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  • 1. NZA O NEW ZEALAND ASSOCIATION OF ORTHODONTISTS NEWSLETTER VOL 18, NUMBER 1, MARCH 2004 www. orthodontists . org. nz President The quarterly publication NZAO Newsletter is a Dr Karen Brook 4 Knights Road,Rothesay Bay, channel of communication for members of the New North Shore City, Auckland Zealand Association of Orthodontists Incorporated. Tel: (09) 479 6263 Fax: (09) 479 6264 Although every effort is made to ensure the accuracy karen.brook@clear.net.nz of material in this publication, neither the New Vice President Zealand Association of Orthodontists Incorporated Dr Mark Beresford nor the Editorial Staff accept liability for errors or 116 Remuera Road Remuera, Auckland omissions. Opinions expressed are not necessarily Tel: (09) 520 0159 those of the New Zealand Association of Fax: (09) 524 0812 markberesford@orthodontists.co.nz Orthodontists Incorporated. Past President Dr Peter Gilbert PO Box 5217 Inside this issue Dunedin Tel: (03) 477 6372 • Presidential notes Fax: (03) 477 6569 • Editorial pg@orthotago.co.nz • Report on Evidence Based Dentistry Conference Secretary Dr Winifred Harding • Survey Report Part I P.O. Box 5544 • Report on Wellington Day Course Dunedin Tel: (03) 477 9897 • Calendar of Events Fax: (03) 477 9897 • Report on Palm Springs Conference winifred@deepsouth.co.nz • Speaker Profiles for NZAO October Meeting Treasurer Dr Judith Hey • General Notices 2 Walter MacDonald Street Howick, Auckland Tel: (09) 534 3169 Fax: (09) 534 3169 anjh@iprohome.co.nz Councillor Dr Derek Barwood PO Box 38 587, Howick Auckland Tel: (09) 535 4311 Fax:: (09) 535 4311 dbo@ake.quik.co.nz Councillor Dr Janice Somerville 5 St Marks Road Remuera, Auckland Tel: (09) 524 7628 Fax : (03) 524 7631 janice@orthodontist.net.nz Editor Dr Peter Dysart P.O. Box 5217 Dunedin Tel: (03) 477 6372 Fax (03) 477 6265 pd@orthotago.co.nz Professors Birgit Thilander (left) and Inger Kjaer in Wellington Notes for Contributors The NZAO Newsletter welcomes original articles, personal comment and news items. Text should preferably be e-mailed to the Editor at 1
  • 2. pd@orthotago.co.nz as an attachment in rich formatted text (RFT). Illustrations and photographs should also be e-mailed as attachments in jpeg format. Illustrations and photographs may alternatively be sent on diskette provided the resolution is at least 150 dpi. The Editor reserves the right of refusal, the right to edit articles so they conform to the style of the Newsletter and the right to cut to meet space restrictions. Galley proofs will be sent by prior arrangement only. Special thanks to Karen Brook, Janice Somerville, Paul Crowther, Mike Courtney and Kieran O’Neill for their contributions to this issue as well as to our advertisers. Next issue close off date 20 May 2004. PRESIDENTIAL NOTES March 2004 The New Dental Council On the 18th of December the Minister of Health appointed the following people to positions on the Council Dentists: Drs Ed Alcock, Erin Collins, Albert Kewene, Mary Livingston, Robert Love, Brent Stanley Dental Therapist: Vicki Kershaw Dental Hygienist: Robyn Watson Dental Technicians: Keith Pine, Daniel O’Sullivan Lay Members: Riria Handscomb, Victoria Hinson, John Robertson Radiography Training Programme It appears that the Medical Radiation Technologists Board will approve the Radiation Training Course and granted exemption certificates to those who pass. An administrative hiccup has delayed the issuing of exemption certificates to those who attended the Christchurch pilot course. Once those Certificates are received we will proceed with a second course in Auckland administered by Judith Hey. Courses are limited to 15 and we realise that it will be necessary to run the course several times in most main centres. Again my thanks to Peter Fowler who got this course of the ground and who has worked with the MRT Board to achieve this excellent outcome. The Survey Paul Crowther has worked hard to provide Part 1 of two Survey reports and this is published in this Newsletter. Sixty-two members responded including fifty full and provisional members, 7 retired and three student members. 25 (47%) plan to retire in the next 10 years!!! It was pleasing to note only 2 members were dissatisfied with the newsletter and 76% felt the move to an electronic publication was a good one. HPCA This year will see implementation of the HPCA with the Act to becoming operational on September 19, 2004. The amount of work that still needs to be done to have all the Registration boards up and running and registrations and scopes of practice issued by this date is huge and one wonders if it is achievable. Abbreviations which will become a part of practicing life – SOP – Scopes of Practice APC – Annual Practicing Certificate CPD – Continuing Professional Development. The NZAO will be establishing a sub-committee to set up Continuing Profession Development program for orthodontists, based on the NZDA model for general dentists which while structurally sound does not address the specific CPD needs of specialists. 2
  • 3. School Dental Therapists Mark Beresford and I attended a meeting with the NZDA Boards recently to discuss developments in the registration of School Dental Therapists. The Therapists are wanting the right to autonomous clinical practice to be included in their Scope of Practice. This would signal a dramatic change on the provision of dental care resulting in a two-tier system for the delivery of dental care. The Dental Council will send out a discussion document soon and submissions will be requested. Please note that it seems to be the number of submissions that count. A single NZAO submission representing 70 orthodontists is not nearly as influential as 70 separate submissions. There will be a very short time frame for replying with a submission but I would urge you to read the Discussion document carefully and seriously consider providing an individual written submission. Section 11 Workers The Committee has provided the Dental Hygienists Board with a discussion paper on the registration of Orthodontic Auxiliaries and I will attend their first Board meeting on April 5 to discuss our recommendations. This discussion document is available electronically form Winifred Harding at winifred@deepsouth.co.nz The restricted List still has not been published. All our discussions have had to center around the procedures the DCNZ has recommended be placed on this list. Exact wording of these procedures in the final list may make all the difference to which of our staff will need to be registered. Remember you staff will only need to be registered if they perform procedures that are on the Restricted List. We will regularly email all NZAO members as useful information comes to hand. Accident Compensation Corporation You will have all received the new ACC Dental regulations. Not one of the NZAO recommendations was incorporated into these regulations. Peter Gilbert has requested yet again clarification from Rosemary Kennedy about exactly