ORTHODONTIC F AILURE*

CASE REPORT

ALl<'RED PAUL ROGERS, D.D.S., Bosrox, MASS.

I T IS an easy task to write of our successes; it is more difficult to relate ourfailures, but more essential. In our daily routine we meet with success and

failure, and by encountering them our knowledge becomes surer, our judgmentmore acute, and our value to society greater.

In the past it has been our tendency, as we met together for mutual con­sideration of our problems, to place our best foot forward, to talk of our ac­complishments, and by so doing we have advanced-we have accomplished. Ouroffices have been the laboratories in which the trial-and-error method has held aprominent place. It is because of the bitterness of our failures that we seek toforget them when we meet together to advance our common understanding. Nowsome one among us has wisely asked that we discuss the failures we like toforget.

The field is rich in material-s-let it be widely and wisely cultivated, butlet it be done with understanding and in the spirit of true science. It shouldthen yield a harvest more abundant than we are able to foretell.

I have elected on this occasion to relate to you, briefly, my experience withan unusual case of mesioclusion. The case is that of a young man fifteen yearsof age who had previously been treated for the condition that existed when hecame to me. The usual models and radiographs were prepared and plans fortreatment made. Maxillary and mandibular appliances were designed to cor­rect the arch form and at the same time to give opportunity for the use of in­termaxillary elastics.

My experience in the treatment of mesioclusion cases had been particularlygratifying, and I looked forward confidently to the customary responses in tis­sue change and in arch position to the point where it would be possible to placethe patient upon myofunctional treatment. 'I'he initial treatment under theinfluence of appliances and intermaxillary elastics continued for some monthswithout the response I had confidently expected. I believe I was a little tardyin recognizing that this particular individual was placing a challenge before mewhich would require something more than my previous experiences had givenme. Months of treatment passed with no appreciable improvement, when thedisconcerting discovery was made that the maxillary molars which were usedas anchor teeth wore becoming' elongated with hyperplastic manifestations. Itwas noticed at the same time that all teeth, in both maxillary and mandibulararches, on which there was the slightest strain from intermaxillary elastics were

.Presented as part of a symposium given before the New York Society of Orthodontists,New York, N. Y., Nov. 18, 1935.

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336 Alfred Paul Rogers

showing a tendency to supraversion, accompanied by ext reme instability. Hadthis young patient not been in apparent good health I should have suspectedsome unrecognized systemic condit ion which might affect t he reaction of bonytissue to mechanical stimulation.

The treatment was, however , carr ied 0 11 with anxious care for a few monthslon ger when I determined t o cease treatment and give the ti ssues a r est, but Ikept th e patient under observation. During this period it was noticed that theslight cor rect ion which had occurred during the period of t reatment graduallyrelapsed to the form er malocclusion, and at the same time th e teeth becamestable with no evidence of injury to th e alv eolar process. Inasmuch as the casewas one which demanded correction if at all possible, after six months anotherattempt was made with even greater care being used, and more teeth were usedas anchorage than in the former attempt. During this period of treatment I wasable to make a little further progress toward the normal but was unable togain sufficient movement to obtain a position of mechanical advantage whereth e masseter-temporal exerc ise could be prescribed .

The use of more than oue light elastic on either side was found to be outof the question with this patient . All progress in th e cor rect ion of mesiodistalrelation seemed to cease j ust shor t of that position wher e exercises would havebeen of the greatest benefit. Upon his return from a vacat ion, following oursecond attemp t, this patient presented a low gra de Vincent 's infection whichhad invaded the area of t he third molars which had been ext racted during hisvacation. Under these circumstances it was thought advisable again to removeall appliances and to subject t he patient to a thorough t reatment for Vincent 'sin fection. During t his period of about three months, whil e the patient was freef rom appliances, there was very little change in tooth posit ion. Encouraged bythis fact, it was decid ed to make a third at tempt, but with the added disad­vantage of the young man now being away at college.

The medi cal histo ry of this young man migh t possibly throw some lightup on th e condition, as there are allergic manifest ations with accompanyingrhinitis and hay fever, but it is difficult to believe th at this condition could beresp onsible for the unusual t issue responses that have been experienced. Hismedical history gives no indication of endocrine imbalance. All we do know isthat this individual organism refuses to yield to our prescribed methods forthe cor rect ion of mesioclusion-the maxillary arch refuses to develop buccallyand the mandibular arch resist s our efforts to reduce its width in the premolarand molar regions.

Wean recognize that individua ls differ widely in their responses to st imuli,but in my experience I have never seen the pendulum swing so far in one direc­tion.

During certain critical peri ods in treatment, t hro ugh lack of cooperation,the patient handicapped our effor ts to a considerable degree; but I am not in ­clined to believe that this indifference or lack of cooperat ion at these particu­lar per iods could proper ly be ascribed as seriously affect ing the treatment asa whole .

In giving this brief hist ory, there comes to my mind as a cont rast the caseof a young man twenty-two years of age who had a much severer type of mesio-

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elusion , who has received practically the same type of treatment and whose reosponses have been so completely satisfactory that six months' treatment hasseen his difficulty almost corrected.

In contrasting these cases I am unable to assign a scient ific reason whyone case should persist in resisting all efforts and the other should yield withsuch fa cility. Yet there is an undiscovered cause for such behavior.

It is possible that some of you have treated similar cases successfully andhave discovered the cause of resistance.