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ORTHODONTICSCURRENT PRINCIPLES AND TECHNIQUESSIXTH EDITION
Lee W. Graber, DDS, MS, MS, PhDRobert L. Vanarsdall, Jr., DDSKatherine W.L. Vig, BDS, MS, D Orth, FDS RCSGreg J. Huang, DMD, MSD, MPH
ORTHODONTICSCURRENT PRINCIPLES AND TECHNIQUESSIXTH EDITIONLee W. Graber, DDS, MS, MS, PhDSecretary General, World Federation of OrthodontistsPast President, American Association of OrthodontistsPast President, World Federation of OrthodontistsPrivate Practice, Glenview and Vernon Hills, ILKatherine W.L. Vig, BDS, MS, D Orth, FDS RCSOthodontic Faculty, Harvard School of Dental Medicine,Boston, MAProfessor Emeritus and Former Chair of OrthodonticsThe Ohio State University, College of Dentistry, OHPast President, American Cleft Palate-Craniofacial AssociationRobert L. Vanarsdall Jr., DDSProfessor and Chair EmeritusDepartment of OrthodonticsSchool of Dental MedicineUniversity of PennsylvaniaPhiladelphia, PAGreg J. Huang, DMD, MSD, MPHProfessor and ChairDepartment of OrthodonticsSchool of DentistryUniversity of WashingtonSeattle, WA
3251 Riverport LaneSt. Louis, Missouri 63043ORTHODONTICS: CURRENT PRINCIPLES AND TECHNIQUES,SIXTH EDITION ISBN: 978-0-323-37832-1Copyright 2017 by Elsevier, Inc. All rights reserved.No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission inwriting from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the CopyrightLicensing Agency, can be found at our website: www.elsevier.com/permissions.This book and the individual contributions contained in it are protected under copyright by the Publisher (otherthan as may be noted herein).NoticesKnowledge and best practice in this field are constantly changing. As new research and experience broaden ourunderstanding, changes in research methods, professional practices, or medical treatment may become necessary.Practitioners and researchers must always rely on their own experience and knowledge in evaluating andusing any information, methods, compounds, or experiments described herein. In using such information ormethods they should be mindful of their own safety and the safety of others, including parties for whom theyhave a professional responsibility.With respect to any drug or pharmaceutical products identified, readers are advised to check the mostcurrent information provided (i) on procedures featured or (ii) by the manufacturer of each product to beadministered, to verify the recommended dose or formula, the method and duration of administration, andcontraindications. It is the responsibility of practitioners, relying on their own experience and knowledge oftheir patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, andto take all appropriate safety precautions.To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise,or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.Previous editions copyrighted 2012, 2005, 2000, 1994, 1985Library of Congress Cataloging-in-Publication DataNames: Graber, Lee W., editor. Vanarsdall, Robert L., editor. Vig,Katherine W. L., editor. Huang, Greg J., editor.Title: Orthodontics : current principles and techniques / [edited by] Lee W.Graber , D.D.S., M.S., M.S., Ph.D., President, American Association ofOrthodontists, Past President, World Federation of Orthodontists, PrivatePractice, Vernon Hills, IL, Robert L. Vanarsdall Jr, DDS, Professor andChair, Department of Orthodontics, School of Dental Medicine, Universityof Pennsylvania, Philadelphia, Pennsylvania, Katherine W.L. Vig, BDS, MS,D Orth, FDS RCS, Professor Emeritus and Former Chair of Orthodontics, TheOhio State University, College of Dentistry, Past President, AmericanCleft Palate-Craniofacial Association, Greg J. Huang, DMD, MSD, MPH,Professor and Chair, Department of Orthodontics, School of Dentistry, University of Washington.University of Washington.Description: Sixth edition. St. Louis, Missouri : Elsevier, [2017] Revison of: Orthodontics / Thomas M. Graber, Brainerd F. Swain. 1985. Includes bibliographical references and index.Identifiers: LCCN 2016027994 (print) LCCN 2016028815 (ebook) ISBN9780323378321 (hardback : alk. paper) ISBN 9780323444323 (Online)Subjects: LCSH: Orthodontics.Classification: LCC RK521 .G673 2017 (print) LCC RK521 (ebook) DDC617.6/43–dc23LC record available at https://lccn.loc.gov/2016027994Content Strategist: Kathy FalkAssociate Content Development Specialist: Laura KleinContent Development Manager: Jolynn GowerPublishing Services Manager: Hema RajendrababuProject Manager: Srividhya VidhyashankarDesign Direction: Ashley MinerPrinted in United States of AmericaLast digit is the print number:987654321
