Orthodontic Postgraduate Education...Library of Congress Cataloging-in-Publication Data Orthodontic...

Orthodontic Postgraduate Education: A Global Perspective

Th eodore Eliades, DDS, MS, Dr Med Sci, Ph D, FRSC, FIMMM, FRSM, FIn stPProfessor and DirectorClin ic of Orthodont ics and Paediat r ic Dent ist ryCenter of Dental MedicineUniversit y of ZurichZurich , Sw itzerlandForm erly Associate Professor, Departm ent of Orthodont ics, School of Dent ist ry, Aristot le Universit y of Thessaloniki, GreeceEditor-in -Chief, Journal of Dental Biom echanicsAssociate Editor, Am erican Journal of Orthodont ics and Dentofacial Orthopedics Associate Editor, European Journal of Orthodont icsAssociate Editor, Progress in Orthodont ics

Ath an asios E. Ath an asiou , DDS, MSD, Dr Den tAct ing Dean, Professor, and Program Director in Orthodont ics Ham dan Bin Moham m ed College of Dental MedicineMoham m ed Bin Rashid Universit y of Medicine and Health SciencesUnited Arab Em iratesProfessorDepartm ent of Orthodont ics, Faculty of Dent ist rySchool of Health SciencesAristot le Universit y of ThessalonikiThessaloniki, GreeceForm er Dean, School of Dent ist ry, Aristot le Universit y of ThessalonikiForm er Chair and Program Director, Departm ent of Orthodont ics, School of Dent ist ry, Aristot le Universit y of ThessalonikiPast President , Nat ional Academ ic Recognit ion Inform at ion Center, Hellenic Minist ry of Educat ion Im m ediate Past President , World Federat ion of Orthodont istsPast President , European Federat ion of Orthodont icsPast President , Greek Orthodont ic SocietyHonorary Editor, Hellenic Orthodont ic Review

Thiem eStut tgar t • New York • Delhi • Rio de Janeiro

32 illust rat ions

Librar y of Congress Cataloging-in -Publicat ion Data

Orthodont ic postgraduate educat ion : a global perspect ive / [edited by] Theodore Eliades, Athanasios E. Athanasiou . p . ; cm . Includes bibliographical references. ISBN 978-3-13-200401-6 (alk. paper)—ISBN 978-3-13-200411-5 (eISBN) I. Eliades, Theodore, editor. II. Athanasiou , Athanasios E., editor. [DNLM: 1. Orthodont ics—educat ion . 2. Educat ion , Dental, Graduate. 3. Internat ionalit y. W U 18] RK78.5 617.6 ′430071—dc23

2015018457

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v

Contents

Foreword .............................................................................................................................................................. vi Preface ................................................................................................................................................................ viii Con t r ibu tors ........................................................................................................................................................ x

1 Histor ical Aspect s of Postgraduate Or th odon t ic Cu r r icu lu m Form u lat ion : Preceptorsh ips an d Sch ool Cu r r icu la ............................................................................................................. 1Jam es L. Vaden and Jackie Hit tner

2 Con tem porar y Or th odon t ic Postgraduate Program s as Related to th e Rest of Den tal Specialt y Advan ced Edu cat ion .......................................................................................................... 9Henry W. Fields

3 Con tem porar y Or th odon t ic Postgraduate Edu cat ion as Related to Un dergraduate Or th odon t ic Program s .................................................................................................................................... 17Pert t i Pirt t iniem i

4 Or th odon t ic Specialt y Edu cat ion in Eu rope ............................................................................................. 23Stavros Kiliaridis and Anne-Marie Kuijpers-Jagtm an

5 Specialt y Level Edu cat ion in Or th odon t ics in th e Un ited Kingdom ................................................... 34Susan J. Cunningham

6 Postgradu ate Or th odon t ic Edu cat ion in th e Un ited States ................................................................... 42Peter Ngan and Christ ina DeBiase

7 Or th odon t ic Specialt y Edu cat ion in Can ada ............................................................................................ 52W illiam A. W iltshire

8 Or th odon t ic Specialt y Edu cat ion in Lat in Am er ica ................................................................................ 59Julia F. de Har n

9 Or th odon t ic Specialt y Edu cat ion in East an d Sou th east Asia , w ith a Par t icu lar Focu s on Ch in a .............................................................................................................................. 66Jiu-Xiang Lin, Yan-Heng Zhou, Tian-Min Xu, and Xue-Dong Wang

10 Or th odon t ic Specialt y Edu cat ion in Ocean ia ............................................................................................ 73Alexandra K. Papadopoulou, Oyku Dalci, and M. Ali Darendeliler

11 Or th odon t ic Specialt y Edu cat ion in th e Middle East an d Afr ica ......................................................... 83Abbas R. Zaher and Hassan Kassem

12 Or th odon t ic Specialt y Edu cat ion in th e In d ian Subcon t in en t ............................................................. 88Om P. Kharbanda

13 Th e Educat ion al Role of Or th odon t ic Boards arou n d th e World ...................................................... 112Mauro Cozzani and Frank Weiland

14 St ru ct u re an d Organ izat ion of Den tal Specialt y Edu cat ion in th e Un ited Kingdom ................... 117Fraser McDonald, G. How ard Moody, and Dirk Bister

15 In ternat ional Guidelines of the Erasm us Project and the World Federat ion of Orthodon tists ....... 125Athanasios E. Athanasiou and Theodore Eliades

16 Th e Role of New Tech n ologies in Or th odon t ic Specialt y Edu cat ion ............................................... 128Shazia Naser-Ud-Din

17 Th e Role of Con t in u ou s Profession al Developm en t in Or th odon t ic Edu cat ion ........................... 144Athanasios E. Athanasiou

18 Th e Role of Scien t i c Jou rn als in Or th odon t ic Specialt y Edu cat ion ............................................... 147David L. Turpin

19 Th e Role of Research in Or th odon t ic Specialt y Edu cat ion .................................................................. 162Kee-Joon Lee and Young-Chel Park

20 Advan ced Or th odon t ic Edu cat ion : Evolu t ion of Assessm en t Cr iter ia an d Meth ods to Meet Fu tu re Ch allenges ........................................................................................................................... 182Theodore Eliades and Athanasios E. Athanasiou

Appen dix .......................................................................................................................................................... 191 In dex ................................................................................................................................................................. 219

vi

Foreword: Consideration on Wishes and RealityThe dental profession was developed to solve problem s related to teeth . These had earlier been taken care of by the blacksm ith , the barber, or the village doctor. From general dent ist ry several specialt ies have been defined, orthodont ics and oral surgery being am ong the first . The reason was clearly that w ith the developm ent of the pro-fession , the teaching w ith in basic dental educat ion was considered inadequate w ith respect to these disciplines. The perform ance of an orthodont ic t reatm ent required m ore knowledge and m anual t raining than general den-tal t rain ing could include. The present book provides the reader w ith all aspects of graduate t rain ing w ith in or tho-dont ics, including guidelines for cont inuous educat ion; in other words, an updated version of the state of the ar t of orthodont ic educat ion in 2015.

The first schools of orthodont ics were opened in St . Louis, Missouri, m ore than 100 years ago; 20 years la-ter a considerable num ber of dental schools had star ted a st ructured graduate program in or thodont ics. On the other hand, it was not unt il 1961 that the m inim um edu-cat ional requirem ents for the specialt y were form ulated in the United States. Meanw hile, dent ists in other parts of the world star ted developing graduate program s and defin ing necessary ru les for recognit ion of a specialist t it le. In Europe, the Erasm us project guidelines were pub licized in 1992 and an update was published in 2014. Although m any countries have proclaim ed that they fulfill the requirem ents stated in the Erasm us program , diversit y is st ill considerable and an unbiased uniform validat ion is generally m issing. Recognizing the diversit y, the European Federat ion of Orthodont ic Specialists (EFO-SA) has suggested standardizat ion of the exam s.

The or thodont ic specialt y com prised a theoret ical and a pract ical par t , of w hich w ire bending was an im -portant com ponent . With the in troduct ion of the st raight w ire philosophy based on prescript ion brackets and pre-form ed w ires, the need for bending has, according to the com panies, becom e superfluous.1,2,3 This also applied w hen aligners, another alternat ive to w ire bending, was presented. The possibilit y of outsourcing changed the ap -pliances used to generate tooth displacem ent from being “force-driven” to being “appliance-driven.” The prescrip -t ion brackets can be bonded indirectly and standard or custom -m ade w ires can be delivered. Consequently, all dent ists had to do was to insert the prescribed sequence of the w ires; th is m ay also be done by non-or thodont ists. The fact that these appliances can be purchased by any dent ist , even non-dent ists, has changed the profession from a scient ifically based to a m arket-driven profes-sion . The increasing im portance of m aking t reatm ent faster and w ith reduced chair t im e is clearly reflected

in the literature. However, the biggest im pact of th is developm ent is seen in the m arket ing of appliances on the In ternet . The pat ien ts are prom ised “short invisible t reatm ent ,” the general dent ist s “easy gains in incom e” w ith these appliances, and the specialists “less chair t im e – m ore incom e.” Qualit y and long-term results are, on the other hand, rarely m ent ioned. The dom inance of the product-related aspect of or thodont ics is also expressed in the reduced in terest in teaching and research , as the academ ic posit ions render less than half the incom e of a private well-funct ioning clin ic.

The developm ent of m aterials facilitat ing orthodon-t ics has resulted in several consequences: (1) “Appliance-m arket driven orthodont ics” has to a large degree erased the need for w ire bending and producing of custom - m ade appliances; (2) the prefabricated appliances can be acquired by anyone; and (3) the fascinat ion of being in the academ ic environm ent has becom e less at t ract ive: less salary and m inor im pact on the clin ical realit y, hence a lack of dedicated academ ic staff.

The present book expresses not only the realit y, but to an even larger degree the dream . The authors are explai-n ing the rules, but also adm it t ing a concern regard ing the increasing invasion of non-specialists in to our reserve. In spite of th is developm ent the im portance of a profound basic and cont inuing educat ion cannot be overest imated, but even the surveys of the profession are classifying the orthodont ist according to technique. Treatm ent should be goal-oriented and pat ient-focused and not bound to a specific technique. Graduate educat ion should therefore include t rain ing and pract ice w ith in several t reatm ent approaches and the t reatm ent plan should be based on a solid know ledge of both biology and biom echanics. The focus on incom e and outsourc ing evaluated by quest ion -naires used to evaluate the professionals by incom e and technique is reflect ing how deeply the specialt y, w hich was developed on the prem ises that appliances were produced to generate a specific tooth m ovem ent , is being replaced by “fast food orthodont ics.” Levelling of the up -per “social six” m ay sat isfy the pat ient im m ediately, but could have a detr im ental influence on the long-term de-velopm ent of the dent it ion .

The specialist’s t rain ing requires, according to the authors of th is book, cont inuous upgrading. As the or-thodont ic clien tele is changing from an alm ost en t irely young grow ing populat ion to adult pat ien ts, who to a large degree require orthodont ics as part of rehabili-tat ion , the orthodont ist should possess knowledge on biology, including the aging processes and the influence of general diseases on the periodont ium and the bone. Treatm ent of the aging populat ion has to be individua-

lized and the standard appliances w ill rarely deliver a m aintainable result . Teamwork w ith other specialt ies as well as in terdisciplinary t reatm ent in relat ion to other disciplines perform ed by gnathologist s, surgeons, im -plantologists, and prosthodont ists, are necessary. Indivi-dual t reatm ent plans have to be agreed upon and “fast or thodont ics” is rarely a valid opt ion . In teract ion w ith other specialt ies is crucial and as one of the authors, Professor Fields, explains in Chapter 2, overlapping w ith neighboring specialt ies w ill increase.

One quest ion rem ains. What can the profession do to rem ain a research-based specialt y? First: A good educa-t ion is surely one com ponent . Second: Dedicat ion of col-leagues to support a cont inuous developm ent , not only w ith donat ion of m oney but also w ith t im e. What m akes you happier, an increase in incom e or the sat isfact ion gained w hen a really difficult problem is solved? Third: To generate a cam paign inform ing the populat ion of the difference between “fast food appliance-driven or tho-dont ics” and pat ient-oriented goal-driven or thodont ics. There should be a difference. Whereas a large num ber of m inor problem s can be solved by non-specialists by pre-fabricated appliances, the specialist should m aster all of the different t reatm ent approaches and not be lim ited by

one technique. We cannot claim that orthodont ics is only for specialists but the different ial diagnosis should be re-spected also by the non-specialist w ho should be able to recognize, as we all should, our lim itat ions. The present book outlines the state of the ar t of the educat ion and the possibilit ies and w ishes around the world, but the at t itude toward the pat ient is of the utm ost im portance and the m anufacturers’ progress should be beneficial not only for the or thodont ist but also for the pat ient .

Birte Melsen, DDS, Dr OdontProfessor

Aarhus Universit y, Denm arkPast President, European Orthodont ic Society

References

1. Andrews LF. The st raight-w ire appliance. Explained and compared. J Clin Orthod 1976;10:174-95.

2. Andrews LF. The st raight-w ire appliance, origin , con-t roversy, com m entary. J Clin Orthod 1976;10:99-114.

3. Engel GA. Preform ed arch w ires: reliabilit y of fit . Am J Orthod 1979;76:497-504.

Foreword vii

viii

PrefacePostgraduate or thodont ic educat ion has thrived from its in it ial developm ent by m eans of preceptorship program s in the early 1900s to the 21st century’s organized m ult i-perspect ive t rain ing curricula, w hich blend both clin ical and basic sciences. The evolut ion curve of postgraduate program s after the defin it ion of object ives of or thodon-t ic specialt y educat ion dem onstrates a rem arkable pat-tern, characterized by alternat ing peaks of act ivit y fol-lowed by quiescent periods of stat ionary grow th.

Init ially, the progress was based on the introduct ion of novel appliances and treatm ent m ethods, and the science part of curricula was lim ited to fundam entals of osteolo-gy and m edical subjects such as anatomy. However, w ith the introduction of the biological basis of orthodontics and the emphasis on the m echanism s of grow th and de-velopm ent, this m odel was altered. As a result , organized courses on various subjects extending from m olecular biology to genetics have been included in the curricula of m any program s. This sw ift change in the structure of education was accompanied by the introduct ion of sem i-nars on epidem iology, stat ist ics, m echanics, and m aterials science init ially in the orthodontic and at a later stage in organized graduate core course curricula. Depending on the direct ion and areas of interest of academ ic faculty, the level of involvem ent of postgraduate students varies from a superficial knowledge to cover the basics up to the competence level of perform ing independent research on the subject , w hich often found its way to print in highly ranked biom edical periodicals. Consequently, the struc-ture, w ith emphasis on research and academ ic curricula as well as orthodont ic clinical training, shows a high vari-ability am ong program s even in the sam e country; suffice it to m ention that this variat ion m ay reach substantial le-vels w hen different countries are considered.

The foregoing differences m ay be worth review ing from m any perspect ives including that of (1) a dental student or dent ist but prospect ive postgraduate or tho-dont ic program applicant , (2) or thodont ic faculty inquir-ing on the st ructure and funct ion of program s in other countries, and (3) organizat ions seeking an overview of the status of postgraduate or thodont ic educat ion.

Resources providing facts about the educat ional system s and st ructures, and organizat ional aspects of or thodont ic specialt y/board/fellowship exam inat ions, are st r ikingly lacking. Therefore, professionals in the aca-dem ia or candidates seeking inform at ion on the differ-ent t rends and policies followed around the globe must

review a large set of independent m aterials to ret r ieve responses to queries. The void on a concise, updated, and thorough source of postgraduate or thodont ic pro-gram structures around the globe calls for a book, w hich would:

1. serve as a reference source of the variat ion of ortho-dont ic educat ion worldw ide, present ing the individu-al characterist ics of various program curricula;

2. include the updated in ternat ional, regional, or nat ion-al guidelines on recognit ion or accreditat ion criteria of health authorit ies, professional organizat ions, and scient ific societ ies;

3. list all m ajor object ives for postgraduate or thodont ic educat ion and or thodont ic specialt y recognit ion; and

4. feature a self-assessm ent guide for in ternal accredita-t ion based on previous published work.

The t it le of the book was selected w ith dental stu-dents or dent ists seeking postgraduate educat ion in or thodont ics prim arily in m ind. Currently, there are hundreds of program s available in the English lan guage in Europe, North Am erica, Asia, the Middle East , and Oceania. Many postgraduate program s in non-English speaking count ries seek to prom ote their profile in the prospect ive postgraduate student m arket w hile at the sam e t im e offering program s in the English language. This wealth of inform at ion is now, w ith th is publicat ion , available to th is group of colleagues w ho are in terested in pursuing specialt y educat ion in orthodont ics, as well as to orthodont ic specialists, m ainly academ ics, research-ers, and clin ical faculty, w ho are in terested in acquir ing knowledge on the subject and fam iliarizing them selves w ith the current state of or thodont ic advanced educa-t ion worldw ide.

With regard to the lat ter group of potent ial readers, the book also relates advanced or thodont ic educat ion w ith the rest of dental specialt y program s, as well as undergraduate or thodont ic curr icula, and addresses the relevant educat ional roles of new technologies, cont i-nuous professional developm ent , scient ific journals, and research .

Finally, academ ics, organizat ions, societ ies, and groups funct ioning in the w ider field of organized den-t ist ry would also find in th is text a valuable reference guide on the topic.

The contents of such a publicat ion could not be all-inclusive w ith regard to the presentat ion of exist ing

high-level advanced or thodont ic program s in the various countries around the world. However, the editors believe that the regions, countries, organizat ions, and inst itu -t ions presented by the extrem ely qualified and prom i-nent cont r ibutors of the various chapters surely provide a very representat ive global perspect ive.

It should be kindly acknowledged that the t rust and com m itm ent to the aim s of th is publicat ion by Thiem e m ade possible the m aterializat ion of th is project . How-

ever, the authorship of all h igh-m erit chapters by the prom inent and in ternat ionally recognized exper ts de-serves the expression of deep grat itude and sincere appreciat ion by the editors.

Theodore Eliades, DDS, MS, Dr Med Sci, PhD, FRSC, FIMMM, FRSM, FInstP

Athanasios E. Athanasiou, DDS, MSD, Dr Dent

Preface ix

x

ContributorsAt h an asios E. At h an asiou , DDS, MSD, Dr Den tAct ing Dean , Professor, and Program Director in

Or t hodont ics Ham dan Bin Moham m ed College of Dent al MedicineMoham m ed Bin Rash id Un iversit y of Medicine and

Health SciencesUn ited Arab Em iratesProfessor, Department of Orthodontics, Faculty of DentistrySchool of Health Sciences, Ar istot le Un iversit y of

Thessalon ikiThessalon iki, Greece Form er Dean , School of Dent ist r y, Ar istot le Un iversit y

of Thessa lon ikiForm er Chair and Program Director, Depar t m ent

of Or thodont ics, School of Dent ist r y, Ar istot le Un iversit y of Thessalon iki

Past President , Nat ional Academ ic Recogn it ion In form at ion Center, Hellen ic Min ist r y of Educat ion

Im m ediate Past President , World Federat ion of Or t hodont ist s

Past President , Eu ropean Federat ion of Or t hodont icsPast President , Greek Or thodont ic Societ yHonorar y Editor, Hellen ic Or thodont ic Review

Dirk Bist er, MA, FDS (RCSEd in), FDSOr t h , MOr t h (RCSEd in), MSc, Dr. m ed . den t ., Dr. m ed ., FHEA

Con su lt ant in Or thodont icsGuy’s and St . Thom as’ Foundat ion TrustLondon , Un ited Kingdom

Mau ro Cozzan i, DMD, CAGS, MScDProfessor of Or thodont ics and Gnat hologyUn iversit y of Cagliar i, School of Dent al MedicineCagliar i, It a lyDiplom ate, Am er ican Board of Or thodont icsMem ber, Eu ropean Board of Or t hodont ist sPresident , Eu ropean Board of Or thodont ist sPresident , In ternat ional Scient ific Com m it tee UOC

Odontoiat r ia “Ist it u to Gian n ina Gaslin i” and “Galliera Hospit al,”

Genoa, It a lyPast President , It a lian Associat ion of Specialist s in

Or t hodont icsPast President , It a lian Academ y of Or thodont icsPast President , It a lian Board of Or thodont ics

Su san J. Cu n n in gh am , Ph D, BCh D, FDSRCS(Or t h), MSc, MOr t h RCS, FHEA

Professor/Honorar y Con su lt ant in Or thodont icsProgram m e Director MClin Dent in Or thodont icsUn iversit y College London , East m an Denta l In st it uteLondon , Un ited Kingdom

Director of Educat ion , Br it ish Or thodont ic Societ y Honorar y Secret ar y, Eu ropean Or t hodont ic Societ yForm er Chair of t he Specialt y Advisor y Com m it tee for

Or thodont ics in Un ited Kingdom

Oyk u Da lci, DDS, Ph D Sen ior Lect u rer, Discipline of Or thodont icsUn iversit y of Sydney, Facu lt y of Dent ist r ySydney, Aust ralia

M. Ali Daren deliler, DDS, Ph D, Dip . Or t h ., Cer t if. Or t h ., DDSc, PD, FICD, MRACDA (Or t h)

Professor and Chair, Head of Depar tm ent , Discipline of Or thodont ics

Facu lt y of Dent ist r y, Un iversit y of SydneySydney, Aust ra lia

Ch r ist in a B. DeBiase , MA, Ed DProfessor and Associate Dean for Academ ic and

Postdoctoral Affairs School of Dent ist r y, West Virgin ia Un iversit yMorgantow n , West Virgin ia , Un ited St ates

Th eodore Eliades, DDS, MS, Dr Med Sci, Ph D, FRSC, FIMMM, FRSM, FIn st P

Professor and Director, Clin ic of Or t hodont ics and Paed iat r ic Dent ist r y

Center of Dent al Medicine, Un iversit y of Zu r ichZur ich , Sw it zerlandForm erly Associate Professor, Depar tm ent of

Or thodont ics, School of Dent ist r y, Ar istot le Un iversit y of Thessalon iki, Greece

Editor-in -Ch ief, Jou rnal of Dent al Biom echan icsAssociate Ed itor, Am er ican Jou rnal of Or thodont ics

and Dentofacial Or thoped ics Associate Ed itor, Eu ropean Jou rnal of Or t hodont icsAssociate Ed itor, Progress in Or thodont ics

Hen r y W. Field s, DDS, MS, MSDProfessor and Vig/William s Endow ed Division Chair in

Or thodont icsOh io St ate Un iversit y, College of Dent ist r yCh ief, Sect ion of Or thodont ics, Depar tm ent of Dent ist ryNat ionw ide Ch ild ren’s Hospit al Colum bus, Oh io, Un ited St atesForm er Dean , Ohio State Universit y, College of Dent ist ryForm er Vice Chair of t he Com m ission on Dent al

Accred it at ionForm er Chair of t he Cou ncil on Govern m ent Affa irs,

Am er ican Denta l Associat ion

Ju lia F. de Har fin , Ph DProfessor and Chair, Or thodont ic Depar t m entMaim on ides Un iversit yBuenos Aires, Argen t inaPast President , Argent ine Societ y of Or thodont ist s Past President , Latin American Association of OrthodontistsForm er Mem ber of t he World Federat ion of

Or thodont ist s Execut ive Com m it tee

Jack ie Hit t n er, MA, MBALibrary Ser vices Manager, Charles R. Baker Mem or ial

Library Am er ican Associat ion of Or thodont ist sSt . Lou is, Missour i, Un ited St atesIm m ediate Past President , Midcont inent al Chapter of

t he Medical Librar y Associat ion Past President , St . Lou is Medical Librar ian s

Hassan Kassem , BDS, MScAssist an t Lect u rer, Depar t m ent of Or t hodont icsAlexandr ia Un iversit yAlexandr ia , Egypt

Om P. Kh arban d a , BDS, MDS, MOr t h RCS Ed in , MMed , FDS RCS Ed in Hon , FAMS

Professor and Head , Departm ent of Orthodont ics and Dentofacial Deform it ies

Cent re for Dent al Educat ion and Research , All Ind ia In st it u te of Medical Sciences

New Delh i, Ind iaFellow Ind ian Board of Or thodont ics, Hon CausaPresident Elect , Ind ian Societ y for Denta l Research /

In ternat ional Associat ion of Denta l Research Ind ia Division

Consu ltant Editor, Journal of Indian Or thodont ic Societ yPast Ch ief Ed itor, Jou rnal of Ind ian Or thodont ic Societ yPast President , Ind ian Or t hodont ic Societ y Past President , Ind ian Cleft Lip Palate and Cran iofacial

Associat ion

St avros Kilia r id is, DDS, Odon t Dr/Ph DProfessor and Chairm an , Depar t m ent of Or t hodont icsUn iversit y of GenevaGeneva, Sw it zerlandForm er Professor and Chairm an , Depar t m ent of

Or thodont ics, Un iversit y of Athen s, GreeceMem ber of t he Cou ncil of t he Net w ork of Erasm us

Based Eu ropean Or thodont ic Program s

An n e Mar ie Ku ijp er s-Jagt m an , DDS, Ph D, FDSRCSEn gProfessor Em er it u s of Or t hodont ics, Depar t m ent of

Or thodont ics and Cran iofacial BiologyRadboud Un iversit y Medical CenterNijm egen , The NetherlandsDeput y ProfessorUn iversit as Indonesia , Facu lt y of Dent ist r yJakar t a , Indonesia

Mem ber of t he Council of t he Net w ork of Erasm us Based European Or thodont ic Program s

Councillor of t he World Federat ion of Or t hodont ist sEditor-in-Ch ief, Or thodont ics and Cran iofacial ResearchForm er Chair, Depar t m ent of Or thodont ics and

Cran iofacial Biology, Radboud Un iversit y Medical Center

Form er Head , Cleft Palate Cran iofacial Cent re Radboud Un iversit y Medical CenterPast President , Eu ropean Or thodont ic Societ yPast President , Dutch Associat ion for t he St udy of

Or thodont icsPast President , Dutch Cleft Palate Craniofacial Associat ionPast Chair, Cent ral Board for Dent al Specialist s in t he

Netherlands

Kee-Joon Lee, DDS, MS, Ph DProfessor, Depar t m ent of Or thodont icsYon sei Un iversit y, College of Dent ist r ySeou l, Sout h KoreaSecret ary, Korean Associat ion of Cleft Lip and PalateEditor-in -Ch ief, Jou rnal of Korean Dent al Science

Jiu -Xian g Lin , DDS, MS, Ph DProfessor, Depar t m ent of Or thodont ics Peking Un iversit y, School and Hospit al of Stom atologyBeijing, Ch inaPast Vice-President , Peking Un iversit yPast President , Ch inese Or thodont ic Societ y

Fraser McDon ald , BDS, MSc, MA, Ph D, MOr t h , FDSRCS (Ed in bu r gh & En glan d), CSci, CBiol, FSB

Head , Depar t m ent of Or t hodont icsKing’s College London Dent al In st it u teLondon , Un ited KingdomExam inat ion Lead , Facu lt y of Dent al Su rger yRoyal College of Su rgeon s of Ed inburghEdinbu rgh , Un ited Kingdom

G. How ard Moody, BDS, FDSRCSEd , Ph D, FRC Pat h , DFM, FRCSEd (ad h om in em )

Facu lt y AdviserBah rain Postgraduate Denta l CollegeAdilya, Bah rainCon su lt ant Oral Pathologist (ret ired) and Foren sic

Odontologist to t he Crow n Office, Scot landForm er Vice-Dean , Secret ary, Exam inat ion Convener,

Chair of SAB in GDS and Mem ber of Cou ncil, Royal College of Su rgeon s of Ed inbu rgh

Sh a zia Naser-Ud-Din , Ph D, MSc, BDS, CFD, DPHDen t , FICCDE, DCPSP-HPE, MOr t h RCSEd in

Assist ant Professor of Or thodont icsHam dan Bin Moham m ed College of Denta l MedicineMoham m ed Bin Rash id Un iversit y of Medicine and

Health SciencesDubai, Un ited Arab Em irates

Contributors xi

Form er Discipline Lead Or thodont ics, School of Dent ist r y, Un iversit y of Queensland, Aust ralia, Br isbane, Queen sland , Aust ralia

Pet er Ngan , DMDProfessor and Chair, Depar t m ent of Or thodont icsSchool of Dent ist r y, West Virgin ia Un iversit yMorgantow n , West Virgin ia , Un ited St ates

Alexan d ra K. Papadop ou lou , DDS, MSc, Dip . Or t h , Ph DSen ior Lect u rer, Discipline of Or thodont icsFacu lt y of Dent ist r y, Un iversit y of SydneySydney, Aust ralia

You n g Ch el Pa rk , DDS, Ph DProfessor Em er it u s of Or thodont ics Yon sei Un iversit y, College of Dent ist r ySeou l, South KoreaForm er Dean , Yon sei Un iversit y, College of Dent ist r yForm er President , Korean Associat ion of Or thodont ist sForm er President , World Im plant Or thodont ic

Associat ion

Per t t i Pir t t in iem i, DDS, Ph D, Dr Or t h odProfessor and Chair, Depar t m ent of Oral Developm ent

and Or t hodont icsDean , Division of Oral Health ResearchMedical Facu lt y, Un iversit y of Ou luCh ief Dent istMedical Research Center, Un iversit y Hospit al of Ou luOu lu , Fin landMem ber of t he Council of t he Net w ork of Erasm us

Based Eu ropean Or thodont ic Program s Form er Dean , In st it u te of Dent ist r y, Un iversit y of Ou luPast Presiden t , Or t hodont ic Sect ion of Fin n ish Dent al

Societ y

David L Tu r p in , DDS, MSDMoore/Riedel Professor, Depar t m ent of Or thodont icsUn iversit y of Wash ington , School of Dent ist r ySeat t le, Wash ington , Un ited St atesEditor Em er it u s, Am er ican Jou rnal of Or thodont ics and

Dentofacial Or t hoped icsPast Ed itor, Angle Or thodont istMem ber, World Federat ion of Or thodont ist s Execut ive

Com m it tee

Jam es L. Vaden , BA, DDS, MSProfessor and Form er Chairm an , Depar t m ent of

Or thodont icsUn iversit y of Ten nessee Health Science CenterMem ph is, Ten nessee, Un ited St ates

Xu e-Don g Wan g, SMD, Ph DOr thodont ic Specialist and Research Assist ant ,

Depar t m ent of Or thodont icsPeking Un iversit y, School and Hospit al of Stom atologyBeijing, Ch ina

Fran k Weilan d , DMD, Ph DAssociate Professor, Depar t m ent of Or thodont icsMedical Un iversit y of Vien naVien na, Aust r iaIm m ediate Past President , Eu ropean Board of

Or thodont ist s

William A. Wilt sh ire , BCh D, BCh D(Hon s), MDen t , MCh D(Or t h), DSc, FACD, FRCD(C)

Professor and Head , Depar t m ent of Prevent ive Dent al Science

Professor, Head and Program Director, Division of Or thodont ics

Un iversit y of Man itoba, College of Dent ist r yWin n ipeg, Man itoba, CanadaForm er Professor and Head, Departm ent of Orthodont icsUn iversit y of Pretor ia , Facu lt y of Dent ist r y Johan nesburg, Republic of South Afr icaChair, Canad ian Council of Graduate Or t hodont ic

Program DirectorsChair, Council on Or thodont ic Educat ion of t he

Am er ican Associat ion of Or thodont ist sPresident , Societ y of Or t hodont ic Educators of t he

Am er ican Associat ion of Or thodont ist s

Tian Min Xu , DDS, Ph DProfessor, Depar t m ent of Or t hodont icsPeking Un iversit y, School and Hospit al of Stom atologyBeijing, Ch inaVice Secret ar y General, Ch inese Stom atologica l

Associat ionPast President , Ch inese Or t hodont ic Societ y

Abbas R. Zah er, BDS, MS, Ph DProfessor and Chairm an , Depar t m ent of Or t hodont icsFacu lt y of Dent ist r y, Alexandr ia Un iversit yAlexandr ia , EgyptForm er Vice-Dean , Facu lt y of Dent ist r y, Alexandr ia

Un iversit y, Alexandr ia , EgyptPresident , Egypt ian Or thodont ic Societ yIm m ediate Past Vice-President , World Federat ion of

Or thodont ist s

Yan -Hen g Zh ou , DDS, Ph DProfessor and Chairm an , Depar t m ent of Or t hodont icsPeking Un iversit y, School and Hospit al of Stom atologyBeijing, Ch inaPresident , Ch inese Or thodont ic Societ y

Contributorsxii

1

Historical Aspects of Postgraduate Orthodontic Curriculum Formulation: Preceptorships and School CurriculaJames L. Vaden and Jackie Hit tner

Form al dental educat ion began in Am erica in 1839. The Balt im ore College of Dental Surgery was established, the rst periodi-cal devoted to dent ist ry was published, and the Am erican Society of Dental Surgeons was organized—all in 1839.1

Chapin A. Harris lectured on irregu-larit ies of the teeth at the Balt im ore Col-lege of Dental Surgery, but it was not unt il after 1857 that or thodont ia was taught as a special subject at the college.2 Henry Bliss Noble, an 1857 graduate of the Balt im ore College of Dental Surgery, although a gen-eral pract it ioner of dent ist ry, in som e sm all m easure m ade a specialt y of correct ing irregularit ies of the teeth , and he becam e a special lecturer on the subject at the col-lege and also in the dental departm ent of Colum bia Universit y.3

The or thodont ia that was to becom e a specialt y did not em erge unt il Norm an Kingsley, know n as the father of orthodon-t ia, began in 1858 to publish occasional papers on regulat ing the teeth . As early as 1872, he lectured to students on the causes and correct ion of m alocclusion, st ressing the funct ional as well as the aesthet ic value of or thodont ic t reatm ent . His greatest con-t ribut ion to the advancem ent of orthodon-t ia as a science was that he gathered up all the loose ends of or thodont ia and placed them on a rm er basis. Kingsley m ade extensive use of vulcanite plates as retain-ers. He st ressed the im portance of ne m odels, claim ing r ightly that they carry m ore convict ion than any am ount of talk,

1

and was the rst to recognize that success-ful or thodont ia lies in retent ion. He advo-cated a broader educat ion for dent ists.4

The rst textbook on or thodont ia appeared in 1889, w hen Sim eon H. Guil-ford,5 at the request of the Nat ional Asso-ciat ion of Dental Facult ies, w rote a book for the student , not for the pract it ioner. Guil-ford was at the t im e teaching or thodont ia to students of the Philadelphia Dental Col-lege. The course at Philadelphia Dental Col-lege was ent irely didact ic and included no clin ical work.

As the dental colleges cont inued their in terest in or thodont ia, m ore m en becam e in terested in the eld, and m ore papers on the regulat ion of the teeth appeared in the literature. In 1888, Eugene S. Talbot published a book ent it led Irregularit ies of the Teeth and Their Treatm ent ,6 w hich went th rough several edit ions and becam e a standard textbook. Talbot dwelt on the causes of m alocclusion and went so far as to say that , w ithout knowledge of et iology, no one could successfully correct deform i-t ies of the jaws.

In 1886, Edward Hartley Angle read a paper, “Irregularit ies of the Teeth,” before the Minneapolis Dental Society.1 In 1888, he read another paper, “The Angle System of Regulat ing Teeth,” before the Ninth Inter-nat ional Medical Congress. In the sam e year, the rst edit ion of his book, Malocclusion of the Teeth, was published.4 The book went through seven edit ions; the last one pub-lished in English appeared in 1907.7

Orthodontic Postgraduate Education: A Global Perspect ive2

Angle went to the Nat ional Dental Asso-ciat ion m eet ing at Niagara Falls in 1899. At that m eet ing, he succeeded in get t ing four young m en to spend three weeks w ith h im in his o ce in St . Louis. There, he was able to divorce h im self from the handicaps of the dental colleges and to surround him -self w ith young m en w ho were w illing to study or thodont ia in the broad and thor-ough m anner that he had outlined for them . This was the hum ble beginning of the Angle School of Orthodont ia.4 It was the rst postgraduate school to be estab-lished. From that t im e, Dr. Angle conducted a school every year unt il 1911. As a result , there were, in 1911, approxim ately 150 m en devot ing their t im e to the pract ice of orthodont ia.

Each year, Dr. Angle added to h is course such subjects as he thought im portant to the students of or thodont ia. He was aided by h is close fr iend, Edm und Wuerpel, an ar t-ist and teacher of renow n. Form er students w ho showed special abilit ies were added to h is sta . Within a few years, he was receiv-ing m ore applicants for h is course than he was able to accept . So great was the in terest in or thodont ia that in 1911, he had received m ore than 300 applicat ions for h is course and could accept only 23 of them . Ill health caused him to discont inue h is courses after 1911. However, w hen he regained his health , he again star ted to teach. He m oved to Pasadena, California, and restarted the Angle College of Orthodont ia.1

After the success of the Angle School, several other postgraduate schools of or th-odont ia were established. The In terna-t ional School of Orthodont ia was founded in Kansas City, Missouri, and in 1912, Mar-t in Dewey, an early student of Dr. Angle’s, star ted the Dewey School of Orthodont ia in St . Louis, Missouri. Both of these schools m ore or less followed the pat tern of the Angle School.

Beginning about 1907, the in uence of the m any m en w ho had at tended the post-graduate schools began to be felt in the 50 or m ore dental schools in the country. One by one, they added m en t rained in or th -odont ia to their facult ies, and full courses in or thodont ia were o ered to the dental

students. Lectures were given during the senior year, but lit t le of a technical nature was taught . In som e schools, sim ple cases were t reated in the clin ic. For the m ost par t , the courses were inadequate, and the stu-dents st ill looked upon them as a necessary evil. Progress was m ade, but it was slow.8

In 1922, New York Universit y and Colum bia Universit y, both in New York City, began teaching graduate or thodont ics—at Colum bia under the leadership of Leum an M. Waugh (1877–1972), w ho was also a founder of the dental school itself. A self-taught or thodont ist from Canada, Waugh had an illust r ious career in teaching and dental polit ics. He headed the or thodont ic departm ent from 1917 to 1945. He helped found the In ternat ional Associat ion of Den-tal Research (1920), of w hich he was later president . As president of the Am erican Society of Orthodont ists (1935), he was instrum ental in organizing the associat ion in to const ituent societ ies.9

Three m ore schools opened in 1923. Each was associated w ith an im portant person in or thodont ic h istory. A. LeRoy Johnson (1881–1967; Angle School, 1909) w rote “Basic Principles of Orthodont ics,” w hich was considered one of the best expo-sit ions of or thodont ic biology of its t im e. It in uenced schools to lim it undergraduate educat ion to the fundam entals of occlu-sion, diagnosis, et iology, and classi cat ion . Many schools closed their or thodont ic clin -ics. Also as a result of th is ar t icle, Johnson was asked to open one of the rst m aster’s program s in or thodont ics, at the Universit y of Michigan, w here he was appointed pro-fessor of or thodont ics. As such, he becam e the rst full-t im e or thodont ic teacher.10

John V. Mershon (1867–1953; Angle School, 1908) was head of orthodont ics at the University of Pennsylvania from 1916 to 1925. When he took over the newly form ed graduate departm ent , he t ried to present orthodont ics from the biological rather than the m echanical view point . His extensive teaching, including at the Dewey School, was done gratuitously. His study of the relapse phenom enon led to his m em orable quote, “You can m ove teeth to w here you th ink they belong; nature w ill place them

1 Historical Aspects of Postgraduate Orthodontic Curriculum Formulation 3

to Angle in in uencing the developm ent of or thodont ics on the West Coast .15

However, Spencer R. Atkinson (1886–1970; Angle School, 1920) was chosen to head the new departm ent . Orthodont ist , teacher, inventor, innovator, anatom ist , and skilled photographer, Atkinson was origi-nally a children’s den t ist . After studying anatomy and anthropology, he was invited to teach anatomy at the Angle School in Pasadena, w here he becam e a student and then superin tendent . Atkinson’s in terest in the grow th and developm ent of the head led to a collect ion of som e 1,400 skulls, w hich are now housed at the Universit y of the Paci c School of Dent ist ry. He origi-nated the term key ridge.16

The Am erican Associat ion of Ortho-dont ists was founded in 1900 by a sm all group of ve dedicated m en. By 1953, it had grow n to nearly 1,400 m em bers. The parent associat ion was divided into eight const ituent societ ies w ith nam es indicat ive of their geographic areas. Mem bership in the associat ion was by elect ion at the con-st ituent society level, and each society set its ow n requirem ents and quali cat ions. As a consequence, Am erican Associat ion of Orthodont ists m em bership varied consid-erably throughout the ent ire organizat ion. It included those w ho had received graduate or postgraduate t raining at the university level and others w hose t raining consisted of instruct ion in proprietary schools or in short-term preceptorships. There was also the “self-t rained” orthodont ist and occa-sionally the one w hose only evidence of competence was his statem ent that he was an orthodont ist . If pressed, he would pro-duce his professional card or let terhead as “proof” of his status.17

As the associat ion grew in num bers, it becam e m ore m ature, and w ith th is m aturit y there cam e a realizat ion that the requirem ents for m em bership should be standardized. With th is in m ind, the Great Lakes Society of Orthodont ists in t roduced the follow ing resolut ion at the 1953 m eet-ing of the associat ion’s board of directors in Dallas:

RESOLVED: That the Executive Coun-cil of the Am erican Association of Ortho-

w here they w ill best adapt them selves to the rest of the organism .”11 The third school, Northwestern University, opened its gradu-ate departm ent under Charles R. Baker (1880–1970), an orthodont ist in Evanston, Illinois, w ho also gained recognit ion as a w riter, h istorian, editor, and librarian. His library becam e the nucleus of the Am erican Associat ion of Orthodont ists’ library that now bears his nam e.12

The im petus to establish a graduate departm ent in the College of Dent ist ry at the Universit y of Illinois cam pus in Chicago cam e from Frederick B. Noyes (1872–1961; Angle School, 1908). In 1929, as dean of the dental college, Noyes sought to establish a departm ent that would carry on Angle’s ideals. The Angle College had closed two years earlier, and the profession’s leaders—concerned about the fu ture of or thodon-t ics—were asking, “How can we keep the study of our specialt y out of the hands of the m echanist ic ‘diplom a m ills’”?13

The answer, as far as Noyes was con-cerned, was to place the depar tm ent under the leadership of Allan G. Brodie (1897–1976; Angle College, 1927), one of Angle’s last graduates and one of h is favorites (Angle and close fr iends called h im “Steve”). Brodie had been out of school only two years, but h is w rit ing and speaking abili-t ies and h is grasp of the edgew ise appli-ance had catapulted him to the posit ion of spokesm an for the “new m echanism ” and placed him at the forefront of or thodont ic educat ion .14

The rst graduate or thodont ic pro-gram on the West Coast began in 1934 at the Universit y of Southern California School of Dent ist ry, the only dental school in southern Californ ia at the t im e. Since 1910, an undergraduate departm ent had existed there under the direct ion of Profes-sor of Orthodont ics and Radiology Jam es D. McCoy (1884–1965; Angle School, 1905). He and his brother, John, pioneered or th-odont ic o ce design in their showcase o ce on Wilshire Boulevard in Los Angeles, installing one of the rst X-ray units (1908). McCoy w rote two textbooks and m ore than 100 ar t icles. A dynam ic, sought-after speaker and raconteur, he was second only


This was to becom e e ect ive two years after the date of adopt ion. It was read at the 1954 general m eet ing of the associa-t ion, but to com ply w ith the bylaws, it had to be postponed for nal act ion at the next session of the associat ion . It was therefore scheduled for the San Francisco m eet ing in 1955.

