professionnel est un spécialiste. Les dictionnaires donnent deux définitions du mot professionnel : « une personne possédant des compétences impressionnantes dans un domaine d’activité particulier » et « une personne exerçant une activité rémunérée ». La distinction entre un amateur et un professionnel va de soi dans le monde du sport mais, à l’évidence, dans le domaine des soins de santé, la définition d’un professionnel va bien au-delà du fait de toucher des honoraires en contrepartie de services. Selon Norman Mailer, un professionnel c’est « quelqu’un qui accomplit une bonne journée de travail même au cours d’une mauvaise journée ». Apparemment simpliste, la définition de Mailer touche à l’essence même du professionnalisme : soit, faire passer les besoins et les préoccupations d’autrui avant les siens. Quelle que soit votre province de résidence, votre organisme de réglementation dentaire sait à coup sûr ce qu’est un professionnel et en quoi consistent ses responsabilités. En 1964, le juge Potter Stewart de la Cour suprême des États-Unis a publiquement débattu la définition précise de l’obscénité. On n’est pas prêt d’oublier sa remarque de clôture : « Je ne vais pas tenter de définir davantage… (l’obscénité)… mais je la reconnais quand je la vois ». Dans la même veine, après avoir travaillé avec des Specialiste en orthodontie au cours des dix dernières années, je sais reconnaître un professionnel lorsque je travaille avec lui. A mi-parcours de mon mandat (trop court) de président, je m’enorgueillis plus que jamais de pouvoir me définir comme un Specialiste en orthodontie. J’ai eu la chance de me faire de nouveaux amis et de renouer avec d’anciennes connaissances; j’ai été témoin de l’activité de l’ACO dans un certain nombre de domaines et j’entrevois l’avenir avec optimisme. Le site Web de l’ACO a été revampé et comporte notamment deux nouvelles adresses URL : www.canadabraces.org et
www.canadabraces.ca. Notre site continue de présenter de l’information sur les urgences orthodontiques et l’hygiène buccale. Dans les sections réservées aux membres, vous trouverez des renseignements sur l’ACO normalisés et téléchargeables, de même que des formulaires de transfert remplissables en ligne. Notre nouveau forum de discussion est l’élément le plus passionnant du site; affichant des questions ou des commentaires qui sont immédiatement acheminés à plus de 60 orthodontistes d’un bout à l’autre du Canada, il est appelé à devenir une source importante de renseignements. Notre site Web a été conçu pour éventuellement héberger notre nouvel annuaire en ligne. Comme vous le savez peut-être déjà, la ligne d’aide de l’ACO représente un véritable avantage pour les membres. Il s’agit d’une ressource précieuse pour les patients qui ont des préoccupations à propos des soins orthodontiques. Grâce à elle, des membres qualifiés du personnel de l’ACO répondent aux questions et aux préoccupations de personnes de toutes les parties du Canada. Notre personnel accomplit un excellent travail dans ce domaine ; il est très rare qu’un demandeur ait été déçu des réponses reçues. Si vous croyez dans le vieil adage selon lequel on ne peut pas savoir où l’on va si on ne sait pas d’où l’on vient, vous voudrez peut-être jeter un coup d’œil sur un document récent qui retrace l’histoire de l’orthodontie au Canada, rendu possible
grâce au travail de compilation du Dr Bus Haryett et aux compétences organisationnelles du Dr Amanda Maplethorp; c’est grâce aux efforts déployés par deux de nos membres que ce projet est devenu réalité. Santé Canada s’est dotée d’un nouvel administrateur, ESI, qui continue d’accepter les inscriptions des orthodontistes. Avant de les signer, lisez attentivement les conventions, quelles qu’elles soient, afin de bien comprendre les engagements que vous vous apprêtez à prendre. L’inscription est volontaire et n’est nécessaire que si vous acceptez une cession (c’.-à-d. le paiement) des prestations directement du gouvernement. Les patients relevant de la DGSPNI règlent eux-mêmes l’orthodontiste; ce dernier remet au patient un formulaire standard d’orthodontie de même qu’un exemplaire de son dossier d’orthodontie et le patient demande ensuite le remboursement de ses frais en son propre nom. Considérez-vous comme invité à la 62e Séance scientifique annuelle de l’ACO qui aura lieu au Fairmont Château Whistler, du 23 au 25 septembre prochains. Cette année, cette rencontre se tiendra en même temps que la Séance annuelle de l’Association canadienne des spécialistes en chirurgie buccale et maxillo-faciale et elle promet d’être à la fois informative et divertissante. Attendez-vous à une brochette d’excellents conférenciers, un éventail toujours Continued…
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plus large d’exposants commerciaux, des déjeuners tablerondes, des panneaux d’affichage présentant la recherche étudiante, de même qu’un programme auxiliaire qui s’améliore chaque année. Côté divertissements, préparez-vous à : un tournoi de golf de la CFAO, à un parcours d’hébertisme aérien et à des traversées en tyrolienne à Cougar Mountain, de même qu’à un atelier de cuisine avec la réputée chef Melissa Craig. Soyez prêt pour la fête Rock the Creekside avec le groupe Hairfarmers (présent aux Jeux olympiques) qui aura lieu au Dusty’s Bar and Grill le jeudi soir. Le vendredi, on déroulera le tapis rouge à l’occasion de notre Gala hommage à l’Hollywood d’antan. Merci à tous nos commanditaires sans l’appui desquels rien de tout cela n’aurait été rendu possible. Cette année, le Conseil d’administration est composé de personnes tout aussi dévouées qu’énergiques. Le Dr Dan Pollit travaille sans relâche à la maintenance et à l’amélioration de notre site Web. Le Dr Jim Posluns continue de nous tenir informés grâce au bulletin semestriel. Le Dr Susan Tsang, pour sa part, a pris sous son aile le Comité des nouveaux membres et des plus jeunes, et pilote l’un des portefeuilles les plus vivants et les plus actifs. Le Dr Ritchie Mah et le Dr Howard Steiman ont continué à entretenir et à cultiver nos relations avec l’ADC et l’AAO, respectivement, alors que le Dr Don Robertson continue d’assurer la coordination avec les éducateurs en orthodontie. Le Dr Richard Marcus et son équipe incarnent la force motrice de nos séances scientifiques. Le Dr Bob Cram a repris son rôle d’homme de pointe de l’assurance et, en collaboration avec d’autres anciens présidents, nous fournit un second examen objectif. Le Dr Garry Solomon, trésorier, s’occupe de notre « imputabilité » à tous. Enfin, nos dévoués représentants de chacune des associations provinciales complètent le groupe. Et pour terminer, aucun projet ne pourrait prendre forme si ce n’était de la précieuse collaboration de notre personnel de l’ACO, dirigé par Mmes Diane Gaunt et Alison Nash. Merci de la possibilité que vous nous donnez de vous servir.
In Memoriam
Mervyn Rabinovitz Dr. Mervyn Rabinovitz passed away on Tuesday, January 26, 2010 at the age of 68 years. A long-time member of the Canadian Association of Orthodontists, Dr. Rabinovitz practiced in Calgary’s Bankers Hall. Originally trained in South Africa, Mervyn is survived by his wife Rochelle and his daughters Zoey, Deanna and Maggie. Known as a wonderful gentleman, with a huge heart and an adorable smile, Dr. Rabinovitz was dearly loved and will be greatly missed by his family, friends and patients.
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CAO Bulletin • Spring 2010
Making Our Members Aware... The CAO has recently become aware of at least one dentist in Ontario who has been required by the Royal College of Dental Surgeons of Ontario to make an apology to the profession for using the term “Premier Elite Provider” on his website in relation to use of the “Invisalign” system. The RCDSO regulations on advertising state, in part, that: “Publishing, displaying, distributing, or using or causing or permitting, directly or indirectly, the publication, display, distribution or use of any advertisement, announcement or information related to a member’s practice, which…(iii) makes comparisons with another practice or member or would be reasonably regarded as suggestive of uniqueness or superiority over another practice or member…” (Section 2 of Ontario Regulations 853/93) Certainly all Ontario members should review his/her own promotional material. It would seem that, if use of this wording is inappropriate for one Ontario dentist, then it is likely so for all. An additional note of caution: many members will have his/her name listed on the Invisalign website itself, together with these designations. Since the Ontario regulation seems to pertain equally to “publishing, displaying, distributing or using” and “permitting, directly or indirectly, the publication, display, distribution or use”, there would seem to be a concern even if one’s name were listed on the Invisalign website itself, with the “Premier” or “Elite” provider terminology. The CAO has requested further clarification from the RCDSO on this specific circumstance. Dental regulatory bodies do not, of course, regulate the manufacturers or providers of dental supplies and services. It would seem to be the dentist, once again, who is at risk of violating the Ontario Regulations in this circumstance. As other provincial regulators may have regulations and/or guidelines that outline what is acceptable and what is not in the field of advertising, it would be prudent for all CAO members to review existing regulations in his/her own provinces with respect to their own promotional materials.
