By Marc Ackerman

Lower incisors have to be positioned upright over basal bone and you must measure this on a lateral cephalometic radiograph before and after treatment. If you don’t finish your cases like this, they’ll be unstable, and you’ll definitely fail the American Board of Orthodontics exam!

Haven’t we all heard this before? I bet some of you got shipped off to Tucson during residency just to make sure you never forget it. This month in the AJODO, the lead editorial is written by the ABO and discusses the most common reasons why candidates fail the board exam. Sure enough, excessive proclination of lower incisors is high on the list.

What is the basis for this central tenet of “good” orthodontics? It was a simple theory of geometry that was advanced by Charles Tweed nearly 75 years ago. Why are we still adhering to this mythology? Exceptional defensive play by academia.

That’s right, academia!

The role of the academic is much like that of a judge. Hear the facts, remain neutral and offer an opinion. Whenever there is an idea or theory put forth in a discipline, the onus of proof is on the believer and not the skeptic. The academic is supposed to test the theory and regardless of the outcome, report on what they found. Well, that’s the way it’s supposed to work.

In reality, we all know that it doesn’t work that way. It is because of what I would call “non-profit” bias. In this paradigm, the rigors of testing are determined by who presented the theory. If the ABO says it, it must be true and a strong defense comes on to the field. If an orthodontic manufacturer says it, it must be false and the offense comes on to the field. The non-profit must always win in the mind of the academic. Unless the for-profit is funding their slush fund!

Now I’m not arguing that for-profits don’t make their share of false claims. What I am saying is that there is no difference between anyone presenting a theory/rule/concept when it can’t be substantiated by material fact. In my short time in full time academia (3 years), I got a sense that most of my peers were excellent defensive players and there were few standouts on the offense. Any person with a new idea that challenged the status quo in orthodontics was usually cut in tryouts.

I’m a clinician and I suspect that the near decade that I spent in private practice before teaching put me at a tremendous disadvantage in academia. Clinical experience is apparently not a requirement for teaching as evidenced by the large amount of brand new graduates populating the orthodontic faculty today.

I left academia because I wanted to be more academic. In the near decade of full time practice after teaching, I have come to realize that all of us in full-time clinical practice are running elegant prospective studies that are self-funded. The only bias that cripples some colleagues is their inability to acknowledge success and failure.

Success in our specialty requires a delicate balance between offense and defense. Give me an O, Give me an R, Give me a T…

3 thoughts on “Playing Offense or Defense?

  1. Right on point. I wonder if 4B years of evolution favored the “ideal” Tweed value for IMPA. Probably not.

  2. Good job! Keep lowering the standards so the rest of us can breathe easy….teeth don’t need bone. If they are proclined, the lips will support them.

  3. Thanks for proving the point of the article. Well done sir!

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