CANADIAN ASSOCIATION OF ORTHODONTISTS / ASSOCIATION CANADIENNE DES ORTHODONTISTES Your Smile is Our Specialty!
Bulletin Fall 2015
In this Issue… ■
■
■
■
Message from the President Message from the Outgoing President Highlights of the 67th Annual Scientific Session Special President’s Award Winner
■
Committee Reports
■
Component Society Reports
■
Outstanding Post Graduate Orthodontic Programs
■
Student Posterboards
■
CAO Member Honoured
■
In Memoriam
Canadian Association of Orthodontists Association canadienne des orthodontistes 2800 14th Avenue, Suite 210 Markham, Ontario L3R 0E4 Telephone (416) 491-3186 / 1-877-CAO-8800 Fax (416) 491-1670 E-mail cao@associationconcepts.ca Website www.yoursmileourspecialty.ca AND www.canadabraces.ca
2015/2016 Board of Directors OFFICERS President President Elect Past President 1st Vice President 2nd Vice President Secretary/Treasurer
Dr. Jean-Marc Retrouvey Email: Jean-marc.retrouvey@mcgill.ca
Times are changing…..Times have changed. When I was a general practitioner in the early eighties, I oftentimes had to call the only orthodontist in my region to request that he sees a patient for a consultation without delay. He replied that he had too many patients and that he had to turn down many of them, in effect, triaging the patients that would most benefit from treatment.
Dr. Jean-Marc Retrouvey Dr. Robert D. Kinniburgh Dr. Helene Grubisa Dr. Rick Odegaard Dr. Sheila Smith Dr. Michael Patrician
In the early 1990s I started practising orthodontics in the same region. By that time, the population had increased, but now there were three orthodontists in the area. All of us were busy and despite the fact that a few dentists provided orthodontic services to their patients, there were enough cases to go around. The orthodontists began to expand their scope of practice and treated more adult and compromised cases.
Dr. Gerald Philippson Dr. C. Todd Lee-Knight Dr. Michael Wagner Dr. Susan Tsang Dr. J. Eric Selnes Dr. Michel Di Battista Dr. Donald E. Johnston
In 2015 the picture of orthodontics has changed dramatically in this same region. A waiting list no longer exists. There is fierce competition among a greater number of orthodontists, the orthodontists are treating a greater proportion of complex cases, and in general, the younger members of the profession voice a level of frustration with this situation. To compound the problem, many general dentists now treat their patients using technologically-assisted modalities like 6 Months Smiles and clear aligners.
REGIONAL DIRECTORS British Columbia Alberta Saskatchewan Manitoba Ontario Quebec Atlantic
Message from the President
COMMITTEES President CFAO CAO/CDSA Liaison Insurance Committee
Dr. Stephen Roth Dr. Robert D. Kinniburgh Dr. Mike Wagner Dr. Don Johnston
Membership Committee
Dr. Todd Lee-Knight
Sponsorship Chair
Dr. Michael W. Patrician
WFO - Country Rep
Dr. Jean-Marc Retrouvey
WFO - Member-at-Large Conference Advisory Committee Chair New & Younger Members Rep CAO/AAO Liaison Planning & Priorities Communications Nominations Canadian Orthodontic Educators RCDC Liaison
Dr. Michael Patrician Dr. Howard Steiman Dr. James Posluns Dr. Rick Odegaard Dr. Jean-Marc Retrouvey Dr. Daniel Pollit Dr. Helene Grubisa Dr. James Posluns Dr. Thomas R. McIntyre
CAO Web Master Bulletin Editor Parliamentarian/Historian/Archivist CAO Helpline Task Force GST/HST Advisor
Dr. Daniel Pollit Dr. James Posluns Dr. Amanda Maplethorp Dr. Howard Steiman Dr. Michael W. Patrician
The traditional relationship between the dentist and the orthodontist appears to have changed. Less direct referrals come to the orthodontist via the dentist and the orthodontists are concerned. In response to this shift, commonly heard sentiments from orthodontists include ‘’we need to tell the patients that we are the best at delivering orthodontic care”, “we must educate the patients” and “my association does nothing for me!” Placing the blame on the association does not resolve the fact that the patients want a good product at a low price delivered in a convenient location. Patients have trust in their dentist and are compelled to initiate treatment in familiar surroundings when the product is available in the identical box at less cost. The role of the CAO may have to change. Greater representation at the dental regulatory association level may be required. At the moment, our concerns as specialists as general dentists expand their field of expertise may not be a priority to the regulatory bodies. But a change in this mindset will be extremely difficult. Continued…
FALL 2015 • CAO Bulletin
3
The orthodontists’ greatest opportunity may be via direct marketing. An effective strategy like the Consumer Awareness Program has defined the orthodontist as THE specialist for the creation of beautiful smiles. Effective communication tools that emphasize direct communication with the public are critical. Organized orthodontics must become the initial Internet site that the public accesses to obtain unbiased and relevant information. Hyperlinks that connect the public to the practitioner are key. The goal of an improved and expanded communication program is to position the orthodontic profession as the only location that patients access when making and inquiry into what orthodontics can do for them. At the same time, the value of the referral must be maintained. Orthodontists must continue to work with the general practitioners who value the speciality. Orthodontics is a rewarding profession and the CAO works on behalf of its membership to maintain the high standards of care all practitioners value. The ultimate goal of the CAO is for its members to be recognized by the public as the unique providers of quality orthodontic care. While it may not be possible, ideally all Canadian orthodontists would be members of the CAO and positively contribute to keep the association and the profession strong. I want to thank all the board members, past and present for their selfless contributions to the CAO and to the profession. It is indeed a privilege to be part of such a great group of dedicated people.
Message de la présidente sortante Les temps changent, les temps ont changé. Dans les années 80, au tout début de ma pratique de dentiste généraliste, il n’était pas rare que j’appelle le seul orthodontiste de ma région pour lui demander la faveur de recevoir un de mes patients le plus rapidement possible pour une consultation. Il se plaignait d’avoir une longue liste d’attente et d’avoir une charge de travail trop élevée. Il devait régulièrement refuser des patients potentiels et avait tout à loisir de sélectionner les patients qu’il souhaitait traiter sur la base des besoins ou de la motivation du dit patient. Au début des années 90, je suis retourné pratiquer dans ma région d’origine. La population locale s’était accrue et il y avait maintenant trois orthodontistes pour desservir la région. Nous étions tous très occupés malgré le fait que quelques dentistes généralistes prodiguaient des soins orthodontiques. Nous devions traiter plus de cas graves et de compromis. Nous devenions moins électifs mais la profession
4
CAO Bulletin • FALL 2015
se portait toujours bien. L’orthodontiste duquel j’avais acheté la pratique se plaignait que l’orthodontie n’était plus ce qu’elle était à son époque et que les temps changeaient. En 2015, l’image de la profession a dramatiquement changé. Finies les listes d’attente sécurisantes, une compétition féroce entre les orthodontistes pour les patients, des cas de plus en plus complexes, et un nombre croissant de jeunes gradués pour qui la pratique de cette magnifique profession est de plus en plus difficile. Les jeunes membres éprouvent beaucoup de frustration face à la vieille garde qu’ils perçoivent comme étant choyés et insensibles à leur cause. De plus, les dentistes généralistes se sont lancés à pieds joints dans le monde de l’orthodontie en offrant des traitements de moins de 6 mois et évidemment des traitements orthodontiques au moyen de gouttières d’alignement. Le dentiste généraliste observe un malignement dentaire chez son patient et s’empresse de prendre des empreintes pour l’envoyer à la compagnie d’aligneurs XYZ. Les gouttières de traitement sont retournées et il ne reste au dentiste qu’à remettre les gouttières au patient et voilà, le tour est joué. Le dentiste est content, le patient semble satisfait…. Seul l’orthodontiste se sent lésé. Mais qui s’en soucie? La relation privilégiée qui existait entre l’orthodontiste et le dentiste généraliste s’est détériorée au fil des ans. De moins en moins de patients nous sont acheminés via le dentiste et un climat de méfiance s’est peu à peu installé. “Il est impératif d’informer les patients que nous sommes les meilleurs quand vient le temps de fournir des soins orthodontiques !’’, “Nous devons éduquer les patients à cette réalité!”, “Notre association de fait rien pour nous!’’ sont des slogans que nous retrouvons de plus en plus fréquemment sur les médias sociaux. Malheureusement, faire reposer le blâme sur le dos de l’Association Canadienne des Orthodontistes ne résout pas le fait que les patients magasinent les prix et services de façon régulière. Les patients font d’abord confiance à leur dentiste et croient à tort ou à raison, particulièrement quand il s’agit de gouttières, qu’ils achètent un produit et non pas un service. Pourquoi payer davantage pour des gouttières semblables, présentées dans des boîtes identiques lorsque mon dentiste me ‘’vend’’ les mêmes gouttières à prix moindre? Le rôle de l’Association des orthodontistes du Canada sera appelé à changer sur ce sujet : un militantisme plus soutenu et une présence accrue au niveau des ordres professionnels est à l’ordre du jour.