Committee Reports Treasurer’s Report Report Dr. Garry Solomon Treasurer
orthodontists and the Input Tax Credits (ITC). While information is forthcoming, indications are that current protocols may remain unchanged.
Insurance Report
[Email: hellener@lks.net]
Dr. Robert Cram Insurance Committee Chair [Email: drbob@reddeerortho.com]
Treasurer’s Report - CAO The CAO remains in a strong financial position and operates with a sustained efficiency and net revenue. The general operations of the CAO for 2009 created net revenues of $47,647.04. The Kelowna Scientific Session created net revenues of $26,844.13; when combined with the general operations of the CAO yielded total net revenue of $74,491.19.
Treasurer’s Report - CFAO The CFAO created a net revenue loss of $41,727.72 in 2009 due in large part to disbursements for the publishing of the History of Orthodontics book ($8,086), the scientific posterboards ($18,222) and the 2009 disbursement quota dictated by the CRA ($60,000 shared among the five university orthodontic programs).
GST Report Dr. Garry Solomon GST Advisor [Email: hellener@lks.net] The CRA continues to adhere to its official CRA/CDA guidelines. There have been no reported incidents of GST disagreements arising from misinterpretation of the negotiated protocols from any CAO members within the last six months. On July 1, 2010, in Ontario and B.C. the Provincial and Goods and Services taxes will combine as a Harmonized Sales Tax (HST). To date, it remains unclear as to how the HST will affect
Thank you to Dr. Richard Marcus for taking such good care of the Insurance Committee over the course of the previous year. Not much has changed since having hands-on responsibility for the Committee (that is either a good thing or a bad thing, depending upon your point of view!) Over the past twenty-plus years, the CAO has established a good relationship with the private carriers of orthodontic benefits in Canada, as well as with CLHIA the representative organization of most private insurance carriers. The largest group of carriers not represented by CLHIA is Blue Cross. Most concerns that arise are easily explained and/or corrected. The office forwards all member inquiries, they are discussed at length with those in the know and then a response is returned. Questions seldom arise when orthodontic offices follow the recommended CAO insurance guidelines. It is difficult for the CAO to broker a compromise when the member’s office has utilized procedure codes (specifically: codes for diagnostic records and then not for treatment), standard dental claims forms (specifically: for diagnostic records using procedure codes, and then refused a claim form and/or procedure codes for treatment), and/or accepted assignment from a carrier for some patients (specifically: patients with ‘special’ circumstances, or for staff members’ family) and not others. At the request of Dr. Marc Plante, several CAO Board Members participated in a conference call with the administrative staff at FNIHB / Health Canada. The purpose of the call was to discuss having additional CAO members sign on as ‘providers’ with ESI, the new payment contractor for the FNIHB program after taking over from First Canadian Health on December 1st, 2009. Dr. Plante confirmed that orthodontists Spring 2010 • CAO Bulletin
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Committee Reports may provide orthodontic care for aboriginal patients without signing up with ESI only if they are paid by the patient and not accepting assignment from the government program. FNIHB does not encourage this type of arrangement, nor does it publicize its existence.
set up the guidelines and the terms of reference, defining the membership, fee structure, and role of NDSO going forward and planned for all NDSO representatives to bring the proposal to their respective specialties for review as soon as possible.
There has been at least one recent report of an adjudicator from the Orthodontic Review Centre calling an orthodontist to make his recommendation for an alteration in a submitted treatment plan. More than once over the past six years, the CAO has been promised that this practice would cease. Alas, such is not the case.
Several dental schools operating without an oral radiologist on faculty was a topic of concern once again. The radiologists consider this situation as priority and note that, in some cases, other specialists teach radiology in some schools. The radiologists want the NDSO to raise this crisis as an issue for the CDA to pursue with the faculties of dentistry.
COSA Report Dr. Ritchie Mah CDA/COSA Liaison [Email: ritchiemah@yahoo.ca] Although there was not an official COSA meeting held during the latest CDA Interim Meeting November 5-7 2009, the respective specialties met as National Dental Specialty Organization (NDSO) representatives. Exactly how the new NDSO would function in relation to CDA was the main topic of discussion. In theory, the role of the NDSO would be dependent on the participation of all specialties. Dr. Lee McFadden of the Canadian Association of Oral and Maxillofacial Surgeons agreed to
DIRECTORY UPDATE Members of the Board and the staff at the CAO are completing the transition to an online directory. A working version will hopefully be available soon with the final version planned for later this year. Input from our membership is encouraged to improve the ‘user-friendliness’ of the directory. A demonstration of this new online service will be presented at the CAO Annual Session in Whistler BC this fall. Please plan on dropping by to see how the new directory can be of benefit to your practice.
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CAO Bulletin • Spring 2010
The Next CDA and COSA meeting is the April 2010 General Assembly.
New and Younger Members Dr. Susan Tsang New and Younger Members Representative [Email: s_tsang2@hotmail.com] Thank you to Dr. Helene Grubisa for all her hard work to get our New and Younger Members group up and running over the past several years. Hopefully this group will continue to be a useful resource for residents and for new graduates. Since many Canadian orthodontists are trained in the United States, the CAO will be attending the August 2010 GORP meeting at the University of Michigan to provide US residents with information about the benefits of joining the CAO and to facilitate the membership process. The AAO will now inform the CAO when students indicate on their AAO application form that they are interested in joining the CAO in an effort to minimize the confusion that repeatedly arises. At the upcoming Annual Scientific Session in Whistler BC, Mr. Derek Scheurs, a chartered accountant with KPMG based in Kamloops BC, will address the NYM luncheon on Friday, September 24, 2010. Mr. Scheurs will be speaking on the topics of accounting, bookkeeping and practice transition. This lecture is open to everyone including residents, new graduates and anyone else interested in picking up some useful accounting information. The online NYM discussion forum historically found on Yahoo Groups is now located on the discussion forum page on the members’ side of the CAO website at www.canadabraces.ca. There will be a specific NYM group forum for questions from
Committee Reports residents and new graduates. All new and younger members are encouraged to log in, to sign up, and to begin posting in order to make the site a useful learning resource for everyone.
and radio commercials are also available.
Please feel free to contact me or the CAO office with any questions, comments, or concerns about the NYM group.
Active AAO members can easily link up their practice website to www.braces.org. Simply email your practice web site URL to info@aaortho.org and request that it be added to the Orthodontic Locator.
See you all in Whistler!
AAO and the Economic Slowdown
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CAO/AAO Report Dr. Howard Steiman CAO/AAO Liaison [Email: straightsmile@sympatico.ca] Having trouble sleeping at night? Being my last Ad Interim report in this board position, I will make the material as mundane and boring as possible. Enjoy...BUT WAIT! There is a surprise waiting for you at the end... Update on the Consumer Awareness Campaign The fourth year of the AAO Consumer Awareness Campaign is being driven by new research providing information on consumer attitudes and marketing trends. Consumers respond very positively when told that orthodontists have two to three years of additional training beyond dental school. The AAO plans to launch a nineteen-month integrated advertising/public relations effort to continue to build awareness among mothers regarding the extra education of orthodontists. The goal of the original campaign was to educate the consumer and to drive them to the AAO website. The new campaign will attempt to increase market share of the AAO member orthodontist by directing the public to the orthodontic offices directly. The new tagline is ‘Our Expertise Will Make You Smile.’ Media will include magazine, internet, radio, direct mail, posters and actual puzzles. The AAO decided that television advertisements were no longer an effective marketing tool. For those wishing to use the previous campaign materials, the AAO recently revised its policy making it easier for individual members and groups to use and to customize the advertisements. ‘More Than a Smile’ and ‘Say it All’ print advertisements are available in three languages with numerous templates for doctors’ names. Television, online banner ads
AAO surveys have shown that nearly fifty-nine percent of orthodontists report a decline in new patient starts. Nearly half of the respondents report a decline in fee collections and net practice income. Thirty one percent of respondents admitted their planned time until retirement had increased. Many practitioners are responding to the slowdown by reducing expenses, while others are stepping up marketing efforts by establishing or expanding patient referral programs. The AAO recommends that practitioners take advantage of their ability to use the ‘More Than a Smile’ campaign material. The AAO also suggests investing in your staff. The ‘AAO Orthodontic Staff Club’ is inexpensive and offers numerous benefits including on-line continuing education. Doctors can take advantage of the one hundred dollar annual subscription for distance learning offered through the AAO, while doctor CE points can also be earned inexpensively on-line. AAO-Funded Distance Education for Residents Most orthodontic residency programs continue to find faculty recruitment a challenge. Using information-age technology, the AAO is evaluating the use of online interactive distance learning seminars for orthodontic residents in the United States and in Canada. Initial participant response was positive. A twenty-two thousand dollar grant from the AAO made the program viable for this year and a larger scale evaluation is needed to determine the long term-potential in graduate programs. Distance learning seminars are available to all residency programs until July, 2010. More information is available at www.aaorthodseminars.org New Fundraising Strategies for the AAOF The goal of the AAOF is to raise the current level of pledges from thirty-three million to one hundred million dollars. In order to freshen up the AAOF and to make it more appealing, the foundation has a new logo and is in the process of rebranding and updating its marketing tools, including its website. New fundraising tools include: • The Century Club which asks for a $100.00 each month continued… Spring 2010 • CAO Bulletin
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Committee Reports on a long term basis. • The Grateful Patient/Professional Courtesy Program that encourages orthodontic patients who are happy with their treatment to directly support the AAOF with contributions in honour of their orthodontist. • The AAOF will begin to ask each resident to pledge $5000.00 at GORP. Those making pledges are given five years from their graduation date to fulfill their obligation. • The AAOF Board members are asking other current contributors to upgrade their pledges and are calling upon orthodontic suppliers for support.
