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higher equivalent dose than do adults' organs under


identical imaging conditionswas observed for all
combinations of imaging parameters used in our study.
This is likely to be true for other combinations of imaging parameters, including the 4.8-second scan time.
Although absolute organ doses are expected to be
smaller in the 4.8-second scan than in the 8.9-second
scan for both children and adults, the point of the study
was not to compare absolute organ doses. Furthermore,
the 4.8-second exposure time is available for the 0.4mm voxel, but not for the 0.2-mm voxel scan on the
i-CAT unit we used; we chose the 8.9-second scan for
consistency.
On his Web site, Dr Molen acknowledged that with
the introduction of CBCT machines and the multitude
of third-party DICOM readers, orthodontists today
have been left to sort through volumes of information
on their own. In our conclusions, it was our intention to
provide an evidence-based recommendation on the
use of CBCT images and to clarify the clinical signicance of the overall ndings of our study, something
that can easily be lost amid all the numbers provided.
We acknowledge that this study has inherent aws
but note that awless research projects exist only on
paper. Future directions certainly include the areas
mentioned by Dr Molen's group and beyond. The necessity for standardized guidelines for the use of
CBCT is constantly understated. We hope that our articles, along with others in the eld, will help to enlighten
doctors about this valuable tool, provide guidelines for
CBCT use, and eliminate surprise reactions to comments such as CBCT should not be used for routine
diagnosis.
Anas Al Najjar
Dan Colosi
Lawrence T. Dauer
Robert Prins
Gayle Patchell
Iryna Branets
Arthur D. Goren
Richard D. Faber
Stony Brook, NY

Am J Orthod Dentofacial Orthop 2013;144:512-7), the


authors made a major claim that the ndings from their
study negate the results of several previous studies. As the
authors admit, these previous investigations found that
centric relation (CR) can be consistently found with
repeatable accuracy. It begs the question as to why
Dr Kandasamy, who made the CR bites, was unable to
achieve similar accuracy with his 19 subjects when so
many others have been able to do so.
The answer to this question may be explained in an
ingenious study on recording CR and training.1 This
study found that without proper training, dentists
were able to accurately locate a repeatable CR in 0 of
132 attempts. However, with 3 hours of training from
experienced clinicians who locate CR routinely in their
ofces, the newly trained dentists could locate CR on
the same joints to within 0.11 mm 106 of 110 times
on the rst attempt. On the second attempt, the results
were 4 of 4.
Dr Kandasamy has long professed his objections to
placing any importance on condylar position in orthodontics. As such, it raises the question as to whether
he is an experienced and unbiased choice to gather accurate data on techniques to locate the condylar positions,
something he has gone to great lengths to vilify. The decision to use chin-point guidance where he forced the
condyles posteriorly in the fossa suggests that his understanding of CR is several decades out of touch. Even this
article acknowledges that a posterior position in the
fossa as the goal of CR was before 1968. Why design
a study to investigate a concept that has not been the
predominant view of CR in 45 years? This study might
have been relevant once upon a timeone predating
the birth of many of todays orthodontists. Today, however, it is just a fatally awed application of an interesting idea.
J. Michael Hudson
Decatur, Ill

Am J Orthod Dentofacial Orthop 2014;145:125-6


0889-5406/$36.00
Copyright 2014 by the American Association of Orthodontists.
http://dx.doi.org/10.1016/j.ajodo.2013.11.007

REFERENCE
1. McKee R. Comparing condylar position repeatability for standardized versus non-standardized methods of achieving centric relation.
J Prosthet Dent 1997;77:280-4.

Condylar position
n the recent article Condylar position assessed by
magnetic resonance imaging after various bite position
registrations (Kandasamy S, Boeddinghaus R, Kruger E.

February 2014  Vol 145  Issue 2

Am J Orthod Dentofacial Orthop 2014;145:126


0889-5406/$36.00
Copyright 2014 by the American Association of Orthodontists.
http://dx.doi.org/10.1016/j.ajodo.2013.12.003

Authors response

e thank Dr Hudson for his interest in our study. We


are not surprised that it has generated a strong

American Journal of Orthodontics and Dentofacial Orthopedics

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