what we claim for the Study Models that are required for prior approval and how this is coded. Marketing The two new brochures have been very well received by members and Derek Barwood still receiving new orders. A poster for distribution to School Dental Clinics is being developed promoting the message that “Orthodontists build Great Smiles”. These will be available later in the year. Conference and Continuing Education Clinical Day Professors Birgit Thilander and Inger Kjaer provided us with an excellent one-day course in Wellington on Friday March 19, 2004. This was an opportunity hear two very respected orthodontists speak on a variety of clinical and research topics and the meeting is reviewed in detail later in the Newsletter. It was great to see such a good attendance and the feedback was very positive. My personal thanks to Michael Taylor who brought the speakers to the attention of the Committee, liased with them, entertained them and organised the Wellington venue. Clinical Day 2005 Mark Savage is organising next year’s Clinical day, which will be on Friday April the 8th at the Intercontinental in Wellington. Dr Robert Little will be the speaker. Dunedin, 13 - 16 October 2004 The Conference will open with Welcome drinks, at the Art Gallery at 5pm on Wednesday October 13. The Assistants Program will run all day Thursday and Friday. Survey responses indicated there could be as many as100 staff registered!!! The Orthodontist’s programme will run all day Thursday and Friday and Saturday morning with a farewell lunch at 1pm on Saturday. Friday afternoon will be a joint session with Rosemary Bray for all orthodontists and staff. (You still attend even you have not bought your staff). 3
  • 4. Cheap airfares are currently available on the Net so you may wish to book early particularly if you are bringing staff. Accommodation details will be in the Registration brochure, which will be mailed out mid May. Registration on-line will open June 1. If you have any general queries about the meeting please contact Pat at Dunedin Conference Management Services pat@dcms.co.nz. Specific queries about the Staff program can be directed to Peter Fowler at info@braces.co.nz Queries about the orthodontists program should go to Janice Sommerville at janice@orthodontist.net.nz Communication While 91% of members were satisfied with communication from the Committee and the same percentage felt the President’s Notes provided them with sufficient knowledge of Committee issues. four people wanted to see more detailed minutes and more frequent communications from the Committee. The secretary will attempt to provide meatier minutes in the future. Past Committee meeting minutes are now available to members on the website. 26% of you indicated you would always read the minutes and another 55% thought you may do so occasionally so please log on if you want more detailed information on what your Committee is doing. Next Meeting The next meeting of the NZAO Committee will be a Teleconference meeting on Wednesday May 12 and an agenda is available from the Secretary on request one week prior to the meeting. Karen Brook 4
  • 5. EDITORIAL How should speakers be selected for our meetings? I think most would agree that we wish to avoid those whose material is flagrantly at odds with published evidence, but there is not uniform agreement on the extent to which this requirement should be taken. This issue of the Newsletter contains a very illuminating discussion of the concept of “evidence based practice” by Mike Courtney, who attended a recent international meeting devoted to this topic. His report discusses some of the objections raised by opponents of EB dentistry, but he reaches the conclusion that evidence must be regarded as the basis of future dental practice. The issue of evidence in conference presentations was recently discussed by the Committee after reviewing the survey results and other correspondence received on this matter. It would be extremely challenging to adhere to a requirement of strict evidence based content in presentations to meetings and to do so would, in the current environment, dramatically limit the options available when choosing speakers. Such a requirement would also open the issue of whether particular evidence is of sufficient merit. As Mike indicates in his report, any casual scan of orthodontic literature will reveal that journals publish research of widely variable quality, despite the earnest efforts of referees. There is no doubt that some investigations are designed and executed better than others, and even when editorial staff have the opportunity to scrutinise articles before publication a wide range of quality remains. Such ability to pre-appraise content is not available to those selecting speakers at conferences and meetings. The reputation or “track record” of the speaker assumes greater significance when material will be spoken rather than written. Accordingly it has to be expected by those attending courses and meetings that there may be some unsubstantiated or opinion-based material presented. Many may in fact see this as a useful chance to gain a more informal insight into the opinions of a speaker, often as a supplement to more rigorous written publications by that person in the literature. This is not to say that conferences should allow a “free-for-all” of unsupported content, but there should be scope for a variety of views to be represented, which members must appraise from their own perspective. The fact that evidence can at times vary to the point of being contradictory does not necessarily detract from the validity of evidence based practice. Instead, it emphasises the need to adopt an inclusive approach from a wide variety of sources and to glean the best available information from each. During the tenure of the incumbent Continuing Professional Development Subcommittee, an impressively wide variety of themes has been offered at NZAO courses and conferences. The following international speakers have presented, or will present, material: Bjorn Zachrisson (multidisciplinary treatment), Jay Bowman (extraction rationale), David Sarver (art of the smile, condylar resorption), Luc Dermaut (transplantation, critique of growth modification), Birgit Thilander and Inger Kjaer (agenesis, resorption, implants), David Hatcher (maxillofacial radiology) and Bob Little (retention). The survey results indicate that the majority of members approve of the speakers at recent NZAO meetings. As always the Committee welcomes feedback. Meanwhile it is hoped that later this year the Newsletter will present some “viewpoint” items on the issue of evidence based practice. Peter Dysart 5
  • 6. 6