D E D I C AT I O N :T O O R T H O D O N T I C E D U C AT O R S A N D R E S I D E N T SEvery text that is conceived, written and published starts witha purpose. Although this is the sixth edition of Orthodontics: Current Principles and Techniques, the concept of thismulti-authored graduate level textbook started in the late1960’s with work that culminated in the 1969 publication ofCurrent Orthodontic Concepts and Techniques. Why do a graduate level textbook? The answer was very simple: The principaleditor and author Tom Graber, when interviewed later in lifesaid it best—“There was a need.” “The need” was defined by awidely held perception that there was a lack of supportive materials for clinicians teaching in orthodontic specialty educationprograms. Indeed, many of those who served as instructors andlecturers were private practice clinicians with little or no background in professional education.The authors sought to provide a vehicle for educators to meldthe then existing scientific basis of orthodontics with clinicalpractices in a manner that could be universally used. Courseoutlines that followed the textbook chapters as well as supportive slides were made available to help good clinicians becomebetter teachers. A secondary but no less important goal forthe textbook was to provide an organized platform by whichpracticing orthodontists could be updated on current conceptswithin the specialty. Tom Graber championed the need for continuing professional education and often cited G.V. Black, thefather of modern dentistry, who had stated, “The professionalperson has no right to be other than a continuous student.”The focus of the authors and editors who participated in the1969 orthodontic text—and those who now do so in what is theeight iteration1 has remained the same. We want to supportorthodontic educators, the residents they teach and the “continuous students” orthodontic specialists must become.With these thoughts as a background, it is to the educatorsand the orthodontic residents of the past, present and future wewish to dedicate the sixth edition. They embody the purpose ofthis text, because it is from their efforts our supportive scienceand clinical practice has grown and on their shoulders that ridesthe future development of our dental specialty.1Thisis the sixth edition of the current series, with the title of thetextbook and publisher changed in 1985. The first edition of the current series was the third for the text and included a change in title andpublisher.Pictures shown are from top row left: Edward H. Angle and the Classof 1900 of the Angle School of Orthodontia, from American Journalof Orthodontics and Dentofacial Orthopedics, 148:2, cover, 2015;Charles H. Tweed (glasses and bow tie) demonstrating patient at1940’s meeting (courtesy Rolf G. Behrents); Lysle E. Johnston lecturingto residents on cephalometrics (courtesy Rolf G. Behrents); Robert L.Vanarsdall lecturing to residents on three dimensional imaging, 2016.Bottom picture is of resident attendees and faculty at the GraduateOrthodontic Residents Program outside the American Association ofOrthodontists building, St. Louis, 2015 (courtesy Rolf G. Behrents).v