At the rst general business m eet ing of the associat ion in 1955, the am end-m ent proposed at the previous m eet ing in 1954 was presented for considerat ion . After lengthy discussion, a vote was taken and the am endm ent , as in t roduced, was adopted. But there were m any w ho were not com pletely content w ith the am end-m ent . At it s next m eet ing two days later, the board of directors accepted a new m ot ion that a special com m it tee be appointed to again consider educat ional requirem ents for m em bership in the Am erican Associa-t ion of Orthodont ists.

The report of th is special com m it tee was presented at a general business m eet-ing of the associat ion in Boston in 1956. The port ion applicable here reads as follows:

Five years in exclusive practice of orthodontics, at least three consecutive years of w hich shall have been in the o ce of, and in full tim e association w ith, a practicing m em ber of the Am erican Association of Orthodontists. This prac-ticing m em ber shall have been an active m em ber of the Am erican Association of Orthodontists not less than eight years. The applicant m ust be recom m ended by tw o active m em bers of the Constituent Society in w hose jurisdiction he intends to practice .18

This report was adopted in the form of an am endm ent to the bylaws, and as such was referred for nal act ion to the 1957 session of the associat ion . The business m eet ings of the 1957 Am erican Associa-t ion of Orthodont ists general assem bly in New Orleans are st ill rem em bered as pos-sibly the m ost content ious in the h istory of the associat ion , because w hen the 1956 am endm ent was referred to the 1957 ses-sion for nal act ion , each side was fully pre-pared to defend its posit ion .

dontists be urged to appoint a special or standing com m ittee to study m ethods of training orthodontists and to m ake sug-gestions to Constituent Societies which would lead toward uniform ity of training and the raising of standards of require-m ents for m em bership in the Constituent Societies, and also be instructed to rec-om m end additions or alterations to the constitution (bylaws) calling for higher requirem ents for m em bership from tim e to tim e .18

The com m it tee was duly appointed, w ith each const ituent society represented. The seed for a supervised preceptorship program had been planted; germ inat ion would be a long, adventurous, and at t im es hazardous process.

1.1 Seeking a Solution to Training Programs for More OrthodontistsAfter a year of in tensive work and extensive correspondence, the report of the com m it-tee was presented at the rst m eet ing of the board of directors in Chicago in 1954. Dis-cussion cont inued throughout the m orn-ing and afternoon. No conclusion could be reached. The m eet ing adjourned w ith the request that the com m it tee renew its e or ts in an at tem pt to arr ive at an accept -able solut ion . The second m eet ing of the board of directors was alm ost a repet it ion of the rst . Finally, after listening to both a m ajorit y and a m inorit y report from the com m it tee, the board voted to subm it the follow ing am endm ent to the bylaws at the next general m eet ing of the associat ion:

RESOLVED: A person w ho has been in the exclusive practice of orthodon-tics for at least three years, and w ho has successfully com pleted an orthodontic course of a m inim um of 1,500 hours in an approved dental school, and w ho is a m em ber in good standing in his local, state, and national organization, m ay be elected to active m em bership through the Constituent Society. He m ust be rec-om m ended by two active m em bers.18


to acquire a basically sound foundat ion in clinical orthodontics. Both the nat ional and const ituent society com m it tees realized that only through intensive supervision of his t raining could the preceptee be assured that , upon the successful complet ion of his course, he would be a competent ortho-dontist eligible to apply for m em bership in the Am erican Associat ion of Orthodontists and cert i cat ion by the Am erican Board of Orthodont ics.

1.3 Uniform Standards Set for All Constituent Societies18

From the beginning, the com m it tees recog-nized that upon com plet ion of their t rain-ing, preceptees would theoret ically have a clin ical advantage over their un iversit y-t rained contem poraries, but that the lat ter would have a m ore in t im ate knowledge of the basic sciences that are so fundam ental to the scient i c progress of or thodont ics.

To facilitate the work of the const itu-ent society qualifying com m it tees, it was essent ial that there be an established proce-dure that would be followed by all qualify-ing com m it tees and that there be m inim um curricular requirem ents that would be com m on and acceptable to all const ituent societ ies. It was to be two years before the nat ional com m it tee could report that all of the const ituent societ ies had arrived at the “standard level of acceptance” dem anded by the Am erican Associat ion of Orthodon-t ists board of directors. After this had been accomplished, the board authorized the grant ing of cert i cates to those w ho had successfully completed their t raining in the supervised preceptorship program .

The rst class to qualify nished in 1961, and the last in 1970. There were a total of 266 graduates of the program , w ith the fol-low ing distribution at the const ituent soci-ety level: Southwestern Society 76, Paci c Coast Society 30, Southern Society 53, Mid-western Society 23, Middle Atlantic Society 32, Great Lakes Society 17, Northeastern Society 31, and Rocky Mountain Society 4.

1.2 Could the Schools Meet the Demand?18

Discussion was in tense, vigorous, and force-ful. A review of the argum ents shows that advocates of the policy of lim it ing m em ber-ship to un iversit y-t rained m en believed (1) that or thodont ics had achieved such rec-ognit ion as a specialt y that the Am erican Associat ion of Orthodont ists could no lon -ger a ord to accept as m em bers applicants w ho had not received form al t rain ing at the universit y level and (2) that su cient in ter-est was being show n by the dental schools so that , in a short t im e, there would be a balance between supply and dem and.

Those w ho favored the acceptance of preceptorship t rain ing m aintained (1) that there were not enough or thodont ists to sat isfy the dem and and that , if past h istory was any criter ion , it would be m any years before the schools would be of m uch help and (2) that there were m any com petent dent ists w ho wanted to enter the specialt y but w ho could not m eet the t im e require-m ents of the graduate schools. These m en were also worthy of, and ent it led to, our considerat ion .

As the vote was taken and the ballots counted, the result was in favor of form al t rain ing by the narrow m argin of 189 to 186. At the second m eet ing of the asso-ciat ion , two days later, a vote for recon-siderat ion was successful, and Am erican Associat ion of Orthodont ists m em bers favoring a supervised preceptorship as a sat isfactory educat ional requirem ent were the victors by a m ajorit y of 166 to 43.

The 1957 board of directors delegated the responsibilit y for developing th is newly accepted program to a nat ional “m aster” qualifying com m it tee. The m em bers of th is com m it tee were to be the chairm en of the regional qualifying com m it tees of the eight const ituent societ ies. In ret rospect , a signif-icant contr ibut ing factor to the success of the program was the relat ive perm anence of the personnel of the m aster com m it tee over the next 12 years.

The principal object ive of this con-trolled educational experim ent was to pro-vide an opportunity for those part icipating


qualifying com m ittee of the Am erican Association of Orthodontists, and (3) the board of directors of the Am erican Asso-ciation of Orthodontists, whose decision shall be nal.

G. The preceptor w ill be perm it ted to have only one preceptee in t rain ing at any given t im e.

H. The preceptor shall le w ith the qualify-ing com m it tee a detailed outline of the course of inst ruct ion that he proposes to give the preceptee. This outline m ust be approved by the qualifying com m it-tee of the const ituent society.

I. The preceptee shall spend full t im e in the exclusive pract ice of or thodont ics under the personal supervision of h is preceptor (by “personal supervision” is m eant that the preceptor shall be present in the sam e o ce at all t im es that the preceptee is engaged in clin ical pract ice) except during sickness of the lat ter or w hile he is on vacat ion . Should such sickness or vacat ion be for a period longer than two cont inuous weeks, the qualifying com m it tee shall be so not i- ed. At no t im e shall the preceptee en-gage in any other t ype of pract ice, nor shall he pract ice or thodont ics outside the o ce of h is preceptor.

J. The clin ical and laboratory work of the preceptee shall be open to inspect ion by the com m it tee at all t im es.

K. Should either the preceptor or the pre-ceptee becom e dissat is ed w ith their associat ion, either or both shall have the privilege of present ing their case to the qualifying com m it tee.

L. The qualifying com m it tee shall in no case insist upon inst ruct ion in any cer tain t ype of appliance or m ethod of t reatm ent but shall put em phasis upon general or thodont ic knowledge.

M. The preceptee, upon successful com ple-t ion of eighteen m onths of t rain ing, shall be eligible for associate m em ber-ship in the const ituent society under w hose jurisdict ion he is being t rained.

N. Upon successful completion of the pre-ceptorship program , both the preceptor and the preceptee shall be so noti ed in w riting.

1.4 Preceptorship Program of the American Association of Orthodontists: Outline of Procedure and Minimum Requirements for All Constituent Societies19

1.4.1 Procedure

A. The preceptor m ust be an act ive m em -ber of the Am erican Associat ion of Or-thodontists, which m em bership m ust have been cont inuous for the previous eight years, and he m ust have been ap -proved by the qualifying com m it tee to act as a preceptor.

B. The preceptor m ust be an act ive m em -ber of the const ituent society w ith in w hose geographical area he m ain tains a full-t im e pract ice. Should the precep-tor have o ces w ith in the jurisdict ion of m ore than one const ituent society, by m utual consent of these societ ies he m ay m ake a choice.

C. Both the preceptor and the preceptee shall m ake a form al applicat ion to the qualifying com m it tee for perm ission to engage in th is program .

D. Upon receipt of th is applicat ion , a stan-dard quest ionnaire shall be sent to both the preceptor and the preceptee. The quest ions listed in the two form s are such as to give the com m it tee the basic inform at ion that it w ill require in deter-m in ing the tness of each applican t to act in h is respect ive capacit ies. These quest ionnaires are not nal, nor do they preclude the com m it tee from using other m ethods of seeking inform at ion.

E. Upon acceptance, both the preceptor and the preceptee shall be not i ed in w rit ing of the o cial date of the incep-t ion of the preceptorship.

F. Should the qualifying com m ittee of the constituent society refuse either appli-cant, said applicant shall have the right of appeal, in the follow ing order, to (1) the board of directors or other governing body of the constituent society, (2) the


lat ter to the extent given in current textbooks.

4. A w rit ten review of the literature on a subject of the preceptee’s choice.

5. Outline of thesis.

Note: De nite progress should be evi-dent at th is t im e. It is the crit ical stage in the preceptee’s developm ent .

Third-year exam inat ion to include:

1. Com prehensive exam inat ion by the qualifying com m it tee sit t ing as an exam ining board plus w rit ten exam inat ion to be based on anything pertaining to orthodontics, w ith special reference to the literature of the last 15 years.

2. Thesis. This should be subm it ted su ciently in advance to allow t im e for reading by each m em ber of the com m it tee.

3. Resubm ission of 10 cases previously show n, w ith com plete records to date, together w ith ve addit ional cases t reated by the preceptee, w ith com plete records to date.

Note: Records of all cases subm it ted should include a com plete case analy-sis, outline of t reatm ent , and retent ion. All cases show n by the preceptee should be nam ed and num bered w hen rst pre-sented. A record of these cases should be kept by the com m it tee.

The preceptorship program served its purpose. It t rained dent ists to be specialists in or thodont ics. The program was discon-t inued by the Am erican Dental Associat ion House of Delegates, but not before it had added specialist s w ho could successfully correct the m alocclusions of Am erica’s chil-dren. The program was a raging success. Evi-dence is the follow ing statem ent , w hich is an excerpt from the Report of Com m it tee B (Advanced Educat ion and Specialt ies), pre-sented at the Decem ber 8–9, 1966, m eet ing of the Council on Dental Educat ion:

The board of directors of the Am eri-can Associat ion of Orthodont ists takes de n ite pride in the success achieved

1.4.2 Minimum Requirements

The course of inst ruct ion as subm it ted by the preceptor and approved by the quali-fying com m it tee shall serve as the basic guide for the inst ruct ion of the preceptee.

The preceptee shall be examined by the qualifying committee at the end of each year of his preceptorship. The results of these examinations are to be sent to both the pre-ceptor and the preceptee w ith any recom -mendations deem ed essential to the welfare of the program.

The requirem ents listed herein are m in-im um requirem ents, and no revision of th is program shall be allowed w hich is less than those incorporated herein .

First-year exam inat ion to include:

1. Subm ission of a t ypodont w ith an appliance of choice, including auxiliaries for the t reatm ent of m alocclusions for w hich the appliance is m ost suitable.

2. Subm ission of ve cases star ted by the preceptee show ing progress to date.

3. A w rit ten review of the literature in a subject of the preceptee’s choice.

4. An oral or w rit ten exam inat ion , or both , to show a knowledge of the basic fundam entals of or thodont ics.

5. General idea and t it le of a proposed thesis, w hich m ust be acceptable to the qualifying com m it tee.

Second-year exam inat ion to include:

1. Subm ission of t ypodont w ith a second appliance of choice. The preceptee is to dem onstrate a sound working knowledge of th is appliance.

2. Resubm ission of the original ve cases show n w ith com plete records show ing progress to date. Subm ission of ve addit ional cases under t reatm ent by the preceptee w ith com plete records to date.

3. Oral or w rit ten exam inat ion , or both , to show advanced knowledge of clin ical or thodont ics and basic sciences, of the


9. Porter LJ. In m em oriam . Leum an Maurice Waugh (1877-1972). Am J Orthod 1972; 62(5):535–537

10. Cope O, Greep RO, Shaw JH, Thom pson GE, Van Leewen MJ. Mem orial t r ibute for A. LeRoy Johnson (1881-1967). Am J Orthod 1968;54(4):291–295

11. Waugh LM. Orthodont ic pro les: John V. Mershon. Am J Orthod 1958;44:699–706

12. Graber TM. Obituary: Charles R. Baker. Am J Orthod 1970;58:514–517

13. Frederick B. Noyes. Obituary. J Am Dent As-soc 1961;63:440

14. Kloehn JS. Port rait of a giant . Angle Orthod 1990;60(2):129–134

15. Pollock HC Sr. Orthodont ic pro les: Jam es D. McCoy. Am J Orthod 1964;50:918–921

16. Gawley RJ, Stoller AE. In m em oriam : Spen-cer Roane Atkinson (1886-1970). Am J Or-thod 1971;59(5):516–519

17. Wahl N. Orthodont ics in 3 m illennia. Chap-ter 3: The professionalizat ion of or tho-dont ics. Am J Orthod Dentofacial Orthop 2005;127(6):749–753

18. Hahn GW. The story of the AAO-super-vised preceptorship program . Am J Orthod 1971;60(2):189–195

19. Preceptorship program of the Am erican Associat ion of Orthodont ists: Outline of procedure and m inim um requirem ents for all const ituent societ ies. Am J Orthod 1963;49(3):215–221

20. Am erican Dental Associat ion . Council on Dental Educat ion (1966, Decem ber 8–9). Meet ing of Com m it tee B, Advanced Educa-t ion and Specialt ies. Excerpt of Report from Com m it tee B. Am erican Associat ion of Or-thodont ists, Charles R. Baker Mem orial Li-brary, St . Louis, MO

by the supervised preceptorship pro-gram of the Am erican Associat ion of Orthodont ists; however, it acquiesces to the ruling of the House of Delegates of the Am erican Dental Associat ion that no new preceptorship program be approved after January 1, 1967.20

References 1. Lew is SJ. The developm ent of or thodon-

t ic educat ion . J Am Dent Assoc 1934; 27(7):1157–1158

2. Harris CA. The Principles and Pract ice of Dental Surgery. 4th ed. Philadelphia, PA: Blakiston; 1845

3. Sim on W. History of the Balt im ore Col-lege of Dental Surgery. In : Transact ions of the Fourth In ternat ional Dental Con -gress. Vol 3. Press of the “Dental Cosm os”; 1905:290–293

4. Tweed CH. Men and Their In uence on the History of Orthodont ia. Unpublished m anu-scr ipt . Between 1950–1959. Am erican As-sociat ion of Orthodont ists, Charles R. Baker Mem orial Library, St . Louis, MO

5. Guilford SH. Orthodont ia or Malposit ion of the Hum an Teeth : It s Prevent ion and Rem -edy. 4th ed. Philadelphia, PA: Spangler & Davis; 1893

6. Talbot ES. Irregularit ies of the Teeth and Their Treatm ent . 1st ed. Philadelphia, PA: Blakiston; 1888

7. Angle EH. Treatm ent of Malocclusion of the Teeth and Fractures of the Maxillae. 7th ed. Philadelphia, PA: S. S. White Dental Manu-facturing Com pany; 1907

8. Weinberger BW. Historical resum e of the evolut ion and grow th of or thodont ia. J Am Dent Assoc 1934;23:2001–2021

9

Contemporary Orthodontic Postgraduate Programs as Related to the Rest of Dental Specialty Advanced EducationHenry W. Fields

The goal of th is chapter is to provide a con-text for and raise issues related to orth-odont ic postgraduate educat ion , in contrast to postgraduate educat ion in other den tal specialt ies. The focus is largely on the U.S. environm ent , although it is acknowledged that a vibran t system of guidelines exists in Europe through the Network of Erasm us-Based European Orthodont ic Postgradu-ate Program m es (NEBEOP).1 The m aterial is organized in to the follow ing sect ions: “Background and Early Predoctoral and Specialt y Educat ion,” “Comparison w ith Other Selected Areas of Dental Specialt y Educat ion ,” “Special Challenges to Orth-odont ic Specialt y Program s,” “Turf Wars,” and “The European Approach to Program Qualit y and Consistency.”

2.1 Background and Early Predoctoral and Specialty EducationIn the m id-1800s, in terest in or thodont ic educat ion was lim ited, w ith som e em erg-ing pract it ioners t rained m ostly in in -o ce preceptorships. As greater in terest devel-oped, m ore lectures were sporadically pre-sen ted at den tal m eet ings.

In the late 1800s, or thodont ics was in t roduced in to predoctoral curricula. Inst ruct ion began as didact ic o erings,

2

usually in the later years of school. Because of the lim ited num ber of specialist s and rest r icted t im e in pre doctoral curricula, or thodont ics, and certain ly clin ical or tho-dont ics, was not a serious factor in dental schools. Som e schools included laboratory-based exercises, and at best , clin ical obser-vat ion and dem onst rat ion occurred in the th ird or fourth year of school.2

At about the sam e t im e, Edward Angle began lecturing and w rit ing, w ith the not ion that or thodont ics should be par t of the predoctoral and graduate curricula. He was unsuccessful but subsequently devel-oped his ow n Angle School of Orthodont ia around the turn of the century. Students spent weeks to m onths at the proprietary schools that em erged, w here singular g-ures were advocates of par t icular m eth-ods and philosophies. Most notable was the Angle school in w hich resident stu-dents and a m ore diverse faculty advocated st rongly for the non-extract ion approach. Disciples of Angle taught in h is school, and others opened addit ional schools.2 Orga-nized or thodont ics began in 1900 as the Society of Orthodont ics, w hich was the precursor of the Am erican Associat ion of Orthodont ists (AAO), established in 1935.

Although Harvard–Forsyth o ered a graduate program in or thodont ics for sev-eral years in the early 1900s, New York City was the site of the rst two sustainable program s, at Colum bia Universit y and New York Universit y, in 1922. In the next several


years, m ore program s opened and spread to the Midwest and West Coast . The head of each program was a lum inary in the grow -ing eld.3

On the West Coast , an innovat ive pred-octoral program that included a st rong orthodont ic com ponent was begun to bol-ster care for children . This was “Curricu-lum II,” w hich lasted from 1929 to 1969 at the Universit y of California, San Francisco (UCSF) School of Dent ist ry. In th is pro-gram , the nal three years of dental school em phasized pediat r ic dental and orthodon-t ic didact ics and clin ical care. The gradu-ates were eligible to sit for the California State Board exam inat ion , and m ost went direct ly in to or thodont ic specialt y prac-t ice.4 Curriculum II, a predoctoral program w ith graduate content , was an anom aly in specialt y educat ion w ith a unique n iche.

Specialt y educat ion took several form s—graduate program s, postgraduate program s, and preceptorships. The gradu-ate program s o ered didact ic and clin ical educat ion and led to a degree. The post -graduate program s provided an ongoing sequence of educat ion, on less than a full-t im e basis in som e instances, and awarded a cert i cate upon com plet ion . A new con-cept in or thodont ic educat ion developed in the 1950s, w hich was designed to produce m ore well-t rained or thodont ists unt il the universit y-based t rain ing capacity was suf- cient to m eet dem and. The AAO precep -tor program prepared clin ical candidates from 1961 to 1970, and or thodont ists were t rained in private pract it ioners’ o ces in a prescript ive three-year program w ith exact ing protocols.5

When one considers the h istory of the evolut ion of or thodont ic educat ion , it becom es clear how a profession could grow, ow, and turn w ith the ideas and views of a selected few individuals. Early form al edu-cat ion st ruggled. St rong gures entered the picture, lled the void, and founded pro-prietary schools centered around one per-sonalit y. When graduate program s began in universit ies, only one st rong gure was required to bring the program recognit ion . The preceptor program s that followed to ll the pract it ioner void revolved around

one teacher and one pupil. All these devel-opm ents and m ethods h inged on singular gures w ith a point of view. Although som e t r ied to reinforce and advocate for the sci-ent i c basis of or thodont ics, the t radit ion began and cont inues today that a st rong personalit y w ith new or renewed ideas can alter the course of the profession in posit ive and negat ive ways. Even today, cont inuing educat ion speakers recom m end new m eth-ods, som e unproven and often underw rit-ten by or thodont ic supply com panies, to pract it ioners eager for bet ter m ethods of t reatm ent . The advocate claim s that the m ethods are successful, but that there is inadequate t im e for docum entat ion and evaluat ion . By the t im e the evidence is in hand, the advocate has m oved on and adopted another new m ethod.

Science has had a tough t im e acquir-ing a foothold, and th is has been so for the ent irety of the profession. If th is were not the case, orthodont ics would not redis-cover old ideas w ith new vigor after they had been discredited years before. How else can we account for the pendulum sw ing in controversies regarding ext ract ion versus nonextract ion , early versus late t reatm ent , and grow th m odi cat ion versus dental m ovem ent?2 If we t ru ly learned from sci-ence and our experiences, the extent of the pendulum sw ing would be reduced, and we would gradually see the pendulum begin to hover over the cent ral t ru th and not be kick-star ted again by the m ere breath of the sam e argum ent years later. This m ay also explain w hy m any of the advances we have m ade have been technical and m echanical rather than biological.

Good science is com plex, often leaving som e am biguit y regarding its generalizabil-it y and fur ther quest ions, so that there is an opening for the acceptance of “w hat works in my hands” rather than w hat rout inely has been proved to work after r igorous scien-t i c scrut iny. Acquiring an understanding of evidence-based care, even w ith a cent ral place in the advanced educat ion guidelines, in a specialt y that currently has a dear th of h igh-qualit y studies, takes careful thought and considerat ion and is not uniquely an or thodont ic dilem m a.

2 Orthodontic Postgraduate Programs for Dental Specialty Advanced Educat ion 11

and or thodont ics are two of the special-t ies generally based in outpat ient clin ical set t ings.

Since 1997, the program directors for all t ypes of educat ion m ust be board cer-t i ed.10–13 Before th is, in 1988, pediat ric dent ist ry required ve years of clin ical experience for a program director, as well as form al educat ion in teaching for resi-dents in preparat ion for their encounters w ith predoctoral students (and possibly later as faculty m em bers).14 This showed great foresight because in a num ber of inst itut ions, t itular board-cer t i ed clin i-cians were installed as program directors to m eet the let ter of the new standard. Unfortunately, board cert i cat ion did not speak to the organizat ional, educat ional, curricular, or academ ic quali cat ions of a program director. After 2008, or thodont ics did rule that before becom ing a program director, the candidate m ust have two years of teaching experience.15 There is lit t le or no evidence that th is requirem ent for board cer t i cat ion upgraded program per-form ance or outcom es because the clin ical exper t ise spoken to by board cer t i cat ion is shared by m any in the clin ical environ-m ent , although program adm inist rat ion is shared by few and not addressed by th is requirem ent . Even today, clin icians and scient ists in dent ist ry spend 6 to 10 years gain ing technical pro ciency, but essen-t ially days, if that , preparing for educat ional inst ruct ion and program adm inist rat ion .

Oral and m axillofacial surgery accredi-tat ion guidelines m ent ion the tem poro-m andibular join t area in the 1970s and or thognathic surgery in the 1980s. Ortho-dont ics was not far behind in the 1980s, but periodont ics arr ived later.9,16,17 Many of these newer inclusions take a decade to becom e m ainst ream in educat ion, after being in t roduced earlier in the pract ice set -t ing. Although it seem s to indicate resis-tance to change, the lag provides t im e to ascer tain that the newly de ned scope has scient i c underpinnings. This is probably as it should be.

Periodont ics and pediat ric dent ist ry are the two disciplines that speci cally note a need for som e level of expert ise in

After m uch debate and discussion, the Am erican Dental Associat ion (ADA) Council on Dental Educat ion proposed that dent ists w ho wanted to declare them selves special-ists in one of the areas approved by the ADA be required to com plete two or m ore years of advanced educat ion “as speci ed by the cer t ifying boards.” The ADA House of Del-egates passed such a resolut ion at the 1961 annual session, although the requirem ent did not take e ect unt il 1965.6 The earli-est such guidelines speci c to or thodont ics, dated 1963, were prepared and issued by the AAO Council on Orthodont ic Educat ion , created in 1962.7

From 1974 to 1984, the ADA Com m ission on Dental Accreditat ion (CODA) produced and issued general program requirem ents applicable to all advanced specialt y pro-gram s, to w hich the curriculum guidelines authorized by each specialt y board were appended to m ake them speci c to that specialt y. The rst such ADA-issued guide-lines for or thodont ics on le in the ADA archives are dated 1975.8 The boilerplate pream bles were speci c regarding facili-t ies, teaching responsibilit ies, research, a liated inst itut ions, resident evaluat ion , and adm issions. After 1984, CODA adopted educat ional requirem ents for curricula devised by each specialt y, and individual advanced educat ion requirem ents were the pat tern for the future.9

2.2 Comparison w ith Other Selected Areas of Dental Specialty EducationOrthodont ic advanced specialt y educat ion has evolved on a t im etable sligh tly di erent from that of som e of the other specialt ies. A brief com parison w ith several other spe-cialt ies is presented here. Oral and m axillo-facial surgery rout inely operates in hospital and outpat ient set t ings; pediat ric dent ist ry has a sim ilar set t ing, depending upon the locat ion of the program , but usually is m ore centered on outpat ient care. Periodont ics


Orthodont ics has em braced a broaden-ing of the basic sciences to include biostat is-t ics, epidem iology, genet ics, biom echanical tenets, and research m ethods. There is now a recognit ion that com plex, in terdisciplin-ary t reatm ent is often necessary, w ith m ul-t iple clin icians required. Evidence-based m ethods have recently taken root w ith the recognit ion of random ized controlled stud-ies, system at ic reviews, and m eta-analyses as the top t ier of r igor. Unfortunately, m ost or thodont ic clin ical science does not pass m uster as robust and unbiased, as m en-t ioned previously, leading som e to conclude m istakenly that any approach is just i ed because none has great science behind it .

2.3 Special Challenges to Orthodontic Specialty ProgramsThe expansion of CODA to include all spe-cialt ies enlarged the com m ission and changed its focus and st rength from pri-m arily general dent ist ry/predoctoral issues to the specialt ies.22 Previously, the m em -bers of the com m ission (ADA appointed) had been from the educat ional, den tal exam ining, and dental pract ice com m uni-t ies, supplem ented by public m em bers. The balance of the com m ission and its focus changed dram at ically w hen all special-t ies were included because the specialt ies then accounted for a larger percentage of the m em bers than any other const ituency groups. This change added a polit ical atm o-sphere to the deliberat ions.

To illust rate, after the specialt y groups were included, they caucused on issues before m eet ings so that their posit ions would be assured. This developm ent was never the in tent ion of those w ho broad-ened the base for discussion and decision m aking. In fact , or thodont ics was a m ajor player in the at tem pt to direct the delibera-t ions regarding issues.

CODA has and cont inues to st ruggle w ith issues of consistency am ong exam iners.

or thodont ic t reatm ent .18,19 Concerns about th is overlap have rarely been voiced rela-t ive to periodont ics. On the other hand, the in terface w ith pediat r ic dent ist ry has been uneven. This controversy usually becom es evident w hen the pediat r ic dent ist ry guidelines periodically undergo revision. The in tensit y of the discussions has been m it igated in recent years by the foresight of both groups. Prelim inary drafts have been shared by the groups, w hich then engage in join t conferencing w ith a focus on care-ful word choices that describe sound t reat-m ent . Coincidentally, the prevent ive and restorat ive needs of pediat ric pat ients have stabilized, w ith an in t ractable pat ien t group requir ing cont inued at tent ion . Addit ion-ally, th is young and disadvantaged group of pat ients is part of the only expanding segm ent of the populat ion gain ing access th rough public funding.20 Because of th is grow th, the pressure to nd alternat ives to restorat ive care to supplem ent pediat r ic pract ices, as was the not ion in the 1980s, has been reduced.

It appears that oral and m axillofacial surgery has been a m onitor of the num ber of cases and procedures of speci c t ypes for years. Pediat r ic dent ist ry and periodont ics have com e to docum ent t reatm ent num -bers and m aintain case logs for di erent t ypes of t reatm ent m ore recently.11,12,16 This m ethod provides assurance of adequate educat ional experience. Orthodont ics has st ressed ensuring that diversit y of t reat-m ent t ypes be em phasized but has never been prescript ive regarding case num bers and types of care provided. Given the diver-sit y of program s, m ovem ent in the direct ion of m ore accountabilit y m ay be reasonable.

Pediat ric dent ist ry and orthodontics led the way in m aking research a “m ust” requirem ent for advanced specialty educa-t ion in 1988 and 1992, respect ively.14,21 In 1997, pediatric dent ist ry required that the experience be data based.11 It is clear that oral and m axillofacial surgery has been clinically based, w hereas periodont ics has expanded its educat ional program s based on disease w ith basic science prem ises (m icrobiology and im m unology).


This seem s to be m ost popular w ith new program s and those undergoing dram at ic changes. Orthodont ics as a w hole m ust face th is issue as the num ber of program s con-t inues to expand.

Another issue that orthodont ics and possibly even dent ist ry as a w hole m ust face is that of the workforce. As m ent ioned earlier, or thodont ics is viewed as a prized specialt y profession. It at t racts m ore pro-spect ive students than there are posit ions for educat ion , and dental and nondental educat ional inst itut ions are opening pro-gram s to capitalize on th is h igh dem and. CODA and the accreditat ion process m ust hold the line for program qualit y.

As a m at ter of public policy, public inst i-tut ions can m ake determ inat ions regarding program size based on the appropriate use of public funds. Private and nondental inst i-tut ions m ore likely m ake their determ ina-t ions based on the potent ial for dem and and on revenue. For every public posit ion closed, a private one can open. Inst itut ions m ust provide only evidence of resources to support a program to just ify program size to CODA, not need.

There is no responsive and t im ely eco-nom ic system in place to react to the supply of and dem and for or thodont ic or dental pract it ioners. Oversupply can readily occur and take a decade to rem edy, w ith in terim deleterious im pact on new and old prac-t it ioners and their pract ices along w ith a negat ive external view of the profession as it t r ies to grapple w ith the situat ion .

The circum stances described here are not unique to or thodont ics; they also apply to dent ist ry. Especially at a t im e of increased scrut iny of dent ist ry by the Federal Trade Com m ission, it is di cult to m anage the workforce in an eth ical, legal, and responsible m anner. The outcom es of a workforce that has becom e deleterious to the pract it ion ers can readily be seen in veterinary m edicine. When current and future needs were evaluated against the status quo, the increase in graduates of new program s, and other potent ial scenarios, a gross and grow ing oversupply of pract i-t ioners was predicted.24 Orthodont ics and dent ist ry w ill need to face th is challenge.

Orthodont ics has left the standards open to the in terpretat ion of the site visitor, w ith guidance from the evaluators’ checklist and CODA sta . Som e specialt ies have gone to num eric procedure counts in an at tempt to reduce the site visitor’s discret ion—a direc-t ion orthodont ics should consider.

Orthodont ics faced a crit ical change in advanced educat ion w hen corporate sup -port was lent to program s and residents in exchange for access to t rain ing facili-t ies and future pract it ioners. In it ially, the bat t le was waged on the basis of the tness of nontradit ional inst itut ions to sponsor program s and on con icts of in terest , but lost on the grounds of site visit–dem on-st rated equivalent educat ional experience and outcom es. This resulted in standards in or thodont ics that scrut in ize the sources of noninst itut ional funding and it s in uence on program s and the opt ions of students follow ing graduat ion 23—a fundam ental test of the accreditat ion process.

Another dilem m a is the acceptance of residents in to the program s. Clearly, there are public and private program s w ith long and short heritages and at h igh and low points in their h istories. Orthodont ics can be port rayed as a prized specialt y w ith unlim ited personal and professional poten-t ial for those seeking adm ission. Follow ing in terviews, program s can choose either to par t icipate in the m atch system used by m edicine and a num ber of the other den-tal specialt ies or to choose and com m it prospect ive students independently. The m atch sim ply follows the rules of an algo-rithm to place students depending upon student and program ranking preferences.

The m atch was originally put in place to standardize the sequence of events and reduce deal m aking between program s and applican ts. This was especially help-ful because the applicants were in h igh-stakes, h igh-pressure situat ions and unsure of their chances for successful accep-tance. Preying on the uncer tain ty of the naïve appeared unethical and unseem ly. Although the m atch init ially helped corral quest ionable behavior, m ore schools have em braced independence from the m atch in an e or t to gain an advantage in recruit ing.


properly. Orthodont ists are now placing tem porary anchorage devices and perform -ing laser surgery for soft -t issue problem s, both of w hich procedures were originally the dom ain of the oral and m axillofacial surgery and periodontal com m unit ies. Som e or thodont ists claim expert ise in occlusal and tem porom andibular join t-related problem s and are diagnosing and t reat ing airway and sleep disturbances. The scope of pract ice of each area gradually becom es de ned as the specialt y organi-zat ions incorporate t rain ing requirem ents in to the educat ional accreditat ion guide-lines. This is an ongoing process, w ith a response that is by nature slow and m ea-sured. As new technology appears to m ake previous in tervent ions sim pler, th is t rend toward increasing the scope of dental spe-cialt ies w ill cont inue.

2.5 The European Approach to Program Quality and ConsistencyThe NEBEOP, founded in 2009, com prises a group of European or thodont ic educators w ho largely focus on or thodont ic advanced specialt y educat ion.1 As one of their act ivi-t ies, they revised the original “Three Years Postgraduate Program m e in Orthodont ics: The Final Report of the Erasm us Project ,” w hich was originally funded by the Eras-m us Bureau of the European Cultural Foun-dat ion in 1989 and nalized in 1992.25

The docum ent describes curricular guidelines for a three-year program w ith associated m inim um curriculum hours. The guidelines are com prehensive and include overall object ives, guidance for operat ions and condit ions, object ives for didact ic edu-cat ion , and then com petencies for all areas of educat ion .

In terest ingly, besides providing topics and hourly guidance, the guidelines also provide recom m endat ions regarding the necessit y of a st ipend, m inim um num ber of hours per week in clin ical contact , m ini-m um num ber of pat ient star ts, faculty-to-student rat ios, lim itat ions on the am ount of

2.4 Turf WarsAll specialt ies have faced turf wars to protect or expand their scope of pract ice. Oral and m axillofacial surgery has long in terfaced w ith both otolaryngology (the specialt y dealing w ith diseases of the ear, nose, and throat) and plast ic surgery regarding areas of the face w here the specialt ies would be separate or would coexist . In m any inst itu-t ions, all cover the m axilla and associated soft t issues, w hile the m andible is usually reserved for oral and m axillofacial surgery. Minor facial surgery and som e m ajor cos-m et ic surgery are now pract iced by otolar-yngology, oral and m axillofacial surgery, and plast ic surgery – based, it is hoped, on adequate t rain ing and docum entat ion , w hich m ost hospitals require for speci c privileges to pract ice. Dental schools are only recently using th is st rategy.

The con icts previously noted regarding the scope of pract ice occur am ong dental and m edical specialt ies, and there are m any legendary con icts of th is nature related to m edicine. Orthopedics, neurosurgery, and osteopathy pract it ioners rout inely com -pete for opportunit ies to t reat the back. Psychiat rists, psychologists, and social workers have com pet ing in terests, as do ophthalm ologists and optom etrists. Anes-thesiologists and cert i ed registered nurse anesthet ists cont inue to joust . Currently, w hen com pet ing therapies are advocated, clin ical t r ials address successful outcom es as the t rue m easure of the preferred t reat-m ent and fur ther scope of pract ice.

Dent ist ry has always claim ed that any general pract it ioner can perform any pro-cedure w ith in the scope of dent ist ry if he or she is t rained and experienced and if the procedure w ill bene t the pat ient . As new technologies appear, th is is becom ing an even m ore challenging area to navigate, and the in ternal dental boundaries of pract ice are not clear. Surgical im plan t placem ent is com pleted by oral and m axillofacial sur-geons, periodont ists, endodont ists, prosth-odont ists, and general pract it ioners. Teeth are uncovered by oral and m axillofacial surgeons and periodont ists, and both can perform dental t ransplants w hen t rained


References 1. Huggare J, Derr inger KA, Eliades T, et al.

The Erasm us program m e for postgradu-ate educat ion in or thodont ics in Europe: an update of the guidelines. Eur J Orthod 2014;36(3):340–349

2. Wahl N. Orthodont ics in 3 m illennia. Chap-ter 3: The professionalizat ion of or tho-dont ics. Am J Orthod Dentofacial Orthop 2005;127(6):749–753

3. Lew is SJ. The developm ent of or th-odont ic educat ion . J Am Dent Assoc 1934;21:1152–1165

4. Dougherty HL Sr. The curriculum II or th-odont ic program at the Universit y of Cali-fornia at San Francisco School of Dent ist ry from 1929 unt il 1969. Am J Orthod Dentofa-cial Orthop 1999;115(5):595–597

5. Hahn GW. The story of the AAO-super-vised preceptorship program . Am J Orthod 1971;60(2):189–195

6. Am erican Dental Associat ion Council on Dental Educat ion. Specialists, specialt ies and specializat ion: associat ion policies and act ions (1946–1961) II. J Am Dent Assoc 1962;64:888–890

7. Am erican Associat ion of Orthodont ists Council on Orthodont ic Educat ion . Ortho-dont ics: Principles and Policies, Educat ional Requirem ents, Organizat ional St ructure. St . Louis, MO: Am erican Associat ion of Ortho-dont ists; 1963

8. Am erican Dental Associat ion Com m ission on Dental Accreditat ion . Orthodont ics: Re-quirem ents and Guidelines for Advanced Specialt y Educat ion Program s. Chicago, IL: Am erican Dental Associat ion; 1975

9. Am erican Dental Associat ion Com m ission on Dental Accreditat ion. Requirem ents for Advanced Specialt y Educat ion Program s in Orthodont ics. Chicago IL: Am erican Dental Associat ion; 1984

10. Am erican Dental Associat ion Com m ission on Dental Accreditat ion . Standards for Ad-vanced Specialt y Educat ion Program s in Oral and Maxillofacial Surgery. Chicago, IL: Am erican Dental Associat ion; 1997

11. Am erican Dental Associat ion Com m ission on Dental Accreditat ion . Standards for Ad-vanced Specialt y Educat ion Program s in Pediat ric Dent ist ry. Chicago, IL: Am erican Dental Associat ion; 1997

12. Am erican Dental Associat ion Com m ission on Dental Accreditat ion . Standards for Ad-

student laboratory work, a 10% cap on resi-dent teaching, required research, and nal assessm ent for all courses and the com -pleted program . The graduates are assessed and also present 10 com pleted cases to a com m it tee w ith at least one external exam iner. Clearly, th is is a m ore detailed and broader educat ional exposure than is required in the United States.

All program s are directed by registered orthodont ists w ith at least ve years of spe-cialt y experience. The guidelines recognize that those headed for educat ion or research w ill require even m ore educat ion . Quite notably, th is docum ent was agreed upon by educators from 15 count ries. Even though it is com prehensive, it is advisory, and the requirem ents of nat ional boards supersede the suggest ions in the docum ent , w hich do not have the in it ial force of law unless they are adopted by the individual nat ions.

2.6 ConclusionOrthodont ics has had a long history of edu-cat ion begun by steadfast individuals w ith singular view points. Som e of that person-alit y-driven evangelism is st ill seen today. The specialt y of or thodont ics cont inues to seek the t ruth and scien t i c underpinnings in an evidence-based world. It faces unique challenges in the future regarding scope of pract ice, workforce, and accreditat ion accountabilit y. Borrow ing insights from our European colleagues m ay prove helpful.

AcknowledgementsThe author would like to thank Karen Hart , Senior Director, Educat ion Operat ions and Director, Council on Dental Educat ion and Licensure; Andrea Matlack, Am erican Den-tal Associat ion archivist; and Jackie Hit tner, Am erican Associat ion of Orthodont ists librarian , for their assistance w ith resources for th is chapter.


