jeudi 9 août 2012

Orthodontic Pearls: A Selection of Practical Tips and Clinical Expertise

Orthodontic Pearls is an attempt to fill gaps in a specialist orthodontist's education. It is about know-how rather than knowledge; the first half of the book covers practice administration, patient management and marketing, and the remainder is a selection of clinical tips gleaned from various contributors.
The opening chapter suggests guidelines in practice and operatory design and makes several sensible points, as well as emphasising the importance of good staff attitude. The following three chapters deal quite comprehensively with the approach to managing and recording a new patient, including impression taking and clinical photography.
Chapter 5 stresses the absolute importance of case discussion, which is often overlooked, but vital in today's climate of informed consent. This is a most welcome section of the book, and covers record keeping and communication.
The next chapter goes on to set out the personal views of Winston Senior on marketing a private practice, and repeats some points previously mentioned. It ends with a section on patient compliance — so essential in orthodontics — and discusses the inter-relationships between child, parent, and operator. As suggested in Chapter 5, time spent in explanation and building rapport is invaluable.
The remainder of the book presents a series of clinical tips on fixed appliances, beginning with detailed advice on setting up a fixed appliance, from bonding, through bracketing to arch wire placement. There are some valuable 'pearls' here, especially the use of autoclave type in band cementation, and prevention of wire end trauma.
The perennial problem of distal movement of upper molars is considered, and three chapters focus on finishing and retention — which complete the clinical section. There is an extensive appendix of specimen pro forma letters and forms covering almost every eventuality encountered in practice.
This book is well produced, with clear print and diagrams. The text is liberally sprinkled with headings and highlighted pearls of wisdom. It is good to see a page devoted to oral hygiene, although the authors are over-confident about the average patient's ability to clean well. The use of jigs and headgear are explained in detail, and safety in headgear use emphasised. Chapter 10, on auxiliary springs used in the Begg appliance, should be deleted altogether.
Overall, there are some useful tips throughout the book, but the layout would benefit from less repetition, and keeping topics together under major headings.

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