LIST OF CONTRIBUTORSAdrian Becker, BDS, LDS, DDOStella Chaushu, DMD, PhDHakan El, DDS, PhDClinical Associate Professor EmeritusOrthodonticsHebrew University-Hadassah School ofDental MedicineJerusalem, IsraelProfessor and ChairOrthodonticsHebrew University-Hadassah School ofDental MedicineJerusalem, IsraelAssociate ProfessorOrthodonticsHacettepe UniversitySihhiye, Ankara, TurkeyErika Benavides, DDS, PhDPeter D. Chemello, DDSClinical Associate ProfessorPeriodontics and Oral MedicineUniversity of MichiganAnn Arbor, MichiganPrivate practice, Northwest Oral andMaxillofacial SurgeryArlington Heights, IllinoisPhilip Edward Benson, PhD FDS (Orth)Professor of OrthodonticsAcademic Unit of Oral Health andDevelopment, School of Clinical DentistryUniversity of SheffieldSheffield, United KingdomIgnacio Blasi, Jr., DDS, MSDiplomate, American Board of OrthodonticsPrivate practiceTysons Corner, VirginiaCharles J. Burstone, DMD, MS, PhD†Professor, EmeritusOrthodonticsUniversity of Connecticut Health CenterFarmington, ConnecticutPeter H. Buschang, PhDRegents Professor & Director of OrthodonticResearchOrthodonticsTexas A&M University Baylor College ofDentistryDallas, TexasTamer Büyükyilmaz, DDS, MSD, PhDPrivate practiceAdana, TurkeyDavid S. Carlson, PhDRegents ProfessorBiomedical SciencesTexas A&M University Baylor College ofDentistryDallas, TexasLucia Cevidanes, DDS, MS, PhDAssistant ProfessorOrthodontics and Pediatric DentistryUniversity of MichiganAnn Arbor, Michigan†Deceased.viClark D. Colville, DDS, MSAssistant Clinical ProfessorOrthodonticsUniversity of Texas School ofDentistryHouston, TexasClinical Advisory BoardInvisalignSanta Clara, CaliforniaHali Dale, HON.B.Sc, DDSDiplomate, American Board of OrthodonticsPrivate PracticeToronto, OntarioJack G. Dale†, BA, DDSPostdoctoral Fellowship inOrthodonticsHarvard UniversityCambridge, MassachusettsAssociate ProfessorFaculty of TorontoToronto, CanadaChairmanCharles H. Tweed FoundationTucson, ArizonaPrivate PracticeToronto, CanadaTheodore Eliades, DDS, MS, Dr Med Sci,PhD, FIMMM, FRSC, FInstPProfessor and DirectorClinic Orthodontics and Paediatric Dentistry,Center of Dental MedicineUniversity of ZurichZurich, SwitzerlandNorah Lisa Flannigan, BDS, MDETSCI,PhD, MFDSRCPS MORTHRCS, FDS(ORTH), RCSSenior LecturerOrthodonticsThe University of LiverpoolLiverpool, EnglandHonorary ConsultantOrthodonticsLiverpool University Dental HospitalLiverpool, EnglandThomas M. Graber†, DMD, MSD, PhD,OdontDr, DSc, ScD, MD, FDSRCS (Eng)Director, Kenilworth Dental ResearchFoundationClinical Professor, Orthodontics, Universityof Illinois, Chicago, IllinoisFormer Professor and Chair, Sectionof Orthodontics, Pritzker School ofMedicine, University of Chicago,Chicago, IllinoisFormer Editor-in-Chief, World Journal ofOrthodonticsEditor-in-Chief Emeritus, AmericanJournal of Orthodontics and DentofacialOrthopedicsDwight Damon, DDS, MSDPrivate practiceSpokane, WashingtonM. Ali Darendeliler, BDS, PhD, Dip Orth,Certif Orth, Priv. Doc, MRACDS (Ortho),FICDProfessor and ChairOrthodonticsUniversity of SydneySydney, NSW, AUSHead of DepartmentOrthodonticsOral Health Services and Sydney DentalHospital, Sydney LHDSydney, AustraliaDan Grauer, DDS, PhDAssistant ProfessorOrthodonticsUniversity of Southern CaliforniaLos Angeles, CaliforniaPrivate PracticeSanta Monica, California
List of ContributorsNigel W.T. Harradine, BDS, MB BS,LMCC, FDS RCS (London), FDS RCS(Edin), MSc (Orth)Senior Clinical LecturerChild Dental HealthUniversity of BristolBristol, United KingdomConsultant OrthodontistChild Dental HealthBristol Dental HospitalBristol, United KingdomJung Kook Kim, DDS, MS, PhDJames A. McNamara, Jr., DDS, MS, PhdAdjunct Associate ProfessorDepartment of OrthodonticsSchool of Dental Medicine University ofPennsylvaniaPhiladelphia, PennsylvaniaClinical ProfessorDepartment of OrthodonticsCollege of Dentistry Yonsei UniversitySeoul, South KoreaThomas M and Doris Graber ProfessorEmeritusOrthodontics and Pediatric Dentistry, Schoolof DentistryThe University of MichiganAnn Arbor, MichiganProfessor EmeritusCell and Developmental Biology, School ofMedicineThe University of MichiganAnn Arbor, MichiganResearch Professor EmeritusCenter for Human Growth and DevelopmentUniversity of MichiganAnn Arbor, MichiganHerbert A. Klontz, DDS, BA, MSJames Kennedy Hartsfield, Jr., DMD, MS,MMSc, PhDProfessor and E. Preston Hicks EndowedChair in Orthodontics and Oral HealthResearchOral Health ScienceUniversity of Kentucky College of DentistryLexington, KentuckyAdjunct Professor of