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Interdisciplinary care leads the way

David L. Turpin, DDS, MSD, Editor-in-Chief
Seattle, Wash

s you read through the historical time line on whereby esthetics and function can be efficiently
the inside front cover of the Journal this month, restored. This treatment modality has several advan-
you cannot help but notice that many of our tages over implants: it can be performed in early child-
leaders in the past made decisions and took action to hood, it induces the formation of new bone, and, after
separate the practice of orthodontics from that of gen- the transplant erupts, it can be moved orthodontically.
eral dentistry. The formation of orthodontics in 1900 as According to Andreasen and Paulsen, both of whom
the third oldest specialty in dentistry and medicine, fol- spoke at the Interdisciplinary Conference, The opti-
lowed by the first issue of this journal in 1915, paved mal time for transplantation appears to be three-
the way for specialty education in the universities. The quarters of root formation, where the tooth is in its
requirement that students spend a minimum of 2 years early stage of eruption. Four months after transplan-
in an ADA-accredited postgraduate program that spe- tation, the tooth can be moved orthodontically with
cialized in orthodontics led to the exclusive practice of limited risk of root resorption. Several long-term
orthodontics by members. I believe this educational studies have shown success rates of more than 90%,
requirement (the exclusive practice requirement) and with observation periods now approaching 25 years.
the formation of the American Board of Orthodontics However, problems may occur even when autotrans-
are responsible for the effectiveness of our specialty, as plantation seems to be the most appropriate treatment
well as for its influence throughout the world. available to the clinician. What can you do if the recipi-
But what happens now? Is this enough to carry us ent site is too small at the ideal time for transplantation or
into the next century? After attending the jointly spon- when orthodontic treatment is needed to gain space? One
sored Interdisciplinary Care Conference in Dallas a few of the answers is provided in an original article by Lau-
weeks ago, I firmly believe that most of those in atten- reys et al (pages 346-52). According to these authors, cry-
dance know the answer to these questionsand a big opreservation may be the long-term answer. Until now, it
part of the answer lies in interdisciplinary care. We have has been impossible to maintain viable pulp tissue in cry-
spent the last 100 years developing as a specialtywe opreserved teeth. The goal of this study was to look at
must spend the next 100 interacting more closely with whether revascularization occurred after autotransplanta-
the other components of dentistry to enhance the overall tion of cryopreserved teeth from which the original pulp
delivery of care. As the baby boomer population eases tissue was extracted before freezing. The authors reported
into retirement with high expectations, it is obvious who that there was no difference in the amount of revascular-
our patients will be. In many situations, interdisciplinary ization between teeth that were transplanted immediately,
care will provide the solution to their dental problems. without freezing, and those stored in a tooth bank, pro-
In support of this belief, you will find a commen- vided the root apex was cut and the pulp tissue was
tary on the autotransplantation of teeth (pages 336-7, removed before freezing.
by Hans Ulrik Paulsen), followed by 2 original Studies like these from European authors are excit-
research papers on the same topic. Both of these ing, but they are of little practical value to the ortho-
papers report on some very creative research with dontist who lacks a working relationship with the refer-
long-term clinical results. Autotransplantion of teeth ring dentist and other specialists. As we enter the 21st
can offer a unique treatment possibility in cases of century, excellent technical skills may not be enough to
congenital tooth aplasia or accidental tooth loss build and maintain an interdisciplinary practice. To
meet the demands of patients, it will take more confer-
Am J Orthod Dentofacial Orthop 2001;119:335
ences that focus more and more on the benefits and
Copyright 2001 by the American Association of Orthodontists
0889-5406/2001/$35.00 + 0 8/1/115345 added value of multidisciplinary treatment, as did the
doi:10.1067/mod.2001.115345 one just held in Dallas.