The 20 Principles of the Alexander Discipline, Volume 2. R.G. "Wick" Alexander
Library of Congress Cataloging-in-Publication Data
Alexander, R. G.
The Alexander discipline / R.G. “Wick” Alexander.
p.; cm.
Includes bibliographical references and index.
9780867155419
1. Orthodontics. I. Title.
[DNLM: 1. Orthodontics--methods. 2. Patient Care--methods. WU 400 A377a 2007]
RK521.A439 2007
617.6’43--dc22
2007010518
© 2011 Quintessence Publishing Co, Inc
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Editor: Leah Huffman
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Internal design: Patrick Penney
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Printed in Canada
Table of Contents
Title Page Copyright Page Dedication Preface Acknowledgments Author’s Note CHAPTER 1 - Introduction: Begin with Stability in Mind CHAPTER 2 - Selective Literature Review on Long-Term Stability CHAPTER 3 - Special Considerations in Orthodontics CHAPTER 4 - Anterior Torque Control CHAPTER 5 - Sagittal Skeletal Alteration and Vertical Skeletal Control CHAPTER 6 - Transverse Skeletal Alteration CHAPTER 7 - Functional Occlusion and Stability CHAPTER 8 - The Smile and Facial Harmony CHAPTER 9 - Factors Related to Relapse Index
Dedication
It is mind-boggling to think about how treatment mechanics have changed over the length of my career. The change in efficiency between the start of my career and today is incredible.
I clearly remember Dr Tweed’s words of advice, given to us University of Texas orthodontic graduate students in 1963: “If you start and finish one case a week, you will have a successful practice.” In other words, he was telling us that we could not control the treatment and produce quality results with a larger practice. He was recommending that each practitioner have around 100 active patients.
At this time, many orthodontists were still “pinching” bands. Preformed bands were just arriving into the market, preformed archwires were nonexistent, and everything was stainless steel. But times were changing!
Two West Texas orthodontists who had a tremendous influence upon my and others’ orthodontic careers were Jim Reynolds and Jay Barnett. They were the first to talk about efficiency and delegation in orthodontics. Their contribution to our profession should be better recognized; they considerably changed the way orthodontic treatment is delivered.
When I opened my private practice in 1964, we were controlling torque, angulation, and off-sets by bends into the stainless steel rectangular archwires. During the next decade, Larry Andrews showed how these archwire bends could be transferred to the bracket. This was a huge change, the beginning of straight-wire mechanics.
With the evolution of bonding, bracket design, and new archwire alloys, a single practitioner can now have a quality practice by starting and finishing one patient a day!
To future generations:
When I graduated from orthodontics school, I thought that I had been given a lifetime of discovery on a silver platter. My predecessors spent their lives searching, discovering, and then sharing. What a difference they made in my life and in the lives of so many others. Little did I realize how much additional change would take place in my generation. Although battles continue regarding extractions, stability, and particular techniques in orthodontics, and although much focus has been on quantity rather than quality of treatment, you don’t have to make a choice between quality results and financial success. A good orthodontist can achieve financial success while producing high-quality results in his or her patients.
Preface
A n old adage says that we all learn from our mistakes. We do something that goes against our education and even though we were taught otherwise, we simply must find out for ourselves. As children we were told not to touch the stove, yet we had to test it and burn our fingers to find out for ourselves.
Having written two book chapters on stability, having seen many former patients return with relatively stable results, and having lectured extensively on the subject, I began to believe that I had solved the problem of long-term stability until a former patient returned 14 years posttreatment showing relapse. Together let us analyze this patient—her diagnosis, treatment plan, and results—and evaluate our treatment and her stability.
Overview
An eleven-year-old girl presented with a convex profile (Fig 1a), lips open when relaxed, and dark buccal corridors when smiling. She exhibited a Class II end-on occlusion with an 11-mm overjet and a 5-mm overbite. The maxillary arch was a typical Class II V-shaped arch form with spacing in the anterior teeth (Fig 1b). The maxillary intermolar width was a narrow 28 mm. Although the patient was still in the mixed dentition with the primary premolars and molars present, the primary canines were missing. The result was a “collapse” of the anterior section of the mandibular arch (Fig 1c). Was this collapse a result of the mandibular lateral incisors’ eruption causing the exfoliation of the canines? Or were these teeth extracted to gain temporary space, allowing the lateral incisors to erupt? This is a question we could not answer.
Although there are exceptions to every rule, my clinical advice is to not extract mandibular primary canines to make space for the incisors. Keep them as long as possible because they maintain the intercanine width and the alveolar bone in this region.
Examination and diagnosis
In