Canadian Orthodontic Educators Report Dr. Donald Robertson Chair, Conference of Canadian Orthodontic Educators [Email: mouthtraps@shaw.ca] Silvano Brecevic has replaced Tony Orfanides at 3M Unitek Canada. 3M Unitek will be sponsoring the interim Educators Meeting April 9-11 at Niagara-on-the- Lake, Ontario. Although not confirmed, expectations are that the 3M meeting will return to Whistler BC in 2011. The University of British Columbia is committed to its graduate orthodontic program and is currently accepting applications for the fall of 2010. The Canadian Educators Group will include representation from UBC as soon as the program is in place. An invitation has been extended for Dr. Ed Yen to represent UBC at the April Educators meeting. The CCGOPD has written to the CDAC and to the RCDC to confirm its endorsement of a minimum thirty-six month program in graduate orthodontics as the Canadian standard. The CCGOPD urges the CDAC to reflect the ‘Canadian standard’ for program length by making it a requirement of accreditation documentation.
RCDC Report Dr. Robert Cram RCDC Liaison [Email: drbob@reddeerortho.com] The latest RCDC oral examination was held in November 2009. There were more candidates than ever as this examination was the last before switching to an annual format. Chief Examiner Ron Sperber and his team worked diligently to administer the exam to the large number of candidates. Forty candidates sat the oral exam, resulting in six failures or a pass rate of eighty-five percent. Going forward, the written exam will take place in January, followed by the oral exam for successful candidates in June of any given calendar year. An examiners workshop was held in Montreal at the end of January 2010 with all Chief Examiners and psychometrician Phil Bashook in attendance. The purpose of the meeting was to train new examiners, to format new questions and to re-evaluate examination content. Previously, Alison Brodie was introduced as the new Executive Director. As of late, her responsibilities have fallen into the hands of the Registrar, Dr. Pat Main while a search is being conducted for a replacement Executive Director.
CFAO Report Dr. Gordie Organ Acting CFAO President [Email: gmo@drgordieorgan.com] The CFAO successfully negotiated a settlement with the CRA regarding the distribution of monies donated and earned over the past several years. In 2009, the CFAO was required to distribute a minimum of $75,800 ($38,000 shortfall from previous years as per the CRA agreement and $37,800 from 2009 donations). Approximately $20,500 was spent on the posterboard program and the History of Orthodontics in Canada project, leaving approximately $55,300 to be distributed for 2009. The Board decided that the remaining funds should be distributed to the five Canadian graduate orthodontic programs.
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CAO Bulletin • Spring 2010
Committee Reports Lengthy discussions ensued regarding the mechanics of fund distribution. The establishment of a CFAO endowment fund for each program was assessed in detail but with interest rates so low, the practically of an endowment fund became questionable. In the end, the Board voted to distribute $12,000 to each program, for a total of $60,000. The Board canvassed each of the five program heads as to how they would spend their respective donation to ensure compliance with CRA guidelines and to ensure CFAO recognition. The responses were vetted by the CAO accountant, who validated that the distribution and the spending of the CFAO funds by the all of the graduate programs complied with the CRA guidelines. Discussions for the distribution of funds for 2010 and 2011 will be on the agenda for the Board’s next meeting. An agreement has been reached between the CFAO and Cerum Ortho Organizers regarding the CFAO Annual Golf Tournament. Cerum has agreed to organize and run the Golf Tournament for the CFAO for another three years and to increase their donation to the CFAO to a minimum of $5000. Cerum Ortho Organizers is willing to accept secondary sponsors for additional prizes or donations to the CFAO. The CFAO has approved in principle and has allocated up to $10,000 in the 2010 budget for the development and the funding of a pilot project to develop a webinar program by the CAO. It has been a pleasure to have served as acting CFAO President this past year.
Wanted by the CFAO A Few Good Benevolent Orthodontists In conjunction with the Oral and Maxillofacial Surgeons, the CAO will be hosting a Silent Auction in support of the Canadian Foundation for the Advancement of Orthodontics at the Joint CAO/CAOMS Scientific Session in Whistler. The Silent Auction will be part of the Friday evening Gala. We are calling for members to consider donating “one of a kind”, fabulous gifts to be used in the silent auction. We are hoping to have between 10 and 15 items for auction. Some examples: • Signed sports memorabilia • “Time Share” Vacation rentals • “Impossible to Get” Sports, Theatre or other event tickets • Original pieces of art or jewelry or other objects d’art • A hosted dinner party • …you get the picture! We would like the items to have an interest to the broad spectrum of our members and to be portable enough to be taken home at the end of the meeting- vacation destinations excepted. Dig deep and consider donating something “priceless”. The CFAO and its beneficiaries – the Graduate Orthodontic Students of Canada, will be forever grateful. Please contact Alison Nash at alisonn@taylorenterprises.com by July 15, 2010 to indicate your interest or if you wish further information.
CFAO Donations (Since November, 2009) Dr. Herman Lee, Winnipeg, MB
Gordie Organ President, Canadian Foundation for the Advancement of Orthodontics
Spring 2010 • CAO Bulletin
11
Committee Reports WFO Report Dr. Amanda Maplethorp WFO Committee [Email: a_maple@shaw.ca] Sydney, Australia hosted the 7th International Orthodontic Congress of the World Federation of Orthodontists (WFO) February 4-9, 2010. Over 4000 persons were registered from 93 countries representing 90 WFO affiliated societies and associations. The Organizing Committee was faced with the challenge of arranging more than 300 speakers while retaining the ‘fun’ feeling of the Australian Orthodontic Congress. In the end, they were successful! The social program had two events filled to capacity and all feedback was complimentary. There was enough rain on the first two days to keep the exhibitors happy attending to the crowd in the exhibition hall. Fortuitously the wet weather abated and all of the social events proceeded without a hitch. Drs. Bob Cram and Ritchie Mah represented the CAO at the Council Meeting where ten individuals were elected to serve on the WFO Executive Committee for the next five years. The Executive Council oversees the WFO between the Council meetings and is composed of the ten elected representatives from the six major areas of the world (with the numbers of representatives based on the numbers of WFO Fellows), as well as the president, secretary-general and a representative from the British Orthodontic Society (BOS), the host of the 8th IOC in 2015. Dr. Roberto Justus of Mexico City, Mexico, succeeded Dr. Athanasios E. Athanasiou of Athens, Greece as President of the WFO, Dr. William DeKock of Cedar Rapids, Iowa, USA, will continue his service as secretary-general. Dr. Paul Jonathan Sandler of Chesterfield, England, will represent the BOS. Dr. Joseph BouSerhal of Beirut, Lebanon will represent Africa and Middle East, Dr. Somchai Satravaha of Bangkok, Thailand and Dr. Keiji Moriyama of Tokyo, Japan will represent Central and East Asia. Dr. Kurt Faltin Jr. of São Paulo, Brazil will represent Central and South America, Dr. Thierry De Coster of Brussels, Belgium and Dr. Allan Thom of Tunbridge Wells, England will represent Europe. Drs. Tom Ahman of Lima, Ohio, USA, F. Amanda Maplethorp of Maple Ridge, BC, Canada and David Turpin of Federal Way, Washington, USA will represent North America and Dr. Himawan Halim of Jakarta Pusat, Indonesia will represent Oceania.
