674 Reviews and abstracts

patients with complex needs. Ongoing communication is

important and includes listening to the patients responses and
concerns.
The second section of the book, which deals with Malpractice and risk management, begins with a significant chapter by
the primary editor, T. M. Graber, who provides a wealth of
information on patient protection and, no less important, basic
ways to defend oneself in case of a lawsuit. Emphasized is the
taking of a comprehensive medical and dental history, and a
functional and temporomandibular-joint examination on every
patient, preferably using 1 of the many available AAO questionnaires. With more adults seeking orthodontic treatment, the
potential for periodontal disease in these patients is high. In the
chapter Medical aspects of orthodontic treatment in patients
with periodontal disease, the author stresses the need to differentiate between types of periodontitisjuvenile, adult, and
refractory periodontitis in which the site of active inflammation
continues to be infected despite aggressive periodontal therapyroot planing, curettage, and other forms of periodontal
treatment. Paradoxically, the most challenging patient to treat is
often the one with the cleanest mouth and no calculus or
evidence of plaque. Because 80% to 90% of all adult patients
have the bacteria that cause loss of attachment and lead to
periodontitis, the need for controlling periodontal disease
throughout orthodontic therapy is stressed. Recognizing warning
signs, taking preventive measures before initiating treatment,
and identifying at-risk patients are among the items debated. It is
difficult for any orthodontist to practice an entire career without
having at least one claim made against him or her. The chapter
Avoiding malpractice lawsuits: lessons learned from actual
malpractice cases offers sound advice and strong recommendations on how to manage various complications that occur in
practice. Cases cited include early termination of treatment,
forgiving or refunding fees, informed consent, accidental injuries, extracting the wrong teeth, making an erroneous decision,
extracting or not extracting, preexisting pathology, root resorption, TMD, and other unanticipated events.
Practical legal advice for avoiding malpractice lawsuits
is the title of the final chapter in which the author recommends participating in ones own defense and shares practical
information about steps to successfully defend ones practice.
Subjects reviewed include the all-important patient records,
informed consent, following certain principles, referring
when in doubt, being careful what is said, and adhering to the
standard of care. The appendix includes some medical and
dental history forms designed specifically for orthodontists;
the forms can be purchased from the American Association of
Orthodontists. The 21 eminent specialists from 6 countries are
to be commended for having produced a sorely needed text
designed to protect orthodontists from malpractice litigation.
This book belongs in the office of every practicing orthodontist. It is highly recommended reading.
Alex Jacobson
Am J Orthod Dentofacial Orthop 2005;128:673-4
0889-5406/$30.00
Copyright 2005 by the American Association of Orthodontists.
doi:10.1016/j.ajodo.2005.08.006

American Journal of Orthodontics and Dentofacial Orthopedics

November 2005

The art of the smile: Integrating

prosthodontics, orthodontics,
periodontics, dental technology, and
plastic surgery in esthetic dental
treatment
Rufi Romano, editor; Nitzan Bichacho and Bernard Touati,
associate editors; 30 contributors
Chicago, Berlin, Tokyo, Copenhagen, London, Paris, Milan,
Barcelona: Quintessence Publishing Company; 2005; 420 pages;
1110 color illustrations; $258

Because the smile is an integral part of ones personality,

people are willing to invest a considerable amount of time,
energy, and money to improve their smiles. This book is divided
into 5 sections; the first deals with prosthodontic methods of
improving a smile. The introductory chapter of this section
discusses treatment modalities for adults whose teeth are malaligned and who choose restorative procedures in lieu of orthodontic treatment. The associate editor, Dr Bichacho, using 4
cases, shows how malaligned teeth and the supporting gingival
tissues can be improved with often extensive restorative procedures. The second through fourth chapters describe other somewhat extensive prosthetic procedures for the esthetic improvement of smiles, which might include multiple all-ceramic
crowns, bleaching, and the selection of the proper alloy for
esthetic restoration, with examples of superlative results by using
contemporary dental procedures.
The orthodontic component of the text (second section)
comprises 7 chapters. The first is an excellent chapter by
Sarver and Ackerman that deals with dynamic visualization
and quantification of a smile and its impact on orthodontic
diagnosis and treatment planning. Before developing a treatment plan, the authors emphasize the need to identify and
quantify the elements of a smile that need correction, improvement, or enhancement, as well as the positive elements
that should be protected. The various static and dynamic
diagnostic and treatment strategies also address the patients
concerns. Interdisciplinary interaction is encouraged. The
second chapter in this section by Zachrisson and Toreskog
describes and illustrates several treatment alternatives for
accidentally lost or missing maxillary central incisors in
adults or children. Here again, to achieve maximal treatment
benefit, the authors emphasize an interdisciplinary approach.
Shown are 7 excellently treated cases, the last of which is a
single tooth implant. This is followed by a chapter by Kokich
and Kinzer that describes the interdisciplinary management of
patients with congenitally missing lateral incisors. Treatment
alternatives include canine substitution, resin-bonded fixed
partial dentures, conventional or pin-ledge cantilevered fixed
partial dentures, and single tooth implants. The criteria for the
various treatment options are clearly addressed. Richard G.
Wick Alexander, in a chapter on considerations to be
included in creating a beautiful smile, lists 10 objectives that
need to be addressed. The various principles are described
and colorfully illustrated. Adult orthodontics: problems and