À l’heure actuelle, nos inquiétudes ne semblent pas affecter particulièrement nos ordres professionnels provinciaux respectifs. Les dentistes généralistes étendent constamment leur champ de pratique via des cours de fin de semaine et des cours d’éducation continue qui leur promettent une expertise quasi instantanée. Ces cours mettent l’accent sur la nécessité de ne plus référer leurs patients et de les garder dans leur pratique pour maximiser les profits. Changer cette façon de pratiquer risque d’être très difficile pour tous les dentistes spécialistes dans le futur. .
Message from the Outgoing President Dr. Helene Grubisa Email: drgrubisa@sympatico.ca
Notre survie dépend peut-être de nos patients eux-mêmes. Le Consumer Awareness Program a contribué à rétablir la position de l’orthodontiste comme le vrai spécialiste dans le domaine de la réhabilitation orthodontique. Améliorer la communication en mettant l’emphase sur l’information directe à nos patients présents et futurs est une avenue activement exploitée par l’ACO. L’association Canadienne se donne le but de créer dans un avenir rapprochée une plateforme qui fournira de l’information professionnelle et non biaisée sur tous les sujets touchant de près et de loin l’orthodontie : le diagnostic, les traitements, les appareils, les conseils, Le but de ce programme de communication élargi est de rétablir et renforcer la position de l’orthodontiste comme le seul et unique spécialiste à consulter pour tous les besoins en orthodontie. La publicité négative n’est d’aucune utilité à long terme sauf peut-être pour exprimer ses frustrations légitimes via les réseaux sociaux . Nos meilleurs atouts consistent à continuer la collaboration avec les dentistes généralistes qui apprécient et valorisent les services que nous prodiguons à leurs patients tout en développant et améliorant nos rapports directs avec la population en général. Attendre passivement que les références des dentistes généralistes remplissent nos cabinets ne suffit plus. Notre profession est des plus gratifiantes. L’AOC, conjointement avec les diverses organisations de spécialistes dentaires travaillent d’arrache-pied à maintenir les plus hauts standards de pratique. Notre but est la reconnaissance ultime par le public des orthodontistes comme spécialistes et uniques pourvoyeurs de soins orthodontiques de qualité. Nous espérons que tous les orthodontistes canadiens se joindront à l’ACO et uniront leurs forces pour maintenir et promouvoir notre profession et notre association dans ces temps mouvementés. Je désire remercier chaleureusement tous les membres du conseil, anciens ou actuels pour leur support constant et généreux à l’ACO et à la profession.
A heartfelt thank-you goes out to fellow Board members this year as well as those in the last five years. I now understand clearly that the CAO president’s job and one’s presidential year is made much more pleasant and much more manageable when one belongs to a cohesive, knowledgeable team. My sincere thanks goes out to everyone who has taken the time to read reports, to take part in conference calls and to attend meetings on behalf of the members of this great organization. The portfolio which has dominated the majority of the airtime and correspondingly a good amount of money, is the Consumer Awareness Program (CAP). Sheila Smith has taken on this initiative and has been a formidable liaison between the CAO, AAO and Athorn-Clark. Sheila has kept us fully informed as to what the AAO is doing with their campaign all the while championing the Canadian market. There has been tremendous support for this initiative as a way of getting the specialists message out to the public and patients. The plan is to continue this campaign into future years, believing that longevity and repetition is the key to public “uptake” of our message. The GST/HST portfolio has taken a great deal of treasurer Michael Patrician’s time. There have been many rescheduled meetings between the treasurer and Canada Revenue Agency. Dr. Patrician and the accountants have been trying and continue to try to meet with CRA. The purpose of this meeting is to get answers to the questions raised by orthodontists as outlined in the GST/HST report as well as to reiterate the historical perspective of the CAO. In the upcoming year, I look forward to seeing Smiles4Canada reach out to members and to patients, as well as seeing how the AAO becomes more inclusive of orthodontists who are in a “non-traditional” style of practice. I am also excited about the AAO’s matching program for funding of the provincial associations’ contribution to the CAP. The more voices involved in getting our message out the better. But what I look forward to most is meeting new CAO members, greeting the new
C’est un privilège et un honneur de faire partie d’un groupe aussi dévoué et enthousiaste.
Continued…
FALL 2015 • CAO Bulletin
5
Message from the Outgoing President Cont’d. students and interacting with the new faces of the Board of Directors. I always include something from my kids in my messages to keep the message from being too serious. Since our two children were present at the Annual Scientific Session in Victoria (which was fantastic I might add) they had a lot to say about the meeting… My favourite comment was “Maman, why were you the only one who had to talk at the big party?” Followed by “Maman, do you usually get to dance when you go to work?” On that note, get involved in the CAO; who knows, you might end up CAO president in which case you can dance when you go to work!
Message de la president sortant Je remercie du fond du cœur mes collègues membres du conseil d’administration de cette année et ceux qui l’ont été au cours des cinq dernières années. Maintenant, je sais sans l’ombre d’un doute qu’il est beaucoup plus agréable et facile qu’il ne le serait autrement de composer avec le travail de présidente, et de passer une année à la tête de l’ACO, au sein d’une équipe unie et chevronnée. J’adresse mes remerciements sincères à tous ceux qui ont pris le temps de lire les rapports, de participer aux conférences téléphoniques et d’assister aux réunions au nom des membres de cette organisation remarquable. Le dossier qui a accaparé la majeure partie du temps, et une somme d'argent d'importance proportionnelle, est Le Consumer Awareness Program (CAP). Sheila Smith a adopté cette initiative et s’est révélée une agente de liaison extraordinaire entre l’ACO, l’AAO et Athorn-Clark. Sheila nous a tenus pleinement informés des faits et gestes de l’AAO entourant sa campagne tout en faisant la promotion du marché canadien. Cette initiative a reçu un appui fantastique à titre de mode de diffusion du message des spécialistes au public et aux patients. La répétition étant le gage d’« assimilation » de notre message, le plan consiste à poursuivre cette campagne au cours des prochaines années. Le dossier de la TPS/TVH a occupé une grande partie du temps du trésorier, Michael Patrician. Nombre de rencontres entre lui et l’Agence du revenu du Canada (ARC) ont été reportées. Le Dr Patrician et les comptables ont tenté, et
6
CAO Bulletin • FALL 2015
tentent toujours, de rencontrer l’ARC. Tel qu’il a été indiqué dans le rapport sur la TPS/TVH, ils cherchent ainsi à obtenir des réponses aux questions qu’ont soulevées les orthodontistes et à faire valoir encore le point de vue de toujours de l’ACO. Au cours de la prochaine année, j’espère voir la portée de Smiles4Canada s’étendre à l’ensemble des membres et des patients et de voir également comment l’AAO s’ouvrira à l’endroit des orthodontistes qui ont adopté un style de pratique « non traditionnel ». Je suis par ailleurs enthousiaste à propos du programme de l’AAO de doublement des contributions des associations provinciales au PSC. La réussite de notre message sera proportionnelle au nombre de voix qui l’exprimeront. Mais, ce qui suscite chez moi la plus grande expectative est la rencontre avec les nouveaux membres de l’ACO, l’accueil des nouveaux étudiants et l’interaction avec les nouveaux visages au conseil d’administration. Afin d’éviter que mes messages soient trop sérieux, je leur ajoute toujours un passage à propos de mes enfants. Étant donné que nos deux enfants étaient présents à l’Assemblée scientifique annuelle qui a lieu à Victoria, en septembre (et, je me permets d’ajouter, qui était fantastique) ils en avaient long à dire sur cette rencontre… Le commentaire que j’ai préféré était « Maman, pourquoi étais-tu la seule qui avait à prendre la parole à la grande fête? » Suivi de « Maman, est-ce que tu as l’habitude de danser au travail? » Dans cet esprit, je vous invite à participer aux activités de l’ACO; qui sait, vous pourriez peut-être en occuper la présidence? Auquel cas, vous pourriez danser au travail!
Holiday Greetings! On behalf of everyone at the CAO office, we wish all of our members a Happy Holiday and a Healthy and Successful 2016!
Kindly note that the CAO offices will be closed from 5:00 pm on December 23rd and will re-open on January 4th at 9:00 am.
Dr. Bryan D. Tompson is a career academic clinician who has guided the Discipline of Orthodontics at the University of Toronto for the past fifteen years. His dedication to the profession and his contributions to orthodontics in Canada are vast, varied and significant. Dr. Tompson, or Bryan as he is known to almost everyone, obtained his dental degree from the Faculty of Dentistry, University of Toronto in 1966. Upon graduation, he spent a year as a dental intern at The Hospital for Sick Children in Toronto. Bryan returned to the Faculty of Dentistry, University of Toronto, completing a Diploma in Paediatric Dentistry in 1969 and a Diploma in Orthodontics in 1970. In addition to private practice Bryan has maintained an association with the Faculty of Dentistry, University of Toronto from day one. He began his academic career as a demonstrator on the clinic floor, instructing in both the paediatric dentistry and the orthodontic departments. By 1971, Bryan was a half –time faculty member in orthodontics. Bryan rapidly ascended through academic hierarchy, first as an Assistant Professor, then as an Associate Professor. In 1991, Bryan became Head of the Division of Orthodontics at the Hospital for Sick Children. Ten years later, he assumed the comparable role in orthodontics at the Faculty of Dentistry, University of Toronto. During his time in academia, Bryan has been a consistent contributor to the field. He has supervised the theses and guided the scholarly work of more than sixty residents, has published numerous articles, contributed to a number of book chapters and has presented both nationally and internationally on orthodontics and craniofacial anomalies. In 2013, Bryan was recognized by the University of Toronto as an Alumnus of Distinction for his outstanding contribution to dental education. In 2015, Bryan officially retired as Discipline Head of Orthodontics at the University of Toronto, however he will continue to contribute as an instructor in the graduate clinic on a regular basis. While a dental student, Bryan found fame as a forward with the Varsity Blues hockey team, and remains an expert on the game today. He is also an accomplished alpine skier and names Aspen Colorado as his destination of choice. On most weekends, Bryan heads north to his family cottage in Muskoka, Ontario where he fixes, improves and builds things. The Board of Directors of the Canadian Association of Orthodontists extends its heartfelt congratulations to Dr. Tompson for his tireless dedication and outstanding contribution to orthodontic education over the course of more than four decades. -Dr. Jim Posluns
FALL 2015 • CAO Bulletin
7
Beautiful room at the Empress, ready for the CAO!