Honoured association representatives at International meetings are often asked to serve as ‘Chairs’ of scientific program segments. CAO Board members were so recognized; Dr. Amanda Maplethorp chaired Basic Science Genetics on February 7th 2010, while Dr. Ritchie Mah stood in for Dr. Bob Cram chairing Diagnostic Methods on February 9th 2010. Speakers from Canada included Dr. William Wiltshire, ‘Something Old and Something New: Making Biomaterials Work For You’; Dr. Eileen Lo, ‘Orthodontic Treatment Timing – A Survey of Orthodontists and Pediatric Dentists in Canada’; Dr. Sercan Akyalcin, ‘Does Long-Term Change in Relative Maxillary Arch Width Affect Buccal Corridor Ratios in Extraction and Non-Extraction Treatment?’, Dr. Amanda Huminicki, ‘Optical Coherence Tomography and Polarized Ramen Spectroscopy Applied to Detect Early Demineralization in Orthodontic Patients’ and Dr. Alan Lowe, ‘Oral Appliances for the Treatment of Snoring and Obstructive Sleep Apnea’. At the 6th IOC in 2005, ‘voluntary’ board certification, such as given by the American Board of Orthodontics, was identified to be of critical importance in elevating the standard of orthodontic care. With that in mind, the representatives concluded that the WFO should promote an affiliation of orthodontic boards and that the WFO should act as an umbrella organization to which boards would be affiliated for the purpose of mutual support, cooperation and collaboration. With these objectives in mind, the WFO established a Committee on National and Regional Orthodontic Boards to affiliate orthodontic boards around the world with an updated list of officers and examiners, to support the development of national and regional orthodontic certifying boards by providing guidelines for use by boards around the world and to provide a board standard against which any of our affiliate’s current board offering can be measured. On February 5th 2010, fifty-one representatives from nearly forty organizations attended a Symposium on Orthodontic Boards. Dr. Justus (Chair) was pleased to announce that the original objectives as outlined at 2005 IOC had been met including the creation of the document entitled ‘Guidelines for Orthodontic Certification.’ This document has the recommended examination standards that were established with the help of representatives from the fourteen identified boards that exist worldwide. The material from this symposium will be used to take this issue forward in the next five years. While at the 2010 IOC, the CAO Board members were invited
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CAO Bulletin • Spring 2010
Committee Reports to attend a private event at the Australian Club, hosted by the WFO and the Australian Society of Orthodontists. Dr. Maplethorp represented the CAO at the British Orthodontic Society function, the President’s Reception at Sydney Harbour, and the WFO Gala Dinner. The 8th IOC will be held in London September 27-30, 2015.
Historian Report
piling and editing the manuscript. Congratulations on a project that will be valued by all for years to come.
Website Report Dr. Daniel Pollit, CAO Webmaster [Email: dpollit@sympatico.ca]
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.
Over the past six months there have been no significant changes to the website, and there has been very limited activity on the new discussion forum. The settings on the discussion forum have recently been changed, increasing the potential for awareness by the membership. All postings to the forum will be emailed to all registrants, provided they have switched on this feature of their account.
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, com-
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. VERY Limited Quantities still available...call the CAO Office to order yours!
Spring 2010 • CAO Bulletin
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CFAO Graduate Student
Posterboards Abstracts from the 2009 CAO Annual Scientific Session – Part 2 of 2 part series
University of Alberta A SYSTEMATIC REVIEW OF THE EVIDENCE BEHIND DENTAL ARCH EXPANSION WITH THE DAMON PHILOSOPHY
University of Alberta CHANGES IN CRANIOFACIAL GROWTH AND DEVELOPMENT ASSOCIATED WITH NASAL CONTINUOUS POSITIVE AIRWAY PRESSURE (NCPAP) THERAPY IN PEDIATRIC PATIENTS
Authors: Hussam Al-Fakir*, Carlos Flores-Mir INTRODUCTION: Depending on the purpose of the expansion and the stage of dental development, arch expansion can be done using various conventional expansion appliances; for example, Hyraxes, Quad helixes, Wilson arches and bonded RMEs. However, in recent years, a new philosophy has been developed for the accomplishment of dental arch expansion, involving more bodily movement of the teeth rather than just tipping the teeth. OBJECTIVE: In this systematic review the evidence behind dental arch expansion with the Damon philosophy was sought. METHOD: Several electronic databases were searched for relevant articles and reference lists of pertinent articles were also searched. RESULTS: Only two articles were found that fulfilled the minimal set of criteria set in advance. One article had a sample of 19 patients with two groups (9 patients treated with RME expansion then full fixed conventional appliance, 10 patients treated only with the Damon system). The second article had a sample of 54 patients with certain selection criteria then divided randomly into two groups (one treated with conventional appliance and second with Damon system). They found that dental arch expansion is possible with Damon philosophy; however, the expansion is mostly tipping in the premolar and molar area. Arch expansion was measured and quantified using dental cast models and posteroanterior cephalometric radiographs. CONCLUSION: The amount of research that has been done on this topic is far from sufficient and neither supports nor dismisses the premise. A more precise tool to measure and quantify arch expansion for the whole maxilla is needed.
(*Presenter)
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CAO Bulletin • Spring 2010
Authors: Mohammed Korayem, Manisha Witmans, Carlos Flores-Mir, Paul Major AIM: The purpose of this project is to review the available evidence concerning changes in craniofacial growth associated with long term nCPAP therapy in pediatric patients. Pediatric patients with obstructive sleep apnea have several treatment options available including nasal continuous positive airway pressure (nCPAP). The nasal mask used to deliver positive airway pressure is secured to the paranasal area using elastic headgear straps, which are adjusted to obtain a tight seal of the mask to the face. The pressure exerted by the mask on the growing bones and soft tissues of the midface may be a potential cause of mid-face hypoplasia in growing children who are on long term CPAP or BiPAP therapy during their peak growth years. METHODS: A systematic review of the literature was conducted to examine the evidence concerning long term nCPAP use in pediatric patients and any associated changes in craniofacial growth and development. Electronic database searches of six databases were conducted, along with manual searches of retrieved abstracts and articles. RESULTS: Only one article was identified that met the selection criteria for the review. The article was a case report describing severe midface retrusion in 15-year old child associated with nCPAP therapy over a ten-year period. CONCLUSIONS: There is insufficient evidence to determine the association between long term nCPAP use and changes in craniofacial growth and development in pediatric patients. The mechanisms, relative risks, and potential consequences of midface hyploplasia associated with long term nCPAP use in growing pediatric patients are discussed.
CFAO Graduate Student Posterboards University of Alberta THE VALIDITY AND RELIABILITY OF MIXED DENTITION ANALYSIS METHODS: A SYSTEMATIC REVIEW Authors: Luu, N.S.*, Kaipatur, N. Faculty Advisors: Flores-Mir, C.F., Major, P.W. OBJECTIVES: The purpose of this systematic review was to determine the best technique to perform a Mixed Dentition Analysis with regards to validity and reliability as well as any relevant factors which could influence the prediction. METHODS: Papers were indentified from a search of seven online databases and evaluated based on technique modality: study models alone, radiographs alone, or combinations of study models and radiographs. RESULTS: 460 papers were identified and ultimately distilled to 32 papers after application of specific inclusion criteria. CONCLUSIONS: Our findings indicate that all mixed dentition analysis techniques and modalities have high reliability. All modalities have positively correlated validity, but there appears to be no difference in terms of overall validity between modalities. The predictions based on combinations of study models and radiographs have the lowest variability in overall validity; radiographs alone have higher variability in overall validity; study models alone have the most variable overall validity. Dimorphisms based on ethnicity, jaw, gender, or side do not appear to have any meaningful influence on the validity of mixed dentition analysis methods.
perspective were identified, selected, and assigned methodological scores. RESULTS: A total of 36 articles met the inclusion criteria. Layperson preferences and sensitivities were determined for tooth shape, tooth wear, midline deviation, incisogingival display, smile arc, buccal corridor, incisor angulation, incisor-tolateral step, overbite, diastema, tooth size, and tooth proportion. CONCLUSIONS: Some of the conclusions are that laypersons do not discriminate tooth shapes when displayed on female models, but prefer square-round incisors and flat canines (when paired with round incisors) in male models. Laypersons can detect dental midline deviations of less than 3.0 mm but when intentionally made aware of midlines, prefer midlines that are coincident with each other and the facial midline. Laypersons prefer unworn dentitions, zero gingival display and minimal buccal corridors. There appears to be aesthetic range of incisogingival display that laypersons tolerate, from 2.0 mm maxillary central incisor coverage to 2.0 mm maxillary gingival display. Laypersons are able to detect variations in crown width or height among individual teeth, especially if the variation is unilateral. Further studies are required to validate conclusions that were based on limited studies.