Orthodontics and OralFacial GeneticsOrthodontics and Oral Facial GeneticsIndiana University School of DentistryIndianapolis, IndianaAdjunct Professor of Medical and MolecularGeneticsMedical and Molecular GeneticsIndiana University School of MedicineIndianapolis, IndianaAdjunct Clinical Professor of OrthodonticsOrthodonticsUniversity of IllinoisChicago, IllinoisClinical Associate ProfessorOrthodonticsCollege of DentistryUniversity of OklahomaOklahoma City, OklahomaAnn M. Mercado, DMD, MS, PhDJong Suk Lee, DDS, MS, PhDAdjunct Assistant ProfessorOrthodonticsSchool of Dental MedicineUniversity of PennsylvaniaPhiladelphia, PennsylvaniaClinical ProfessorOrthodonticsCollege of Dentistry Yonsei UniversitySeoul, South KoreaRobert M. Little, DDS, MSD, PhDProfessor EmeritusOrthodonticsUniversity of WashingtonSeattle, WashingtonNan E. Hatch, DMD, PhDJohn B. Ludlow, DDS, MS, FDS RCSEdAssociate Professor of DentistryLysle E Johnston, Jr. Collegiate Professor ofOrthodonticsChair, Orthodontics and Pediatric DentistryUniversity of MichiganAnn Arbor, MichiganAdjunct ProfessorDiagnostic SciencesUniversity of North CarolinaChapel Hill, North CarolinaSarandeep S. Huja, DDS, PhDProfessor and Division Chief, Orthodonticsand Director of Graduate Studies, DentistryCollege of Dentistry, Division of OrthodonticsUniversity of KentuckyLexington, KentuckyviiLaurie McNamara McClatchey, DDS, MSAdjunct Clinical Assistant Professor ofDentistryOrthodontics and Pediatric Dentistry,School of DentistryUniversity of MichiganAnn Arbor, MichiganClinical Assistant ProfessorOrthodonticsOhio State UniversityColumbus, OhioMember of Medical StaffDentistryNationwide Children’s HospitalColumbus, OhioLorri Ann Morford, PhDResearch Assistant Professor; Supervisor,Genetics/Genomics Core of the Universityof Kentucky Center for the Biologic Basisof Oral/Systemic DiseasesOral Health ScienceUniversity of Kentucky College ofDentistryLexington, KentuckyDavid Musich, DDS, MSClinical ProfessorOrthodonticsUniversity of Pennsylvania School of DentalMedicinePhiladelphia, PennsylvaniaTung Nguyen, DMD, MSAssociate ProfessorOrthodonticsUniversity of North CarolinaChapel Hill, North CarolinaDonald R. Joondeph, BS, DDS, MSJeffrey P. Okeson, DMDProfessor Emeritus and Former ChairOrthodonticsUniversity of WashingtonSeattle, WashingtonProfessor and Chief, Division of OrofacialPainOral Health ScienceUniversity of Kentucky College of DentistryLexington, Kentucky
viiiList of ContributorsJuan Martin Palomo, DDS, MSDProfessor, Director of OrthodonticResidency, Director of CraniofacialImaging CenterOrthodonticsCase Western Reserve UniversityCleveland, OhioLeena Bahl Palomo, DDS, MSDAssociate Professor, Director of DMDPeriodonticsPeriodonticsCase Western Reserve UniversityCleveland, OhioDavid E. Paquette, DDS MS MSDFaculty, Clinical OrthodonticsSt. Louis UniversitySt. Louis, MissouriClinical Advisory BoardInvisalignSanta Clara, CaliforniaYoung - Chel Park, DDS, PhDProfessor EmeritusDepartment of OrthodonticsCollege of Dentistry, Yonsei UniversitySeoul, KoreaDirector, Private ClinicOrthodonticsYonsei Beautiful Friend OrthodonticCenterSeoul, KoreaDubravko Pavlin, DMD, MSD, PhDProfessor and Program DirectorOrthodonticsUniversity of Texas Health Science CenterSan AntonioSan Antonio, TexasW. Eugene Roberts, DDS, PhD, DHC(Med)Professor Emeritus of Orthodontics,and Adjunct Professor of MechanicalEngineeringOrthodontics and Mechanical EngineeringIndiana University and Purdue University atIndianapolisIndianapolis, IndianaVisiting Professor of OrthodonticsOrthodonticsLoma Linda University, School of DentistryLoma Linda, CaliforniaIosif B. Sifakakis, DDS, MS, Dr DentLecturerOrthodonticsSchool of Dentistry, National andKapodistrian University of AthensAthens, GreeceRaffaele SpenaAdjunct Associate ProfessorOrthodonticsUniversità di FerraraFerrara, ItalyKingman P. Strohl, MDAntonio Carlos de Oliveira Ruellas, DDS,PhDAssociate ProfessorOrthodonticsFederal University of Rio de JaneiroRio de Janeiro, BrazilVisiting ResearcherOrthodontics and Pediatric DentistryUniversity of MichiganAnn Arbor, MichiganProfessor of