  • 7. FIRST INTERNATIONAL CONFERENCE ON EVIDENCE-BASED DENTISTRY Atlanta, Georgia November 7-9, 2003 Report by Mike Courtney This conference was divided into two parts, with a pre-conference evidenced-based workshop, followed by the main two-day conference. The four sponsors were the Task Force on Design and Analysis in Dental and Oral Research, Mosby (a division of Elsvier Science), The Journal of Evidence-Based Dental Practice, and Dalhousie University The conference goals were stated to be: • Provide a venue for a highly accomplished group of international speakers to discuss a broad range of topics associated with the methods and outcomes of evidence-based initiatives and programmes. • Provide a context for, and example of, the implementation of cutting edge evidence–based methodologies, skills and research. • Critically examine some of the reasons for barriers and resistance to the evidence-based paradigm that currently prevent assimilation by many stakeholders. • Begin the process of culture change in education and clinical practice. • Enhance networking and the formation of new alliances and partnerships among interdisciplinary attendees. The target audience was listed as - • Educators • Researchers • Clinicians • Policy makers, regulators • Practice Guideline developers • Insurance company workers, benefit managers and those involved in third party organisations • Industry workers involved in product development, clinical research, and professional relations • Directors of licensing bodies, and those involved in continuing education and competency programmes I elected to go to the pre-conference day to brush up on my skills of critical analysis. The day was set up to introduce evidenced-based methods to practitioners, researchers and industry people who were unfamiliar with the concept or wished to enhance their skills in this area. Having had what I felt was an excellent grounding in EBD under Mike Harkness’ tutelage I was surprised to find that the process has developed considerably in the past ten years. The material given in the workshop was developed by Jane Forrest (Acting Chair, Division of Health Promotion, Disease Prevention, and Epidemiology at UCLA, and also an Associate Editor of the Journal of Evidence-Based Dental Practice) and Syrene Millar (Project Director National Centre for Dental Hygiene Research at UCLA). The main conference covered very diverse topics, for example 7
  • 8. • What is EBD? Is it a new name for an old process? • The tools and methods available for evidence-based practice. • What is different about systematic reviews? • The role of educators in evidence–based education at the pre and post doctoral and specialty board level. • The ethics of publishing negative studies. • The influence that evidence-based dentistry has on the courts. • Insurance and evidence-based dentistry. • Industry’s perspective of EBD. There was a full 15 minutes devoted to orthodontics with a lecture given by Bill Shaw. He questioned where our specialty stood in the race to bring us into the 21st century as an evidenced–based discipline. (Not very well, according to Shaw). He said that the specialty has been busy churning out research of fairly dubious standards, and lots of it. We have published more research than any other discipline of dentistry (about 16000 papers) and yet we have less than 10 RCTs. Shaw reminded us of that now infamous comment of Sackett’s “--- in terms of the number of published randomised trials, orthodontics was behind such treatment modalities as acupuncture, hypnosis, homeopathy and orthomolecular therapy, and on a par with scientology, dianetics, and podiatry.” Shaw drew the conclusion that it is not surprising that our profession comprises a whole range of practitioners from the lunatic fringe through to the dedicated clinician/scientist, and yet all manage to prosper. It is worth noting that Bill Shaw could be a keynote speaker for one of our own future conferences, particularly for those of us who enjoy presentations enhanced by dry wit. I didn’t get the opportunity to speak personally with him, but I understood that he has an integral involvement with the Cochran Collaboration and with the protocols of the orthodontic questions that we would all like to have answered with the best available evidence. Some people question whether Evidence-Based is merely a concept that won’t last and resist its integration into 21st century dentistry. You only have to read recent letters to the AJODO that question the relevance of EBD and vehemently oppose its introduction. Obviously people don’t like change when their cherished beliefs and methods of practice are challenged. There is also the mistaken notion that because there is very little “quality” evidence, then “anything goes”. This often invokes a cookbook approach to dentistry without reference to any form of evidence. An adherence to “best current scientific evidence” is but one part of evidence-based practice - equally important is the experience and judgement of the clinician, the clinical/patient relationship, and the patient’s values or individual preferences as to what is best for them. When I first subscribed to the Journal of Evidence-Based Dental Practice I was confused by such terms as PICO, CONSORT, QUORUM, Boolean operator, PubMed, MEDLINE, MeSH, Meta- analysis, Randomised control trials (RCTs), Systematic Review, Cochrane Collaboration, COCH, DARE, OVID and a multitude of other biostatistical terms and abbreviations. The aim of the pre- conference workshop (apart from introducing the EBD concept) was to teach a process whereby practitioners filter and appraise new knowledge from the vast array of Journals, and apply what is best current evidence to make the best decisions about individual patient care. This is called the Evidence-Based Decision Making Process or EBDM process - 1. It is based upon the ability to define a patient-centred question, or PICO, i.e., (P) problem or patient question, (I) intervention, (C) comparison or control, (O) outcome. 2. Where is the evidence found? • Utilising already filtered sources i.e., Systematic reviews eg the Cochrane database (COCH), Evidence-Based journals, online Journals, Clinical Practice guidelines etc. • Utilising unfiltered sources i.e., you conduct your own search of primary studies (unfiltered) utilising Biomedical databases such as MEDLINE (PubMed). 3. How is the evidence found? - you use PICO to guide your search. Your PICO question provides the key elements for searching using PubMed. (For the majority of us who are totally lost by this stage there is a tutorial of how to conduct a search on the PubMed home page.) 8
