CAO Bulletin - Fall 2017

Bulletin

In this issue…

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Message from the President Message from the Outgoing President Highlights of the 69th Annual Scientific Session Committee Reports Component Society Reports Student Posterboards

Fall 2017

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

2017/2018 Board of Directors OFFICERS President President Elect Past President 1st Vice President 2nd Vice President Secretary/Treasurer

Dr. Rick Odegaard Dr. Sheila Smith Dr. Bob Kinniburgh Dr. Michael Wagner Dr. Gerald Philippson Dr. Don Johnston

REGIONAL DIRECTORS British Columbia Alberta Saskatchewan Manitoba Ontario Quebec Atlantic

Dr. Gina Ball Dr. C. Todd Lee-Knight Dr. Brian Phee Dr. Susan Tsang Dr. J. Eric Selnes Dr. Giovanni (John) Scalia Dr. Stuart A. Matheson

COMMITTEES President CFAO CAO/CDSA Liaison Insurance Committee

Dr. Stephen Roth Dr. Michael Wagner Dr. Mike Wagner Dr. Don Johnston

Membership Committee

Dr. Todd Lee-Knight

Sponsorship Chair

Dr. Don Johnston

WFO - Country Rep

Dr. Rick Odegaard

WFO - Member-at-Large Conference Advisory Committee Chair Conference Scientific Content Subcomittee Chair New & Younger Members Rep CAO/AAO Liaison Planning & Priorities Communications Nominations Canadian Orthodontic Educators RCDC Liaison

Dr. Michael Patrician Dr. Howard Steiman

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. Don Johnston

Dr. Howard Steiman Dr. James Posluns Dr. Rick Odegaard Dr. Rick Odegaard Dr. J. Eric Selnes Dr. Bob Kinniburgh Dr. James Posluns Dr. Tarek El-Bialy

President’s Message Dr. Rick Odegaard Email: dr.odegaard@shawcable.com

Membership In The CAO: A Benefit Risk Analysis As a member service organization, a critical role for the CAO is to advocate for its members and to protect the interests of the Canadian orthodontic specialist. Canada is a large and diverse country. As a national organization, it is impossible for the CAO to be all things to all members. However, every orthodontist in Canada, member or not, receives benefit from the programs and activities of the CAO. Which begs the question: Why isn’t every orthodontist in Canada a member of the CAO? Only about 50 percent of licensed Canadian orthodontic specialists are currently CAO members: a surprising and disappointing number. The value of CAO membership is best assessed through a benefit-to-risk analysis, as one would undertake when assessing other decisions or challenges.

Perceived benefit is a driving force of membership and is a constant and recurring topic of discussion at the CAO Board. It is a challenge to determine what can be done to ensure that the CAO provides its members with the services they require.

The Board is sensitive in its reaction to the needs of the orthodontic specialist in Canada. As an organization, it has become more dynamic and more responsive in its representation of the broad demographic of the Canadian orthodontist.

Membership in the CAO provides exceptional value for money. The Annual Scientific Session is an excellent combination of continuing education and social programing that improves and grows each year. The attendance at this year’s meeting in Toronto was record-breaking. The social program offered is unique, fostering interaction between members and strengthening personal and professional relationships.

A consumer awareness program specific to the Canadian market has been fully developed and supported by the CAO. Linked to the consumer program is a new corporate brand and a new website that combines member and public information that is directed primarily at the consumer. A key focus of the website is the promotion of orthodontic treatment by an orthodontic specialist. It has a strong search function enabling the public to quickly and accurately locate CAO member orthodontists. The integration of the awareness program with the consumer-based website will promote the specialty like never before.

The traditional roles of the CAO, such as advocacy with government and other organizations, insurance negotiation and support of orthodontic education continue.

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President’s Message | Message de le président

The benefits of membership in the CAO are many and the value is great. So what are the risks of not being a member?

When orthodontic specialists do not participate, the organization is unable to promote a consolidated message. The greatest challenge faced by the orthodontic specialist is the loss of market share to the non-specialist. As specialists, orthodontists can come together through a national member services organization, in a way that that the non-orthodontists cannot.

The concept of “strength in numbers” is a reality.

The non-member risks isolation from his or her peers. There is a loss of social interaction, communication and peer support.

The importance of networking, mentoring and education cannot be minimized. Personal contact with peers and colleagues has become diluted by online forums which are constant but distant. The “social capital” that comes from direct interaction with like-minded professionals is critical to the preservation of our specialty.

Every membership is valued. Increased membership permits engagement of more orthodontists and increases intellectual input so the organization can better represent the needs of its members. Increased membership enhances financial stability through dues and sponsorship. Financial stability leads to the expansion of the existing and the addition of, new member benefits. Increased membership increases the CAO’s political clout and its credibility.

So why isn’t every orthodontist in Canada a member of the CAO? Perhaps the message of the membership benefits and the importance of unification is not being shared.

Like many professional communications this publication “preaches to the converted”. The challenge is to relay the message to the non-members. To improve in this area, the CAO administration has developed a data base of all orthodontists in Canada to identify those who are members and those who are not. The Membership Committee, along with the CAO staff are developing an outreach program to inform non-members of the value of membership. The New and Younger Members Committee is reaching out to students and to recent graduates to gain their membership in the CAO. The most valuable form of recruitment is ‘word of mouth’. A personal invitation from a CAO member to a non-member to join is the best way for the CAO to grow. Please take the time to engage your non-member colleagues let them know the importance and value of membership in the Canadian Association of Orthodontists and to invite them to join.

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As the members know there is a dedicated team of orthodontists who volunteer their time to the CAO Board and to various CAO Committees. Additionally the CAO is supported by a skillful and committed administration staff at Association Concepts. Together, along with the membership, the specialty of orthodontics is strengthened and supported by all!

Message de le président l'adhésion à l'aco: une analyse des avantages vs risques En tant qu'organisation offrant des services à ses membres, un des rôles principaux de l'Association canadienne des orthodontistes (ACO) est de représenter et de défendre ses membres, tout en protégeant les intérêts des spécialistes orthodontistes canadiens. Le Canada est un pays immense, présentant une grande diversité. À titre d'organisation nationale, il est impossible pour l'ACO de tout faire pour tous ses membres. Toutefois, tous les orthodontistes canadiens, qu'ils soient membres ou non de l'association, reçoivent des avantages des programmes mis sur pied et des activités tenues par l'ACO. Ce qui nous mène à la question: Pourquoi tous les orthodontistes du Canada ne sont-ils pas membres de l'ACO? Seulement 50% des orthodontistes canadiens sont actuellement membres en règle de l'ACO. Ce faible pourcentage est étonnant et décevant tout à la fois. La valeur de l'adhésion à l'ACO se perçoit mieux par l'analyse des avantages vs les risques, comme on le ferait pour analyser la prise de décision ou l'acceptation d'un défi.

Les avantages perçus sont une importante source de motivation à l'adhésion. Il s'agit d'un sujet de discussion constant et récurrent aux réunions du conseil d'administration de l'ACO. Le défi est de déterminer ce qui peut être fait pour s'assurer que l'ACO procure à ses membres les services dont ils ont besoin. Les membres du Conseil sont sensibles aux besoins des spécialistes en orthodontie au Canada. En tant qu'organisation active à l'échelle nationale, l'ACO est maintenant plus dynamique et réceptive dans sa représentation de la communauté de spécialistes orthodontistes canadiens.

L'adhésion à l'ACO procure une valeur exceptionnelle en regard du montant investi. L'Assemblée scientifique annuelle fournit une excellente panoplie de formations continues et d'activités sociales, combinaison qui s'améliore et s'accroît

CAO Bulletin • FALL 2017

President’s Message | Message de le président

chaque année. La participation à l'Assemblée de cette année à Toronto a battu tous les records. Le programme d'activités sociales est tout à fait unique en son genre, favorisant l'interaction entre les membres et renforçant les relations personnelles et professionnelles de tous les participants.

Un programme de sensibilisation des consommateurs, spécialement développé pour le marché canadien, a été entièrement conçu et soutenu par l'ACO. En lien avec le programme visant les consommateurs, nous avons établi une nouvelle marque et créé un nouveau site internet, fournissant ainsi de l'information pertinente à nos membres et au public plus spécifiquement. Un des éléments clé de notre site internet est la promotion des traitements orthodontiques exécutés par un orthodontiste certifié. La fonction Recherche est exhaustive, permettant ainsi à la population de trouver rapidement et facilement un spécialiste en orthodontie, membre de l'ACO, dans leur région. L'intégration du programme de sensibilisation dans ce site destiné aux consommateurs fera la promotion de notre spécialité, comme jamais auparavant.

Les rôles traditionnels de l'ACO, tels que la représentation auprès du gouvernement et d'autres organismes, la négociation des programmes d'assurances, ainsi que le soutien à la formation continue en orthodontie, se poursuivent évidemment.

Les avantages d'être membre de l'ACO sont nombreux et de grande valeur. Quels sont donc les risques encourus lorsqu'un orthodontiste n'est pas membre?

