CANADIAN ASSOCIATION OF ORTHODONTISTS / ASSOCIATION CANADIENNE DES ORTHODONTISTES Your Smile is Our Specialty!
Bulletin Spring 2017
In this Issue… ■
69th Annual Scientific Session Program at a Glance
■
Message from the President
■
Committee Reports
■
Insurance Guidelines
■
Component Society Reports
■
Student Posterboards
■
Membership Milestones
■
In Memoriam: Dr. Ewart Dudley MacKay
Toronto, Ontario Site of the 69th Annual CAO Scientific Session! Fairmont Royal York Hotel September 14-16, 2017
Message from the President 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
2016/2017 Board of Directors OFFICERS President President Elect Past President 1st Vice President 2nd Vice President Secretary/Treasurer
Dr. Robert D. Kinniburgh Dr. Rick Odegaard Dr. Jean-Marc Retrouvey Dr. Sheila Smith Dr. Michael Wagner Dr. Michael Patrician
REGIONAL DIRECTORS British Columbia Alberta Saskatchewan Manitoba Ontario Quebec Atlantic
Dr. Gerald Philippson 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. Michael W. Patrician
WFO - Country Rep
Dr. Robert D. Kinniburgh
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 Dr. Howard Steiman Dr. James Posluns Dr. Rick Odegaard Dr. Robert D. Kinniburgh Dr. J. Eric Selnes Dr. Jean-Marc Retrouvey Dr. James Posluns Dr. Tarek El-Bialy
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
Dr. Robert D. Kinniburgh Email: drbob@ncortho.ca
A request for attendance and participation in a joint Assembly of First Nations (AFN)/Health Canada review of the Non-Insured Health Benefits (NIHB) program was received in October, 2016. The CAO indicated to AFN that it was pleased to be consulted as a stakeholder in the NIHB program going forward. Since the disbursement of this correspondence, there has been no further contact with AFN or NIHB. The CAO is grateful to Dr. Michael Patrician for his many years of service as treasurer. Dr. Patrician has kindly given the CAO an opportunity to transition this role to the new incoming treasurer, Dr. Don Johnston. Dr. Johnston will officially assume the role at the Annual General Meeting in September of 2017. At the ad-interim meeting on March 4, 2017, The Canadian Dental Association (CDA) President, Dr. Randall Croutze, discussed the ongoing initiatives at the CDA including the taxation of health benefits, Secure Send, CDSPI, and the management of the influx of internationally trained dentists/specialists. The federal government had proposed the possibility of imposing taxation on health benefits, including dental benefits. The CAO, along with other dental specialties, dental regulators and the CDA successfully lobbied the federal government away from this potential policy. In February, 2017, the Prime Minister of Canada announced in the House of Commons that his government would not tax health benefits. The 69th Annual Scientific Session of the CAO will be held in the vibrant city of Toronto, Ontario. This year’s theme, “Controversies in Orthodontics”, is something that providers experience daily when we blend the art, science and technology of orthodontics. The Board of the CAO hopes that these sessions will permit one to assimilate the evidence presented and to take home some impartial recommendations for clinical practice. The CAO Conference and Scientific Session Committee has been hard at work to put together a first-rate program, including tremendous scientific and lifestyle educational opportunities. The social events planned throughout the weekend will highlight all that Toronto has to offer. Connecting and networking with friends (old and new) and colleagues around science, education and social events is what makes the Canadian Association of Orthodontists meeting so special. While at the conference, feel free to reach out to share your thoughts with any board members of the CAO, and then continue the involvement through your regional membership upon your return home. It has been a privilege to serve as President of the CAO this year.
SPRING 2017 • CAO Bulletin
3
Message du président Une invitation à assister et à participer à une Assemblée paritaire des Premières Nations (APN)/Santé Canada, visant à se pencher sur la révision du Programme de services de santé non assurés, nous est parvenue en octobre 2016. L'ACO a indiqué à l'APN que l'Association appréciait le fait d'être consultée à titre d'intervenant au futur programme. Suite à la réception de cette correspondance, il n'y a eu aucun autre contact, ni avec l'APN, ni avec le Programme de services de santé non assurés. L'ACO désire exprimer sa gratitude au Dr Michael Patrician pour ses années de service à titre de trésorier. Dr Patrician a généreusement offert à l'ACO l'occasion d'assurer la transition et l'intégration du trésorier entrant, Dr Don Johnston. Dr Johnston acceptera officiellement le rôle de trésorier à l'Assemblée générale annuelle, en septembre 2017. À l'occasion de la réunion intérimaire du 4 mars 2017, Dr Randall Croutze, président de l'Association dentaire canadienne (ADC) a ouvert la discussion sur les initiatives en cours à l'ADC, incluant l'imposition d'une taxe sur les services d'assurance-maladie, l'ExpédiSécur, le CDSPI, ainsi que la gestion de l'arrivée au pays de dentistes/spécialistes formés à l'étranger. Le gouvernement fédéral a avancé la possibilité d'imposer une taxe sur les services de santé, incluant sur les soins dentaires. À l'instar des autres associations de spécialistes en soins dentaires, des organismes de réglementation en matière de soins dentaires et de l'ADC, l'ACO est intervenue avec succès auprès du gouvernement fédéral, pour écarter la politique envisagée. En février
2017, le Premier Ministre du Canada a annoncé à la Chambre des Communes que ce gouvernement ne procéderait pas à l'imposition d'une taxe sur les soins de santé. La 69e Réunion scientifique annuelle de l'ACO se tiendra dans la belle ville animée de Toronto, en Ontario. Le thème de cette année, Les controverses en orthodontie, est un sujet auquel nous sommes confrontés en tant que fournisseurs de soins où s'entremêlent l'art, la science et la technologie sur une base quotidienne. Le Conseil d'administration de l'ACO espère que cette réunion vous permettra de prendre connaissance des éléments de preuves présentées, et de repartir avec des recommandations impartiales pour votre pratique clinique. Le Comité scientifique et des conférences de l'ACO a travaillé sans relâche pour établir un programme de premier ordre, incluant de fantastiques occasions de formation en matière de sciences et de mode de vie. Également, les activités sociales prévues pour ce week-end mettront en valeur les attractions touristiques de la ville de Toronto. Cette réunion exceptionnelle de l'Association canadienne des orthodontistes est l'occasion rêvée pour rencontrer vos amis (anciens et nouveaux) et réseauter avec des collègues, dans un cadre portant sur les sciences, les formations et les activités sociales. À l'occasion de cette réunion annuelle, n'hésitez pas à venir rencontrer les membres du Conseil d'administration de l'ACO, afin de partager votre opinion sur notre profession. De retour à la maison, nous vous invitons à poursuivre votre implication, par l'entremise de votre adhésion au niveau régional. Soyez assuré que ce fut un privilège pour moi d'agir à titre de Président de l'ACO cette année.
It’s time to rally again for the 2017 CFAO Silent Auction at the CAO Scientific Session in Toronto! Dr. Stephen Roth, CFAO President (and Coach) is looking to knock it out of the park this year and a great way to support the CFAO is by donating an item for the auction!
Our bidders will be cheering on items such as: l
One of a kind art/jewelry pieces
l
Use of a Resort Condo or “Time Share”
l
Tickets to Sporting Events or Live Theatre
l
Spa/Restaurant Certificates
l
Electronic gadgets
l
Wine Clubs or similar
l
4
Sports Memorabilia (think “The Goal Heard ‘Round the World”!)
CAO Bulletin • SPRING 2017
We want some great competition over the hot items at the auction table, so help us run the distance and score a touchdown! With some exciting new items for this year’s auction we can help to support a number of the CFAO programs and initiatives, like Smiles4Canada. Batter Up!!!
Please contact the CFAO office at 416-491-3186 for more information.
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 December 31, 2016, the general operations of the CAO had generated net income of $138,687.14 and the Scientific Session had generated net income of $-48,476.30. The combined net revenue of the CAO as of December 31, 2016, was $90,210.84. The total member's equity was $657,554.12 and the total current assets stand at $781,621.22. At the Annual General Meeting in Charlottetown, the membership approved the addition of an assessment of $200.00 plus GST/HST to the dues for 2017/2018. To date, the general operations of the CAO are proceeding according to plan. Upgrades to the website are ongoing. The Communications Committee is currently in the planning stages of a new multimedia campaign. The contract with Association Concepts is slated for renewal, as the current contract is due to expire at the end of 2017.