  • 9. 4. Critically appraise the evidence for its validity and applicability, then correctly apply the evidence to decisions about patient care, and finally to evaluate your performance of the process. • This is where that word CONSORT comes into the picture-CONSORT or the CONSORT STATEMENT (Consolidated Standards of Reporting Trials 2001) - was developed by an international group of scientists and editors to improve the quality of reporting of RCTs. • The CONSORT objective is to facilitate critical appraisal and interpretation of RCTs i.e., it is an important research tool. (This can be viewed on www.consortstatement.org). • The CONSORT checklist has 22 items to aid in critiquing a research article. • The Journals that have adopted or are considering adopting the consort statement at this time are the British Dental Journal, British Journal Of Orthodontics and Journal of Orthodontics. • Finally the QUORUM Statement and Systematic Reviews. • The QUORUM Statement– (Quality of Reporting Meta-analysis) addresses standards for improving the quality of reporting meta-analyses of RCTs. • It was developed by an international group of epidemiologists, clinicians, statisticians, editors and researchers. • It comprises a checklist of 18 items. • It can be viewed at www.consort-statement/quorum.pdf Why is this process necessary? - It can simply be summed up by “garbage in equals garbage out.” If the research is flawed and included in a meta analysis then the flawed results are reflected in the conclusions of the systematic review. The Systematic Review sits at the top of the hierarchy of evidence and is considered the gold standard. It is a scientific process that collates information, under the strict guidelines of the QUORUM Statement from a number of RCTs or other well controlled studies which are investigating the same question. How are they used? – Systematic reviews along with clinician input and feedback are used to develop clinical practice guidelines, and when properly developed and disseminated they have the potential to translate research findings into practice. These guidelines from a systematic review, must be evidence-based and are seen as a clinical tool to enhance rather than dictate practice. Visit www.cccd.ca which is the Canadian Collaboration on Clinical Practice Guidelines. It is an excellent site that is linked to a number of Evidence-Based sites, including the NZ Guidelines Group promoting Health and Disability Services at www.nzgg.org.nz. (There is no information about clinical guidelines for Dentistry in New Zealand, and it is particularly disturbing to see a link to alternative medicine in the “Evidence for Consumers’’ Menu). Where are Systematic Reviews found? - The Cochrane Collaboration at www.cochrane.org/ or the Centre for review and dissemination databases www.nhscrd.york.ac.uk/welcome.htm. I believe EBD is a fundamental premise of modern dental practice and that it will become universally accepted as such over time. The process is well established in the USA and Canada, and at the conference seventeen countries were represented among the delegates (two from New Zealand - one Orthodontist and one Restorative Specialist, neither were representatives of NZDA or the School of Dentistry). All the key EBD players were represented amongst the speakers and delegates (as outlined in the target audience). The ADA has taken a leadership role in EBD by promoting and integrating it. Some of the Dental schools in the USA have fully integrated EBD into their curricula and seen fit to give it precedence by creating chairs in EBD. Ralph Katz runs a successful EBD program at NYU for undergraduates. The course is a core subject, and a 4 year model for building EBD skills. There are EBD exams, and the topic is integrated into all the clinical courses with EBD being one of the 32 competencies that comprise the NYU dental degree. Katz freely admits that it works because all the lecturing staff support it, and they are fortunate to have a Dean with the vision and drive to make it happen. The role of the educators at undergraduate level at the University of Otago School of dentistry is beyond the scope of this article, as I have no knowledge if EBDM is integrated into the under- 9
  • 10. graduate course. The NZDA appears to have embraced the concept (Karl Lyons has produced a link page for EBD on the NZDA website) and it is to be hoped that NZDA now goes out and actively sells the concept via workshops and conferences. Website information is merely a first step that will reach only the converted few. Derek Richards, (Editor of Evidence-Based Dentistry), and Deborah Matthews, (Chair of Evidence-Based Dentistry Programme at Dalhousie University, Halifax, Canada), were flying to Brazil as soon as the conference ended to carry out further workshops. What about us? I believe that if the profession is tardy or unwilling to embrace EBD it will be forced to do so by third parties. The general public are now becoming better informed and are able to access information readily and are also becoming better at evaluating research. There are consumer links to the major EBD sites on the Internet that publish practice guidelines. The EBDM process identifies effective procedures that are invariably cost effective. Insurers have a bottom line - viz. How much does a procedure cost? A single evidence based treatment procedure is less costly than the extensive treatment variations that occur when there is an absence of diagnostic information. Insurance companies, including ACC, will therefore insist on EBD procedures in due course. (Read ACC Review: Evidence-Based Medicine (EBM) Issue 5 November 2003) Having attended the pre-conference workshop I believe these skills should be part of the armamentarium for all NZAO members. It would make our ERDG symposiums more effective. I can remember asking the Question at the final wrap-up in Napier –“Is this as good as it gets? Are these papers the best there are?” After all, the symposium topic was merely a PICO question, but did the best papers surface? We would have known this if we had carried out the structured search of the biomedical databases I described earlier. Perhaps the ERDG committee or future Conference committees could look at inviting people such as Derek Richards, Deborah Matthews Jane Forrest, Syrene Miller and Pam Overton to run a workshop for NZAO. Complement that with the wit, charm and intelligence of a Bill Shaw and we have the makings of an inspiring conference that will encourage us at the very least to contemplate change. A recent Turpin AJODO editorial offered an appropriate summary - “Simply stated, the purpose of using an evidence-based approach in clinical care is to close the gap between what is known and what is practised and to improve patient care based upon informed decision making.” Finally, for those that are interested in this topic, it is worth noting that the EBD Conference is to become a biennial event. My overall rating of the conference was excellent, and I would strongly encourage NZAO members to consider attending the next conference as part of their own professional development. NZAO SURVEY REPORT By Paul Crowther This report is a summary of the numerical data collated from responses to the NZAO Survey of members November 2003. The survey consisted of seventy-four questions on topics of interest to the membership. Considerable provision was made within the survey for comment on the topics. A summary of the collated comments will be provided later in a separate document. A total of ninety surveys were sent out, including two overseas. Sixty-two replies were received. Demographic Respondents were Female 12 (19%) Male 49 (79%) 10