University of Alberta WHAT ARE LAY PUBLIC’S FRONTAL DENTOFACIAL AESTHETIC PREFERENCES? A SYSTEMATIC REVIEW Authors: Matthew Witt*, Mohammed Korayem, Carlos Flores-Mir AIM: The objective of this review is to evaluate the magnitude of aesthetic impairment that the general public is able to discern. METHODS: A systematic computerized search of electronic databases was undertaken in Medline, Pubmed, EMbase, Cochrane Library and Web of Science until April of 2009. Abstracts of the retrieved results were scrutinized by two independent reviewers and papers that investigated variables that impact anterior dental aesthetics from the layperson’s
Thanks to GAC for their support of the CFAO Posterboards Spring 2010 • CAO Bulletin
15
CFAO Graduate Student Posterboards University of Manitoba RELAPSE OF THE LOWER INCISORS POST ORTHODONTIC TREATMENT: WHEN IS RE-TREATMENT PERCEIVED AS CLINICALLY NECESSARY, ACCORDING TO DENTAL PROFESSIONALS? Authors: Dr. Christie Laberge*, Dr. William Wiltshire, Dr. Doug Brothwell, Dr. Igor Pesun INTRODUCTION: Relapse is defined as the return, following correction, toward the pre-existing condition and presents mainly as mandibular anterior re-crowding post orthodontic treatment. The purpose of this study was to examine the perception, importance, necessity and desirability of various perspectives regarding the subjective need for orthodontic re-treatment among dental professionals.
recommendation for re-treatment between mild and severe cases, as well as between moderate and severe cases (p < 0.001). Orthodontists in both groups recommended re-treatment between mild and severe cases and between moderate and severe cases (p < 0.001). Orthodontists in group 1 recommended re-treatment for mild and moderate cases (p < 0.05), however, orthodontists in group 2 had no significant difference between the recommendation for re-treatment between mild and moderate relapse cases (p > 0.05). Orthodontists in group 1 recommended the need for re-treatment the most for all categories (p < 0.001). The dentists and orthodontists of group 2 were similar in their acceptance of mild and moderate relapse (p=0.794), whereas the orthodontists in group 1 recommended re-treatment significantly more (for mild and moderate relapse) than both dentists and orthodontists of group 2 (p < 0.05). Dentists recommended retreatment less than both orthodontist groups for severe relapse cases (p < 0.001).
METHODS: A questionnaire was distributed to orthodontists across Canada (Canadian Association of Orthodontist members) as well as to dentists registered with the MDA (Manitoba Dental Association). The orthodontists were randomly assigned to two different groups; they answered the questions based on the cases as being: 1) their own patients and 2) as transfer patients.
CONCLUSIONS: Both consistencies and variations between dentists and orthodontists were noted, as well as, between the two groups of orthodontists in regards to recommendations for re-treatment of relapse cases. Orthodontists were more critical if they perceived the work as their own.
RESULTS: Dentists and orthodontists found a significant difference between mild, moderate and severe relapse of the lower incisors (p < 0.001). Dentists recommended re-treatment similarly between mild and moderate relapse cases, however, there was a significant difference between the
University of Montreal MANDIBULAR MORPHOLOGY AND GROWTH RELATED TO HYPODONTIA AND RESPIRATORY DISTRESS IN SUBJECTS WITH PIERRE ROBIN SEQUENCE Authors: Christos Sideris*, Hicham El-Khatib, Claude Remise, Louise Caouette-Laberge, Pierre Rompré
What’s In A Name? That which we call a Discussion Forum by any other name would inform as sweet (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. Send your suggestion along with your name, phone number and e-mail to cao@taylorenterprises.com. The winner will be notified.
Pierre Robin Sequence (PRS) consists of a triad of distinctive symptoms that are expressed concurrently: micrognathia, glossoptosis – causing respiratory distress – and cleft palate. The hypothesis of this study is that mandibular morphology and growth in subjects with PRS varies with the severity of respiratory distress and mandibular hypodontia. The experimental group consisted of 32 patients with the nonsyndromic form of PRS (15 males, 17 females). Cephalometric tracings were performed at T1 (mean 7.8 years) and T2 (mean 12.6 years). Statistical comparisons were made using one-way ANOVA; the significance level was set at p< 0.05. Patients with PRS and mandibular hypodontia when com-
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CAO Bulletin • Spring 2010
CFAO Graduate Student Posterboards pared to those with PRS and normal dentition, have a shorter posterior cranial base (observed at T2 only), a shorter mandibular body, a larger ANB angle, a shorter lower facial height, a higher facial convexity, a higher A-B(HP) value and a longer Y-axis. All these clinical characteristics don’t normalize with growth. Patients with a severe respiratory distress compared to those with a mild respiratory distress observed at birth have a shorter ramal length and a higher gonial angle. These clinical characteristics are inexistent at T2. In conclusion, mandibular morphology and growth in subjects affected by PRS and mandibular hypodontia is different than those affected by PRS with normal dentition. This results in a more severe Class II jaw relationship that does not normalize with growth. In addition, the severity of respiratory distress observed at birth affects future mandibular morphology but only in a transitory manner.
University of Montreal PERIODONTAL EFFECTS OF SARPE : CLINICAL AND CONE BEAM COMPUTERIZED TOMOGRAPHY EVALUATION 6-Month Preliminary Results. Author:
Gauthier, Chantal, DMD*, Papadakis, Athena, BDS (Hons), FDS RCS (Eng), M.Sc., FRCD(C) Voyer, René, DMD, M.Sc., FRCD(C), Diplomate, American Board of Periodontology Paquette, Manon, M.Sc., DMD, M.S. Rompré, Pierre, M.Sc.
In skeletally mature patients, transverse maxillary deficiency can be treated with surgically assisted rapid palatal expansion (SARPE). Forces delivered by the expander produce areas of compression in the periodontal ligament, which could lead to alveolar bone resorption and possible changes in the attachment level. The aim of this prospective clinical study was to evaluate the periodontal effects of SARPE, by means of a complete clinical evaluation and Cone Beam Computerized Tomography (CBCT) evaluation. METHODS: The sample included 14 patients (5 males, 9 females), with a mean age of 23.0 y. ± 1.9 years (range: 16 y. 4 to 39 y. 7). All patients were treated using a bonded Hyraxtype expander and the mean expansion was 9.82 mm (7.5 12.0 mm). All patients had a one-year retention period. CBCTs were taken and periodontal charts completed at each time point: T0 (initial), T1 (6 months post-expansion) and T2 (1 year
post-expansion). RESULTS & DISCUSSION: SARPE seemed to have little detrimental clinical effects on the periodontium. Radiographic data demonstrated statistically significant changes: a significant decrease in the buccal alveolar bone thickness on most teeth, a significant increase in the palatal alveolar bone thickness on most teeth, a decrease in the buccal alveolar crest level of all canines and posterior teeth, and a tendency towards a decrease in the interproximal alveolar crest level on the mesial aspect of both central incisors. These changes could eventually have a significant clinical impact on the periodontium.
University of Toronto DEVELOPMENT OF A THREE-DIMENSIONAL IN VITRO MODEL SYSTEM TO STUDY ORTHODONTIC TOOTH MOVEMENT Authors: A.J. Heckler*, I.J. Pereira, P.J. Brooks, S-G. Gong, C.A. Simmons Few three-dimensional (3D) models exist to study cell and molecular regulation of orthodontic tooth movement (OTM). The aim of this work was to develop a 3D in vitro model to study mechanical loading of human periodontal ligament fibroblasts (hPDLF). METHODS: hPDLFs were seeded into fibrillar collagen gels constrained in culture wells. The viability, proliferation, and function of the hPDLFs were characterized over 14 days. hPDLF-seeded collagen gels were then cast in a device with movable end plates and subjected to static tensile, compressive, or no loading conditions. Cells were characterized within the model and the strain distribution was assessed. RESULTS: Within the well-based cultures, cell viability was uniform throughout the gel. The number of cells increased five-fold by D7 (p<0.05) and remained similar until D14. Collagen fibre alignment and the degree of contraction of released gels was highest in the D7 and D14 gels (p<0.05). In the 3D model, viability was greatest in hPDLFs subjected to tension (p<0.05). Finite element modelling of the 3D model predicted strain magnitudes of approximately 12% in both the compression and the tension cases. CONCLUSIONS: The collagen gel supports hPDLF proliferation, viability, and the emergence of a contractile phenotype, replicating the constrained condition of the human PDL in vivo. The 3D model mimicked PDL strains similar to those observed during OTM, and can be continued… Spring 2010 • CAO Bulletin
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CFAO Graduate Student Posterboards used for future studies to better understand the effects of OTM on PDL fibroblasts. SUPPORT: AAOF Center Award; Alpha Omega Foundation of Canada.