CFAO Donations Donational since October 1, 2017 McIntyre Fellows Dr. Jeff Corbett Dr. John Daskalogiannakis Dr. James Hickman Dr. Simon Jacobson Dr. Parm Lalli CAO In Memoriam of Dr. Ewart Dudley MacKay
The Canadian Foundation for the Advancement of Orthodontics (CFAO) Silent Auction held during the Scientific Session in Charlottetown generated $5,695.00. Thank you again to the individuals and the component associations that donated items to the auction. The CFAO is committed to continuing with the Silent Auction into the coming years and donations to the auction have been included in the contracts for the upcoming venues. Congratulations to the organizing committee on another successful Student Research Symposium at the 2016 Scientific Session. The CFAO was pleased to offer its financial support to this worthwhile event. It has been a busy time for Smiles4Canada. In September, the program expanded with chapters forming in British Columbia, the Prairie Provinces and Ontario. Letters were sent to stakeholders in these areas through mailings to the members. In January, the CFAO participated in a radio interview with CBC Halifax. The interview featured one of the first patients to receive treatment through the program. Please make a point of listening to the interview as the family’s story is very powerful. The story was posted on the CBC website and generated a huge amount of positive exposure for the program. As of April 23, 2017, there have been approximately 74,000 social media shares of the story. This exposure has been favourable for the profession, CAO members and orthodontic treatment in general. All of the exposure has generated a significant increase in applications to the program. As of April 23, 2017, there have been 153 completed applications to the program. Thirty-nine of these applications have been accepted and matched to participating orthodontists. An additional 92 applications are under review by the Regional Committees. Thank you to Alison Nash, Shannon Whitteker, Avi Goldberg, Gordie Organ, Sunny Leong, Jeff Stewart, all the Regional Committee members and especially to all the orthodontists who have agreed to provide treatment through the program. Continued…
SPRING 2017 • CAO Bulletin
5
Committee Reports CFAO Treasurer Report As of December 31, 2016, the net revenue for the Canadian Foundation for the Advancement of Orthodontics (CFAO) was - $6,733.77. The total current assets are $344,136.22. Total member equity is $209,591.25. The 2016 disbursements from the Foundation have been completed. The disbursement quotient for 2016 was $10,364.17. The disbursement quotient for 2017 is estimated to be $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 will continue to monitor the potential need for funds that may arise in the future and to reassess novel fundraising initiatives as a counteractive measure. Since the CFAO spent $26,406.00 in 2015 on charitable activities, it has a carry-forward disbursement excess of $16,604.05. This disbursement may be carried forward for five years. The Board will have to decide, if and when, it plans to use this excess contribution.
CAP Report Dr. Sheila Smith
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.
GST/HST Report 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 GST/HST in Canada. In November and December of 2016, the CAO was audited by CRA for it’s GST/HST ITC returns. No challenges or changes to the returns were found by CRA. There continue to be CRA audits of orthodontic offices in Canada but the frequency of the audits has decreased. The member e-blast and joint CRA/CAO question and answer document appears to have been of benefit.
Email: stuart.smith4@sympatico.ca 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
6
CAO Bulletin • SPRING 2017
Communications Report Dr. J. Eric Selnes Communications Chair Email: str8smiles@sympatico.ca The CAO Communications Committee consists of Chair, Dr. J. Eric Selnes, committee members Drs. Will Chow, Sarah Davidson, Adriano Farina, Todd Lee-Knight, Brian Phee and CAO Staff Liaison, Ms. Alison Nash. The committee was tasked with preparing a Request for Proposal (RFP) and with tendering marketing and public relation firms to develop, support, promote and market the CAO. An additional objective is for the firm to enhance the CAO’s communication with the public and its members. The committee set out its objectives and terms of reference. It reviewed 14 proposals then screened and contemplated the proposals and the merits of the best 5 Canadian PR firms including Felicity (Toronto), Blackjet (Toronto), Evans Hunt (Cal-
Committee Reports gary), Jelly (Vancouver) and Herscu & Goldsilver (Toronto). The goals for evaluation included an increased online and social media presence, an outline of their digital marketing campaign, a perception of target demographics and potential plans for the public-directed website rebuild. Specific questions asked of the firms included impact of the proposal on the individual member, can the firm make use the NFP Google grant and what experience does the firm have in this area.
being felt across the board and the graduate orthodontic programs are not immune. The successful university researcher and resident oral and poster programs are of huge benefit to all of the graduate programs. The financial assistance to the residents in support of their attendance at the CAO Scientific Session, in order for them to permit showcasing of their research at a national forum amongst peers and colleagues, is highly appreciated.
After considerable discussion, Blackjet, Evans Hunt and Jelly were invited to submit video presentations to the committee on January 27, 2017. The committee was impressed with the bold, innovative and edgy nature of the presentation by Blackjet and has proposed this firm as the one to be contracted by the CAO Board for the purposes of marketing and promotion.
NOTICE OF CAO ANNUAL GENERAL MEETING
CAO/AAO Report
NOTICE IS HEREBY GIVEN that the Annual General Meeting of the Canadian Association of Orthodontists will be held the 16th day of September, 2017 from 7:00 am to 8:30 am in the Fairmont Royal York Hotel, Toronto, Ontario.
Dr. Rick Odegaard CAO/AAO Liaison
The following matters will come before the meeting:
Email: dr.odegaard@shawcable.com
1.0
Call to Order
2.0
Approval of Minutes of last Annual General Meeting, September 17, 2016*
3.0
President’s Report
4.0
Reports of Officers and Directors 4.1 Treasurer’s Report 4.1.1 2016 Reviewed Year-end Financial Statement* 4.1.2 Appointment of Outside Year-end Reviewers for 2017
5.0
Reports of of Committees
6.0
Unfinished Business
7.0
Nominations and Election of Officers and Officials*
8.0
Indemnification Clause
9.0
New Business
Dr. Ron Wolk, Chair of the AAO Council on Membership, Ethics and Judicial Concerns presented a Resolution to the AAO House of Delegates to accept satisfactory completion of the RCDC requirements as eligibility for AAO membership. This was presented and voted on at the Annual Session in San Diego and the vote resulted in a change to the membership criteria.
CCOE Dr. James Posluns Educators Liaison Email: james.posluns@utoronto.ca The Canadian Council of Graduate Orthodontic Program Directors (CCGOPD) had a successful meeting in Charlottetown, PEI. A major item on the agenda was a discussion with the RCDC regarding a cephalometric error in the most recent Component II exam. The RCDC became aware of the error at the last minute and was unable to rectify it in time, but assured the CCGOPD that the error had no effect on the candidates’ final grades. The CCGOPD met again at the AAO Annual Session in San Diego, California. Cutbacks at all universities in Canada are
10.0 Adjournment
Robert Kinniburgh President, CAO * Reports will be posted in June on the CAO Members' Website. If you wish a full copy of the AGM material in advance, please contact the office at cao@associationconcepts.ca.
SPRING 2017 • CAO Bulletin
7
Committee Reports New and Younger Members Report Dr. James Posluns New and Younger Members Representative
Of the 111 candidates, 106 passed representing a pass rate of 95.5 percent. 98 of these candidates were then successful in challenging the oral examination known as Component II, representative of a pass rate of 92.5 percent.
Email: james.posluns@utoronto.ca It is with great excitement that the New and Younger Members announce that Michael Landsberg of TSN’s Off the Record with Michael Landsberg will be the featured speaker at the upcoming NYM Luncheon at the Annual Scientific Session in Toronto in 2017. Michael will share his experiences growing up the son of an orthodontist, being a diehard sports fan and his struggles with depression. In 2013, Landsberg’s documentary, “Darkness and Hope: Depression, Sports and Me,” was nominated for a 2013 Canadian Screen Award for Best History or Biography Documentary Program or Series. In 2012, the Canadian Alliance on Mental Illness and Mental Health also named Landsberg one of its Champions of Mental Health. Landsberg also takes to Twitter to encourage discussion around mental health and to create a forum for those needing help. He founded the not-for-profit corporation #SickNotWeak. Funds collected in support of #SickNotWeak help provide education, while supporting a community for those suffering as well as those supporting a loved one who needs help. Michael has thousands of followers on his Daily Landsblog. For his longstanding dedication to promoting mental health awareness, Landsberg was honoured with the Humanitarian Award at the 2015 Canadian Screen Awards. The CAO is truly fortunate to have Michael present at this year’s New and Younger Members Luncheon. Be sure and get there early.
