688 Readers forum

American Journal of Orthodontics and Dentofacial Orthopedics

December 2010

make complete root coverage less predictable, as you mentioned. Treatment decisions are based on a cost-benefit ratio.
For this patient, we thought that this was the best way to go.
However, perhaps the other way would have been better.
Guilherme Janson
Karina Freitas
Marise Cabrera
Bauru, S~
ao Paulo, Brazil

the force on the left side was greater than on the right side.
The anterior diagonal elastic was used from a hook soldered
mesially to the mandibular right canine to a hook soldered
mesially to the maxillary left canine on the archwires. We
should also have mentioned that the initial malocclusion
shown in Figure 1 was in centric relationship. Therefore,
there was no contribution of mandibular repositioning to
the correction.

Am J Orthod Dentofacial Orthop 2010;138:687-8

0889-5406/$36.00
Copyright 2010 by the American Association of Orthodontists.
doi:10.1016/j.ajodo.2010.10.010

Asymmetric elastics for Class III

subdivision
Congratulations to Dr Janson and his coauthors for their
successful treatment of an interesting and complicated case
(Janson G, de Freitas MR, Araki J, Franco EJ, Barros SEC.
Class III subdivision malocclusion corrected with asymmetric
intermaxillary elastics. Am J Orthod Dentofacial Orthop
2010;138:221-30). However, their report raised certain
questions and observations.
Considering the title and references in the article
regarding asymmetric treatment, I failed to understand the
photographs in Figure 4 showing symmetrical use of Class
III elastics, particularly since the legend refers to asymmetric
Class III elastics. Additionally, the authors stated that the anterior diagonal elastic is not shown but failed to indicate the
direction of wear. With apologies for nit-picking, that question
arose as a result of my confusion regarding the symmetrical
Class III elastics illustrated.
Since a functional shift often accompanies an anterior
crossbite, I would like to have read a functional evaluation
of the case and to have learned to what extent, if any, mandibular repositioning contributed to the correction.
It is infinitely easier to be a critic of an article than to be an
author and a clinician. So, once again, congratulations on your
report and the quality of your results.
Morton Speck
Lexington, Mass
Am J Orthod Dentofacial Orthop 2010;138:688
0889-5406/$36.00
Copyright 2010 by the American Association of Orthodontists.
doi:10.1016/j.ajodo.2010.10.015

Authors response
Thank you for your compliments regarding our article
(Janson G, de Freitas MR, Araki J, Franco EJ, Barros SEC.
Class III subdivision malocclusion corrected with asymmetric intermaxillary elastics. Am J Orthod Dentofacial Orthop
2010;138:221-30). We realize that Figure 4 is not clear, and
we should have described more details of the treatment
progress. Most of the time, Class III elastics were used
only on the left side; when elastics were used on both sides,

Guilherme Janson
Janine Araki
S
ergio Estelita Barros
Bauru, Brazil
Am J Orthod Dentofacial Orthop 2010;138:688
0889-5406/$36.00
Copyright 2010 by the American Association of Orthodontists.
doi:10.1016/j.ajodo.2010.10.011

Conflicts of interest
I wish to compliment you for 2 fine articles in the September issue: Financial conflicts of interest policies: From confusion to clarity (Turpin DL. Am J Orthod Dentofacial
Orthop 2010;138:245-6), and In the land of no evidence, is
the salesman king? (OBrien K, Sandler J. Am J Orthod
Dentofacial Orthop 2010;138:247-9).
Regarding the editorial, I have practiced orthodontics for
50 years and still practice three days a week. I admit to having succumbed to the allure of beautiful advertising and the
misplaced belief that a particular appliance was going to
change the quality of my orthodontic treatment. Thinking
is what determines the quality of your orthodontic treatment,
not some appliance. I have tried self-ligating brackets from
2 different companies and found that, in my practice, they
caused more problems than they solved and I am now back
to using standard twin brackets with my prescription of
choice. Time-wise at the chair, I might be 10 seconds behind;
quality wise, I think I am back in control of my practice.
I have also tried implants for temporary anchorage and
I found that an 80% percent success rate did not justify
utilizing them.
I have been on the Louisiana State Board of Dentistry for
a total of 24 years. During most of that time we have required
continuing education. What I see happening across the board
in the specialties and general practice is that most of the
courses put forward for approval in our licensing process involve some sort of company sponsorship. It is very difficult
to find pure presentations that have enough glitz and glamour. You correctly touched on the financial burden of the
schools and societies presenting the programs and how
much easier it is to close your eyes to what I call tainted
research in the interest of attracting large crowds and participation in state, district, and national society meetings and
school-sponsored continuing education.
On the state board level, at least in Louisiana, quality of
care is the byword. The problem is who determines what is
quality care? It seems it is the manufacturers of dental
products.