19. Am erican Academy of Pedodont ics. Guide-lines for Advanced Educat ion in Pedodon-t ics: Principles and Policies—Educat ional Requirem ents. Chicago, IL: Am erican Acad-emy of Pedodont ics; 1969

20. Wall TP, Vujicic M, Nasseh K. Recent t rends in the ut ilizat ion of dental care in the United States. J Dent Educ 2012;76:1020–1027

21. Am erican Dental Associat ion Com m ission on Dental Accreditat ion . Standards for Ad-vanced Specialt y Educat ion Program s in Orthodont ics. Chicago, IL: Am erican Dental Associat ion; 1992

22. Am erican Dental Associat ion Com m ission on Dental Accreditat ion . Supplem ental Re-port 2: Revision of the Rules of the Com m is-sion on Dental Accreditat ion . Chicago, IL: Am erican Dental Associat ion; 1997

23. Am erican Dental Associat ion Com m ission on Dental Accreditat ion . Advanced Spe-cialt y Educat ion Program s in Orthodont ics and Dentofacial Or thopedics. Chicago, IL: Am erican Dental Associat ion; 2002

24. Dall TM, Forte GJ, Storm MV, et al. Execu-tive sum m ary of the 2013 U.S. Veterinary Workforce Study. J Am Vet Med Assoc 2013;242(11):1507–1514

25. van der Linden FPGM. Three years postgrad-uate program m e in orthodont ics: the nal report of the Erasm us Project . Eur J Orthod 1992;14(2):85–94

vanced Specialt y Educat ion Program s in Periodont ics. Chicago, IL: Am erican Dental Associat ion; 1997

13. Am erican Dental Associat ion Com m ission on Dental Accreditat ion . Standards for Ad-vanced Specialt y Educat ion Program s in Orthodont ics. Chicago, IL: Am erican Dental Associat ion; 1997

14. Am erican Dental Associat ion Com m ission on Dental Accreditat ion . Standards for Ad-vanced Specialt y Educat ion Program s in Pediat ric Dent ist ry. Chicago, IL: Am erican Dental Associat ion; 1988

15. Am erican Dental Associat ion Com m is-sion on Dental Accreditat ion . Accreditat ion Standards for Advanced Specialt y Educat ion Program s in Orthodont ics and Dentofacial Orthopedics. Chicago, IL: Am erican Dental Associat ion; 2008

16. Am erican Dental Associat ion Com m ission on Accreditat ion . Oral Surgery: Require-m ents and Essent ials for Advanced Specialt y Educat ion Program s. Chicago, IL: Am erican Dental Associat ion; 1975

17. Am erican Dental Associat ion Com m ission on Dental Accreditat ion . Standards for Ad-vanced Specialt y Educat ion Program s in Periodont ics. Chicago, IL; Am erican Dental Associat ion; 1994

18. Am erican Dental Associat ion Com m ission on Dental Accreditat ion . Requirem ents for Advanced Specialt y Educat ion Program s in Periodont ics. Chicago, IL: Am erican Dental Associat ion; 1986

17

Contemporary Orthodontic Postgraduate Education as Related to Undergraduate Orthodontic ProgramsPertti Pirt tiniemi

3.1 Current Level of Postgraduate Orthodontic Education in Relation to Undergraduate EducationIt is a known fact that the current volum e, as well as the contents, of undergraduate orthodontic teaching is highly variable, both internationally1 and nationally.2,3 The num -ber of lectures and hours devoted to ortho-dontics is generally m uch m ore variable at the undergraduate level4 in comparison w ith those typically reported or set as a goal in postgraduate education.5,6 The reported m ean (standard deviation [SD]) of curriculum hours devoted to orthodontics is about 110 (86),4 which is approxim ately 6% of the num-ber of curriculum hours typically included in three years of postgraduate orthodontic training. At m axim um , the num ber of hours in Europe is 360 at the undergraduate level, which is m ore than three tim es the average and nearly 20 tim es m ore than the num ber of hours in schools w ith the least num ber of orthodontic curriculum hours. Therefore, there is an extrem ely large variation in the volume of undergraduate orthodontic curri-cula. The large variation in hours is re ected in the contents of the teaching. In all schools, orthodontic diagnostics is taught, and in m ost schools at least observing simple orth-odontic treatm ents is possible. In the schools w ith the m ost extensive orthodontic cur-riculum at the undergraduate level, the stu-

3

dent can bond brackets and x arch w ires in several patients under supervision. On the other hand, opinions have been expressed that at the undergraduate level, for example, the construction of orthodontic appliances in a laboratory should not be included in the curriculum .4

When com pared w ith undergraduate educat ion , current contem porary post-graduate or thodont ic program s are well balanced, last ing typically three years and providing a good professional basis for the fu ture specialist . It can be concluded that the theoret ical and system at ic approaches of m ost or thodont ic postgraduate pro-gram s m ake them unique in com parison w ith specialist t rain ing in other elds.

3.2 General Aims of Orthodontic EducationThe presen t aim s of postgraduate or th-odont ic educat ion have been form ulated clearly in the 2009 publicat ion of the World Federat ion of Orthodont ists task force,5 and fur ther updated in the Erasm us program (European Com m unity Act ion Schem e for the Mobilit y of Universit y Students) guidelines, published in 2014.6 The or tho-dont ist shall be com petent to diagnose and t reat all or thodont ic problem s and cases and to work in groups, w hen needed. Fur-therm ore, the or thodont ist m ust possess a


w ide knowledge of craniofacial grow th and m any other associated factors.

The aim s of undergraduate teaching are m uch m ore vague and are lacking in gen-eral agreem ent . Hobson et al7 form ulated the aim s of educat ion as follows:

The newly quali ed dent ist should be able to access the general orthodont ic needs of every pat ient . They should be able to recognize and describe m ani-fest and developing m alocclusions. In addit ion, they should also be able to undertake a lim ited num ber of rela-t ively sim ple procedures in w hich they are com petent , w hilst recognizing those cases that should be referred for specialist t reatm ent .

In th is respect , Chadw ick et al8 take a di erent approach as they st ress m ore knowledge and less clin ical t rain ing:

Dental graduate should provide a sound knowledge of cran iofacial grow th and occlusal developm ent; to provide the knowledge and skills to be able to m ake a clin ical or thodont ic diagnosis; to provide the knowledge and skills to be able to design and const ruct a rem ovable or thodont ic appliance to correct sim ple occlusal features.

The Associat ion of Dental Educat ion in Europe (ADEE)4 describes the aim s of undergraduate or thodont ic educat ion based on com petencies. The ADEE species that on graduat ion, “a dent ist m ust be com petent at m anaging lim ited develop -m ental or acquired dento-alveolar, grow th-related and funct ional abnorm alit ies of the prim ary, m ixed and perm anent dent it ion .” The ADEE also lists a variety of support -ing com petencies, including diagnost ic and laboratory skills, especially those related to rem ovable appliances. In addit ion , the list includes com petency in m anaging em er-gency situat ions, ident ifying unhealthful oral habits and prevent ing them , assessing facial form and deviat ions in it , determ in-ing a pat ient’s aesthet ic requirem ents and how they can be m et , and carrying out an or thodont ic assessm ent .

It is clear that in m any respects these ADEE com petencies are relat ively broad and dem anding, and even di cult to reach. However, they m ay provide a good basis for an individual dental school to develop it s ow n aim s and plans suitable for the environm ent .

3.3 Di erent Views Concerning the Contents of Undergraduate Orthodontic EducationAlthough the aim s of undergraduate or th-odont ic educat ion are relat ively constant , w hen it com es to diagnost ic skills, or the abilit y of a general dent ist to refer pat ients to specialists, or to act during em ergency situat ions, the views regarding the need for or thodont ic m anual skills vary w idely. This is to a large extent based on the fact that in m any countries, vir tually all or th -odont ic xed appliance t reatm ent is done by specialists, and therefore it has been quest ioned w hether the general pract it io-ner should be t rained in xed orthodon-t ics at all. It is noteworthy that m ost list s of com petencies in undergraduate or tho-dont ics have been form ulated in the United Kingdom . It is in terest ing that in a survey of United Kingdom dental schools concern-ing the undergraduate or thodont ic cur-r iculum , Derringer3 not iced a large variety of subjects being taught and also a sh ift in content from rem ovable appliances to xed appliances.

However, th is is not the case in m any count ries. One reason m ay be a sm all num -ber of specialists, or the fact that the spe-cialt y m ay not be recognized at all. Also, in som e sparsely populated countries, the specialist m ay act as a consult ing or tho-dont ist , and t reatm ent m ay at least par t ly be adm inistered by a general pract it ioner. It is natural that in this kind of situat ion the dem and for the m anual skills of the general pract it ioner is m uch higher, and th is sets di erent requirem ents for the undergradu-

3 Orthodontic Postgraduate Education for Undergraduate Orthodontic Programs 19

the e cacy of com puter-assisted learn ing (CAL) in com parison w ith t radit ional m eth-ods of learning in or thodont ic educat ion . They found that the e cacy of CAL was greater, and they ident i ed a knowledge gain favoring CAL. In Belgium , Aly at al12

studied the use of an in teract ive m ult i-m edia package developed for or thodont ics teaching and in tended to provide under-graduate and postgraduate dental students w ith an in teract ive tool for self-study and self-evaluat ion . The m ajorit y of under-graduate and postgraduate students in the study were very sat is ed w ith th is form of educat ional approach because it was felt to be very helpful in enabling them to under-stand the or thodont ic curriculum m ore e ciently. In the United Kingdom , Bains et al13 com pared the e ciency of e-learning, face-to-face learning, and blended learning and students’ at t itudes toward them . In a random ized t rial, four di erent groups of students received the sam e cephalom et-r ic tutorial but were allocated to di erent m odes of learning. The students’ at t itude toward each learning m ethod was posit ive, but blended learning was signi cantly the m ost accepted and face-to-face learning the least accepted. Also, e-learning was sig-ni cantly less preferred in com parison w ith blended learn ing.

3.5 Evaluation of LearningPar t ly because of new teaching m ethods, but also because of new t rends in evalua-t ion in general, new m ethods of evaluat ion have recent ly been developed, par t icularly in undergraduate educat ion . This is related to the fact that undergraduate classes are so large that individual assessm ent is not always possible. It is natural that the teach -ing m ethods used st rongly in uence the assessm ent m ethods used. Thus, in con-vent ional teaching w ith lectures and sem i-nars, w rit ten essays are a com m on m ethod of assessm ent . However, assessm ent is always necessary, regardless of the m ethod of teaching. Clin ical skills are in m ost cases assessed by clin ical teachers, but prefer-

ate or thodont ic curriculum . Therefore, it m ay be feasible that the undergraduate curriculum be locally adjusted to m eet the dem ands of the surrounding society. This does not , however, alter the increasing need for the coordinat ion of undergradu-ate or thodont ic educat ion as a result of the increasing in ternat ional m ovem ent of working dent ists.

3.4 Developments and Trends in TeachingDent ist ry has been greatly involved in the rapid developm ent of undergraduate teach-ing and learning during the last decades. One of the m ost frequent topics of discus-sion in th is respect has been the in t roduc-t ion of problem -based learning (PBL) in to the or thodont ic curriculum . Because PBL is no longer new, experiences have been described and opinions expressed both for and against it . The use of PBL in or thodon-t ics has been studied, and it has been found that t radit ional teaching w ith lectures and sem inars provides a student w ith bet ter coverage of the curriculum in com parison w ith PBL. With PBL, however, the long-term recollect ion of learned subjects appears to be bet ter.8,9 It has also been pointed out that t radit ional assessm ent m ethods favor t radit ional teaching m ethods.

Experience w ith PBL in postgraduate educat ion is m uch less com m on than in undergraduate educat ion . Bearn and Chad-w ick10 studied the use of PBL in postgradu-ate orthodont ic teaching, ant they noted that although in it ial expectat ions of the m ethod were h igh, it eventually proved disappoint ing. PBL led to tension between individuals or w ith in groups, and fear of failure was com m on. The current t rend appears to be a decrease in the use of PBL.

Very popular in or thodont ics teaching, at both the undergraduate and postgradu-ate levels, has been the use of e-learning or m ult im edia tasks. An applicat ion is blended learning, w hich is a m ixture of t radit ional learning and e-learning. Al-Jewair et al11 conducted a m eta-analysis of


m odalit ies, the years spent in postgradu-ate educat ion m ay be too lim ited. In turn , th is sets new requirem ents for the under-graduate curriculum . It would be bene cial if new postgraduate students had the best possible quali cat ions in basic or thodont ic know ledge. The quest ion then becom es: Is it bet ter for postgraduate educat ion if undergraduate educat ion st resses theo-ret ical issues or clin ical aspects? In m any cases, postgraduate educat ion does not t ake p lace in the sam e locat ion as under-graduate educat ion . When the curr iculum is analyzed, it can often be seen that the teaching of the theoret ical and diagnost ic par ts of the curr iculum is relat ively con-stan t from school to school. In regard to the or thodont ic m echanics of xed or rem ov-able appliances, the curriculum is in m any cased h ighly variable. Thus, from the poin t of view of postgraduate educat ion , it m ost likely would be bene cial if the theoret ical basis of or thodont ic teaching or diagnos-t ic skills were increased and at the sam e t im e coordinated. This would m ake the in i-t iat ion of postgraduate or thodont ic educa-t ion som ew hat easier. In m any cases, th is kind of developm ent is not easy because the undergraduate or thodont ic curricu-lum m ay be pressured to include other expanding subjects, and the adm inist ra-t ion m ay be pressured to lim it the num ber of teaching personnel for var ious econom ic reasons. This is w hy or thodont ic subjects in som e schools have been lim ited, or the m ethod of teaching has been changed to a sim pler form w hen fewer teachers are available. Another relevant factor of im por-tance is the chronic lack of academ ic teach-ers of or thodont ics in m any count ries.

3.7 Increasing International Movement and the Contents of Orthodontic Undergraduate EducationOrthodontics, like dentistry in general, is a very international profession. It has always been easy for a dentist to change his or her location or country of practice if the local

ably in a st ructured m anner and w ith a tested m ethod. In th is respect , we have seen a m ovem ent toward the evaluat ion of com petencies instead of the test ing of pure know ledge. The rat ionale for test ing com petence is descr ibed by Cham bers14: “The behavior that is expected of the inde-pendent pract it ioner at the beginn ing. This behavior incorporates understand-ing, skills and values in a response to the fu ll range of circum stances encountered in general pract ice.” In it s best form , the test -ing of com petence can be done so that the test situat ion m im ics the authent ic clin i-cal situat ion w ith in real circum stances. A good way in both undergraduate and post-graduate learn ing is the use of log books. Students record their learn ing experiences, and they can easily be checked afterward w hen an evaluat ion is perform ed.

Regardless of the teaching m ethod, the chosen assessm ent m ethod should be object ive, reliable, and just i ed. It also should be relat ively easy to perform and repeat , and naturally it should re ect the contents of the subject .

3.6 Demands That Current Postgraduate Education Places on Undergraduate EducationThe or thodont ic profession is a h igh ly dem anding one, and therefore special-ist educat ion is requested by and popular am ong dent ists. It has been est im ated that in the United States, there are m ore post-graduate students in or thodont ics than in any other discipline.15 It is also noteworthy that the European Union o cially recog-n izes on ly or thodont ics and oral surgery as specialt ies in dent ist ry. In m ost dental schools or or thodont ic program s, post-graduate educat ion last s from two to four years, a th ree-year program being t ypical. Because the subjects that m ust be taught during the postgraduate per iod are con -stan t ly increasing, as a result of the devel-opm ent of new diagnost ic and t reatm ent

3 Orthodontic Postgraduate Education for Undergraduate Orthodontic Programs 21

are continually tested and m onitored. The educat ional eld is very dynam ic, not the less so because of new technology or theories of learning. At the sam e t im e, the clinical eld is changing w ith new treatm ent m ethods and m aterials. Working w ith patients has becom e m ore dem anding as their aware-ness of di erent t reatm ent alternatives and aesthetic requirem ents has increased.

Perhaps the biggest challenges to the learning environm ent in or thodont ics are the lack of teaching personnel and the eco-nom ic const rain ts that m ay m ake the devel-opm ent of the teaching unit di cult . The best way to deal w ith the lack of teachers in both undergraduate and postgraduate educat ion is to increase the am ount of sci-ent i cally oriented teaching at the under-graduate level. Indeed, it has been shown that any exposure to teaching or research during dental studies m ay increase a grad-uate’s in terest in an academ ic career.16 A m andatory research experience during the undergraduate years m ay result in a larger num ber of graduates hoping to incorpo-rate research in their careers. This, in turn , m ay fur ther the scient i c developm ent of the dental profession. Naturally, the sam e is t rue for postgraduate educat ion . There-fore, in the recently updated recom m enda-t ions of the Erasm us guidelines, a separate period of research is included in the post-graduate curriculum .6 This research leads, in an opt im al situat ion , to the publicat ion of a scient i c report of the project . In turn , students graduat ing w ith a postgraduate degree m ay w ish to m aintain their scien-t i c contacts and pursue a scient i c career and teaching act ivit ies.

It is clear that all procedures that aim for or lead to a greater coordinat ion of undergraduate teaching in or thodont ics are bene cial in m any respects. The con-sequences w ill facilitate the m ovem ent of dent ists and enable them to work in dif-ferent environm ents. The other advantage relates to postgraduate educat ion . The m ore consistent the com petencies of new postgraduate students, the easier the task of teachers in postgraduate educat ion . This can be especially bene cial in theoret ical subjects and in diagnost ic skills, but also in scien t i c skills and basic orientat ion .

regulations or laws allow. For decades, the European Union has set the free m ovem ent of the workforce as a clear and important goal. Therefore, the European Union has implem ented standards for undergraduate teaching in dentistry. For the undergraduate orthodontic curriculum , the requirem ents of the European Union are relatively broad. This m ay be related to the fact that when new countries were accepted into the Euro-pean Union, som e comprom ises had to be m ade. Possibly for this reason, the DentEd project was initiated in the European Union, in which teaching in dentistry in m ore than 20 European Union countries was evaluated during site visits, and the results of these visits were published.1 In parallel w ith the undergraduate project, a project directed at the coordination of postgraduate orthodontic education was initiated (Erasm us program for postgraduate education in orthodontics in Europe).6 As well, the European Union launched a visitor program for university students and teachers in Europe, in which teachers of orthodontics could easily m ake site visits to other European universit ies and share teaching. Together, these program s have clearly had a coordinating e ect on both undergraduate and postgraduate teach-ing. In addition, the relatively long site visits of num erous students, both undergraduates and postgraduates, to other European univer-sities have undoubtedly in uenced teaching at both the sending and receiving universities.

It m ust be rem em bered that the orth-odontic specialists working in the United States and Canada, for example, are not in m any cases native cit izens and have been educated, at least at the undergraduate level, abroad. It is quite clear that the trend in the direct ion of m ore international teaching and learning is perm anent and can be considered posit ive in nature. This developm ent inevita-bly results in a requirem ent for further coor-dination of teaching in all countries.

3.8 Future PerspectivesUndergraduate orthodontic teaching, as well as postgraduate educat ion, is constantly fac-ing new challenges. New teaching m ethods


9. Bearn DR, Chadw ick SM, Jack AC, Sackville A. Orthodont ic undergraduate educat ion: assessm ent in a m odern curriculum . Eur J Dent Educ 2002;6(4):162–168

10. Bearn DR, Chadw ick SM. Problem -based learning in postgraduate dental edu-cat ion: a qualitat ive evaluat ion of stu-dents’ experience of an orthodontic problem -based postgraduate program m e. Eur J Dent Educ 2010;14(1):26–34 10.1111/j.1600-0579.2009.00588.x

11. Al-Jewair TS, Azarpazhooh A, Suri S, Shah PS. Computer-assisted learning in orthodontic education: a systematic review and meta-analysis. J Dent Educ 2009;73(6):730–739

12. Aly M, Willem s G, Van Den Noortgate W, Elen J. E ect of m ult im edia inform a-t ion sequencing on educat ional outcom e in or thodont ic t rain ing. Eur J Orthod 2012;34(4):458–465 10.1093/ejo/cjr036

13. Bains M, Reynolds PA, McDonald F, Sher-ri M. E ect iveness and acceptability of face-to-face, blended and e-learning: a ran-dom ised t rial of or thodont ic undergradu-ates. Eur J Dent Educ 2011;15(2):110–117 10.1111/j.1600-0579.2010.00651.x

14. Cham bers DW. Com petencies: a new view of becom ing a dent ist . J Dent Educ 1994;58(5):342–345

15. Burk T, Orellana M. Assessm ent of graduate or thodont ic program s in North Am erica. J Dent Educ 2013;77(4):463–475

16. Nalliah RP, Lee MK, Da Silva JD, Allareddy V. Im pact of a research requirem ent in a dental school curriculum . J Dent Educ 2014;78(10):1364–1371

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2. Rock WP, O’Brien KD, Stephens CD. Orth-odont ic teaching pract ice and undergradu-ate knowledge in Brit ish dental schools. Br Dent J 2002;192(6):347–351

3. Derringer KA. Undergraduate orthodon-tic teaching in UK dental schools. Br Dent J 2005;199(4):224–232

4. Oliver R, Hingston E. Undergraduate clinical orthodontic experience: a discussion paper. Eur J Dent Educ 2006;10(3):142–148

5. Athanasiou AE, Darendeliler MA, Eliades T, et al; World Federation of Orthodontists (WFO) Guidelines for Postgraduate Orthodontic Edu-cation. World J Orthod 2009;10:153–166

6. Huggare J, Derringer KA, Eliades T, et al. The Erasm us program m e for postgraduate edu-cation in orthodontics in Europe: an update of the guidelines. Eur J Orthod 2014;36(3): 340–349 10.1093/ejo/cjt059

7. Hobson RS, Car ter NE, Gordon PH, Mat t ick CR. Undergraduate or thodont ic teaching in the new m illennium —the Newcast le m odel. Br Dent J 2004;197(5):269–271

8. Chadw ick SM, Bearn DR, Jack AC, O’Brien KD. Orthodont ic undergraduate educat ion: developm ents in a m odern curriculum . Eur J Dent Educ 2002;6(2):57–63

23

Orthodontic Specialty Education in EuropeStavros Kiliaridis and Anne Marie Kuijpers-Jagtman

The history of or thodont ic specialt y educa-t ion in Europe spans a period of 80 years. It star ted in 1935, w hen ve Germ an and two Austrian universit ies o ered students the opportunity to specialize in or thodon-t ics by working as assistants in their or th -odont ic clin ics. Other countries in Europe followed, but form al t rain ing based on an agreed curriculum did not yet exist .1 On the other side of the ocean, the rst graduate or thodont ic depar tm ents had been open from the early 1920s on , and a st ructured course program in or thodont ics had been established by Dr. Allan Brodie at the Uni-versit y of Illinois in Chicago in 1930.2 This program served as a m odel for or thodon-t ic specialt y educat ion in the United States and in uenced or thodont ic educat ion in Europe as well. In the 1950s, the specialt y of or thodont ics was o cially recognized in a few countries, m ainly in the northern par t of Europe. The Netherlands, the Scan-dinavian countries, and Sw itzerland were am ong the rst to organize their postgrad-uate program s in or thodont ics, avored by the Am erican m odel.1 In the United King-dom , the Royal Colleges assum ed a role com parable to the one that already existed for the m edical specialt ies (see Chapters 5 and 14). In the year 2015, m ost European count ries have recognized or thodont ic spe-cialists and have im plem ented specialt y educat ion program s.

However, there is st ill a w ide diversit y in the st ructure and contents of specialist educat ion program s in Europe. Typically, th is rather com plicated situat ion has a h is-

4

torical background. Notw ithstanding the bir th of the European Econom ic Com m u-nit y (EEC) in 1957, w hich was the predeces-sor of the European Union (EU) as we know it today, each of the 28 m em ber states st ill has its ow n nat ional laws, regulat ions, and adm inist rat ive provisions w hen it com es to dental specialist educat ion. The sam e holds t rue, of course, for the countries that do not belong to the EU.

In th is chapter, we star t w ith a shor t in t roduct ion to legislat ion at the EU level regarding specialist educat ion and rec-ogn it ion . First in regard to the recogni-t ion of professional quali cat ions are the relevan t EU direct ives. However, the EU direct ives do not include any descr ipt ion of the required study con ten t of postgrad-uate program s. Because the EU funct ions as a single m arket , it becam e urgen t to lay dow n a statem ent about the con ten ts of postgraduate educat ion in or thodon t ics to guaran tee the qualit y of or thodon t ic spe-cialist s all over Europe. Th is was the reason for the in it iat ion of the Erasm us program (European Com m unit y Act ion Schem e for the Mobilit y of Universit y Studen ts) in 1989 and the star t of the Net work of Eras-m us-Based European Or thodon t ic Post-graduate Program s (NEBEOP) in 2008.3 We also descr ibe br ie y the role of the Euro-pean Federat ion of Or thodon t ic Specialist Associat ions (EFOSA), w hich un ites or th -odon t ic specialist organ izat ions in Europe and m ain tains a register of the state of a airs regarding the specialt y in d i eren t count r ies in Europe.


4.1 European Union DirectivesThe EU is an econom ic and polit ical union of 28 countries. It s in ternal m arket allows the free m ovem ent of goods, capital, ser-vices, and people between the m em ber states. The European Econom ic Area (EEA) includes EU countries and also Iceland, Liechtenstein , and Norway. It allows them to be par t of the EU’s single m arket . Sw it-zerland is neither an EU nor an EEA m em -ber but has been par t of the single m arket since 2002 by a series of bilateral agree-m ents. An overview of relevant EU legis-lat ion regarding or thodont ic specialists is given in Table 4.1 .

The rst EU direct ive, “concerning the m utual recognit ion of diplom as, cer t i cates and other evidence of the form al quali ca-t ions of pract it ioners of dent ist ry, including m easures to facilitate the e ect ive exercise of the r ight of establishm ent and freedom to provide services,” dates from 1978.4In Art icle 4, it is stated that each m em ber state shall recognize the diplom as of dental pract it ioners specializing in or thodont ics and oral surgery of other m em ber states in accordance w ith Art icles 2 and 3 of Direc-t ive 78/687/EEC.5 In Art icle 2 of Direct ive 78/687/EEC, a further speci cat ion is given of the m inim um requirem ents that the t rain ing leading to a form al quali cat ion as a dental specialist should m eet .5 One of the ent rance criter ia is that the specialist should rst be a dent ist having completed a ve-year full-t im e theoret ical and pract i-cal course in dent ist ry. In the Annex of the lat ter docum ent ,5 an overview is given of the subjects required in such a ve-year full-t im e course leading to a diplom a in dent ist ry. However, the contents of a spe-cialist educat ion study program in regard to professional knowledge, skills, and com pe-tencies are not speci ed. In 2001, in Direc-t ive 2001/19/EC,6 am endm ents were m ade to the general system for the recognit ion of professional quali cat ions, including the two earlier direct ives of 1978 on the profes-sion of dental pract it ioner. Finally, in 2005, a new direct ive7 was com posed because the relevant direct ives had been am ended

so m any t im es that they had becom e unworkable.

Direct ive 2005/36/EC,7 on the recogni-t ion of professional quali cat ions, cam e in to force on October 20, 2007. It has been am ended 11 t im es since its publicat ion (latest am endm ent dated Decem ber 28, 2013), and two corrigenda were published. A consolidated version of the direct ive and it s annexes is available on the EU Web site (consolidated version of Direct ive 2005/36/EC7 of 20.11.2013). Art icle 35 of the direc-t ive concerns specialist dental t rain ing, and the follow ing requirem ents are listed:

1. Adm ission to specialist dental t rain ing shall be cont ingent upon com plet ion and validat ion of basic dental t rain ing referred to in Art icle 34, or possession of the docum ents referred to in Art icles 23 and 37.

2. Specialist dental t rain ing shall com prise theoret ical and pract ical inst ruct ion in a universit y center, in a t reatm ent teaching and research center, or, w here appropriate, in a health establishm ent approved for that purpose by the com petent authorit ies or bodies.

3. Full-t im e specialist den tal courses shall be of a m inim um of three years’ durat ion and shall be supervised by the com petent authorit ies or bodies. They shall involve the personal par t icipat ion of the dental pract it ioner t rain ing to be a specialist in the act ivit y and in the responsibilit ies of the establishm ent concerned.

Basically, the requirem ents are the sam e as those in the EU direct ives of 1978. In Annex v.3, the subjects for the den-tal curriculum are listed, w hich have also rem ained, am azingly enough, unchanged compared w ith those in the version that was published 27 years earlier! Again , spe-cialist knowledge, skills, and com petencies are not included in the current direct ive. The exist ing diversit y am ong countries in Europe regarding specialist educat ion and the w ish to provide the sam e high-qualit y or thodont ic care for all European nat ion-als called for in ternat ional collaborat ion to form ulate guidelines for the educat ion of

4 Orthodontic Specialt y Educat ion in Europe 25

Table 4.1 Overview of European Union legislation regarding orthodontic specialists

EU document Contents Remark

Council Directive 78/686/EEC of 25 July 1978

Concerns mutual recognition of diplomas, certi cates, and other evidence of the formal quali cations of practitioners of dentistry, including measures to facilitate the e ective exercise of the right of establishment and freedom to provide services

Amended by Directive 2001/19/EC and replaced by Directive 2005/36/EC

Council Directive 78/687/EEC of 25 July 1978

Concerns the coordination of provisions laid down by Law, Regulation, or Administrative Action in respect of the activities of dental practitioners

Amended by Directive 2001/19/EC and replaced by Directive 2005/36/EC

Directive 2001/19/EC of the European Parliament and of the Council of 14 May 2001

Amends Council Directives 89/48/EEC and 92/51/EEC on the general system for the recognition of professional quali cations and Council Directives 77/452/EEC, 77/453/EEC, 78/686/EEC, 78/687/EEC, 78/1026/EEC, 78/1027/EEC, 80/154/EEC, 80/155/EEC, 85/384/EEC, 85/432/EEC, 85/433/EEC, and 93/16/EEC concerning the professions of nurse responsible for general care, dental practitioner, veterinary surgeon, midwife, architect, pharmacist , and doctor (text with EEA relevance)

Replaced by Directive 2005/36/EC

Directive 2005/36/EC of the European Parliament and of the Council of 7 September 2005

Concerns the recognition of professional quali cations (text with EEA relevance)

11 amendments until 28 December 2013; consolidated version of Directive 2005/36/EC of 20.11.2013 on the EU Web site

Abbreviations: EC, European Council; EEA, European Economic Area; EEC, European Economic Com -munity; EU, European Union.


m inim um durat ion for an orthodont ic spe-cialist educat ion program was set at three years full t im e (4,800 scheduled hours). It was proposed to reserve 25% of the curricu-lum hours for elect ives. The m ain par t of the report contains a detailed descript ion of the object ives of obligatory courses, the com pe-tency levels that should be reached, and the num ber of hours for each speci c topic.

For m ore than two decades, th is report cont r ibuted signi cant ly to the st rength-ening of the level of postgraduate t rain ing in or thodont ics in Europe and fueled the debate about qualit y enhancem ent and qualit y cont rol. Many program s in Europe used the guidelines outlined in the report as their gold standard for the educat ion of future or thodont ists. After the original publicat ion , however, the eld of orthodon-t ics changed substant ially. New diagnost ic tools and t reatm ent techniques becam e available, and there was a m ajor change from m ono-disciplinary or thodont ics to in terdisciplinary t reatm ent approaches. Moreover, new insights in to adult learn -ing had their im pact on teaching, not only at the undergraduate but also at the post-graduate level.

In the m eant im e, NEBEOP was in it i-ated in 2008.3 The network par t icipants st rongly advised that the 1992 guidelines be updated. Therefore, in 2010, a task force, chaired by Professor Jan Huggare of Swe-den, was form ed to com e up w ith proposals for an update. In 2012, after several rounds of am endm ents, the nal revision was approved by the NEBEOP assem bly, and the nal report about the updated guidelines was published in 2014.10

The postgraduate or thodont ic program object ives, general and speci c condit ions, and dist r ibut ion of hours rem ained largely the sam e as those in the guidelines of 1992. The m ost im portant general and speci c condit ions in the Erasm us guidelines9,10

are sum m arized in Table 4.2 . The theoret i-cal contents are divided in to eight them es, w hich were rede ned and m odernized. An overview of the updated guidelines for the theoret ical contents of the program and the dist r ibut ion of hours is given in Table 4.3 . Furtherm ore, in the 2014 guidelines, essen-

or thodont ic specialists. This gave r ise to the star t of several in it iat ives: the Erasm us pro-gram in 1989, EURO-QUAL II as par t of the Biom ed 2 program in 1995,8 and NEBEOP in 2008.3

4.2 ErasmusThe freedom of exchange of or thodont ists w ith in the EU and the EEA m ade a con-sensus of educat ional standards an urgent m at ter. As previously outlined, the EU direct ives provide only general guidelines for specialist educat ion , and they are not speci c enough to form the basis of a well-de ned curriculum for the educat ion of or thodont ic specialist s. About 25 years ago, in 1989, an in it iat ive arose, funded by the Erasm us Bureau of the European Cultural Foundat ion of the Com m ission of the Euro-pean Com m unit ies, to develop guidelines to arr ive at a com m on curriculum for post-graduate educat ion in or thodont ics. The m ain reason for developing such an exam -ple curriculum was to establish guidelines that could serve as baseline criter ia for the developm ent of an orthodont ic postgradu-ate program in each country in Europe. It was an t icipated that th is would contr ibute to reducing the diversit y in the contents and durat ion of the exist ing program s and would assist countries about to em bark on the postgraduate t rain ing of specialists in or thodont ics.

A com m it tee of 15 program directors represent ing 15 European countries (Aus-t ria, Belgium , Denm ark, Finland, France, Germ any, Greece, Ireland, Italy, the Neth-erlands, Norway, Spain , Sweden, Sw itzer-land, United Kingdom ) was set up for th is project . The nal results were published in 1992, ent it led “Three Years Postgradu-ate Program m e in Orthodont ics: the Final Report of the Erasm us Project .”9 In the fol-low ing years, it becam e w idely know n as the Erasm us program for specialt y educa-t ion in or thodont ics.

The com m it tee form ulated m ain objec-t ives and general and speci c condit ions for specialty educat ion in or thodont ics. The


• Encouraging the evaluat ion of uni-versit ies and other o cially recog-nized inst itut ions for the training of orthodontic specialists w ithin the EU

EFOSA m ade an im portant contr ibut ion to ident ify and understand the huge diver-sit y of the European educat ion program s in or thodont ics as the rst step before t rying to advance w ith their coordinat ion . This e or t was par t ially achieved because each country in Europe has a specialist associa-t ion that has access to all inform at ion about the educat ion, recognit ion, and regist rat ion of specialists. An e or t was m ade by van der Linden 1 to presen t the situat ion regard-ing the educat ion of or thodont ic specialists in 20 European countries, as well as Israel and Turkey, based on the inform at ion col-lected through a survey perform ed by EFOSA in 2002 of the nat ional orthodon-t ic specialist organizat ions. The collected inform at ion dealt w ith the exist ing oppor-tunit ies in each country for postgraduate t rain ing, the content of the specialt y educa-t ion program s, the em bedding of specialist educat ion w ith in universit ies or elsew here, the existence of an exam inat ion at the end of the program , and last but not least the evaluat ion of the level of the t rain ing.

Based on th is survey, Cyprus, Iceland, and Luxem bourg did not report special-ist educat ion facilit ies in or thodont ics. All the other countries m ent ioned three-year specialt y educat ion program s except Bel-gium , France, the Netherlands, Poland, and Sw itzerland, w here four years of edu-cat ion was requested. All program s were fu ll t im e except in France. The represen-tat ives of m ost of the countries claim ed that or thodont ic specialist educat ion in their countries adhered to the guidelines of the Erasm us program , and that it took place exclusively at universit ies w ith one except ion , Germ any, w here “the general requirem ent is at least one year’s univer-sit y experience and up to two years’ pre-ceptorship w ith in a privately pract icing or thodont ic specialist , approved for that purpose by the State Dental Organisat ion .”

Large variat ions existed in the form at of the nal exam inat ion , if there was one. The exam iners were m ainly universit y

t ial com petency levels were de ned for the skills and com petencies that residents should have acquired at the end of their postgraduate educat ion .

It should be noted that the revision of the Erasm us program should be used as a guideline to assist in the developm ent and m aintenance of h igh-qualit y postgraduate educat ion in or thodont ics. The Erasm us program is not par t of EU legislat ion , and NEBEOP, w hich took the in it iat ive to update the guidelines, is not a legal authorit y that can override the EU direct ives or nat ional laws and regulat ions. Nevertheless, the guidelines can serve as a useful m odel for good-qualit y postgraduate t rain ing in or thodont ics and have had proven im pact in m any countries in Europe.

4.3 European Federation of Orthodontic Specialists AssociationsIn 1977, the European Federat ion of Orth-odont ic Specialist s Associat ions (EFOSA) was founded by nat ional or thodont ic spe-cialists associat ions from Belgium , Den-m ark, England, France, Germ any, Ireland, Italy, and the Netherlands, and in 1998, after changes in the EFOSA bylaws, other European nat ional associat ions joined EFOSA. Am ong the aim s stated in the EFOSA const itut ion , the follow ing deal w ith spe-cialt y educat ion:

• Improving the contents and quality of education for orthodontic specialists by means of formulating proposals geared toward de ning and coordinat-ing the teaching of orthodontics at the university and post-university level

• Standardizing European exam ina-t ions at the end of specialist t rain ing program s in or thodont ics

Furtherm ore, the EFOSA Web site (w w w.efosa.eu) provides a list of tasks and responsibilit ies:

• Prom oting a high level of t raining of orthodont ic specialists w ithin the EU


Table 4.2 Erasmus guidelines for the theoretical contents of postgraduate education in orthodontics

Part/hours Contents

A310 hours

General biological and medical subjects

A1 Pediatrics

A2 Anatomy and embryology of craniofacial structures

A3 Genetics

A4 Cell and molecular biology, immunology, and microbiology

A5 Oral pathology and medicine

A6 Pharmacology

A7 Ear–nose–throat and speech

A8 Craniofacial syndromes

A9 Psychology of the child, adolescent, and adult

A10 Research methodology and biostatistics

B325 hours

Basic orthodontic subjects

B1 Development of the dentition (normal and abnormal)

B2 Facial growth (normal and abnormal)

B3 Physiology and pathophysiology of the stomatognathic system

B4 Aspects of tooth movements and dentofacial orthopedics

B5 Oral and maxillofacial radiology and other imaging techniques

B6 Cephalometric radiography

B7 Orthodontic materials

B8 Orthodontic biomechanics

C340 hours

General orthodontic subjects

C1 Etiology and epidemiology of malocclusions

C2 Need and demand for orthodontic treatment

C3 Diagnostic procedures

C4 Orthodontic diagnostic assessment, treatment objectives, and treatment planning

C5 Growth and treatment analysis

C6 Long-term e ect of orthodontic treatment

C7 Iatrogenic e ects of orthodontic treatment

C8 Orthodontic literature


Part/hours Contents

D195 hours

Orthodontic techniques

D1 Removable appliances

D2 Functional appliances

D3 Extra-oral appliances

D4 Partial xed appliances

D5 Fixed labial and lingual appliances

D6 Retention appliances

D7 Skeletal anchorage devices, temporary anchorage devices

D8 Oral devices for obstructive sleep apnea treatment

E125 hours

Interdisciplinary treatment procedures

E1 Adult orthodontics

E2 Treatment of patients with orofacial clefts and craniofacial anomalies

E3 Orthodontic–surgical treatment

E4 Orthodontic–periodontal treatment

E5 Orthodontic–restorative treatment

E6 Craniomandibular disorders

F25 hours

Management of health and safety

F1 Management of oral health

F2 Health and safety in orthodontic practice

F3 Multicultural health and health care behavior

G45 hours

Practice management, administration, and ethics

G1 O ce management

G2 Communication

G3 Ergonomics

G4 Legislation

G5 Professional ethics

Helective

Extramural educational activities

Participation in activities like meetings and congresses of (inter)national orthodontic societies, Distinguished Teacher lectures, and postgraduate courses of the European Orthodontic Society

Source: Huggare J, Derringer KA, Eliades T, et al. The Erasmus programme for postgraduate educa-tion in orthodontics in Europe: an update of the guidelines. Eur J Orthod 2014;36(3):340–349.


Table 4.3 Summary of the general and speci c conditions speci ed in the updated guidelines of the Erasmus program for postgraduate education in orthodontics

Program

• Structured program

• Minimum of 3 years’ full-time equivalent

• Delivered in universities or institutes with an academic a liation

Clinical activity

• Clinical activit y (chair-side time): minimum of 16 hours per week (approximately 2,000 hours over the 3-year program)

• Treatment of at least 50 new cases with a variety of malocclusions

• Clinical supervision by an orthodontic specialist

Theoretical education

• Based on a prede ned structured program

• Lectures and seminars equivalent to at least 5 hours per week (minimum of 600 hours over the 3-year program) distributed over the entire educational period

• Treatment planning or treatment evaluation seminars or discussions equivalent to at least 3 hours per week

• Assessment of knowledge within the educational period and a summative nal examination

Research

• Protected research time must be included with the provision of clear academic guidance.

• The research should be of su cient quality to lead to a publication or a congress presentation.

Source: Huggare J, Derringer KA, Eliades T, et al. The Erasmus programme for postgraduate educa-tion in orthodontics in Europe: an update of the guidelines. Eur J Orthod 2014;36(3):340–349.


founded in Novem ber 2008, after three years of preparat ion, according to the principal dem and raised and approved by m ore than 60 par t icipants of the European Orthodont ic Teachers’ Forum s in 2006, 2007, and 2008. In the founding m eet ing in Geneva, 36 at tendees were present from 17 countries. During the founding m eet-ing, the NEBEOP bylaws were discussed and approved to establish a form at for funct ion-ing of the network.3

Thus, the network com prises a group of or thodont ic postgraduate t rain ing pro-gram s represented by program directors or or thodont ists assigned by inst itu t ions that deliver a st ructured program in or thodon -t ics. The prim ary concern of the network is educat ion that is speci c to the specialt y of or thodont ics, and its m ain purpose is the advancem ent of or thodont ic post-graduate t rain ing in Europe. The network consists of full m em bers and provisional m em bers. The provisional m em bers m ust have previously com pleted a self-assess-m ent form indicat ing that their program broadly ful lls the requirem ents for m em -bership according to the Erasm us program . To m aintain and im prove the qualit y of advanced educat ion in or thodont ics, a periodic external assessm ent of the educa-t ional process and st ructure of each post -graduate program in or thodont ics is par t of the qualit y assurance guidelines of NEBEOP and a requirem ent for fu ll m em bership in NEBEOP. This external periodic review process includes a self-assessm ent of the program and a site evaluat ion by external assessors. The purpose of the site visit is to obtain in -depth inform at ion concern ing all educat ional and adm inist rat ive aspects of the program . The site visit veri es and supplem ents the inform at ion contained in the com prehensive self-assessm ent docu-m ent com pleted by each inst itut ion before the site evaluat ion .

A program director applies on a vol-untary basis to have the program of h is or her inst itut ion assessed against cer tain prede ned m inim um criter ia of qualit y that have been developed by NEBEOP in the past . In the assessm ent procedure for full m em bersh ip, the backing of the un iversit y

professors, som et im es reinforced by exter-nal exam iners or by governm ent-assigned boards. In the United Kingdom and Ireland, the exam inat ions were held by the Royal Colleges. Although or thodont ic educat ion in m ost countries took place exclusively at un iversit ies, as required by the Erasm us program , the contents of the courses of study were not veri ed. A m ajor problem encountered in evaluat ing th is aspect was that the inform at ion obtained in the sur-vey of 2002 failed to reveal adequate infor-m at ion about the individual educat ional inst itut ions and the extent of the Erasm us program im plem entat ion .

4.4 Network of Erasmus-Based European Orthodontic Programs: External Assessment of Postgraduate ProgramsIn 2006, the rst European Orthodon-t ic Teachers’ Forum took place after the authors of th is chapter’s in it iat ive. The goal of th is event , w hich was supported by the European Orthodont ic Society, was to pro-vide a forum in w hich or thodont ic teachers could m eet one another to exchange infor-m at ion, opinions, and ideas on undergradu-ate and postgraduate teaching and research. The organizing com m it tee ident i ed and invited representat ives of approxim ately 260 or thodont ic postgraduate program s in Europe, m any of them in eastern Europe.

The idea of NEBEOP was born as a result of the dem and of the par t icipants of the rst Teachers’ Forum , w ho pointed out the problem of the diversit y of the European educat ional program s in or thodont ics. It was seen to be necessary to establish som e com m on feasible standards to be used as guidelines for European postgraduate edu-cat ion in or thodont ics. The am bit ion was that in a reasonable period of t im e, the m ajorit y of the inst itutes providing or th -odont ic educat ion in Europe would be able to m eet the standards of the updated guide-lines of the Erasm us program . NEBEOP was


4.5 DiscussionIn their discussion on the ndings of a Europe-w ide survey in to the state of or th-odont ic educat ion , the professional devel-opm ent group of EURO-QUAL II of the Biom ed 2 Project stated, “One of the joys of living in Europe is the cultural diversit y w ith in a relat ively sm all geographical area. It would appear that th is diversit y also m anifests itself in the postgraduate special-ist or thodont ic t rain ing w ith in Europe.”11

This w ide diversit y st ill exists 15 years later, and it is unlikely that it w ill disappear in the near future. Nevertheless, the coordina-t ion of standards in specialist educat ion is an issue that a ects the qualit y of care and that depends, at least par t ly, on the educa-t ion and t rain ing that or thodont ists receive and the com petencies they have achieved at the beginning of their careers.