American Journal of Orthodontics and Dentofacial Orthopedics

Volume 128, Number 5

solutions with lingual orthodontics is the subject of a chapter

by Fillion of Paris, France. The invisibility of a lingual
orthodontic appliance often makes it the treatment of choice
among adults who are reluctant to wear traditional facial
brackets and archwires. Shown are 7 patients beautifully
treated with lingual orthodontics. In chapter 10, Seron of
Israel discusses the nonsurgical treatment of severe open bite
malocclusions by using a lingual orthodontic appliance. The
brackets of choice in the treatment of these cases are lingual
brackets (Ormco, Orange, Calif) with posteriorly projecting
long hooks on each anterior bracket that act as spurs. To
reduce tongue irritation after bonding, the patient is instructed
to position the tongue behind the brackets at rest and during
swallowing and speech. As a consequence, tongue position is
modified. The treatment sequences are described and shown.
In the next chapter by Romano, also of Israel, the closing of
spaces with lingual orthodontics and various mechanisms for
different smiles and profiles are discussed. To close spaces
and enhance facial esthetics, the author emphasizes having a
sound knowledge of biomechanical principles of lingual
orthodontics; 3 case reports are featured in this chapter.
The chapter by Saadoun introducing the third section
relates to periodontics; the author describes the many subtle
aspects of a smile, beginning with what is a perfect smile?
Included in the many ways a smile can be modified by
dentists are alterations to tooth color, shape, and alignment;
improved gingival health; and esthetic surgery. Patient psychology in esthetic dentistry and the doctor-patient relationship are further aspects discussed in the chapter. The last 3
chapters in this section deal with preserving implant papillae
in the esthetic zone, optimizing esthetics at the periodontalrestorative interface, and a microsurgical approach to the
management of soft tissue around teeth and implants.
The fourth section comprises 3 chapters that relate to
dental technology in which the art and science of dental
porcelain have been drawn together by 5 dedicated experts in
the field of duplicating the dentition with challenging materials. Chapter titles include new approaches to shade communication, reproducing the natural smile through proper material selection, and illusions and reality in the esthetic work of
the dental technician, the fourth dimension.
The last section, concerning plastic surgery, comprises 2
chapters: an overview of various plastic procedures designed
to rejuvenate the face and perioral structures, and rhinoplasty
procedures to help sculpt the face.
Orthodontists understandably would be most interested in
the 7 substantial chapters on the various orthodontic procedures
that relate to the creation of a beautiful smile. However, the other
4 sections of the text would be of immense value to the
orthodontist if only to be aware of the potential of the other
disciplines to assist in creating appealing and harmonious smiles.
In all, this book would be a valuable addition to any orthodontists library.
Alex Jacobson
Am J Orthod Dentofacial Orthop 2005;128:674-5
0889-5406/$30.00
Copyright 2005 by the American Association of Orthodontists.
doi:10.1016/j.ajodo.2005.08.007

Reviews and abstracts 675

Orthodontic-surgical treatment of
dentofacial anomalies: An integrated
esthetic-functional approach
Paolo Ronchi, editor
Chicago, Berlin, Tokyo, Copenhagen, London, Paris, Milan,
Barcelona: Quintessence Publishing Company; 2005; 304 pages;
1141 illustrations (most in color); $268

In cases of severe malocclusion with dentofacial discrepancy, the therapeutic options are modification of growth, camouflage with dental compensation, and surgical positioning of
the bony bases. These options and the indications for surgical
intervention are briefly described in the introductory pages of the
text. The clinical and diagnostic considerations of various
dentoskeletal anomaliesClass III malocclusions, Class II malocclusions, dentofacial asymmetry, open biteare discussed
under separate subheadings in Chapter 1. At the end of the
chapter is a useful anomalies data form. Chapter 2, Cephalometry in dentofacial anomalies, focuses on the anteroposterior,
vertical dentoskeletal, and soft tissue relationships of the craniofacial complex from a lateral and posteroanterior aspect. Also
described and illustrated are various anterior and lateral facial
measurements from an esthetic viewpoint. Chapter 3 discusses
in general the treatment objectives in patients with dentofacial
anomalies, which include the establishment of normal occlusal
and joint functions. Stressed are the clinicians need to be aware
of the patients expectations and the patients need to clearly
understand which goals can be reasonably achieved. Age and the
characteristics of the soft tissues must necessarily be considered
before selecting the surgical procedure.
Chapter 4 addresses in general the various preoperative
orthodontic procedures before the surgical repositioning of the
bony bases in all 3 spatial dimensions. The subsection that deals
with Class III malocclusion describes and illustrates the decompensation of incisors and the need for their restoration to the
correct position on their bony bases before surgery. Transverse
coordination of the dental arches, dental midlines, canine symmetry, and the curve of Spee likewise must be considered before
surgery for any dentofacial anomaly. Chapter 5 describes various
commonly used mandibular surgical procedures. Included are 2
types of bilateral split osteotomies, vertical osteotomy of the
mandibular ramus, subapical osteotomy, genioplasty, and mandibular distraction osteogenesis. This is followed by a chapter
that discusses the 2 schools of thought about which type of
fixation should be used after mandibular osteotomy, and how the
2 types of fixation relate to the position of the condyles in the
fossae. Chapter 8 is devoted to describing various whole or
multiple-piece surgical maxillary osteotomy procedures. This is
followed by a chapter in which the contributor describes many of
the soft tissue changes to nose and upper lip, zygoma and
cheeks, lower lip, and chin as a consequence of maxillary and
mandibular osteotomy.
Chapter 9 deals with selecting the appropriate oseteotomy
for the correction of the particular dentofacial osteotomy. The
surgical procedures described relate to the treatment of Classes II
and III malocclusions, dentofacial asymmetry, open bite, and