Medicine, Physiology &Biophysics, and OncologyCase Western Reserve University School ofMedicineCleveland, OhioSleep Center DirectorUniversity Hospitals Case Medical CenterCleveland, OhioDirector Sleep Disorders ProgramLouis Stokes Cleveland VA Medical CenterCleveland, OhioRohit ChamanLal Sachdeva, BDS,M Dent ScZongyang Sun, DDS, MS, PhDCo-Founder and Former Chief ClinicalOfficerOrametrix, Inc.Richardson, TexasAssociate ProfessorOrthodonticsThe Ohio State University College of DentistryColumbus, OhioGlenn T. Sameshima, DDS PhDBirgit Thilander, Odont Dr (PhD), MedDr (hc), Dr Odont (hc)Associate Professor and ChairOrthodonticsHerman Ostrow School of DentistryUniversity of Southern CaliforniaLos Angeles, CaliforniaProfessor EmeritusOrthodonticsInstitute of Odontology, Sahlgrenska AcademyUniversity of GothenburgDavid M. Sarver, DMD, MSPatrick K. Turley, DDS, MSD MedProfessor Emeritus and formerly KenanDistinguished ProfessorDepartment of OrthodonticsUniversity of North CarolinaSchool of DentistryChapel Hill, North CarolinaAdjunct ProfessorOrthodonticsUniversity of North CarolinaChapel Hill, North CarolinaAdjunct Clinical ProfessorOrthodonticsUAB School of DentistryBirmingham, AlabamaProfessor Emeritus and former ChairOrthodontics and Pediatric DentistrySchool of DentistryUniversity of California at Los AngelesLos Angeles, CaliforniaPrivate practice Manhattan Beach, CAJorge A. Ayala Puente, DDSAntonino G. Secchi, DMD, MSFACECirujano DentistaSpecialist in OrthodonticsSantiago, ChileDiplomate, American Board of OrthodonticsFormer Clinical Assistant Professor ofOrthodonticsUniversity of PennsylvaniaPrivate PracticeDevon, PennsylvaniaWilliam R. Proffit, DDS, PhDPatricia Turley, DDSPrivate practice, pediatric dentistryManhatten Beach, CaliforniaDavid L. Turpin, DDS, MSDMoore/Riedel ProfessorOrthodonticsSchool of DentistryUniversity of WashingtonSeattle, Washington
List of ContributorsSerdar Üşümez, DDS, PhDDirk Wiechmann, DDS, PhDBjorn U. Zachrisson, DDS, MSD, PhDProfessorOrthodonticsBezmialem Vakif University, Faculty ofDentistryIstanbul, TurkeyProfessorOrthodonticsHannover Medical SchoolHannover, GermanyPrivate PracticeBad Essen, GermanyOrthodonticsUniversity of OsloOslo, NorwayJames L. Vaden, BA, DDS, MSProfessorOrthodonticsUniversity of TennesseeMemphis, TennesseeTimothy T. Wheeler, DMD, PhDProfessor, Former Academy 100 EminentScholar, Former Chair & ProgramDirectorOrthodonticsUniversity of FloridaGainesville, FloridaLeslie A. Will, DMD, MSDChair and Anthony A. Gianelly Professor inOrthodonticsOrthodontics and Dentofacial OrthopedicsBoston University Henry M. GoldmanSchool of Dental MedicineBoston, MassachusettsAdjunct ProfessorOrthodonticsUniversity of Pennsylvania School of DentalMedicinePhiladelphia, Pennsylvaniaix
P R E FA C EThis is the eighth re-writing of a textbook that has remained themost widely used graduate orthodontic textbook in the worldand has now been translated in to multiple languages. TomGraber was the initial editor in the late 1960s. He was encouraged by colleagues within the orthodontic educational community to fill what they saw as a void within orthodontic specialtyprograms. They perceived that although there were many excellent graduate programs, there was significant variance in theeducational assets these programs provided for their residents.In bringing together the thoughts of excellent clinicians andrelated scientists in a text specifically meant for the advancedstudy of orthodontics, concepts and techniques could be sharedwith all benefitting.An additional thought, shared at the time in both academicand professional association circles, was the need for a means toprovide better continuing education to those already in practice. Today we take for granted that technologies and conceptschange very quickly, and we must keep ourselves current. Forty-five plus years ago, the need was not as self-evident. Thus, indeveloping a textbook with recognized and vetted authorities ona wide array of subjects impacting clinical practice, the editorscould provide a critical resource to those who had completedtheir formal education