  • 11. Unspecified 1 (2%) NZAO Membership 50 full/provisional NZAO members 7 retired members 3 student members 1 overseas Respondents practices were located in the; Northern North Island 20 (32%) Central North Island 16 (26%) Southern North Island 3 (5%) South Island 16 (26%) Overseas 1 (2%) The respondents had worked in specialist practice for 1-5 years 5 (8%) 6-15 years 17 (27%) 16-25 years 17 (27%) 26-30 years 12 (19%) Over 30 years 8 (13%) With 3 yet to graduate and begin practice, the respondents were planning to retire within the next 5 years 9 (14%) within the next 10 years 16 (26%) later 30 (48%) already retired 7 (11%) NZAO Newsletter Are you satisfied with the content and emphasis of the newsletter? Yes 93% No 3% Is there too much emphasis on any aspect? No 89% How about the amount of research/science material in the newsletter? Enough 74% Not enough 18% Are you in favour of the change to electronic publication? Yes 76% No 23% Did you have any difficulties with the new format? Yes 10% No 81% The advertising in the electronic newsletter is Appropriate 37% Satisfactory 43% Inappropriate 2% I am happy to contribute material for the newsletter in its current form. Yes 73% No 23% Website 11
  • 12. All except one respondent had an email address. 39% regularly use the NZAO website, 60% do not. Reasons why not: no need (9 comments), no time (6 comments), forget/hassle/not interested (6 comments), forget password (2 comments), no computer (1 comment), no use (2 comments). 47% visit the website rarely, 21% visit the website monthly, 17% visit the website every few weeks, 6% visit the website weekly, 5% visit the website every few days. 65% would prefer an emailed out NZAO newsletter 22% would rather access the newsletter via the website. 18% would prefer a printed newsletter to be mailed out. 59% would like to have NZAO minutes placed on the website. 39% would not. 31% would like more Members material on the website, 56% would not. 40% would like more Public information on the website, 39% would not. Ratio of Members/ Public information desired on the website. Of the 37 replies 28 favoured ratios between 60/40 and 40/60. Communication Regarding information received about issues being dealt with by the NZAO committee. 31% are very satisfied, 60% are satisfied, and 6% are not satisfied. Those who are not satisfied would like; more communication, more frequent updates from the committee with more detail on arguments in the minutes. 91% feel that the Presidents Notes in the newsletter provide sufficient knowledge of committee issues. 5% did not. If Committee Minutes were placed on the website, they would be read; Occasionally by 55%, always by 26% and never by 16% of respondents. Marketing 61% would be happy for the marketing committee to spend money on articles in high profile magazines. (Some of the Yes responses had appended conditions such as “if sponsored” and “if members approved”) The top 7 suggested topics for articles were; Adult ortho, ‘branding’ of specialist orthodontics, extraction vs non-extraction, functional appliance vs conventional orthodontics, examples of treated cases, the range of treatments available and the futility of early treatment. 66% did not have brochures or articles that could be adapted or endorsed for NZAO use. 21% did 69% would make use of NZAO PowerPoint presentations. 21% would not. 24% had PowerPoint presentations, which could be used by NZAO. Conferences, Courses and Education Optimal length of the NZAO conference 42% preferred 2 days 44% preferred 3 days 13% preferred a variable 2-4 days Several commented that the conference length should vary in length from year to year. Conference Format 55% preferred two full conference days 35% preferred three or four days of conference including scheduled recreation time. 12
  • 13. Several appended comments suggested alternating formats from year to year. Childcare was an issue for some regarding the longer format. Conference Speakers A combination of overseas and local speakers received the largest number of first preferences (39). North American (17) and then European (16) speakers were the next favoured. Australian speakers were the first preference of 11 respondents. Local speakers were no ones first preference. Quality of Speakers The quality of speakers heard at NZAO meetings over the last two years was rated as; Very Good Value 24% Good Value 37% Satisfactory 21% Poor or Very Poor Value 7% Frequency of One-Day Clinical Meetings 11% prefer one meeting every second year 66% prefer one meeting per year 10% prefer two meetings per year Preferred One--Day Meeting Speakers 3% prefer academic speakers 35% prefer clinical speakers 56% prefer a balance of academic/clinical speakers Posters 21% would consider presenting a poster at the 2004 Dunedin Meeting 69% would not 69% would take time to read conference poster presentations 26% possibly would Should the NZAO continue to use commercially sponsored speakers? 95% agreed that we should (14 of the 62 respondents agreed conditionally) 3% were opposed Orthodontic Assistants Course Total number of staff employed (by 51 respondents) 204 (average 4) Total number of orthodontic auxiliaries employed 72 (average 1.4) of these auxiliaries 49 are ex SDTs (68%) 82% (34) plan to bring staff to the staff course at the Dunedin NZAO meeting 9% (5) may bring staff 23% (12) will not bring staff 100 staff in total from these orthodontists may attend the 2004 Dunedin meeting. The most popular reason for not bringing staff was “too close to the last course”. Two respondents thought that courses were too expensive and four thought they were of no benefit. Preferred Topics for Staff Courses Sterilisation and Cross Infection 76% 13
  • 14. Products and Equipment Clinical Photography all 57% Telephone Skills ACC Stress Management Debt Collection all 27% Building Relationships with GDPs Would you be interested in enrolling your staff in a course to gain a formal qualification? Yes 71% No 25% Not Sure 4% Training formats preferred; A. Distance teaching 23% B. Course in conjunction with NZAO conference 18% C. Separate regional courses 22% A+B+C 8% A+C 12% B+C 6% A+B 2% How many staff would you have wishing to participate in training courses? No. of respondents No. of staff 11 1 10 2 8 3 4 4 3 5 1 6 1 8 3 0 Total no. of staff 100 Average per respondent 2.4 How frequently should these courses be run? six monthly 8% annually 47% biennially 35% Would you consider sending your staff to a Radiographic training course at the Dunedin NZAO meeting? Yes 73% No 27% How many of your staff would need to take this course? No. of respondents No. of staff 11 1 12 2 5 3 4 4 14