Highlights of the 2015 An
Greeting friends at the Welcome Reception
A Round Table session
Auxiliary Sessions were well attended
8
CAO Bulletin • FALL 2015
New and Younger Members’ Luncheon
Dr. Hister was entertaining
Asking Questions
nnual Scientific Session!
Passing the Gavel
Thank you to Dr. Solomon
McIntyre Lecturers
Enjoying an Alumni Reception
Having Speakeasy fun!
Checking out the Exhibits
FALL 2015 • CAO Bulletin
9
President’s Banquet
10
CAO Bulletin • FALL 2015
Highlights of the 2015 Annual Scientific Session!
Past Presidents and Officers of CAO
2015/16 Board of Directors
Prize Winners:
U of T contingent
Learning at Round Tables
Monica Choi Pacific West Dental Group Bose Soundlink Speaker Donated by: CAO Caitlin Bruce Dr. Andrew Woo Kobo Glo Donated by: CAO
Dr. Manuel Lagravere Dr. Austin Chen Opal Whitening Kit Donated by: Ortho Essentials Dr. Robert Drummond Dr. Sunjay Suri Dr. Rick Odegaard Ortho Pulse Donated by: Biolux Research Dr. Jay Philippson
Dr. Crystal Riley Nepresso Machine Donated by: 3M Oral Care
50/50 Draw Proceeds donated to Raincoast Conservation Authority
Lots of business being done on the exhibit floor
FALL 2015 • CAO Bulletin
11
THANK YOU TO OUR 2015 CAO ANNUAL SCIENTIFIC SESSION SPONSORS
12
CAO Bulletin • FALL 2015
CAO MEMBER HONOURED
I N M EMORIAM Dr. John Fasken Dr. John Fasken passed away August 23, 2015. Dr. Fasken was a popular, respected and well-loved orthodontist in Oakville Ontario, where he practiced for over 37 years. He was also held in similar esteem at the Faculty of Dentistry, University of Toronto where he was a clinical instructor in the graduate clinic for many years. Paired with Brian Hurd and eventually Sunjay Suri every other Tuesday, Dr. Fasken consistently provided residents with solid practical clinical advice that is so critical when one is developing his or her life-long decision-making skills. John was an avid skier, amateur chef and beloved joke-teller. Always one to relay an interesting or entertaining story, he will be greatly missed by all. “One more fish upsets the barrel!”
Dr. Hermann Lee Winnipeg, MB
Congratulations go out to Dr. Hermann Lee, from Winnipeg, MB, who was bestowed the highest provincial honour of Order of Manitoba. “Recognizing Individuals who have demonstrated excellence and achievement in any field of endeavour, benefitting in outstanding manner the social, cultural or economic well-being of Manitoba and its residents”. Dr. Lee was presented his award in May 2014 at a ceremony attended by Their Royal Highnesses the Prince of Wales and the Duchess of Cornwall. Dr. Lee has already been honoured with a Queen’s Diamond Jubilee Medal in 2012, and his commitment to his profession and his volunteerism within the community has continued. Dr. Lee has a private practice in Winnipeg, teaches at the University of Manitoba and has even served as CAO Conference Photographer in the past!
Dues Assessment for 2016: What You Need to Know! The original CAO Consumer Awareness Program (CAP) expenditure was planned for a duration of three years. A survey of the membership, completed in 2014 indicated that a dues assessment of up to $350.00 was acceptable to cover this expenditure. The 2014 and 2015 CAP expenditures were taken from current CAO reserves. For 2016 only, the annual dues will increase $10 to $645 plus HST. In addition, an assessment of $200.00 plus HST will be added to the annual dues for a total of $845 plus HST. These fees will permit the CAO to clear the balance of the three year CAP expenditure by the end of 2016 and to build up reserves for an ongoing CAP should the Board decide to continue with the program. The Board anticipates that it will continue with the CAP into the future. The AAO has recently increased its funding initiative to assist the CAO in continuing with this program. It is for this reason that the Board has decided to determine the extent of upcoming assessments for 2017 and 2018 at that time. The assessments due for each member will follow the protocol already approved by the Board.
FALL 2015 • CAO Bulletin
13
Committee Reports
Treasurer’s Report
Insurance Report
Dr. Michael Patrician Treasurer
Drs. Mike Wagner & Don Johnston Co-Chairs, Insurance Committee
Email: drpatrician@bellnet.ca
Email: insuranceenquiries@cao-aco.org
As of June 30, 2015, the CAO general operations and the Scientific Session generated net income of $ 102,459.80 and $204,107.76 respectively for a combined net revenue of $306,567.56. The total member's equity is $863,973.55 and the total current assets stand at $902,028.65. The December 31, 2014, auditor's report stands in agreement with the CAO books prepared for and held by Association Concepts. To date, the general operations are proceeding as planned. A decrease in net operating income is expected by year end, principally due to the expenditure for the Consumer Awareness Program (CAP). The original CAP expenditure was planned for three years. The survey completed in 2014 indicated that a dues assessment of up to $350.00 was acceptable to the membership to cover this expenditure. The 2014 and 2015 CAP expenditure will be taken from the current CAO reserves. The 2015 dues were increased by $20.00 to $635.00 plus HST partly in response to the anticipated costs of the CAP, in addition to the costs associated with future website re-development. In 2016, the annual dues will increase $10 to $645 plus HST. An assessment of $200.00 plus HST is anticipated that will be added to the annual dues in 2016 for a total of $845 plus HST permitting the CAO to clear the balance of the three year CAP expenditure by the end of 2016 and to build up reserves for an ongoing CAP should the Board decide to continue with the program. The Board anticipates that it will continue with the CAP into the future because of the potential benefit to all Canadian orthodontists. The AAO has increased its funding initiative to assist the CAO in continuing with this program.
The Insurance Committee has been active over the past several months responding to member enquiries ranging from simple enquiries, to issues requiring much more detailed investigation and intervention. The Committee has also working towards the establishment of electronic pre-determination of orthodontic benefits. At present, the Committee is negotiating with Benoit Soucy at CDA and Karen Voin at CLHIA (Canadian Life and Health Insurance Association). The aim of the project is to translate the current CAO predetermination and claims process to EDI within the CDAnet framework and to be ready for beta testing in 2016, followed by full implementation by 2017. The final hurdle is to come up with a procedure for handling parts of the form which does not exist within the CDANet framework. The CAO does not advocate the use of codes under any circumstance so the Committee is looking for an alternate approval process as a means of describing the orthodontic condition. Despite what the membership may have heard from third-party organizations the Committee is sensitive of, and taking every possible step to, protect the current methodology of orthodontic practice. With any new implementation there will always be concern – please have faith in the Committee’s position and progress. Please contact your local provincial representative or one of any member of the Committee directly should there be any confusion on acceptable insurance practice. This Committee will dispel any myths heard from any third party that is not directly involved with this project. Moving forward, the Committee appreciates the continued support of the membership as it continues to adapt to the future for the betterment of the profession.
FALL 2015 • CAO Bulletin
15
Committee Reports CAO/AAO Report Dr. Rick Odegaard CAO/AAO Liaison Email: dr.odegaard@shawcable.com The most recent CAO/AAO liaison meeting was held in San Francisco California, on May 17, 2015. A resolution had been put forth at the AAO House of Delegates General Chairs Meeting to support component societies, individual states and individual provinces in dealing with issues affecting the orthodontic specialty. Lee Erickson and Richard Marcus were concerned that including the provinces may be problematic because there are differences in political systems between the US and Canada when it comes to lobbying and that such a resolution would include advocacy that is not included in Canadian dues. The initial wording of the resolution is as follows. “Be it resolved that a centralized legislative network be developed by the board to improve the ability to assess emerging issues, to share information between components within the US and to act as necessary”. The latter part of the resolution describes the ability to act on issues. The CAO may not have the ability or the infrastructure to act on such issues. The first version did not present Canadian interests. An alternative resolution for consideration by the CAO was presented. Canadians would be involved early on with respect to emerging issues, thereby permitting the CAO access to information. The CAO would then have the opportunity to act on the information while not preventing the CAO from approaching the AAO for assistance. The 2015-16 AAO Consumer Awareness Program plans for a greater presence using same tag line. The “My Life My Smile” website continues to evolve. The plan is to maintain some of the artistics while creating a number of new ones. The newest campaign rolled out this past June has resulted in a significant increase in traffic to the website. An investigation into trademarking the phrase “healthy, beautiful, smiles” is currently underway, as is the US translation into Spanish. In light of the success of the campaign, the potential for a levy increase next year remains a possibility. Metrics in the US market indicate that over the last four years, 60 percent of orthodontic care involving aligners, and 85 percent of fixed appliances in adults was done by orthodontic specialists.