and were subsequently in primarily solopractices offices. The concept was that the text would be a basisfor continued learning—a foundation on which these clinicianscould better judge new material seen in their journals and professional lectures. By the very nature of this concept, there wasan inherent demand that the text itself be updated to reflectthe current basis on which the orthodontic specialty was beingpracticed. This demanded that it be updated on a regular basis,reducing emphasis in some areas, adding in others as both basicscience concepts and clinical techniques further matured.The task of “keeping current” is not an easy one and hasbecome more difficult with the explosion of orthodontic- relatedresearch and technical development. Additionally, in the earlyyears of the text, chapters were developed primarily by NorthAmerican-educated authors. Today’s world of orthodonticsis significantly expanded with great work being done globally,as is seen in the variety of locations listed by authors in ourmost prestigious journals. Tom Graber was often heard saying,“Science has no borders!” and as the initial editor of the textsought the best and the brightest to contribute, a tradition weare proud to uphold to this day. Tom was the solo editor forthe first two editions published by Saunders and was joined byBrainard Swain when C.V. Mosby became the publisher of whatwas then the first edition of the current Mosby (now Elsevier)series. Subsequently Tom, seeking a broader expertise to aid inthe development of the text, was joined in the editorial role byRobert Vanarsdall in the second edition and then KatherineVig in the third edition followed by Lee Graber and now GregHuang in this sixth edition. As the scope of the orthodonticspecialty has grown, so has the need for added editorial background and expertise.We write this text with the presumption that those using itwill have had a basic exposure to orthodontic principles provided in dental school education both within their undergraduate dental courses and from basic orthodontic texts used in theDDS/DMD curricula. The purpose of this graduate orthodonticxtextbook remains the same—to provide a compendium ofinformation from authors who are experts in specific topics thatare considered important to the education of orthodontic specialists. This was the vision of Tom Graber when he wrote thefirst edition which met with much acclaim from educators whoused it as the assigned readings for their residents. It is to theseeducators and the orthodontic residents of the past, present andfuture that we have dedicated the sixth edition.In the writing of this text, we are acutely aware of an addedneed within orthodontic education. That call is to encouragecurrent residents as well as clinicians to become part of theorthodontic specialty teaching and/or research corps for thefuture. This text demonstrates the broad scope of orthodontics, from basic science concepts to intricate clinical techniquesas well as patient management considerations. With suchbreadth, the specialty provides opportunities for motivatedindividuals to consider becoming part- or full-time educators or research scientists (or both). We can all remember theteachers we have had who made special impact on our lives.They shared their passion for their subject, the excitement overtheir research and their interest in mentoring a following generation. There is much within the chapters of this text aboutwhich to have excitement and passion—as well as providemotivation for answering still vexing problems through clinical and basic science research.What is new in the presentation of this sixth edition? Themost notable changes are in how the textbook may be used. Theadvent of computers and advances in technology for transmitting information have resulted in transforming the methodswith which we share information and teach students. Thesetechnology changes have been matched by research in education that demonstrates that there is broad variability on howindividuals learn. By the fifth edition we had started to put partof the text online. This