RCDC Report Dr. Tarek El-Bialy CAO/RCDC Liaison Email: telbialy@alberta.ca The current RCDC Executive consists of Dr. Christopher Robinson, President, Dr. Adel Kauzman, Vice-President, Dr. Hugh Lamont Immediate, PastPresident, Dr. James Posluns, Treasurer, Dr. Benjamin Davis, Examiner-In-Chief, and Mr. Peter McCutcheon, Secretary. Between 2012 and 2016, 111 orthodontic candidates took the written examination of the RCDC known as Component I.
8
CAO Bulletin • SPRING 2017
CDSA Report Dr. Mike Wagner CDSA Liaison Email: wagner.cao@gmail.com The most recent CDSA AGM was Thursday, April 20, 2017, at the Chateau Laurier, in Ottawa, Ontario. Dr. Christina McCord, of the Canadian Association of Oral and Maxillofacial Pathology/Oral Medicine (CAOMP/OM), joined the executive as Secretary Treasurer. Dr. Frank Hohn of the Canadian Association of Oral and Maxillofacial Surgery (CAOMS), is the current Vice-President and Dr. Jean-Pierre Picard of the Canadian Association of Prosthodontists (CAP) is the current President. The CDSA Travel Award criterion was uploaded to the website and was added to the new Policy and Procedures manual. The award will fund $1000.00 for a graduate and an undergraduate student to attend the Annual Meeting of the International Association for Dental Research (IADR). The 2016 travel award recipient was Dr. Rana Tarzemany of the University of British Columbia, Discipline of Periodontics. There were no qualified undergraduate applications. The 2017 IADR meeting was held March 25 to 27, 2017, in San Francisco, California. CDSA has written to the Assembly of First Nations (AFN) to request that the CDSA and all individual specialties be contacted in regard to proposed changes to the NIHB program. Smaller specialties support the CDSA in this initiative but have not requested an invitation to the table on an individual level as they are not primary providers to this program. Representation has been made to the Executive of the Canadian Dental Association (CDA) that CDSA has no affiliation with the Canadian Dental Specialties Organization (CDSO). No further action has been taken on this issue by the CDSA other than to verify that the CDSO is not a registered corporate entity within the province of Ontario. Sedation guidelines across the country are being reviewed following an unfavorable outcome involving a patient in Alberta and a trained Dental Anesthesiologist. Stakeholders within
Committee Reports the CDSA will advocate to regulatory bodies to develop equal sedation standards across the country. A letter writing campaign was encouraged for all the component specialties as a result of the proposed federal taxation of health benefits. As of February 2017, this campaign has proven to be successful as the Prime Minister of Canada has recently indicated that his government has no plans to tax health benefits of any sort, inclusive of dental benefits.
dontic Health Day and posters were handed out. Materials, such as logos and posters, to use to celebrate that day will be available from the website and more will be added as they are developed. May 15, 1995, was the date the Charter of the WFO was signed. In 2020 there will be a special celebration for the silver jubilee. WFO is now on Wikipedia and has a Facebook page, with other forms of social media currently under consideration.
WFO Liaison Report Dr. Amanda Maplethorp WFO Executive Committee Email: a_maple@shaw.ca In March 2017, Dr. Vinod Krishnan of Trivandrum, Kerala, India was selected as the new Editor in Chief of the Journal of the World Federation of Orthodontists. He began his term April 1, 2017, by selecting a very strong editorial board including Associate Editors Jae Hyun Park, Arizona, Carlos Flores-Mir, Alberta, Shin-Jae Lee, Korea and Carlalberta Verna, Switzerland. His Consultant Editors include David Turpin, Washington, Jorge Faber (Immediate Past Editor in Chief JWFO), Brazil and Jyothindra Kumar, India. The Editorial Board members include Ayca Arman-Ozcirpici, Turkey, David Normando, Brazil, Guoqiang Guan, Philadelphia, James K. Hartsfield Jr, Kentucky, Lorenzo Franchi, Italy, Mani Alikhani, Massachusetts, Masaru Yamaguchi, Japan, Marcio Rodrigues de Almeida, Brazil, Maja Ovesenik, Slovenia and Michael G. Woods, Australia. The WFO Executive Committee met April 21, 2017 in conjunction with the AAO Annual Session in San Diego. The Albanian Association of Orthodontists was accepted to the WFO and several other applications from organizations are pending receipt of documents. The WFO website home page is under revision to make it more active and mobile-friendly. The WFO Gazette will now be available online instead of in print and therefore will be available to members much quicker in a technology-friendly format. Dr. Robert Kinniburgh represented the CAO at the WFO Breakfast Meeting in San Diego on April 23, 2017. The 10th IOC meeting in 2025 will be held October 8 to 11 in Rio de Janeiro, Brazil.
Webinar Update Dr. Gerry Zeit The 2016 fall webinar was presented on Thursday, November 24, at 8:00 EST. The speaker was Lianne Chan, a physiotherapist with extensive experience and interest in temporomandibular dysfunction. Her presentation was entitled “TMJ Disorders: A Physiotherapists Perspective”. It was enlightening to hear how another discipline approaches this common and wide ranging collection of symptomologies. The webinar will be available for review on the CAO website until November, 2017. The CAO was approached by Don Millar (Cerum) to have Dr. Luis Carriere present a webinar in February, 2017. This webinar fit with the CAO’s desire to increase the number of annual webinars. Unfortunately due to scheduling constraints, this webinar was not secured. The spring webinar featured Dr. Bruce McFarlane on March 29th, 2017 at 8:00 pm EST. Dr. McFarlane was able to share his experience with Dr. Carriere’s Motion Appliance in a “fast paced, entertaining hour”. Thank you to Cerum for their support and sponsorship of this presentation. As always, many thanks to the entire CAO staff and especially to Alison Nash and David Petrie for organizing and hosting the webinars. I remain interested in feedback and ideas or suggestions regarding topics and possible speakers for future webinars.
It was announced that henceforward, May 15 will be Ortho-
SPRING 2017 • CAO Bulletin
9
CAO Insurance Guidelines History: 25 years ago, the CAO battled with the insurance companies over the use of codes for orthodontic specialists. This fight lasted 5 years and the CAO won so that codes were abolished for orthodontic specialists. The major achievement of this agreement was the establishment of the precedent that, as specialists, there would be no requirement to submit records or treatment details to the insurance companies. Insurance predetermination has recently become more complex. Plans are adopting new “pockets” of coverage instead of one umbrella of orthodontic coverage. There may be more coverage if Interceptive Phase and Full Phase is defined in the predetermination, as some carriers have begun segmenting plans between Interceptive phase and Full phase Orthodontic Treatment. The key to successful submission of pre-determination forms lies in accurately and completely filling out the form as prescribed by the CAO guidelines. An example of this form (fictional patient, insurance policy holder and information) is attached. • Complete all portions of the form.
the patient they have coverage, but it is actually dental coverage for “medical necessity”. Orthodontics will never be covered under this section unless it can be deemed a “medical necessity” as determined by the insurance company. 2. Make sure you document all conversations with the insurance company and obtain the representative’s name and number. Remember that you are speaking to a call center employee with limited dental/orthodontic knowledge. 3. Remind them that in accordance with guidelines from CLHIA (Canadian Life and Health Insurance Association) no codes, records or treatment plans are required for orthodontic specialists. 4. If this is not sufficient, ask to speak to a supervisor and repeat steps 1-3 with the supervisor. If the insurance company is still not being cooperative, send all information including a copy of the CAO insurance form, any correspondence from the insurance company, a copy of the patient’s insurance policy and documentation of phone conversations to the CAO. The Insurance Committee may be able to help. Direct Billing/Assignment
• Start date is optional, but can be filled if known. • Description of the condition has always been optional, but if you fill it in, it generally makes life easier. The CAO advises members to fill this section using generic terms such as: anterior crossbite, mandibular retrognathia, deep overbite, maxillary crowding etc. You may also include a phase of treatment i.e. Interceptive, Phase I, Comprehensive Orthodontics
The CAO does not recommend direct billing by orthodontists as the use of general dentist codes is required. The orthodontic codes that exist are for use by general dentists only. The more orthodontists that use dental codes, the more difficult it becomes for the CAO to reach the objective of digitization of insurance by a specialty office.