Lorsqu'un spécialiste en orthodontie n'est pas membre de notre association, nous ne pouvons pas l'aider à promouvoir un message fort auprès de la population. Le plus grand défi à relever pour un orthodontiste, c'est la perte des parts de marché, qui sont de plus en plus revendiquées par les nonspécialistes. En tant que spécialistes certifiés, les orthodontistes peuvent se réunir au sein d'une organisation nationale de services aux membres, ce que ne peuvent pas faire les médecins non-orthodontistes. Le concept de «la force du nombre» est réelle et prend ici tout son sens.

Les non-membres courent le risque de se retrouver isolés de leurs pairs. Ils éprouvent également une perte d'interaction sociale, de communication et de soutien de la part de la communauté professionnelle. L'importance du réseau, du mentorat et de la formation ne doit pas non plus être ignorée. Les contacts personnels avec les pairs et les collègues se sont déjà vus diminués en raison de l'arrivée des forums en ligne, qui sont constants, mais qui créent tout de même une certaine distance entre collègues. Le «capital social» provenant de l'interaction avec des professionnels aux vues similaires est essentiel à la préservation de notre spécialité.

Chaque membre est valorisé. Plus nous comptons de membres, plus l'engagement est renforcé et plus l'apport intellectuel de chacun augmente. Ainsi, l'organisation peut représenter les besoins de ses membres de manière plus efficace. L'augmentation des adhésions assure également la stabilité financière de l'organisation, par l'apport régulier de cotisations et de commandites. Telle stabilité financière contribue évidemment à l'accroissement des avantages existants à l'adhésion, en plus de permettre l'ajout de nouveaux avantages pour les membres. Finalement, l'augmentation d'affiliations à notre organisation accroît d'autant plus l'influence politique que peut exercer l'ACO, tout en augmentant notre crédibilité à tous les niveaux.

Alors, pourquoi tous les orthodontistes du Canada ne sontils pas membres de l'ACO? Le message démontrant les avantages d'être affilié, ainsi que l'importance de nous réunir tous ensemble, n'est peut-être pas suffisamment partagé.

Comme la plupart des outils de communication entre professionnels, le présent bulletin «prêche à des convertis». Le véritable défi, c'est de relayer ce message aux non-membres. Pour améliorer notre rendement à cet égard, les administrateurs de l'ACO ont développé une banque de données identifiant tous les orthodontistes du Canada, ceux qui sont membres autant que ceux qui ne le sont pas. Le Comité des Membres, en collaboration avec le personnel administratif, travaille actuellement à mettre sur pied un programme de sensibilisation et de rayonnement, visant à informer les non-membres de la valeur de l'adhésion à notre association. Le Comité Jeunes et nouveaux membres s'applique à contacter les étudiants et les jeunes diplômés, afin de les convaincre de s'affilier à l'ACO. La façon la plus efficace de recruter de nouveaux membres reste le «bouche à oreille». Une invitation à joindre nos rangs, envoyée personnellement d'un membre de l'ACO à un nonmembre, représente la meilleure manière de favoriser la croissance de l'ACO. Nous vous prions de prendre le temps d'entrer en contact avec vos collègues qui ne sont pas encore membres, afin de leur faire voir l'importance et la valeur d'une adhésion à l'Association canadienne des orthodontistes, et de les inviter à joindre notre communauté.

Comme vous le savez déjà sans doute, une équipe d'orthodontistes généreux et engagés siègent bénévolement au Conseil d'administration de l'ACO, ainsi qu'à divers comités de l'ACO. De plus, l'association est soutenue par une équipe d'employés dévoués et talentueux, dédiés au programme Concepts de l'Association. Par l'implication collective de tous nos membres, la spécialité d'orthodontie en est encore davantage renforcée et soutenue par tous et chacun!

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Outgoing President’s Message Dr. Robert D. Kinniburgh Email: drbob@ncortho.ca

The executive members of the CAO had the opportunity to meet with the leadership of the AAO in San Diego, CA, during the AAO Annual Session.

The topics of discussion included the changes in the leadership of the AAO awareness campaign, the new direction and platform of the campaign and the assessment reduction to AAO members because of the improved efficiencies of the program. In addition, the AAO in-house legal counsel discussed the rationale for the DIY orthodontics campaign and the AAO actions being taken to address Smile Direct Club in over 30 states. Discussions were held to look at ways to improve value for the Canadian membership of the AAO. I attended the WFO Presidents’ Breakfast in San Diego.

Among the highlights was the declaration of May 15 as WFO Day (resources on their website for future years) and, with much fanfare, the announcement of Rio De Janeiro, Brazil, as the host city for the 2025 WFO conference. The 2020 conference is in Yokohama, Japan.

In order to improve communication with the provincial component societies, a conference call was held on March 28, 2017, to discuss the AAO PAC and to introduce the Canadian Awareness Campaign. A follow-up with the presidents took place in May. The presidents were provided updates on the information gathered at the AAO, as well as offers to attend the provincial components’ breakfast meeting at the 2017 Scientific Session. There is a strong willingness to collaborate and to share information among all. Hopefully, efficiencies can be improved across the country through better communication on issues that are common to all.

A position statement, now posted on the CAO website, has been drafted on DIY orthodontics. In addition, letters were been sent to perceived interested stakeholders in the possible introduction Smile Direct Club to the Canadian market.

In the 2017 Federal Budget, it was announced that the Government is considering legislative changes that affect small businesses in an effort to restrict the tax benefits provided by private Canadian corporations.

On July 18, 2017, the Honourable Bill Morneau released proposed changes to areas that include income splitting, holding passive investments inside a private corporation, and converting income into capital gains. MNP hosted an information webinar on this topic on August 3, 2017. Due to demand for additional resources, MNP held a second webinar for our members in late August 2017.

Correspondence has been drafted and sent to the federal government in order to make representation of the concerns that the CAO and its members have on this issue. Secondly, an information package was distributed to members, so that CAO members may directly advocate to the government and their local MP’s on these proposed changes.

Thank you to Dr. Eric Selnes and his committee for the development and the launch of the new CAO website and the home-grown awareness campaign. I fully support the new look to our organization and the new direction on the message to the public.

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CAO Bulletin • FALL 2017

Bob and Shannon Kinniburgh

Outgoing President’s Message | Message de la president sortant

Toronto proved to be a fantastic venue for the 2017 meeting with incredible attendance numbers. Thank you to Howard, his committees, along with Alison and her team at Association Concepts for making this such a great and memorable event.

It has been a pleasure and honor to serve as CAO President over the last year. The Board is moving forward in both a responsive and proactive manner to build value for all of our members. I look forward to a bright future for our organization in the coming years.

a été fait auprès des présidents. À cette occasion, nous avons fourni aux présidents des mises à jour sur les informations recueillies auprès de l'AAO. Ils ont également été invités à prendre part au déjeuner-conférence des membres provinciaux, au cours de l'Assemblée scientifique de 2017. Nous avons noté une forte volonté de collaborer et de partager l'information entre nous tous. Espérons que l'efficacité peut encore s'améliorer partout au pays, par une meilleure communication sur les questions qui touchent tous les membres en tant que communauté médicale.

Nous tenons à remercier Dr Eric Selnes, ainsi que son comité, pour son implication dans le développement et le lancement du tout nouveau site internet de l'ACO, ainsi que dans la campagne de sensibilisation conçue à l'interne. J'appuie entièrement la nouvelle image de marque de notre organisation, telle qu'elle est maintenant partagée avec le public.

Message de la president sortant Dans le cadre de l'Assemblée annuelle de l'ACO, les membres exécutifs de l'ACO ont eu l'occasion de rencontrer la direction de l'association américaine des orthodontistes (AAO) à San Diego, en Californie. Parmi les sujets discutés, les changements de direction concernant la campagne de sensibilisation de l'AAO, la nouvelle plate-forme et la nouvelle direction de la campagne, ainsi que la réduction des évaluations des membres de l'AAO, en raison de l'efficacité supérieure du programme. De plus, le conseil juridique interne de l'AAO a discuté des tenants et aboutissants de la campagne de sensibilisation concernant les traitements orthodontiques maison. Également au menu, les actions posées par l'AAO dans plus de 30 états américains en regard du Smile Direct Club. Des discussions ont aussi eu lieu pour trouver des façons d'augmenter la valeur de l'adhésion des membres canadiens à l'AAO.

Une prise de position, actuellement publiée sur le site internet de l'ACO, soulève le sujet des traitements orthodontiques maison. De plus, des lettres ont été envoyées à certaines parties prenantes pouvant s'intéresser à l'introduction du Smile Direct Club sur le marché canadien en mars 2018.

Dans le budget fédéral 2017, il a été annoncé que le gouvernement envisage d'apporter des modifications législatives affectant les petites entreprises, dans une tentative de réduire les avantages fiscaux assurés par les sociétés privées canadiennes.

J'ai participé au Déjeuner du Président de la fédération internationale des orthodontistes (WFO) à San Diego. Parmi les faits saillants de cette rencontre, notons l'officialisation du 15 mai comme jour désigné pour célébrer le WFO Day (ressources présentes sur leur site internet pour les prochaines années). De plus, il fut annoncé en grandes pompes le choix de la ville de Rio De Janeiro, au Brésil, comme ville-hôte du congrès de la WF0 en 2025. Le congrès de 2020 se tiendra à Yokohama, au Japon.