The EU direct ives do not de ne and w ill probably never de ne the required con-tents for an educat ional program because th is is left to the authorit y of the m em ber states. Therefore, a bot tom -up approach was seen as the best way forward. NEBEOP was not born as a result of bureaucrat ic requirem ents; rather, it was developed by a group of European educators in terested in h igh-qualit y postgraduate educat ion in or thodont ics in Europe. Som e of the pro-gram s wanted to go one step fur ther by opt ing for a voluntary object ive qualit y assessm ent to let them know w here they are. This bene ts even program s that do not yet ful ll the criter ia because they are m ade aware of the areas w here im prove-m ent can be at tem pted in accordance w ith the NEBEOP guidelines.

This feasible approach to coordinate the levels of specialist educat ion beyond the borders of the EU m em ber states gives hope that gradually, in a reasonable period of t im e, the m ajorit y of the inst itut ions providing or thodont ic educat ion in Europe w ill be able to m eet the standards of the Erasm us program m e. This e or t dem ands an external evaluat ion to guarantee the im plem entat ion of these guidelines. An

is com pulsory because in terviews w ith the program director and the dean or head of the dental school, am ong others, are par t of the procedure.

To guarantee the object ive assessm ent of postgraduate program s, in the in it ial period unt il June 2014, only external asses-sors w ho were not involved in NEBEOP were invited to perform site visits. Once 12 program s have been approved for full m em bership in NEBEOP, representat ives of these program s w ill have the obligat ion to perform the site visits.

The standards by w hich the evalua-t ion com m it tee evaluates a postgraduate program are based upon the NEBEOP self-assessm ent guide. The self-assessm ent guide sets for th the standards for educa-t ional content , clin ical t rain ing, research, evaluat ion and assessm ent , program director and teaching sta , facilit ies and resources, and qualit y assurance that post-graduate program s in or thodont ics should m eet according to the updated version of the Erasm us guidelines.10 Thus, one of the m ajor tasks of NEBEOP is to assess w hether these guidelines have been im plem ented during site visits and other act ivit ies of the organizat ion.

At the m om ent , the network has 70 European program directors as provisional or full m em bers. It should be st ressed that NEBEOP is not an o cial authorit y for accredit ing schools or cert ifying program s. Most countries in Europe have their ow n accreditat ion system , and NEBEOP is not overruling any of the national regulat ions. NEBEOP provides guidelines on the st ruc-ture and contents of a program that pro-m ote the qualit y of postgraduate educat ion in countries building their postgraduate program in orthodontics, or in those w here the specialty is not yet recognized. In con-clusion, NEBEOP is a network of European program s that are at tempting to comply w ith the Erasm us guidelines.3 The m em -bers have agreed on a voluntary system of assessm ent against the standards set by NEBEOP as the qualit y of their postgraduate program is their m ain goal.


5. 78/687/EEC: Council Direct ive 78/687/EEC of 25 July 1978 concerning the coor-dinat ion of provisions laid dow n by Law, Regulat ion or Adm inist rat ive Act ion in respect of the act ivit ies of dental pract i-t ioners. O cial Journal of the European Com m unit ies L233, 1978;21:10–14. h t tp://e u r - l e x .e u r o p a .e u / l e g a l - co n t e n t / EN/ALL/?uri=CELEX:31978L0687

6. 2001/19/EC: Direct ive 2001/19/EC of the European parliam ent and of the Council of 14 May 2001 am ending Council Direct ives 89/48/EEC and 92/51/EEC on the general sys-tem for the recognit ion of professional qual-i cat ions and Council Direct ives 77/452/EEC, 77/453/EEC, 78/686/EEC, 78/687/EEC, 78/1026/EEC, 78/1027/EEC, 80/154/EEC, 80/155/EEC, 85/384/EEC, 85/432/EEC, 85/433/EEC and 93/16/EEC concerning the professions of nurse responsible for gen-eral care, dental pract it ioner, veterinary surgeon, m idw ife, architect , pharm acist and doctor. O cial Journal of the European Com m unit ies L206/1, 2001;44:1–51. h t tp://eu r - lex .eu rop a .eu / lega l-con ten t / EN/ TXT/? q id =1431800969100&u r i=CELEX:32001L0019

7. 2005/36/EC: Directive 2005/36/EC of the European Parliam ent and of the Council of 7 Septem ber 2005 on the recognition of profes-sional quali cations. O cial Journal of the European Union L255, 2005;48:22–142. Con-solidated docum ent w ith am endm ents and corrigenda of 20.11.2013 at the EU Web site. h t tp ://ec.europa.eu/in ternal_m arket /quali-ficat ions/policy_developm ents/legislat ion /index_en.htm . Accessed January 26, 2015

8. Original Report Series. Series of repor ts on European or thodont ics. The EURO-QUAL Biom ed 2 Project . Original report series. J Orthod 2000;27(1):83–84


10. Huggare J, Derr inger KA, Eliades T, et al. The Erasm us program m e for postgradu-ate educat ion in or thodont ics in Europe: an update of the guidelines. Eur J Orthod 2014;36(3):340–349

11. McDonald JP, Adam idis JP, Eaton KA, Seehol-zer H, Siem inska-Piekarczyk B. A survey of postgraduate (specialist ) or thodont ic edu-cat ion in 23 European count ries. J Or thod 2000;27(1):92–98

organizat ion like NEBEOP can be of bene t for those program s that require external accreditat ion and qualit y assessm ent based on peer-review standards. When th is pro-cess proceeds, the bene t s w ill be seen in all countries as Europe cont inues to func-t ion as a single m arket and m obilit y am ong educated professionals, such as or thodon-t ists, increases. It is clear that in m any Euro-pean count ries, there is a well-funct ioning external review system , and therefore those universit ies do not need an ext ra assess-m ent procedure. On the other hand, an im portant num ber of European postgradu-ate program s do not have external assess-m ent procedures, and an evaluat ion of their program s sim ilar to the evaluat ion of those w ith h igh standards w ill be a driving force to increase the educat ion standards of our specialt y.

The in terest in educat ional issues shared by the “academ ic” NEBEOP and the profes-sional organizat ion EFOSA provides hope for a prom ising collaborat ion and com ple-m entary act ions of these two groups.

References 1. van der Linden FPGM. Orthodontic special-

ists education in Europe: past , present and future. Prog Orthod 2005;6(1):14–35

2. Wahl N. Orthodont ics in 3 m illennia. Chapter 3: The professionalizat ion of or-thodont ics. Am J Orthod Dentofac Orthop 2005;127(6):749–753

3. Network of Erasm us Based European Orth-odont ic Postgraduate Program m es. Bylaws. h t t p : / /w w w .eoseu rop e .org/u sefu l_lin ks/NEBEOPBylaws- nal.pdf. Published May 2009. Accessed January 26, 2015

4. 78/686/EEC: Council Direct ive 78/686/EEC of 25 July 1978 concerning the m utual rec-ognit ion of diplom as, cer t i cates and other evidence of the form al quali cat ions of pract it ioners of dent ist ry, including m ea-sures to facilitate the e ect ive exercise of the r ight of establishm ent and freedom to provide services. O cial Journal of the Eu-ropean Com m unit ies L233, 1978;21:1–9. h t tp ://eur-lex.europa.eu /legal-con ten t /EN/ALL/?uri=CELEX:31978L0686

34

Specialty Level Education in Orthodontics in the United KingdomSusan J. Cunningham

5.1 Postgraduate Specialty Level Training in Orthondontics and the General Dental Council CurriculumPostgraduate specialt y level t rain ing in or thodont ics in the United Kingdom fol-lows the General Dental Council (GDC) cur-riculum , the m ost recent version of w hich can be found on the GDC Web site (h t tps://w w w .gd c- u k .o r g / De n t a lp r o fe ss io n a ls /Specialist list /Docum ents/Or thodont icCur-riculum .pdf). Training to specialt y level requires th ree years of full-t im e inst ruc-t ion (or the par t-t im e equivalen t) and involves both clin ical and academ ic learn-ing; the academ ic elem ent usually consists of undertaking a university postgraduate degree alongside the clin ical t rain ing, and th is can be at a m aster’s or taught doctor-ate level. Individual universit ies o er dif-feren t degree program s, so it is im portant that applicants invest igate them to apply for a program that m eets their personal requirem ents.

Th e GDC cu r r icu lum in clu des th e feat u res of t h e European Erasm u s p ro -gram 1 an d fu lfills th e requ irem en t s of t h e d irect ives of th e Com m ission of t h e Eu ropean Com m un it ies on Den t al Edu -cat ion regard ing th e edu cat ion of or th o-don t ist s2 an d th e World Federat ion of Or th odon t ist s gu idelin es for postgradu -ate or th odon t ic edu cat ion .3

Upon successful com plet ion of the cur-r iculum , t rainees are eligible to take the

5

Mem bership in Orthodont ics (MOrth) exam inat ion of the Royal College of Sur-geons. At the t im e of the w rit ing of th is chapter, there are two MOrth exam ina-t ions: one is a bi-collegiate exam inat ion run join t ly by the Royal College of Surgeons of England and the Royal College of Physicians and Surgeons of Glasgow, and the other is run by the Royal College of Surgeons of Edinburgh . Som e universit ies o er a two-year stand-alone m aster’s degree program , but th is does not give eligibilit y to take the MOrth exam inat ion .

The purpose of the three-year curricu-lum is to enable t rainees in or thodont ics to achieve the level of com petence expected to provide appropriate care for the group of pat ients norm ally seen by a specialist in or thodont ics. There are currently 34 m od-ules in the curriculum , and t rainees m ust show com petence in all of these areas for successful com plet ion of the program . The ways in w hich th is m ay be achieved for each individual m odule are detailed in the curriculum . The m odules are divided in to “Generic Knowledge, Skills and At t itudes” (9 m odules) and “Orthodont ic Specialist Speci c Knowledge, Skills and At t itudes” (25 m odules).

The curriculum prepares trainees to undertake and m aintain a contemporary evidence-based approach to orthodont ic pract ice, and therefore trainees are expected to undertake personal research training and experience. This can be achieved either by preparing a research dissertat ion or through two papers in appropriately peer-reviewed journals subm it ted on work undertaken during the training period. The research

5 Specialt y Level Education in Orthodontics in the United Kingdom 35

component of the program m ust ful ll the m inim um m aster’s level requirem ents of the Quality Assurance Agency. In the United Kingdom currently, the vast m ajority of spe-cialty trainees pursue a m aster’s (or taught doctorate) level postgraduate degree at a United Kingdom university to ful ll the aca-dem ic requirem ents of the curriculum .

Specialt y level t rain ing in or thodon-t ics in the United Kingdom takes place w ith in hospital depar tm ents, linked to the follow ing recognized universit ies for the academ ic and research com ponents of t rain ing: Barts and The London (Queen Mary Universit y), Birm ingham , Bristol, Car-di , Dundee, Edinburgh, Glasgow, King’s College London, Leeds, Liverpool, Manches-ter, Newcast le, She eld, and UCL Eastm an Dental Inst itute. Queen’s Universit y Belfast does not currently run a program but m ay do so again in the future. Not all un iversi-t ies have program s every year, and the num ber of program s and t rainees depends on workforce needs. All program s work to a nat ionally agreed-upon, balanced t im eta-ble of clin ical sessions, research , academ ic teaching, personal study, adm inist rat ion , and audit .

5.2 Teaching MethodsDi erent universit ies vary in their teaching m ethods; for example, som e program s are tradit ional and relat ively didactic in their approach, w hereas others focus on student-centered m ethodologies, such as problem -based learning (PBL), in w hich t rainees learn about a part icular area through their expe-rience of problem solving. Applicants are advised to research the m ethodologies used in the program s for which they are apply-ing, to ensure that they m eet their personal requirem ents. Addit ionally, som e universi-t ies provide all of their teaching “in house,” whereas in other cases, teaching is shared am ong several universit ies in the same geo-graphic area.

The teaching m ethods vary from pro-gram to program , but those m ost com -m only used are the follow ing (please note

that the list does not include all teaching m ethods used):

• Clin ical pract ice, including personal t reatm ent w ith chair-side teach-ing and at tendance at new pat ient clin ics

• Pract ical and technique courses• Lectures• Sem inars and problem -solving

sessions• Online learning

5.2.1 Clinical Practice

Training takes place w ith in hospital depart-m ents, w here or thodont ists work in team s. This hospital set t ing ensures close super-vision of all clin ical work. Clin ical pract ice includes personal t reatm ent sessions dur-ing w hich t rainees undertake t reatm ent planning and hands-on t reatm ent of their ow n pat ients under the close supervision of sen ior clin ical supervisors. There is also at tendance at new pat ient clin ics and a range of m ult idisciplinary clin ics; the clin-ics available m ay vary am ong hospitals.

The aim of clin ical t raining is to provide t rainees w ith the skills and com petence required for the independent pract ice of orthodont ics, and the skills necessary to use di erent appliance system s to t reat pat ients w ith a w ide range of m alocclusions. All program s teach the use of rem ovable, func-t ional, and xed appliance system s. Pro-gram s in the United Kingdom provide good clinical exposure, and chair-side teaching form s an essent ial elem ent of the program s. Each hospital takes this important fact into account and ensures that the appropriate personnel are available to provide this level of teaching and supervision. Training is led by consultant level sta who have under-taken at least ve years of t raining: three years of specialist t raining and an addit ional period of at least two years of advanced t raining to consultant level. Many of those providing teaching and supervision also have form al teaching quali cat ions. Con-sultants m ay be em ployed by the National Health Service or by the universit y and have honorary consultant status.


senior clin icians or academ ics in the United Kingdom , and they include inform at ion on a par t icular topic, suggested references for that topic, and also in teract ive quest ions so that t rainees can test their ow n knowledge. The m odules are all contem porary and updated on a regular basis.

5.3 Assessments and ExaminationsAll or thodont ic specialt y program s incor-porate assessm ents and exam inat ions. Assessm ents are both form at ive and sum -m at ive, and those com m only used in the United Kingdom include the follow ing (please note that the list does not include all assessm ent m ethods used, and m ethods vary am ong program s):

• Writ ten assessm ents• Pract ical assessm ents• Treatm ent planning assessm ents/

diagnostic tests/structured clinical reasoning

• Case presentat ions• Object ive st ructured clin ical exam i-

nat ions (OSCEs)• Workplace-based assessm ents

(WBAs)• Presentat ion of a research thesis/

disser tat ion

5.3.1 Written Assessments

These m ay include essays, m ult iple short-answer quest ions, m ult iple-choice ques-t ions, and/or extended m atching quest ions.

5.3.2 Practical Assessments

These m ay include, for example, assess-m ents of w ire-bending skills under t im ed condit ions. Trainees m ay be asked to under-take the w ire bending required for xed and/or rem ovable appliances in speci ed clinical situat ions.

5.2.2 Practical and Technique Courses

These courses play an important part in developing practical skills. Trainees are required to at tend several courses during their t raining, including w ire-bending and typodont courses in w hich speci c appliance techniques are taught. Typodont courses are extrem ely useful in the early stages of train-ing because they allow practical skills to be acquired before such skills are used in the clinic.

5.2.3 Lectures

Lectures are st ill used in m any program s to allow the basic principles of or thodont ics to be im parted to a group of t rainees.

5.2.4 Seminars and Problem-Solving Sessions

Sm all-group sem inars are often used to dis-cuss a speci c t ype of clin ical problem or a cer tain topic from the curriculum . Trainees w ill usually be given a reading list before the sem inar so that they com e prepared w ith a certain background level of knowl-edge. The session m ay be led by a m em ber of sta or by the t rainees them selves if the program uses PBL.

5.2.5 Online Learning

Most universit ies in the United Kingdom have their ow n vir tual learning environ-m ents (VLEs). These provide lectures, read-ing lists, t im etables, and other inform at ion relevant to individual program s. Addit ion-ally, the Brit ish Orthodont ic Society (BOS) has funded the developm ent of a nat ional VLE that includes m odules m apped to the GDC curriculum , and th is inform a-t ive resource is available to those enrolled in United Kingdom t rain ing program s. The individual m odules are all w rit ten by


improvem ent. Observers provide in-depth feedback to the trainee; the trainee and trainer then discuss potential areas that could be worked on to enhance the trainee’s future clinical practice. The WBAs currently used in orthodontic training are the follow ing:

• Direct observat ion of procedural skills (DOPS)

• Case-based discussions (CBD)• Clin ical evaluat ion exercises (CEX) • Mult iple-source feedback (MSF)

DOPS: A t rainee is observed perform ing a cer tain pract ical procedure (e.g., a bond-up, the placem ent of an arch w ire, the t -t ing of a funct ional appliance); the observer then provides const ruct ive feedback at the end of the clin ical episode.

CBDs are st ructured in terviews designed to assess a t rainee’s professional judgm ent regarding the m anagem ent of a pat ient for w hom he or she has responsibilit y. The dis-cussion of the pat ient’s t reatm ent is based on evidence in the case notes; the pat ient is not present . A CBD allows discussion and explorat ion of the t rainee’s understanding of the t reatm ent provided, and the t rainee receives feedback at the end.

CEXs are used to assess the skills required in clin ical encounters. Trainees are often assessed during new pat ien t clin -ics and w hile discussing t reatm ent p lans and opt ions w ith a pat ien t . The clin ical encounter is observed, and in-depth for-m at ive feedback is provided at the end of the t reatm ent episode.

MSF is a way of assessing a t rainee in the workplace by asking trainers, peers, co-workers, and patients to complete surveys about the t rainee and his or her clinical prac-t ice. The person being assessed then receives feedback w ith a sum m ary of the rat ings.

5.3.7 Presentation of a Research Thesis or Dissertation

Research is a key com ponent of the or th-odont ic curriculum , and the ndings of the research are usually presented as a thesis

5.3.3 Treatment Planning Assessments/Diagnostic Tests/Structured Clinical Reasoning

These assessm ents are usually centered on the clin ical records of an unseen pat ient . Trainees are given su cient t im e to study the records, follow ing w hich they undergo an oral exam inat ion . They are expected to show an understanding of the m ain issues related to that pat ient and to discuss appro-priate t reatm ent st rategies.

5.3.4 Case Presentations

In a case presentation, the trainee w rites a comprehensive case report for a patient under his or her care. This is usually followed by an oral exam ination to allow the exam iner(s) to assess the trainee’s understanding of the salient features of the case, understanding of the treatm ent plan and treatm ent m echanics, and knowledge of lim iting factors and alter-native treatm ent options.

5.3.5 Objective Structured Clinical Examinations

This style of assessm ent generally involves a series of short (usually last ing 10 m inutes) stat ions, in w hich the t rainee is required to undertake cer tain clin ically based tasks. OSCEs test com petence in speci c clin ical skills—for exam ple, com m unicat ion and the abilit y to in terpret radiographs and/or other clin ical records.

5.3.6 Workplace-Based Assessments

Workplace-based assessm ents (WBAs) are form ative assessm ents, which m eans that they do not contribute to nal m arks in a training program but are designed to help trainees identify their own strengths and weaknesses and target areas that require


the individual universit ies w hen apply-ing. There are also addit ional costs, such as the purchase of com puter and photogra-phy equipm ent , t ravel costs, and the costs of prin t ing and photocopying, and these should be borne in m ind.

5.5 Applying for Programs

5.5.1 Entry to Salaried Specialty Training

5.5.1.1 Application Process for Salaried Specialty Registrar Training

The applicat ion for ent ry to one of the sala-r ied specialt y regist rar (StR) t rain ing pro-gram s is a com pet it ive process that takes place nat ionally once a year. Applicants m ust check their eligibilit y by referr ing to the Person Speci cat ion at the t im e they are applying.All salaried StR t rain ing program s in the United Kingdom are join t program s shared by hospital or thodont ic departm ents, w hich em ploy the t rainee, and universit y dental schools, w hich provide the academ ic teaching. The t rain ing program s are a li-ated w ith the universit ies listed earlier in the chapter, and the num ber of posts varies from year to year.

Posts are advert ised early in the year, w ith interviews scheduled for May or June each year. Applicat ions are subm it ted online, and several resources are available about each program to help inform candidates and assist them in their choice of posts. The pro-gram s available through nat ional recruit-m ent all follow the GDC curriculum , and if the trainee successfully completes the pro-gram , he or she is recom m ended to the GDC as eligible for entry to the specialist list in orthodont ics held by the GDC.

In 2014, the essent ial and desirable crite-ria for those applying for StR posts included those detailed in the follow ing paragraph. It is important to note that these are subject

or disser tat ion . According to the GDC cur-r iculum , it is also acceptable to provide evidence of com petency in the research m odule by having two papers in appro-priately peer-reviewed journals subm it ted on work undertaken during the t rain ing period. However, the subm ission of a the-sis/dissertat ion is by far the m ost com m on way of sat isfying th is criterion. The require-m ents for the thesis/disser tat ion vary, and the details can be obtained from individual universit ies.

5.3.8 Membership in Orthodontics

Mem bership in Orthodont ics (MOrth) of one of the Royal Colleges sets a nat ional standard w ith in the United Kingdom and is held both in the United Kingdom and in ternat ionally; th is quali cat ion is now accepted in m any countries as a benchm ark for specialt y level t rain ing. Writ ten assess-m ents, diagnost ic tests/st ructured clin ical reasoning tests, case presentat ions, OSCEs, com m unicat ion scenarios, and general vivas are used in the MOrth exam inat ion . Further details of the assessm ent m ethods used can be found on the Royal College Web sites (addresses are included at the end of th is chapter).

Candidates w ho are able to provide evidence of successful com plet ion of the w rit ten exam inat ion papers leading to an approved universit y quali cat ion in or tho-dont ics at a center recognized by the Royal College of Surgeons of England, Glasgow, or Edinburgh are exem pt from the w rit ten com ponent of the MOrth exam inat ion .

5.4 Costs of TrainingTrainees are required to pay fees to the universit y for the academ ic com ponent of their t rain ing, and these fees vary am ong universit ies and am ong United Kingdom /European Union and non–United Kingdom /European Union t rainees. It is im portant for a candidate to check fee levels w ith


Web sites listed at the end of th is chapter

• Broad clin ical experience• Vocat ional t rain ing cert i cate or

equivalent• Com plet ion of dental foundat ion

t rain ing/general professional t rain-ing (or the equivalen t)

• Experience in teaching and enthusi-asm for teaching

• Experience in research (includ-ing publicat ions, posters, and presentat ions)

The in terview process involves several “stat ions,” at w hich the applicant’s essen-t ial and desirable criteria are assessed, as detailed in the Person Speci cat ion . The applicants are then ranked according to their perform ance during the in terviews, and they are subsequently asked to indicate w hich of the posts they would be w illing to accept . Applicants are able to visit any of the posts in w hich they are in terested after the in terviews. Posts are then o ered in early or m id-July and star t at the end of Septem ber or beginning of October, w hen the universit y term com m ences.

If an applicant accepts a post , he or she is allocated a unique nat ional t rain ing num -ber; this allows t rain ing to be m onitored as described under Sect ion 5.5.1.2, “Qual-it y Managem ent of the Salaried Specialt y Train ing Program s,” and as detailed in the Dental Gold Guide, w hich is available on the UK Com m it tee of Postgraduate Dental Deans and Directors (COPDEND) Web site (h t tp://w w w.copdend.org).

5.5.1.2 Quality Management of the Salaried Specialty Training Programs

The quality of salaried StR t raining pro-gram s is m anaged by Health Educat ion Eng-land and by deaneries in Scotland, Wales, and Northern Ireland. The Specialty Advi-sory Com m it tee for Orthodontics of the Royal College of Surgeons also plays a role in this process by providing expert advice.

to change, and applicants m ust check care-fully to determ ine w hether they ful ll the criteria detailed in the Person Speci cat ion at the t im e of their applicat ion.

Essent ial criteria in 2014 included the follow ing:

• Eligibilit y for regist rat ion w ith the United Kingdom GDC

• Bachelor of dental surgery (BDS) degree or the equivalent

• Eligibilit y to work in the United Kingdom (ht tps://w w w.gov.uk/governm ent/organisat ions/uk-visas-and-im m igrat ion)

• At least 24 m onths of full-t im e post prim ary quali cat ion clin ical expe-rience (or the par t-t im e equivalent) at the t im e of applicat ion

• Dem onstrable skills in w rit ten and spoken English adequate to en-able e ect ive com m unicat ion w ith pat ien ts and colleagues (support ing evidence m ay be required)

• Abilit y to pract ice safely and apply sound clin ical judgm ent

• Understanding of clin ical gover-nance and evidence of act ive par-t icipat ion in audit

• Good com m unicat ion skills, em pa-thy, and sensit ivit y

• Good organizational skills and the ability to work under pressure

• Flexibilit y and w illingness to work as par t of a team

• Understanding of the principles of research

• Com m itm ent to or thodont ics• Professional in tegrit y

Desirable criteria in 2014 included the follow ing:

• Possession of the FDS (Fellow sh ip in Dental Surgery), FFD (Fellow sh ip of the Facult y of Dent ist ry), MFDS (Mem bersh ip of the Facult y of Den tal Surgery), or MJDF (Mem ber-sh ip of the Join t Den tal Facult ies) of the Royal Colleges of Surgeons, or equivalen t quali cat ion ; fur-ther details can be found on the


career in a prim ary care set t ing, a second-ary care hospital set t ing, or a com binat ion of the two.

For a specialist to work in a hospital orthodont ic service as a consultant , a fur-ther two years of t raining is required at a post-specialty level. This t rain ing includes the m anagem ent of m ore complex interdis-ciplinary orthodont ic cases, experience in hospital m anagem ent , and teaching expe-rience. The intercollegiate specialty fellow -ship exam inat ion (ISFE), run by the dental facult ies of the Royal Colleges of Surgeons in the United Kingdom and Ireland, m arks the end of this t raining and incorporates three m ajor sect ions: clinical, m anagem ent , and research/crit ical appraisal. To becom e an academ ic consultant based w ithin a univer-sity, there is also the requirem ent to under-take research toward the award of a higher universit y degree, such as a PhD.

5.5.2 Entry for Those Who Do Not Meet the Essential Criteria for Salaried Specialty Training

Trainees w ho do not m eet the essent ial requirem ents in the Person Speci cat ion for salaried StR t rain ing apply direct ly to a uni-versit y. Each universit y has it s ow n applica-t ion process, requirem ents, and deadlines, so applicants need to invest igate each indi-vidual program carefully. Program s star t in late Septem ber or early October, and the curriculum followed is the GDC curricu-lum detailed previously. Adm ission is also th rough com pet it ive ent ry, and short-listed applicants m ay be in terviewed in person or via elect ronic link.

Three-year program s incorporate a m aster’s or taught doctorate level degree alongside the clin ical t raining, and upon suc-cessful complet ion of the program , t rainees are eligible to take the MOrth exam inat ion of the Royal College of Surgeons. Trainees do not , however, undergo the sam e ARCP/ISCP processes as salaried StRs.

During the t rain ing program , progress is m onitored through a process called the annual review of com petence progression (ARCP), w hich is m anaged by postgraduate dental deans as em ployees of Health Edu-cat ion England or deaneries. The t rainee m ust have a sat isfactory ARCP at the end of years 1 and 2 to be allowed to progress to the next year of t rain ing.

At the end of year 3, t rainees are required to have a sat isfactory ARCP, to have passed the sum m at ive exam inat ion (the MOrth exam inat ion), and to have com -pleted all com ponents of the GDC curricu-lum (including sat isfactory com plet ion of the research com ponent) in order that the postgraduate dental dean can recom m end the award of a Cert i cate of Com plet ion of Specialt y Train ing (CCST). At that stage, the t rainee can apply to be accepted onto the GDC specialist list in or thodont ics; accep-tance allows one to pract ice as a specialist in orthodont ics in the United Kingdom .

5.5.1.3 Electronic Training Record and Workplace-Based Assessments

The ARCP process is inform ed by an elec-t ronic t rain ing record, w hich is held on the in tercollegiate specialt y curriculum pro-gram (ISCP). The ISCP stores inform at ion regarding personal developm ent plans, global object ives for the t rain ing program , appraisals, and assessm ents. Addit ional inform at ion , such as publicat ions, audits, and presentat ions, can also be stored. All salaried StRs are required to be registered on the ISCP as par t of their t rain ing.

WBAs are a m andatory par t of the ARCP process, and a speci ed num ber of WBAs m ust be com pleted at the appropriate level each year to have a sat isfactory ARCP.

5.5.1.4 Career Progression

Once accepted onto the GDC specialist list in or thodont ics, or thodont ic specialists can choose w hether they w ish to pursue a


• UK Com m it tee of Postgraduate Dental Deans and Directors (h t tp://w w w.copdend.org)

• Individual universit y Web sites• Royal College of Surgeons of England

(h t tps://w w w.rcseng.ac.uk)• Royal College of Surgeons of Edin-

burgh (h t tp://w w w.rcsed.ac.uk)

• Royal College of Physicians and Sur-geons of Glasgow (h t tp://w w w.rcpsg.ac.uk)

• Royal College of Surgeons in Ireland (h t tp://w w w.rcsi.ie)

• UK Visas and Im m igra-t ion (h t tps://w w w.gov.uk/governm ent/organisat ions/uk-visas-and-im m igrat ion)

To the best of the author’s knowledge th is inform at ion was correct at the t im e of w rit ing the chapter: Decem ber 2014.

References 1. Huggare J, Derr inger KA, Eliades T, et al.

The Erasm us program m e for postgradu-ate educat ion in or thodont ics in Europe: an update of the guidelines. Eur J Orthod 2014;36(3):340–349

2. Advisory Com m it tee on the t raining of den-tal pract it ioners repor t on the eld of act iv-it y and t rain ing program m es for the dental specialists. 1986 European Com m ission Di-rect ive num ber III/D/1374/5/84-EN

3. Athanasiou AE, Darendeliler MA, Eliades T, et al; World Federation of Orthodontists. The World Federation of Orthodontists (WFO) guidelines for postgraduate orthodontic education. World J Orthod 2009;10(2):153–166

As m entioned earlier in th is chap -ter, som e universit ies o er a two-year (or par t-t im e equivalent) m aster’s level pro-gram w ithout an addit ional th ird year of t raining; it is im portant to note that th is does not give eligibilit y to take the MOrth exam inat ion .

Those t rainees w ho have not been appointed through the nat ional process for salaried StRs, w ho do not have a unique nat ional t rain ing num ber, and w ho are therefore not on a recognized StR t rain -ing program are not autom at ically ent i-t led to specialist recognit ion in the United Kingdom or in their hom e country, even if they have been successful in the MOrth exam inat ion . To apply for regist rat ion in the United Kingdom , a t rainee would have to apply for ent ry to the United Kingdom GDC specialist list in or thodont ics through the process of equivalence. To do th is, the t rainee m ust have full regist rat ion w ith the GDC and be able to dem onst rate that the t raining undertaken was the sam e as that undertaken by those t rainees w ho success-fully com pleted an approved StR t rain ing program as evidenced by the award of a CCST. There is no guarantee of acceptance onto the specialist list via th is route.

5.6 Sources of Further InformationFurther sources of inform at ion that poten-t ial applicants m ay nd useful are listed below:

• Brit ish Orthodont ic Society (h t tp://w w w.bos.org.uk)

• General Dental Council (w w w.gdc-uk.org)

42

Postgraduate Orthodontic Education in the United StatesPeter Ngan and Christina DeBiase

Orthodont ics and dentofacial or thopedics are de ned as the dental specialt ies that include the diagnosis, prevent ion, in tercep -t ion, and correct ion of m alocclusion, as well as neurom uscular and skeletal abnorm ali-t ies of the developing or m ature orofacial st ructures (adopted by the Am erican Asso-ciat ion of Orthodont ists [AAO], April 2003).1There are current ly 66 accredited or th-odont ic program s in the United States and ve in Canada. Each year, approxim ately 350 or thodont ists graduate from these pro-gram s. The Com m ission on Dental Accredi-tat ion advocates for the oral health care needs of the public through the develop -m ent and adm inist rat ion of standards that foster the cont inuous qualit y im provem ent of dental and dental-related educat ional program s. Program s that earn approval and are fully operat ional achieve or exceed the basic requirem ents for accreditat ion. Pro-gram s that receive approval w ith report ing requirem ents have speci c de ciencies or weaknesses in one or m ore areas. Evidence of com pliance w ith the cited standards m ust be dem onstrated w ith in 18 m onths if the program is two years or longer in length , or w ith in two years if the program is up to two years in length . If the de ciencies are not corrected w ith in the speci ed t im e period, accreditat ion w ill be w ithdraw n, unless the com m ission extends the period for achieving com pliance for good cause. Circum stances under w hich an extension for good cause would be granted include, but are not lim ited to, sudden changes in inst itut ional com m itm ent; natural disaster that a ects a liated agreem ents between inst itut ions; faculty support; facilit ies;

6

changes in inst itut ional accreditat ion; or in terrupt ion of an educat ional program because of unforeseen circum stances that take faculty, adm inist rators, or students away from the program .

Program s that are not fully operat ional are those that have not enrolled or gradu-ated at least one class of students/residents and do not have students/residents enrolled in each year of the program . The accredita-t ion classi cat ion granted by the Com m is-sion on Dental Accreditat ion to program s that are not fu lly operat ional is term ed init ial accreditat ion . When in it ial accredi-tat ion status is granted to a developing educat ion program , it is in e ect th rough the projected enrollm ent date. However, if enrollm ent of the rst class is delayed for two consecut ive years follow ing the projected enrollm ent date, the program ’s accreditat ion w ill be discont inued, and the inst itut ion m ust reapply for in it ial accredi-tat ion and update per t inent inform at ion on program developm ent . Follow ing th is, the com m ission w ill reconsider grant ing in it ial accreditat ion status. This accreditat ion clas-si cat ion provides evidence to educat ional inst itut ions, licensing bodies, and govern-m ent or other grant ing agencies that , at the t im e of in it ial evaluat ion(s), the develop -ing educat ion program had the potent ial for m eet ing the standards set for th in the requirem ents for an accredited educat ional program for the speci c occupat ional area. The classi cat ion of in it ial accreditat ion is granted based upon one or m ore site evalu-at ion visit(s). A developing program can-not enroll students/residents unt il in it ial accreditat ion has been achieved.

6 Postgraduate Orthodontic Educat ion in the United States 43

Maintaining and improving the qual-ity of advanced education in the nationally recognized specialty areas of dentistry is a prim ary aim of the Com m ission on Den-tal Accreditat ion. The com m ission is rec-ognized by the public, the profession, and the U.S. Departm ent of Educat ion as the specialized accredit ing agency in dentist ry. Accreditat ion of advanced specialty edu-cation program s is a voluntary e ort of all parties involved. The process of accredita-t ion assures students/residents, specialty boards, and the public that accredited train-ing program s are in compliance w ith pub-lished standards. Accreditat ion is extended to inst itut ions o ering acceptable program s in orthodontics and dentofacial orthopedics. Program accreditat ion w ill be w ithdrawn w hen the training program no longer con-form s to the standards as speci ed in this docum ent, w hen all rst-year posit ions rem ain vacant for a period of two years, or w hen a program fails to respond to requests for program inform ation. Exceptions for non-enrollm ent m ay be m ade by the com -m ission for program s w ith “approval w ith-out report ing requirem ents” status upon receipt of a form al request from an inst itu-t ion stat ing reasons w hy the status of the program should not be w ithdrawn.

Advanced educat ion in a recognized specialt y area of dent ist ry m ay be o ered on either a cer t i cate-only or a cer t i -cate- and degree-grant ing basis. Accredita-t ion act ions by the Com m ission on Dental Accreditat ion are based upon inform at ion gained through w rit ten subm issions by program directors, and evaluat ions m ade on site by assigned consultants. The com -m ission has established review com m it-tees in each of the recognized specialt ies to review site visit and progress reports and m ake recom m endat ions to the com -m ission. Review com m it tees are com posed of represen tat ives selected by the special-t ies and their cer t ifying boards. The com -m ission has the u lt im ate responsibilit y for determ ining a program ’s accreditat ion status. The com m ission is also responsible for the adjudicat ion of appeals of adverse decisions and has established policies and procedures for appeal.2

6.1 Commission on Dental Accreditation StandardsThe Com m ission on Dental Accreditation establishes general standards that are com -m on to all dental specialt ies, institutions, and program s regardless of specialty. Each spe-cialty develops specialty-speci c standards for educational program s in its specialty. The general and specialty-speci c standards, sub-sequent to approval by the Com m ission on Dental Accreditation, set forth the standards for the educational content, instructional activit ies, patient care responsibilities, super-vision, and facilit ies that should be provided by program s in that particular specialty.2

6.2 Standard 1: Institutional Commitment/Program E ectivenessThe program m ust develop clearly stated goals and object ives appropriate to advanced specialty education that address educat ion, patient care, research, and service. Plan-ning for, evaluation of, and improvem ent in educat ional quality for the program m ust be broad-based, system atic, cont inuous, and designed to prom ote the achievem ent of program goals related to education, patient care, research, and service.

6.2.1 West Virginia University Goals and Objectives

Graduates m ust receive inst ruct ion in the applicat ion of the principles of eth ical rea-soning, eth ical decision m aking, and profes-sional responsibilit y as they per tain to the academ ic environm ent , research, pat ient care, and pract ice m anagem ent .

At West Virginia University (W VU), a full-day sem inar is given to students annu-ally addressing a range of resources, such as professional codes, regulatory law, and ethical theories, to guide their judgm ent


their professional em ploym ent set t ings. The program encourages graduates to com plete the last clin ical phase of the ABO exam inat ion . The num bers of alum ni w ho cont inue to pursue the clin ical por t ion of the ABO exam inat ion are tabulated.

The outcom es of the program are also assessed each year to m onitor the achieve-m ent of the program ’s goals and object ives. We w ill know that we are producing gradu-ates w ho dem onst rate outstanding clin ical skills based on the follow ing:

• Faculty assessm ent of the qualit y of student clin ical perform ance yielded pat ient outcom es of outstanding qualit y 100% of the t im e.

• A chart review conducted at the end of the second sem ester of the th ird year revealed no seriously m ism anaged cases and that at least 95% of cases were m anaged successfully.

• All graduates passed the ABO phase II w rit ten exam inat ion successfully before graduat ion .

• All graduates passed the ABO m ock clin ical exam inat ion given by the th ree board-cer t i ed or thodont ists in the state of West Virgin ia. Students are required to prepare th ree cases in ABO style and take the oral exam inat ion as par t of the exam inat ion .

We w ill know we are producing gradu-ates w ho dem onstrate e ect ive m anage-m ent skills if:

• Tracking records do not show excessive num bers of em ergency phone calls, canceled appointm ents, and appliance breakage.

• The ent ire facult y agrees and cer t i es that 100% of the students com plet ing the program each year have e ect ive m anagem ent skills.

We w ill know we are producing gradu-ates w ho dem onstrate a h igh level of eth ics and professional responsibilit y if:

• Our records show no breaches of eth ics or professionalism during school year by any student .

and act ions regarding issues that are com -plex, novel, ethically arguable, divisive, or of public concern.

The program m ust docum ent its e ec-t iveness by using a form al and ongoing outcom es assessm ent process that includes m easures of advanced education student/resident achievem ent.

At W VU, the follow ing program goals and object ives for postgraduate or thodon-t ic educat ion exist:

• To provide educat ional experiences that produce graduates w ho dem onstrate outstanding clin ical skills

• To provide a program that produces graduates w ho dem onstrate e ect ive pat ient m anagem ent skills

• To provide a program w ith a h igh level of eth ics and professional responsibilit y

• To provide adequate or thodont ic pract it ioners for the state of West Virgin ia and the profession

• To encourage and assist in increasing the supply of orthodont ic educators

• To prom ote and enhance research in the specialt y of or thodont ics

To achieve these goals and object ives, graduate students are evaluated every year by all faculty on their progress in didact ic and clin ical work. Graduates are required to take the m ock Am erican Board of Ortho-dont ics (ABO) exam inat ion conducted by three board-cer t i ed or thodont ists in the state of West Virgin ia. In addit ion , the results of the w rit ten ABO exam inat ion are evaluated to check if there are de ciencies in the didact ic or clin ical port ion of the W VU curriculum .

Program e ect iveness is evaluated by both faculty and residents. Faculty and resi-dents are given evaluat ion form s to indicate their perceived e ect iveness of courses, clinical adm inist rat ion, and faculty teach-ing. At the t im e of graduat ion, graduates are also asked to part icipate in an exit interview.

Every seven years, the program con-ducts an alum ni survey to gather inform a-t ion on how graduates are perform ing in


program directors appointed after January 1, 1997, w ho have not previously served as program directors m ust be board-cer t i ed).

At W VU, the program director is board-cer t i ed in or thodont ics and dentofacial or thopedics. The program director has su cient authorit y and t im e to achieve the educat ional goals of the program and assess the program ’s e ect iveness in m eet-ing it s goals. The program director spends 70% of h is or her t im e on the graduate pro-gram to com plete h is or her educat ional and adm inist rat ive responsibilit ies. The program director has su cient t rain ing and experience in teaching or thodont ics and dentofacial or thopedics at both the predoctoral and graduate levels. Periodic faculty m eet ings are held for the proper funct ion and im provem ent of an advanced specialt y educat ion program in or thodon-t ics and dentofacial or thopedics.

Most of the specialt y inst ruct ion and supervision is conducted by individuals w ho are educat ionally quali ed in or tho-dont ics and dentofacial or thopedics. The clin ical inst ruct ion and supervision in or thodont ics and dentofacial or thopedics are provided by individuals w ho have com -pleted an advanced specialt y educat ion program in or thodont ics and dentofacial or thopedics approved by the Com m ission on Dental Accreditat ion , or by individuals w ho have equivalent educat ion in ortho-dont ics and dentofacial or thopedics. Full-t im e faculty m em bers have adequate t im e for their ow n professional developm ent . The num ber and t im e com m itm ent of fac-ulty are su cient to provide full supervi-sion of the clin ical port ion of the program . Faculty evaluat ions are conducted and doc-um ented at least annually. The qualit y of t reatm ent provided by residents/students in the program is evaluated by:

• All faculty for each pat ient seen each sem ester

• Review of all char ts by the clin ic director each sem ester

• Preparat ion of com pleted cases in ABO style

• Survey of pat ient sat isfact ion before the rem oval of or thodont ic appliances for all pat ients

• Faculty evaluat ions show no breach of eth ics or serious professional infract ions during the year.

We w ill know that we provide adequate or thodont ic pract it ioners for the state of West Virgin ia if:

• There is no drast ic increase or decrease in the num ber of or thodont ists pract icing in the state of West Virgin ia. The program m onitors the total num ber of or thodont ists pract icing in the state. If a drast ic reduct ion occurs, the program w ill urge students to pract ice in the state.

We w ill know that the program encour-ages and assists in increasing the supply of or thodont ic faculty if:

• The survey of alum ni ident i es that graduates are act ively involved in teaching in a full-t im e or par t-t im e capacity.

• The program can m aintain a m inim um of three full-t im e faculty and six par t-t im e faculty for the graduate program .

• The ent ire faculty is board-cer t i ed or board-eligible.

We w ill know that the program is successful in prom ot ing and enhancing research in the specialt y of or thodont ics if:

• At least 50% the com pleted m aster’s theses are published in refereed or thodont ic journals.