• DO NOT – use classifications such as Class I, Class II etc.
CDAnet
• Filling out the financial information is crucial. There is enough flexibility built into this section to accommodate most payment options. • The Additional Explanatory Comments are optional, but it doesn’t hurt to add the illustrated comment. • Never provide the appliance type in any predetermination or treatment details such as extractions, surgery, etc. If you are ever asked by an insurance company for records, codes or a treatment plan. Please follow these steps: 1. Ensure that the patient/parent does indeed have orthodontic coverage. In most plans, it is provided as a separate entity from regular dental coverage. Some companies will tell
10
CAO Bulletin • SPRING 2017
The CAO has been working diligently for the past two years along with several other associations including the CDA to figure out a platform for pre-determinations. The use of a single code for predetermination is what the CAO is working toward. The first application has been rejected but the CAO continues to work toward this objective. Currently, you can submit over CDAnet with codes (as a general dentist) but of the 68 insurance providers on CDAnet, only 15 will reply with the amount of coverage. The remaining 47 will just respond that they received the request and will conventionally mail the info to the patient.
SPRING 2017 • CAO Bulletin
11
Component Society Reports
British Columbia
Alberta
Dr. Jay Philippson
Dr. Todd Lee-Knight
Email: jayp@shaw.ca
Email: todd@drlee-knight.com
The Consumer Awareness Program (CAP) is consuming most of the attention of the BCSO board of late. The efforts of Athorn and Clark have been reviewed. Dr. Todd Moore has been in contact with an American firm known as Sutton Group who is working with both Texas and California state associations and now Centrifuge Media to update and to make the BCSO website more user-friendly for the public and for BCSO members. The intent is to move away from Google ad words and to focus in on education and information. Dr. Moore is in the process of forming a BCSO marketing committee that will ensure continuity of the CAP message by minimising the learning curve for each new line member. Hopefully, in Alberta, the committee will receive contributions from the different regions of the province in order to ensure that the message is delivered effectively where needed. Dr. Moore also aims to enhance the positive message that the general practitioner is an important part of the patient’s overall health and that he or she will conduct regular assessments, cleaning and restorations following the completion of orthodontic treatment by a certified specialist. Dr. Moore is attempting to position the BCSO for the future through improved engagement between orthodontists, realising we are stronger together than fragmented. We need a strong relationship province-wide to promote together as specialists. With increased membership we can tackle the issues all orthodontists are going to face in the future. Drs. Rick Odegaard and Jay Philippson met with the UBC graduate students in November. The group was engaged and asked many questions. Following the meeting, the students left with a greater appreciation for the CAO. The next BCSO meeting is scheculed for June 9, 2017.
12
CAO Bulletin • SPRING 2017
The Alberta Society of Orthodontists (ASO) held its Annual Scientific Session and Meeting on Friday April 7 and Saturday April 8, 2017, at the RimRock Hotel in Banff. The ASO executive committee was excited to have ‘Accelerated Orthodontics’ as the theme of this year’s meeting. The Friday sessions featured speakers from Acceledent (Dr. Sonia Palleck), OrthoPulse (Dr. Tim Shaughnessy and Dr. Todd Dickerson), and Propel (Dr. Thomas Shipley). Saturday’s session was presented by Dr. German Ramirez, an internationally renowned speaker on the topic of ‘Myofunctional Orthodontics’. The ASO continues to work on issues in advertising within the governance framework. Additionally, the ASO continues to assess the relationship with the CAO / AAO Consumer Awareness Program and other public education programs currently in the planning phases. Over the past year, the ASO Executive submitted a successful application to the AAO to receive matching funds to further supplement the CAP program. The ASO continues to be a supporter of the CFAO Silent Auction Program, by again donating a weekend for two at the RimRock Hotel in Banff.
Saskatchewan Dr. Brian Phee Email: brianphee957@gmail.com The Saskatchewan Society of Orthodontists met for their AGM on January 20, 2017, in Saskatoon. The meeting was held in conjunction with a continuing education session that was sponsored by Dentsply GAC. The keynote speaker was Dr. Antonino Secchi, who spoke on the Complete Clinical Orthodontics System.
Component Society Reports Cont’d During the meeting, members discussed some changes in the undergraduate dental curriculum at the University of Saskatchewan. Dental students will now have their clinical orthodontic training limited to Phase 1 treatments with greater emphasis on integration with the pediatric curriculum. SSO members also expressed interest in developing a website for public education regarding the differences between orthodontists and general dentists as well as to provide a list of certified specialists throughout the province. The SSO is proud to have its members contribute their time both nationally and internationally. Dr. Kam Olfert of Regina is President-Elect of the Pacific Coast Society of Orthodontists and Dr. Mike Wagner of Saskatoon will continue in his role with the Canadian Association of Orthodontists as the 2nd Vice President.
Manitoba Dr. Susan Tsang Email: drtsang@winnipegorthogroup.com The fall Manitoba Orthodontic Society (MOS) dinner meeting was held on October 7, 2016 in conjunction with continuing education by Dr. Patrice Pellerin, sponsored by 3M Oral Care. At the University of Manitoba, the Graduate Orthodontics Department, three incoming residents hail from Quebec, Ontario and Australia. All four of the senior residents, as well as faculty member Dr. Fabio Pinheiro, were successful in passing their spring 2016 RCDC examinations. At the CAO meeting in Charlottetown, the Graduate Orthodontics Department celebrated its 50th anniversary. Congratulations to the department for its success! The MOS president, Dr. Bobby Ward, met with the Manitoba Dental Association (MDA) Executive Director, Dr. Rafi Mohammad and the Registrar, Dr. Marcel von Woensel, in November 2016, to advocate for the MDA to be proactive in the management of misleading advertising by general dental colleagues. Following the meeting, according to a report by Dr. Ward, the MDA did not indicate specific plans for action.
Ontario Dr. J. Eric Selnes Email: str8smiles@sympatico.ca The Ontario Association of Orthodontists (OAO) had positive net revenue this year with the help of the Scientific Session. The advertising campaign with the AAO started in the summer, so half was budgeted for 2017, a total of a $75,000 commitment over three years. The OAO will spend about $30,000 of its own funds on the CAP program in 2017. The total spent is $60,000, with the remaining half forthcoming from the AAO. In addition, the AAO will match costs on the OAO web design. The OAO investigated if it should or should not be charging HST on OAO activities, based on the ODA having to retroactively remit HST arising out of a CRA investigation. The Ontario advertising campaign is going strong. Ontario is spending approximately $4,500 per month for the on-line campaign. The non-grant account is generating 10,000 visitors to OAO website and 16 percent used locator, while the grant account is generating 5,500 visitors to OAO website and 8 percent used locator. There have been 1,440 doctor locator clicks since June 2016. The OAO has received $11,000 in free advertising thru Google with the grant account. Now with decent traffic to the website, the OAO enhanced and upgraded the look of the website home page. The goal was to have the new page by February 28, 2017 and it was presented to the membership on March 30, 2017. Dr. Dale Anne Featheringham, President of the Great Lakes Association of Orthodontists (GLAO) presented to the OAO members on March 30, 2017. The next GLAO Annual Session is September 14 to 16, 2017 in New Orleans LA. The 2018 GLAO Annual Session will take place September 13 to 16, 2018, in Toronto. The GLAO has asked the OAO to host its fall meeting in conjunction with the GLAO. The Executive of the OAO had dinner with Mr. Irwin Fefergrad, Registrar of the Royal College of Dental Surgeons of Ontario on February 2, 2017. Some of the issues discussed included informed consent, CDA Level 2 and Smile Care Club. There were two complaints last year filed against dentists. Both complaints are still in limbo and waiting for a hearing. The OAO had its members send advertising complaints directly to the OAO president and he has explained the issues to the Continued…
SPRING 2017 • CAO Bulletin
13
Component Society Reports Cont’d dentists, requesting them to remove their advertisements on their own. The first complaint dating from the summer of 2014 is still pending a hearing There has been an increase in the OAO group Facebook membership from 55 to 70 following the meeting in November. There has been increased participation from younger members and on the public page. The OAO is permitted to use the AAO visuals on its Facebook page. Planning for the Third Biennial Scientific Session to take place in the spring of 2018 is underway. The newly elected OAO Board is Dr Mitch Miller, President, Dr. Emel Erat, Vice-President, Dr. John Bozek, Past-President, and Dr Kent Floreani, Secretary/Treasurer. OAO Directors include Drs. Michael Goldstein, Pourang Rahimi and Shervin Abaszadeh.