Afin d'améliorer les communications entre les membres provinciaux, nous avons organisé un appel-conférence qui s'est tenu le 28 mars 2017, pour discuter du Comité d'action politique de l'AAO (PAC program), et pour présenter la campagne de sensibilisation canadienne. En mai, un suivi sur cette question

Passing the Gavel

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Highlights of the 2017 Annual Scientific Session!

THURSDAY NIGHT SOCIAL

Hanging out with hockey icons!

The Kingston Crew

Cheering on the CAO

Showing their team spirit!

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CAO Bulletin • FALL 2017

Thank you to Howard Steiman Recipient of the 2017 Award of Merit

2017-2018 CAO Board of Directors

The CAO Past Presidents

Thank you to retiring Board members Jean-Marc Retrouvey and Michael Patrician

S CI E NTI FI C S E S S I ON S

Packed session.

Dr. Anthony Mair introducing for Dr. Stephan Dewitt.

Dr. Miles keeping everyone riveted.

Michael Landsberg with his father, CAO Member Dr. Ron Landsberg and Annalee Landsberg.

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CAO Staff

Techs In The City!

G R EAT D I S CU S S I ON S AT TH E R OU N D TA B LE S E S S I O N S

A B U SY TR AD E S H OW FLOOR

ALU M N I R E CE PTI ON

Tires, tune up & teeth!

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Western crowd meets up!

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F R I DAY N I G H T G AL A

Beautiful setting at the Design Exchange.

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Who wants to buy in to the CFAO?

The band.

Hit me!

The Lo & Elliott team

High Rollers!

Fun with caricatures.

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CAO R A FFL E W I N N E R S …

Ms. Mariangela Fabiano Apple iPad – Courtesy of: Ortho Supply of Canada Dr. Laura MacDonald iRobot Roomba Vacuum Courtesy of: 3M Oral Care Ms. Julie Pfohl Kobo Aura H2O Courtesy of: CAO Ms. Rachel Bussell Bose Soundlink Bluetooth Speaker Courtesy of: CAO

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Ms. Eva Jones Unlimited Case Submission/Marketing Kit Courtesy of: Clear Correct Ms. Margarida Barbosa Sonicare Gift Basket Courtesy of: Philips Sonicare Ms. Guneet Marwah 10 Day Whitening Kit Courtesy of: Ortho Essentials

Eva Jones collects her prize!

50/50 Raffle Winner!

Dr. Sonya Lacoursiere $1,105 to each Dr. Lacourisere and Sick Kids Hospital

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Committee Reports Treasurer’s Report

CFAO Report

Dr. Michael Patrician Treasurer

Dr. Stephen Roth CFAO President

Email: drpatrician@bellnet.ca

Email: stephenfroth@mac.com

As of June 30, 2017, the general operations of the Canadian Association of Orthodontists had generated a net income of $211,639.90. For the same time period, the CAO Scientific Session had generated a net income of $285,639.36. The net combined net revenue of the CAO as of December 31, 2016, was $497,279.26. The total members equity was $1,143.388.49 and the total current assets stand at $1,199,636.16.

The CFAO Silent Auction continued at the Annual Scientific Session in Toronto.

Thanks to the provincial associations and to the individuals that donated items this year, raising over $5,000.

At the Annual General Meeting in Charlottetown, PEI, an assessment of $200.00 plus GST/HST was approved for the years 2017 and 2018. Total fees for 2017 including the assessment, was $855 plus GST/HST. Total fees for 2018 will be $865 plus GST/HST. The Board of Directors (BOD) approved the 2018 budget prior to the meeting in Toronto in September.

To date, the CAO general operations are proceeding to plan.

Upgrades to the CAO website continue, tied to the needs of the Communications Committee that is overseeing the new multi-media consumer campaign. Projected budgets presented by Blackjet Communications were higher than initially anticipated. To cover the fees, additional CAO reserves will need to be drawn upon and a revised assessment will need to be planned for 2019 and 2020. The BOD has approved the Blackjet Communications contract and a deposit has been sent to initiate the program.

After a solid 20 year run, the CFAO Annual Golf Tournament was not held at the Annual Scientific Session this year. The CFAO appreciates Cerum Ortho Organizers’ commitment to the CFAO by sponsoring the activities on Thursday, September 14, 2017.

The CFAO was pleased to support the McIntyre Lecture again in 2017. Dr. Peter Miles presented “Controversies in Clinical Orthodontics - What works and what wastes our time?”

The Smiles4Canada Regional Committees and the staff at Association Concepts have had a busy few months. The response to the media exposure in January has been dramatic. To date, 353 completed applications have been received. The Regional Committees have screened 172 of the applications and approved 95 for treatment. So far, 71 of these applicants have been matched to participating orthodontists. The CFAO thanks these orthodontists for their service. Thanks also to the Regional Directors Dr. Jeff Stewart, Dr. Sunny Leong, Dr. Gordie Organ and to staff Alison and Kimberley for all of their hard work. The CFAO has made a priority of translating the application form and the supporting information into French and hopes to begin accepting applications from Quebec in 2018.

Much has been learned from the launch of Smiles4Canada. The CFAO plans to move to a periodic application process, meaning that applications would only be accepted during a certain time period each year. The acceptance period would then be followed by other periods where the applications are reviewed and are assigned. The CFAO believes that this process will make it easier for the Regional Committees to identify the patients most in need of treatment each year and to ensure that they are the

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Committee Reports

ones to receive treatment. This process should also reduce the amount of work for the volunteers and administrative staff. More to come in the near future.

CFAO Treasurer Report As of June 30, 2017, the net revenue for the CFAO was $5,303.38. For the same time period, the total current assets were $332,345.56. Total member equity was $204,124.67.

The 2017 disbursements from the Foundation have not been completed. The disbursement quotient for 2017 is $10,739.00.

Member Equity and Total Current Assets have decreased in response to the increase in expenditures arising from the Smiles4Canada program. The Board of Directors will monitor any future potential drain on funds that might continue and reassess the need for fund raising initiatives as a counteractive measure.

mination forms. Blue Cross coverage in the western provinces has become selective with respect to the above and has become selective with respect to their payouts. The publication of the Predetermination Guide in the Bulletin has assisted the membership in its preparation of insurance forms overall.

The ability to directly invoice insurance companies has continued to be of importance. An increasing number of offices in Western Canada are direct billing using general practice codes. Members have contacted the Insurance Committee to inquire about the timeline of code acceptance. The perception is that the process is simple, when in fact the process involves multiple committees and requires trans-provincial approval.

When members hear this, most clinicians indicate that they may accept assignment under general practitioner codes regardless of the process. Further, many of the new and younger practice owners are feeling the crunch of significant debt and are willing to accept the risks of direct billing no matter what the cost. However, the more members that take on this method of payment, the more challenging is the CAO’s position on the rejection of a specialty code.

Since the CFAO spent $26,406.00 in 2015 on charitable activities, the CFAO has a carry-forward of $16,604.05 as a disbursement excess that can remain for up to five years. The Board of Directors will have to decide, if and when, it can make use of this excess contribution.

CAP Report Dr. Sheila Smith Email: stuart.smith4@sympatico.ca

Insurance Report Drs. Mike Wagner & Don Johnston Co-Chairs, Insurance Committee Email: insuranceenquiries@cao-aco.org An above average number of calls and emails have been received in western and central Canada. Insurance companies may be attempting to revise internal rulings on insurance assessments for orthodontic specialist predetermination. Requests for millimetric quantifications for overbite, overjet, crowding, classification of occlusion, the type of appliance and specification of Phase I versus Phase II versus full phase treatment have become more frequent. There have been requests for treatment procedural codes. Phase I treatment plans have been rejected without a description of the appliances used.

Some insurance companies are trying to transfer the responsibility of paying for adult tooth removal if placed on the predeter-

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The Consumer Awareness Program (CAP) has been running across the country in English since early October, 2016. It continued to run until the end of May, 2017. The French version has been in place since November, 2016. Three quarters of the funds were allocated to the digital campaign and the remainder to television advertisements. Recently, the CAO logo graphics were changed for both digital and television advertisements. The CAO has maintained a presence on the “Red Carpet” programs prior to award shows. This year the CAO placed advertisements during the first, second and third rounds of the NHL playoffs. This exposure was intended to broaden the target audience that traditionally had been females between the ages of 25 and 50.

The CBC/SRC homepage takeovers on Wednesday, November 10, 2016, were a success. The homepages had 2.4 million hits on the CBC site that day producing approximately 7,000 hits on the CAO/AAO sites arising from Canada.

Currently Alberta, British Columbia, Ontario and Quebec are

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Committee Reports

participating in the AAO match program. There are matching funds available from the AAO earmarked to the Atlantic provinces, Manitoba and Saskatchewan. The match program will continue through the next sixteen months, after which the AAO will reassess the program. Currently there is no additional information available from the AAO for the CAO to make any future plans regarding the CAP.

the most recent CDA communication to Mr. Bob Hamilton, Commissioner and Chief Executive Officer of the CRA to • request a moratorium on audits until CRA is back in a position where it can provide clear guidance on the application of the Excise Tax Act to orthodontic appliances and dental prosthesis; • remind him of the commitment made by CRA in 2004 and repeated in 2015, to implement any changes to the Orthodontic Supply Agreement in a prospective fashion only;

HST/GST Report

• initiate as rapidly as possible discussions towards the negotiation of a new agreement to replace the now invalidated Orthodontic Supply Agreement and to ensure that issues with the determination of the effective tax rate applicable to various orthodontic supplies continue to be managed fairly for all.