University of Western Ontario ARE SKELETAL AND DENTAL CHARACTERISTICS, AS WELL AS CERTAIN ASPECTS OF TREATMENT, RELATED TO BONY CONDYLAR CHANGES? Authors: Dr. Dolly Bharwani, Dr. Antonios Mamandras, Dr. Lesley Short, Dr. John Murray, Dr. David Banting, Dr. Harinder Sandhu, Dr. Zach Williams* INTRODUCTION: Degenerative joint disease is mildly prevalent in a pre-orthodontic population and can contribute to jaw pain and skeletal relapse post-orthodontic treatment. PURPOSE: To determine whether craniofacial form or particular treatment modalities are related to TMJ condylar degeneration. MATERIALS AND METHODS: The cephalometric radiographs of 61 subjects with moderate-severe condylar degeneration (as diagnosed from panoramic radiographs) were traced and treatment factors were recorded. RESULTS: Cephalometric findings of significance in this study included increased facial convexity, increased ANB, decreased SNB, decreased Pg-NA perpendicular, increased mandibular plane angle, increased gonial angle, increased overjet, and upright lower incisors when compared to cephalometric standards. Treatment modalities of significant prevalence are orthognathic surgery and Class II or Cl III elastics. CONCLUSIONS: Results from this study are inconclusive without a control group but the following observations can be made: 1. The prevalence of moderate to severe TMJ condylar degeneration, in a pre-orthodontic population was 3.02% 2. Subjects with moderate to severe TMJ condylar degeneration demonstrated: a. Mandibular retrognathia b. Upright mandibular incisors c. Dolichofacial pattern and vertical growth pattern 3. Females are at higher risks for developing TMJ condylar changes than males 4. Subjects requiring orthognathic surgery may be at risk of developing TMJ condylar changes
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CAO Bulletin â&#x20AC;˘ Spring 2010
5. The use of Class II or III elastics may increase the risk of developing TMJ condylar changes
University of Western Ontario IN-VITRO COMPARISON OF THREE INDIRECT BONDING ADHESIVE SYSTEMS AND A DIRECT BONDING CONTROL Authors: Dr. Mitch Miller, Dr. Timothey Foley, Dr. Antonios Mamandras, Dr. Lesley Short, Dr. Amin Rizkalla, Dr. David Banting, Dr. Sherri Leung* PURPOSE: This in-vitro study investigated shear peel bond strength (SPBS), bond failure upon transfer tray removal, adhesive remnant index (ARI), and enamel fracture incidence for three indirect bonding adhesive systems 123 compared to a direct bonded control 4. MATERIALS AND METHODS: One hundred ninety-two human bicuspid teeth were arranged in acrylic bases mimicking human archforms, with four arches per group. Teeth were etched, bonded, stored for 100 days at 37°C, thermocycled and subsequently debonded with an Instron universal testing machine. RESULTS AND CONCLUSIONS: All adhesive groups demonstrated sufficient in-vitro SPBS values. Significant differences (p<0.05) were found among the four adhesive groups. The Direct and Light-Cured indirect groups had significantly higher bond strengths than the other indirect groups. The lowest SPBS values observed in all groups were clinically acceptable; however, the lowest values in the Sondhi and Thermacure groups less optimal. Two bond failures were noted upon transfer tray removal, one in the Sondhi group and one in the Light-Cured indirect group. ARI values showed the Direct group experienced mainly adhesive-bracket interface failures, while Indirect groups demonstrated cohesive bond failures, with a disproportionately high number of enamel-adhesive failures in the Sondhi indirect group. Despite having the highest SPBS, the Light-Cured group exhibited the lowest incidence of enamel fracture. 1
Sondhi (Transbond XT base, MIP primer, Sondhi Rapid Set A+B chemical cure adhesive)
2
Light-Cured (Transbond XT base, MIP primer, Filtek Supreme Plus flowable light-cured resin)
3
Thermacure (Thermacure base, Assure primer, FlowTain flowable light-cured resin)
4
Direct (Transbond XT with MIP primer)
Spring 2010 â&#x20AC;˘ CAO Bulletin
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Component Society Reports
British Columbia
Alberta
Dr. Rick Odegaard
Dr. Phil Williamson
[Email: dr.odegaard@shawcable.com]
[Email: drphil@telusplanet.net]
Following a survey of the membership, the BC Society of Orthodontists has contracted the Shupp Company of St. Louis to develop a proposal for a public media campaign. Members were queried as to the amount each would be willing to contribute as well as their opinion on the most effective form of media. The campaign is to focus on public education regarding the value in seeking the services of an orthodontic specialist.
The 2009-2010 Executive of the Alberta Society of Orthodontists (ASO) is comprised of Dr. Keith King as President, Dr. Mike Bleau, as Vice President and Dr. Cory Liss, as Secretary-Treasurer. The ASO Annual Scientific Meeting was held in Banff on March 5th and 6th, 2010 and featured Dr. Bill Proffit as the keynote speaker.
The graduate orthodontic program proposal at UBC has passed the Senate and is set to go before the Board of Governors for budgetary review. The program is accepting applicants for September 2010, with preference given to six-year PhD candidates. There will be three positions available per year. If any one of the three positions is not filled by a PhD candidate, then a three year Masters position will become available. A vote taken of the membership at the September 28th BCSO meeting resulted in an overwhelming lack of support for the Masters program.
The Alberta Dental Association and College (ADA&C) has developed Infection Prevention and Control (IPC) Standards in response to requirements set down by the Government of Alberta. In the draft document dated June 2009, the ADA&C has advanced the development of these standards beyond member input, with recommendations ranging from long overdue to overly excessive. At present, there is uncertainty as to the finality of this document or if further revisions are pending prior to final approval by the Minister of Health and Wellness and the ADA&C Council. By January 1, 2011, implementation of the Standards will be made upon final approval.
There is new legislation impacting the practice of orthodontics. The structure of the Harmonized Sales Tax (HST) has not been finalized, and the impact that this new tax will have on the profession remains unclear. Dentists and certified dental assistants will be required to maintain a minimum amount of continuous practice in compliance with the recently implemented Health Professions Act. The new regulations will be phased-in over two years. By March 1, 2010 CDAs and dentists must have 200 and 300 hours of continuous practice respectively within the previous three years in order to renew their registrations. The Canadian Association of Orthodontists and the Canadian Association of Oral and Maxillofacial Surgeons will be holding a joint Annual Scientific Session at Whistler B.C., September 23 – 25, 2010. Be sure your plane ticket says Whistler and not Kelowna before you head to the airport.
November 2009 marked the passing of Bill 53 by the Alberta Legislature impacting share ownership in professional corporations (PCs) within the Province. Bill 53, expected to be proclaimed into law on February 28, will allow spouses and children to own non-voting shares in Alberta PC’s and will allow family members to receive dividends, traditionally taxed at a lower rate than if paid directly to the professional.
Τhe University of Alberta Faculty of Medicine and Dentistry has been restructured under the leadership of the new dean. There are now eight schools of which Dentistry is listed as one. Dr. Paul Major has been appointed Lead, School of Dentistry; an equivalent to the dean of dentistry at comparable Canadian universities. Dr. Carlos Flores-Mir will assume the role of director of orthodontics with Dr. Manuel Lagravere and Dr. Tarek El-Bialy part of the orthodontic faculty. Dr. Major will continue to provide clinical teaching in the orthodontic graduate program and will continue with supervision of the graduate student research.
Finally, the BCSO website, www.canadabraces.ca/BCSO/, is now up and running. Please take a moment to check it out.
Spring 2010 • CAO Bulletin
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Component Society Reports Saskatchewan Dr. Ross Remmer [Email: dr.remmer@sasktel.net] The Saskatchewan Society of Orthodontists (SSO) held its annual meeting in October, 2009 with CAO President Gerry Zeit in attendance via Skype. In conjunction with the AGM, the inaugural Board meeting of the recently incorporated SSO took place in compliance with the new AAO component requirements. The small number of SSO members supported the incorporation through a levy specifically to cover the associated legal costs. As a side-note, discovery indicated that the Society had been incorporated thirty years ago but the corporate status had long since lapsed. The Society is investigating withdrawal from the terms of the Letter of Understanding between FNIHB Regina and the College of Dental Surgeons of Saskatchewan whereby all members of the College are obliged to accept direct reimbursement from ESI at a rate negotiated by the College. This relationship is contrary to the CAO recommendation that orthodontists deal directly with their patients not their patientsâ&#x20AC;&#x2122; insurers. FNIHB has yet to respond to the SSO letter of intent.
Manitoba Dr. Susan Tsang [Email: s_tsang2@hotmail.com]
The Fall Manitoba Orthodontic Society (MOS) dinner meeting was held November 5th, 2009 where it was decided to discontinue the group Yellow pages advertisement in favour of other forms of advertising, including a stronger presence on the world-wide-web. The potential for organized delivery of pro-bono care to underprivileged children, augmenting the treatment that is currently provided at graduate orthodontic clinic at the University of Manitoba was also discussed. Compiling bylaws, as required for the AAO Affiliation agreement, are also underway. Budget cuts at the University of Manitoba and the Faculty of Dentistry had the potential to put an end to the dental outreach programs. To prevent the closure of dental clinics for the underserviced populations of Manitoba, the Manitoba Dental Association passed a by-law at their January 2010 Annual General Meeting earmarking a levy of five hundred
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CAO Bulletin â&#x20AC;˘ Spring 2010
dollars to the license fees of all Manitoba dentists to fund the deficits of these outreach programs. Congratulations to Dr. Babette Cohen for being named as the Vice-President of the Midwestern Society of Orthodontists.
