Teaching the Graduate Orthodontic Student
My experience in teaching in any level of education is extremely limited. It is at great risk of being ridiculed by my colleagues that I have the audacity to presume to know anything about teaching! Please bear in mind that the prime essential in teaching is to know something important to teach. The teacher who has a deep understanding of his or her subject will always find a way to impart this knowledge to students.
A few years ago there was an incidence of a practicing orthodontist who wished to go into teaching. He went back to school and earned a Ph.D. degree in methods of teaching. To his great disappointment he found that he did not know anything to teach. He lasted about one year as the head of a graduate department and then went back to private practice.
My only experience at teaching, other than lectures, was that I trained three orthodontists in a preceptor program – Dr. Clarence Hertsler of Port Arthur, Texas, Dr. Robert Natoli of Houston, Texas, and Dr. Thomas Creekmore of Houston, Texas. The last two doctors, Natoli and Creekmore, each wrote a thesis to fulfill the requirements of their training. Each discovered important new concepts regarding the treatment of malocclusion.
When graduate training reaches the point of beginning to measure anatomical relationships, the very first measurements are growth increments. The first increment is from the gonion angle to sella horizontal perpendicular to Frankfort. This measurement represents the effective vertical condylar growth. The next measurement is the horizontal condylar growth. This usually is posterior horizontal condylar growth, but it may be anterior horizontal condylar growth.
The next step is to measure the vertical growth of the upper first molar teeth from sella horizontal to the occlusal plane perpendicular to Frankfort, at the site of the distal of the molar. The vertical growth of the lower first molars is measured perpendicular to the occlusal plane, from the occlusal plane to the mandibular plane.
A thorough knowledge of the relationship of these increments will enable us to predict all movements of the mandible – all sagittal movements, all vertical movements of the chin, all rotations of the mandible, as well as the translation of the mandible. By measuring all vertical growth from sella horizontal and all horizontal growth from the great divide we have a valid basis for measuring the entire craniofacial complex.
When we first start by measuring the downward movement of the palatal plane, the occlusal plane and the mandibular plane and by measuring the forward and vertical movement of all points on the hard and soft tissue profiles, we have no idea of why the face changes as it does. If we never measure anything but the effects of growth increments we will never understand how the face grows.
At the university level it is usually customary to first start by measuring the downward movement of the palatal plane, the occlusal plane and the mandibular plane, as well as the tipping of these planes. Then the next step is to note the A-P and vertical changes of all points on the hard and soft tissue profiles. But such a method of study will never teach the “WHYs” of growth.
A thorough knowledge of growth increments and their interrelationship will tell us (1) why the horizontal lines move downward, (2) why they tip forward and backward, (3) why they move downward remaining parallel to their origin inclination, (4) why the chin moves forward, (5) why the chin moves downward and backward, (6) why the chin fails to move downward, and (7) why the mandible translates forward. We cannot know these things without measuring increments.
The students of twenty-five years ago are now the professors – heads of Orthodontic Departments. They can only teach what they have learned. If they only learn from the effects of growth increments instead of growth increments, then their knowledge is quite limited. Therefore the entire system of education is lacking. The only solution is to start by first measuring increments. When we have built a good foundation, we can then build a good building.
It is my deeply studied opinion that most students start by only studying the effects of growth, and never learn the “WHYs” pertaining to how malocclusions are produced. When they complete treatment they do not understand why the jaws and teeth react as they do. If I am incorrect I would apreciate being corrected. The only way to understand the growth of the jaws is to start by first measuring growth increments.
It could be pointed out that a rather large number of orthodontists who graduated in the early and middle sixties have had outstanding careers, who never measured growth increments, who are now retiring, and never understood how the jaws grow. It is incredible that members in the field of education can enjoy what is considered successful careers and never understand anything about anatomical principles. It brings tears to the eyes of the deeply concerned members who are vitally interested in the future of our profession.
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