• Every year, graduate students are encouraged to par t icipate and at tend professional m eet ings and present their research ndings.

6.3 Standard 2: Program Director and Teaching Sta The program m ust be adm inistered by one director w ho is board-cer t i ed in the respect ive specialt y of the program . (All


• Equipm ent that is subjected to periodic state inspect ion to ensure com pliance w ith safet y standards

• Monitoring of the departm ent of radiology by the oral radiology qualit y assurance program

6.4.1 Policies and Procedures on the Management of Hazardous Materials and Blood-Borne and Infectious Diseases for Patients, Advanced Education Students/Residents, and Sta

At W VU, the School of Dent ist ry m aintains an infect ious disease cont rol and biohaz-ards com m it tee. Inspect ions are com pleted on a regular basis by Occupat ional Safety and Health Adm inist rat ion (OSHA) com pli-ance faculty to provide not ice of incidents of noncom pliance. Correct ional m easures are inst ituted im m ediately. The faculty and sta are required to pass a m andatory annual online course on infect ion control and blood-borne pathogens. The infect ious disease control and biohazards com m it-tee m onitors sat isfactory com pliance w ith infect ion control, un iversal precaut ions, and regulatory waste disposal. Such safet y m easures include the follow ing:

• The provision of sterile inst rum ent casset tes for all clin ical procedures by central ster ilizat ion and dispensing

• Mandated full-length , long-sleeve clin ical disposable cover gow ns that exceed OSHA recom m endat ions/requirem ents

• Cont inuous prin touts that m onitor the proper funct ioning of cent ral ster ilizat ion equipm ent

• Microban disposable infect ious waste containers that are collected by a special crew each evening and incinerated on site

• Annual m andated blood-borne pathogen t rain ing/ret rain ing sem inar

6.4 Standard 3: Facilities and ResourcesInst itut ional facilit ies and resources m ustbe adequate to provide the educat ional experiences and opportunit ies required to ful ll the needs of the educat ional program as speci ed in these Standards. Equipm ent and supplies for use in m anaging m edical em ergencies m ust be readily accessible and funct ional.

The advanced specialt y program needs to docum ent that it s facilit ies and resources are adequate to provide the educat ional experiences and opportunit ies required to ful ll the needs of the educat ional pro-gram . At W VU, the equipm ent and supplies for use in m anaging m edical em ergencies are readily accessible. Em ergency car ts are ready and funct ional on dem and. The program docum ents its com pliance w ith the inst itut ion’s policy and the applicable regulat ions of local, state, and federal agen -cies, including but not lim ited to radiat ion hygiene and protect ion , ionizing radiat ion , hazardous m aterials, and blood-borne and infect ious diseases. The above policies are provided to all students/residents, faculty, and appropriate support sta and cont inu-ously m onitored for com pliance.

At W VU, the facilit y o ers com pre-hensive radiologic assessm ent capabilit y that includes convent ional peri-apical and panoram ic m achines, as well as cephalo-m etric and cone beam com puted tom ogra-phy units. All residents are t rained to take full-m outh series, panoram ic radiographs, and cephalom etric radiographs for their pat ients. Radiologic protect ion is ensured by the follow ing:

• Lead aprons and sh ields for pat ients• Machines that are t r iggered from

behind lead-lined walls• The use of ult ra-speed lm to lessen

exposure t im e• Autom ated lm processors w ith

fresh solut ions to m inim ize retakes result ing from processing errors

• Radiology personnel wearing exposure badges


6.4.3 Instrument Sterilization and Dispensing of Clinical Supplies

At W VU, all inst rum ents are stored as sets in m arked casset tes and are decontam i-nated and sterilized at the Suncrest Tow ne Center Clin ic, Morgantow n, West Virgin ia. Students, facult y, and sta obtain w rapped sterile casset tes and clin ical supplies from the dispensing w indow of the “clean” sec-t ion of cen t ral processing. Contam inated inst rum ents in casset tes are returned to the receiving w indow of the “contam i-nated” sect ion of cent ral processing. In the contam inated area of cent ral processing is a large washer/decontam inator, through w hich all inst rum ents in casset tes are pro-cessed. After cleaning, the inst rum ents w ith in the casset tes are w rapped in the clean area and then sterilized in either an autoclave or a dry heat sterilizer.

Biological m onitoring is conducted in cent ral processing three t im es each week (Monday, Wednesday, and Friday) for the autoclaves and two t im es a week (Tuesday and Thursday) for the dry heat sterilizer. Spores tested for are Bacillus stearother-m ophilus and Bacillus subt ilis var. niger. The records of all biological m onitoring results are kept on le for ve years in central processing.

The persons w ho process all inst ru-m ents in central processing work only in that area and include the supervisor and seven sta m em bers w ho are t rained by the supervisor of cent ral processing and clin i-cal dispensing.

6.4.4 Enforcement of the School’s Policy on Preclinical, Clinical, and Laboratory Asepsis and Infection Control

At W VU, the chair of the infect ion disease control and biohazards com m it tee of the School of Dent ist ry coordinates regular inspect ions of all clin ics and laboratories

• An infect ion control m anual that is updated as required

• Departm ental exposure control plans in the case of needlest icks, etc.

• Weekly biological reports that m onitor all ster ilizat ion equipm ent

• Universal precaut ions for all pat ient t reatm ent by all faculty, residents, and sta

6.4.2 Handling of Hazardous Waste, Disposal of Hazardous Waste and Hazardous Waste Spills, and Enforcement of the Dental Hazardous Waste Policy

Once a year, or sooner if noncom pliance is reported, the Health Sciences Center health and safety director inspects each laboratory for com pliance. Noncom pliance w ith any direct ive is forwarded to the chair or direc-tor of the speci c depar tm ent involved. Individuals m ay be required to at tend edu-cat ional sessions on the par t icular noncom -pliance issue, and/or the departm ent m ay be ned.

Annually, all den tal school facult y, stu-dents, and clin ical sta are required to take an online course in blood-borne pathogens and infect ion control speci c to the W VU School of Dent ist ry. This includes inform a-t ion on blood-borne pathogens; preclin i-cal, clin ical, and laboratory asepsis; and infect ion and biohazard cont rol. Par t-t im e faculty are given a packet contain ing the above inform at ion, w hich they m ust read; they then sign and return a veri cat ion form to the director of clin ical educat ion and pat ient care. In addit ion , rst -year den-tal students are presented w ith a one-hour overview of blood-borne pathogens and infect ion control during orientat ion week in July, as well as a two-hour detailed lec-ture during the m iddle of the fall sem ester.


6.4.6 Private O ce Facilities Used as a Means of Providing Clinical Experiences in Advanced Specialty Education

The advanced specialt y program should be able to dem onstrate that the space designated speci cally for the program is adequate, and that facilit ies perm it the students/residents to work e ect ively w ith t rained allied dental personnel.

6.4.7 Radiographic, Biometric, and Data-Collecting Facilities Readily Available to Document Both Clinical and Research Data

The advanced specialty program should be able to dem onstrate that im aging equipm ent is available for collecting radiographic and biom etric data, and that students/residents in the orthodontic program have access to adequate space, equipm ent, and physical facilit ies to do research. At W VU, adequate secretarial, clerical, dental auxiliary, and technical personnel are provided to enable students/residents to achieve the educa-t ional goals of the program . Su cient space is provided for the storage of patient records, m odels, and other related diagnostic m ate-rials. These records and m aterials should be readily available to e ectively docum ent active treatm ent progress and im m ediate as well as long-term results of t reatm ent.

6.5 Standard 4: Curriculum and Program Duration

6.5.1 Curriculum Approach: Evidence-Based Dentistry

Evidence-based dent ist ry is an approach to oral health care that requires the judicious in tegrat ion of system at ic assessm ents of

in the School of Dent ist ry. When possible, these inspect ions are conducted two t im es a m onth by m em bers of the infect ious dis-ease control and biohazards com m it tee. Using the “Infect ion Control and Safety Guidelines for the School of Dent ist ry,” the inspect ion team visits each clin ic and labo-ratory on a designated day and observes all faculty, sta , and students. Any violat ions of these guidelines are recorded on “OSHA violat ions” sheets, along w ith the nam e of the violator. This record of violat ions is returned to the o ce of the director of clin-ical educat ion and pat ien t care.

6.4.5 Infection Control Policies Provided to All Students, Residents, Faculty, and Appropriate Support Sta and Continuously Monitored for Compliance

The program should be able to dem onstrate that all students, faculty, and sta in terfac-ing w ith pat ients are apprised of the proto-col and periodic upgrades. All or thodont ic inst rum ents are centrally sterilized. The infect ious disease control and biohazards com m it tee perform s periodic inspect ions of the clin ic to m ake sure that all stu-dents, sta , and faculty com ply w ith OSHA requirem ents. All new graduate students are required to take the OSHA course, and all sta , students, and facult y are required to take the OSHA update each year.

Policies on blood-borne and infect ious diseases are m ade available to applicants for adm ission, and patients. Students/resi-dents, faculty, and appropriate support sta encouraged to be im m unized against and/or tested for infect ious diseases, such as m umps, m easles, rubella, and hepat it is B, before contact w ith pat ients and/or infec-t ious objects or m aterials, in an e ort to m inim ize the risk to pat ients and dental per-sonnel. All students/residents, faculty, and support sta involved in the direct provision of patient care are continuously recognized/cert i ed in basic life support procedures, including cardiopulm onary resuscitat ion.


t ion and culm inates in the award of a m as-ter of science degree and a cert i cate in or thodont ics.

6.5.3 Biomedical Sciences Curriculum

Advanced specialt y program s m ust be able to show that their graduates are com petent to:

a. Develop t reatm ent plans and diagnoses based on inform at ion about norm al and abnorm al grow th and developm ent

b. Use the concepts gained in em bryology and genet ics in planning t reatm ent

c. Include knowledge of anatomy and histology in planning and carrying out t reatm ent

d. Apply knowledge about the diagnosis, prevent ion, and t reatm ent of diseases of the oral t issues

At W VU, biom edical science m odules in anatomy, m icrobiology, and pharm acol-ogy are provided to ensure that the stu-dents gain advanced knowledge in these disciplines and can apply th is knowledge to direct pat ient care.

6.5.4 Clinical Sciences Curriculum

Advanced specialt y program s m ust be able to show that their clin ical sciences cur-r iculum is evidence-based. At W VU, the curriculum is designed to ensure that the literature reviewed is applied to clin ical t reatm ent decisions, current system at ic lit -erature reviews are in tegrated w ith t reat-m ent conferences, and eth ics are applied to pat ient m anagem ent .

The clin ical t rain ing in or thodont ics should be extensive, w ith com prehensive clin ical experience that is representat ive of the character of or thodont ic problem s encountered in private pract ice. Students/residents should be able to acquire experi-ence in the t reatm ent of all t ypes of m al-occlusion, w hether in the perm anent or

clin ically relevant scien t i c evidence, relat-ing to the pat ient’s oral and m edical condi-t ion and history, w ith the dent ist’s clin ical exper t ise and the pat ient’s t reatm ent needs and preferences (adopted by the Am erican Associat ion of Orthodont ists House of Del-egates, May 24, 2005).3

The advanced or thodont ic educat ion program should provide special knowl-edge and skills beyond t rain ing for the DDS or DMD degree and orientat ion to the accepted standards of specialt y pract ice. The program should include inst ruct ion and learning experiences in evidence-based pract ice. This inform at ion allows graduates to judiciously in tegrate clin ically relevant judgm ents based on scient i c evi-dence w ith the pat ient’s t reatm ent needs and preferences in m ind. At W VU, these instruct ions include:

• Form al inst ruct ion (a m odule/lecture m aterials) on evidence-based pract ice

• Case presentat ions that in tegrate aspects of evidence-based pract ice

• Literature review sem inars• Projects/portfolios that include

crit ical reviews of the literature according to evidence-based pract ice principles (“search of publicat ion databases and appraisal of the evidence”)

• Assignm ents that include publicat ion database searches and literature appraisal for best evidence to answer pat ien t-focused clin ical quest ions

6.5.2 Program Duration: Advanced Specialty Education Programs in Orthodontics and Dentofacial Orthopedics Must Be a Minimum of 24 Months and 3,700 Scheduled Hours in Duration

All advanced specialt y educat ion program s m ust adhere to the program durat ion set for th by the accreditat ion guidelines. At W VU, the program is 34 m onths in dura-


m . Pract ice or thodont ics in full com pliance w ith accepted standards of eth ical behavior

n . Manage and m ot ivate pat ients to par t icipate fully w ith or thodont ic t reatm ent procedures

o. Study and crit ically evaluate the literature and other inform at ion per tain ing to th is eld

Other than clin ical t rain ing, gradu-ates m ust have an understanding of the follow ing areas as par t of the support ing curriculum :

a. Biostat ist icsb. History of or thodont ics and dentofacial

or thopedicsc. Ethics and jurisprudenced. Oral physiologye. Pain and anxiety controlf. Pediat r icsg. Periodont icsh . Pharm acologyi. Prevent ive dent ist ryj. Psychological aspects of or thodont ic

and dentofacial or thopedic t reatm entk. Public health aspects of or thodont ics

and dentofacial or thopedicsl. Speech pathology and therapym . Pract ice m anagem entn . Various recognized techniques used in

contem porary or thodont ic pract ice

6.6 Standard 5: Eligibility and Selection of Advanced Education Students and ResidentsEligible applicants to advanced specialt y educat ion program s accredited by the Com m ission on Dental Accreditat ion m ustbe graduates of:

a. Predoctoral dental program s in the United States accredited by the Com m ission on Dental Accreditat ion , or

t ransit ional dent it ion , and their experience should include t reatm ent of the prim ary dent it ion , w hen appropriate. At W VU, graduates are com petent to:

a. Coordinate and docum ent detailed in terdisciplinary t reatm ent plans that m ay include care from other providers, such as restorat ive dent ists, oral and m axillofacial surgeons, or other dental specialists

b. Treat and m anage developing dentofacial problem s that can be m inim ized by appropriate and t im ely in tervent ion

c. Use dentofacial orthopedics in the t reatm ent of pat ients w hen appropriate

d. Treat and m anage m ajor dentofacial abnorm alit ies and coordinate care w ith oral and m axillofacial surgeons and other health care providers

e. Provide all phases of or thodont ic t reatm ent , including in it iat ion , com plet ion , and retent ion

f. Treat pat ients w ith at least one contem porary or thodont ic technique

g. Manage pat ients w ith funct ional occlusal and tem porom andibular disorders

h . Treat or m anage the or thodont ic aspects of pat ients w ith m oderate or advanced periodontal problem s

i. Develop and docum ent t reatm ent plans w ith the use of sound principles of appliance design and biom echanics

j. Obtain and create long-term les of qualit y im ages of pat ients by using techniques of photography, radiology, and cephalom etrics, including com puter techniques, w hen appropriate

k. Use dental m aterials knowledgeably in the fabricat ion and placem ent of xed and rem ovable appliances

l. Develop and m ain tain a system of long-term t reatm ent records as a foundat ion for understanding and planning t reatm ent and retent ion procedures


nature of their assignm ents to other depar t-m ents or inst itut ions and teaching com -m itm ents. Teaching com m itm ents cannot exceed 10% of the curriculum . Addit ionally, all advanced specialt y educat ion students/residents should be provided w ith w rit ten inform at ion that a rm s their obligat ions and responsibilit ies to the inst itut ion, the program , and the program facult y.

6.9 Standard 6: ResearchAdvanced specialt y educat ion students/residents m ust engage in scholarly act ivit y.

At W VU, students/residents are required to in it iate and com plete a research project that includes a crit ical review of the literature, developm ent of a hypoth-esis, stat ist ical analysis, and in terpretat ion of data, culm inat ing in an original w rit ten thesis. They are also required to defend their theses orally in fron t of a com m it tee of faculty and peers. A draft of the m anu-script is required to be subm it ted and pub-lished in peer-reviewed journals follow ing program graduat ion .

References 1. Accreditat ion standards for advanced spe-

cialt y educat ion program s in Orthodont ics and Dentofacial Or thopedics. Com m ission on Dental Accreditat ion , w w w.ada.org

2. Com m ission on Dental Accreditat ion . Ac-creditat ion standards for advanced spe-cialt y educat ion program s in or thodont ics and dentofacial or thopedics. h t tp://w w w.ad a .org/~/m ed ia /CODA/ Files/or t h o .ash x . Accessed January 25, 2015

3. Am erican Associat ion of Orthodont ists House of Delegates, May 24, 2005. h t tp://u thscsa.edu/vpaa/accreditat ion /docs/coda_standard_4_1_orthodont ics.pdf. Accessed May 27, 2015

b. Predoctoral dental program s in Canada accredited by the Com m ission on Dental Accreditat ion of Canada, or

c. In ternat ional dental schools that provide equivalent educat ional background and standing as determ ined by the program

The adm ission of students/residents w ith advanced standing m ust be based on the sam e standards of achievem ent required of students/residents regularly enrolled in the program . Transfer students/residents w ith advanced standing m ust receive an appropriate curriculum that results in the sam e standards of com pe-tence required of students/residents regu-larly enrolled in the program . A com m it tee of or thodont ic faculty m em bers m ust be responsible for the select ion of students/residents for postdoctoral t rain ing unless the program is sponsored by a federal ser-vice u t ilizing a centralized student/resident select ion process. At W VU, the select ion and in terview process is included in the program policies and is docum ented on the school’s website and in the m inutes of com -m it tee m eet ings.

6.7 Due ProcessThe inst itut ion or program should have speci c w rit ten due process policies and procedures for the adjudicat ion of aca-dem ic and disciplinary com plaints that parallel those established by the sponsor-ing inst itut ion .

6.8 Rights and ResponsibilitiesAt the t im e of enrollm ent , advanced spe-cialt y educat ion students/residents should be apprised in w rit ing of the educat ional experiences to be provided, including the

52

Orthodontic Specialty Education in CanadaWilliam A. Wiltshire

Canada, the second largest country in the world, has an area of 9,984,670 square kilo-m eters; it ranks 37th in populat ion density, w ith 35,427,524 inhabitants.1,2 The report of the Canadian Dental Associat ion , “Den-tal Health Services in Canada,” est im ates that there were 19,563 licensed dent ists in Canada in January 2010, of w hom 11% were specialists. Orthodont ists accounted for the h ighest num ber of specialist s in Canada, w ith a total of 735.3 By June 30, 2013, the num bers had increased to 20,616 dent ists and 790 or thodont ists.

There are 10 dental schools across Canada graduat ing approxim ately 512 dent ists per year, and six have or thodont ic program s: the Universit y of Toronto, Uni-versit y of Western Ontario, and Universit y of Montreal (the French language univer-sit y o ering an or thodont ic program ) in the provinces of Ontario and Quebec; the Universit y of Manitoba and Universit y of Alber ta in the prairie provinces; and the Universit y of Brit ish Colum bia in the west . All dental schools and or thodont ic pro-gram s are in publicly funded universit ies.3The Universit y of Toronto or thodont ic pro-gram is the oldest in Canada, established in 1945, followed by the Universit y of Mon-t real (1947), Universit y of Manitoba (1966), Universit y of Alberta (1969), Universit y of Western Ontario (1973),4 and Universit y of Brit ish Colum bia (2010).

Dental Health Services Canada states that 4.1% of Canadians were receiving or th -odont ic t reatm ent in 2010; 18% of these were adolescents and 6.2% were children . It was est im ated that by 2010, alm ost 20% of Canadians had received or were in the process of receiving or thodont ic t reatm ent ,

7

equat ing to approxim ately 7 m illion Cana-dians in total.3

7.1 Regulatory Organizations Governing Orthodontic Education and Practice in Canada

7.1.1 Commission on Dental Accreditation of Canada

The CDAC head o ce, situated in Ot tawa, Ontario, establishes the m inim um nat ional guidelines for or thodont ic educat ion in Canada. It establishes site visits to Canadian program s every seven years. The reviewer has the opportunity to m ake recom m en-dat ions to the program in areas w here weakness or de ciency exists. When a rec-om m endat ion is m ade, it is expected that the program w ill address the issue. When issues are ident i ed that m ay im prove or enhance a program , the reviewer m ay m ake suggest ions that are m eant to be helpful to the program . The accreditat ion require-m ents for or thodont ics were last updated on Novem ber 30, 2013.5 In 2014, all six Canadian program s were accredited.

7.1.2 Commission on Dental Accreditation

The CODA is the o cial accreditat ion body in the United States. Its o ces are located in Chicago, Illinois. By reciprocal agree-m ent , or thodont ic program s in Canada that

7 Orthodontic Specialt y Education in Canada 53

are recognized by the CDAC are also rec-ognized by the CODA in the United States, and vice versa.6 This reciprocal agreem ent allows or thodont ic graduates of accred-ited program s in North Am erica (CDAC and CODA) to be able to challenge the Am erican Board of Orthodont ics exam inat ion , w hich is regarded as an excellence exam inat ion, as well as the Royal College of Dent ists of Can -ada (RCDC) nat ional dental specialt y m an-datory licensing exam inat ions in Canada. In Canada, all or thodont ic graduates of pro-gram s in the United States and Canada are required to pass the RCDC exam inat ions to be licensed to pract ice as specialist or tho-dont ists anyw here in Canada, subject to im m igrat ion or work perm it requirem ents.

7.1.3 Royal College of Dentists of Canada

The RCDC was established by an act of the federal governm ent of Canada in 1965 to m aintain h igh standards of specialt y prac-t ice in Canada. Applicants for fellowship in the RCDC m ay challenge the exam inat ions via direct applicat ion only if they have com -pleted their specialt y t rain ing at an accred-ited North Am erican program in Canada or the United States. Successful candidates are then adm it ted as fellows of the RCDC and m ay use the FRCD(C) designat ion if they are successful in both com ponents of the exam inat ion .

The RCDC exam inat ion is a m anda-tory credent ial of all the dental regulatory authorit ies in the 13 Canadian provinces and terr itories. To obtain fellowship in the RCDC, the dental specialt y program is required to provide proof to the RCDC that the applicant has graduated from an accredited program , and in addit ion , a let-ter is required from the regist rar of the relevant dental regulatory authorit y con- rm ing that the candidate has the relevant m oral and eth ical standing in the profes-sion. RCDC exam inat ions are o ered once annually, Com ponent I in March each year and Com ponent II in June. Candidates w ho fail the exam inat ion m ay apply to retake it follow ing paym ent of the exam inat ion fees.

Applicat ions to challenge the exam inat ions are due by m id-Septem ber of the previous year. Candidates failing Com ponent II th ree t im es are required to retake Com ponent I w ith in a ve-year w indow before at tem pt-ing to retake Com ponent II.7

Orthodont ists w ho graduated from non-accredited program s m ay opt to w rite the dental specialt y core knowledge exam i-nat ion (DSCKE), w hich is a general den-t ist ry exam inat ion adm inistered by the Nat ional Dental Exam ining Board of Can-ada (NDEB); if successful, they m ay apply to one of the Canadian or thodont ic program s that o er dental specialt y assessm ent and t raining program s (DSATP). An alternat ive pathway is an academ ic pathway. In th is pathway, an applicant is required to have a full-t im e academ ic appointm ent at the rank of assistant professor or h igher and to have been in that posit ion for at least 12 m onths. The applicant also needs to have taken the DSCKE and m ust obtain a let ter from the program director and the dental regulatory authorit y support ing h is or her applicat ion to take the RCDC exam inat ion .8

The fees levied to challenge the RCDC exam inat ions in August 2014 were as fol-lows9: applicat ion fee: C$500; Com ponent I: C$1,000; Com ponent II: C$4,500; total: C$6,000.

7.1.4 National Dental Examining Board of Canada

The NDEB was established in 1952 by an act of the Canadian Parliam ent and is responsible for establish ing qualifying con-dit ions for a nat ional standard of dental com petence.10

The NDEB adm inisters the DSCKE, which is a requirem ent for all applicants for entry to the DSATP and the RCDC exam inations for orthodontists from non-accredited pro-gram s. This nine-hour exam ination consists of four components taken over two days. Applicants m ay retake the exam ination only once.

Spaces for the DSATP are presently lim -ited to one applican t for those of the six program s annually accept ing DSATP stu-


it s role as being the o cial voice of gradu-ate or thodont ic educat ion in Canada.

The CCGOPD m eets tw ice a year, at the annual CAO m eet ing in Septem ber and at the annual Am erican Associat ion of Ortho-dont ists (AAO) m eet ing in April/May. Edu-cat ional issues at the provincial, nat ional, North Am erican , and in ternat ional levels a ect ing or thodont ic educat ion are dis-cussed, as well as st rategies form ulated to aid in the recruitm ent and retent ion of academ ic sta . It also puts system s in place each year regarding the “Canadian m atch” for applicants to Canadian program s, ensur-ing that dates do not clash nat ionally or w ith the U.S. m atch program . The CCGOPD also m eets w ith representat ives of exter-nal organizat ions, such as the CAO, dental regulatory authorit ies, RCDC, and CDAC, on an as-needed basis to discuss m at ters of m utual in terest and concern .

7.3 Graduate Orthodontic Programs in CanadaThere are som e 72 accredited graduate orthodont ic program s in North Am erica, six of w hich are in Canada. Although all Canadian program s and m any Am erican program s now have a m inim um length of 35 to 36 m onths, there rem ain several Am erican program s that are 24 m onths in length. The lengths of the program s do not a ect accreditat ion or the reciprocal agreem ent between Canada and the United States.12 The CCGOPD st rongly supports 35- or 36-m onth m inim um program lengths, w hich represent the “Canadian standard,” and are of the opinion that the RCDC should lim it its access to licensing exam inat ions to graduates from accredited program s in the United States and Canada, w hich are a m inim um of 35 to 36 m onths in length. The program s in Alberta and Montreal are 35 m onths in length, and the other four pro-gram s are 36 m onths long.

In m ost European countries, program s also have a m inim um length of 36 m onths, w hich appears to be the “in ternat ional stan-dard.”13 The Canadian program s all require

dents. The results of the DSCKE are used to evaluate and select , am ong others, success-ful applicants for the DSATP.

Applicat ion fees for the DSCKE are as follows11: applicat ion fee: C$1,500; exam i-nat ion fee: C$3,000; total fees: C$4,500.

The total est im ated fees for an or tho-dont ist from a non-accredited program to go through the pathway process for fellow -ship in the RCDC, provided that the appli-cant passes all the exam inat ions the rst t im e around and depending on the indi-vidual assessm ent and t rain ing fees at the di erent universit ies o ering the DSATP, can be on the order of the follow ing: DSCKE process: C$4,500; RCDC process: C$6,000; DSATP process: C$65,000; total: C$75,500. These est im ated fees do not include living expenses and the costs of t ransportat ion , inst rum ents, textbooks, and conference at tendance, am ong others.

7.2 Canadian Council of Graduate Orthodontic Program DirectorsThe Canadian Council of Graduate Orth -odont ic Program Directors (CCGOPD) was established in Toronto in 2002 at a join t m eet ing of the educat ional execut ives of the Canadian Associat ion of Orthodont ists (CAO: Drs. Gerry Solom on, Richard Marcus, and Donald Robertson) and the or thodon-t ic program directors of the ve program s at the t im e. The inaugural m em bers of the CCGOPD were Drs. Antonios Mam an-dras (Western Ontario), Bryan Tom pson (Toronto), Claude Rem ise (Montreal), Wil-liam Wiltshire (Manitoba), and Paul Major (Alber ta); Dr. Claude Rem ise was elected the inaugural chair. The CCGOPD added the Universit y of Brit ish Colum bia to its ranks in 2010 after the com m encem ent of its new program , w ith Dr. Edw in Yen serving as the program director. Dr. Carlos Flores-Mir has replaced Dr. Paul Major as the program director at Alberta. Dr. William Wiltsh ire currently chairs the CCGOPD. The CCGOPD is an independent council of Canadian edu-cators w ho are program directors and sees


7.4.1 The Accreditation Document

The accreditat ion docum ent is divided in to n ine sect ions:

1. Program inform at ion2. Inst itut ional st ructure3. Educat ional program4. Adm inist rat ion , facult y, and faculty

developm ent5. Educat ional support and services6. Clin ic adm inist rat ion7. Research and scholarly act ivit ies8. Program relat ionships9. Appendix A: dental specialt y

assessm ent and t rain ing program

7.4.2 Curriculum Content

The curriculum content consists of basic sciences and clin ical sciences. The didac-t ic program list does not represent course conten t , but rather the necessary knowl-edge, skills, and behaviors w ith in the scope and depth required for a specialt y program . This m ust include the follow ing14:

• Anatomy of the head and neck• Biology of or thodont ics and

dentofacial or thopedics• Biostat ist ics• Cephalom etrics• Craniofacial grow th and

developm ent• Design, fabricat ion , and

m anipulat ion of rem ovable, funct ional, and xed appliances

• Diagnost ic techniques and analyses• Ethics• Et iology of dentofacial m alrelat ions• Evidence-based clin ical decision

m aking• History of or thodont ics and

dentofacial or thopedics• Literature review and scient i c

w rit ing• Managem ent and or thodont ic

correct ion of m alocclusions in :– Medically com prom ised pat ients

a m aster’s degree research project and a thesis defense. The United States also has accredited hospital-based program s that are not necessarily associated w ith dental facult ies/schools or colleges. However, all Canadian or thodont ic program s are uni-versit y-based, and all are also at tached to m edical schools.

In Canada, the deadlines for applica-t ions for adm it tance to the rst -year pro-gram s vary between July 1 and October 1. The Canadian rst-year residents star t their program s from June to August each year.12 Tuit ion fees across Canada vary from C$3,300 to C$48,000 for Canadians and perm anent residents. In ternat ional stu-dents’ fees vary from C$22,000 to C$68,000. Som e U.S. program s charge as m uch as US$80,000 to US$111,000, w hereas others charge no tuit ion and in addit ion pay a st i-pend to their residents. The Canadian pro-gram s do not pay st ipends, other than that som e program s assist their residents w ith t ravel st ipends to at tend scient i c confer-ences. The CAO also provides som e t ravel assistance to residents w ho are present ing research papers at the annual CAO confer-ence in Canada.12

In total, Canadian program s graduate approxim ately 21 or thodont ists per year. An est im ated 50 applicants challenged the RCDC exam inat ions in 2014, suggest ing that there are m ore graduates of non-Canadian program s taking the RCDC exam inat ions. It is clear that the largest group increasing the potent ially eligible or thodont ic workforce in Canada are the graduates of accredited United States–based program s.

7.4 The Commission on Dental Accreditation of Canada Graduate Orthodontic CurriculumThe curricula of the six Canadian graduate orthodont ic program s are governed by the CDAC.14


they had received the appropriate num ber of form al didact ic teaching sessions and am ount of dedicated and protected aca-dem ic t im e. All residents indicated that their program s o ered t rain ing in num er-ous t reatm ent philosophies: 93.18% said they had su cient clinically based t rain ing, and 72.73% indicated that their research-based t raining was su cient . All respond-ing residents indicated that they would complete m ore than 30 pat ients from start to n ish, and 25% est im ated complet ion of m ore than 70 pat ients by graduat ion. Resi-dents said they would complete on average 5 orthognathic surgeries, 24 extract ions, 31 non-extract ions, 8 adults, and 13 pat ients w ith m ixed dent it ion . Only 50% said that their program s contained care for disabled or underserved pat ients. Most (86.36%) said they felt they would be adequately pre-pared to provide unsupervised orthodontic care after graduat ion. These orthodont ic residents indicated that they collaborated m ost w ith the disciplines of oral surgery, periodont ics, and prosthodont ics. However, only 52.27% indicated that they had a for-m al interdisciplinary program for t reat ing pat ients. In conclusion, Canadian orthodon-t ic residents are sat is ed w ith the didact ic, clinical, and research aspects of their pro-gram s. They receive comprehensive instruc-t ion w ith the opportunity to complete a signi cant num ber of pat ients, employing a variety of t reatm ent approaches.15

In another study, Noble et al16 investigated the motivation of orthodontic residents in Canada and the United States to treat patients with craniofacial anomalies, cleft lip and pal-ate, and special needs. Residents who indicated that they would not treat these patients cited limited experience and inadequate expertise as the reasons. Fewer than 30% indicated a willingness to pursue a fellowship program.16

7.6 Challenges Facing Orthodontic Graduate Education in CanadaUndergraduate orthodontic program s across Canada teach varying am ounts of clinical orthodont ic techniques, from rem ovable

– Pat ients w ith clefts palate and other facial deform it ies

– Pat ients w ith tem porom andibular disorders

– Pat ients requir ing in terdisciplinary t reatm ent plans

• Neurophysiology• Occlusion• Pathology of oral system s• Orthodont ic m aterials• Orthognathic surgery• Physiology• Pract ice m anagem ent• Psychological aspects of orthodontic

and dentofacial orthopedic treatment• Radiology• Rat ionale for orthodont ic

t reatm ent14

Regarding the clin ical requirem ents of the Canadian program s, the CDAC accredi-tat ion requirem ents state that14:

A graduate of an advanced specialty education program in orthodontics and dentofacial orthopedics must be com-petent to provide all active phases of treatment and retention, diagnose and treatment plan, malocclusion, manage developing problems, patients requiring orthognathic surgery and exposure and orthodontic eruption of impacted teeth. Radiographic interpretation and systemic condition recognition is also required.

There must be opportunities to provide treatment for patients who are medically com-promised or who have craniofacial di erences or temporomandibular joint disorders.14 In general, students in Canadian programs start between 50 and 70 new patients and complete approximately 75% of their patient starts.

7.5 Residents’ Evaluation of Orthodontic Programs in CanadaNoble et al15 explored residents’ evaluat ions of orthodontic program s in Canada. A total of 44 residents responded, for a part icipa-t ion rate of 81.48%. Overall, 86.36% of the responding residents were sat is ed w ith their program . Respondents said they felt


m ents have m andated that an or thodont ist have ABO eligibilit y in the United States or the FRCD(C) designat ion in Canada to be appointed as a program director. Exten -sive experience as a clin ician and exten-sive research credent ials are not par t of the stated requirem ents. This could well be a re ect ion of the cont inued di culty of recruit ing academ ics w ith m any years of experience in the clin ical, research , and adm inist rat ion areas.

Another challenge is the lure of “quick and easy orthodontics” o ered to general dentists. Orthodontic treatment is being advertised as possibly being completed in as short a time as three or six months, often w ith the use of only one arch wire and often w ith a focus on align-m ent of the “social six” as the only treatment goal. This com es at a tim e when the num-ber of new orthodontic specialists in Canada increased by 55 in the two and one-half years between the end of 2010 and June of 201317 (deaths and retirem ents not taken into account). Of further note is the potential mar-keting of a “do-it-yourself orthodontic kit” containing a do-it-yourself impression and advertised as requiring no professional ser-vices by either a dentist or an orthodontist.18

Thus, the fu ture challenges facing the or thodont ic profession in Canada are m any and varied. Indeed, an ever-changing land-scape dem ands that leaders in or thodont ics cont inually step forward, be w illing and able to face these challenges head on, and be prepared to lead Canadian or thodont ists to m eet those challenges as a uni ed group, always w ith the best in terests of the Cana-dian public in m ind.

May the noble Hippocrat ic Oath always be forem ost in our m inds as we cont inue to endeavor to serve the Canadian public to the best of our abilit ies: I w ill prescribe reg-im ens for the good of my pat ients according to my abilit y and my judgm ent and never do harm to anyone .19

References 1. List of countries by populat ion . h t tp://

en .w ikiped ia .org/w iki/List_of_cou n t r ies_by_populat ion . Published 2014. Accessed July 18, 2014

2. List of count ries and dependencies by area. h t tp ://en .w ikipedia.org/w iki/List_of_coun -

appliances lim ited to interceptive ortho-dont ics to full xed braces. General dent ists also at tend orthodontic continuing educa-t ion courses across Canada and the United States, m any of which emphasize full xed procedures. The introduction of clear aligner therapy has also found favor am ong m any general dentists, who are at tending t raining courses and providing increasing num bers of orthodont ic pat ient starts, from basic to advanced orthodont ic care, w ith braces and clear aligners. Whether dentists are also being schooled in the m ore advanced diag-nostic and treatm ent-planning skills and biom echanics to m irror and complem ent the complexity of their orthodont ic t reat-m ent starts is unknown. A recent survey indicated that 15.4% of Canadian dentists provide full xed orthodont ic t reatm ent , while the cohort of dent ists w ith 5 to 24 years of experience treat up to 19% of full xed cases them selves, which include orth-odontic–orthognathic surgical cases.17

The increase in the num bers of or tho-dont ists graduat ing from the increased num bers of new orthodont ic program s start ing across North Am erica is also note-worthy, par t icularly because pat ient star ts are often related to socioeconom ic factors.

Despite the increased production of ortho-dontists, there remains a very real concern regarding the shortage of full-time academic orthodontists. It is becoming increasingly dif- cult to nd orthodontic program directors w ith eight or more years of clinical experi-ence and a signi cant body of research and peer-reviewed publications in journals of high standing to manage our programs.

New graduates w ith h igh levels of debt and the threat of tenure denial if they fall short of research product ion requirem ents and expectat ions of research funding are reluctant to enter academ ia, par t icularly w ith non–m arket-related salaries on o er.

While the quant it y of or thodont ic pro-gram s is undoubtedly on the r ise, there is a concern regarding the lim ited num ber of or thodont ic educators w ho have earned h igher degrees, such as m aster’s and doc-toral (PhD/DSc) credent ials, and w ho have acquired signi cant research and clin ical experience before being appointed as pro-gram directors in North Am erica. From January 1997, CODA and CDAC require-


12. Graduate Orthodont ic Program s. h t tps://w w w.aaoinfo.org/system / les/m edia/docu -m en t s/Grad u ate%20Or t h od on t ic%20Pro -gram s%20Form %20-%20Aug%202014 .p d f. Published 2014. Accessed August 20, 2014

13. Athanasiou AE, Darendeliler MA, Eliades T, et al; World Federat ion of Orthodont ists. World Federat ion of Orthodont ists (WFO) guidelines for postgraduate orthodontic educat ion. World J Orthod 2009;10(2): 153–166

14. Accreditat ion requirem ents for or thodon-t ics and dentofacial or thopedics program s. h t t p s: / /w w w .cd a-ad c.ca /cdacw eb /_files/Orthodont icsRequirem ents.doc. Updated Novem ber 30, 2013. Accessed August 30, 2014

15. Noble J, Hechter FJ, Karaiskos NE, Wilt-shire WA. Resident evaluat ion of or th -odont ic program s in Canada. J Dent Educ 2009;73(2):192–198

16. Noble J, Schroth RJ, Hechter FJ, Hum inicki A, Wiltshire WA. Motivat ions of orthodont ic residents in Canada and the United States to t reat pat ients w ith craniofacial anom alies, cleft lip/palate, and special needs. Cleft Pal-ate Craniofac J 2012;49(5):596–600

17. Aucoin M, Wiltsh ire WA, Hechter FJ, Torchia M. Provision of or thodont ic care by den -t ists in Canada and cer t i ed or thodont ists’ perspect ives. Presented at: 66th Annual Scient i c Session - Canadian Associat ion of Orthodont ists; Septem ber 4–6, 2014; Mon-t real, Quebec, Canada

18. Do-it-yourself orthodontic kit and method. US Patent and Trademark O ce patent applica-tion 20060105287. http://www.freshpatents.com /Do- it -you rself-or th odon t ic-kit -an d -m ethod-dt20060518ptan20060105287.php. Patent led 2004. Accessed August 30, 2014

19. The Hippocrat ic Oath . h t tp://en.w ikipedia.org/w iki/Hippocrat ic_Oath . Published 2014. Accessed January 26, 2015

tries_and_dependencies_by_area. Accessed July 18, 2014

3. Dental health services in Canada. h t tp://w w w .m e d .u o t t a w a .c a / s im / d a t a / De n -t a l/ De n t a l_Hea lt h _Se r vices_in _Can ad a_June_2010.pdf. Published 2010. Accessed July 18, 2014

4. Haryet t RD. A history of or thodont ics in Canada. Toronto, Ontario: Canadian Asso-ciat ion of Orthodont ists; 2008

5. Com m ission on Dental Accreditat ion of Canada (CDAC). h t tps://w w w.cda-adc.ca/cdacweb/en/. Published 2013. Accessed Au-gust 9, 2014

6. Com m ission on Dental Accreditat ion (CODA). h t tp://w w w.ada.org/en/coda/ac-creditat ion/about-us/. Published 2014. Ac-cessed August 9, 2014

7. The Royal College of Dent ists of Canada. h t t p : //w w w.rcdc.ca/en ?CFID=14817192&CFTOKEN=1ca1af0dd6507912-591AF326-B3E4-5485-8DCB1E6E3803DFD4. Pub-lished 2014. Accessed August 6, 2014

8. The Royal College of Dent ists of Canada. In ternat ional candidates. h t tp://w w w.rcdc.ca/en/in ternat ional-candidate. Published 2014. Accessed August 9, 2014

9. The Royal College of Dent ists of Canada. Fees st ructure. h t tp://w w w.rcdc.ca/en/ex-am inat ion/fees. Published 2014. Accessed August 9, 2014

10. Nat ional Dental Exam ining Board of Canada (NDEB). h t tp://w w w.ndeb.ca/about . Pub-lished 2014. Accessed August 9, 2014

11. Nat ional Dental Exam ining Board of Canada. Graduates of eligible non-accredited dental specialt y program s. Fees. h t tp://w w w.ndeb.ca/non-accredited-specialt y/fees. Published 2014. Accessed August 9, 2014

59

Orthodontic Specialty Education in Latin AmericaJulia F. de Harf n

Latin Am erica is the subregion of the Am ericas that includes the countries where Rom ance languages are spoken—m ostly Spanish and Portuguese. There are 22 countries in Latin Am erica; they start at the southern border of the United States, include the Caribbean region, and extend across South Am erica (Table 8.1). Latin Am erica has a wealth of cul-ture. The countries of this region share m any features, but they also di er greatly from one another in num erous aspects.

8.1 Brief History of Dentistry in Latin AmericaThe pract ice of dent ist ry is alm ost as ancient as the h istory of hum anit y and civilizat ion . In regard to the h istory of dent ist ry, in m ost of the countries of Lat in Am erica, the beginnings were sim ilar. Den-tal problem s and needs have existed since ancient t im es. A diversit y of dental t reat-m ents and rem edies has been present in Lat in Am erica since before colonial t im es. In m any countries, there are chronicles that provide inform at ion about the di er-ent kinds of dental t reatm ent that Nat ive Am ericans perform ed before the arrival of the rst colonials. After the star t of Euro-pean colonizat ion, dental t reatm ent began to evolve. It was provided by m onks, m ili-tary o cers, and later barbers. Ult im ately, m edical doctors becam e responsible for dental t reatm ent . Most of these doctors cam e from North Am erica and from France, am ong other European countries. In the late 1700s and early 1800s, as universi-t ies star ted to appear in Lat in Am erica, the

8

need for speci c studies and t rain ing led to the form at ion of schools that specialized in dent ist ry.

