Thank you for publishing Drs. Donald J. Rinchuse and Sanjivan Kandasamy’s April JADA article, "Centric Relation: A Historical and Contemporary Orthodontic Perspective" (
JADA 2006;137:494–501
). It’s time that conventional orthodontic practice, which the conclusions of this article represent, came to this larger theater for closer scrutiny.
The authors have, through the use of "evidence-based" jargon, manipulated a 107-article reference list to show that historical and contemporary orthodontics are essentially the same and, by deduction, the best way to practice. While this may be great for practice management and maintenance of academic curricula, it’s ominous for future human dental system health.
Shouldn’t we be alarmed when professionals, doing comprehensive dentistry (orthodontics) on our children every day, are following a two-dimensional treatment philosophy promulgated when life expectancy was in the low 60s, and the temboromandibular joint (TMJ) was not considered a part of the dental system? Any seasoned comprehensive restorative dentist or orthodontist who stabilizes jaws and mounts cases for diagnosis can report the multitude of worn-down, TMJ-problematic, 20-year post-orthodontic cases.
Thankfully, a growing group of enlightened orthodontists are aware that, along with the frontal and horizontal planes, the sagittal plane and its relationship to the TMJ are fundamental to long-term orognathic success in the orthodontic process.
What has to change, to move beyond the dangerously flawed conclusions of this article, is the criterion on which we base our treatment. If we, as dental professionals, simply react to dental system deformity and disease with technical invention, there will never be an agreed-upon standard of care. Witness the chaos and confusion about occlusion today. In order to satisfy both the evidence-based and experience-based test, there must be a health-oriented biological basis for what we do. What if we had a proven model of optimal orognathic health as a treatment goal? Would the conclusions be the same?
In the 1980s, the late Dr. Robert L. Lee investigated healthy, minimally worn dentitions in adults of all ages.1 In his study, the healthiest dentitions showed a stable centric relation equal to, or close to, centric occlusion; incisal guidance with a 3- to 5-millimeter over-bite and a 2- to 3-mm overjet; posterior canine guidance negating working and balancing bite contacts; and, as a result, slight wear on the teeth regardless of age. He started practicing dentistry using the optimal parameters observed, and was pleased. He named this process "bioesthetic dentistry," and his measured observations "bioesthetic principles and guidelines."
At this writing, a few hundred dentists are regularly providing successful diagnosis and treatment based on this optimal health model. The most experienced of this group have been doing bioesthetic dentistry for at least 20 years.
Having replicated Dr. Lee’s findings many times, we know that an optimal biological model exists naturally in a small percentage of the human population and serves superbly as a therapeutic guide. Does biological existence qualify as evidence-based?
With human tactile sensitivity at 8 micrometers, orthodontists provide comprehensive dental system treatment with the twist of a pliers. Shouldn’t they be looking at the optimal biological model as a goal for treatment? This article suggests everything is fine just the way it has been. Our experience and evidence do not agree.
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