Dr. Michael Patrician Treasurer Email: drpatrician@bellnet.ca

There have been no new communications with The Canada Revenue Agency (CRA) regarding the Input Tax Credit (ITC) system for Canadian orthodontists over the last year.

In November and December of 2016, the CAO was audited

by CRA for its GST/HST ITC returns. No challenges or changes to the returns were requested by CRA. There continue to be CRA audits of orthodontic offices in Canada but the frequency has reduced of late and hence communication to the membership has decreased. The member e-blast and joint CRA/CAO question and answer document appears to have been of benefit.

The CAO was made aware of a judicial ruling in a case involving a CAO member. The case was an appeal of an assessment, made under Part IX of the Excise Tax Act, by the Canada Revenue Agency. The CAO had no advance knowledge of the case and had not been given any of the related details by those involved.

A letter was sent by the CAO President Dr. Bob Kinniburgh to the CDA president Dr. Larry Levin to seek representation of the CDA with the CRA regarding this judgment and its future implications. The decision by the court appeared to directly contradict CRA’s own historical interpretation of the Canadian ITC system and the original Hicks GST Agreement.

The CAO is of the opinion that the effect of this judgement will put orthodontists at risk both legally and financially. The CAO has worked closely with the CDA on GST/HST issues in the past and is of the opinion that a renewed consultation with the CDA and KPMG is warranted. To date, here is a summary of

New and Younger Members Report Dr. James Posluns New and Younger Members Representative Email: james.posluns@utoronto.ca Mr. Michael Landsberg spoke at the New and Younger Member Luncheon at the CAO Scientific Session in Toronto. With both of his parents in the audience, Michael made the rounds connecting with the members in the room before taking the stage and delivering what can only be summarized as a very powerful message. Michael spoke with a unique combination of insight, humility and humour that made the hour fly by. The CAO thanks Michael for making time in his very busy schedule for the New and Younger Members of the CAO. With approval of the Board, the CAO was present at the 2017 GORP meeting in Cleveland, Ohio August 5 to 6, 2017. The decision was made to attend this meeting because the number of registrants was large, it was easy to get to and because the rate offered by organizers was favourable.

Many people came by the booth, and not necessarily just to play table top hockey (although it was tough to compete with virtual reality glasses and the racing goldfish). As per usual, most wished to discuss the RCDC and Canadian licensure.

Approximately 20 people signed up for membership information, most it seemed from the West Coast.

More to come from this vibrant group in short order!

CAO Bulletin • FALL 2017

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Committee Reports

CCOE Dr. James Posluns Educators Liaison Email: james.posluns@utoronto.ca

Toronto. In addition, a number of Undergraduate Program Directors also met to discuss recent changes to their respective programs and the need for a national shared curriculum. Presentations were given Program Directors from British Columbia, Dalhousie, Manitoba and McGill, Toronto and Western Ontario.

The CCGOPD had a productive meeting in San Diego at the AAO Annual Scientific Session in May, 2017. The AAO again kindly donated a room for use by the CCGOPD. Of all of the Graduate Programs in Canada, only the University of Montreal was without representation.

The Canadian match system was discussed at length. The dates for interviews were decided upon. Other topics of discussion included the ongoing problems and solutions in Canadian education. The continued budget cuts which negatively affect all programs were central to this discussion All of the Graduate Program Directors, save for Montreal attended the Educators meeting at the Scientific Session in

CAO/AAO Report Dr. Rick Odegaard CAO/AAO Liaison Email: dr.odegaard@shawcable.com Mr. Chris Varanas is no longer the American Association of Orthodontists (AAO) Executive Director (ED).

Dr. Dwayne McCamish, AAO Past President, is the interim ED. The AAO has enlisted an executive search team and struck a committee to select a new ED. They announced their selected candidate this past fall.

Ms. Linda Gladden has been replaced by Ms. Katie Maassen as the Director of Communications. Ms. Maassen is now the staff person in charge of the Consumer Awareness Program.

The consumer awareness program has undergone a complete reorganization. The relationship with the advertising agency Athorn and Clark has been terminated. The marketing and creative team has now been moved in-house at the AAO. Direction for the CAP is being provided by the Council on Communication chaired by Dr. Anil Idiculla. The council is composed of a member from each AAO constituent organization.

The CAP message is unchanged: the promotion of orthodontic care by an orthodontic specialist member of the AAO. The method of delivery has changed, with a focus on digital advertising and promotion.

Integral to this change is a completely redesigned website that will consolidate the member and the public websites. The AAO is expanding its digital footprint through multiple strategies that include updates to search engine optimization, the expansion of the reach and the content of the social media marketing, growth in the search presence for the AAO when consumer searches for anything related to orthodontics online and new creative materials for online use.

CAO Booth at the 2017 GORP Meeting

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The digital approach is more dynamic, increasingly agile and more specific in reaching target markets, reacting to consumer trends and finding consumers based on for what they are searching. The mandate of the Council on Communication is

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Committee Reports

to respond quickly to promotional concepts, news items and other items of importance.

As part of the new program there will be a focus on branding and brand awareness. All AAO member orthodontists will be encouraged to prominently display the AAO logo on their websites to develop consumer awareness around the value of an AAO orthodontic specialist.

The goal of the program is to drive the “Find an Orthodontist” search component of the AAO website to the benefit of the member. Since the change to a digital focus, tracking has shown that 75 percent of the searches for on orthodontist using the locator have come as a result of a link through from the consumer awareness material.

Since February, 2017, the AAO Facebook and Instagram sites have had 23 million impressions from 9 million individual consumers. Facebook “likes” are up 700 percent. The AAO website has been averaging 100,000 (up from 66,000) visits per month since February, 2017.

In addition, the AAO is launching advertisements and information campaigns on social media. The first video posted focused on the importance of direct supervision by an orthodontist during treatment. In the first week there were 1.5 million views with 600,000 views demonstrative of active engagement through the visitation to the AAO website, the consumer website or through comments arising out of sharing the ad.

The switch to intensive digital marketing has also resulted in an $200 cost savings to each member annually.

The funds matching program available to state and provincial orthodontic societies will terminate in May, 2018. Any unused funds will go back to general reserves. There are no plans for continuation of this program at this time.

The AAO House of Delegates met at the Annual Scientific Session in April and modified the membership criteria. The previous educational requirement of completion of an accredited American or Canadian orthodontic program remains in place, but successful completion of the Royal College of Dentists of Canada (RCDC) National Dental Specialty Examination will also satisfy the educational requirement for AAO membership.

This amendment benefits internationally trained orthodontists that have gained their specialty certification in Canada. Thank you to Dr. Ron Wolk for championing this change with the House of Delegates.

Webinar Update Dr. Gerry Zeit The spring webinar was scheduled with Dr. Bruce McFarlane on March 29, 2017, at 8:00 pm EST. Dr. McFarlane`s presentation was entitled A-P Correction Prior to Orthodontics: The Time is Right and was characterized by a strong focus on the use of Dr. Carriere`s Motion Appliance. The webinar had 67 registrants and 36 log-ins. Dr. McFarlane filled in on short notice to make this presentation happen. His support of the CAO is much appreciated.

On August 22, 2017, Calvin Carpenter CPA CA, Marty Clement CPA CA and Nick Korhonen CPA CA, all of MNP LLP presented a webinar entitled Proposed Tax Measures and GST Ruling regarding Orthodontists. In fact, there were two opportunities for CAO members to obtain this information as, in addition to presenting on the CAO platform, MNP had also invited CAO members to register for its own webinar on Proposed Tax Changes for Private Corporations on August 3, 2017.

This is the second time that members of MNP have presented a webinar for the CAO, the last time being a 2014 presentation on GST/HST. The webinar had 121 registrants and 76 log-ins.

Beyond continuing education, the webinar has shown itself to be a nimble and flexible platform for disseminating information to the membership on short notice.

As always, many thanks to the entire CAO staff and especially to David Petrie and to Alison Nash for organizing and hosting the webinars.

Continued…

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Committee Reports

In response to the Smile Direct Club, which has a presence in 49 states, the AAO has sent letters to 36 state dental regulatory bodies advising and alleging statutory and regulatory violations that Smile Direct Club has committed. There is no report on responses from the state regulators at this writing.

The CAO Board is closely following the progress of the AAO on this issue and is prepared to respond if Smile Direct Club attempts to establish itself in the Canadian market.

The next AAO Annual Scientific Session will be held in Washington D.C, May 4 to 8, 2018.

CDSA Report Dr. Mike Wagner CDSA Liaison Email: wagner.cao@gmail.com

under-serviced areas regarding caries prevention. The darkening of tooth pallor caused by this agent remains the largest deterrent for routine prescribed use. Clinical trials for a “nonstaining” formula are presently under way.

The CAO’s consumer education campaign and insurance objectives were discussed. Member-based services were also brought up as each discipline noted a decline in membership on a yearly basis.

