READERS' FORUM
Letters to the editor*
About light and shadow
e were delighted to find that the American Jour-
W nal of Orthodontics and Dentofacial Orthopedics
has continued to publish on key issues in early ortho-
dontic diagnosis, offering its readers articles that explore
novel diagnostic criteria. An example is the recent article
in the September issue (Baccetti T, Leonardi M, Giuntini
V. Distally displaced premolars: a dental anomaly associ-
ated with palatally displaced canines. Am J Orthod
Dentofacial Orthop 2010;138:318-22) investigating, in
a retrospective study, the association between distally
displaced premolars and palatally displaced canines
(PDC). This well-designed study appears to be a continu-
ation of a number of studies investigating the associa-
tions between dental anomalies and PDC.1,2 The main
motivation for these articles, including this one, seems
to be the clinical significance of early diagnosis of the
likelihood of canine impaction.
The authors, however, did not explain exactly what
clinical significance an early diagnosis of PDC could
have. We doubt that an early diagnosis of PDC might
have an important impact on clinical treatment strategy.
To date, there is a lack of evidence that early diagnosis
may influence subsequent planning of orthodontic treat-
ment for the impacted canines. Successful treatment of
tooth impaction seems to depend, rather, on the accurate
positional diagnosis and the proper mechanotherapy.3
One more question arises in that line of thought. Can
we, as clinicians, be held accountable for x-ray exposure
of our young patients merely to identify a remote “prob-
ability” of PDC, by prescribing radiographic exposure,
when the results will have no influence on treatment
planning? Generally, can we justify panoramic x-rays
and lateral cephalograms at such an early age, as per-
formed in the study by Baccetti et al (mean age, 9 years
7 months 6 1 year 3 months)? Council Directive 97/43/
Euratom4 clearly enough states that radiographic expo-
sure is justified only when the management of the
patient depends on the information obtained from the
radiography. Cephalometrics, for example, was shown
not to be required for orthodontic treatment planning,
since it has no influence on treatment decisions.5
So, the answer to the question of whether the risk of
more irradiation of a growing child is worth the diagno-
sis of PDC would depend on the possible “dramatic”
*The viewpoints expressed are solely those of the author(s) and do not reflect
those of the editor(s), publisher(s), or Association.
2
consequences an impacted canine would have. We
should not overestimate our specialty. Due to progress
in medical technology (such as x-rays—Roentgen re-
ceived the Nobel Prize for its discovery in 1901), it seems
that the clinician is tempted to place a growing amount
of trust in technology and modern computer-assisted
facilities for data analysis, sometimes neglecting his nat-
ural diagnostic potential. X-rays should only supplement
his clinical diagnosis—and only when it is really needed.
Rumors have it that Konrad Roentgen once said, “Where
there is light, there is also shadow.”
Alexander Spassov
Dragan Pavlovic
Kamen Spasov
Greifswald, Germany
Am J Orthod Dentofacial Orthop 2011;139:2
0889-5406/$36.00
Copyright Ó 2011 by the American Association of Orthodontists.
doi:10.1016/j.ajodo.2010.11.014
REFERENCES
1. Baccetti T. A controlled study of associated dental anomalies. Angle
Orthod 1998;68:267-74.
2. Peck S, Peck L, Kataja M. Prevalence of tooth agenesis and peg-
shaped maxillary lateral incisor associated with palatally displaced
canine (PDC) anomaly. Am J Orthod Dentofacial Orthop 1996;
110:441-3.
3. Becker A, Chaushu G, Chaushu S. Analysis of failure in the treatment
of impacted maxillary canines. Am J Orthod Dentofacial Orthop
2010;137:743-54.
4. Council Directive 97/43/Euratom. Available at: http://ec.europa.eu/
energy/nuclear/radioprotection/doc/legislation/9743_en.pdf. Ac-
cessed on October 7, 2010.
5. Nijkamp PG, Habets LL, Aartman IH, Zentner A. The influence of
cephalometrics on orthodontic treatment planning. Eur J Orthod
2008;30:630-5.
Authors’ response
W e would like to thank Dr Spassov and coworkers for
their interest in our research work. The concerns by
Dr Spassov and his team probably derive from their lack
of awareness of the effectiveness of early interceptive
treatment of a PDC to prevent impaction. Our research
group has published to date several randomized clinical
trials on this topic, with the consistent result of an in-
crease in the prevalence rate of spontaneous eruption
of PDCs after different interceptive techniques (extrac-
tion of the deciduous canine, rapid maxillary expansion,