16
CAO Bulletin • FALL 2015
The numbers are holding steady since 2010. It is felt that these results are a positive sign, that the message delivery is solid and the public is beginning to comprehend the specialists’ message. An online petition concerning the actions of the AAO has been started by Ben Burris, an orthodontist in the US. Chris Vranas responded with a letter to the membership offering reassurance that the AAO continues to act in the best interest of the membership. The postings to this petition are controlled by Dr. Burris and what he puts out is read by orthodontists at large. The AAO has responded by reaching out to its members, by strengthening its message and by verbalizing its value of membership. Currently greater than 99 percent of statements sent by the AAO are renewed. The new and younger member component continues to be strong and there has been a 60 percent increase in student membership through greater involvement with students outside of North America. Currently there are 73 orthodontic programs in the US of which 65 are associated with dental faculties. The AAO has plans to improve its communication with Canadian residents in American orthodontic programs. Recognizing that newer graduates may not want the responsibilities of solo practice or of associateship, the AAO has struck a task force to assess and to engage the orthodontists practicing in a corporate setting. The AAO has met with three of the largest corporate dental providers. The providers are seeking legitimacy from the AAO while the AAO desires advocacy on their behalf. While the AAO recognizes that some members may react negatively to the inclusion of corporate dental providers, the inclusive nature of this approach has the potential to prevent an autonomous group from starting up.
CAP Report Dr. Sheila Smith Email: stuart.smith4@sympatico.ca The Consumers Awareness Program (CAP) will have both a television and a digital presence this year. The CAO already has exposure through Pandora and through Hula via the AAO program. ‘W’ and ‘E!’ Networks have been proposed as partner channels from August/September 2015 until the end of May 2016, as well as specific event broadcasting on MTV and Much Music. The French language advertisement will be carried nationally on RDC and CBC Radio Canada for specific events.
Committee Reports CAO/AAO banner ads were seen on CBC.ca and the CAO had a ‘Homepage Takeover’ for a day in October, the day after the Federal Election. The exposure limit for the banner advertisements is September 2015 until June 2016. The AAO has provided approximately $340,000 (US) for the program in Canada. These funds arise out of the assessment of Canadian AAO members in addition to an additional $40,000 (US) as a one-time ‘gift’. The AAO will also provide funds as a ‘matching program’. The details of this program have yet to be announced.
CFAO Treasurer Report As of June 30, 2015 the net revenue for the CFAO was $4,953.70 and the total current assets are $350,163.37. The total members’ equity is $220,143.37. The 2015 disbursements from the Foundation are on schedule. An investigation into the tax implications of the Smiles 4Canada program for individual orthodontists is ongoing.
CFAO Report Dr. Stephen Roth CFAO President Email: stephenfroth@mac.com The Silent Auction at the Gala Banquet in Victoria was a tremendous success. Thanks to the generosity of the CAO membership and guests $6,610.00 was raised in honour of the Foundation. The CFAO extends its sincere thanks to the organizations and to the individuals who were kind enough to donate items to the auction. The CFAO appreciates Cerum Ortho Organizers’ sponsorship and organization of the Annual Golf Tournament this year at the Royal Colwood Golf Club in Victoria, BC. The day was a huge success, with a fun time being had by all. Congratulations to Todd Moore, Bernard Lim and Andrew Woo for the team low score of the day. The CAO Scientific Session for 2016 is in Prince Edward Island; a golfer’s paradise. Bring your clubs, enjoy a round with your colleagues and help support the CFAO.
CFAO Donations Since Fall 2015 CAO In honour of Conference Speakers and Round Table Presenters Dr. Kathleen A. Russell McIntyre Fellow
The Smiles4Canada National Organizing Committee is pleased to announce the launch of a pilot program in the Maritimes. This program will significantly benefit the profession and the participating orthodontists who will provide a life-changing service to those lucky enough to receive treatment through the program. Full details about the program can be found on the website: smiles4canada.ca. Plans are in the works to launch the program nationwide next year and volunteers are needed now to serve on various regional committees. Welcome to our newest MacIntyre Fellows. The support of the Foundation and its efforts are sincerely appreciated. The CFAO Auction raised $6,610 for the Foundation during this year’s Conference.
FALL 2015 • CAO Bulletin
17
Committee Reports RCDC Report Dr. Tom McIntyre Orthodontic Councillor, CAO/RCDC Liaison Lesley Williams, Chief Examiner in orthodontics, has provided the following data regarding the spring fellowship examinations. The written examination, Component 1, was held on March 7, 2015 of which 43 of 47 candidates (95.7 percent) were successful in passing. The oral examination, Component 2, was held on June 19 and 20, 2015. 40 of 54 (74. 1 percent) successfully passed this examination. The construction and organization of both of these examinations is a challenge. Credit goes to Lesley and her team of examiners. They produce a fair and an equitable examination of consistent quality and in order to do so, they give up hours of personal time. Keith Morley, a paediatric dentist based in Barrie, Ontario, was recently elected Registrar of the RCDC. Keith is well-known to many orthodontists and brings to the position a wealth of knowledge and experience in both clinical and organized dentistry. The 2015 50 Year Anniversary Convocation and the Annual General Meeting were held on September 19 and 20, 2015, respectively, followed by two days of intense strategic planning.
faculty to present a poster in the future. The Board was receptive of this endeavour to encourage scholarship and to encourage promotion within the respective institutions. While it was recognised that the Scientific Session is not a peer-reviewed research-based meeting like the IADR, it was noted that as a national meeting it makes sense for Canada’s academics to present in some capacity. Bryan Tompson has retired as discipline head at the Faculty of Dentistry, University of Toronto, a position he has held for the past 15 years. The educators hosted a dinner in Bryan’s honour at a local restaurant in Victoria and the CAO formally recognised Bryan at the Gala Dinner on Saturday September 19, 2015. A copy of the gala program write-up appears in this edition. Congratulations to Sunjay Suri, who was made program director at Toronto effective July 1, 2015. The next meeting of the Educators will take place during the AAO in Orlando, Thursday April, 28, 2016. Should the group require CAO representation the liaison will attend via Skype.
New and Younger Members Report Dr. James Posluns New and Younger Members Representative Email: james.posluns@utoronto.ca
CCOE Dr. James Posluns Educators Liaison Email: james.posluns@utoronto.ca The Graduate Educators from Alberta, British Columbia, Manitoba and Ontario met on September 16, 2015, just prior to the Scientific Session in Victoria. The resident poster presentation was discussed. There was concern over the continuing scheduling conflict with the RCDC that potentially limits participation by new graduates. This conflict continues to recur in spite of knowledge of the problem by both parties. The posters are customarily located in a strategic area in order to increase exposure during the Scientific Session. One point of continuing education was earned by viewing the posters and certificates were available on site. The Educators thank the CFAO for its continuing support of this program. A request was made to the Board for permission of junior
18
CAO Bulletin • FALL 2015
The New and Youngers Members Group hosted its annual luncheon at the Scientific Session on September 18, 2015. This year’s talk was a series of four speakers who each presented on the unique challenges of practicing in a competitive area. Steven Budd, Austin Chen, Lorne Kamelchuk and Bruno Vendittelli offered their unique insight into this ever-perplexing issue. Thanks to all the presenters and to all who attended this informative session. Plans are already underway with regards to next year’s speaker in Charlottetown. One of the objectives for this year is to increase the engagement of this group. Two conference calls are planned for the year; one in the fall and one in the spring. A sign-up sheet for the call was distributed at the luncheon. If you missed it and would like to participate, please respond to the email in the header bar. A committee is being struck to discuss the issues specific to the younger orthodontist. This committee will set the agenda for the conference calls. If you have an interest in joining this committee, please get in contact to discuss.
Committee Reports A section in the Bulletin is reserved for a contribution from a new and younger member. The Editor is always open to content at any time. Finally, thank you to Susan Tsang for her stewardship over this portfolio in the past. Susan’s efforts have solidified a group that is strong in numbers and enthusiastic in support.
CDSA Report
The development of CDAnet and communication with the dental benefit carriers continues. The initial launch of the E-referral service was not well embraced primarily due to the complexity of the program. The CDA is rewriting the software and remains committed to development of this service. In addition, the CDA continues to improve the Oasis product and has recently launched a smartphone App. The CDSA website (http://www.cdsa-acsd.ca) continues to improve. The site contains the mission and the objectives of the CDSA, its bylaws and its contact information.