Ontario Dr. Helene Grubisa [Email: drgrubisa@sympatico.ca]
A new regulation has been recently passed by the Royal College of Dental Surgeons of Ontario (RCDSO) concerning small field of view (i.e. less than 8 cm) cone beam CT systems. This regulation has now been forwarded to the Ministry of Health for approval, expected early in 2010. When the regulation takes effect, any dentist in the province (specialist or generalist) will be able to own and operate a small field machine after they have successfully completed a minimum two-day university-based training course (details to be finalized). Upon acquisition of an image volume the dentist will be responsible for a formal written report of the findings entered into the patientâ&#x20AC;&#x2122;s chart. A second regulation for large field of view will be completed in due course. Dr Ernie Lam, Head of Radiology at the Faculty of Dentistry, University of Toronto, informed the Ontario Association of Orthodontist Executive that risks of ionizing radiation are higher with cone beam CTs for children than for adults and that the risks from CTs are higher for the entire population than originally thought. The new infection control guidelines based on the precautionary principle were approved with a strong majority at the Nov. 2009 RCDSO Council meeting. Effects on orthodontic practice include a requirement that all surgical instruments (i.e. for the placement of TADs) and infrequently used items be bagged and sterilized. The RCDSO has deferred to the operator to assess each situation individually and to apply the approved guidelines as recommended. The public relations campaign is a go with digital media, social networking and print creatives from mid April until the end of July. The print campaign in Canadian Family will have the AAO and the OAO banners incorporated. The October 2009 GLAO meeting in Toronto was a success, yielding the largest registrant turn-out since 1996; a testimonial to the hard work of the organizers and the contributors.
Component Society Reports Quebec Dr. Jean-Marc Retrouvey [Email: jmretrouvey@videotron.ca] The Association des Orthodontistes du Quebec had the opportunity to hear Dr. David Sarver present ‘Contemporary Orthodontics: The Role of Appearance and Esthetics in Diagnosis and Treatment Planning’ on October 16, 2009. While the meeting was well attended and the presentation first rate, the ‘piece de résistance’ took place that evening when the ADQ held its first ever ‘Gala Bénéfice’ in support of the Sainte-Justine and the Montreal Children’s Hospital Foundations. By the evening’s end, $82,000 had been raised by the ADQ members for these two very worthwhile causes. The ADQ volunteers, buoyed by the success of this year’s event, are already hard at work planning for next year. It’s amazing what
can be accomplished when the orthodontists of Quebec pull together. In November Dr. Neal Kravitz gave an informative presentation on iBraces, indirect bonding and micro anchorage. On January 29, 2010, the Alumni of the Université de Montréal invited Dr. Emile Rossouw, then Chair of orthodontics at Baylor University to speak on clinical applications of the SPEED appliance. Dr. Antonio Secchi will speak next at the ‘Journées Paul-Geoffrion’ where he will present the ‘Marriage between Classic Mechanics and Modern Straight Wire Self Ligating Appliance to Achieve Excellent Clinical Results.’ The Jounrées Dentaires Internationales du Québec will take place May 31, 2010, with the CAO President Dr. Gerry Zeit updating the membership at the Quebec AGM the night before. The Executive of the ADQ, speaking for the entire membership, voiced concerns regarding the newest Invisalign production requirements in that, according to legal counsel of the Ordre des Dentistes du Quebec may present as a breach of continu…
Spring 2010 • CAO Bulletin
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Component Society Reports trust between the patient and the provider. A potential conflict of interest between the orthodontists and the patient may also be present if the orthodontist is forced to consider Invisalign over a comparable modality in order to satisfy the company’s requirements and to keep his or her ‘certification’ current. A letter was sent to Align Technology by the ADQ to voice concerns with regards to the legality of its current practice policy. ADQ members have been requested to refrain from signing the ESI agreement that promotes ‘preferred provider’ status among its subscribers. The potential for ESI to have unprecedented powers and to ultimately control the delivery of care to aboriginal patients is a cause for concern. Orthodontists providing treatment to First Nations patients are recommended to invoice as per usual, without an agreement with ESI. The 2009-2010 ADQ Executive is Dr. Rejean Labrie, President, Dr. Geaoge Papanastasoulis, President-Elect, Dr. Fanny Brousseau, Secrétaire, Dr. Luigi Di Battista, Treasurer, Dr. Florence Morrison, Archivist, Dr. Martin Rossoueau, Member-at – Large, Dr. Catherine Jomphe, Past-President, Dr. Athena Papadakis, NESO Representative and Dr. Sylvain Gagnon, ODQ Representative. Drs. Cedric Cardona, Chantal Gauthier, Oliver Quintin and Chritos Sideris are the 2009 graduates from the Université de Montréal; best wishes in their new career.
Rapport de la province de Québec Les orthodontistes du Québec ont eu le plaisir d’écouter le Dr David Sarver le 16 Octobre 2009. Le sujet de cette conférence était: « L’orthodontie contemporaine: le rôle de la physionomie et de l’esthétique dans le diagnostic et dans l’établissement du plan de traitement ». Bien que la conférence ait été très intéressante et que nombre d’orthodontistes québécois se soient déplacés pour écouter le Dr Sarver, le clou de la journée fut sans contredit le premier gala bénéfice de l’AOQ, organisé pour venir en aide aux fondations de l’Hôpital Sainte Justine et de l’Hôpital pour Enfants de Montréal. A la fin de la soirée, la rondelette somme de 82 000$ avait été amassée pour supporter ces deux importantes fondations québécoises. Un événement extraordinaire qui devrait se répéter dans le futur. L’AOQ peut être fière d’avoir créé et organisé un tel événement. Elle a suscité un vif enthousiasme auprès de ses membres et le taux de participation a largement dépassé ses attentes. Au mois de novembre, le Dr Neal Kravitz a présenté une conférence sur les « ibraces », la méthode de pose indirecte
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CAO Bulletin • Spring 2010
des boîtiers orthodontiques et les micro implants. Puis, au mois de janvier 2010, Dr Émile Roussow, le directeur du département d’orthodontie de l’université Baylor, fut invité par l’association de diplômés en orthodontie de l’Université de Montréal. L’utilisation clinique des boîtiers de type Speed était à l’ordre du jour. Dr Antonio Secchi sera l’invité des “Journées Paul Geoffrion” le 31 mai prochain pour présenter: “Le mariage entre les mécaniques classiques et les boîtiers autoligaturants dans l’excellence des résultats cliniques. Le président de l’ACO, le docteur Gerry Zeit sera présent afin de mettre au courant tous les membres québécois des derniers développements au sein de leur organisation nationale. L’exécutif de l’AOQ, au nom de tous ses membres, s’interroge au sujet des nouvelles exigences de la compagnie Invisalign qui, de l’avis de l’ordre des dentistes du Québec, pourraient être un élément de litige entre le patient et l’orthodontiste. En exigeant d’un orthodontiste un nombre minimum de cas afin de conserver sa certification, l’indépendance du praticien face au choix de de traitement à proposer à son patient pourrait être compromise. Une lettre a été envoyée par l’AOQ à la compagnie Invisalign pour l’informer de la position de l’organisation quant aux nouvelles exigences de la compagnie. Les membres de l’AOQ ont aussi été avisés de réfléchir au bien fondé de signer l’entente de “preferred provider” avec ESI. Cette entente pourrait donner à ESI des pouvoirs importants ayant le potentiel d’engendrer la prise de contrôle par cette organisation des traitements orthodontiques prodigués à la population aborigène. L’exécutif de l’AOQ pour 2009-2010 consiste en: Dr Réjean Labrie, président, Dr George Papanastasoulis, président élu, Dre Fanny Broussean, secrétaire, Dr Luigi Di Battista, trésorier, Dre Florence Morrison, archiviste, Dr Martin Rousseau, membre invité, Dre Catherine Jomphe, présidente sortante. Le Dre Athéna Papadakis est la représentante du NESO tandis que le Dr Sylvain Gagnon est le représentant auprès de l’Ordre des dentistes du Québec. Les Drs Cédric Cardona, Chantal Gauthier, Olivier Quintin et Christo Sideris sont les gradués de l’année 2009 de l’Université de Montréal. Nos meilleurs vœux les accompagnent dans leur nouvelle carrière.
Component Society Reports ORTHODONTIST
Atlantic Report
We are booming!
Dr. Stephen F. Roth [Email: stephenfroth@mac.com]
The Atlantic Orthodontists Association (AOA) held a special meeting during the NESO Annual Session in New York City in November 2009 to accept the proposed NESO affiliation agreement. Legal council has informed the AOA of new laws for the incorporation of non-profit organizations in Canada, and has advised postponement of incorporation until early 2010. Other provincial associations may want to explore these laws further if they have not already incorporated. The AOA is appreciative of the CAO’s assistance in setting up an association website, and is continuing to attend to the details before ‘going live.’ A special thank-you is extended to Dr. Amanda Maplethorp for all of her efforts. The AOA is holding its annual session, this year a return to the simple ‘dinner meeting’, May 14th, 2010 in Halifax, Nova Scotia. Arrangements have been made with 3M Unitek to confirm speakers for the following day.
