In recent months and years a number of our leaders have expressed an intense interest in prospective studies of the treatment of malocclusion. Obviously these investigators feel that prospective studies will prove to be of greater value than retrospective studies. The entire profession should welcome these studies and hope that they prove to be of great value. Much time and much work is involved in completing one of these studies, and those involved deserve a great deal of credit. I personally do not have strong feelings regarding such studies, but I wish them well. Retrospective studies have served us quite well, but if early studies prove to be superior, then we welcome the enhancement of treatment concepts.

So far, these studies seem to be revealing information which favors early treatment. Tulloch, Proffit and Phillips in the AJODO in 1997, stated, "Approximately 75% of children undergoing treatment with either headgear or modified bionater, experience a favorable or highly favorable reduction in skeletal reduction discrepancy." Also they state, "This response to early treatment is significantly different from the growth experienced by similar but untreated children with Class II malocclusion. When evaluating the success or failure of different approaches to growth modification, it is important to understand the variability in growth experienced by untreated patients." These authors further state, "Even though reliable indicators of the magnitude and direction of facial growth have yet to be identified, clinicians do consider not only the existing facial proportions but also anticipated horizontal and vertical growth when planning Class II correction."

My question is how do you consider the "existing facial proportions" unless you measure causative growth increments? In order to inform the younger members of our profession, "reliable indicators" were identified in 1960, and were published in complete detail in 1964 and 1965; and declared a classic in 1991 by the American Association of Orthodontists.

This has been discussed in lectures and publications in the years since 1960. Apparently the vertical and horizontal growth increments, the building blocks, are still not understood. How can we make progress unless we use what is known and build on it? To ignore what has been proven to be true, valid and useful is an indictment of our leaders in the profession.

In 1998 in an abstract of a published booklet of a Website, the Schudy Chronicles, Dr. Alex Jacobson, Birmingham, Alabama USA, expressed his views on prospective studies. He states, "Currently many orthodontic departments are conducting meaningful clinical research on patients. Theoretically it is easy to devise longitudinal randomized clinical trials designed to compare the results of two or more appliances or treatment therapies on patients with specific type malocclusions, and compare the results with those of an adequate control sample. The practical applications of such investigations, however, are significantly different. To randomly assign a group of patients for either extraction or non-extraction, surgical or non-surgical treatment for example, in order to evaluate or compare the pre, post treatment and long-term results with (or even without) serial cephalometric radiographs with those of an untreated control group, would not only be unthinkably unethical, but undeniably illegal." (This has been published with the consent of Dr. Jacobson.)

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