Dr. Robert Kinniburgh CDSA Liaison Email: drbob@ncortho.ca The Canadian Dental Specialists Association (CDSA) annual meeting with the CDA Board of Directors was held April 23, 2015, in Ottawa, Ontario. This meeting provided an excellent forum to discuss issues relevant to dental specialists as well as an opportunity to keep abreast of the goals and activities of the CDA. Current CDA President, Alastair Nicoll, and the entire CDA Board of Directors have both been very supportive of the CDSA and both have made significant effort to reach out to the CDSA and its member associations. In return, the CDSA has been available to respond to many requests by the CDA for input on pertinent issues such as changes to the accreditation requirements for dental specialty program directors, the application for recognition of dental anesthesia as a specialty nominations for special task forces such as the NIHB Task Force and the revision of policy statements of the CDA. CDSA representatives will attend and will make a presentation at the annual council meetings of the Royal College of Dentists of Canada (RCDC) as well as attend portions of the board meeting of the Canadian Dental Regulatory Authorities Federation (CDRAF) as invited observers. The CDSA Executive has reached out to provincial dental specialty organizations and will endeavor to attend, to make presentations and to open dialogue at all annual provincial dental specialty meetings in order to close the gap between these organizations and the CDSA. In the interest of attracting Canadian students to pursue specialty studies and to remain in the academic environment, the CDSA has established an undergraduate and a graduate student travel award of $1000.00 each to attend the annual IADR meetings. This award will be administered and funded by the CDSA.
GST/HST Report Dr. Michael Patrician Treasurer Email: drpatrician@bellnet.ca As a result of a meeting with representatives of the Canadian Dental Association (CDA) a dialogue has been opened with Canada Revenue Agency (CRA). Multiple conversations have ensued between the CAO chair of the GST/HST committee and Benoit Soucy of the CDA and Mr. Rob Allwright, Associate Partner, Indirect Tax Services of KPMG, the accounting firm representing the CDA. Both the CDA and KPMG have been sympathetic to the problems experienced by orthodontists and the Input Tax Credit (ITC) system. Together, an initial representation was made to CRA outlining the problems faced by the Canadian orthodontist when trying to claim a GST/HST rebate. Attempts have been made to arrange a face-to-face meeting with the national CRA GST/HST office in Ottawa. This meeting was originally scheduled to occur in May, 2015, but it has been rescheduled by CRA multiple times. Potentially some of the problems facing the membership regarding the ITC system are the implementation of a younger CRA ITC audit team lacking the insight into the history and the background of the ITC system and/or an overly-aggressive stance taken by some members when applying for ITC's. The committee is of the opinion that the rules governing the application for ITC's have been changed by CRA and that these changes have not been clearly articulated to the CAO. It has been years since the CAO has had direct communication from CRA. The CAO has not been able to communicate any of these ITC system changes to the membership because the CAO wasn’t notified of any of these changes by CRA. Continued…
FALL 2015 • CAO Bulletin
19
Committee Reports The major concerns arising out of orthodontic office audits are: 1. There is an apparent lack of documentation on monthly invoices to the patient, stipulating the services component of the GST/HST ITC of the monthly billing. It is the committee's opinion that invoicing should not be the sole basis for an assessment by CRA to deny the ITC's 2. There is an inaccurate and an unsubstantiated percentage used to calculate the services portion of the ITC. The percentage (IP/Total Fee) used for the calculation of the orthodontic services part of the ITC should be reconciled at each year end and an adjustment made, if required, for the returns made over the course of the year, The maximum percentage allowable is 35 percent. Recently, CRA has hinted at the possible cancellation of the ITC system for dentistry and orthodontics but the committee is hopeful that the ITC system can be maintained and ultimately improved over time. Once the committee has completed its negotiations with CRA, the CAO will inform the membership of all accepted and new guidelines for the ITC system.
WFO Report Dr. Amanda Maplethorp WFO Executive Committee Email: a_maple@shaw.ca The Executive Committee of the World Federation of Orthodontists (WFO) has voted to continue free student membership for another year. The WFO is a great way for students to connect with their peers from around the world and an attempt is being made to recruit students through the CAO Educator Liaison. The student liaison is examining student opportunities such as the inclusion of poster boards at WFO meetings and inclusion in the WFO journal. Helene Grubisa attended the WFO Breakfast Meeting held in conjunction with the AAO Annual Session in San Francisco in May. Mike Patrician and Ritchie Mah represented the CAO at the WFO Council Meeting held during the 8th International Orthodontic Congress in London, September 27 to 30, 2015. Amanda Maplethorp also attended as one of the three North America representatives on the Executive Committee. Amanda Maplethorp has been elected to serve on the Executive Committee for a second term (2015-2020). The number of representatives from North America will be reduced from three to two as the percentage of members from North America has dropped. Membership from China has increased the
overall numbers from central Asia, which has led to a proportional increase in representation for Asia, on the Executive Committee. The next IOC meeting will be held in Japan in 2020. Eric Chou the senior manager, at Association Relations, MCI Canada has inquired into whether or not the CAO is interested in a Toronto bid for the 2025 IOC meeting. The bid will likely need to be submitted by December 2016. The WFO interest was more with Vancouver for the 2015 meeting, but where the AAO was held in that same year was a determining factor.
Communications Report Dr. Daniel Pollit Communications Chair Email: dpollit@rogers.com The new-look CAO members website has been launched. Please log onto www.cao-aco.org to provide your feedback. The Selfie submission section ‘Smilesbyorthos’ is now complete. All members will have received promotional material that should bring considerable traffic and interest to the website. A new addition to the public website ‘Ask the Experts’ will consist of video interviews with selected CAO members. Topics discussed include the need for treatment, the type of appliances, adult treatment and much more.
I N M EMORIAM Dr. Charles Bruce Morrow Dr. Charles Bruce Morrow passed away May 30, 2015, in Dundas Ontario. A member of the University of Toronto, Faculty of Dentistry Class of ’46, Bruce graduated from U of T Orthodontics in 1953. A member of the CAO since 1954, Dr. Morrow retired from practice in 2004. The CAO extends its sincerest condolences to the Morrow family for their loss.
FALL 2015 • CAO Bulletin
21
The Latest Advances in Canadian Orthodontic Research [LACOR] Outstanding Post Graduate Orthodontic Programs Canada has six outstanding post graduate Orthodontic programs which have achieved international recognition for their published areas of research. At this year’s Annual Scientific Session in British Columbia, post graduate students from Canadian orthodontic institutions, presented abstracts of their current research projects.
University of BC DENTOFACIAL MORPHOLOGY IN CHILDREN WITH OBSTRUCTIVE SLEEP APNEA Author: Kevin Lee* OBJECTIVES: Altered dentofacial morphology has been suggested as an etiology for childhood OSA with limited evidence of greater prevalence of posterior crossbite, Class II skeletal and dental pattern, and openbite in this patient population. Existing reports on the occlusal characteristics of children with OSA vary significantly and are limited by the infrequent use of polysomnography (PSG) for diagnosis. Therefore, the objective of this study is to establish the prevalence of malocclusion in children with OSA diagnosed using PSG. METHODS: The sample comprised 64 children between the ages of 4-16 who were referred to BC Children’s Hospital for PSG. Diagnosis of OSA was provided by an overnight, in-laboratory PSG. Malocclusion was assessed clinically by one orthodontist (K.L.), blinded to PSG results. RESULTS: Children with previous orthodontic treatment were excluded and children with craniofacial syndromes were analyzed separately. The 17 patients with craniofacial syndromes presented significant higher prevalence of altered dentofacial features when compared to the non-syndromic children. The remaining 39 patients were divided into an OSA group (AHI >= 2; n=17) and a control group (AHI < 2; n=22). The two groups presented with similar demographic characteristics. The OSA group had a higher number of patients who reported snoring more than 3-4 nights per week (61.9 vs. 82.4%). There were no statistically significant differences in frequency of any specific dentofacial features between the two groups; although OSA group had lower prevalence of convex profile, Cl II molar relationship, and OJ ≥ 5mm. The OSA group was further divided into lower AHI (AHI between 2-5; n=9) and higher AHI group (AHI ≥ 5; n=8). There was no statistically significant difference in frequency of any dentofacial features between the three groups. Nevertheless, (*Presenter)
22
CAO Bulletin • FALL 2015
LACOR Presenters
the higher AHI group had less prevalence of convex profile and poster crossbite, and less crowding and smaller OJ on average. This dentofacial morphology contradicts what is reported in the literature and warrants further investigation. CONCLUSIONS: In this patient population of 39 children between the ages of 4-16 who were referred to BCCH for an overnight sleep study, no statistically significant differences in dentofacial morphology and occlusal characteristics were found between children diagnosed with and without OSA.
University of Alberta ASSESSING RISK OF BIAS OF TRIALS IN SYSTEMATIC REVIEWS OF ORAL HEALTH INTERVENTIONS: CROSS SECTIONAL STUDY Authors: Humam Saltaji*; Susan Armijo-Olivo; Greta G. Cummings; Maryam Amin; Carlos Flores-Mir Orthodontic Graduate Program, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
BACKGROUND & OBJECTIVES: The conduct of systematic reviews (SRs) relies heavily on the internal validity of the included trials. Critical appraisal of the methodological quality
Outstanding Post Graduate Orthodontic Programs of trials —or risk of bias assessment— is an essential feature of SRs of therapeutic interventions. The objectives of this study were to describe how the methodological quality of trials is assessed in SRs of oral health interventions and to identify determinants of quality assessment in oral health SRs.
CONCLUSIONS: A number of quality assessment tools have been used in apprising risk of bias of studies included in oral health SRs; however, there is no tool specifically designed for assessing the methodologic quality of oral health trials. There is a need for a methodological quality assessment tool designed specifically for assessing quality of oral health trials.