8.2 The Role of Orthodontic Societies in Latin AmericaOrthodont ic societ ies are of singular im por-tance in every count ry in Lat in Am erica. Their m ission is to develop and ensure the qualit y of or thodont ic pract ice. They aim to m ake signi cant contr ibut ions to oral health , foster research , and m aintain the h ighest standards in educat ion and spe-cialized t rain ing. Thanks to the guidelines that the World Federat ion of Orthodont ists (WFO) has provided,1 it is now m uch easier to evaluate the funct ion ing of postgraduate program s. The real di erences are related to how health and educat ion laws w ith in each country and/or region are applied and im plem ented. In som e countries, or th-odont ic societ ies are invited to assist the Minist ry of Educat ion or Minist ry of Health in determ ining the best way to recognize or thodont ic specialists.

8.3 Orthodontic Postgraduate Programs in Latin AmericaIn general term s, the program s include theoret ical and clin ical hours, although the num ber of hours varies greatly from


Table 8.1 Subregions of Latin America in North America, Central America, and South America

Country Population Area, km2

North America

Mexico 103,460,000 1,958,000

Central America

Costa Rica 4,667,096 51,100

El Salvador 6,108,590 21,040

Guatemala 15,438,384 108,890

Honduras 8,555,072 112,090

Nicaragua 5,788,531 130,373

Panama 3,661,868 78,200

South America

Argentina 41,660,417 2,766,890

Bolivia 10,461,053 1,098,580

Brazil 201,032,714 8,514,877

Chile 17,556,815 756,950

Colombia 47,387,109 1,138,910

Ecuador 15,439,429 283,560

Guyana 772,298 214,999

Paraguay 6,800,284 406,750

Peru 30,475,144 1,285,220

Suriname 472,000 16,327

Uruguay 3,324,460 17,622

Venezuela 31,648,930 91,645

8 Orthodontic Specialt y Education in Latin America 61

8.3.1 Postgraduate Orthodontic Curriculum

Although the curricula in postgraduate program s in or thodont ics vary from coun-t ry to count ry, m any have a lot in com m on. A t ypical curriculum in m ost current pro-gram s is the follow ing:

First year

• Prenatal grow th and developm ent• Biology of tooth m ovem ent• Research fundam entals I and II• Basic or thodont ic diagnosis• Developm ent of dent it ion and

occlusion I and II• Biophysics and biom echanics• Preclin ical or thodont ics I• Basic clinical orthodont ics I and II• Sem inars in surgical or thodont ic

cases I and II• Techniques in or thodont ics• Dentofacial anom alies I• Assessm ent and m onitoring of cases

I and II• Bioethics• Basic biom echanics• Research in or thodont ics I• Grow th and postnatal developm ent• Biology of craniofacial developm ent• Orthodont ic clin ic in adults I• Relat ions of or thodont ics w ith other

specialt ies I• Basic correct ive or thodont ic clin ic I

Second year

• Relat ions of or thodont ics w ith other specialt ies II

• In term ediate biom echanics• Basic and advanced applied

biom echanics• Orthodont ic m anagem ent I• Orthodont ic clin ic in adults II and III• Orthodont ic diagnosis in term ediate

and advanced• Interm ediate correct ive or thodont ic

clin ic

one country to another, and each program has som e unique characterist ics. Som e require that residents begin and com plete a cer tain num ber of cases, w hereas oth-ers do not . The program requirem ents also di er in regard to the num ber of pat ients each resident m ust t reat . Orthodont ic societ ies, in conjunct ion w ith universit ies, should encourage and m ot ivate colleagues to becom e actual specialists in or thodon-t ics. In regard to the num ber of residents, the num ber of those accepted in to each program varies w idely. Som e universit ies adm it ve residents in to an ent ire two- or th ree-year program , w hereas others adm it ve to seven new students per year in to a th ree-year program (total of 15 to 21 resi-dents at the sam e t im e). The criteria for the select ion of residents vary not only am ong countries but also w ith in each count ry. Som e countries require that the fu ture resi-dent have two to three years of pract ice in general dent ist ry before acceptance in the or thodont ic program . Others require ve years of experience as a general pract it io-ner. This requirem ent has advantages and disadvantages. Som e program s have fewer requirem ents and prefer that residents begin the program as soon as they n -ish their undergraduate dental program . Another signi cant di erence is related to residents’ par t icipat ion in research proj-ects. Som e postgraduate program s require the com plet ion of a research project to m eet the program object ives, w hereas oth-ers do not . In m ost cases, a research paper, m onograph, or nal paper is required for each resident to com plete the program .


8.3.1.3 Orthodontic Postgraduate Programs in the Dominican Republic

The only recognized full-t im e program available is three years long and includes approxim ately 4,380 hours. Each group has four to ve students.

8.3.1.4 Orthodontic Postgraduate Programs in Colombia

For the Colom bian Society of Orthodont ics to recognize a postgraduate program , it m ust be at least 3,000 hours long, in terns m ust be in at tendance ve days a week, each day m ust be six to eight hours long, and nally the program m ust belong to a dental school that has previously been approved.

8.3.1.5 Orthodontic Postgraduate Programs in Venezuela

Two program s that specialize in or thodon-t ics are recognized by the Society of Ortho-dont ics of Venezuela. Both follow WFO guidelines and are full-t im e two-year pro-gram s w ith an average of n ine students per course.

8.3.1.6 Orthodontic Postgraduate Programs in Ecuador

Four program s that specialize in orthodon-t ics are recognized. All of them are full-t im e, two and one-half-year program s w ith an average of seven to eight students per course.

8.3.1.7 Orthodontic Postgraduate Programs in Brazil

Although m ore than 200 program s are cur-rently available in Brazil, only 23 m eet WFO guidelines. The program s have a durat ion of two to three years.

• Sem inars in surgical or thodont ic cases III and IV

• Early t reatm ent clin ic I and II• In terdisciplinary clin ical cases• Dentofacial anom alies II• Research in or thodont ics II and III• Assessm ent and m onitoring of cases

III and IV• Advanced biom echanics• In term ediate correct ive or thodont ic

clin ic II• Dentofacial anom alies III• Occlusion and tem porom andibular

join t disorders (TMD) basic• Retent ion I

Third year

• Cleft lip and palate I and II• Early t reatm ent clin ic III and IV• Assessm ent and m onitoring of early

t reatm ent cases I and II• Orthodont ic clin ic in adults IV and V• Advanced or thodont ic clin ic I and II• Orthodont ic m anagem ent II• Dentofacial anom alies IV and V• Orthodont ic research IV• Sem inars in surgical or thodont ic

cases V and VI• Retent ion II and III• Assessm ent and m onitoring of cases

V• Occlusion and TMD interm ediate

and advanced• Orthodont ic m anagem ent III• Assessm ent and m onitoring of cases

V and VI

8.3.1.1 Orthodontic Postgraduate Programs in Guatemala

Two program s are recognized in Guatem ala.

8.3.1.2 Orthodontic Postgraduate Programs in Panama

Two program s are recognized in Panam a. Both last two and one-half to three and one-half years. One program allows 8 stu-dents per course and the other 20.


of Orthodont ics and have the opt ion of at tain ing cer t i cat ion .

8.4 Goals for the FutureBecause educat ion is key to achieving excel-lence in professional life, we all need to keep in m ind w here we are headed and w hat our vision is—in other words, w here we want to be. Many countries in Lat in Am erica are in the process of considering som e if not all of the follow ing goals to raise the standards of their postgraduate program s.

8.4.1 Training in English

English as a second language is essent ial for professional life, no m at ter w hat the pro-fession. Providing par t of the program in English would be helpful for future or tho-dont ists because they could access and consult all the in form at ion available at an in ternat ional level. Panam a is one of the countries that is doing th is now. Addit ional t rain ing in English would allow us to open doors for postgraduate students.

8.4.2 Academic Research

Everyone knows that conduct ing accurate, valid, and t im ely research is cr it ical to suc-cess. Academ ic research is used to establish or con rm facts, rea rm the results of pre-vious work, and solve new or exist ing prob-lem s. Although academ ic research is part of m ost program s, postgraduate students should perform m ore academ ic research , w hich w ill help them im prove their ana-lyt ical skills and m ot ivate them to becom e involved in basic sciences.

8.4.3 Interdisciplinary Teamwork

Learning to work as a team is im portant in m ost jobs today. It is essent ial that future or thodont ists learn to work in in terdisci-

8.3.1.8 Orthodontic Postgraduate Programs in Argentina

In Argentina, 10 programs are recognized. They are two- to three-year programs, and the number of students per course ranges from 12 to 50, although managing 50 postgraduate students at the same time is very di cult.

8.3.1.9 Orthodontic Postgraduate Programs in Chile

The 10 recognized program s in Chile are two and one-half- to three-year program s w ith approxim ately 10 to 22 students per course. Regarding the num ber of hours, although these are par t-t im e program s, all of them include the num ber of hours required by the WFO guidelines.

8.3.1.10 Orthodontic Postgraduate Programs in Bolivia

The program s are three years long and include a total of 3,000 hours. Residents at tend three days a week, seven hours a day. There are approxim ately 20 students per course.

8.3.1.11 Orthodontic Postgraduate Programs in Peru

Four program s are recognized in Peru .

8.3.1.12 Orthodontic Postgraduate Programs in Mexico

There are approxim ately 75 postgraduate program s in Mexico, w hich are available in public and private universit ies as well as private inst itu t ions and schools. Univer-sit ies and inst itut ions recognized by the Mexican governm ent are given Recogni-t ion of O cial Validit y of Studies (Recono-cim iento de Validez O cial de Estudios, or RVOE). To obtain th is recognit ion , the schools m ust present their program s to the secretary of public educat ion. Program s last two to three years, and the num ber of students per course ranges from 10 to 15. After n ishing their studies, students m ay becom e a liates of the Mexican Academy


specialist s but do not have the m eans to do so. Naturally, di eren t t ypes of scholar-sh ips would be o ered, and each speci c case would be evaluated independent ly.

8.4.7 Faculty

To ensure academ ic success, it is essent ial that appropriately quali ed academ ic sta be available. Ideally, the program director should have a PhD degree w ith an ade-quate teaching and research background, and the director should also be an experi-enced or thodont ic specialist . Lower-rank faculty (e.g., assistant professors) should be or thodont ic specialists w ith experience. It would be also advisable to use external exam iners/evaluators for each program .

8.4.8 Recerti cation

To encourage fur ther study and ensure that or thodont ic specialists are well acquainted w ith new developm ents in the eld, recer-t i cat ion of the postgraduate degree would be an in terest ing opt ion. Recert i cat ion is an excellent way to guarantee stan-dards of excellence am ong the or thodont ic com m unity.

8.4.9 Exchange Programs

Spending two or three m onths before grad-uat ion as an exchange student in another program w ith in the sam e or a di erent country is also a worthy goal. The advan-tage is that residents have an opportu-nit y to increase their experience at other inst itut ions.

8.4.10 Congresses and Meetings

In the past few years, m ost congresses held in Lat in Am erica have included a special chapter for postgraduate residents from di eren t universit ies. The residents are invited to give presentat ions on clin ical or

plinary team s because doing so provides them w ith m ult iple approaches to the study of health care, encourages an appreciat ion and understanding of other disciplines, and helps them understand st rategies for future pract ice. Through in terdisciplinary team -work, they learn to seek opinions about problem s from appropriate team m em bers, each of w hom contributes h is or her ow n unique professional perspect ive. Together, the team develops and evaluates poten-t ial solut ions or m anagem ent plans and chooses the best ones for each speci c case.

8.4.4 Curriculum

It is of the u tm ost im portance for residents to gain pract ical experience in a variet y of set t ings, so that they can put the skills they have learned in to pract ice w ith real pat ients. It is also of great im portance that dental students receive increased levels of pract ical experience during their prepara-t ion for dental pract ice. Each postgraduate student m ust com plete 25 to 30 cases, and these should represent a variety of prob-lem s, including pat ients w ith cleft palate, pat ients undergoing or thognathic surgery, and m edically com prom ised pat ients, am ong others.

8.4.5 Research Facilities

It is h ighly recom m ended that radiology and dental laboratories be located w ith in the sam e facilit y. This elim inates the need to send pat ien ts elsew here and allows or th-odont ic residents to have closer contact w ith these act ivit ies.

8.4.6 Scholarships

As we all know, it is di cult or even im pos-sible for som e students to fur ther their studies. Everyone should have the sam e opportun it y to becom e a specialist in h is or her chosen eld . Providing m ore schol-arsh ips is an im por tan t step toward help -ing those w ho w ish to becom e or thodont ic


is im portant to keep in m ind that not all of these program s have been approved by the local relevant authorit ies. In fact , m any are not . It is essent ial that all recognized (validated/cer t i ed) program s m aintain a full-t im e schedule w ith a durat ion of 30 to 36 m onths. Orthodont ic societ ies in con -junct ion w ith universit ies should encour-age and m ot ivate dent ists to becom e actual orthodont ic specialists. Unfortunately, one of the biggest problem s is that m any young colleagues are tem pted to take brief courses provided by or thodont ic com m ercial com -panies. Each nat ional or thodont ic society has an im portant role to play in controlling these program s to ensure that all pat ients receive top -qualit y t reatm ent .

Reference1. Athanasiou AE, Darendeliler MA, Eliades T, et

al; World Federation of Orthodontists. World Federation of Orthodontists (WFO) guide-lines for postgraduate orthodontic education. World J Orthod 2009;10(2):153–166

research topics. It is very im portant to pro-m ote th is pract ice because it st im ulates teaching am ong young or thodont ists, and teaching im proves not only knowledge but also clin ical skills. It adds to residents’ expe-rience and bet ter prepares them to t reat all t ypes of m alocclusion. O ering awards and honors for the best presentat ions is a good way to m ot ivate young colleagues, and som e countries currently do o er awards for excellent scient i c cont r ibut ions pre-sen ted at m eet ings.

8.4.11 Information and Orientation

Orthodont ic societ ies can help fu ture resi-dents by providing vital inform at ion to the dental com m unity, and by o ering objec-t ive orientat ion and speci c inform at ion about all the program s that are available. During the past years, a huge num ber of private universit ies have opened their doors, m any of w hich have created and are now o ering postgraduate courses. It

66

Orthodontic Specialty Education in East and Southeast Asia, with a Particular Focus on ChinaJiu-Xiang Lin, Yan-Heng Zhou, Tian-Min Xu, and Xue-Dong Wang

Orthodont ics, an im portant branch of oral m edicine, is par t of the postgraduate edu-cat ion system globally, and professional postgraduate educat ion is one of the m ost im portant and standardized m ethods of cult ivat ing or thodont ic specialists.

The qualit y of or thodont ic t reatm ent and oral health care is based on the qualit y of the educat ion and t rain ing that the doc-tors w ho provide such care receive at the in it ial pract icing stage. Generally speaking, the object ive of or thodont ic specialt y edu-cat ion is to (1) provide educat ion in or tho-dont ics at h igher levels, (2) create a solid foundat ion for diagnosis and t reatm ent , and (3) prom ote act ive “orthodont ic” in u-ences in the science world.

This chapter in t roduces the concepts and characterist ics of or thodont ic specialt y educat ion in East and Southeast Asia. Pro-viding inform at ion m ainly on the current status of or thodont ic educat ion in China, we in t roduce the various educat ional sys-tem s at the un iversit y level. The content of educat ional courses, nature of m edical con-dit ions, and aspects of scient i c research are also sum m arized.

9.1 Status of Orthodontic Specialty EducationEast Asia and Southeast Asia com prise m any countries, including China, Japan, South Korea, Thailand, Singapore, and Malaysia. It is grat ifying that or thodont ic

9

specialt y educat ion in East and Southeast Asia has evolved rapidly, and that a series of necessary steps has been im plem ented. The content and durat ion of specialist t rain ing in or thodont ics are generally sim i-lar in East and Southeast Asia but do vary slightly. In these countries, or thodont ic specialt y educat ion and t rain ing are under-taken essent ially at the postgraduate level, follow ing the com plet ion of an undergrad-uate degree. In the undergraduate learning phase, the content of or thodont ics learning is m ainly basic theory and sim ple orthodon-t ic techniques, such as sim ple w ire bending and brackets bonding. After undergradu-ate dental studies graduat ion , the student learns m ore speci c t reatm ent technology and diagnost ic m ethods as par t of a com -plete graduate course in orthodont ics, or as par t of short-term studies in or thodon-t ics. In general, all of the well-st ructured educat ional system s involve a m ix of for-m al lectures, pract ical skills t rain ing, and supervised clin ical pract ice.

9.2 Orthodontic Specialty Programs in Dental SchoolsThe goal of orthodont ic specialty educa-t ion is to produce graduates w ho have obtained a solid background in diagnosis and t reatm ent and w ill becom e specialists in orthodont ics; a diversity of educat ional form s exists. In China, several orthodont ic

9 Orthodontic Specialty Education in East and Southeast Asia, with a Particular Focus on China 67

specialty program s are available in den-tal schools, including three-year m aster’s degree and ve-year doctoral degree educa-t ion. Each program has two t raining objec-t ives: one is t raining in scient i c research , including fundam ental and clinical research in orthodontics; the other is t raining in clinical orthodont ic t reatm ent . Students are awarded an associate degree in science for the PhD degree or in a clinical specialty for the SMD (stom atologic MD) degree. There is also an eight-year program and an eight- plus three-year double doctoral degree pro-gram , the lat ter of w hich was speci cally, and rst successfully, com pleted at Peking Universit y in China. In this program , the students are t rained in orthodont ics in the last one or two of the eight years and are awarded a doctoral degree in stom atologic m edicine; they then receive another three years of t raining in both orthodont ic clini-cal pract ice and scient i c research and are awarded a PhD degree. Unlike the m edical eld in China, the m edical eld in Japan (including dent ist ry) has available only a doctoral degree w ith a durat ion of four to ve years. Another educat ional program is for specialized students w ho focus on clini-cal pract ice and prepare for the opening of future dental clinics; the durat ion of this is generally at least three years. Overall, orth -odont ic specialty t raining com es in various form s, including academ ic courses, clinical t raining, and basic research.

9.3 Quali cation of Applicants and Selection CriteriaGraduates of oral m edicine w ho apply for fur ther studies are considered as candidates for postgraduate educat ion in or thodont ics. This stage usually includes two degrees: a three-year m aster’s degree and a ve-year doctoral degree. Applican ts m ust pass the uniform entrance exam inat ions, including those in English and or thodont ics. They are in terviewed by ve professors. Only the students w ho perform outstandingly are accepted.

9.4 Characteristics of Orthodontic Specialty ProgramsEnrollm ent in postgraduate educat ion is un iform throughout China. After graduat-ing from ve-year colleges, graduates w ho are recom m ended by their colleges and t rainees w ho ranked top in the ent rance exam inat ions for postgraduate schools have the opportunity to enter a three- or ve-year postgraduate t rain ing course in or thodont ics.

9.4.1 Three-Year Master’s Degree Education

The students in the three-year educat ional program focus on clin ical educat ion and, in par t , clin ical research . They take m ult iple basic and them at ic or thodont ic courses in the rst year, including lectures on or th -odont ic principles and current clin ical techniques, the preparat ion of study casts, photography, and so on. They begin to consult w ith and t reat pat ien ts under the supervision of a tu tor after the rst w in-ter vacat ion . Som e clin ical research is also perform ed. At the end of the three years, the students are required to undergo the assessm ent m ent ioned previously and to have com pleted 20 or thodont ic cases.

9.4.2 Five-Year Structured Education for the PhD and SMD Degrees

In the ve-year st ructured educat ional pro-gram , students are t rained for the PhD and SMD degrees, the highest quali cat ions that a physician or scient ist can achieve. How-ever, these two degrees are characterized by dist inct t raining m odels. PhD students, w ho are required to focus m ainly on basic science t raining, m ust take several courses related to basic science and experim ental skills, produce an integrated dissertat ion, and publish a high-level scient i c paper upon graduat ion. Although these individu-


dont ics at PKUSS. To cult ivate versat ile doc-tors w ith both clin ical and scient i c skills, the program requires students to com -plete another three years of study after the eight-year program to com pete for the PhD degree, sim ilar to the ve-year PhD t rain ing previously described. Graduates w ho dem -onst rate outstanding and com prehensive abilit y and w ho have passed the ent rance exam inat ions for doctoral degrees are per-m it ted to proceed to th is second stage. They m ust com plete 30 cases and a scien-t i c research disser tat ion at a h igh level. After 11 years of com prehensive educat ion , these students becom e excellent doctors w ith both clin ical and scient i c skills. To date, PKUSS has graduated two cohorts of students w ith double doctoral degrees.

Ult im ately, after receiving their profes-sional or thodont ic educat ion , students have acquired com prehensive abilit ies, including clin ical skills in the specialt y of or thodon-t ics, academ ic com m unicat ion skills, skills in scient i c th inking, and pract ical abilit y. They can not only expert ly t reat or thodon-t ic pat ients but also system at ically conduct scien t i c research in accordance w ith the aim s of the com bined program in clin ical and academ ic work. Such professionals w ill be the backbone of future or thodont ics.

9.5 Orthodontic Courses and Academic ResearchWe have m ent ioned repeatedly the t rain ing in or thodont ic clin ical pract ice and scien-t i c research included in the diverse edu-cat ional system s because it const itutes the m ost im portant educat ional content .

These or thodont ic courses lay the foun-dat ions for educat ion in the specialt y. They can be divided in to basic and advanced courses. Speci c textbooks are used for both , w hich are w rit ten by specialt y pro-fessors in China. The basic courses cover m ainly ent ry level knowledge, including the follow ing topics: exam inat ion and diag-nosis; et iology; classi cat ion and com m on types of m alocclusion; craniofacial grow th and developm ent; a general in t roduct ion to

als are not required to complete clin ical cases, they can t reat pat ients and pract ice orthodont ic specialt y th inking and skills under the supervision of senior tutors, just like the clinical students. For this rea-son, increasing num bers of undergraduates choose to st rive and compete for the ve-year PhD program s.

In contrast , the ve-year SMD degree is available to m edically quali ed individuals, who are required to complete 30 orthodon-t ic pat ient cases by the t im e of graduation. The degree involves part-t im e research, related to clinical topics or basic science, undertaken by the trainees. Before achiev-ing the SMD degree, students are expected to produce and defend successfully a disser-tat ion, as well as to publish the ndings of their dissertat ion in core journals.

9.4.3 Eight-Year Program

Peking Universit y School of Stom atology (PKUSS) was the rst top school in China to develop the eight-year program sys-tem . Only the students w ho are ranked top in the school ent rance exam inat ion are accepted in to the program at PKUSS. There is only one class w ith 40 to 50 students in each year of the eight-year system . During the rst ve years, students m ust take m ul-t iple courses relevant to basic science, such as physiology and pharm acology; to clin i-cal topics, such as in ternal m edicine, sur-gery, and m edical eth ics; and to research m ethods, such as anim al experim entat ion and m olecular biology. Clin ical pract ice is also required at th is stage. Three or four of the top students then begin specialt y edu-cat ion for or thodont ics during the last one or two years of the eight-year program .

9.4.4 Eight- plus Three-Year Double Doctoral Degree Program

We would like to em phasize the eight- plus three-year double doctoral degree program , w hich was rst im plem ented successfully by the departm ent of or tho-


m ent for pat ients w ith m alocclusion. This clinical research has an irreplaceable role in orthodont ic specialt y educat ion .

However, basic research is also a crucial aspect of any educat ional system , especially one that t rains candidates for scient i c degrees. Scient i c research is increasingly popular in Asia because it not on ly helps discover and fur ther solve clin ical quest ions but also provides an object ive criterion for assessing the st rength and potent ial of a teaching hospital, w hich should be com -petent in both clin ical pract ice and aca-dem ic research. Scient i c research has a broad range, w ith m any branches. Teach-ing hospitals and departm ents of or tho-dont ics at tem pt to encourage applied basic research , in terdisciplinary research, t ranslat ional m edicine research, and so on. They also encourage extensive explorat ion and report ing of all elds of science, aim -ing for breakthroughs in orthodont ic bond-ing m aterials, the genet ic m echanism s and diagnosis of congenital m issing teeth , the ar t i cial m ineralizat ion or regenerat ion of tooth enam el and dent in , t ranslat ional m edicine research in bone t issue engineer-ing and bone defect repair, tem porom an-dibular join t disorders and m alocclusion, the evaluat ion of or thodont ic t reatm ent m echanics and new m aterials, and com -puter-based oral m edicine research . This research is perform ed by various team s that have constantly prom oted its clin ical applicat ion .

9.6 Quali cations of the Teaching TeamA key elem ent of educat ion is teaching, the qualit y of w hich direct ly in uences the learning and pract ice of every student or t rainee. The qualit y of the teaching team in schools or inst itutes that carry out or th-odont ic specialt y educat ion should be of a very h igh level and adhere to r igorous stan-dards. A teacher should be a doctor and a scien t ist w ho takes responsibilit y for teach-ing basic courses and clin ical techniques and for supervising scient i c research .

or thodont ic appliances; the biom echanical principles of t reatm ent , or thodont ic appli-ances, and techniques; or thodont ic early t reatm ent; retent ion; oral health care; and educat ion in or thodont ic t reatm ent . These general courses are oriented to students in the fth year of their eight-year course and those in the rst year of their postgraduate educat ion .

The enhanced courses also play an im portant role in or thodont ic educat ion . They are taught by specialt y professors as lessons of un xed form , lectures, and forum s concentrat ing on specialized and detailed topics, such as anchorage protec-t ion during or thodont ic t reatm ent , in ter-disciplinary cases, asym m etric ext ract ion choice, t im ing for skeletal Class III m aloc-clusion, etc. These advanced courses help the or thodont ic t rainees im prove their spe-cialt y knowledge and assist them in clin ical diagnosis and t reatm ent .

Clin ical courses involve t ypodont t rain-ing, archw ire bending, and or thodont ic techniques. Case report ing is another indis-pensable par t of pract ice; it is required daily and is perform ed regularly in sm all groups and also weekly w ith the w hole departm ent , w ith a focus on special, di -cult , and com plicated cases.

It is generally agreed that academ ic courses should not be the only elem ent in orthodont ic specialt y educat ion. As a hospital-based academ ic m edical center, PKUSS is com m it ted to both basic and clini-cal research. Based on its abundant clinical resources, the departm ent has long devoted itself to developing clinical research. It cov-ers the predom inant research direct ions of orthodont ic digital diagnosis and t reat-m ent system s, interdisciplinary t reatm ent , novel orthodont ic ideas, and the explora-t ion of new types of orthodontic appli-ances. For instance, the use of computed tom ography, digital im aging, and three-dim ensional m odeling illustrates how orthodont ists have increased their abilit y to provide each pat ient w ith a full diagnosis. The developm ent-related studies, clinical technique-related m echanism studies, and orthodont ic biology-related basic research facilitate faster and m ore e ect ive t reat-


other oral disciplines. Three to ve or th-odont ic professors are present to assess each student’s perform ance, including his or her clin ical knowledge, th inking, and reasoning. Each professor com pletes a standardized checklist according to the student’s perform ance. The average score of the three steps of the exam inat ion is the student’s nal result .

Besides the general exam inat ions, all graduat ing students are required to produce a disser tat ion related to their research subject and publish ar t icles in in uen t ial journals before being awarded a m aster’s or doctoral degree. There is also a China-speci c professional degree, for w hich students m ust exhibit 20 to 30 com -pleted or thodont ic cases upon graduat ion . This degree aim s m ain ly to produce stu-dents w ith professional clin ical skills and experience.

9.8 Orthodontic Specialty RequirementsOrthodont ic residents m ust pass vocat ional quali cat ion exam inat ions before they can enter the professional stage of t rain ing. As an or thodont ic professional doctor, the res-ident m ust be equipped w ith com prehen-sive in tellectual and physical skills as well as innovat ive and rigorous scient i c skills. Not only solid m edical exper t ise in or th-odont ic basic theories and knowledge but also clinical or thodont ic skills in diagnosis and t reatm ent are needed. In addit ion, to obtain a professional degree, or thodon-t ists should have engaged in oral m edicine research and be able to com bine theory w ith pract ice. The abilit y to engage in inde-pendent scient i c research or be indepen-dently responsible for specialized technical work is another necessit y. Orthodont ists m ust also possess good academ ic com -m unicat ion skills and at tend regional or nat ional conferences related to oral m edi-cine. Students can report their research results as oral reports or poster boards, or they m ay use other m ethods.

In m ost academ ic schools in China, the teachers are at least associate professors. As an exam ple, m ore than 20 of the 40 doc-tors at the departm ent of or thodont ics of PKUSS are involved in teaching. They are assigned various teaching tasks and are required to prepare extensively before for-m ally present ing their courses. In the clin ic, professors m onitor the students t reat ing or thodont ic pat ients daily, aiding them in planning t reatm ents and the details of the t reatm ent procedures. The qualit y of the teaching and quali cat ions of the teach-ers are m onitored by established system s, ensuring that the teaching progresses sm oothly.

9.7 Assessment of Graduating ClassesAt the end of or thodont ic t rain ing, the qualit y of specialt y educat ion is assessed w ith exam inat ions. Such exam inat ions are deem ed to evaluate the qualit y of care that an or thodont ist can provide. The principal bene t of the assessm ent and evaluat ion of the graduat ing class is the provision of a uniform and object ive standard regard-ing students’ knowledge. The exam ina-t ions also m ot ivate the students to learn and m ake progress. At present in East and Southeast Asia, exam inat ion m ethods vary w idely, from externally audited tests of or thodont ic abilit y to closed discussions between students and their ow n or thodon-t ic tutors.

To assess the e cacy of the three- and ve-year courses, nal exam inat ions are taken . These exam inat ions involve a series of steps to ensure an object ive result and cover all required areas of learning. Knowl-edge related to the or thodont ic specialt y is rst assessed. Then, w ire-bending skills are evaluated by having the student n ish ordered bends, loops, or arch form s, w hich are com m only used in clin ical or thodon-t ics. Finally, each student m ust analyze one of two com plicated or thodont ic cases, w hich m ay incorporate m any problem s of


technique, t ransm ission st raight w ire tech-nique, m icro-im plan t anchorage system , lingual appliances, Invisalign , t reatm ent of obst ruct ive sleep apnea syndrom e, and so on. The durat ion varies from two days to one m onth . Besides these short-term classes, m any dental schools or hospitals provide a one-year fur ther study program in w hich students take or thodont ic courses and receive t rain ing in clin ical skills. They m ay also t reat the pat ients of supervisors in the independent clin ic. This program is very popular throughout the country.

9.11 ConclusionIn th is chapter, we in t roduced or thodon-t ic specialt y educat ion in East and South -east Asia, w ith a par t icular focus on China; the topics described included the status of or thodont ic specialt y educat ion , orthodon-t ic specialt y program s in dental schools, quali cat ions of applicants and select ion criter ia, or thodont ic specialt y program characterist ics, assessm ent of graduat-ing classes, and or thodont ic specialt y requirem ents. The object ive of postgradu-ate or thodont ic educat ion in th is region is to produce graduates w ho w ill com plete their clin ical educat ion in an advanced educat ional inst itut ion , obtain a solid background in diagnosis and t reatm ent , and becom e specialists in or thodont ics. St rongly m ot ivated, in telligent graduates w ho have passed the ent rance exam ina-t ions are welcom ed to study or thodont ics. They receive system at ic clin ical t rain ing in or thodont ics and conduct related scien-t i c research during the three- to ve-year program s. At the end of their t rain ing, they are required to subm it a t ypical m aster’s or doctoral thesis and com plete m ult iple or th -odont ic cases before they are awarded their degree. In addit ion, inst itut ions of h igher educat ion provide cont inuing orthodont ic educat ion for residents or or thodont ists.

Considering the present state of or th -odont ic specialt y educat ion worldw ide, we realize that m any aspects can and m ust be

9.9 Departments’ FacilitiesIn the preceding sect ions, we described the basics of or thodont ic specialt y educa-t ion in China. In addit ion , the facilit ies of an or thodont ic depar tm ent are crucial for realizing the stated object ives. The gen-eral organizat ion and st ructure of teaching hospitals do not di er m uch . In China, for exam ple, m ore than 100 universit ies and m edical colleges have established or th-odont ic depar tm ents, and there are m ore than 3,000 fu ll-t im e or thodont ists and m ore than 2,000 par t -t im e or thodont ists nat ionw ide. The depar tm ent of or tho-dont ics of PKUSS, for exam ple, w hich was the rst established in China, has a well-st ructured sta com prising 58 clin icians, 48 nurses, and 10 technicians. The dist inct levels of experience of the clin icians fu l ll the requirem ents for clin ical, teach ing, and scien t i c work. In addit ion , there are 51 dental un its and 9 independent outpat ien t clin ic room s. These clin ical facilit ies and sta cont r ibute to the successful im ple-m entat ion of or thodont ic specialt y educa-t ion and allow it to proceed steadily and develop cont inually.

9.10 Continuing EducationBecause of rapid progress in science and technology, specialist or thodont ists m ust update their exist ing scien t i c knowledge and cont inue their educat ion by at tending refresher courses, as well as acquire further clin ical experience. Thus, visit ing scholar program s and cont inuing educat ion have becom e global t rends and increasingly pop-ular in recent years. As an im portant par t of orthodont ic specialt y educat ion , cont inu-ing educat ion has developed rapidly. In China, cont inuing educat ion in or thodon-t ics takes the form of annual short-term courses on various “hot topics,” such as the Tweed–Merri eld technique, st raigh t w ire


have taken place during recent years. Let us un ite to contr ibute to worldw ide or thodon-t ic educat ion and support the cont inued e or t toward achieving the goals of or tho-dont ics globally.

im proved, and that m any issues need to be resolved. Orthodont ic specialt y educat ion in East and Southeast Asia has a long way to go. However, we should recognize the signi cant achievem ents and progress that

73

Orthodontic Specialty Education in OceaniaAlexandra K. Papadopoulou, Oyku Dalci, and M. Ali Darendeliler

In the early 20th century, as orthodontic training was not provided in Oceania, som e general dent ists went overseas rst to the United States, to study under the fam ous Dr. E. H. Angle, and later to the United King-dom . Those rst specialists in orthodontics founded the Australian Society of Ortho-dont ists (ASO) in 1927. The rst full-t im e, 18-m onth course that had the scope of pre-paring students for specialist orthodontic pract ice was established at the University of Sydney in 1962. Later, in 1964, this was changed into a two-year m aster’s degree course. The University of Adelaide started the rst equivalent course ve years later, and very quickly courses providing specialist educat ion were begun at the Universit ies of Melbourne, Queensland, and Western Aus-tralia, as well as at the University of Otago in New Zealand. These courses have becom e well-know n over the years as they have adm it ted and graduated m any national and international applicants.

Curren tly, dental graduates w ishing to pract ice as specialized or thodont ists are required to undertake a three-year pro-gram leading to a doctor in clin ical den-t ist ry or equivalent degree at an Aust ralian or New Zealand accredited universit y. These program s involve three years of full-t im e supervised pract ice and inst ruct ion in a universit y environm ent . The process consistent ly concludes w ith a nal exam i-nat ion that assesses knowledge, com pe-tency, and pro ciency in a w ide range of procedures w ith in the scope of pract ice of a specialist or thodont ist .1 Regist rants m ay

10

pract ice in all states or terr itories of Aust ra-lia and New Zealand.2–4

The Aust ralian Dental Council (ADC) has been appointed by the Dental Board of Aust ralia, under the Health Pract it ioner Regulat ion Nat ional Law Act 2009 (Nat ional Law ), as the accreditat ion authorit y respon-sible for accredit ing educat ion providers and program s of study for the dental pro-fession, including general dent ist ry and all dental specialt ies, including or thodont ics. The ADC and the Dental Council of New Zealand (DCNZ) have adopted a join t con-tact for an Aust ralasian accreditat ion pro-cess w ith the const itut ion of the ADC/DCNZ Accreditat ion Com m it tee. Accreditat ion of a program signi es that the program o ered by the educat ion provider has been found to m eet ADC/DCNZ accreditat ion standards and provides graduat ing students w ith the knowledge, skills, and professional at t r i-butes necessary to pract ice the profession in Aust ralia and New Zealand.

Accredited or thodont ic courses in Aus-t ralia and New Zealand are o ered by the follow ing universit ies5–9:

• The Universit y of Adelaide School of Dent ist ry

• The Universit y of Melbourne Melbourne Dental School

• Universit y of Otago Faculty of Dent ist ry

• The Universit y of Sydney Faculty of Dent ist ry

• The Universit y of Western Aust ralia School of Dent ist ry


10.1 Australian Dental Council/Dental Council of New Zealand Accreditation Standards: Education Programs for Dental Specialists 2

The ADC/DCNZ Accreditat ion Standards: Educat ion Program s for Dental Specialt ies are the criter ia against w hich dental spe-cialt y educat ion and t rain ing program s are assessed for accreditat ion purposes. These standards are regularly m onitored based on experience and feedback from par t ici-pants, and they are periodically reviewed and updated w ith w ide consultat ion and appropriate external assistance. The stan-dards are organized around the follow ing broad st ructure:

• Context/overview of the program• Act ions taken since the last review• Adm inist rat ion and educat ional

resources• Students• Sta • Peer evaluat ion• Curriculum and assessm ent• Delivery of the program• Research• External relat ionships• Program evaluat ionFor each accreditat ion standard, evi-

dence requirem ents are listed to assist schools in their self-assessm ent and prepa-rat ion of their accreditat ion subm ission responses.

10.1.1 Standard 1: Overview of the Program

The school m ust have a clearly de ned educat ional philosophy for each of its dental specialt y program s. Dental spe-cialt y educat ion should be a core act ivit y and be governed by bodies such as a post-graduate studies com m it tee and a research com m it tee.

Evidence requirem ents are overview of the follow ing:

• The philosophy of postgraduate educat ion

• The object ives of postgraduate educat ion

• The com m on tem plate across individual dental specialt y program s

• The balance of basic science, stat ist ics, and the specialist discipline

• The balance of research and course work

10.1.2 Standard 2: Responses to Conditions, Recommendations, and Suggestions from the Previous Accreditation Process

The school m ust address the recom m enda-t ions and suggest ions m ade in the report of the previous accreditat ion visit and in any other reports since that t im e. This is an im portant determ inant of the accredi-tat ion status awarded because it dem on-st rates the school’s awareness of the need for cont inual im provem ent . The school pro-vides a detailed report on how each condi-t ion , recom m endat ion, and suggest ion of the previous accreditat ion report has been addressed.

10.1.3 Standard 3: Peer Evaluation

Evidence m ust be provided of peer evalu-at ion of the content of each of the dental specialt y program s being accredited and of m easures taken to implem ent any recom -m endat ions of such evaluat ions. The evalu-at ing body or person m ust be representat ive of the contemporary specialty and be rec-ognized by the ADC/DCNZ as appropriate to undertake the peer evaluat ion. The review reports are to be included in the subm is-sions for individual dental specialt ies.

10 Orthodontic Specialt y Education in Oceania 75

• Level of support provided by any other in terested par t ies

10.1.5 Standard 5: Relationship between Dental Specialty Students and Education Provider/University

Dental specialt y students m ust have the sam e rights and privileges as other post -graduate students. Program s and services are provided that are speci c to dental spe-cialt y studies/students, and representat ion on the central com m it tees of the educat ion provider/universit y is established.

10.1.6 Standard 6: School Administration and Budget

The cont inuing nancial resources, m an-agem ent st ructure, and adm inist rat ive and support sta of the educat ion provider m ust be adequate to enable the objec-t ives of its dental specialt y program s to be achieved. The educat ion provider has to supply detailed evidence of the follow ing:

• Governance of dental specialt y educat ion

• Adequacy of nancial support• Adm inist rat ion and support of the

dental specialt y students w ith in the school

• Areas requir ing fur ther developm ent and const rain t

• “Outsourcing” of students to other departm ents for speci c t rain ing/subjects

10.1.7 Standard 7: Teaching Facilities

School facilit ies, including sem inar room s, laboratories, clin ics, hospitals, and general educat ion provider facilit ies, and their rele-vant equipm ent m ust be adequate to allow the dental school to achieve it s dental spe-cialt y educat ional object ives.

In the accreditat ion of dental specialt y program s, peer review takes on an added dim ension w ith the cont ribut ion of the relevant specialt y academy or society. The specialt y program m ust provide evidence of peer evaluat ion of the content of the pro-gram and of m easures taken to im plem ent any recom m endat ions of such evaluat ions. This is a considerable responsibilit y, and the assistance of specialist societ ies and academ ies is acknowledged in the lead-up to the accreditat ion process for dental spe-cialt y program s.

Inform at ion and recom m endat ions are provided concerning the follow ing:

• An overview of the peer review process

• Guidelines provided to reviewers• Peer review reports• Response of the school to the

recom m endat ions of peer review reports

• The current peer review status

10.1.4 Standard 4: Relationship between School and the Education Provider/University

The dental school m ust exist as a dist inct ent it y w ith in the educat ion provider/uni-versit y, w ith adm inist rat ive responsibilit y and status sim ilar to those of com para-ble units, such as schools of other health professions.

An overview is provided of the follow ing:

• Postgraduate st ructure w ith in the educat ion provider/universit y

• Posit ion of the educat ion provider/universit y w ith in th is st ructure

• Degree of control and independence of postgraduate studies w ith in the school

• Level of support and any infrast ructure given by the educat ion provider

• Level of support provided by the faculty (w here relevant)


ence of the sta m ust be appropriate for the specialist disciplines seeking accreditat ion . There m ust be a director for each specialty program w ith de ned responsibilit ies. The current sta status m ust be provided.

10.1.10 Standard 10: Admissions Policies and Procedures

Adm ission in to a dental specialt y program m ust be based on published select ion cri-teria that are applied equitably during the select ion process. These m ust be cont inu-ally evaluated to assess their e ect iveness. The educat ion provider m ust have estab-lished, clear processes and provide details on the follow ing:

• Inform at ion provided to all students• Quotas and num ber of individual

st ream s in each discipline• Current select ion procedures• Reference of curren t processes• Special condit ions applying to

in ternat ional students• Opt ions for in tegrat ion w ith

concurrent doctoral or other h igher degree program s

• Policy on blood-borne viruses and im m unizat ions for new students

• Dental specialt y course guide for new students

• In t roduct ion program for new postgraduate students

10.1.11 Standard 11: Interface w ith Community

Dental specialt y students should be under-standing of, and be responsive to, the oral health needs of the Aust ralian/New Zealand com m unity and of overseas com m unit ies, as well as those of the individual pat ients.

As a result , an epidem iologic com po-nent is included in all or som e program s. The program develops an understanding of disease as a public health issue, and dental specialt y students are educated in the m an-agem ent of eth ical issues.

The follow ing details m ust be m et:

• School teaching facilit ies for dental specialt y program s

• Sharing arrangem ents w ith undergraduate and other program s

• Tim e allocat ions and const rain ts of shared facilit ies

• Access to elect ronic teaching m aterials

• E-m ail and In ternet access• Student o ces

Any outplacem ent facilit ies used in the dental specialt y program (including the num ber of chairs in each clin ic) m ust be listed, as well as any form al relat ion-ships/agreem ents between the educat ion provider responsible for dental specialt y educat ion and the agency engaged in the teaching and supervision of students in these outplacem ent set t ings.

