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