METHODS: Oral health SRs that evaluated a therapeutic intervention related to dental, oral or craniofacial diseases/disorders were identified through searches of seven databases. Data were extracted from all SRs on methodological quality assessment tools used. Associations between trial quality assessment and publication and review characteristics were explored in logistic regression analyses. RESULTS: 1,114 therapeutic oral health SRs (130 Cochrane and 984 non-Cochrane) published between 1991 and May 2014 were identified (including 134 orthodontic SRs). The methodological quality of primary studies was assessed in 61.4% of the SRs (including 65% of orthodontic SRs). This occurred more often in Cochrane SRs than in non-Cochrane SRs (100% vs. 56.3%, p < 0.01) and in SRs published after dissemination of the PRISMA statement in 2009 (OR: 1.55; 95% CI: 1.18, 2.03). Compared to SRs of periodontics and public health interventions, SRs of orthodontics and dentofacial orthopedics were less likely to assess risk of bias of individual trials (OR: 0.49; 95% CI: 0.28, 0.86). Furthermore, SRs published in specialized dental journals were less likely to assess risk of bias of individual trials (OR: 0.23; 95% CI: 0.15, 0.34) compared to SRs published in non-dental journals. Finally, SRs published in journals with impact factors above the median impact factor of publication were more likely to assess risk of bias of individual trials (OR: 0.45; 95% CI: 0.34, 0.60).
University of Manitoba CLASS II MALOCCLUSION: A CEPHALOMETRIC ASSESSMENT Authors: Santhosh Jayachandran a*; William A. Wiltshire b; Fabio H. Pinheiro c a Orthodontic Specialty Resident, Department of Preventive Dental Science,
Faculty of Dentistry, University of Manitoba, Canada b Professor and Head, Department of Preventive Dental Science and the Di-
vision of Orthodontics, Faculty of Dentistry, University of Manitoba, Canada Assistant Professor, Department of Preventive Dental Science, Division of Orthodontics, Faculty of Dentistry, University of Manitoba, Canada c
OBJECTIVES: The purpose of this study was to investigate the skeletal, dentoalveolar and soft tissue effects of the AdvanSyncTM appliance in the correction of Class II malocclusions in growing patients. AdvanSyncTM was compared to a typical method of Class II correction (intermaxillary elastics) and an untreated Class II control group. MATERIALS AND METHODS: A retrospective study was conducted using lateral cephalograms of patients taken pretreatment (T1) and post-comprehensive treatment (T2). 41 patients consecutively treated with AdvanSyncTM (24 males, 17 females; mean age 11.6 years at T1, 14.3 years at T2) were compared to 41 similar patients treated with intermaxillary Class II elastics (24 males, 17 females; mean age 11.5 years at T1, 14.4 years at T2). All patients had significant growth potential during treatment as assessed by the cervical vertebral maturation method. Both treated groups were also compared to a matched, untreated control sample generated from the University of Michigan and Bolton-Brush growth studies. Data was analyzed using one-way analysis of variance and TukeyKramer tests. RESULTS: Initially (T1), the three groups were well matched in most cephalometric measurements. The effects of AdvanSyncTM (T2-T1) included maxillary growth restriction, protrusion, proclination and intrusion of mandibular incisors and mesialization of mandibular molars (p<0.01). The effects
More LACOR Presenters
Continued…
FALL 2015 • CAO Bulletin
23
Outstanding Post Graduate Orthodontic Programs of Class II elastics were similar to AdvanSyncTM, with the exceptions of less maxillary growth restriction and greater retrusion and retroclination of maxillary incisors (p<0.01). Significant mandibular growth stimulation did not occur with either modality.
dient-recalled (GRE), axial diffusion-weighted (DWI), axial magnetic resonance angiography (MRA) and axial fluid attenuated inversion recovery (FLAIR). The final sample included 13860 MR images analyzed by 2 neuroradiologists with regard to the extent of distortion in 9 regions of the head.
CONCLUSION: AdvanSyncTM and intermaxillary elastics are effective in normalizing Class II malocclusions. AdvanSyncTM produces its effects through maxillary skeletal growth restriction and mandibular dentoalveolar changes. Class II elastics work primarily through dentoalveolar changes in both the maxilla and mandible.
RESULTS: Interrater(kappa=0.842) and intrarater agreements were high (reviewer 1: k=0.717, 2: k=0.768). Wilcoxon signed rank test showed a statistically significant difference between the distortion scores of all appliances compared to each other (p<0.0001). For 3T brain MRI; none of the appliances need to be removed for MRA, FlAIR, and T2 sequences; steel brackets and tubes need to be removed for T1, GRE, and DWI; ceramic brackets do not need to be removed; steel molar tubes need to be removed for GRE and DWI; steel lingual retainer does not need to be removed.
University of Toronto EFFECTS OF ORTHODONTIC APPLIANCES ON DIAGNOSTIC QUALITY OF MR IMAGES OF THE HEAD Authors: D. Zhylich*, S. Suri, B. Tompson, W. Lou, M. Shroff, P. Krishnan, P. Muthusami, A. Doria, T. Rayner-Kunopaski. INTRODUCTION: We aimed to study in-vivo the influence of commonly used fixed appliances on the diagnostic quality of 3 Tesla head MRI to determine which appliances should be removed for MRI of specific head regions. METHODS: Head MRI were acquired for 10 adults wearing Essix trays with embedded 4 common fixed appliances: ceramic brackets, steel brackets, combination of ceramic brackets and steel molar tubes, steel mandibular lingual retainer. 6 sequences were included for each appliance: sagittal T1, axial T2, axial gra-
Helpline Numbers Available for Member Assistance Programs (MAP) This list of contact numbers will provide support to any CAO member who might need or seek additional support in a crisis situation affecting their personal lives. These are anonymous contacts and will provide support and resources for a variety of situations. Nova Scotia Professional Support Program (PSP) - 902-4688215 Quebec (Medi-Secours) - 514-440-4520 Ontario and Manitoba (CDSPI) English - 1-800-265-5211 French - 1-800-363-3872 Saskatchewan (PAR Consulting) Saskatoon: 1-800-978-8282 or 306-652-3121 Regina: 1-877-352-0680 or 306-352-0680 Alberta (Confidential Assistance Program â&#x20AC;&#x201C; CAP) 1-800-226-6433
Thanks to GAC for their support of the Latest Advances in Canadian Orthodontic Research Symposium and the CFAO Posterboards
24
CAO Bulletin â&#x20AC;˘ FALL 2015
British Columbia (CDSPI) English - 1-800-265-5211 French - 1-800-363-3872 or Dental Professional Assistance Plan (DPAP) 1-800-661-9199
Student Posterboards Abstracts from the 2015 CAO Annual Scientific Session – Part 1 of 2 part series
University of British Columbia THE HUMAN SOFT PALATE FUSES MORE RAPIDLY THAN HARD PALATE SUGGESTING REGIONAL REGULATION OF DEVELOPMENT
the hard and soft palate suggests that the two regions of the palate have their own internal clocks regulating the timing of seam removal.