10.1.8 Standard 8: Education Provider/University Library

Students m ust have access to library resources, services and facilit ies, and sta to support both learning and research. Infor-m ation retrieval, analysis, and organizat ion should be an integral part of the educat ional process. These include the follow ing:

• Library as a postgraduate resource• Adequacy of acquisit ions• Educat ional program s by library

sta for dental specialt y students• Inclusion of adequate library t im e

w ith in individual program s• Plans for future developm ent• Borrow ing rights• Access to general, health sciences,

and biological sciences libraries

10.1.9 Standard 9: Specialist Sta

The sta -to-student rat ios m ust be adequate for the school to achieve its dental specialt y educat ional object ives. The specialty quali- cat ions, t im e com m itm ent , and experi-


• Provide details of the m anagem ent of poor perform ance and m entoring and/or supervision program s

• Describe the input to program s from relevant specialist bodies

• Detail the involvem ent of students in cont inuing educat ion courses, as par t icipants or presenters

10.1.14 Standard 14: Student Assessment

A clearly stated, valid, and reliable system of form at ive and sum m at ive assessm ent m ust be used to determ ine the progression and graduat ion of students. This includes the follow ing:

• Assessm ent m ethods as related to educat ional object ives

• The school’s assessm ent procedures, including portfolio/logbook requirem ents

• Select ion of exam iners• Policy of supplem entary

exam inat ions• Involvem ent of specialist bodies in

assessm ent of students

10.1.15 Standard 15: Student Representation

The school m ust have m echanism s in place for the representat ion of its dental specialt y students on relevant com m it tees or boards responsible for postgraduate m at ters.

10.1.16 Standard 16: Student Well-being

Counseling and health services should be available to all dental specialt y students.

The health services m ust:

• Be available to both local and in ternat ional students

• Include requirem ents for and access to rout ine vaccinat ions

• Com ply w ith occupat ional health and safety protocols

10.1.12 Standard 12: Principles of Mana Māori and the Treaty of Waitangi; National Strategic Framework for Aboriginal and Torres Strait Islander Health

New Zealand educat ion providers m ust dem onstrate that the principles of m ana Māori and of the Treaty of Waitany are upheld throughout the program s. Australian educat ion providers should dem onstrate that the n ine principles in the Nat ional Strategic Fram ework for Aboriginal and Torres Strait Islander Health are prom oted throughout the program , and that there is a com m itm ent to contribut ing to the devel-opm ent of an Aboriginal and Torres St rait Islander (ATSI) dental specialt y workforce.

E ect is given in the recruitm ent of Māori and ATSI students and in scholar-ship, teaching, and research. For New Zea-land educat ion providers, the school has to describe it s relat ionship w ith local iw i and hapū in ways that illust rate plans to increase Māori par t icipat ion w ith in the profession and ways to ensure cross-cul-tural understanding. In addit ion , st rategies have to be outlined to ensure the retent ion of Māori and ATSI students and for achiev-ing Māori and ATSI t reatm ent object ives.

10.1.13 Standard 13: Scholarship and Expertise

Graduates of dental specialt y program s m ust be capable of com petent independent specialt y pract ice im m ediately upon gradu-at ion and m ust be com m it ted to cont inue professional developm ent . They m ust be provided w ith suitable pat ients and facili-t ies during their t rain ing program to enable them to develop th is level of com petence.

To sat isfy the above standard the educa-t ion provider m ust:

• Describe the progression of students through specialt y t rain ing

• Detail the use of assessm ent as a determ inant of progression


• List of publicat ions in each discipline over the past ve years ident ifying papers authored or co-authored by specialist students

10.1.19 Standard 19: Undergraduate Teaching

Dental specialt y students should be encour-aged to par t icipate in undergraduate teach-ing throughout their program . In detail, th is includes:

• School policy on undergraduate teaching by specialist students

• Individual program requirem ents for par t icipat ion of specialt y students in undergraduate teaching

• Perceived value of undergraduate teaching in dental specialt y program s

• Student paym ent for teaching• Dental specialt y student

appointm ents to teaching posit ions

10.1.20 Standard 20: Evaluation of Outcomes

Ongoing evaluat ion of the outcom es of den-tal specialt y program s m ust be undertaken to determ ine w hether the speci c objec-t ives are being m et . Results m ust be used to im prove the program . The evaluat ion requirem ents m ust have a descript ion of the follow ing:

• How dental specialt y program outcom es are evaluated

• School processes for subsequent review and im plem entat ion of the evaluat ion recom m endat ions

• The frequency of evaluat ions

10.1.21 Standard 21: Strategies for Improvement

Each school m ust form ulate st rategies and a t im etable for the im provem ent of it s den tal specialt y program based on the self-assess-m ent process undertaken for accreditat ion .

• Ensure the presence of protocols so that students are provided w ith a safe working environm ent

10.1.17 Standard 17: Interface with Government, Hospitals, and Professional Bodies

The education provider must have functional relat ionships w ith the follow ing bodies:

• The dental authorit y• A general hospital• A dental hospital• Inst itut ional health care facilit ies• Specialist societ ies• Other educat ion provider

departm ents• The dental profession, the Australian

and New Zealand dental associat ions, and specialist academ ies/societ ies

• Specialt y areas at in terstate inst itut ions

Depending upon the par t icular spe-cialt y, dental specialt y students should gain experience in the m anagem ent of pat ients in the general hospital set t ing and in other ext ram ural facilit ies.

10.1.18 Standard 18: Research

There m ust be a dem onstrated com m it-m ent to research act ivit y by the dental school. Research m ust represent an iden -t i able and substant ial com ponent in all specialt y program s. Students m ust receive form al inst ruct ion in scien t i c m ethod, research m ethodology, biom etrics, and eth ical conduct .

The educat ion provider m ust have a detailed:

• Research philosophy• Research requirem ent• Form al and program t im e

com m itm ent to research• Requirem ent for preparat ion and

presen tat ion of a thesis/research report


educat ionally quali ed and appropriately registered in or thodont ics by an equivalent teaching program . This list should include a brief curriculum vitae and details of the period of service to the departm ent .

10.2.3 Visiting Specialists/Lecturers

A list of visit ing specialist /lecturers w ith a brief curriculum vitae is required.

10.2.4 Other Specialist Student Support Mechanisms

Clin ical assistants, technicians, and a departm ental secretary are required.

10.2.5 Course Objectives

These are as stated in Standard 1 of the ADC.

10.2.6 Prerequisites for Application to the Specialty Programs (Primary Examinations, Research/Teaching Experience)

Each school m ust clearly state the speci c criter ia and policy of select ion, as well as the process and m echanism of select ion. Individually, fur ther details are provided on the Web site of each school.5–10

Com pliance w ith the follow ing guide-lines is necessary, and dent ists w ith the stated quali cat ions and experience are eli-gible for considerat ion to en ter a graduate t raining program s in or thodont ics:

• Graduates of inst itu t ions m ust have com pleted a bachelor’s degree or the equivalent and m ust have sat is ed the requirem ents for general regist rat ion as a dent ist w ith the Dental Board of Aust ralia.

• Graduates of in ternat ional dental schools w ho possess equivalent educat ional background and standing as determ ined by the

10.1.22 Standard 22: SWOT Analysis

The school m ust ident ify it s ow n st rengths, weaknesses, opportun it ies for im prove-m ent , and threats to the qualit y (SWOT) of its dental specialt y program s.

10.2 Australian Society of Orthodontist Education Committee Guidelines1

The ASO participates in the peer review assessm ent of specialty program s and m ain-tains an active role in the prom otion of high-quality education w ithin these program s. Throughout the period from its establish-m ent to current years, the ASO has supported orthodontic research and education, either by sponsoring overseas competent academ ics or by funding research projects of specialty students and of doctoral or postdoctoral stu-dents w ith the rationale of furthering the developm ent of the specialty. The ASO, in its com m itm ent to the high standards of educa-tion m aintained by Australasian university specialty program s, provides guidelines addi-tional to the ADC/DCNZ accreditation stan-dards through the ASO education com m ittee.

10.2.1 Course Director

A course director m ust have evidence of a regist rat ion cer t i cate w ith the Aust ralian Health Pract it ioner Regulat ion Agency con- rm ing regist rat ion as a specialist in or tho-dont ics. In addit ion, docum entat ion of cer t i cat ion by the Aust ralasian Orthodon-t ic Board or evidence of progressing through the cer t i cat ion process is required, as well as docum entat ion con rm ing experience in teaching or thodont ics in an academ ic departm ent for a m inim um of two years.

10.2.2 Academic Sta

A list m ust be included of the registered quali cat ions of the full-t im e and frac-t ional sta to dem onstrate that they are


10.2.10 Clinical and Practical Training

A case log for a t ypical graduate student is subm it ted to dem onstrate exposure and involvem ent in the t reatm ent of all t ypes of m alocclusion, including experience and inst ruct ion in the in terdisciplinary m an-agem ent of com plex dentofacial problem s. The scope of cases should represent the range of problem s encountered in private pract ice.

10.2.11 Average Number of New Cases Started by Each Candidate under Direct Supervision as Opposed to Cases Treated for Paid Service and Transfer Cases

At least 50 and no m ore than 90 act ive new cases in com prehensive appliance therapy are advised for each graduate student .

10.2.12 Teaching Commitments of Each Candidate

Specialt y students m ust cont ribute to undergraduate teaching in any area of the dental school.

10.2.13 Patient Management

Patients are seen in the screening clinic, and when they are allocated for treatm ent, the student obtains records (photos, impressions, radiographs). The student then prepares all the diagnostic records, and before treatm ent begins, the cases are presented to the dele-gated faculty m em ber or to the departm ent at case presentation sessions during which the ndings are discussed and a treatm ent plan is decided, so that all individuals involved bene- t from the experience. Surgical or interdisci-plinary cases are presented to a joint sem inar before any treatm ent com m ences.

inst itut ion and the program are eligible. Graduates m ust have sat is ed the requirem ents of lim ited regist rat ion w ith the Dental Board of Aust ralia before ent ry in to the program .

• Prospect ive candidates m ust have com pleted a m inim um of two years in general dental pract ice before being adm it ted to graduate dental t rain ing. General dental pract ice m ay include pract ice in an academ ic or governm ent inst itut ion or in the m ilitary service.

10.2.7 Number of Students Accepted per Year and Overall Number of Students Enrolled

The num ber of students accepted per year is 3 or 4, and the total num ber of students is 9 to 12.

10.2.8 Course Structure

The chronological progression, year of the course, and subject codes w ith credit rat-ings for w hich the candidates are form ally enrolled at the universit y level m ust be listed in detail for each sem ester and year of study. An academ ic t im etable to dem -onst rate that the num ber of sta and their t im e com m itm ent are su cient for full supervision of the clin ical com ponent of the course is also advised.

10.2.9 Course Content

The content of each form al subject as pre-viously described and the num ber of hours devoted to each area w ith a detailed descrip -t ion of the courses are required. Copies of course outlines have to be subm it ted, and speci c courses in biom edical sciences w ith applicat ion to the diagnosis, prevent ion, and t reatm ent of disease of the oral t issues should be included. Graduate specialt y pro-gram s m ust be a m inim um of three full-t im e academ ic years or the equivalent .


• Writ ten and oral exam inat ions• Assessm ent of the clin ical cases

previously unseen by the student• Subm ission of a research report

based on original work conducted by the candidate during the course

10.2.16 Internal Course Evaluation

In ternal procedures to evaluate course conten t should be applied, and students m ust be provided w ith an assessm ent of their perform ance and progress at least each sem ester as par t of a regular feedback session w ith the course director. Depart-m ental m eet ings m ust be scheduled on a regular basis to ensure adequate funct ion-ing of the teaching unit . A m echanism m ust be in place for the ongoing and system at ic review of the qualit y of t reatm ent provided in the program .

10.2.17 Issues Identi ed in Previous Review and Action Taken

The educat ion provider m ust prepare a detailed descript ion of the act ions taken for im provem ent , according to the recom -m endat ions of the previous peer review evaluat ion .

10.3.18 Issues That Have Changed Since the Last Review

Signi cant changes in funding, adm inist ra-t ion , curriculum , clin ical, laboratory, and research facilit ies m ay have an im pact on the abilit y of a program to com ply w ith the ADC/DCNZ accreditat ion standards. If such circum stances arise after the review, an ext raordinary peer review m ay be neces-sary to ensure that the program m eets the equivalent nat ional standards.

10.2.14 Facilities

The follow ing issues m ust be sat is ed:

• The clin ical facilit ies m ust operate w ith in the um brella of a ter t iary inst itut ion , either a universit y or a hospital, su cient to ful ll the educat ional needs of the program .

• The clin ical facilit ies m ust have access to radiographic and diagnost ic data collect ion facilit ies and m ust m aintain an adequate storage and ret r ieval process.

• The clin ical facilit ies m ust perm it students to work e ect ively w ith allied dental health professionals.

• This environm ent m ust have in place policies consistent w ith governm ent regulat ions related to health care delivery at an inst itut ion .

• The use of private o ces as a m eans of providing clin ical experience is not supported.

10.2.15 Examinations

Details of assessm ents and exam inat ion protocols and the nam es of the exam iners for the various stages over the past three years have to be provided.

Docum ents that dem onstrate regu-lar (at least each sem ester) reviews of the knowledge, skills, eth ical conduct , and pro-fessional grow th of the students by m eans of w rit ten , oral, and/or pract ical exam ina-t ions have to be subm it ted. In addit ion, com plet ion of a com prehensive nal exam -inat ion process is required; th is includes a review by at least one individual external to the inst itut ion , w ho m ust be educat ion-ally quali ed in or thodont ics and from an equivalen t teaching program . In m ore detail, the exam inat ion process should include the follow ing:

• Presentat ion of 15 to 20 t reated cases dem onstrat ing various t ypes of m alocclusion that re ect the range of problem s encountered in the Aust ralian clin ical set t ing


5. The Universit y of Adelaide School of Den-t ist ry. h t tps://health .adelaide.edu.au/den-t ist ry. Accessed January 28, 2015

6. The Universit y of Melbourne Melbourne Dental School. h t tp://ww w.dent .unim elb.edu.au . Accessed January 28, 2015

7. Universit y of Otago Faculty of Dent ist ry. h t tp://dent ist ry.otago.ac.nz. Accessed Janu-ary 28, 2015

8. The Universit y of Sydney Faculty of Dent ist-ry. h t tp://sydney.edu.au/dent ist ry. Accessed January 28, 2015

9. The Universit y of Western Australia School of Dent ist ry. h t tp://w w w.dent ist ry.uwa.edu.au . Accessed January 28, 2015

Acknowledgments

Material published w ith the perm ission of the Aust ralian Dental Council.

References 1. Aust ralian Societ y of Orthodont ists. h t tp://

w w w.aso.org.au . Accessed January 28, 2015 2. Aust ralian Dental Council. h t tp://w w w.adc.

org.au . Accessed January 28, 2015 3. Dental Board of Australia. http://www.dental-

board.gov.au. Accessed January 28, 2015 4. Aust ralian Health Pract it ioner Regulat ion

Agency. h t tp://ahpra.gov.au . Accessed Janu-ary 28, 2015

83

Orthodontic Specialty Education in the Middle East and AfricaAbbas R. Zaher and Hassan Kassem

A quest ionnaire was sent to the author’s personal com m unicat ions in the Middle East and Africa. Addit ional inform at ion was acquired through universit y Web sites. A de nit ion of the Middle East region is the one adopted by the World Federat ion of Orthodont ists. Furtherm ore, the data col-lected represent the received responses from the m ain geographic areas that con-st itute the regions of the Middle East and Africa.

11.1 North African Countries

11.1.1 Egypt

In Egypt , seven governm ent-funded uni-versit ies o er specialt y or thodont ic t rain -ing ending in the award of either a m aster of science or a doctor of philosophy degree. The t ypical durat ion of a m aster’s degree program is three years, w hereas it is four to ve years for a doctoral degree program , w ith a special em phasis on a research proj-ect in the lat ter. A previous m aster of sci-ence degree is a prerequisite for adm ission to a PhD program . The num ber of teaching sta in every program is 10 on average. The m aster of science degree program s accept from three to ve applicants every year. Doctoral candidates are accepted on an individual basis.

11

The didact ic par t of the program includes lectures, sem inars on selected topics, journal clubs, and workshops. At the outset of the program , the resident is assigned a m inim um of 50 new cases, in addit ion to a variable num ber of t ransfer cases. The candidate receives on average 25 hours of supervised clin ical t rain ing per week. Diverse clin ical techniques are taught in the program , including convent ional and m odi ed edgew ise appliances, st raight w ire appliances, funct ional appliances, and convent ional and skeletal anchorage m odalit ies. The candidates see pediat r ic pat ients requir ing space supervision or or thopedic t reatm ent , t ypical adolescent pat ients requiring or thodont ic t reatm ent , adults w ith m alocclusion and in terdisci-plinary problem s, pat ients w ith orofacial clefts or other craniofacial anom alies, and pat ients undergoing or thognathic surgery. A weekly case presen tat ion sem inar is con-ducted at w hich residents are required to present their assigned cases and discuss t reatm ent planning opt ions w ith the fac-ulty and other residents. Each resident has to com plete 20 cases of various m alocclu-sion problem s by the end of the program . Periodic form s of evaluat ion include w rit-ten papers, sem inars, and clin ical and oral exam inat ions. At the end of the program , the resident m ust pass a w rit ten exam ina-t ion, a case-based oral exam inat ion, and a pract ical test . The candidate is awarded the degree upon the successful defense of a research disser tat ion .


11.1.2 Morocco

Moham m ed V Universit y at Souissi in Rabat , Morocco, o ers a cer t i cate of or thodont ics and m aster’s and doctor’s degrees. All pro-gram s are conducted in French. The pro-gram accepts an average of 20 candidates every year. Each candidate has to com plete four hours of supervised clin ical t rain ing per week. The candidates are assigned 40 new and 10 t ransferred pat ients, and they are expected to n ish a m inim um of 10 cases by the end of the program . The nal assessm ent includes a w rit ten test , an oral presen tat ion, and a presen tat ion of n ished cases. The program research plan focuses on the topics of biocorrosion , arch length discrepancy, and dental caries.

11.2 Central and South African Countries

11.2.1 Nigeria

In Nigeria, seven inst itut ions o er t rain-ing for or thodont ic residents; the largest is Lagos Universit y Teaching Hospital in Lagos, w hich accepts two to four candidates every year. The or thodont ic resident is awarded a fellowship diplom a of either the West Afri-can College of Surgeons or the Faculty of Dental Surgery of the Nat ional Postgradu-ate Medical College of Nigeria, w hich in Nigeria is considered superior to a PhD. The average durat ion of the program , w hich is conducted in English , is four and a half years. The candidate receives two didact ic. Each resident is assigned 50 pat ients at the outset of the program , in addit ion to a vari-able num ber of t ransfer pat ients. The can-didate com pletes 30 hours of supervised pat ient m anagem ent per week, w ith t rain -ing in the use of st raight w ire and funct ional appliances. To graduate, the candidate is required to com plete 25 xed appliance cases, 5 rem ovable appliance cases, and 1 in terdisciplinary case. The nal assessm ent includes the defense of a disser tat ion on research perform ed by the resident and an oral exam inat ion .

11.2.2 South Africa

The governm ent of South Africa registered or thodont ics as a specialist dental pract ice in 1948. Currently, an or thodont ist has to com plete a four-year full-t im e postgradu-ate program after earning the dental degree to specialize in the eld . The longest-run-ning or thodont ic program is the one at the Universit y of the Witwatersrand, Johan-nesburg, w hich star ted in 1953. At presen t , th ree m ore universit ies o er specialized t rain ing: the Universit y of Pretoria; the Universit y of the Western Cape, Cape Tow n; and the Universit y of Lim popo.

11.2.3 Sudan

Advanced orthodont ic t raining at the Uni-versit y of Khartoum includes both a m as-ter’s degree and a doctor’s degree. On average, six candidates are accepted every year. There as 23 full-t im e sta m em bers part icipat ing in the program , w hich lasts for an average of three years. Candidates at tend eight hours of lectures per week and are required to complete 20 hours of supervised clinical t rain ing per week; they are assigned 60 new and 20 t ransferred pat ients. Tech-niques taught in the program include both xed and rem ovable appliances. Candidates for the m aster’s and doctor’s degrees are required to complete two and three hours of research work per week, respect ively. The candidate subm its ve nished cases at the complet ion of the program .

11.3 Asian Countries

11.3.1 Iraq

Three universit ies have postdoctoral or th-odont ic educat ion program s. The MSci and PhD degrees are o ered. Full-t im e sta is involved in conduct ing these program s. Each universit y accepts three to ve can-didates every year. Both program s are con-ducted in English . The average durat ion of the m aster’s degree program is two years,

11 Orthodontic Specialt y Educat ion in the Middle East and Africa 85

36-m onth in ternat ional specialt y program , conducted in English , that leads to a m as-ter’s degree in dental sciences. The pro-gram m eets the academ ic guidelines of the European Erasm us program . There are 26 faculty m em bers involved in the program . The curriculum consist of core courses, sem inars on diverse topics, workshops, and a supervised research project . At the end of the program , the candidates take a nal w rit ten exam inat ion , w hich is followed by an oral exam inat ion if they pass the form er. All students are concurrently enrolled in a two-year m aster of science program in the biom edical sciences and are awarded the MSci degree from the Hebrew Universit y upon the com plet ion of a research project . Research act ivit ies in the departm ent focus on craniofacial developm ent and develop-m ent of the dent it ion; biological aspects of tooth m ovem ent; or thodont ic t reatm ent for children w ith special needs, clefts, and cran iofacial anom alies; and or thodont ic m aterials.

The School of Graduate Dent ist ry at Ram bam Health Care Cam pus o ers an or thodont ic residency program three and a half years in durat ion . The facult y includes 14 sta m em bers and a unit director. The program em phasizes the in terdisciplinary t rain ing, com bining pediat r ic and adult surgical or thodont ic techniques for the t reatm ent of acquired and congenital cra-niofacial anom alies.

11.3.3 Lebanon

Saint Joseph Universit y, in Beirut , o ers several postgraduate degrees in both Eng-lish and French, including a cert i cate of or thodont ics and a m aster’s and a doctoral degree. The m aster’s degree program is on average three years long. Other program s are custom izable to each candidate. The academ ic sta is m ainly par t-t im e. Two to three residents are accepted every year. The prim e focus of the program is on the clin ical skills of the residents. Each resident is assigned 50 new pat ients and 30 t rans-ferred pat ients. Residents undergo 15 hours of supervised clin ical t rain ing every week,

and it is three years for the doctoral degree program . Upon ent ry, each candidate is assigned from 20 to 40 new pat ients and from 10 to 20 t ransferred pat ients. The candidate has 15 to 20 hours of supervised clin ical t rain ing per week. Candidates are t rained in edgew ise and st raight w ire tech-niques, in addit ion to the use of funct ional appliances and skeletal anchorage devices. To graduate, each candidate m ust com plete at least 20 cases. The nal assessm ent of the residents takes the form of a com pre-hensive oral and w rit ten exam inat ion . Periodic evaluat ion includes pract ical and w rit ten tests, in addit ion to oral presenta-t ions. A research thesis is required for the com plet ion of both degrees.

11.3.2 Israel

The Goldschleger School of Dental Medi-cine at Tel Aviv Universit y, w here the Eras-m us program curriculum of the European Union was rst im plem ented, conducts an in ternat ional or thodont ic t rain ing program in English . The program o ers a cer t i cate in or thodont ics and either a m aster’s or a doctor’s degree. The program is conducted by 22 faculty m em bers, w ho include 4 pro-fessors, 2 lecturers, and clin ical inst ruc-tors. The durat ion of the program is three and a half years, w ith an addit ional two to three years of research for those on the PhD t rack. Various t reatm ent philosophies are taught in the program , including m odi ed edgew ise, st raight w ire, lingual, and rem ov-able and xed funct ional appliances; clear aligners; and tem porary anchorage devices. Each candidate is assigned 40 new and 30 t ransfer and retent ion cases. The candidate m ust com plete 10 new cases of di erent categories to graduate; the cases are evalu-ated according to the Am erican Board of Orthodont ists requirem ents. The program concludes w ith clin ical oral exam inat ions and a thesis defense. The research con-ducted in the departm ent covers a w ide scope of topics featuring root resorpt ion and funct ional appliances.

The Hebrew Universit y Hadas-sah School of Dental Medicine o ers a


evaluated periodically and at the end of the program w ith oral, w rit ten, and pract ical tests. At the end of the program , a typical candidate has nished a m inim um of 30 cases and defends a research thesis. Cur-rently, the program does not endorse a par-t icular area of research.

11.3.5 United Arab Emirates

The United Arab Em irates (UAE) features two postgraduate or thodont ic program s in Dubai. The rst is a m aster of science in or thodont ics program o ered by the Ham dan Bin Moham m ed College of Dental Medicine, an inst itu t ion of the Moham -m ed Bin Rashid Universit y of Medicine and Health Sciences. The durat ion of the program is 36 m onths and incorporates clin ical t rain ing at the level of specialist t rainee and appropriate preparat ion for the Mem bership Exam inat ion of The Royal College of Surgeons of Edinburgh (UK). The program is conducted in English and accepts six residents every academ ic year. Four full-t im e academ ic sta m em bers run the or thodont ic curriculum of the program and 10 other academ ic faculty m em bers are involved in educat ional aspects related to basic sciences, radiology and im aging, biostat istcs, research m ethodology, eth-ics and legislat ion , and m ult idisciplinary m anagem ent . Each resident is assigned 35 to 40 new pat ien ts and is expected to n ish a m inim um of 25 cases by the end of the program . The candidates m ust com plete 25 hours of supervised pat ient m anage-m ent per week, w hich includes prevent ive, in tercept ive, and correct ive or thodont ics of children , adolescents, and adults. The m ajorit y of the knowledge base of the curriculum is delivered through a blend of learn ing styles including lectures and sm all group enquiry-based learning. Resi-dents are expected to prepare in advance for sm all group teaching that w ill then be used to put knowledge in to context of the clin ical experience of teachers and learners and current research evidence. The resi-dents are required to com plete four hours of research work every week leading to the

w hich is focused m ainly on xed appliance therapy in addit ion to the im plem entat ion of skeletal anchorage techniques. Periodic evaluat ion includes w rit ten exam inat ions, presentat ions, and pract ical tests. The pro-gram does not include a form al nal assess-m ent of the residents. The m ain research dom ain is clin ical.

In 2001, the Am erican Universit y of Beirut star ted a com bined specialt y t rain-ing and m aster of science degree program in or thodont ics in the newly founded divi-sion of orthodont ics and dentofacial or tho-pedics of the departm ent of otolaryngology and head and neck surgery. The program is conducted by four academ ic sta , 13 clin ical associates from di eren t dental and m edical elds, and a research consultant . Three to four candidates are accepted every year. The course spans 36 m onths and includes didact ic and clin ical m odules. The program is not rest r icted to cer tain t reat-m ent m odalit ies. Residents are exposed to the various philosophies used to t reat dif-ferent t ypes of or thodont ic pat ients in dif-ferent age groups. Residents graduate upon the com plet ion of clin ical requirem ents and the defense of a thesis.

Postdoctoral or thodont ic t rain ing is also o ered by Beirut Arab Universit y and the Lebanese Universit y.

11.3.4 Jordan

The Jordan University of Science and Tech-nology, near Irbid, o ers a m aster of science degree. The program is conducted in English. Five full-t im e academ ic sta m em bers are involved in the three-year program . Three candidates on average are accepted every year. The program comprises six didact ic hours of lectures and sem inars every week, two hours of t reatm ent planning sessions, and 15 hours of pract ical work, in addi-t ion to three hours of research work. Each resident is assigned a m inim um of 50 new pat ients and 30 t ransferred pat ients. The candidates are t rained m ainly in the st raight w ire technique and funct ional appliance therapy. Skeletal anchorage is also included in the t raining program . Each candidate is

11 Orthodontic Specialt y Educat ion in the Middle East and Africa 87

Swedish Nat ional Board of Health and Wel-fare. The faculty includes four full-t im e and eight part-t im e sta . Both program s are conducted in English . The m aster’s degree program consists of three years of full-t im e study, w hereas the cert i cate of orthodon-t ics program is o ered on a part-t im e basis and can take up to ve years. The candidates are t rained in all m odern xed appliances techniques, including the use of edge-w ise, st raight w ire, funct ional, and lingual appliances, in addit ion to skeletal anchor-age m ethods. Each candidate is assigned a total of 50 pat ients and receives supervised clinical t raining for 26 hours per week. The candidate has to com plete 30 cases to graduate. Final assessm ent of the residents includes an external exam inat ion by Malm ö University faculty. Master’s degree candi-dates are required to complete two hours of research per week ending in the complet ion and defense of a research thesis. Areas of research include the epidem iology of m al-occlusion, oral hygiene in UAE and expatri-ate samples, and outcom es and e ciency of di erent t reatm ents, w ith a special empha-sis on cort icotomy-facilitated orthodontics.

presentat ion and defense of a disser tat ion by the end of the program . Final candidate evaluat ion includes a w rit ten exam inat ion and a case presentat ion, in addit ion to the successful com plet ion of the research the-sis. At the end of the program , the candi-date takes a nal exam inat ion , w hich can also take place as a conjoint exam inat ion w ith the Royal College of Surgeons of Edin-burgh for the Mem bership in Orthodont ics. Diverse periodic evaluat ions com prise oral and w rit ten evaluat ions, research reviews, case presentat ions, sem inars on selected topics, and pract ical tests. Current areas of research com prise epidem iology of m al-occlusion in UAE, or thodont ic t reatm ent outcom es, or thodont ic m aterials, e-m odels technology as well as system at ic reviews and/or m eta-analysis.

The European University College (for-m erly Nicolas & Asp University College) is a private dental inst itut ion in Dubai that o ers both a specialt y cert i cate in ortho-dontics and a m aster’s degree in ortho-dontics. The t raining program s are o ered in collaborat ion w ith Malm ö Universit y, in Sweden, follow ing the regulat ion of the

88

Orthodontic Specialty Education in the Indian SubcontinentOm P. Kharbanda

The Indian subcont inent , a region of south Asia, com prises the countries of India, Paki-stan , Bangladesh, the Him alayan states of Nepal and Bhutan, and Sri Lanka, an island o the southeastern t ip of the Indian pen-insula.1 Before 1947, the three nat ions of India, Pakistan , and Bangladesh were h is-torically com bined and com prised Brit ish India. “The seven countries of South Asia const itute geographically a com pact region around the Indian subcont inent .”2 To foster regional polit ical and econom ic coopera-t ion , the governm ents of the seven coun-t ries created the South Asian Associat ion for Regional Cooperat ion (SAARC) in 1980. The rst sum m it was held in Decem ber 1985. The countries included Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan , and Sri Lanka.3 Since then, the organiza-t ion has expanded by accept ing one new full m em ber, Afghanistan , and several observer m em bers.4 “The Indian subcont i-nent is hom e to a vast diversit y of peoples, m ost of w hom speak languages from the Indo-Aryan subgroup of the Indo-Euro-pean fam ily.”5 Nearly 25% of the world’s populat ion (22% in 2010) lives in the Indian subcont inent .6

12.1 History of Dental Education in India

12.1.1 The Beginning

Dr. Ra udin Ahm ed established the rst form al dental college in India in 1920 at Calcut ta (now Kolkata), West Bengal. The

12

college star ted w ith a one-year License in Dental Surgery (LDS) diplom a. In 1922, the durat ion of the course was increased to two years, and fur ther increased to four years in 1936–1937. A chronology of the signi cant events on the developm ent of dental edu-cat ion in India is given in Table 12.1 . The rst dental faculty of independent India was form ed in Bom bay (now Mum bai) in 1957, o ering a bachelor of dental surgery (BDS) degree.7 At present , India has m ore than 300 dental colleges recognized by the Dental Council of India (DCI) that o er BDS quali cat ion .8

It was in 1933 that a series of lectures in the subject of or thodont ics were delivered for the rst t im e in a teaching inst itu t ion , at Nair Hospital Dental College by H.D. Mer-chant . In 1937, or thodont ics was accepted as a separate subject .9

12.1.2 Postgraduate Dental Education

Before the 1950s, facilit ies for postgraduate dental education hardly existed in India. In the 1940s, a m aster’s degree in dentistry (MDS) was awarded by the one and only col-lege of dentistry, De’Montm orency College of Dentistry at Lahore, and the graduates of this college form ed the nucleus for the advance-m ent of dental education during the t im e of Brit ish India. After independence from Brit-ish rule (1947), India was part it ioned into India and Pakistan (East and West). Lahore being in Pakistan, India had no institut ion granting postgraduate quali cation in den-

12 Orthodontic Specialt y Education in the Indian Subcontinent 89

Table 12.1 Chronology of signi cant events related to the dental profession and dental education in India

1920 Dr. R. Ahmed establishes rst formal dental college in India at Calcut ta, West Bengal. The college starts with a one-year LDS diploma. In 1922, the duration of the course is increased to two years.

1923 First dental and optical college established – namely, Punjab Dental College, Lahore. However, it cannot be sustained and eventually closes.

1926 American Dental College, Karachi established; however, it closes in 1947.

1928 Andhra Dental College and Hospital Bezwada founded. Renamed American Dental College and Hospital, Madras. Functions until 1947.

1932 City Dental College, Calcut ta founded; closes in 1940.

1933 Bai Yamunabai L. Nair Hospital Dental College started in Bombay. In 1946, taken over by the municipal corporation of Bombay. In 1954, becomes a liated with Bombay University.

1933 De’Montmorency Dental College and Hospital, Lahore. Regular BDS course started with Punjab University in 1936. First postgraduate course in dentistry started in 1945. Dr. K. L. Shourie among the rst recipients of MDS degree, who eventually heads the Dental Council of India as president.

1938 Delhi Dental College and Hospital established but does not survive.

1940 Sir C.E.M. Dental College, Bombay. In 1945 becomes a liated with Bombay University. In 1960 becomes Government Dental College, Bombay.

1943 Health Survey and Development Commit tee established by the government of India. Chairman Sir Joseph Bhore. Recommendations pave the way for enact-ment of the Dentists Act 1948 and the formation of Dental Council of India.

March 29, 1948

Dentists Act (XVI of 1948) reviewed; assent of the president of India.

April 12, 1949

Dental Council of India formed by the government of India by a special noti cation.

1953 First Indian Dentists Register prepared and placed before the council.

1957 Formation of the rst dental faculty in India, at the University of Bombay.

1959 Dental Council of India establishes regulations and syllabus for master’s de-gree courses. Universities encouraged to establish postgraduate courses in the following:Prosthetic dentistryOral surgeryOperative dentistryOrthodontiaPeriodontiaOral diagnosis and dental radiologyDental pathology and bacteriology

(Continued on page 112)


1960 Approval of government of India for a minimum basic quali cation for appoint-ment of teaching sta for master’s degree courses (MDS).

1963 Government of Ut tar Pradesh sanctions start of postgraduate courses at Luc-know Dental College.

1963 Dental Council of India lays down syllabus for master’s degree in pedodontia and preventive dentistry.

1964 Dentists Act 1948 extended to Union Territories of Goa, Daman, and Diu.

1965 Government approves MDS courses in periodontia.

1971 Dental Council of India lays down syllabus for master’s degree in periodontics.

1983 Dental Council of India course regulations for master’s degree program.

1986 All India Institute of Medical Sciences, New Delhi starts rst full-time three-year residency program for master’s degree in orthodontics.

1993 Indian Orthodontic Society conducts National Workshop on Postgraduate Orth-odontic Education. Recommends higher case load.

1993 Dental Council of India passes a resolution (DE-1[SC]-93/2064 28.10.1993) for MDS course duration of three years.

1998 Dental Council of India regulations for master’s degree courses (unpublished).

2000 National Board of Medical Examinations established. Orthodontics included in 2002.

2006 National workshop at All India Institute of Medical Sciences to update curricu-lum in all nine specialties of dentistry.

2006 Dental Council of India course regulations.

2007 and later

Dental Council of India course regulations and amendments.

Abbreviations: BDS, bachelor of dental surgery; LDS, license in dental surgery; MDS, master of dental surgery.Source: History of Dental Council of India. Souvenir released on the occasion of the Silver Jubilee of the Dental Council of India. New Delhi, India: Dental Council of India; 1973:59–67, 70–73.7

Table 12.1 (Continued) Chronology of signi cant events related to the dental profession and dental education in India


ing the 1990s, w ith private ent repreneurs taking the lead. The num ber of postgradu-ate departm ents grew to 48 in 2005 and reached the enorm ous num ber of 186 by 2014.8 The com plete list of inst itu t ions updated up to 2014 is given in Table 12.2 . In addit ion , m any Indian dental graduates pursue h igher dental educat ion in or tho-dont ics in Russia, China, and the Philip -pines, as well as the United Kingdom and the United States. Their exact num ber can-not be ascer tained.

12.1.2.2 Evolution of Orthodontics Syllabus and Curriculum in India

The MDS course regulat ions 1965 listed rather a brief syllabus in the subject of or thodont ia.13 There was no m ent ion of the quantum of the clin ical workload to be undertaken and the outcom e to be assessed. It m ent ioned only techniques and laboratory work, clin ical or thodont ia, and lectures and sem inars.

The subjects of the sem inars were listed as or thodont ics, ar t , applied oral and m axillofacial surgery, otolaryngology, and speech. The exam inat ion pat tern consisted of two par ts. The prerequisite for taking the Part II nal exam inat ion included sub-m ission of a thesis, in addit ion to passing the Part I exam inat ion. The durat ion of the course was two years.

The rst form al DCI regulat ions contain-ing a syllabus on m aster’s degree courses were published in 1965. 13 The subsequent detailed revision of the course regulat ions by the DCI in 1983 contained exhaust ive guidelines for all n ine specialt ies of den -t ist ry. 14

The revision included a detailed list of the preclin ical work to be undertaken by students. Clin ical t rain ing was based on the preparat ion of case records, the use of appliances, and the t reatm ent of di erent t ypes of m alocclusion w ith di erent tech-niques. It categorically m ent ioned that a student was expected to subm it ve n-ished cases t reated w ith any technique. A case presentat ion and discussion of the sam e were to const itute an im portant par t

t istry in 1947. Then, East Pakistan in 1971 separated from Pakistan to form Bangladesh.

The foundat ion of h igher dental edu-cat ion in Brit ish India was laid by the rec-om m endat ions of a com m it tee chaired by Sir Joseph Bhore. In 1943, the Bhore com -m it tee recom m ended that all graduates in dent ist ry be encouraged to pursue a post -graduate degree and that provisions be m ade in all universit ies to establish MDS courses because these m easures could ensure the gradual grow th of a cadre of well-t rained teachers in dent ist ry. The Dental Council of India (DCI) was incor-porated under the Dent ists Act 1948 to regulate dental educat ion and the dental profession throughout India. In 1959, the DCI laid dow n regulat ions and a syllabus for the m aster’s degree courses. The DCI recom m ended the follow ing specialt ies for postgraduate educat ion in dent ist ry: prosthet ic dent ist ry, oral surgery, operat ive dent ist ry, or thodont ia, periodont ia, oral diagnosis and dental radiology, and dental pathology and bacteriology. Pedodont ia, prevent ive dent ist ry, and public health dent ist ry were established in 1963 and 1971 respect ively.7,10

12.1.2.1 First Master of Dental Surgery Orthodontic Course in India

MDS courses in India, including orthodon-t ia, were established in 1959 sim ultane-ously at Nair Hospital Dental College and Governm ent Dental College and Hospital, both in Bom bay and both a liated w ith the Universit y of Bom bay.7,10,11 This was fol-lowed by MDS in or thodont ia at Lucknow 1964, Bangalore 1966, Trivandrum 1969, Ahm adabad 1970, Manipal 1972, Madras 1975, Hyderabad 1978, Nagpur 1985, All India Inst itu te of Medical Sciences, New Delhi 1986, and so on.10,12 By the 1970s, seven dental schools o ered MDS courses in or thodont ics, w ith 31 adm issions per year. Half of these belonged to the two den -tal colleges in Bom bay. The dental profes-sion and educat ion showed steady grow th unt il the 1980s and incredible grow th dur-

(Text cont inued on page 99)


Table 12.2 Institutions granting master of dental surgery (MDS) quali cation in India

State

Institutions granting MDS quali cation in India (approved/recognized by Dental Council of India as of August 27, 2014) Type

No. of admissions for 2013–2014

1 DL All India Institute of Medical Sciences, Centre for Dental Education and Research, New Delhi

Federal govt.

4

2 KA A.B. Shet ty Memorial Institute of Dental Sciences, Mangalore

Private 9

3 KA A.J. Institute of Dental Sciences, Mangalore Private 64 GJ Ahmedabad Dental College & Hospital,

GandhinagarPrivate 5

5 KA Al Ameen Dental College & Hospital, Bijarpur Private 26 KA Al-Badar Rural Dental College & Hospital,

GulbargaPrivate 5

7 KA AME’s Dental College & Hospital, Raichur Private 28 KL Amrita School of Dentistry, Kochi Private 39 MH Annasaheb Chudaman Patil Memorial Dental

College, DhulePrivate 3

10 MH Armed Forces Medical College, Pune Govt. 211 AP Army College of Dental Sciences, Secunderabad Private 212 DL Army Hospital (Research and Referral), Cant t,

DelhiGovt. 2

13 JH Awadh Dental College & Hospital, Jamshedpur Private 214 KL Azeezia College of Dental Sciences & Research,

KollamPrivate 3

15 UP Babu Banarasi Das College of Dental Sciences, Lucknow

Private 6

16 KA Bangalore Institute of Dental Sciences & Hospital, Bangalore

Private 3

17 KA Bapuji Dental College & Hospital, Davangere Private 618 MH Bharati Vidyapeeth Dental College & Hospital,

PunePrivate 6

19 MH Bharati Vidyapeeth Dental College & Hospital, Navi Mumbai

Private 3

20 HP Bhojia Dental College & Hospital, Nalagarh Private 321 BR Buddha Institute of Dental Sciences & Hospital,

PatnaPrivate 3

22 AP C.K.S. Teja Institute of Dental Sciences & Research, Renugunda, Tirupati

Private 6

23 UP Career Institute of Dental Sciences & Hospital, Lucknow

Private 2

24 UP Chandra Dental College & Hospital, Safedabad, Barabanki

Private 2

25 MH Chatrapati Shahu Maharaj Shikshan Sanstha’s Dental College & Hospital, Aurangabad

Private 3

26 CG Chat tisgarh Dental College & Research Institute, Rajnandgaon

Private 2



State



27 GJ College of Dental Sciences and Research Centre, Ahmedabad

Private 3

28 KA College of Dental Sciences, Davangere Private 629 MP College of Dentistry, Indore Govt. 230 KA Coorg Institute of Dental Sciences, Verajpet,

CoorgPrivate 6

31 KA D.A. Pandu Memorial R.V. Dental College, Bangalore

Private 5

32 HR D.A.V. Centenary Dental College, Yamuna Nagar

Private 3

33 UP D.J. College of Dental Sciences & Research, Modi Nagar

Private 6

34 RJ Darshan Dental College & Hospital, Udaipur Private 435 PB Dasmesh Institute of Research & Dental

Sciences, FaridkotPrivate 3

36 KA Dayanand Sagar College of Dental Sciences, Bangalore

Private 5

37 KL Dental College, Medical College Campus, Kozhikode

Govt. 2

38 OR Dental Wing, S.C.B. Medical College, Cut tack Govt. 239 GJ Dharmsinh Desai University, Faculty of Dental

Science, NadiadPrivate 3

40 BR Dr. B.R. Ambedkar Institute of Dental Sciences & Hospital, Patna

Private 2

41 MH Dr. D.Y. Patil Dental College & Hospital, Pune Private 642 WB Dr. R. Ahmed Dental College & Hospital,

Calcut taGovt. 4

43 KA Dr. Syamala Reddy Dental College, Hospital & Research Centre, Bangalore

Private 2

44 UP Dr. Ziauddin Ahmad Dental College, Aligarh Govt. 245 AP Drs. Sudha & Nageswara Rao Siddhartha

Institute of Dental Sciences, Krishna DistrictPrivate 3

46 UP Faculty of Dental Sciences, Lucknow Govt. 447 KA Farooqia Dental College & Hospital, Mysore Private 348 AP G. Pulla Reddy Dental College & Hospital,

KurnoolPrivate 3

49 PB Genesis Institute of Dental Sciences & Research, Ferozepur

Private 2

50 AP Gitam Dental College & Hospital, Visakhapatnam

Private 5

51 Goa Goa Dental College & Hospital, Bambolin Govt. 2


State



52 MH Govt. Dental College & Hospital, Mumbai Govt. 553 AP Govt. Dental College & Hospital, Afzalganj Govt. 254 RJ Govt. Dental College & Hospital, Near T.B.