A new CDSA website to promote specialties is in development. Additional details are to be released. The validity of a survey to general dentists was a topic of conversation. Areas of concern include 1. How can specialists better serve the needs of the public. 2. What is the main reason for the decline in referrals. 3. Practice standards and should there be a minimum publication of specialty practice standards to better serve patients and referral sources.

The most recent Canadian Dental Specialties Association (CDSA) annual meeting was held in conjunction with the Annual General Meeting of the Canadian Dental Association (CDA) in Ottawa, Ontario, on April 20, 2017. Most disciplines were represented with the exception of the Oral and Maxillofacial Surgeons (OMFS) group. Several topics arose of discussion during this all day event.

Denturists are increasing their scope of practice in Alberta.

The immediate referral sources to prosthodontists in that province are feeling potentially challenged. Currently there is no prosthodontic specialty member in Alberta to advocate to the Alberta Dental Association and College.

As the number of certified oral radiologists are changing within the country, the CDSA was made aware that the Oral and Maxillofacial Radiology (OMFR) group is assessing the interpretation and radiographic demands and needs of each province. The CDSA is aware that the OMFR specialty group is working on an agenda for cross-country and cross-provincial radiology reporting. At this time, interpretations are only to be done by those radiologists within each home province.

The periodontists have released an updated website this year and have noted a huge success in the “Find a Periodontist” section of their website. Additional referral-based concepts are in development.

In pediatric dentistry, silver diamine fluoride is a big topic for

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RCDC Report Dr. Tarek El-Bialy CAO/RCDC Liaison Email: telbialy@alberta.ca As of September 23, 2017, the Examination Committee members of the RCDC are Drs. Susan Eslambolchi - Chief Examiner, Lesley Williams - Past Chief Examiner, Timothy Agapas - Component 1 Section Leader, Austin Chen and Kamrin Olfert - Component II Section Leaders, and Sonya Lacoursière - French Content Reviewer.

In 2017, 50 candidates sat the Component I examination. 44 candidates passed this examination, for a pass rate of 88 percent. 53 candidates sat the Component II examination. 44 candidates passed this examination for a pass rate of 83.02 percent. From 2010 to 2016, 111 candidates challenged Component I. 106 Candidates were successful for a past rate of 95.5 percent. Of the 106 successful candidates of Component I, 98 successfully passed Component II for a pass rate of 92.5 percent.

RCDC Council for 2017 consists of Dr. Christopher Robinson - President, Dr. Adel Kauzman - Vice President, Dr. Hugh Lamont - Immediate Past President, Dr. James Posluns - Treasurer, Dr. Benjamin Davis - Examiner-In-Chief and Mr. Peter McCutcheon - Executive Director.

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Committee Reports

WFO Liaison Report

all continents. The WFO Promotions Committee is currently active and plans are underway for next year’s event. Any ideas or suggestions are welcome.

Dr. Amanda Maplethorp WFO Executive Committee Email: a_maple@shaw.ca The Executive Committee of the World Federation of Orthodontists (WFO) met in April, 2017 and again in conjunction with the Chinese Orthodontic Society Annual Session in Shanghai in September, 2017.

The 2020 meeting in Japan is drawing nearer. The WFO will celebrate its Twenty Fifth Anniversary that year, so it will be a special event. All Canadian orthodontists are invited to join the WFO and to attend this fabulous meeting. Orthodontics is a varied profession around the world and much can be learned from international lecturers. There are updated WFO applications available at WFO.org for those who would like to join.

The social program will be outstanding and Japan has much to offer as a tourist destination.

The Cambodian Society of Orthodontists has recently been created and has joined the WFO. Dr. Rick Odegaard will be invited to represent the CAO at the WFO Breakfast Meeting in Washington D.C. May 6, 2018. In conjunction with the AAO Annual Session, the WFO will be hosting a meeting of the 17 National and Regional Orthodontic Board Committees from around the world to facilitate collaboration between all the certifying boards.

The 10th IOC will be held October 8 to 11, 2025, in Rio de Janeiro, Brazil.

Gail Gartner is new editor of the new electronic WFO Gazette.

Dr. Vinod Krishnan, the new Editor-in-Chief of the Journal of the World Federation of Orthodontists is updating the journal and is making it more accessible.

The first Annual World Orthodontic Health Day that took place on May 15, 2017, was successful with events happening on

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Component Society Reports British Columbia

Alberta

Dr. Jay Philippson

Dr. Todd Lee-Knight

Email: jayp@shaw.ca

Email: todd@drlee-knight.com

The British Columbia Society of Orthodontists (BCSO) held its Annual General Meeting on June 9, 2017 at the University of British Columbia. Presentations made by the UBC graduate students followed the annual golf tournament.

Dr. Todd Moore completed his busy year as president. The Consumer Awareness Program (CAP) and how funds are to be used in the future were major foci. A new website, with improved intraorganizational communication, is in the works to improve public access to information, to search for members, to link to member websites and to manage a member forum. There is interest in creating a media-savvy core of orthodontists available for interviews when hot button topics such as DIY orthodontics come up.

Smiles4Canada is up and running in BC with Dr. Jeff Stewart as the Regional Chair. Patients are now in treatment. The College of Dental Surgeons of BC has reversed much of the restrictions placed on dentists with respect to educational or membership designations on their respective correspondence or advertisements. Previously all designations, such as RCDC, were prohibited but the proposed changes allow these to be included in unabbreviated form with the year granted, the jurisdiction and the name of the granting organization.

The BCSO Executive for 2017-18 includes Dr. Lucien Bellamy - President, Dr. Fred Cheung - Vice President and Dr. Jordan Miller - Secretary Treasurer.

The latest BCSO meeting was held on November 20, 2017.

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The Alberta Society of Orthodontists (ASO) is holding its Annual Scientific Session and Meeting in beautiful Banff on Friday April 6 and Saturday April 7, 2018. The ASO has secured an exciting slate of speakers with ‘Early Orthodontic Treatment’ as the theme. A wide variety of appliances and techniques commonly utilized in early treatment will be discussed, including: Invisalign (Dr. Dona Galante), the Wilson appliance (Dr. Tim Auger), myofunctional therapy and ALF (Dr. Derek Mahoney), early open-bite correction (Dr. Budi Kusnoto), and practice management and profitability with early treatment (Dr. Moe Razavi).

The ASO continues to work on the issue of advertising within the Alberta governance framework. Given the changes that have occurred with the AAO and CAO Public Awareness Programs, the ASO is excited to gauge the outcome of the newly minted CAO promotional initiative.

The timing of the new CAO orthodontic promotional campaign is perfect, as a number of Alberta orthodontists have expressed the expectation of our professional organizations (be it the CAO or ASO) to be more proactive in their positive representation of the specialty to the public. Additionally, membership at all levels of organization has been in decline over recent years. It is anticipated that the new CAO campaign may be the catalyst to generate new excitement for the existing members and a reason for the new and younger orthodontists to join the organization.

The CAO and the ASO may have a new initiative to collaborate on as the Government of Alberta has been pressing the Alberta Dental Association and College to publish a fee guide.

Typically fee guides require codes, but codes are something to which the CAO has historically been in opposition. Yet again, Alberta clinicians find themselves forging a path that they may wish they were not on, but one that may prove to be an important one for those who follow.

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Component Society Reports

If you are interested in attending this year’s meeting of the Alberta Society of Orthodontists, please consult the ASO website for details.

June 2017 and hail from Dublin, Winnipeg and Calgary.

The 2017 fall MOS meeting took place on October 27, 2017.

Ontario

Saskatchewan

Dr. J. Eric Selnes

Dr. Brian Phee

Email: str8smiles@sympatico.ca

Email: brianphee957@gmail.com The Saskatchewan Society of Orthodontists (SSO) held its annual general meeting for members and support staff in January of 2017 and is not scheduled to meet again until spring of 2018.

There have been some changes at The University of Saskatchewan including budget cuts resulting in significant tuition increases for students in the College of Dentistry. Dr. Doug Brothwell has been appointed as Dean of the College of Dentistry for a five-year term.

The SSO would like to congratulate Dr. Kam Olfert of Regina on his appointment to President of the Pacific Coast Society of Orthodontists and we would also like to welcome Dr. Kristopher Currie back to Saskatoon as one our new members.

Thank you to the CAO Board and support staff for all of their hard work in putting together another very successful conference in Toronto.

There are approximately 410 orthodontists in Ontario, of which 55 percent are OAO members. The OAO is investigating ways to boost membership and to garner interest in the organization.

The OAO runs a balanced budget year over year, outside of the current CAP. $25,000 of its reserves have been spent on the CAP program to date and the plan is to continue this program at least until May, 2018.

The OAO Executive has been busy monitoring the increased attention on infection control standards and the proposed revisions to healthcare professional corporations (HPCs) by ensuring that an OAO Executive member regularly attends the RCDSO Council meetings. The OAO will continue to follow and to offer input on infection control and the potential impact of the Smile Direct Club.

An e-blast letter template, regarding the proposed changes to HPCs has been sent to all members. When completed, these templates are to be forwarded to members’ respective MPs and/or to the Federal Finance Minister, The Honourable Bill Morneau.