High-end, dental office in the South West of Calgary is looking for an experienced orthodontist. Current owner is returning to school. Annual orthodontic billings are in excess of 1.5 million in annual revenues on a 3 day per week schedule. Looking for an Associate that could move into a Partnership based on assimilation into the culture. The candidate is committed to ongoing education and growth within the industry. Practice utilizes a passive self ligation system and extracts mainly for facial esthetic reasons. Approximately 50% of patients are adult orthodontic cases and we are focused on facial esthetics and healthy stable occlusion.
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Gerry Wants YOU To Join As you may or may not be aware, we have a new Discussion Forum. If you have not yet joined, this article is aimed at you. It is a step by step description of how to register. The Discussion Forum is located on the CAO Website www.canadabraces.ca in the Members Only section. If you click on CAO Discussion Forum !NEW! you will enter the new forum. To register click on the word REGISTER located in the top right corner of the page. After you click on Agree to These Terms, you will go to a page that asks for a username, e-mail address and a password. In addition, you will be asked for language and time zone. Finally, you will be asked to copy the confirmation code. IMPORTANT, do not hit Refresh Code or Reset, simply click on Submit. Congratulations, you are now registered. We hope you will now be an active participant in all matters of orthodontics discussed on our new forum.
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CAO Bulletin â&#x20AC;˘ Spring 2010
From the Editor
Dr. James Posluns [Email: james.posluns@utoronto.ca]
Things That Make You Go… Arrggh!
glasses and the haircut. The film itself isn’t about violent retaliation; it’s about reacting to all the little things in life that drive one nuts. I can think of just a few examples. I have a Blackberry communication device. For the privilege of having this item of convenience, I get to send Bell Mobil-
I started to go to the movies by myself a few years back. (Not the ones Pee-Wee likes; the real kind, Hollywood stuff). Whenever I’d get a free night, I’d sit in the dark, eat a bucket of popcorn and see something I really wanted to see. One movie that stuck with me was the 1993 neo-classic Falling Down starring Michael Douglas. The main character is a dorky middleaged male with glasses and a bad haircut. In the opening scene, he’s sitting in his boiling-over Chevette, stuck in a line of traffic when he decides enough is enough. He walks away from his car amid a symphony of horns and shouting. From there, he goes on a rampage through the city dealing with frustration and pettiness the way I suspect we all would want to, but can’t. There are number of memorable yet all-too-familiar scenes: The shopkeeper who won’t give change unless a purchase is made, the fast food restaurant that won’t serve breakfast because its one minute past ten-thirty, the street punks who try over and over to intimidate. Watching it, one can’t help but have an eerie feeling of déjà-vu.
ity multiple hundreds of dollars every month. Lately, my poor old Blackberry stubbornly refused to accept email like it promised it would. Four telephone calls and hours of explanation later to Employee Number 136578 that ‘No it wasn’t my battery and yes I’ve spoken with the IT people at U of T, it took a visit to The Bell Centre to be told that nothing could be done in-house. I needed to call 1-800-341-Bell and was then pointed in the direction of the telephone in the corner. Arrgghh!!
I’m more of a boy-meets-girl, boy-losesgirl, boy-wins-girl-back type of film fan, but Falling Down is relatable beyond the
Another example: I needed a Canada Post Express Envelope of a specific size. Like an idiot, I left this very important pur-
chase to the very last minute and travelled to a large Toronto post office under the assumption that this endeavour was a slam-dunk. Upon inquiring about the envelope in question, the pony-tailed Jerry Garcia lookalike behind the counter replied that they didn’t have any. No apology, no alternate suggestion; just that they were out. I, perhaps unjustly, asked “If this establishment is in fact a post office how is it possible that it could be out of envelopes?” The counter-dude simply replied that they had a right to be sold out, complete with an unmistakable patented ‘sucks to be you’ tone to his voice. Double Arrgghh! One more example, before I get to how this all relates to orthodontics. (Believe me when I say that writing this really helps!) I was riding my bicycle to the university on a cold February morning. As a year-round cyclist, I don’t believe that I am saving the world, but I do believe that by leaving the car in the garage every morning, under the guise of common sense, certain laxities with respect to the rules of the road apply. I approached the three-way stop at McCaul and Baldwin with caution, and in seeing no cars or trucks stopped at the intersection, proceeded to turn left as I have done countless times before. Out of the shadows emerged Toronto’s finest, lights ablaze and siren a-wailing. I turned and pointed to myself as if to say “Who? Me?” while unmistakably being shown to the curb. Upon receipt of the $110.00 ticket, I offhandedly inquired as to the three cyclists who barreled through the same intersection whilst being pulled over, only to be told “We can’t stop you all.” Triple Arrgghh! All of these examples are true and continued… Spring 2010 • CAO Bulletin
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represent a mere single day in the life, but now it’s; time to talk orthodontics. Two weeks ago, my office was in the process of closing up for the night. My last appointment, a retention patient, failed to show so at fifteen minutes past five, I gathered up my long johns and pulled out my bike. As I ducked my head in to say goodbye, I noticed a young man at the counter. I looked at him and he looked at me, but neither of us spoke. He looked familiar, but then, so do a lot of people. After he left, I inquired. The receptionist said he was my last patient and because he was late, she rebooked him. I couldn’t believe it. I didn’t recognize him; I swear he grew a foot and a moustache in three months! But more importantly, I wonder what he was thinking. ‘The office is still open. The lights are on. It’s cold as blazes outside. I trudged all the way out to have my stupid retainer looked at and that jerk wouldn’t see me because I’m fifteen minutes late? Arrgghh!’ Frustration from the other side is just as frustrating.
caveman his dinner in exchange for a couple of rocks, the customer is always right. So the next time something so silly drives you absolutely around the bend, take it from me. Grab hold of the steering wheel; grip it as tight as you can and…. Stay the heck in the car! Have an awesome construction season boys and girls. Jimmy P
Lucky for me this one I could fix. A quick call to mom (his, not mine) and everything was right in the world. We all make mistakes. A great man (or woman) once said; Orthodontics is ten percent diagnosis, ten percent biomechanics and eighty percent customer service (or something like that). And in the service business, ever since one caveman delivered another
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CAO Bulletin • Spring 2010
May 1-4 . . . . . . . . . .AAO Annual Session, Hawaii
Diversions and Distractions Straight Shooters:
This Edition’s Puzzle:
Original creations by Your Editor Why did the veterinarian purchase a cone beam CT machine?
There were only four horses in the first race at the race meeting at Blueridge Moor, all ridden by amateur jockeys. From the clues given, can you fill in on the drawing the name of each horse, the name of its rider and the colors of his ‘silks’?
To locate impacted canines while his cat scan was on the fritz!
Clues:
Why did the groom decide to bond a bracket to his wedding finger? Because brackets are much less invasive and way easier to remove than bands.
Congratulations to Dr. Alan Bobkin and to Dr. Bruce Ross, each of whom submitted correct answers to the puzzle in the previous Bulletin. Look for a gift card to Indigo Books in the mail gentlemen! Answer to last edition’s puzzle:
1. Tony Nagg, whose silks were yellow and black, started somewhere to the left of White Surrey. 2. The rider of horse A wore red and green silks. 3. Nick Steed rode horse C, while his brother Mick rode his own horse, Thunderer; the silks worn by the Steed brothers had no colours in common. 4. Golden Bridle’s jockey wore the red and white silks. Horses: Coppenhagen; Golden Bridle; Thunderer; White Surrey Jockeys: Mick Steed; Nick Steed; Sam Dobbin; Tony Nagg Colors of Silks: blue/gold; red/green; red/white; yellow/black
1) Ice Cream 2) Leo, Age 9, Vanilla Ice Cream 3) Francis, Age 7, Chocolate Ice Cream 4) Steven, Age 10, Raspberry Ripple Ice Cream
[A]
[B]
[C]
[D]
Horse:
____________
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____________
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Jockey:
____________
____________
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Colours:
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At the CAO Educators meeting April 10th in Niagara on the Lake. The back Row L to R: Carlos Flores-Mir(Alberta), Billy Wiltshire (Manitoba), Bryan Tompson (Toronto), Silvano Brecevic (3M Unitek), Claude Remise (Montreal) The front row L to R: Don Robertson (CAO), Antonios Mamandras (Western Ontario), Richard Marcus (CAO), Gerry Solomon(CAO) Thanks to the generous support of 3M UNITEK for making this meeting possible.
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CAO Bulletin • Spring 2010