sixth edition expands that effort and theease with which the electronic version of the text may be usedby way of the Expert Consult, a feature rich eBook format formedical and dental education. The ability to have added material online also increases the opportunity for more content asdiscussed below. Downloading sections and chapters on to yourcomputer, laptop or tablet—or even your phone—is now possible and widely used. Using Expert Consult, readers can accessand work with the text on any platform and even communicate on material with colleagues through social media. Indeed,with the inherent convenience of an electronic format, and theopportunities for editors and authors to update material without waiting for a “new edition”, the investment one makes inthe purchase of the text has the potential to last long after theprinted publication date. These considerations coupled withthe high cost of physically printing a textbook, could result inthe sixth edition being the last one offered in a printed format.What has changed in terms of content? A lot! Fully one thirdof the material in this edition is completely new. In addition,chapter authors from prior editions have been joined withco- authors to further update their own material. Improvements range from the organization of the chapters and thesubject material to the new chapter authors who have joinedus to provide the best background for orthodontists possible within the confines of a broad-based textbook. Additional
Prefaceinformation on the science that supports orthodontics, diagnostics and therapeutic interventions has been developed.New chapters on adjunctive treatments as well as management of the potential adverse sequelae from orthodonticshave been added. We also have selected several chapters fromprior editions and placed them online as “classic chapters”.These represent clinical topics that had to be incorporatedinto other chapters to maintain the already “heavy” book ina manageable size. The material in these online-only chaptersfurther expands the scope of the textbook, better matchingthe increased scope of material with which a practicing orthodontist must be knowledgeable.Finally, the chapters within the text have been reorganizedto better match the progression of subjects addressed in anorthodontic specialty residency program. Section heads providea means by which educators and residents can better identifysubject material as they move through the material. Equallyimportant, the re-organization provides the practicing clinicianwith a logical grouping of subjects that can be efficiently referenced. As editors, we hope that the challenge of presentingadded material to residents and practitioners is made easier byway of the improved organization of material within the text.PART ONEFoundations of OrthodonticsChapter 1: Craniofacial Growth and Development: Developinga Perspective. In the opening chapter of the text, authors DavidCarlson and Peter Buschang provide an up-to-date discussionof craniofacial growth and development. They review the basicanatomical and functional structures within the craniofacialcomplex, and starting with pre-natal development, describe thecomplex interrelationships influencing form and function. Indescribing the importance of the subject material, they aptlystate, “ knowledge of how the craniofacial complex developsand grows provides the foundation for understanding the etiology of the various dental and skeletal malocclusions, the best ofall possible treatment approaches, and how patients might beexpected to respond after treatment.”Chapter 2: Genetics and Orthodontics. James Hartsfield,joined in this edition by Lori Ann Morford, has further developed
Diplomate, American Board of Orthodontics Private practice Tysons Corner, Virginia Charles J. Burstone, DMD, MS, PhD† Professor, Emeritus Orthodontics University of Connecticut Health Center Farmington, Connecticut Peter H. Buschang, PhD Regents Professor & Director of Orthodontic Research Orthodontics Texas A&M University Baylor College of .
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