The OAO has filed a formal complaint against a general dentist in the London area for falsely advertising and continues to monitor these types of issues with continued input from the membership.

Manitoba Dr. Susan Tsang Email: drtsang@winnipegorthogroup.com The fall Manitoba Orthodontic Society (MOS) dinner meeting was held May 4, 2017. Discussions took place about the formation of an adhoc committee to address concerns from MOS members about the provision of orthodontic treatment by non-specialists.

At the University of Manitoba, all three third-year residents and two full-time faculty members passed Component II of the 2017 RCDC examination. Congratulations to all on your success. The three first-year residents started their program in

The OAO will start the HST election process mid-October as per the suggestion from the Auditor in advance of our renewal year. It has been suggested that the OAO start collecting HST on dues and events as directed by CRA. This change will come into effect January 1, 2018.

The next OAO Scientific Session will be held in Niagara-onthe-Lake June 8 to 10, 2018.

The Executive has approved bylaw changes that were voted upon at the Membership Meeting held on November 2, 2017.

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Component Society Reports

Quebec

Atlantic Report

Dr. Giovanni (John) Scalia

Dr. Stuart A. Matheson

Email: johnny.scalia@gmail.ca

Email: smatheson1@mac.com

The AAO-based CAP marketing Program in Quebec is entirely digital and successful encompassing both Google and Facebook campaigns. 3,443,758 impressions and 11,598 Facebook clicks were generated in the first 6 weeks (May 25-July 12), of which 97 percent used mobile devices to consult. The Facebook campaign currently is an age-group targeted campaign with adjusted budgets for better-performing posts. The top three websites where the campaign was featured were Journal de Montréal, Radio-Canada.ca and outlook.com.

Quebec hosted the first International orthodontic conference of the Francophonie. Orthodontists gathered for conferences and socializing in Montreal associated with the Journées Dentaires Internationales du Québec.

Rapport de la province de Québec La campagne de marketing CAP de l'AAO au Québec est maintenant entièrement diffusée sur support numérique, et cette campagne remporte autant de succès sur Google que sur Facebook. Un total de 3 443 758 vues et de 11 598 clics sur Facebook ont été comptabilisés au cours des six premières semaines (du 25 mai au 12 juillet). De ce nombre, 97% des internautes ont utilisé des appareils mobiles pour visiter notre page. La campagne médiatique sur Facebook vise actuellement un groupe d'âge spécifique et compte sur un budget ajusté pour publier des posts à rendement supérieur. Les trois principaux sites Internet sur lesquels la campagne fut diffusée sont le Journal de Montréal, RadioCanada.ca et outlook.com.

The annual meeting of the Atlantic Provinces Orthodontic Association (AOA) was held in Halifax on April 7, 2017. Presentations by Drs. Curtis Gregoire and Dan Stuart were about orthodontic preparation for orthognathic surgery. A business meeting followed the continuing education presentation. The evening was capped off with a social for members and guests at Dr. Stuart’s home.

Participation in the AAO Consumer Awareness Program matching grants was the issue that received the most discussion. The group assembled was in favor of participation but there were inadequate numbers at the meeting to make a decision for the entire association. As a result, it was decided to establish a private Facebook group to further discuss the issue. The AOA was aware of impending changes at the AAO and was unsure about how the program will look going forward. With the onset of summer, plans were placed on the backburner, but there is a volunteer ready to establish the Facebook group and to distribute information to the membership soon.

The next meeting of the AOA will be held in Halifax on April 13, 2018.

Le Québec a accueilli la première Conférence internationale en orthodontie de toute la Francophonie. Les orthodontistes se sont réunis à Montréal, pour assister à des conférences et prendre part à des activités sociales, au cours des Journées dentaires internationales du Québec.

CFAO Donations Nicole Popovich In Memory of Mrs. Gail Meadows Larry Herscu In Memory of Mrs. Gail Meadows Heppel Family Foundation In Support of Smiles4Canada CAO In Memoriam of Dr. Garry Solomon CAO In Honour of the Scientific Session Speakers

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CAO Bulletin • FALL 2017

Student Posterboards Abstracts from the 2017 CAO Annual Scientific Session – Part 1 of 2 part series University of Alberta POSTERIOR CRANIAL BASE AND SURROUNDING AREA CHANGES ASSESSED THROUGH CBCT IMAGING IN ADOLESCENTS

University of British Columbia ALTERED CRANIOFACIAL MORPHOLOGY IN CHILDREN WITH OSAS: A CLINICAL PHOTOGRAPHIC STUDY Authors: Evan Ayers, Fernanda Almeida, Mona Hamoda, Nelly Huynh, Benjamin Pliska UBC Division of Orthodontics

Authors: Kris Currie, Carlos Flores-Mir, Heesoo Oh, Manuel Lagravere

INTRODUCTION: Altered craniofacial morphology such as backwardly positioned jaws, small upper jaw/lower jaw ratios, and long narrow faces, has long been associated with pediatric obstructive sleep apnea syndrome (OSAS). Standardized craniofacial photography has been used in adult populations as screening tool for OSA, but has yet to be utilized in a pediatric population.

METHODS: A standardized orthodontic exam, including calibrated frontal and lateral photographs, were performed on children of consenting families who were attended BCCH for overnight sleep evaluation.

RESULTS: 65 participants (29 female, 36 male, mean age 8.9 ± 3.1 years) were compared based on their AHI. 27 children had an AHI < 2/h (deemed not to have sleep apnea), 21 had mild OSAS (AHI 2 to 5/h), and 17 children were found to have severe OSAS (AHI >5/h). 19/65 participants (29.2%) were obese, and were excluded from final analysis due to craniofacial differences. Of the remaining children, no significant differences were found for any clinical measurements between children with and without OSAS. Analysis of the standardized photographs revealed children with OSAS had a more obtuse cervicomental angle (7° increase), and an increased lateral facial height (6 mm increase). Increasing cervicomental angle, intercanthal distance, mandibular width, and cricomental distance were all correlated with the severity of OSAS. CONCLUSION: Aside from an increased cervicomental angle, altered craniofacial morphology was not significantly associated with pediatric OSAS. Standardized craniofacial photography, in particular the measure of cervicomental angle, shows promise as a potential screening tool for OSAS, but requires further research.

OBJECTIVE: To determine if landmarks in the posterior cranial base and surrounding areas are stable during adolescent years in the horizontal, vertical and antero-posterior dimensions.

METHODS: Sixty (60) patients were randomly selected from a clinical trial and each had two CBCT images taken previously, one before and one after they received orthodontic treatment. Images were taken using an iCAT CBCT scanner on an average of 17.5 months apart and retrospectively assessed. Twenty-nine (29) landmarks previously deemed reproducible and accurate landmarks were marked on pre-treatment (T1) and post-treatment (T2) images.

RESULTS: When all distances were considered jointly, there was evidence of significant differences of the dependent variables (p < 0.001) between these time-points. This indicates some statistically significant change in distance of several measurements between T1 and T2. Adding age at T1 as a covariate, a non-significant result indicates that age at time of initial CBCT image does not affect potential growth (p = 0.639).

When treatment time is added as a covariate, suggestive but inconclusive results are revealed.

CONCLUSION: Horizontal, vertical and antero-posterior dimension of the cranial base and surrounding areas show a few statistically but not clinically significant changes over T1 and T2. Measurements which took point Basion into consideration all showed changes, most likely due to spheno-occipital synchondrosis growth in addition to previously demonstrated changes in point Basion position.

*LACOR presenter

CAO Bulletin • FALL 2017

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CFAO Graduate Student Posterboards

University of Alberta AESTHETIC OUTCOME OF MAXILLOMANDIBULAR ADVANCEMENT SURGERY FOR TREATMENT OF OBSTRUCTIVE SLEEP APNEA Authors: J Curran, A Tassi, M Shimizu Schulich School of Medicine and Dentistry University of Western Ontario, London, Ontario INTRODUCTION: Obstructive sleep apnea (OSA) is a common sleep disorder in which complete or partial airway obstruction causes disruptive sleep and excessive daytime sleepiness. Researchers have reported highly successful surgical treatment for OSA utilizing maxillomandibular advancement (MMA) surgery. However, there are concerns amongst potential patients about the final aesthetic outcome and how they will appear after surgery.

OBJECTIVE: To evaluate facial aesthetic changes in patients treated for OSA with MMA surgery utilizing panels of oral and maxillofacial surgeons (OMFS) and laypeople (LP).

MATERIALS AND METHODS: This was a retrospective cohort analysis. Pre and post-treatment silhouettes of patients who underwent successful MMA surgery for OSA (n=22) were generated from patient photographs using Photoshop™ software. The silhouettes were shown in random order to a panel of judges consisting of OMFS (n=29) and LP (n=71).

The panel of judges was asked to rate the patient silhouettes on a 10-point visual analog scale based on attractiveness, paying particular attention to facial balance. *LACOR presenter

Thanks to Dentsply Sirona for their support of the Latest Advances in Canadian Orthodontic Research Symposium and the CFAO Posterboards

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RESULTS: The post-surgical silhouette ratings were significantly higher (more attractive) than the pre-surgical ratings in 20 of the 22 MMA patients scored (P<0.05) with an overall mean increase of 1.6 for all judges combined. There was a significant difference (P<0.05) in the way that OMFS rated silhouettes as compared to LP for 8 of 22 patients, with OMFS attributing greater positive aesthetic change (2.1) than LP (1.4).

