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Letters to the Editor |
Braylsham Castle, Broad Oak, Heathfield, Sussex TN21 8TY, U.K.
Dear Sir,
I was most impressed by the cases treated by Ian Lund which justifiably won the Orthologic ‘A’ Company Award for 1997 (BJO, 26, 1–8, 1999). To see such difficult cases treated to such a standard leaves most of us feeling rather humble and should help to motivate all of us to improve out own standards.
However, the presentation raises further questions. Will the right mechanics always get results like these? If not why not? We all know that some cases grow favourable and some do not. Is this the luck of the draw or are there hidden factors which we do not yet understand? What do we actually learn from seeing successfully treated cases? Many would admit to learning more from our failures than our successes and some might be tempted to mutter ‘He was lucky with that case, it will probably relapse later’. In our efforts to demonstrate the potential of orthodontic treatment, could we be misleading not only the public, but also ourselves?
Unfortunately, most results do not reach this standard, and many leave much to be desired. Even the more successful cases may raise uncomfortable issues, such as root damage, decalcification, facial aesthetics, and long-term stability.
While it is good to be inspired, we are unlikely to learn very much from cases that grow favorably. We might learn more if only we had the courage to survey blocks of con-secutive patients 10 years after treatment and show our failures as often as our successes.
Yours sincerely,
67 Woodland Rd, Darlington. Co. Durham DL3 8BQ, U.K.
Dear Sir,
First, I would like to thank Dr Mew for his interest in the Orthologic ‘A’ Company award for 1997 (BJO 26, 1–8, 1999) and for his generous comments upon the results.
The editorial policy of the BJO and the criteria which are set down by the examiners of the Membership of Orthodontics for which these cases were originally presented, and the criteria for the Award itself are not for my comment. However, as an orthodontist who has recently completed a 3-year postgraduate course, I feel that case reports published within the BJO are of considerable interest and contributed to y overall training.
It is now generally accepted that the gold standard for any orthodontic research is a prospective randomized controlled trial. However, case reports are recognized as having a part to play in the hierarchy of evidence and are often of educational value.
Cases submitted by 25 registrars from units throughout the country were all treated to a high standard, a tribute to those clinicians and also to their clinical trainers. I was fortunate in receiving this award and do not feel that these cases are necessarily strokes of luck as Dr Mew implies. I believe that the majority of my colleagues would aim to treat these cases in the manner described. There is certainly a consensus among our trainers with regard to treatment philosophy in orthodontics.
Orthodontists acknowledge the contribution of favour-able growth to the outcome of cases and wish that there were more in our power to predict those cases which will not grow favourable. I feel, however, that it is all too easy to blame unfavourable growth when perhaps in fact it may be due to other factors.
Yours sincerely,
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