Authors: Carly Jade Dool*, Adrian Danescu, Melanie Mattson, Virginia M. Diewert and Joy M. Richman
University of British Columbia EFFECTS OF SURFACE CONDITIONING AND STORAGE TIME ON THE BOND STRENGTH OF ORTHODONTIC BRACKETS TO LITHIUM DISILICATE CERAMIC
Life Sciences Institute, Faculty of Dentistry, University of British Columbia, Vancouver, Canada
In humans, hard palate development occurs between 7-12 weeks post conception with the fusion of the epithelial lined maxillary prominences creating a midline epithelial seam. The failure of fusion or seam removal in hard palate leads to cleft palate or cyst formation. The mechanism of soft palate formation is less well defined. Evidence exists supporting both fusion and the alternative mechanism of merging. The aim of this study is to densely sample the late embryonic-early fetal period between 54-74 days post-conception to determine the mechanism and timing of soft palate closure. We confirm the presence of an epithelial seam extending throughout the soft palates in 57-day specimens suggesting fusion. Cytokeratin antibody staining confirmed the epithelial character of the cells in the midline seam. The seam is rapidly degraded and exists only in the posterior soft palate by 64 days. Our data shows that the soft palate follows a developmentally more rapid fusion compared to the hard palate. Differential development of
Authors: Jonathan Paxon, Benjamin Pliska, N. Dorin Ruse and Ricardo M. Carvalho Faculty of Dentistry, University of British Columbia, Vancouver, Canada
The long term bracket bond strength of several lithium disilicate surface conditioning techniques was assessed, including various hydrofluoric acid (HF) etching times and non-thermal plasma (NTP). The efficacy of enamel bonding agents was also evaluated. Brackets were bonded to 300 IPS e.max samples (Ivoclar Vivadent). Five surface conditioning techniques were tested: 15 seconds 37% H3PO4, 20 seconds 9.5% HF, 60 seconds 9.5% HF, 60 seconds 9.5% HF with an enamel bonding agent and 20 seconds NTP only. All samples were treated with a silane coupling agent prior to bonding with an orthodontic adhesive and were stored in distilled water at 37°C for 30 minutes, 24 hours and 6 months before testing the shear bond strength. Results showed that all surface treatment groups yielded clinically acceptable bond strengths at all water storage times. Bond strengths increased from 30 minutes to 24 hours and then decreased at 6 months, but this decrease was significant only for the H3PO4 group. At 24 hours, HF etching for 60 seconds followed by enamel bonding agent exhibited significantly higher bond strength than phosphoric acid or HF for 20 seconds. Etching with HF resulted in increased adhesive residue compared to treatment with NTP or H3PO4. The results suggest that surface treatments with NTP or 20 to 60 second 9.5% HF etching times yield acceptable long-term bond strengths as the bond strengths did not significantly reduce after 6 months. Continued…
Poster participant Dr. Carly Dool
FALL 2015 • CAO Bulletin
25
CFAO Graduate Student Posterboards University of Alberta COMPARISON OF THE SKELETAL AND DENTAL CHANGES OF TOOTH-BORNE VS. BONE-BORNE EXPANSION DEVICES IN SURGICALLY ASSISTED RAPID PALATAL EXPANSION: A FINITE ELEMENT STUDY Authors: Zahra Najirad1; Abolfazl Ghorbani2; Mohammadamin Najirad3; AzitaTehranchi4 1Orthodontic Graduate program ,School of Dentistry ,University of Alberta, 2DDS, Practice limited to Oral Surgery, Toronto, Canada, 3DDS student,
School of dentistry, Islamic Azad University of Medical Sciences, Tehran, Iran, 4Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences
BACKGROUND: The aim of this study was to compare the skeletal and dental changes of a tooth- borne (Hyrax) and a bone-borne (Smile distractor) expansion devices using threedimensional model of an adult human skull. MATERIALS & METHODS: A finite element model of human skull was generated using data from 3-DCT scans of an 11year-old female child. Then a Hyrax expander (tooth-borne appliance)and Smile distractor (bone-borne appliance) in three different positions were adapted to the finite element model and expanded for 0.5 mm simulating the clinical situation. The 3-D pattern of displacement and stress distribution was then analyzed. RESULTS: The results of this study showed that screw position affects the stress and displacement pattern within the Nasomaxillary complex and maxillary dental arch. CONCLUSIONS: Closer teeth feel more stress and undergo more displacement than the farther ones. Moreover, skeletal effects of the Smile distractor were greater than of Hyrax in all different positions. Keywords: Dental, expansion device, finite element method, skeletal
Poster participant Dr. John Scalia
University of Toronto MANDIBULAR GROWTH IN CLASS II PATIENTS WITH SKELETAL DYSPLASIA, AFTER THE PUBERTAL GROWTH SPURT Author: Scalia G*, Gong SG, Metaxas A, Tompson BD Department of Orthodontics, Faculty of Dentistry, University of Toronto
BACKGROUND: Class II malocclusion is a common clinical problem in North America. Treatment timing depends on the severity of malocclusion, on treatment modality and on skeletal maturation. OBJECTIVES. To evaluate the extent of mandibular growth, after the peak in pubertal growth, in Class II patients with a severely undersized mandible. MATERIALS AND METHODS: 27 subjects with Class II division I malocclusion (13m, 14f) were selected from six longitudinal growth centers. Subjects were selected using lateral cephalometric radiographs at: (T1) after the pubertal growth spurt (CVM stage 4, 5, or 6) and (T2) minimum 2 years after T1. Each subject had ANB ≥ 6 and maxillo-mandibular length difference ≤ 19.5. 27 controls were selected with Class I occlusion matched for age, gender, and CVM stage. RESULTS: Mandibular growth between T1 and T2 was 1.1 mm less for every year increase of age at T1. Males grew about twice as much as females between T1 and T2 (4.0 mm versus 2.1 mm). Differences in growth between class I occlusion and class II occlusion were 2.6 versus 2.7 mm respectively. CONCLUSIONS: Early surgical treatment of patients with severe skeletal dysplasia should be cautious of potential postpubertal mandibular growth.
Poster participant Dr. Zahra Najirad
26
CAO Bulletin • FALL 2015
Component Society Reports
British Columbia Dr. Jay Philippson Email: drgphilippson@shaw.ca The BCSO Annual General Meeting was held on June 5, 2015, at Mayfair Lakes Golf Club in Richmond, BC. The annual golf tournament followed the AGM and as a new endeavour this year, wine tasting and massages were available. Hopefully these activities suggest that there will be continuing activities for non-golfers and will encourage greater attendance at the AGM. The consumer awareness program was discussed. Due to cost of process, there were no metrics completed in Canada attesting to the success of the program. However, an informal study demonstrated a positive increase in the number of hits on the BCSO website following the airing of the advertisements. The consultation process for an update on the radiation guidelines for dentistry has been completed by the College of Dental Surgeons of BC. The guidelines are expected to be published in the fall of 2015 and may impact the routine use of cone beam CT in orthodontics. Bryan Hicks of West Vancouver was installed as president of the PCSO at the annual session in Palm Springs, California in October, 2015.
Alberta Dr. Todd Lee-Knight Email: todd@drlee-knight.com The Alberta Society of Orthodontists will be holding its Annual Scientific Session and Meeting on Friday April 8 and Saturday April 9, 2016 at the RimRock Resort in Banff, Alberta. This year’s meeting will feature two full-day speakers. Dr. Luis Carriere will be presenting Friday’s topic: ‘Achieving Complete Facial, Skeletal and Dental Harmony in Class II and Class III Treatments’. Ms. Lori William will follow up on Saturday with a practice management seminar entitled: ‘What Di-
rection is Your Customer Service Heading?’ The ASO membership has once again agreed to continue its support of the CAO Consumer Awareness Program by committing additional funds to supplement the national campaign. The ASO has recently struck a task force to further align and to develop efforts between regional and provincial public awareness programs, further coordinating them with the CAOAAO CAP program. The ASO executive continued its support of the CFAO (by donating a weekend stay for two in Banff) at the silent auction fundraiser in Victoria.
Saskatchewan Dr. Mike Wagner Email: wagner.orthodontics@gmail.com As the province turned into “harvest mode” and little ones started back to school, things are quiet this time of year. Specialist recognition continues to remain in the forefront: the webpage is being revised and will hopefully be up and running by the first of the new-year. Changes have been encouraged on the topic of auxiliary education; it is the executive’s belief that staffing shortages should be addressed starting at the academic level. There continues to be a lengthy wait list for dental assisting admissions that further contributes to the lack of dental personnel to staff orthodontic clinics. Being a small society when compared to our national counterparts, Saskatchewan had excellent attendance at the annual general meeting this November featuring a lecture by Dr. Dan Bills. Saskatchewan hopes the membership had an enjoyable fall and wishes everyone an enjoyable, safe (and short) winter.
Continued…
FALL 2015 • CAO Bulletin
27
Component Society Reports Cont’d Manitoba Dr. Susan Tsang
dontic practice. The corporatization and the unionization of dental offices continues to be a concern. The RCDSO is seeking an exemption for dentistry in the EU-Canada trade deal.
Email: s_tsang2@hotmail.com The spring Manitoba Orthodontic Society (MOS) dinner meeting was held on April 23, 2015. To date, the Manitoba chapter of Smiles for Lifetime Foundation has offered free orthodontic treatment to 14 successful applicants. The program currently has 8 participating orthodontists. As applications continue to be reviewed, the process continues to be revised to facilitate the selection of the most appropriate candidates. The Orthodontic Department at the University of Manitoba is planning to celebrate its 50th anniversary of the Graduate Program at the CAO Annual Scientific Session meeting in Charlottetown PEI, September 2016. The fall MOS meeting was held on November 20, 2015 in conjunction with a continuing education lecture.
Ontario Dr. Eric Selnes Email: str8smiles@sympatico.ca The OAO has retained Bond Management Offices to manage the administrative duties, to organize and coordinate the executive meetings, and to arrange the fall and spring dinner meetings. Bond will also organize the next Scientific Session on May 26 to 29, 2016 in Niagara-on-the-Lake. Ms. Gayle Fielding, the OAO administrator, who has kept the OAO running smoothly for so many years will retire in December 2015. The OAO extends its gratitude to Gayle for all her hard work. The OAO wishes her well and many happy travels in the days to come. At the Annual General Meeting in April 2015, the corporation bylaws were passed unanimously by the OAO membership. Mr. Chris Vranas of the AAO was the guest speaker. Congratulations are extended to Arlene Dagys upon receiving the Award of Merit and to Jack Dale for receiving the Award of Honorary Membership. The OAO has petitioned the RCDSO to clarify and to establish increased delegation of duties for dental assistants in ortho-
28
CAO Bulletin • FALL 2015
The 2015-2016 OAO Executive is Lui Redigonda - President, John Bozek - Vice President, Mitch Miller - Secretary/Treasurer, Drew Smith - Past-President, Eric Selnes - CAO Representative and Gagan Bhalla - GLAO Representative.
Quebec Dr. Michel Di Battista Email: micheldibattista@gmail.com
At its Annual General Meeting, the Quebec Association of Orthodontists voted to join the Federation of Dental Specialists of Quebec. Our first joint convention is scheduled to take place in the Fall of 2016. A Quebec division of the Sourire pour la Vie/Smile for a Lifetime foundation has come into existence in Montreal. Those we have to thank for its creation are Paul Korne and three of his confreres (www.s4lmtl.org). Erratum: Some obvious errors have found their way into our latest report, for which I fear I must hold myself partially responsible. Our immediate past president was Martin Rousseau. His dedicated and much appreciated work on the Board of Directors of the AOQ deserves special acknowledgement.