Quebec Dr. Giovanni (John) Scalia Email: johnny.scalia@gmail.ca The Federation of Dental Specialists of Quebec has voted on a special assessment for a spring 2017 media campaign (television, social media, billboards, city bus stations). For Quebec, this is the first provincial media campaign designed to educate the public about dental specialists: who we are and what services we provide. For orthodontists, the special assessment totaled roughly $2,500. The AAO-CAP program for Quebec is in full force, planned for a 100 percent web campaign. The local media campaign is currently preparing to begin the targeted Google display ad campaign. All web traffic will be directed to the French version of the AAO’s website “Find an Orthodontist.” The annual convention of the Journées dentaires international du Québec is happy to host the first conference uniting orthodontists of the francophonie from May 27 to 29, 2017. This is the first opportunity for members of the Quebec Association of Orthodontists to have cultural and scientific exchanges with orthodontists of the international francophonie.
14
CAO Bulletin • SPRING 2017
Rapport de la province de Québec La Fédération des dentistes spécialistes du Québec s'est prononcée en faveur d'une analyse spécifique, en vue du montage d'une campagne médiatique pour le printemps 2017 (télévision, médias sociaux, panneaux publicitaires, stations d'autobus). Au Québec, il s'agit de la première campagne médiatique provinciale, visant à informer le grand public des spécialisations en dentisterie: soit notre identité et les services que nous offrons à la population. Pour les orthodontistes, le coût de cette évaluation spéciale s'est élevé à environ 2 500$. Le programme québécois AAO-CAP est déjà en vigueur et prévoit une campagne qui sera à 100% destinée à Internet. Le service de comptabilité de l'AAO se penche actuellement sur la révision de notre campagne médiatique locale. Au Québec, nous envisageons l'utilisation de ces fonds en avril 2017, suite à la campagne médiatique provinciale. Les internautes seront dirigés vers la version française du site internet de l'AAO, à l'onglet «Trouver un orthodontiste». Du 27 au 29 mai 2017, le congrès annuel présentant les Journées dentaires internationales du Québec sera heureux d'accueillir la toute première conférence réunissant les orthodontistes de toute la francophonie. Ce congrès représente la première occasion, pour les membres de l'Association des orthodontistes du Québec, de prendre part à des échanges culturels et scientifiques avec des orthodontistes de la francophonie à l'échelle internationale.
Atlantic Report Dr. Stuart A. Matheson Email: smatheson1@mac.com The Executive of the Atlantic Association of Orthodontists (AOA) met informally in Charlottetown during the 2016 Annual Scientific Session. The AOA expresses its sincere appreciation to the CAO Board, the organizing committee and the CAO staff for bringing the annual meeting to Prince Edward Island. Thank you for a job well done. The new Secretary-Treasurer of the AOA has updated the roster of orthodontists in the four Atlantic Provinces. The most recent annual meeting was held in Halifax on April 7, 2017. The continuing education component of the meeting was a review of the concepts of orthognathic surgery. The AOA intends to present the AAO CAP matching grant and to move forward with this program pending approval by the membership.
Student Posterboards Abstracts from the 2016 CAO Annual Scientific Session – Part 2 of 2 part series
University of Alberta EMERGENCIES AND COMFORT LEVELS WITH COMPLIANCEFREE FIXED CLASS II CORRECTORS DURING CLASS II MALOCCLUSION TREATMENT: A SYSTEMATIC REVIEW Author: Ashley Phuong*; Carlos Flores-Mir (Supervisor) Objective: To qualify and quantify the emergencies and comfort levels associated with compliance-free fixed Class II correctors during Class II malocclusion treatment. Methods: A systematic search of several electronic databases (Medline, PubMed, Embase, and Web of Science) was conducted until May 2016, as well as a limited grey-literature search (Google Scholar). Prospective and retrospective human studies that used a compliance-free fixed Class II appliance in a non-extraction and non-surgical approach were selected. Two authors independently reviewed and extracted data from the selected studies. Risk of bias was assessed. Results: Eleven studies satisfied the inclusion criteria. The patients’ mean age ranged from 10.3 – 15 years and the fixed Class II corrector treatment duration ranged from 3.8 – 12 months. The studies involved variations of the Herbst and Forsus only. The rate of emergency appointments ranged from 22.28% of patients treated with a stainless steel crown Herbst to 88% of patients treated with a removable mandibular acrylic splint Herbst. The main area of discomfort was soreness in the cheek. There was a lack of standardized reporting methodology between studies. Conclusions: Emergencies associated with fixed Class II correctors are frequent and differ with appliance design. Future research should examine other Class II correctors. A standardized method for reporting emergencies must be developed to allow for comparison of different Class II correctors. This additional information may be useful to clinicians when selecting a Class II corrector.
University of Alberta 3D EVALUATION OF MOLAR AND CANINE BUCCOLINGUAL INCLINATIONS IN MAXILLARY TRANSVERSE DEFICIENCIES. Authors: Dr. Manuel Lagravere-Vich (Supervisor), Dr. Carlos Flores-Mir, Dr. Martin Palomo Objective: Propose a novel 3D method for measurement of molar and canine buccolingual inclinations in maxillary transverse deficiencies and compare it to the CWRU transverse analysis. Methods: Pre-treatment CBCTs of 60 patients with different degrees of maxillary transverse deficiencies were assessed using two methods to evaluate maxillary and mandibular molar and canine buccolingual inclinations. A novel method was proposed that used the 3D potential of DICOM images with a 3D skeletal maxillary reference plane and a software algorithm to determine 3D angular measurements through the true buccolingual plane of each tooth. These findings were compared to the CWRU transverse analysis that used coronal slices for 2D buccolingual angular measurements. Each method was assessed for intra- and inter-examiner reliability. Results: Both techniques demonstrated excellent reliability (ICC>0.91). There was a statistically significant difference for all measured teeth between techniques. Using a clinically significant difference of 10 degrees, only maxillary canine buccolingual inclinations showed a clinical difference between both methods. Conclusion: The clinical difference between methods for maxillary canines can be attributed to the use of different reference planes and different approaches to the long axis of the teeth. However, a new reliable method for 3D analysis of buccolingual inclinations was developed and shown that it did not differ clinically from the CWRU transverse analysis for all teeth except maxillary canines. Further studies are required to confirm the accuracy of either analysis, to develop norms and to assess its clinical application.
SPRING 2017 • CAO Bulletin
15
CFAO Graduate Student Posterboards University of Alberta PREDICTORS OF LONG-TERM STABILITY OF MANDIBULAR DENTAL ARCH DIMENSIONS IN PATIENTS TREATED WITH A LIP BUMPER DURING MIXED DENTITION FOLLOWED BY FIXED APPLIANCES
University of Alberta OBSTRUCTIVE SLEEP APNEA AND MANDIBULAR CORTICAL THICKNESS: A RETROSPECTIVE STUDY
Authors: Gaetana Rauccia; Camila Pacheˆco-Pereirab; Maryam Elyasic; Fabrizia d’ Apuzzod; Carlos Flores-Mire; Letizia Perillof
1
Background: This retrospective study aimed to identify which dental and/or cephalometric variables were predictors of longterm mandibular dental arch stability in patients that underwent treatment with transpalatal arch and lip bumper during mixed dentition followed by full fixed appliances in the permanent dentition. Methods: Thirty-one patients were divided into stable and relapse groups based on the long-term presence or not of relapse. Intercuspid, interpremolar and intermolar widths, arch length and perimeter, crowding and lower incisor proclination were evaluated before treatment (T0), post-lip bumper treatment (T1), post-fixed appliance treatment (T2), and a minimum of 3 years after full fixed appliances’ removal (T3). Logistic regression analyses were performed to evaluate the effect of changes between T0 and T1, as predictive variables, on the occurrence of relapse at T3. Results: The model explained 53.5% of the variance in treatment stability and correctly classified 80.6 % of the sample. Of the seven prediction variables, intermolar and interpremolar changes between T0 and T1 (p=0.024 and p=0.034 respectively) were statistically significant. For every millimeter of increase in intermolar and interpremolar widths there was an increase of 1.52 and 2.70 times in the odds of having stability. There was also a weak evidence for the effect of sex (p= 0.047). Conclusions: The best predictors of long-term mandibular dental arch stability after treatment with a lip bumper followed by full fixed appliances were intermolar and interpremolar width increases during lip bumper therapy. The amount of relapse in this crowding could be considered clinically irrelevant.