  • 15. 1 5 1 7 3 0 Total no. of staff 78 Average per respondent 2.1 Do you feel that you would also benefit from a radiography refresher course? Yes 57% No 39% Finances Should the NZAO continue to contribute funds towards orthodontic graduate students registering for courses/conferences in NZ? Yes 90% No 6% Should grad. students pay any registration fee at all for orthodontic courses/conferences in NZ? Yes 61% No 32% If yes, what percentage? 25% or less (20 respondents) 26%-50% (14 respondents) 100% (2 respondents) Social functions only (5 respondents) NZDA Membership How well do you feel NZDA represents your interests? Very well 11% Well 19% Adequately 27% Poorly 26% Very poorly 10% How well do you feel that NZDA represents the interests of orthodontists in general? Very well 11% Well 11% Adequately 24% Poorly 31% Very poorly 18% Should NZDA membership remain a requirement of fullNZAO membership? Yes 58% No 32% Ambivalent 3% Competency Assessment Programme Status regarding the programme; Already registered 14 (23%) Planning to register in next 12 months 11 (18%) Will register some time later than 12 months 20 (32%) Not planning to register 12 (19%) How good do you feel the programme is? Very good 11% Good 19% Satisfactory 39% Poor 6% 15
  • 16. Unsatisfactory 10% Mentoring Should the NZAO have a formal mentoring programme? Yes, for recent ortho grads 24% Yes, for orthos new to NZ 5% Both the above 45% No 18% How should the mentoring programme be structured? Study group 24% Senior ortho as advisor 27% Both the above 26% Other 2% Should the mentoring programme be Voluntary 45% Mandatory 35% Are you prepared to take an active role as a mentor? Yes 55% No 31% 16
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  • 18. NZAO CLINICAL MEETING 19 March 2004 Report by Kieran O’Neill More than 30 NZAO members, postgraduate students and others were privileged to listen to sage clinical advice with sound science backing from two leading European Orthodontists at Wellington on 19 March 2004. Professors Inger Kjaer and Birgit Thilander were invited to New Zealand by Dr Mike Taylor and those present at the Intercontinental Hotel were no doubt very pleased both women took up Dr Taylor’s invitation. Prof Kjaer, an academic contemporary of Arne Bjork and Beni Solow, and Chair of the Orthodontic Department, School of Dentistry, University of Copenhagen, in Denmark, opened the day and spoke about tooth agenesis, normal and pathological tooth eruption, and tooth resorption from an embryological perspective. Surface ectoderm, neural ectoderm and mesoderm all influence the developing tooth germ and depending on the timing and what embryological tissue is affected, varying teeth ageneses and/or eruption problems result. Prof Kjaer brought up the 3 developmental fields concept, with third molars, second premolars and lateral incisors all at the end of the respective branches of the three neural branches that innervate them. If the neural innervation of the developing tooth germ fails to eventuate then the tooth does not develop. Genetics also plays its part, with 10 different genes connected to tooth development; the Pax 9 gene, for example, being implicated in molar agenesis. Other factors can cause neural innervation disturbances, such as the mumps virus that attacks the surrounding myelin sheath, stopping or disrupting tooth development and eruption. Tooth ankylosis was also commented upon by Prof Kjaer who believes it is a consequence of resorption, possibly following a trauma and bleeding, then some repair of the resorption that does not include a periodontal ligament. She stated that 25% of patients who have ectopic/impacted permanent first molars also get ectopic upper permanent canines that may resorb the adjacent incisors (so keep an eye on those young patients you place separating elastics in to dis-impact the first molars). Additionally, 60% of orthodontically treated cases that had teeth with greater than 1/3 of their roots resorbed, had problems with abnormal primary teeth root resorption. Indeed, she believes most root resorption associated with orthodontic treatment was due to the predisposition of the patient. Three or more signs such as deviations in roots, short, “clumpy”, or tapering roots (particularly of permanent second molars), should alert the clinician and they should tell the parent/patient they have a higher risk of resorption. Professor Birgit Thilander, from the Faculty of Odontology, School of Dentistry, Goteborg University, in Sweden, in between Prof Kjaers lectures, discussed the clinical implications of the timing in placing titanium implants, plus possible autotransplantation, orthodontic space closure or prosthodontic replacement when tooth agenesis occurs. She spent several months studying implants in piglets, all in the name of science, to convince Prof Branemark, a University contemporary, that continued facial and general body growth is not the best thing after placing titanium implants. Some other clinical cases (of humans this time, not pigs) were refreshingly less than perfect, but were deliberately presented to show how poor decision-making regarding implant placement and the age of the patient results in infra-occlusion of the superstructure years later. Her criteria for the timing of the implant placement included all the usual suspects such as completion of skeletal development and general body growth, however she stressed a fixed chronological age is no guarantee for a successful result. One case, aged 34 when implants were placed, had infra-occlusion of the superstructure years later. She believed patients need the expectation to replace the superstructure at least once during their life. She emphasised the requirement for a multi-disciplinary/team approach 18
  • 19. and to have confidence in each other. If the anatomical crown/superstructure is not accurate, plaque accumulation and microbial infection can occur, leading to marginal bone loss. One interesting comment Prof Thilander made concerned unilateral lateral incisor agenesis and orthodontic space closure. In these cases she also extracts the normally opposing lower lateral incisor to get canine-canine occlusion on the affected side. Prof Thilander completed the day by discussing long term changes associated with orthodontic treatment. After covering aspects of relapse, including some of the bony changes which occur following treatment, she described her study of a mixed longitudinal sample of Swedish Caucasians. All the subjects had “ideal” occlusions and some were followed from the age of 5 to 30 years, allowing assessment to be made of skeletal, soft tissue and dental relationships well into adulthood. Prof Thilander concluded that much orthodontic treatment is a “battle against nature”. In conclusion thanks must go to Dr Mike Taylor who organised all the details of the meeting in Wellington and did a superb job, and to Ormco who sponsored the meeting and so helped defray some of the costs. CALENDAR OF EVENTS The list below includes NZAO events and also those of other Associations and Societies that have officially notified NZAO of conferences and meetings. For a far more comprehensive database of international orthodontic events visit the WFO website at www.wfo.org 2004 9-14 June European Orthodontic Society Congress, Aarhus, Denmark. 8-13 Aug Xth International Symposium on Dentofacial Development and Function. Bahia, Brazil. 14-16 Oct NZAO Conference, Dunedin. 15-19 Oct Royal Australasian College of Dental Surgeons 17th Convocation. Alice Springs, NT, Australia. 2005 31 March – 2 April APOS Meeting, Beijing, CHINA 8 April Robert Little One Day Course, Wellington July/August NZAO ERDG Symposium, Tauranga ADVANCES IN ORTHODONTICS & DENTOFACIAL SURGERY Meeting Report by Janice Somerville A Report on the three-day ‘Advances in orthodontics and Dentofacial Surgery’ scientific symposium, sponsored by the American Association of Orthodontists (AAO) and the American Association of Oral and Maxillofacial Surgeons (AAOMS), held in Palm Springs, California February 6-8, 2004. 19