CONCLUSIONS: MMA surgery for the treatment of OSA does not have a negative impact on facial aesthetics. Both OMFS and LP feel that post-surgical aesthetic changes were positive, with OMFS observing a higher positive change than LP.

University of Alberta PATIENT EXPERIENCES WITH THE XBOW APPLIANCE COMPARED TO THE FORSUS FATIGUE RESISTANT DEVICE: A RANDOMIZED CLINICAL TRIAL Authors: Ashley Phuong, Paul Major, Mary Roduta-Roberts, and Carlos Flores-Mir OBJECTIVE: To examine adolescent patients’ experience with the Xbow appliance and compare it with that of the Forsus Fatigue Resistant Device (FFRD) inserted over an archwire using a questionnaire. Also to examine if patients’ experience changes over time.

METHODS: Paper questionnaires were administered to 48 adolescent patients with mild-moderate Class II malocclusion randomly allocated into 2 treatment groups: Xbow and FFRD. Patients were instructed to complete the questionnaires at 1 week after insertion of the appliance, and 2 months after insertion of the appliance. Amount of time required to become accustomed to the appliance, side effects experienced, breakage occurrence, as well as the degree of discomfort were explored.

RESULTS: The overall experience with the appliance was similar between the Xbow group and the FFRD group. The majority of the FFRD group felt that insertion of the appliance was quick and easy, compared to the Xbow group which tended to disagree with that statement. The Xbow group reported the appliance was noticeable, and also some difficulty to open wide/yawn compared the FFRD group. The majority of patients were accustomed to the appliances within 2 months, with the reported mean time to “get used to” the Xbow being 3.95 weeks, and 2.25 weeks for the FFRD. Within the first 2 months, 50% of Xbow patients and 31.57% of FFRD patients reported experiencing a breakage that required an additional

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CFAO Graduate Student Posterboards

appointment. There was no difference in questionnaire responses after 1 week or 2 months.

CONCLUSIONS: The Xbow and the FFRD are similar in terms of additional appointments and overall patient experiences. Any differences are likely due to the fact that the FFRD is inserted after patients have already become accustomed to full fixed braces. Patients’ experiences do not change significantly between 1 week and 2 months.

No significant difference (p > 0.05) was found amongst the gender groups for the Overall 12 and the Anterior 6. A significant difference (p = 0.007) was found amongst the different ethnic groups for the Overall 12 but not for the Anterior 6 (p >0.05). For the Anterior 6 there was a significant difference (p = 0.04) in the group variances with the Caucasian group showing more variance.

For improved accuracy it will be advisable to generate Chinese- specific Bolton tables.

*LACOR presenter

University of Manitoba SHEAR BOND STRENGTH OF RE-BONDED ORTHODONTIC ATTACHMENTS USING SELF-ETCHING PRIMERS

University of Manitoba BOLTON COMPARISON BETWEEN CAUCASIAN AND CHINESE POPULATIONS

Authors: Beaudet, A., Wiltshire, W.A., França, R., Klus, B. University of Manitoba

Authors: Y. Roos, WA. Wiltshire, R. Drummond, and R. Todescan Abstract: To determine the preferred management approach before commencing orthodontic treatment, the clinician should do a Bolton calculation to detect tooth size discrepancies. The aim of this study was to use the Bolton calculations to compare and detect any tooth size discrepancies which may exist between Caucasian and Chinese subjects, and between males and females.

Fifty Caucasians and fifty Chinese subjects’ casts (25 male and 25 female) were selected who had a complete permanent dentition up to the first molars, without interproximal restorations or caries, and had no previous orthodontic treatment.

Casts were measured with a Digital Caliper (accurate to 0.01mm), Boley Gauge Vernier Caliper and OrthoCAD . The measurements were used to do the Bolton calculations for the over-all ratio (Overall 12) and for the anterior ratio (Anterior 6).

Linear regression models with main effects for race and gender as well as an interaction effect between them were used.

The purpose of this study was to evaluate the difference in shear bond strength of bonding and re-bonding orthodontic attachments when using a conventional etching primer (CEP) compared to a self-etching primer (SEP), as well as to evaluate if re-etching is necessary prior to re-bonding a bracket with either a CEP or a SEP. Orthodontic metal buttons were bonded to extracted human third molars according to 4 protocols. In Group A, teeth were bonded with the CEP technique for the first and second bondings. In Group B, teeth were bonded with the CEP technique for the first bonding but re-etching was omitted for the second bonding. In Group C, teeth were bonded with the SEP technique for both bondings. In Group D, teeth were bonded with the SEP technique for the first bonding but re-etching was omitted for the second bonding.

Continued…

Presenters at the “LACOR” symposium with Mr. Don Grant of Dentsply Sirona

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CFAO Graduate Student Posterboards

The shear bond strengths when the SEP was used for the first bonding were significantly lower (P <0.0001; 10.65 ± 4.33 MPa) than when the CEP was used (14.04 ± 3.51 MPa). The second bonding omitting re-etching but using the primer and adhesive generated significantly lower bond strengths (P <0.0001; 9.07 ± 4.53 MPa) than when re-etching was used (14.66 ± 3.70 MPa), but still above the “clinically acceptable” standard of 6-8 MPa for in vitro shear bond strength testing.

The second bonding omitting re-etching and not using any primer or adhesive was very low (2.61 ± 2.34 MPa) and would definitely effect the outcome of orthodontic bonding clinically.

When rebonding a bracket, re-etching may be omitted but then a primer and adhesive must be applied to obtain a ”clinically acceptable” shear bond strength. *LACOR presenter

Université de Montréal IMPACT OF MALOCCLUSION ON THE PREVALENCE OF DENTAL TREATMENT NEED AMONG UNDERPRIVILEGED SCHOOLCHILDREN Authors: Michael Taieb, Félix Girard, Caroline Quach, Pierre Rompré, Athena Papadakis (supervising faculty) ABSTRACT : The aim of this study was to investigate the association between malocclusion an dental treatment need (DTN), country of origin (CO) and immigration date (ID) among underprivileged schoolchildren and to explore the association between dental treatment need (DTN), country of origin and immigration date to Canada. Two hundred and seventy children aged 7-12 years old in a Montreal public school were enrolled in a cross-sectional study. Parents completed a structured questionnaire including demographic variables such as country of origin and immigration date. Malocclusion was scored using the Dental Aesthetic Index (DAI), and the presence of dental treatment need was recorded. Data analysis included T-Tests, Pearson Correlation, Anova test and Fisher’s exact test. In our results no association was found between DTN and DAI (p=0.179). We found no association between ID and DAI (p=0.989). DAI was significantly higher in the children from Maghreb countries compared to Africa, Central America and Asia (p=0.229). No association was found between CO and DTN (p=0.229) neither ID and DTN (p=0.817).

University of Toronto CRANIOFACIAL MORPHOLOGY IN CHILDREN WITH OBESITY AND TRISOMY 21 WITH AND WITHOUT OBSTRUCTIVE SLEEP APNEA Authors: Corey Ng1, Bryan Tompson1,2, Sunjay Suri 1,2,, Reshma Amin3 Department of Orthodontics, Faculty of Dentistry, University of Toronto 2 Orthodontics, The Hospital For Sick Children, Toronto, ON 3 Respiratory Medicine, The Hospital For Sick Children, Toronto, ON 1

INTRODUCTION: Obstructive Sleep Apnea (OSA) is common in children and leads to significant morbidity if left untreated. Risk factors for childhood OSA include adenotonsillar hypertrophy, obesity, and genetic diseases associated with craniofacial abnormalities such as Trisomy 21 (T21). Craniofacial characteristics have been suggested to contribute to OSA in children. The literature regarding the role between craniofacial morphology and OSA is deficient, partly due to limited access to polysomnography (PSG), the gold standard for diagnosing OSA. Presently, a formal orthodontic evaluation is not standard of care for children referred for PSG query OSA. The aim of this study is to compare the prevalence of craniofacial abnormalities in children with suspected OSA who have been referred for a PSG. METHODS: This was a cross-sectional study of children between the ages of 5 and 18 years with a diagnosis of obesity or T21 who were referred for PSG at The Hospital for Sick Children in Toronto. Participants underwent an orthodontic evaluation, PSG, and lateral cephalogram. Participants also completed two sleep questionnaires: 1) Spruyt and Gozal Sleep Questionnaire, and 2) Pediatric Sleep Questionnaire, Sleep-Disordered Breathing Subscale. Research Ethics Board approval was obtained at both The Hospital for Sick Children and the University of Toronto.

RESULTS: Twenty five children (18 M, 7 F) between the ages of 5 and 18 (mean = 11.3) participated in the study. Thirteen (52%) had obesity and 12 (48%) had T21. 83% (n = 10) of T21 patients had mild, moderate, or severe OSA compared to 46% (n = 6) of obese patients, (p = 0.053). T21 patients had less overjet compared to those with obesity (OJT21 = -0.20 mm, OJOb = 2.31 mm, p = 0.003). A greater proportion of T21 patients had a narrow palate (T21 = 66.7%, Ob = 15.4%, p=0.009) and macroglossia (T21 = 66.7%, Ob = 15.4%, p=0.009).