16
CAO Bulletin • SPRING 2017
Authors: Hazem Eimar1, Arthur Rodriguez Gonzalez Cortes2, David Gozal3, Daniel Graf1, Carlos Flores-Mir1 School of Dentistry, Faculty of Medicine and Dentistry, Edmonton Clinic Health Academy, University of Alberta, 11405-87 Avenue, Edmonton, Alberta T6G 1C9, Canada 2 Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil. 3 Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, Illinois 60637, USA. Purpose: To evaluate the cortical thickness of the mandible on dental panoramic radiographs of children diagnosed with obstructive sleep apnea (OSA) and children with no reported sleep disorders. Mandibular cortical thickness has been strongly linked to skeletal bone density. Methods: Mandibular cortical thickness measurements were retrospectively assessed using mandibular cortical width index (MCW) and Panoramic mandibular index (PMI) obtained from panoramic images of 27 OSA PSG diagnosed children between 2009 and 2016. Following a matching process based on age and sex, 81 children with no reported sleep disorders (controls) were selected. Factorial analysis of variance was used to compare MCW and PMI measurements between the 2 groups. Results: ICC results for reliability assessment were found to be excellent (ICC values were above 0.9). No significant differences were found based on sex (p>0.05), therefore both sexes were evaluated together. An increase in MCW and PMI values associated to aging in OSA (MCW, R=0.72, p <0.01; MCI, R=0.55, p <0.01) and control children (MCW, R=0.66, p <0.01; MCI, R=0.57, p <0.01) was identified. MCW and PMI mean values were significantly lower in OSA children (MCW=3.1±0.06mm; PMI=0.32±0.04) compared to control children (MCW=3.6±0.06mm; PMI=0.38±0.05). Conclusions: Findings of this study indicate that children with OSA have thinner mandibular cortex (based on MCW and PMI measurements) compared to children with no reported sleep disorders. This study represents the first clinical evidence suggesting that children with OSA are at higher risk to develop bone disease (such as osteopenia and osteoporosis) in the future.
CFAO Graduate Student Posterboards University of Alberta IMPACT OF BREASTFEEDING ON PEDIATRIC SLEEP BREATHING DISORDERS: A SYSTEMATIC REVIEW
University of Manitoba GROWTH MODIFICATION VERSUS SURGERY FOR SEVERE CLASS II MALOCCLUSIONS
Authors: Ponce-Garcia C, Hernandez I, Flores-Mir C (Supervisor)
Authors: William A. Wiltshire, BChD, BChD(Hons.), MDent, MChD(Orth), DSc, FACD, FRCDC
AIM: To methodically synthesize the available literature concerning the impact of breastfeeding on sleep disordered breathing in young children. METHODS: Eligibility criteria: Prospective and retrospective cohorts, case-controls, cross-sectional studies and clinical trials that evaluated the association between infant’s feeding methods and pediatric sleep disordered breathing were included. No restrictions were applied regarding language, year of publication, sex, or ethnicity. We excluded studies that included patients with severe craniofacial anomalies, genetic syndromes, and/or neuromuscular diseases. Information Sources: A systematic search of five electronic databases (Embase, Medline via OVID, Web of Science, LILACS and SCOPUS) was carried. All searches were inclusive until May 11, 2016.
Introduction: Growth modification(GM) of severe Class II malocclusions in growing patients may serve to reduce or even eliminate the need for orthognathic surgery. Aim of the study: To evaluate the clinical outcomes of a growth modification treatment protocol in patients with severe Class II malocclusions who refused a surgical option Subjects and methods: Fourteen skeletal Class II retrognathic patients (ANB= 5° - 10°) with severely enlarged overjets (8mm – 10mm) and proclined upper incisors were treated with a van Beek HGA followed by full-fixed appliances and matched with non-growing patients with similar growth patterns whom were treated with full-fixed orthodontics and surgery. Continued…
Risk of bias Assessment: The Newcastle-Ottawa Scale was used for quality assessment. RESULTS: Included studies: From the 70 articles initially retrieved and reviewed only 10 studies fulfilled the criteria to be finally included in this review. Synthesis of results: While seven of the selected studies reported a positive significant association between breastfeeding and sleep breathing disorders, the remaining three studies did not show any association. DISCUSSION: Strengths and Limitations of evidence: The main methodological limitation was related to data collection on infant feeding methods. All of the identified studies used a validated questionnaire to investigate if children were breastfed. However, some of them were retrospective and did not specify duration and/or exclusivity. CONCLUSION: The cumulative evidence is non-conclusive that exclusive breastfeeding is associated with decreased sleep breathing disorders in children.
Thanks to GAC for their support of the Latest Advances in Canadian Orthodontic Research Symposium and the CFAO Posterboards
Registration: “PROSPERO registration: CRD42016036250”
SPRING 2017 • CAO Bulletin
17
CFAO Graduate Student Posterboards RESULTS: GM varied from 4 – 11 months. Molar relationship, overjet, overbite and lip competence were all reduced to within normal limits. Total treatment time varied from 19 – 30 months(x= 24). Patients with GM were deemed not to require surgery after Phase 1 or, were satisfied with the aesthetics and opted not to pursue that option following GM. Patients in the surgical control group often did not achieve the aesthetics and function attained in the GM group. CONCLUSIONS: Despite current RCT data, GM seems to present a viable alternative to surgery in selected, compliant, growing Class II patients, even in severe dysplasias, within a 2 year time frame. Surgery should not be considered as a sine qua non for every Class II malocclusion, and individual variation and patient/parent concerns and preferences must be taken into account in clinical decision-making by the orthodontist in pain when using this device. Tooth movement is accelerated.
The strongest correlation was found between MMB Wits and ANB angle in the open bite group (r=0.74). CONCLUSIONS: The Wits appraisal using the MM bisector is a valid indicator of the sagittal discrepancy. The MMB Wits had a higher correlation coefficient to the ANB angle than the FOP Wits, further reinforcing its validity. Caution must be exercised in trying to relate any of Wits appraisal to the gold standard of the ANB angle.
University of Manitoba DENTAL, SKELETAL AND GROWTH EFFECTS OF MALOCCLUSIONS TREATED WITH THE VAN BEEK HEADGEAR ACTIVATOR AND COMPREHENSIVE FIXED ORTHODONTIC APPLIANCES - PRELIMINARY FINDINGS Author: Kotyk, M.W.; Wiltshire, W.A.; Drummond, R.J.; Pesun, I.J.
University of Manitoba VALIDITY OF THREE REFERENCE PLANES IN THE ASSESSMENT OF OPEN BITE AND DEEP BITE SUBJECTS. Authors: Dr. Virginie Provencal Dr. William A. Wiltshire (BChD, BChD (HONS) M. Dent, MChD(Orth); DSc, FACD, FPFA, FRCD (C) Dr. Kris Row (BA, DDS, M Sc.) Dr. Catalena Birek (DDS, PhD, FRCD (C)) OBJECTIVES: The purpose of this retrospective study was to evaluate the reliability and accuracy of three anteroposterior reference planes applied in the Wits analysis. MATERIALS AND METHODS: A retrospective chart review was undertaken on 150 subjects. Subjects were categorized into 3 groups based on the value of pre-treatment overbite; 50 normal (1-3 mm), 50 deep (more than 3mm) and 50 open bite (less than 1 mm) subjects. The maxillomandibular bisector (MMB) was used to evaluate the anteroposterior jaw discrepancy and compared to the Wits analysis and the ANB angular measurement using the bisecting occlusal plane (BOP) as well as the functional occlusal plane (FOP). RESULTS: The correlations of the three Wits appraisals (FOP Wits, BOP Wits, MMB Wits) to each other were moderate to high ranging from 0.56 to 0.89. The strongest correlations were found between BOP Wits and MMB Wits in the open bite group (r=0.89). Moreover, the correlations of the three Wits appraisals (FOP Wits, BOP Wits, MMB Wits) to the ANB angle were low to moderate ranging from 0.39 to 0.76.
