Text review by Dr. Joseph Zernick with Comments by Dr. Sarver below!
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Esthetic
Orthodontics and Orthognathic Surgery 304 pp ISBN: 0815179979 Price: $136 Reviewed
by Joseph H. Zernik, DMD, PhD
The uniqueness of this new book in the orthodontic literature is clear at a glance - it contains some 470 illustrations, mostly in color. This feature fits the subject of the book: esthetic orthodontics and orthognathic surgery, and the use of imaging techniques. The chapters of the book follow a logical progression, from analysis and diagnosis, to the use of computerized, video-based, diagnostic tools, and treatment planning. The last chapters deal with specific treatment options for adolescents and adults with emphasis on various types of facial problems. Many of the treatment examples combine a variety of surgical procedures beyond the traditional mandibular sagittal split and maxillary Le Fort I osteotomies. |
Digital imaging, digital cephalometrics, and digital treatment planning are presented in the book in great detail. This book will thus provide a valuable resource regarding systems now available in the market. Many of these programs allow simulation of the surgical treatment plan on the lateral cephalogram or the digitized cephalometric tracing. Similarly, surgery can also be simulated on the lateral photographic/videographic facial view. These programs use various algorithms, based on data available in the literature to project soft tissue changes such as upper or lower lip anterior-posterior or vertical movements in response to changes in the underlying skeleton following orthognathic surgery. |
The programs have achieved a high level of accuracy and ease of use in the last decade, but, they still depend on specific manipulations by the operator, which can bias the projected treatment outcome. For example, airbrushing or similar techniques used to mask or blend the area where the soft tissue image was cut and modified can dramatically alter the esthetic of the resulting image.Such small airbrushing changes, particularly around the mouth, nose, and chin are critical. Thus, the skills of the operator of the program are still an essential element, just as they were with more traditional methods of treatment planning methods. Similarly, superposition of the lateral cephalometric image on the lateral photographic image involves inherent difficulties. Correct implementation of this technique requires critical skills. Dr. Sarver clearly points out the potential pitfalls at both the theoretical and practical levels - through excellent examples. Thus, this book is essential for any practitioner who decides to move on to videographic treatment planning system. Any orthodontist should be knowledgeable of the range of treatment options available to the patient. | |||||||
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Dr. Sarver's book is highly recommended for any orthodontist or orthodontic resident who is interested in state-of-the-art knowledge in these options. However, keep in mind that surgical intervention at the level shown in Dr. Sarver's book requires subjective, personal esthetic decisions on the part of the orthodontist and the patient. The wealth of examples here would sensitize the practitioner to these treatment options. In this respect, Dr. Sarver's book is a major educational contribution. The orthodontic community should be grateful for those of us who undertake book publishing in this day and age. The time and efforts consumed in the process can only be guessed. However, books such as this one, providing state-of-the-art view of the art and science of orthodontics, are the stepping stones for progress in our field. Joseph
H. Zernik, D.M.D. Ph.D. |
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It is not very often that an author is given an opportunity to answer the review of his own book, but upon reading Dr. Zernik's review of Esthetic Orthodontics and Orthognathic Surgery, I have just a few comments to make, which I hope the readers of The Orthodontic CYBERjournal will appreciate. 1. I sincerely appreciate Dr. Zernik's very kind evaluation of the text. Many of the readers may not realize that I am in full time private practice, and the effort behind the book represents significant thievery of time from both my practice and my family! So what reviewers think of the text means a lot to me. The fact that this text is written by a full time practitioner certainly contributes to Dr. Tom Graber's comment in his review in the AJODO that this book is "written by a clinician for clinicians" 2. Dr. Zernik's review concentrates on the technological aspects of the manuscript, and his comments are cogent and insightful. But, as author, I hope that readers of this text, when finished, don't see it as a "computer book", or a "surgery book." Instead, I hope the orthodontist who reads it cover to cover recognizes a greater philosophy of the interaction of orthodontics, patients, and functional and esthetic goal setting. In this philosophy, technology serves a function, but by no means is it the end all in contemporary orthodontic treatment philosophy. 3. In my mind, Chapter 1 was written to set the tone for the rest of the book. The systematic evaluation of the face first, before dental evaluation, is a major departure from traditional treatment planning concepts that tend to be cephalometrically and dentally based. The idea of facial keys for treatment planning is something most practitioners who have been in practice more than 5 years depend on in patient assessment, but this chapter was my effort to dissect the components of the face and quantify these facial characteristics that we find attractive so that we may offer guidelines as to how to assess a patients dentoskeletal pattern and how we can affect it, positively and negatively, by our orthodontic treatment. 4. As far as imaging technology is concerned, it serves as: a. A graphical and visual technology that dramatically facilitates communication with patients in terms they can understand and to a degree unattainable with words, hand gestures, and photographic simulations. b. This graphical interface also serves the orthodontist to visualize his/her ideas of the effects of treatment plans c. A method of quantitatively testing treatment plans for visualization of its esthetic impact before treatment is delivered 5. The chapters on case presentation, are weighted with orthognathic cases with adjunctive soft tissue surgery since this a relatively new concept which has implications in our adolescent care as well. It's just that the tools are different! In the adolescent we have growth, and in the adult we have no growth to work with. Thus the chapter on adolescent soft tissue growth, maturation and aging. We have, as a profession, tended to ignore how soft tissue has such a critical effect on how our patient's long term appearance. Dr. David M. Sarver |