CONCLUSIONS: A diagnosis of OSA was more common in patients with T21. A retrognathic maxilla, decreased overjet, a narrow palate, and macroglossia may be associated with a diagnosis of OSA. *LACOR presenter

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Diversions and Distractions

Canadian Association of Orthodontists

UPCOMING ORTHODONTIC MEETINGS

A man is the owner of a winery who recently passed away. In his will, he left 21 barrels (seven of which are filled with wine, seven of which are half full, and seven of which are empty) to his three sons. However, the wine and barrels must be split, so that each son has the same number of full barrels, the same number of half-full barrels, and the same number of empty barrels. Note that there are no measuring devices handy.

2018 March 9-12 . . . . . . . . . . .Australian Society of Orthodontists, Sydney, AUS May 4-8 . . . . . . . . . . . . . .AAO Annual Session, Washington, DC September 6-8 . . . . . . .CAO 70th Annual Scientific Session, Vancouver, BC September 13-16 . . . . .GLAO/MASO Annual Meeting, Toronto, ON September 21-22 . . . . .MSO Annual Meeting, Bloomington, MN

How can the barrels and wine be evenly divided?

October 11-14 . . . . . . . .PCSO Annual Meeting, Monterey, CA November 2-3 . . . . . . . .NESO Annual Meeting, Uncasville, CT

2019

– Answer on page 30 –

May 3-7 . . . . . . . . . . . . . .AAO Annual Session, Los Angeles, CA September 12-15 . . . . .GLAO/MASO Annual Meeting, St. Thomas, USVI September 19-21 . . . . .CAO 71st Annual Scientific Session, Fredericton, NB

Straight Shooters

September 26-29 . . . . .NESO Annual Meeting, Boston, MA

1. Facial profiling is a nasty business.

October 3- . . . . . . . . . . .PCSO Annual Meeting, Honolulu, HI

(Courtesy of Dr. Kathy Russell, Halifax, NS.)

October 25-26 . . . . . . . .MSO Annual Meeting, Branson, MO

2. When asked if he had an amalgam separator in the office, the orthodontist replied “I use elastomerics. It doesn’t make a difference to me if the teeth are filled or not!”

2020 May 1-5 . . . . . . . . . . . . . .AAO Annual Session, Atlanta, GA September 24-26 . . . . .CAO 72nd Annual Scientific Session, Kelowna, BC October 2-3 . . . . . . . . . .MSO Annual Meeting, Chicago, IL October 4-7 . . . . . . . . . .WFO International Orthodontic Congress, Yokohama, JAPAN

3. I will always remember David, every morning when I run my Bowie-Dick test.

October 22-25 . . . . . . . .PCSO Annual Meeting, Calgary, AB November 5-8 . . . . . . . .NESO Annual Meeting, Montreal, QC

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) - 902-468-8215 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 – CAP) 1-800-226-6433 British Columbia (CDSPI) English - 1-800-265-5211 French - 1-800-363-3872 or Dental Professional Assistance Plan (DPAP) 1-800-661-9199

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From the Editor

Dr. James Posluns Email: james.posluns@utoronto.ca

CA-O Yeah!

There is a town in north Ontario, With dream comfort memory to spare, And in my mind I still need a place to go, All my changes were there.

– Neil Young, 1970

My good friend Al and I used to be big fans of the Buffalo Bills during the early nineties. The Bills were a powerhouse team back then, making it to the Superbowl over four consecutive seasons. Sure they lost every one, but remember, its the city of Buffalo we are talking about. Whenever things went well for the Bills, Al would repeatedly ask, to no one in particular “Are the Bills really that good or is team ‘X’ really that bad?” How does one answer such a question?

For as long as I can remember, Canada has lived in the shadow of the United States. But that was a long time ago.

Since January of 2017, we have borne witness to the rapid descent of a once great nation into anarchy. During this same period of time, the virtues of Canada have been extolled both here and abroad. Sure we have a leader who is essentially the “Anti-Trump” but that aside, I continue to hear Al’s voice in my ear: “Is Canada really that good or is America that bad?” Canada is pretty great, but has much changed in the last year or is the world just waking up to something we have known all along?

It is indeed noteworthy that a mini version of world events has transpired right in our own back yards. When you read though this edition of the Bulletin, you will note more than one reference to the leadership upheaval at the American Association of Orthodontists. People have been let go, programs have been annexed and calamity has run amok for months. For as long as I have been an orthodontist, the AAO has been THE

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organization everyone believed in; solid, powerful and unwavering in its message. Not so much anymore. Like the nation in which it is based, the AAO has displayed a degree of weakness never before witnessed by its members. The CAO, by comparison, has never looked so good. All of which brings me back to Al’s question. “Is the CAO really that good, or is the AAO really that bad?”

Sure, I may be a bit biased, seeing how this is the official publication of the CAO, but while I may not be so sure about a lot of things like the fate of our beloved professional corporations, the price of the next iPhone or who will hoist the Stanley Cup in 2018 (Leafs), I am certain that the strength of the CAO is absolute and that it is an organization whose time has come.

As a practitioner in Canada, I never saw much value in holding a membership in the AAO. The AAO always seemed to be too big, too complicated and simply located too far away to hold any relevance in my day-to-day operation. (This sentiment is in no way meant to be critical of those Canadians who hold membership in the AAO. It’s a personal choice and the purpose of this piece is not to judge or suggest that there isn’t value in holding membership in both organizations.) As a Canadian, my natural instinct is to turn to an organization that is based in Canada. If there is any organization that would hear and understand my concerns, it would be the one flying the red, white and …. Well, that’s it really.

I’m proud to be a member of this organization. Just as the AAO Consumer Awareness Program lost its way, the CAO launched its own national campaign, tailor made to address the issues that directly impact Canadian orthodontists. One has to be impressed with an organization that can see the writing on the wall and put together its own program in the span of six short months. Just a coincidence? I think not.

The Canadian health care system, warts and all, is held to be an example to all nations that struggle with the equitable delivery of service to its citizens. I lived in the United States for a few months and the health care insurance system was so complicated and so expensive, I just prayed I never got sick.

Even the politicians can’t figure it out. How many times does

From the Editor

I N M EMORIAM “Repeal and Replace” have to fail until the folks in charge realize that just maybe Obamacare finally put them on the right track all along. Orthodontic insurance kind of feels the same way. There are immense pressures to change the system in place. The demands for fee guides, insurance codes and regimented systems continue to bombard our profession from all sides. Fortunately, as a member of the CAO, one is part of a team that is at the foreground in dealing with these challenges and is privy to the collective decisions that ensure that what is best for the profession, taking into account the viewpoints of all Canadian orthodontic practitioners.

When it comes to meetings the AAO Annual Session is impressive: you and thirty thousand of your nearest and dearest.

There is nothing else like it on earth. I’m glad I’ve experienced it. Having not been to an Annual Session in almost eight years, I can’t say that I miss it. The CAO Scientific Session, on the other hand, has evolved into a category unto itself. I look forward to it every year. In an age where competition rivals collegiality, the CAO has been able to keep the emphasis on the latter. Goldilocks said it best, “not too big, not too small, but just right”.

Give it three more years and there is no doubt in my mind that America will begin to recover from its big experiment. In less time than that there is no doubt in my mind that the AAO will soon rediscover its direction and become the organization it once was. And as of right now, unlike Al’s unanswerable question, there is no doubt in my mind that the CAO is really that good.

Thank you for being a member.

Dr. Anthony Garry Solomon Dr. Anthony Garry Solomon passed on October 5th, 2017 after a brief illness. Dr. Solomon completed his DDS at the University of Toronto in 1971, where he was awarded the Alpha Omega Fraternity Award for outstanding academic achievement and membership in the Omicron Kappa Upsilon Honour Dental Society.

Dr. Solomon completed his orthodontic training at the University of Toronto in 1973. His diploma thesis, on the relationship between third molars and mandibular incisor crowding was overseen by Drs. Donald Woodside and Frank Popovich.

Dr. Solomon practiced in Belleville, Ontario since 1973 until his retirement in 2016. Always an articulate and impassioned contributor at the Board table, Dr. Solomon was a past president of the Bay of Quinte Dental Society and the Ontario Association of Orthodontists. Dr. Solomon was president of the Canadian Association of Orthodontists from 2013 to 2014.

The Canadian Association of Orthodontists extends its condolences, and its appreciation for Garry’s service to the organization, to Garry’s wife Helen and his daughters Sara and Cindy at this difficult time.

Jimmy P

Kindly note that the CAO offices will be closed from 2:00 pm on December 22nd and will re-open on January 2nd at 9:00 am.

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.

Puzzle Answer from above.

On behalf of everyone at the CAO office, we wish all of our members a Wonderful Holiday Season and a Healthy and Successful 2018!

Two half-full barrels are dumped into one of the empty barrels. Two more halffull barrels are dumped into another one of the empty barrels. This results in nine full barrels, three half-full barrels, and nine empty barrels. Each son gets three full barrels, one half-full barrel, and three empty barrels.

Holiday Greetings!

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.

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