18
CAO Bulletin • SPRING 2017
OBJECTIVE: To assess the dental and skeletal treatment and growth changes in growing Class II malocclusions with the van Beek Headgear Activator appliance followed by full fixed orthodontic treatment. MATERIALS AND METHODS: The treatment group consisted of 40 growing patients (20 males, 20 females, mean age 11.8 +/- 1.3 years) with Class II malocclusions that met the inclusion criteria and were treated under the supervision of one instructor (W.A. Wiltshire) with a first phase of van Beek Headgear Activator followed by a second phase of full fixed orthodontic appliance treatment. Lateral cephalometric radiographs were taken for all subjects pretreatment (T0) and after the completion of the second phase of treatment (T2) and a subgroup of the treatment group had lateral cephalometric radiographs taken after the completion of the first phase of treatment (T1). Dental, skeletal and growth effects were assessed by sagittal, vertical, and angular cephalometric parameters. RESULTS: Comparison of the cephalometric radiographs showed a decrease in ANB angle (T1 = -1.9º; T2 = -2.3º), Wits value (T1 = -2.1mm; T2 = -4.2mm), and overjet (T1 = 4.4mm; T2 = -5.9mm) with an increase in SNB angle (T1 = +1.1º; T2 = +1.4º) and Harvold difference (T1 = +3.9mm; T2 = +5.4mm). CONCLUSIONS: The van Beek Headgear Activator was found to be an effective treatment modality in the correction of Class II malocclusions in growing patients.
CFAO Graduate Student Posterboards University of Toronto LONGITUDINAL CRANIOFACIAL GROWTH IN PIERRE ROBIN SEQUENCE (PRS) IN COMPARISON WITH UNAFFECTED CHILDREN
CONCLUSION: Remarkable differences were noted in the maxilla, mandible and cranial base of PRS subjects over the long period of active facial growth studied, resulting in a bimaxillary retrognathic profile.
Authors: Fay Pereira*, David Fisher, Wendy Lou, Sunjay Suri
Acknowledgements: Lynn Cornfoot, AAOF Biomedical Research Award 2015-16 (SS), Burlington Research Centre
OBJECTIVE: This retrospective longitudinal study aimed to analyze trends and quantitative differences in craniofacial morphology and facial growth patterns between non-syndromic Pierre Robin Sequence (PRS) and unaffected subjects. METHODS: Characteristics of the maxilla, mandible and cranial base were examined at 6 years, 12 years and 18 years, using a comprehensive cephalometric analysis that focused on regional detail by means of internal and external landmarks. Lateral cephalometric tracings of 43 Caucasian subjects with PRS treated at the Hospital for Sick Children were compared with age- and sex-matched Caucasian unaffected subjects from the Burlington Growth Centre archives. Between-group differences of craniofacial measurements were analyzed. RESULTS: The PRS group had smaller cranial base lengths. Their maxillas were smaller with shorter anterior maxillary height and remained retrusive throughout the period of active facial growth. Their mandibles were smaller in body length and height as well as ramal width and height and also remained retrusive throughout growth. The PRS group also displayed a vertical growth pattern as indicated by an increased gonial angle.
University of Western Ontario DEXAMETHASONE REGULATES GENE EXPRESSION INDUCED BY THE MECHANOSENSITIVE P2X7 RECEPTOR IN OSTEOBLASTS Authors: Erin Eyer*, M Na, A Pereverzev, MW Grol, SJ Dixon Division of Graduate Orthodontics, Schulich School of Medicine and Dentistry, Western University Orthodontic tooth movement involves activation of osteoblasts and osteoclasts in response to mechanical forces. Extracellular nucleotides, released in response to mechanical stimuli, signal through P2 receptors in osteoblasts. P2X7 receptors are ATPgated cation channels implicated in mechanotransduction in bone. Corticosteroids such as dexamethasone exhibit anti-inflammatory effects and their chronic use has been linked to serious side-effects such as osteoporosis. We investigated gene expression following P2X7 receptor activation with benzoylbenzoyl-ATP (P2X7 receptor agonist) in osteoblast precursor cells in the presence or absence of dexamethasone. We hypothesized that dexamethasone inhibits the ability of ATP to stimulate the expression of anabolic (bone forming) genes in osteoblasts. We showed that benzoylbenzoyl-ATP stimulation of Ptgs2 and Dmp1 expression is indeed inhibited by dexamethasone. Thus, intracellular events following activation of P2X7 may be important in regulating osteoblast differentiation, maturation and eventual bone formation during orthodontic tooth movement. Dexamethasone may adversely affect these processes. Continuedâ&#x20AC;Ś
LACOR presenter Fay Pereira
SPRING 2017 â&#x20AC;˘ CAO Bulletin
19
CFAO Graduate Student Posterboards University of Western Ontario QUALITY OF LIFE AND SUBJECTIVE OUTCOMES FOLLOWING MAXILLOMANDIBULAR ADVANCEMENT SURGERY FOR THE TREATMENT OF OBSTRUCTIVE SLEEP APNEA Authors: Michelle Watroba*, A Emanuele, R Bohay, M Shimizu, A Tassi Division of Graduate Orthodontics, Schulich School of Medicine and Dentistry, Western University OBJECTIVE: The aim of this study was to assess outcomes related to general quality of life, daytime sleepiness and functional sleep outcomes, functional outcomes of orthognathic surgery, and facial aesthetics in patients undergoing maxillomandibular advancement (MMA) surgery for the treatment of obstructive sleep apnea (OSA). MATERIALS AND METHODS: This was a cross-sectional self-report study. A questionnaire was constructed using questions drawn from previously validated questionnaires. The survey was distributed to 25 patients who underwent MMA surgery for the treatment of OSA at LHSC in London, Ontario by a single surgeon between 2002 and 2013. RESULTS: The survey results showed that MMA patients responded positively with respect to quality of life, snoring, functional sleep outcomes and daytime sleepiness, and facial aesthetics. Nineteen (86.4%) indicated that their sleep apnea symptoms have improved since the surgery. Eighteen (81.8%) reported neutral or positive changes with respect to facial attractiveness. Nineteen (86.4%) indicated that their overall quality of life has become better since having MMA. Most patients indicated that the surgery was worthwhile and would recommend it to others suffering from OSA. CONCLUSIONS: MMA surgery for the treatment of OSA appears to have an overall positive effect on quality of life, sleep outcomes, and aesthetic outcomes. The majority of patients found the surgery worthwhile. Orthodontic treatment in conjunction with MMA appears to enhance the subjective aesthetic outcomes of treatment.
20
CAO Bulletin • SPRING 2017
SHOW US YOUR SELFIE SMILE…AGAIN! The CAO ran its second “Show Us Your Selfie Smile” contest in the fall of 2016. Over 100 entries later, our members’ patients were proud to show off their smiles that YOU made happen! People from all ages and all over the country participated in the contest, and were excited to be shared on Facebook and the CAO Consumer site: www.yoursmileourspecialty.ca Just in time for the holidays, the CAO collected the entries and drew the winner for a brand new iPhone 7.
Congratulations to: Brianna M. – patient of Dr. Grace Richardson, Stellarton, NS She was so excited that a local paper even highlighted the contest!
Thank you to all that participated and encouraged your patients to SHOW US THEIR SELFIE SMILES!
Membership Milestones Congratulations to the following members celebrating milestones in their CAO membership for the 2017 Membership Year!
60+ Years of Membership
40 Years of Membership
Dr. Douglas N. Allen Dr. Gerald P. Copeland Dr. Arthur A. Fraser Dr. Frank J. Furlong Dr. Rowland D. Haryett Dr. Arthur M. Hayes Dr. Jack Alan Langmaid Dr. Ronald P. Mullen Dr. Robert M. Perry
Dr. Michael Bindman Dr. Norma Chou Dr. Arlene P. Dagys Dr. Rosalinda U. Go Dr. Barry D. Hoffman Dr. Ray L. Kemp Dr. Louis Metzner Dr. Roy Queen Dr. Garry O. Robertson Dr. Gary F. Stauffer Dr. David G. Tarry Dr. Ronald Wolk Dr. Edwin H. Yen
50 Years of Membership Dr. Roger Dufresne Dr. C. Ronald Hill Dr. Earl Lerner Dr. Kenneth Neil Munro Dr. Howard Tile
35 Years of Membership Dr. Guy Dean Dr. Sheldon Dorfman Dr. Peter A. Konchak
I N M EMORIAM Dr. Ewart Dudley MacKay Ewart Dudley MacKay was born January 21, 1934 in Woodville, Ontario. He passed away on March 3, 2017, surrounded by his family at Markham-Stouffville Hospital, following a brief illness. He is survived by his wife Brenda Luka-MacKay, his four children and four grandchildren. Dr. MacKay was the son of the late Rev. E.W.B MacKay and Margaret Mae Shannon. He was educated at the University of Toronto and practiced orthodontics for over fifty years. Ewart is well-remembered for his gregariousness, his sense of humor and his regular attendance at the University of Toronto Orthodontic Alumni Annual Woodside Lecture. The CAO extends its condolences to the MacKay family in recognition of their loss.