Rapport de la province de Québec Lors de son assemblée générale annuelle, l’Association des Orthodontistes du Québec a voté en faveur de son adhésion à la Fédération des Dentistes Spécialistes du Québec. Nous planifions ensemble notre premier congrès pour l’automne 2016. Une division québécoise d’Un Sourire pour la Vie/ Smile for a Lifetime a vu le jour à Montréal. Dr Paul Korne, accompagné de trois autres orthodontistes, en est l’instigateur (s4lmtl.org). Erratum. Il s’est glissé de grossières fautes dans le dernier rapport dont je confesse une responsabilité partielle. Notre dernier président, se nomme Dr Martin Rousseau. Son travail constant et fort apprécié au sein du conseil d’administration de l’AOQ mérite d’être souligné.
Component Society Reports Cont’d
Atlantic Report Dr. Don Johnston Email: johnston.donald@gmail.com
The Atlantic Orthodontic Association met on April 24, 2015 at the Delta Barrington Hotel in Halifax. The meeting was held in conjunction with a continuing education session sponsored by Cerum Ortho Organizers. Dr. Louis Carriere was the keynote speaker. There were no major issues brought forward at the meeting and the highlight was the passing of amended bylaws thereby permitting the Atlantic Association to be in compliance with the newly enacted CAO bylaws. The next step is to complete the incorporation of the Atlantic Association. The next meeting is tentatively scheduled for May 27-28, 2016, at a venue yet to be determined. This meeting will mark the installation of Stuart Matheson as incoming president of the AOA.
1. A man stands on one side of a river, his dog on the other. The man calls his dog, who immediately crosses the river without getting wet and without using a bridge or a boat. How did the dog do it? 2. A sundial has the fewest moving parts of any timepiece. Which has the most? 3. What is unusual about the following words: revive, banana, grammar, voodoo, assess, potato, dresser, uneven? 4. What makes this number unique — 8,549,176,320? 5. Put a coin into an empty bottle and insert a cork into the neck. How can you remove the coin without removing the cork or breaking the bottle? 6. Two boxers are in a match scheduled for 12 rounds. (Pure boxing only – no kicking, UFC takedowns, or anything else). One of the boxers gets knocked out after only six rounds, yet no man throws a punch. How is this possible? 7.
In 1990, a person is 15 years old. In 1995, that same person is 10 years old. How can this be?
8. A man takes his car to a hotel. Upon reaching the hotel, he is immediately declared bankrupt. Why?
Canadian Association of Orthodontists
UPCOMING ORTHODONTIC MEETINGS 2016 April 29 - May 3 . . . .AAO Annual Session, Orlando, FL September 15-17 . . .CAO Annual Scientific Session, Charlottetown, PEI September 22-25 . . .GLAD/MASO Annual Session, Phoenix, AZ October 6-9 . . . . . . . .NESO Annual Session, New York, NY
9. What do these words have in common: polish, job, herb? 10. You’re standing in a hallway with three light switches on the wall, each of which turns on a different lamp inside a closed room. You can’t see inside the room, and you can’t open the door except to enter the room. You can enter the room only once, and when you do, all the lamps must be turned off. How can you tell which switch turns on which lamp? – Answer on page 31 –
October 13-16 . . . . .RCSO Annual Session, Seattle, WA November 4-5 . . . . . .MSO Annual Session, Chicago, IL
2017 September 14-16 . . .CAO Annual Scientific Session, Toronto, ON
2018 September 6-8 . . . . .CAO Annual Scientific Session, Vancouver, BC
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 2015 • CAO Bulletin
29
From the Editor
Dr. James Posluns Email: james.posluns@utoronto.ca
If You’re Buying, I’m Selling! I have to write something about Justin Trudeau. Talk about being in the right place at the right time, just as the evil empire was crashing to the ground. Don’t get me wrong. JT seems like a nice guy, a solid family man with decent values, but c’mon! JT was handled from the ground up and kudos to the Liberal Party strategists for pulling themselves out of the gutter. I wonder if Mulroney’s kid is lying awake right now, second-guessing E Talk Live? I’m hoping that JT enjoys his honeymoon and further, his time in office, because as legend has it, ‘Canadians don’t vote people into office, they vote them out’. Surely you remember the scandal and the waste when the Big Red Machine was at the helm the last time. Back then, a young upstart named Stephen was the saviour. Not so much in 2015. What amazes me most about politics isn’t what the candidates say and the elected officials do, it’s what the public believes, time and time again. And these are smart people. JT’s plan is to deficit spend the country into prosperity following a path of ‘Sunny Ways’. This I do not understand. Wasn’t this his Old Man’s plan? Sorry, I need a bit more before sending what little I have left to the good folks up-province. There seems to be a recurring theme here. Say something obtuse, get the public’s attention and reap the rewards. People are so ready to believe when they want change. We’ve seen it at the local level; Rob Ford got elected by promising to ‘stop the gravy train’, all the while answering telephone calls and living a dou-
30
CAO Bulletin • FALL 2015
ble life. Nice try! City Hall seemed pretty much the same to me, albeit somewhat more entertaining. Let’s take a gander south of the border. Two unashamedly unqualified kooks continue to lead the Republican polls with less than a year to go. The thought
works” he’d respond to questions from the crowd, “It just does. I’m Dwight Damon, a good-old boy from Spokane, Washington. I wouldn’t lie to you nice folks, would I?” I watched the eyes widen and the heads nod up and down. I saw the brackets roll into the University only to watch them languish on the shelf shortly thereafter. The Damon bracket isn’t a bad bracket and I mean absolutely no disrespect to the skilled practitioners who can do great things with it. But it’s a bracket and it works the same as any other selfligating bracket when it comes to the biomecanical principles of tooth movement.
of either Donald Trump or Ben Carson sitting in the Oval Office scares the bejeebers out of me. Both of these gentlemen spew forth the most baseless, senseless, stream-of-consciousness refuse, yet the public continues to lap it up time and time again. Remember the old saying ‘nothing succeeds like success’; let’s amend it slightly to ‘nothing succeeds like blind optimism, frustrating abstractness and outright craziness.’ How does all this relate to orthodontics, other than our taxes going up in very short order? The politicians of today can’t help but remind me of Dwight Damon. I recall him at various meetings spouting the virtues of the latest incarnation of his bracket. “I don’t know how it
It’s enticing to believe in something so new, so bright and so innovative, but at the end of the day, we tend to fall back on what we know to be true. I checked a write up about Dr. Damon recently (wsm.wsu.edu). He believes, (and I quote) “that adjustments to the Damon System might help breathing problems such as sleep apnea”. Hmmm. I’m actually speechless. Here’s another example. Acceledent. Admittedly, I don’t know much about this device, but a quick check on the company website reveals a pretty interesting read. “Clinically proven to move teeth up to 50 percent faster in a U.S. clinical trial.” Reference Number 1. ‘Cleared by the USFDA and available Continued…
From the Editor Cont’d. only from your orthodontist.’ Again, Reference Number 1. ‘Patients have reported reduced discomfort with their orthodontics.’ Guess what, Reference Number 1. Where does one find Reference Number 1? “Data on file.” So, there you have it; a single study, I think, and a less than compelling reason to give Aceledent a try, regardless of the virtues that the company extolls. Most of the orthodontists I know of are none too impressed. But at least the venture capitalists think it’s worth a shot. Gadgets may come and go, but I learnt that that teeth move fastest when the diagnosis is accurate and the treatment plan is bang-on. I’m looking forward to the next five years. Actually, I wish I had a crystal ball. I wanna see if JT is still sitting pretty. I wanna see if either The Donald or Dr. Ben pulled off the impossible. I wanna see if the world is still spinning solidly on its axis.
Straight Shooters Why do orthodontists hate roller coasters? Because they have to brace themselves! Why did the orthodontist spend hours in front of a mirror on a Saturday night? Because she had to make a great first impression! Why did the orthodontist hire the supermarket clerk?
Because he was good with the scanner!
And I really wanna see what’s coming next!
Jimmy P
10. Turn on the right switch and leave it on for two minutes. After two minutes, turn on the middle switch and leave it on for one minute. When that minute is up, turn off both switches and enter the room. One light bulb will be hot (1st switch) and one will be warm (2nd switch). The cold bulb will correspond to the switch you didn’t turn on.
Happy Holidays to all and to all a good night.
9. All three words are pronounced differently when the first letter is capitalized. 8. The man is playing Monopoly. He lands on a property with a hotel and doesn’t have enough money to pay the rent. 7.
The person was born in 2005 B.C.
6. Both boxers are female.
Seeing what’s new at the CAO booth
5. Push the cork down into the bottle. Then shake the coin out. 4. It contains each number, zero through nine, in alphabetical order. 3. Take the first letter of each word and place it at the end. It will spell the same word backwards. 2. An hourglass, with thousands of grains of sand. 1. The river was frozen. Puzzle Answer from page 31:
Dr. Steiman thanking our Exhibitors at the Exhibitor’s Reception
FALL 2015 • CAO Bulletin
31