60 MINUTES recently showed a program on TV3 concerning Orthodontics.

As professional orthodontic specialists, we are concerned that patients may be alarmed by what was an unbalanced, sensationalised programme, lacking a basis in scientific evidence. The following information may be helpful.

The key issue is good orthodontics versus bad orthodontics, not extraction of teeth versus non-extraction.

One of the features of good orthodontics is to focus on the face, not merely on the teeth.

Good orthodontics requires that, when tooth extractions are indicated, the facial appearance is not compromised. Appropriate mechanics are required to keep the teeth forward in the face, to avoid flat or dished-in faces.

So why are extractions sometimes recommended as part of orthodontic treatment?

1. The alternative to extraction is likely to be an attempt to expand the dental arches to accommodate crowded teeth. On occasions, this is appropriate. However, research repeatedly shows that expansion treatment almost inevitably relapses, with a few rare exceptions.
   
   It should be noted that all the orthodontic patients interviewed in the 60 Minutes documentary were young. It would be interesting to revisit those people in 10 or 15 years time. It can be expected, on the evidence of every major and recognised study that has been carried out, that relapse will occur in the majority of those people whose teeth were crowded and who were treated without extraction.
2. Many non-extraction treatments may straighten the teeth from the first molar teeth forward, while the second molar teeth are prevented from erupting because of lack of space. It is generally agreed that a second molar tooth is a more valuable tooth than, for example, a second bi-cuspid tooth.

Well educated orthodontists, because of their understanding of facial biology, know that in a number of cases it is not possible to achieve the desired combination of:

1. straight teeth, in stable positions on the dental base, and
2. a good profile without integrating orthodontic treatment with surgical re-positioning of one or both jaws (orthognathic surgery).

Established current New Zealand practice is that patients and parents are informed of those options, and the advantages and disadvantages of each of them. Informed consent is essential before treatment begins.

Treating with extractions is more difficult than treating non-extraction. It requires appropriate paralleling of roots across extraction spaces and torque control of upper and lower anterior segments.

Quite clearly, bad orthodontics is very common in the National Health Service in the UK, where, because of costs, proper technique is not always employed. There are thus many cases which could be cited by the British orthodontist, Dr Mew.

In New Zealand, by contrast, we have a generation of orthodontists who are well trained, who understand the biology of the face, arrange extractions where it is appropriate, and have the mechanical skills to protect faces.

Patients of this practice can be assured that our priority is to protect and enhance facial appearance, while working to achieve the optimum dental alignment and occlusion.

We invite you to discuss whatever concern you may have on these matters with us.

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