Dr. Stanley Markin Dr. Angelos Metaxas Dr. Clifford J. Moore Dr. Bruce M. Oliver Dr. Daniel J. Sullivan Dr. Carol Anne C. Wishart
25 Years of Membership Dr. Isabelle Baillargeon Dr. Claude J. Boutin Dr. Mark Gwartz Dr. Linda M. Taylor Dr. LouAnn Visconti
30 Years of Membership Dr. Paul Castonguay Dr. Gary William Keyes Dr. Joanne Lafond Dr. Robert Love Dr. Paul W. Major Dr. Richard Miller Dr. Donald G. Robertson Dr. Victor R. Schacher Dr. E. Fraser Sherrard Dr. Dorothy A. Sonya Dr. Mark Eric Vukovich
10 Years of Membership Dr. Mariela Anderson Dr. Ajeet Ghumman Dr. Andy Ho Dr. Amer Hussain Dr. Mo Korayem Dr. Catherine McLeod Dr. Mike Wagner Dr. Matthew Witt
Vancouver, BC Independent Orthodontist Wanted!! Independent Orthodontist wanted to join 10 (soon 12) office, 28 GP dentists as our in-house orthodontist. Aarm Dental Group is a solo-group – not a franchise or large dental corporation. All partners have 100% clinical control, own 100% of charts, receive 100% of revenue. Our partnership purchase is ridiculously low, and our facility fees are about 2/3 of average. We have great work-life balance — we work 3.5 days per week maximum. We want ethical specialists who will help us craft the 21st century GP/Specialist partnership for the benefit of our patients. All our offices are state of the art and have fantastic retail ground floor locations. New specialist office will be available November, 2017 (with CBCT). Please send your CV with covering letter to Dr Jim Armstrong, Aarm Dental Group, aarm@axion.net
SPRING 2017 • CAO Bulletin
21
From the Editor
Dr. James Posluns Email: james.posluns@utoronto.ca
Membership has its Privileges “I’d never be a member of a club that would have me as a member.”
They were trying to save the club from imminent demise.
Groucho Marks, 1949
As a kid, I ran a company that maintained sail boats at the Island Yacht Club in Toronto. It was the mid- eighties. A Republican actor was the president and the stock market was surging. At least that president didn’t launch cruise missiles over dessert, change policy on a whim, or accuse his predecessor of wire-tapping, but I digress. For once, the state of the nation is not the purpose of this piece.
A firm position on membership either defines a value that builds a base, or it ticks-off the establishment enough that it forces it to vote with their feet, leaving the organization to burn to the ground. In the unfortunate case of the Island Yacht Club, it was the latter that transpired; literally and figuratively. You can read about the fire in old newspapers if you really want to.
Granted, there are differences between professional organizations and ritzy sailing clubs, but the issue of membership is consistent. Without a steady influx of new members plus a consistent solid membership base upon which to rely, the organization cannot sustain itself. Everybody knows this. The key is to recognize a problem early enough to do something about it.
Eventually, I became a member of this sailing club in my own right. And the place was hopping. Then, slowly, steadily, for whatever the reasons, things began to change. One could feel it in the air, like a shift of the wind in the harbor. Long-term members began leaving the club and people began to talk. I remember one annual meeting in particular that focused on membership. A wellknown periodontist from Toronto, stood up and lamented the club’s policy limiting the number of times his non-member adult children could visit as guests. The club board was adamant; either the kids joined the club, or they were exempt from the privileges of membership. A lively discussion erupted from the floor. It got ugly. At the time, I was troubled. How could the board be so hard-hearted as to exclude the children of their own members? Looking back, from where I sit now, I see the method to their madness.
22
CAO Bulletin • SPRING 2017
on the value of membership. The policies are firm. The terms are understood by all. If you want the benefits that the club has to offer, you maintain your membership. If young sailors want to use the club, they join as junior members after the age of sixteen, no exception. The membership base is strong and there is a steady influx of young members from a variety of diverse backgrounds. Today the club is over 100 years old and my money is on its surviving for years to come.
Today, I’m a member of a neighbouring sailing club. I often wonder why the new club is a success, while the other one failed woefully. They are literally a stonesthrow apart, made up of the same one percent, with a common interest at heart. As a non-board member of the new club, I believe success is rooted in the club’s ability to sustain a solid young membership base and to build a culture based
With regards to organized orthodontics, I’m feeling that same funny feeling that I had as a kid, way back when the periodontist spoke his mind from the floor. If you are reading this, and are (hopefully) a member of the CAO, then you need to know the facts. The membership base is starting to falter. Newer orthodontists aren’t joining but that’s not the crux of the problem. Multitudes of established members are not renewing their membership. Once the base falls below the critical mass, whatever that may be, there is going to be a real problem. We, as a profession in Canada, cannot let this happen. Two things need to happen right now.
From the Editor Cont’d. First, all members need to strongly encourage all non-member orthodontists to join. The Board does its best, but it needs the help of all members to ensure that the programs like the Consumer Awareness Program, brand marketing and insurance reforms can continue. The costs for all of these benefits are continually on the rise. Orthodontists who do not join receive the benefit, but pay none of the cost, while those who have joined (yes, you) pay an increasing proportion of these costs over time. That’s simply not right, nor is it sustainable. Second, the Board must adapt and offer new initiatives to stabilize membership. The current structure of organized orthodontics was set up before the rise of the internet and social media. One used to need many layers of organization to ensure that information was disseminated to the masses. No longer. I know as much as The Donald does about what’s going on between North Korea and the United States with one click of the keyboard. Well, almost as much. Probably more. It is a small world after all. Sometimes, it all seems like too much; too many organizations,
too many memberships and too many reminders. Wouldn’t life be simpler with just a single membership that serves everyone’s needs from the national down to the local level? I love the thought of writing a single cheque once a year that sees to all of my professional obligations. Whether or not this concept is something that can be explored remains to be seen, but to me, making things easier in a not-so-easy world is a real member benefit that would keep me coming back for years to come. How about you? Yay Summer! Jimmy P
A blind beggar had a brother who died. What relation was the blind beggar to the brother who died? “Brother” is not the answer.
Canadian Association of Orthodontists
UPCOMING ORTHODONTIC MEETINGS – Answer below –
2017 September 14-16 . . . CAO Annual Scientific Session, Toronto, ON September 14-17 . . . MSO GLAO Annual Meeting, New Orleans, LA October 11-15 . . . . . PCSCO Annual Meeting, Reno, NV
2018 May 4-8 . . . . . . . . . . . . AAO Annual Scientific Session, Washington, DC September 6-8 . . . . . CAO Annual Scientific Session, Vancouver, BC September 13-16 . . . GLAO Annual Meeting, Toronto, ON September 21-22 . . . MSO Annual Meeting, Bloomington, IN October 14-18 . . . . . PCSO Annual Meeting, Monterey, CA November 1-4 . . . . . . NESO Annual Meeting, TBD
2019
Straight Shooters What do you call orthodontic treatment that promises one thing but does another? Two faced treatment. What do Australian orthodontists eat for breakfast? Scrambled Beggs. Generous orthodontists 'spring' for everything!
May 3-7 . . . . . . . . . . . . AAO Annual Scientific Session, Los Angeles, CA September 12-15 . . . . GLAO Annual Meeting, US Virgin Islands
So simple its scary…. The blind beggar was the sister of her brother, who died
September 19-21 . . . CAO Annual Scientific Session, Fredericton, N B October 2-6 . . . . . . . . PCSO Annual Scientific Session, Honolulu, HI
Puzzle Answer from above. SPRING 2017 • CAO Bulletin
23