  • 20. Heather Keall and I, together with Lance West (OMS) attended this meeting in the golf mecca of Palm Springs (without our clubs….). About 550 orthodontists and 250 Oral Surgeons were present and most of the presentations were by a ‘team’ of Orthodontist and Surgeon. The roster of speakers included many of the prominent speakers from the international circuit and the range of combined topics was wide and varied… a brilliant combination that kept us in the lecture hall the entire program! The speakers weren’t however without controversy. The Seattle team (Joondeph and Bloomquist) spoke twice, once on mandibular midline osteotomy for constriction, the other on openbite closure with mandibular osteotomy alone. The procedures advocated were to be used instead of maxillary surgery (which they did not favour)… a stance not supported by any of the other groups presenting. Grubb & Smith (Cailfornia) spoke on distraction osteogenesis, showing successful width and space gain in the lower anterior region to enable treating lower crowding non extraction..(I was tempted till I got home and thought about it!) Kokich (Seattle) spoke twice, first on the timing of exposure of impacted canines (he favoured exposing then waiting in many instances) and then on single tooth implants (Lance was heard to mutter he was surprised to have learnt so much about implant placement from an orthodontist!). Zachrisson and Haanes (Norway) presented on autotransplantation for missing anterior teeth (it seems it is not favoured in the US for potential litigation reasons), and later on the aesthetics of replacing missing anterior teeth with implants, extruding teeth to gain bone prior to extractions etc. Arnett and McLaughlin (California) presented on planning for surgery, dental and facial, while Sinclair and Kohn (California) gave a fascinating talk on ‘interesting cases from St Elsewhere’…the lessons learnt and traps not to fall into. Sarver and Rousso (Alabama) gave a presentation firstly on what you can do ENT/Plastic surgically to improve aesthetics if orthognathic surgery is not an option and a second talk on adjunctive facial plastic surgical procedures at the same time as orthognathic surgery. The last presentation provoking much discussion (when is enough too much..?) however it was probably one of the most thought provoking for me as it brought to mind several patients for whom an added procedure may well have enhanced the final aesthetics considerably. Bailey (North Carolina) reviewed their research into surgical stability, Roberts (Indiana) and Engen (Spokane) discussed using implants for anchorage, while Hatcher and Mah (California) ended the meeting with a glimpse of the future and three dimensional craniofacial imaging (you really can see if those roots have been expanded out of bone…..) The combination of excellent speakers and a variety of topics (within the combined framework) ensured attention–holding lectures, the meeting size was manageable (we all stayed in one large hotel), the lunches were pleasant under umbrellas outside in the desert sun, and the trades sufficient to add diversion to the breaks. This combined meeting was last held four years ago and may not be held again for five years, however we thoroughly enjoyed and recommend it, especially if you have the opportunity to attend with your surgeon and discuss interesting points as they arise. Lastly, it was refreshing to note that at this highest calibre international meeting, the speakers roster included the keynote speakers from this years and the previous two NZAO meetings. SPEAKER PROFILES FOR NZAO MEETING IN DUNEDIN OCTOBER 2004 20
  • 21. The following items introduce two of the main speakers at this year’s NZAO conference. A profile of the other main contributor, Dr Bergstrand, will appear in the June issue David C. Hatcher David C. Hatcher, D.D.S., M.Sc., M.R.C.D.(c) received his D.D.S. degree from the University of Washington in 1973. Subsequently he completed two years active duty in the U.S. Public Health Service and a one year general practice residency program at the University of Vermont Medical Center. Following three years as an instructor and one year as acting director of the general practice residency and the hospital dental clinical at the University of Washington, Dr. Hatcher entered the graduate program in radiology at the University of Toronto and was granted a specialty degree in Oral and Maxillofacial Radiology in 1982 and an M.Sc. in 1983. His thesis topic dealt with radiology of mandibular dysfunction. Dr. Hatcher was an Associate Professor and Chairman of the Division of Radiology for five years at the University of Alberta, Canada. He was also Director of the Temporomandibular Joint Investigation Unit and Clinic while at the University of Alberta. Presently Dr. Hatcher is in private practice in Sacramento and Carmichael, California and has faculty appointments at both the University of California San Francisco and the University of Pacific Dental Schools. He has published many articles and lectured extensively to medical and dental organizations in the United States and Canada. Presentation Title - Clinical Applications of Digital and 3D Imaging Brief Abstract Current and New Technology: Orthodontics has always relied on imaging and the associated technology to assist with diagnosis, communication, treatment planning, treatment simulation, treatment and evaluation of treatment outcomes. The recent introduction of the NewTom 9000 Volume Scanner (digital imaging technology) into dentistry has opened the door for advancements that will benefit orthodontic practitioners and their patients. This presentation will introduce new multidimensional imaging technology that can benefit the practicing orthodontist in routine and atypical cases. PROBLEM SOLVING: A portion of this course will be dedicated applied imaging (diagnosis of clinical cases). 3D IMAGING: A discussion of 3D imaging applied to the study of asymmetrical jaws, impacted teeth, facial growth, occlusion, root alignment, airway and TMD. Learning Objectives 1. Participants will be able to design and implement an imaging strategy for solving many types of clinical problems 2. Participants will be able to apply a problem solving diagnostic strategy for cases dealing with TMD and Orofacial pain, Implants, mandibular asymmetries and pathology involving the maxillofacial regions. 3. Participants will be able evaluate various imaging modalities including panoramic, tomographic, CT and MRI projections. 4. Participants will be able to discuss future technology. Gerald Samson 21
  • 22. The Retraction Reaction Just a Moment! Forces, Moments, Couples Moments of Forces, Moments of Couples Equilibrium A Simple minded Approach to Complicated Concepts For this seminar, our attention will focus on a simplified approach to understanding applied clinical orthodontic physical science: moments, forces, couples, moments of forces, moments of couples and their equilibrium. Clinical highlights will include simplified and super efficient incisor retraction techniques. Dr Gerald Samson, DDS, is a Diplomat of the American Board of orthodontics (ABO) and a Fellow of the American College of Dentists (FACD). Dr Samson has been a featured speaker for numerous regional, national and international meetings including the annual sessions of the American Association of Orthodontists (AAO). He was co-principal investigator in studying the Psychological Aspects of Orthodontic Patient Compliance, funded by the NIH. Since 1981 he has been in the fulltime private practice of orthodontics and dentofacial orthopedics in Marietta, Georgia. Because of his special interest in the clinical modification of dentofacial development, Dr Samson’s private practice is essentially limited to ‘growing’ patients. 22
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  • 24. GENERAL NOTICES PRACTICE FOR SALE Part-time established practice Situated SE Qld, 1hr north of Brisbane; 45 mins to beaches. Enjoy a relaxed lifestyle, ideal family environment. Potential for growth. Phone: (07) 54460158 AH NZAO BROCHURES Members are reminded that further stocks of both NZAO brochures (“Your Questions Answered” and “What You Need to Know”) are available for order from Derek Barwood. An electronic order form will soon be provided. ORTHODONTIC PRACTICE WANTED I am looking for an established orthodontic practice to purchase, or partnership arrangement, preferably in the Auckland region. I am a kiwi and have spent the last ten years in the UK where I specialised in orthodontics. I now wish to escape the London crowds, traffic jams and cold weather and gain a more relaxed New Zealand lifestyle. Please email susan at susancarpenter67@hotmail.com Susan Carpenter NOTICE OF ONE DAY COURSE Advance notice is given of a one day course by Dr Robert Little to be held at the Hotel Intercontinental in Wellington on Friday 8 April 2005. Dr. Little has been a member of the faculty at University of Washington since 1972. Dr. Little serves as Professor of Orthodontics teaching half time in the graduate orthodontic program at the University of Washington. His research has focused on the evaluation of long-term treatment results. Dr. Little has published numerous articles and chapters on this subject and has lectured extensively to national and international audiences. The course outline is Stability and Relapse of Orthodontic Treatment Untreated normal occlusions Untreated malocclusions Excess arch length cases Adequate arch length cases Inadequate arch length cases Extraction strategies Non-extraction strategies Arch enlargement or “development” Arch form, overbite, and third molars Growth considerations Retention strategies Mixed dentition treatment stability Quality of treatment vs. stability Clinical recommendations THE SOUTHERN DOCTOR LTD New Zealand’s new forum for dental recruitment advertising www.nzdentist.com 24
  • 25. A dental practice relies on the presence of several professional groups to allow it to function. The timely recruitment of full time and locum staff is necessary to allow your members to treat their patients. The New Zealand based website www.nzdentists.com provides a professionally designed and managed marketplace for the NZ dental community to source dental practice staff, and sell equipment and premises. This is a genuine, independent venture; we are not a recruitment agency or equipment supply company. Our enquiries amongst dentists and allied dental health staff have shown concerns regarding: • Decreasing practice values • Lost sessions due to lack of staff • Increasing difficulty finding locum and permanent staff We believe that the free advertising generously provided by the NZDA, and some equipment vendors, is insufficient to allow the development of a mature, buoyant market in NZ for dental job and practice opportunities. Therefore www.nzdentists.com offers a full-featured service allowing full length adverts with inclusion of logos, photographs and hyperlinks. The site has a sophisticated search function and also allows registration for “Job Alert” e-mails. The cost per position/practice advertised is $95 plus GST, which keeps the advert active for two months. Richard French Director ORTHODONTIST SEEKS WORK Please note that this correspondent is making preliminary enquiries only at this stage and is yet to gain registration in NZ I recently retired after 30 years of orthodontic practice. It is my intention to continue in orthodontics on an occasional basis, working for the Indian Health Service on reservations here in the States. I would also be very interested in securing a temporary position with an orthodontic practice in your country. A good friend of mine, who is a retired pediatrician, travels to New Zealand periodically to work on a locum tenens basis doing pediatrics. Please contact: Peter J. Abell, DMD, MsD 321 Hillwinds Road Brattleboro, Vermont 05301 USA abellvt@adelphia.net CHANGE OF ADDRESS Mike Courtney and Trevor Leigh New Premises from 1 March 2004 499 Church Street Palmerston North Phone and fax unchanged typingnz 25
  • 26. Professional offsite medical typing service The world is a rapidly changing environment.Businesses everywhereare constantlyseeking ways of doing it better,fasterand cheaper It's . becoming a world of specialists. Outsourcing is becominga smart way of doing business. We believe it makes sense for businesses to outsource their typing work in particular because secretaries are now more than just typists and their skills are better utilised to focus on core business. Don’t take our word for it: "By switching to digital dictation we can now enjoy typingnz's same-day typing service. Dictation sent electronically in the morning can be typed during the day and returned to us the same afternoon. We can make any changes to the document at our end before printing out, and no longer are we dependent on couriers and a minimum 48-hour turnaround. We receive a high quality off-site word-processing service at a fraction of the cost of hiring in-house staff." KarenJ Brook, Orthodontist, Auckland, New Zealand (We can also put you in touch with other orthodontists and dental industryspecialists currently using our service). *** allow us to demonstrate our capabilities To we offer all NZAOmembers theirfirst 2 hours of typing at no charge *** You can read all about us on our website: www.typingnz.co.nz. Or call Kimon (07) 579- 2388. 26