Hospital, JaipurGovt. 2

55 GJ Govt. Dental College & Hospital, Ahmadabad Govt. 456 MH Govt. Dental College & Hospital, Nagpur Govt. 257 KA Govt. Dental College & Research Institute,

BangaloreGovt. 3

58 HR Govt. Dental College, Medical Campus, Rohtak Govt. 359 KL Govt. Dental College, Medical Campus,

TrivandramGovt. 3

60 J & K Govt. Dental College, Srinagar Govt. 261 KL Govt. Dental College, Gandhinagar Govt. 362 PB Guru Nanak Dev Dental College & Research

Institute, Bhatinda Road, SunamPrivate 2

63 WB Gurunanak Institute of Dental Science & Research, Kolkat ta

Private 5

64 KA H.K.E. Society’s S. Nijalingappa Institute of Dental Sciences & Research, Gulbarga

Private 3

65 HP H.P. Govt. Dental College & Hospital, Shimla Govt. 266 HP Himachal Dental College, Mandi Private 567 HP Himachal Institute of Dental Sciences, Sirmour Private 368 MP Hitkarini Dental College & Hospital, Jabalpur Private 369 UP I.T.S. Centre for Dental Studies & Research,

GhaziabadPrivate 5

70 UP I.T.S. Dental College, Hospital & Research Centre, Greater Noida

Private 3

71 TN Indira Gandhi Institute of Dental Sciences, Pondicherry

Private 3

72 OR Institute of Dental Sciences, Bhubaneswar Private 373 UP Institute of Dental Sciences, Bareilly Private 374 UP Institute of Dental Studies & Technology,

ModinagarPrivate 3

75 UP Institute of Medical Sciences, Banaras Hindu Universit y, Varanasi

Govt. 3

76 RJ Jaipur Dental College, Jaipur Private 577 TN J.K.K. Natarajah Dental College & Hospital,

NamakkalPrivate 2

78 KA J.S.S. Dental College & Hospital, Mysore Private 479 UP K.D. Dental College, Mathura Private 6

Table 12.2 (Continued) Institutions granting master of dental surgery (MDS) quali cation in India



State



80 GJ K.M. Shah Dental College & Hospital, Vadodara Private 481 TN K.S.R. Institute of Dental Science & Research,

NamakkalPrivate 3

82 KA K.V.G. Dental College & Hospital, Kannada Private 583 AP Kamineni Institute of Dental Sciences,

NalgondaPrivate 3

84 KL Kannur Dental College, Kannur Private 285 GJ Karnavati School of Dentistry, Gandhinagar Private 386 KA KLE Society’s Institute of Dental Sciences,

BangalorePrivate 3

87 KA KLE Vishwanath Kat ti Institute of Dental Sciences, Belgaum

Private 7

88 KL KMCT Dental College, Kozhikode Private 389 UP Kothiwal Dental College & Research Centre,

Kanth Road, MoradabadPrivate 6

90 KA Krishnadevaraya College of Dental Sciences & Hospital, Bangalore

Private 5

91 MH Late Shri Yashwantrao Chavan Memorial Medical & Rural Development Foundation’s Dental College & Hospital, Ahmednagar

Private 3

92 MH M.A. Rangoonwala College of Dental Sciences & Research Centre, Pune

Private 6

93 KA M.R.A. Dental College & Hospital, Bangalore Private 494 KA M.S. Ramaiah Dental College, Bangalore Private 395 KA Maaruti College of Dental Sciences & Research

Centre, BangalorePrivate 6

96 MP Maharana Pratap College of Dentistry & Research Centre, Gwalior

Private 3

97 HR Maharishi Markandeshwar College of Dental Sciences & Research, Ambala

Private 6

98 RJ Mahatma Gandhi Dental College & Hospital, Sitapura, Jaipur

Private 2

99 MH Mahatma Gandhi Missions Dental College & Hospital, Mumbai

Private 3

100 MH Mahatma Gandhi Vidya Mandir’s Dental College & Hospital, Nasik

Private 3

101 CG Maitri College of Dentistry and Research Centre, Anjora, Durg

Private 0 (3)

102 AP Mamata Dental College, Khamamam Private 3103 HR Manav Rachana Dental College, Faridabad Private 3


State



104 KA Manipal College of Dental Sciences, Mangalore, Mangalore

Private 5

105 KA Manipal College of Dental Sciences, Manipal Private 3106 GJ Manubhai Patel Dental College & Dental

Hospital & SSR General Hospital, VadodaraPrivate 3

107 KL Mar Baselios Dental College, Ernakulam Private 3108 KA Maratha Mandal’s Dental College & Research

Centre, BelgaumPrivate 3

109 DL Maulana Azad Dental College & Hospital, New Delhi

Govt. 2

110 TN Meenakshi Ammal Dental College & Hospital, Chennai

Private 7

111 AP Meghna Institute of Dental Sciences, Nizambad Private 3112 AP M.N.R. Dental College, Sangareddy Private 3113 MP Modern Dental College & Research Centre,

IndorePrivate 5

114 MH Nair Hospital Dental College, Mumbai Govt. 2 (10)115 AP Narayana Dental College & Hospital, Nellore Private 5116 GJ Narsinhbhai Patel Dental College & Hospital,

VisnagarPrivate 3

117 KA Navodaya Dental College, Raichur Private 3118 CG New Horizon Dental College & Research

Institute, BilaspurPrivate 3

119 RJ NIMS Dental College, Jaipur Private 3120 KA P.M.N.M. Dental College & Hospital, Bagalkot,

BijapurPrivate 2

121 RJ Paci c Dental College & Hospital, Udaipur Private 5122 MH Padmashree Dr. D.Y. Patil Dental College &

Hospital, Navi MumbaiPrivate 6

123 MH Pandit Dindayal Upadhyay Dental College, Solapur

Private 2

124 AP Panineeya Mahavidyalaya Institute of Dental Sciences & Research Centre, Hyderabad

Private 5

125 HR P.D.M. Dental College & Research Institute, Jhajjar

Private 3

126 MP People’s Dental Academy, Bhopal Private 3127 MP People’s College of Dental Sciences & Research

Centre, BhopalPrivate 5

128 KL PMS College of Dental Science & Research, Tiruvananthapuram

Private 3




State



129 CH Postgraduate Institute of Medical Education & Research, Chandigarh

Govt. 2

130 TN Ragas Dental College & Hospital, Chennai Private 8131 TN Rajah Muthiah Dental College &Hospital,

Annamalai University, ChidambaramPrivate 6

132 KA Rajarajeswari Dental College & Hospital, Bangalore

Private 6

133 RJ RJ Dental College & Hospital, Jaipur Private 3134 UP Rama Dental College, Hospital & Research

Centre, KanpuPrivate 5

135 AS Regional Dental College, Kamrum Govt. 2136 MP Rishiraj College of Dental Sciences & Research

Centre, BhopalPrivate 2

137 KL Royal Dental College, Palakkad Private 3138 CG Rungta College of Dental Sciences & Research,

BhilaiPrivate 3

139 MH Rural Dental College, Ahmednagar Private 4140 MH S.M.B.T. Dental College & Hospital,

AhmednagarPrivate 3

141 TN S.R.M. Dental College, Chennai Private 9142 MH S.R.M.M.M.T.’s Sharad Pawar Dental College &

Hospital, WardhaPrivate 6

143 UP Santosh Dental College & Hospital, Ghaziabad Private 2144 MH Saraswati Danwantri Dental College & Hospital,

ParbhaniPrivate 2

145 UP Saraswati Dental College, Lucknow Private 6146 UP Sardar Patel Post Graduate Institute of Dental &

Medical Sciences, LucknowPrivate 4

147 TN Saveetha Dental College & Hospital, Chennai Private 7148 UP School of Dental Sciences, Greater Noida Private 3149 KA SDM College of Dental Sciences & Hospital,

DharwadPrivate 6

150 UK Seema Dental College & Hospital, Rishikesh Private 3151 UP Shree Bankey Bihari Dental College & Research

Centre, GhaziabadPrivate 3

152 AP Sibar Institute of Dental Sciences, Guntur Private 5153 MH Sinhgad Dental College & Hospital, Pune Private 3154 TN Sree Balaji Dental College & Hospital, Chennai Private 4155 MP Sri Aurobindo College of Dentistry, Indore Private 3


State



156 HR Sri Govind Tricentenary Dental College, Hospital & Research Institute, Gurgaon

Private 6

157 PB Sri Guru Ram Das Institute of Dental Sciences & Research, Amritsar

Private 3

158 KA Sri Hasanamba Dental College & Hospital, Hassan

Private 2

159 TN Sri Mookambika Institute of Dental Sciences, Kulasekharam, K.K. District

Private 2

160 KA Sri Rajiv Gandhi College of Dental Sciences & Hospital, Bangalore

Private 3

161 TN Sri Ramachandra Dental College & Hospital, Chennai

Private 4

162 TN Sri Ramakrishna Dental College & Hospital, Coimbatore

Private 2

163 AP Sri Sai College of Dental Surgery, Vikarabad Private 5164 KL Sri Sankara Dental College,

ThiruvananthapuramPrivate 2

165 KA Sri Siddhartha Dental College, Tumkur Private 2166 AP Sri Venkata Sai Institute of Dental Sciences,

MahabubnagarPrivate 5

167 AP St. Joseph Dental College, West Godavari Private 3168 UP Subharati Dental College, Meerut Private 6169 HR Sudha Rustagi College of Dental Sciences &

Research, FaridabadPrivate 3

170 RJ Surendra Dental College & Research Institute, Ganganagar

Private 3

171 HR Swami Devi Dyal Hospital & Dental College, Panchkula

Private 0 (3)

172 MH Swargiya Dadasaheb Kalmegh Smruti Dental College & Hospital, Nagpur

Private 3

173 TN TN Government Dental College & Hospital, Chennai

Govt. 6

174 MH Tatyasaheb Kore Dental College & Research Centre, Kolhapur

Private 2

175 UP Teerthanker Mahaveer Dental College & Research Centre, Moradabad

Private 3

176 TN Thai Moogambigai Dental College & Hospital, Chennai

Private 6

177 KA The Oxford Dental College, Bangalore Private 8178 KA V.S. Dental College, Bangalore Private 4



State



179 MH Vasantdada Patil Dental College and Hospital, Sangli

Private 5

180 MH Vidya Shikshan Prasarak Mandal’s Dental College & Research Centre, Nagpur

Private 3

181 TN Vinayaka Mission’s Sankarachariyar Dental College, Salem

Private 2

182 AP Vishnu Dental College, West Godavari Private 6183 RJ Vyas Dental College & Hospital, Jodhpur Private 3184 KA Vydehi Institute of Dental Sciences & Research,

BangalorePrivate 2

185 KA Yenepoya Dental College & Hospital, Mangalore Private 8186 MH Yerala Medical Trust & Research Centre’s Dental

College & Hospital, MumbaiPrivate 5

Abbreviations: AP, Andhra Pradesh; AS, Assam; BR, Bihar; CG, Chhat tisgarh; CH, Chandigarh; DL, Delhi; GJ, Gujarat; HP, Himachal Pradesh; HR, Haryana; JH, Jharkhand; J & K, Jammu & Kashmir; KA, Karnataka; KL, Kerala; MH, Maharashtra; MP, Madhya Pradesh; OR, Orissa; PB, Punjab; RJ, Rajast-han; TN, Tamil Nadu; UK, Ut trakhand; UP, Ut tar Pradesh; WB, West Bengal. Source: www.dciindia.org.in.13

of the pract ical exam inat ion . The revision also gave details on the curriculum and the num ber of papers required for the Par t I exam inat ion , w hich applied to all n ine spe-cialt ies of dent ist ry. Requirem ents for the thesis were also given as were details of the Part II exam inat ion (both theory and prac-t ical). The durat ion of the course rem ained two years.

An MDS orthodontics program at All India Inst itute of Medical Sciences (AIIMS), New Delhi, began in 1986 as a full-t im e three-year residency program based on regulat ions sim ilar to those for the Master in Surgery/Doctor of Medicine (MS/MD) of m edical disciplines.12 This was the rst paid residency program in orthodont ics in India whereby each postgraduate student would

progress from rst-year junior resident to third-year junior resident . A residency pro-gram entails an obligation to provide hos-pital services sim ilar to that expected from residents in m edical disciplines and for that a substant ial salary is paid. This obliged a resident to be a part of hospital service pro-vider and t reat a variety of cases in m uch greater num bers than other postgraduate non-residency program s. AIIMS, being a ter-t iary care hospital and referral center for the cleft lip and palate orthodont ics, provided ample opportunit ies of interdisciplinary cleft care training in orthodont ics. AIIMS also introduced a requirem ent for m ore than ve cases to be presented in the nal exam i-nation, including preparat ion of a myofunc-t ional appliance for a provided case.


and e ciency of this appliance soon perco-lated throughout India. Teaching institut ions in India started using functional appliances m ore often than before; Tw in Blok is the m ost w idely accepted and used functional appliance. The construction of a functional appliance was also introduced at AIIMS as a m ajor component of the clinical exam ination at the end of the MDS course, rst at AIIMS and soon followed by others, and so the DCI guidelines were m odi ed as well.

The DCI m ade som e e orts to change the curriculum in all nine postgraduate specialt ies of dent ist ry through workshops held in 1998 and 2001.

12.1.3 National Board of Examinations

In 2000, the Minist ry of Health and the gov-ernm ent of India in it iated board cer t i ca-t ion and exam inat ion in th ree disciplines of dent ist ry, in addit ion to the exist ing post-graduate board cer t i cat ions in the m edical disciplines.15 The purpose of the Nat ional Board of Exam inat ions (NBE) was to pro-vide m ore opportunit ies for postgradu-ate quali cat ion to dent ists across India and to have uniform nat ional standards of educat ion . Orthodont ics was included as a new specialty, and a new curriculum was designed in 2002. At rst , those w ho had com pleted an MDS program in the spe-cialt y subject were eligible to take an NBE exam inat ion . Eventually, the exam inat ions were opened to dent ists w ith three years of t rain ing at NBE-cert i ed centers across the country.

The NBE curriculum was a fair and recent update that addressed recent devel-opm ents in or thodont ic m aterials and the com petencies expected of an or thodont ist . The object ives of in terdisciplinary or tho-dont ics were also included. The syllabus speci ed a variety and a m inim um num ber of cases that the student should have t reated before taking a sum m ative exam inat ion. The m inim um caseload was 20; however, the student was expected to present ve n ished cases in the exam inat ion , and th is presentat ion would com prise a signi cant

12.1.2.3 Technique-Oriented Approach to Orthodontic Education in India

Tradit ionally, orthodontic training in India has been largely in uenced by teachers who were t rained in North Am erica.9 Dr. Prem Prakash rst introduced Edgew ise Technique at Sir CEM Dental College in Bom bay.9 In the 1960s, orthodontic equip -m ent and m aterials were imported m ainly from the United States. Econom ic develop-m ent of India has been slow after indepen-dence, w ith constraints and a heavy duty on imports contributing to di cult ies in teach-ing and pat ient services. Although the init ial MDS courses that were started at Mum bai and later at Lucknow and Nair Hospital Den-tal College were headed by teachers t rained m ainly at North Am erican universit ies in edgew ise techniques, the scarce availability of m aterials and high import cost led them to choose other options, including the Begg appliance. While the dental school at Luc-know w ith Professor Ram Nanda as its rst chair continued to teach the Tweed edge-w ise technique, there was a drift toward use of the Begg appliance in other inst itut ions and in private services. In the 1970s, Begg tubes and brackets were m anufactured in India. The low cost and the ease of availabil-ity of these m aterials further popularized the Begg technique in India.

During the 1980s, w ith the advent and popularizat ion of preadjusted appli-ances, there has been a gradual drift by the Begg pract it ioners to adopt preadjusted appliance system s. Som e m oved to the t ip edge technique, a com binat ion of the Begg appliance w ith the control of the edgew ise system , w hereas others m oved on to the so-called st raigh t w ire appliances.

During the 1980s and 1990s, m any ref-erences to functional appliances and their proven clinical e cacy in grow th m odi ca-tion in uenced thinking across the United States and am ong the Indian orthodontic fra-ternity. In the year 1990, the author had the opportunity to visit William Clark, the inven-tor of the Tw in Blok appliance, and received rst-hand clinical exposure; it was then introduced in AIIMS. Treatm ent outcom e


12.1.5 Postgraduate Dental Education Reforms by Dental Council 2006

To review the exist ing guidelines and update the postgraduate curr iculum , a nat ional workshop on postgraduate den -tal educat ion was organized by the DCI in collaborat ion w ith the Cent re for Dental Educat ion and Research and KL Wig Cen-t re for Medical Educat ion and Technology at AIIMS.18 In th is nat ional workshop, fac-ult y from postgraduate depar tm ents in all n ine specialt ies in dent ist ry from across the count ry debated, revised, and sub-m it ted an updated curr iculum to the DCI for considerat ion . With respect to or tho-dont ics, a nat ional survey on the status of or thodont ic educat ion and curriculum , conducted by the author, laid the founda-t ion for change. The ndings were in ter-est ing in several respects, par t icularly in term s of caseload and the num ber and variet y of cases to be t reated by an or th -odont ic student , and the num ber of cases to be presen ted in sum m at ive exam ina-t ions. Consequent ly, an appropriate casel-oad was considered a vital par t of t rain ing for all other dental specialt ies. The work-shop recom m endat ions eventually evolved as DCI guidelines for MDS courses 2007.19

Subsequent ly, the updated guidelines on the syllabus and curriculum were estab-lished in 2007. These guidelines have been am ended from t im e to t im e.20,21

12.1.5.1 Extending Course Duration

Adm ission to a postgraduate course in m edicine and dent ist ry usually required one year of housem anship follow ing grad-uat ion (i.e., at tainm ent of a bachelor of m edicine, bachelor of surgery [MBBS]/BDS degree) but was not m andatory. To m ain-tain uniform ity in course durat ion w ith m edical sciences, i.e., MS/MS, DCI sug-gested that housem anship of one year be m erged w ith the postgraduate course of two years to m aintain uniform it y of course durat ion, three years postgraduate courses to three years durat ion .22,23

com ponent of the pract ical exam inat ion . There was no deviat ion from the norm of ve n ished cases speci ed in the DCI guidelines of 1965, although the current durat ion of the course had been extended to three years. The only change in clin ical com petencies m ent ioned was the availabil-it y of 10 n ished cases before the exam i-nat ion , of w hich ve would be selected for the exam inat ion. A m inim al detail on a research com ponent was included—m en-t ion of com plet ion of a disser tat ion .

12.1.4 National Workshop on Postgraduate Orthodontic Education in India (1993)

The Indian Orthodont ic Society (IOS) in 1993 convened a Nat ional Workshop, “Postgraduate Orthodont ic Educat ion in India—Its Future Direct ions” at Bom bay. The workshop recom m endat ions included three years of full-t im e inst ruct ion for the MDS course. In addit ion, a two-year diplom a in or thodont ics (DOrth) was rec-om m ended to encourage qualit y or thodon-t ic pract ice, w hile MDS candidates were also expected to be t rained as teachers and researchers as well as good clin icians. A need to encourage students to obtain a PhD in or thodont ics and the related sciences was st rongly felt .

The prescribed syllabus consisted of an exhaust ive list of topics, including digital cephalom etry and m odern dental m ate-rials. The assessm ent m odalit y outlined in ternal form at ive assessm ents based on a six-m onth sem ester. Only one sum m a-t ive exam inat ion had been recom m ended at the end of three years. Perhaps the m ost signi cant workshop recom m endat ion was an increase in the num ber of n ished cases to be presented in the exam inat ion , from

ve to ten .16,17

The recom m endat ions of IOS could be routed only through the DCI for im ple-m entat ion . The DCI m ade som e e or ts to change the curriculum in all n ine postgrad-uate specialt ies of dent ist ry through their revisions and the organizat ion of dental educat ion workshops.18,19


ducted by DCI nom inees to ensure that the guidelines are followed to ensure quality control of education. Exceptions to the above are two institut ions in India: All India Insti-tute of Medical Sciences (AIIMS), New Delhi, and Post Graduate Institute of Medical Edu-cation and Research (PGIMER), Chandigarh, that enjoy im m unity from the Medical and Dental Council of India, as a special status granted by acts of Parliam ent. These institu-t ions are expected to provide a leadership role in m edical and dental education in India and are autonom ously enabled to issue a degree w ithout the a liation of a university.

12.1.6 Indian Orthodontic Society and Its Role in Education and Faculty Development

The IOS started as a study group in Bom -bay (now Mum bai) way back in 1963.24 It was form ally established as the Indian Orthodont ic Societ y on October 5, 1965, by seven or thodont ists. The late Dr. H.D. Merchant was the founding president , and Dr. Naishadh Parikh was the founding sec-retary and t reasurer. Other founding m em -bers included Drs. A.B. Modi, Prem Prakash, H.S. Shaikh , Keki Mist ry, and Mohan Das Bhat t . IOS is the rst den tal specialist’s pro-fessional society in India.

IOS held it s rst conference in 1967 in New Delhi. This was followed by regular annual conferences, w hich are at tended by a large num ber of or thodont ists from w ith in the country and abroad. IOS w ill cel-ebrate its golden jubilee in 2016 at Hyder-abad. IOS has also established regional study groups to encourage the exchange of scien t i c knowledge am ong it s m em bers. IOS and study groups organize cont inuing educat ion program s (CDE) and hands-on courses for the bene t of the m em bers, fac-ulty, and graduate students. Nat ional con-ferences and regional workshops are aim ed at and have contr ibuted to advancem ents in contem porary diagnost ic m ethods, and appliances/techniques and t reatm ent approach for bet ter qualit y of or thodont ic t reatm ent outcom e and research .

AIIMS, New Delh i, w hich had a three-year durat ion for its m aster’s degree pro-gram in m edical sciences, m aintained the sam e pat tern of in-house, full-t im e, three-year residency for its MDS in or thodont ics program , star ted in 1986. It is worth m en-t ioning that AIIMS, having been created by a special act of parliam ent , enjoys im m u-nity to the Medical Council of India (MCI) and the DCI. In the rest of the country, a few dental colleges followed DCI direc-t ives for a three-year course, w hile oth-ers were reluctant to increase the course durat ion . A direct ive issued by the DCI on October 27, 1994, reiterated, “The council decided to reiterate it s circular sent earlier for a three-years MDS Program m e in all the Dental specialt ies from the academ ic year 1993–94.”23

12.1.5.2 Three-Year Curriculum

E orts were m ade to m odify or extend the durat ion of the curriculum to three years. The unpublished DCI guidelines of 1998 provided a m uch m ore elaborate curricu-lum for the durat ion of three years. They outlined the object ives of the course, details of preclin ical and laboratory work, clin i-cal caseload, t ypes of cases to be t reated, m echano-therapy to be used, details of the topics to be covered, and exam inat ion schedule to be m aintained for the period of three years. This curriculum was fur ther debated and discussed in 2001 and 2006.

The dental colleges that o er MDS pro-gram s m ust follow and adhere to the DCI guidelines. The guidelines include speci -cations for buildings, physical space, equip-m ent, laboratory and clinical requirem ents, m inim um num ber of teachers (faculty) and their teaching and professional experience, and the teacher-to-student ratio. The num -ber of students adm it ted per year in each departm ent is regulated by the DCI based on the num ber of teachers and their quali- cations and experience. The courses can-not start w ithout the prior approval and perm ission of the DCI and the Ministry of Health, governm ent of India. Any course to be accredited by the DCI m ust abide by the guidelines. Planned inspections are con-


graduate quali cat ions in the United States and Turkey.26

12.2.1 College of Physicians and Surgeons of Pakistan

Lt . Gen. Wajid Ali Burki founded the Col-lege of Physicians and Surgeons Pakistan (CPSP) in 1962 w ith the object ive of pro-m ot ing postgraduate educat ion in general surgery, m edicine, and other subjects. CPSP o ers adm ission to fellowship of the Col-lege of Physicians and Surgeons (FCPS) in 70 specialt ies/subspecialt ies and to m em -bership (MCPS) in 21 specialt ies. In 1999, CPSP star ted postgraduate fellowship and m em bership quali cat ions in all the dis-ciplines of dent ist ry. Presently, 21 inst itu-t ions in Pakistan are accredited by CPSP for the four-year t rain ing program leading to a fellowship in or thodont ics.27 In addit ion to the CPSP postgraduate program s, several universit ies o er four-year m aster’s degree program s in or thodont ics. Whereas there were only four overseas-quali ed or tho-dont ists in Pakistan in 1996, currently there are m ore than 100 or thodont ists. Approxim ately sim ilar num bers of or th-odont ic residents are currently enrolled in postgraduate program s in the country (Table 12.3).27,28

12.2.2 Pakistan Association of Orthodontists

The Pakistan Associat ion of Orthodont ists (PAO) was established in 2006 w ith the object ive of organizing and prom ot ing the specialt y of or thodont ics in Pakistan . PAO is the sole representat ive of the or thodont ists in Pakistan and cont inuously plays a vital role in the developm ent of the specialt y of or thodont ics in the country. In addit ion , PAO has developed close t ies w ith in ter-nat ional or thodont ic societ ies around the world to facilitate the sharing of knowledge and expert ise am ong professionals. PAO is a m em ber of the Asian Paci c Orthodont ic Society and the World Federat ion of Ortho-dont ists.29 The m em bers elect the execut ive

IOS has published a quarterly scient i c journal nam ed Journal of Indian Orthodon-t ic Society (JIOS) since 1968 and an IOS newslet ter since 2009. Since 1996, the IOS has held a convent ion for postgraduate stu-dents every year. This event is m uch sought after, w here postgraduate students have the opportun ity to listen to and in teract w ith facult y and other students from across the count ry. IOS established a library and the rst dental m useum in India in 1998.

In 1999, the IOS established the Indian Board of Orthodont ics, the rst such board in the eld of dent ist ry in India and the th ird in the world. The board was estab-lished to exam ine IOS m em bers w ith ve years of experience after the MDS degree for clin ical excellence in the pract ice of or thodont ics. Board cer t i cat ion encour-ages the m em bers to pract ice and st r ive for clin ical excellence and qualit y t reatm ent .26

With the signing of the charter of the World Federat ion of Orthodont ics in San Francisco, California, United States, in 1995, the IOS becam e a par t of the World Federa-t ion of Orthodont ics.

The rst SAARC orthodont ic conference was held in Delhi in 2009, and the Eighth Asian Paci c Orthodont ic Conference was held in Delhi in 2012. IOS in collabora-t ion w ith the World Im plant Orthodont ic Society is ready to host the Eighth World Im plant Orthodont ic Societ y Conference in 2016.

12.2 Orthodontic Education in PakistanPakistan has a long history in dental educa-t ion since establishm ent of the rst dental teaching inst itut ion in Undivided India, the de’Montm orency College of Dent ist ry in 1929 by the then Governor of the Punjab, Sir Geo rey Fritz Harvey de’Montm orency. Current ly, there are 40 recognized dental schools in Pakistan (11 public and 29 pri-vate).25 General dent ists in Pakistan have always been keen on learning the ar t and science of or thodont ics. Som e of the early or thodont ists there acquired their post-


Table 12.3 Postgraduate programs in India and the subcontinent as of 2014

Country Quali cation/degree

awarded

Year of start

Current course duration

Full-time/part-time

1 India MDS (Master of Dental Surgery)

1959

1986

3 y Full-time

Full-time residency program

Total

2 Bangladesh FCPS (Fellow of the College of Physicians and Surgeons)MS

2002

2006

4 y

5 y

Full-time

Full-time residency

3 Nepal MDS (Master of Dental Surgery)

2008

2010

2012

2014

3 y Full-time

4 Pakistan FCPS (Fellow College of Phy-sicians and Surgeons Paki-stan) OrthodonticsMCPS (Member College of Physicians and Surgeons Pakistan)MDS in OrthodonticsMSc in Orthodontics

19991985

4 y2 y4 y2 y

Full-timeFull-timeFull-timeFull-time


Number of institutions Number of

admissions per year

Certifying or regulatory body

University a liation/curriculumG P T

25

2

27

159

159

184

2

186

692

8

700

Dental Council of India (DCI)Institute Body l of All India Institute of Medical Sciences, New DelhiPost Graduate In-stitute of Medical Education and Re-search, Chandigarh

DCI regulations 2007 for MDS examination

All India Institute of Medical Sciences

Post Graduate Institute of Medical Education and Re-search, Chandigarh

2 2 24 Bangladesh Medical and Dental Council (BMDC)

Bangladesh College of Physi-cians and Surgeons Part I, Part II, and DissertationBangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka

1

1

1

0

0

2

0

1

1

3

1

1

5–10 Nepal Medical Council (NMC)

National Academy of Medical Sciences, KathmanduTribhuvan University, KathmanduB.P. Koirala Institute of Health Sciences, DharanKathmandu University – Dhu-likhel, Kathmandu

121212

994

212152

8 trainees per supervi-sor per yearSame as above126

Pakistan Medical and Dental Council (PMDC)Pakistan (CPSP)Pakistan Medical and Dental Council (PMDC)Pakistan (CPSP)Pakistan Medical and Dental Council (PMDC) and rel-evant university (same for both MDS and MSc)

College of Physicians and Sur-geons PakistanCollege of Physicians and Sur-geons PakistanRelevant university to which the college is a liated (same for both MDS and MSc)



12.3.1 Bangladesh College of Physicians and Surgeons

A draft postgraduate curriculum in or tho-dont ics and dentofacial orthopedics at the Bangladesh College of Physicians and Surgeons was prepared in 1996. The rst group of FCPS Part II in or thodont ics candi-dates enrolled at Dhaka Dental College and Hospital (DDCH) in 2002. Between 2002 and 2014, 24 dental surgeons received FCPS status in or thodont ics and dentofa-cial or thopedics. With the expansion of a large faculty, 32 t rainees are registered for FCPS t rain ing at DDCH. There are two lev-els of exam inat ion . The Part I exam inat ion is focused on basic sciences. During their clin ical tenure, fellows undergo t rain ing in contem porary or thodont ic techniques, as well as a m andatory rotat ion in oral and m axillofacial surgery for three m onths and in plast ic surgery for three m onths. A fu ll-t im e MS residency program was in it iated

council for a one-year tenure. PAO has m ore than 75 act ive and 150 student m em bers.30

Pakistan Orthodont ic Journal, star ted in 2009, is an o cial publicat ion of the PAO (Table 12.3).31

12.3 Orthodontic Education in BangladeshForm al dental educat ion in Bangladesh star ted w ith the opening of Dhaka Den-tal College and Hospital in 1961. Professor Em adul Haq, the rst quali ed or thodon-t ist , obtained a DOrth from the Royal Col-lege of Surgeons of England in 1973 and joined as an assistant professor in 1976. Dr. Zakir Hossain joined as an assistant profes-sor after com plet ion of a PhD degree from Hiroshim a Universit y, Japan, in 1989 and contr ibuted signi cantly to h igher orth-odont ic educat ion and the Bangladesh Orthodont ic Societ y (BOS).32,33

Table 12.3 (Continued) Postgraduate programs in India and the subcontinent as of 2014

Country Quali cation/degree

awarded

Year of start

Current course duration

Full-time/part-time

5 Sri Lanka MS in Orthodontics, changed to MD since 2010

MD in Orthodontics

MD in Orthodontics

1989

2010

2014

4 y

4 y

5½ y

Full-time

6 Bhutan* – – – –

7 Maldives No – – –

8 Afghanistan No – – –

* Only one orthodontist with MDS quali cation from India.


Number of institutions Number of

admissions per year

Certifying or regulatory body

University a liation/curriculumG P T

1 2–8 Sri Lanka Medical Council (SLMC)

Sri Lanka Medical Council (SLMC)

Sri Lanka Medical Council (SLMC)

Postgraduate Institute of Med-icine, University of Colombo



– – – – – –

– – – – – –

– – – – – –

at Bangabandhu Sheikh Mujib Medical Uni-versit y (BSMMU) in 2009. The course dura-t ion is ve years.33,34

12.3.2 Bangladesh Orthodontic Society

The Bangladesh Orthodont ic Society (BOS) was founded in 1993. The BOS joined the World Federat ion of Orthodont ists in 1995 by sign ing the charter. Secretary General Dr. Zakir Hossain and Joint Secretary Dr. Mostaque Hasan Sat tar were representa-t ives at th is h istoric event . At present , there are 70 full m em bers and 50 student m em -bers. The BOS conducts a nat ional confer-ence and cont inuing m edical educat ion . It organized the rst in ternat ional or th-odont ic conference in 2012. The BOS is a m em ber of the Asian Paci c Orthodont ic Society and represented Bangladesh during the rst SAARC orthodont ic conference in New Delhi in 2009. The BOS sends repre-

sentat ives to the Asian Paci c orthodont ic m eet ing every year, and representat ives at tended the World President Orthodon-t ic Sum m it Meet ing in Taipei, Taiwan, in Decem ber 2010 and appealed for coopera-t ion in or thodont ic educat ion in developing countries. Bangladesh Journal of Orthodon-t ics and Dentofacial Orthopedics has been published since 2010 (Table 12.3).35,36,37

12.4 Orthodontic Education in NepalDental educat ion in Nepal star ted in 1998. Presently, there are 12 dental colleges o ering BDS program s and six inst itu t ions o ering MDS program s in various dental specialt ies. The specialt y pract ice of or tho-dont ics is relat ively new in Nepal. During the 1970s and 1980s, or thodont ic service was provided by general dent ists, w ho used rem ovable appliances. During those


12.4.2 Orthodontic and Dentofacial Orthopedic Association of Nepal

Pioneer or thodont ists established the Orthodont ic and Dentofacial Orthopedic Associat ion of Nepal (ODOAN) in 2007, w ith the object ive of im proving or thodon-t ic fraternity in Nepal. ODOAN is the rst registered dental specialt y organizat ion in Nepal. It acquired m em bership in the World Federat ion of Orthodont ics and the Asian Paci c Orthodont ic Society in 2008. ODOAN organized the rst or thodont ic conference of Nepal in May 2008 in Kath-m andu. Subsequently, ODOAN organized an in ternat ional or thodont ic conference in Novem ber 2011 in Dhulikhel and again in Septem ber 2013 in Kathm andu. ODOAN published Orthodont ic Journal of Nepal in Novem ber 2011 as the rst specialt y dental journal of Nepal. Since then, Orthodont ic Journal of Nepal has been published regu-larly as a half-yearly, open-access, indexed scien t i c journal (Table 12.3).42

12.5 Structured Dental Education in Sri LankaForm al dental t raining in Sri Lanka started as early as 1943 w ith the training of ve dental surgeons. Now, the University of Per-adeniya Faculty of Dental Sciences o ers an undergraduate dental program, w ith 75 local and ve foreign students graduating annually. The Sri Lanka Dental Associat ion is the national and parent body of the dental profession in Sri Lanka. Since its form ation in 1932, the Sri Lanka Dental Associat ion has contributed im m ensely to the developm ent of the profession, as well as to the welfare of the public in Sri Lanka.43,44,45,46,47

The or thodont ic profession in Sri Lanka is relat ively young, although the dem and for orthodont ic care is huge. A total of 39 or thodont ists pract ice in Sri Lanka, m ost of them in governm ent hospitals, the Uni-

decades, a few foreign dent ists visited gov-ernm ent hospitals as par t of m issionary program s, and a few orthodont ists from India visited private clin ics in Kathm andu to provide specialist service. Mem bers of elite Nepalese fam ilies visited neighbor-ing cit ies in India to obtain or thodont ic t reatm ent .

The rst Nepalese or thodont ic special-ist was Dr. Sham bhu Man Singh, w ho com -pleted a DOrth from the Royal College of Surgeons of Edinburgh in 1989 and star ted or thodont ic pract ice in 1990. In 1996, Dr. Praveen Mishra star ted an exclusive or th -odont ic pract ice in Nepal after com plet ing an MDS (Orthodont ics) degree in India. Then, after 2002, a num ber of or thodon-t ists graduated every year from inst itu -t ions in India, China, the Philippines, and Russia. At present , there are approxim ately 50 quali ed or thodont ists am ong 1,500 registered dent ists in Nepal. It is est im ated that about another 50 postgraduate stu-dents are studying or thodont ics in Nepal or abroad.38,39,40,41

12.4.1 Master of Dental Surgery in Orthodontics

Postgraduate orthodontic education con-sists of a three-year residency program , and successful candidates are awarded an MDS (Orthodontics) degree. The core cur-riculum comprises applied basic sciences, specialized subjects, and recent advances. A special licentiate exam ination is provided by the Nepal Medical Council for the gradu-ates. National Academy of Medical Sciences Bir Hospital was the pioneer, start ing a post-graduate orthodontic program in Nepal in 2008. Later, Tribhuvan University started an MDS (Orthodontics) program in 2010, and B.P. Koirala Institute of Health Sciences, Dharan, in 2012. Kathm andu University started an MDS (Orthodontics) program in 2014. To date, 10 orthodontic graduates have received MDS degrees from Nepal, and 18 students are studying orthodontics in vari-ous postgraduate colleges in Nepal.38,39,40,41


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2. Vanhanen T. Prospects of Dem ocracy: A Study of 172 Count ries. New York, NY: Rout-ledge; 144. Cited from ht tp://en.w ikipedia.org/w iki/Indian_subcont inent . Accessed Septem ber 14, 2014

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8. w w w.dciindia.org.in . Accessed Novem ber 5, 2014

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versit y of Peradeniya Faculty of Dental Sci-ences, and health services of the arm ed forces. Orthodont ic services in the private sector are available in di erent par ts of the country. There are currently m ore than 15 t rainees at di erent levels of t rain ing.48,49,50

12.5.1 MD/MS Degree in Orthodontics

Postgraduate quali cation in Sri Lanka is called MS/MD in Orthodontics and requires fellowship certi cation. The MD in Orthodon-tics program is o ered at the Postgraduate Institute of Medicine University of Colombo, Sri Lanka. The total duration of the train-ing program is long: ve and a half years. The training is split: four and a half years in approved centers in Sri Lanka and one year at a recognized center overseas. Several ortho-dontists in Sri Lanka have undergone train-ing in the department of orthodontics at the dental school of The University of Western Australia, Perth, and at several centers in the United Kingdom . This is followed by board certi cation as a consultant orthodontist.48,50

12.5.2 Sri Lanka Orthodontic Society

The Sri Lanka Orthodontic Society (SLOS) was form ed in January 1999. SLOS is a specialty organization whose m em bers are quali ed orthodontists w ith board cert i cation. The SLOS is a m em ber of the Asian Paci c Orth-odontic Society and the World Federation of Orthodontics. The SLOS was represented at the SAARC orthodontic conference in New Delhi in 2009 (Table 12.3).

12.6 Bhutan, Maldives, and AfghanistanIt was not possible to obtain inform at ion on orthodont ic educat ion in Bhutan, Maldives, or Afghanistan , although m ent ion of or th -odont ic services in these countries can be found on the in ternet (Table 12.2).


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36. h t t p : / / w w w .b a n g la jo l .in fo / in d e x .p h p /BJODFO/. Accessed May 28, 2015

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41. Shrestha RM. Orthodont ic research in Ne-pal. Orthod J Nepal 2012;2(1):1–3

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46. Sir iyani Basanayake, or thodont ic specialist , Colom bo, Sri Lanka (com m unicat ion)

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15. Nat ional Board of Exam inat ions guidelines of com petency based t rain ing program m e in or thodont ics 2000; Orthodont ics: 438–441

16. Mistry KK. Report of the Nat ional Workshop on Postgraduate Orthodont ic Educat ion in India—Its Future Direct ions. Chennai, India: Indian Orthodont ic Society; 1993

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18. Dental Council of India m aster’s degree courses regulat ions 1988 (unpublished)

19. Dental Council of India. Master’s degree course revised regulat ions 2007. h t tp://w w w .d c iin d ia .o r g .in / Ru le _Re gu la t io n /MDS_Co u r se _Re gu la t io n s_2 0 0 7 _a lo n g-w ith_Am endm ents.pdf

20. Governm ent of India Dental Gazet te Ext ra ordinary No. 139 dated August 20, 2008. First am endm ent for MDS curriculum 2007. h t t p : / / w w w .d ciin d ia .o r g.in / Ru le _Re gu -la t ion / MDS_Cou r se _Re gu la t ion s_2 0 0 7 _alongw ith_Am endm ents.pdf

21. Governm ent of India Dental Gazet te Ext ra ordinary No. 140 dated May 21, 2012. Sec-ond am endm ent for MDS curr iculum 2007. h t t p : / / w w w .d ciin d ia .o r g.in / Ru le _Re gu -la t ion / MDS_Cou r se _Re gu la t ion s_2 0 0 7 _alongw ith_Am endm ents.pdf

22. Dental Council of India let ter No: DE-1(SC)-93/2064, October 28, 1993

23. Dental Council of India let ter No: DE-1(SC)-94/2695, October 27, 1994

24. Directory of the Indian Orthodontic Society. Mysore, India: Roy ET, ed; 2003:i–iv. Pub-lished by Editor Roy ET, Doctors Corner, My-sore, India

25. Eduvision . h t tp://w w w.eduvision .edu.pk/inst itu t ionSearch.php?disciplineType=Medical+Sciences&subLevel=MAJOR+TRAINING+%5BMEDICAL%5D&pageNo=1&discip line=ORTHODONTICS&cit y=&Subm it=Search . Ac-cessed February 11, 2015

26. Professor Sheraz Burki, past president of the Pakistan Associat ion of Ortho (personal com m unicat ion , August 30, 2014)

27. College of Physicians and Surgeons Paki-stan . h t tp://cpsp.edu.pk. Accessed February 11, 2015

28. Dr. Amjad Mehm ood, im m ediate past presi-dent of the Pakistan Associat ion of Ortho-dont ists (personal com m unicat ion)


dont ics. h t tp://pgim .cm b.ac.lk/w p-content /u p load s/2014 /04 /Pros- Or t h od on t ics .p d f. Accessed March 17, 2015

50. Universit y Grants Com m ission—Sri Lanka. h t t p ://w w w.ugc.ac.lk/en /un iversit ies-and-in st it u t es/d egree -cou r ses/p ostgrad u ate -courses.h tm l. Accessed on March 17, 2015

48. Universit y Grants Com m ission, Sri Lanka. Postgraduate courses. ht tp://w w w.ugc.ac.lk / e n /u n ive r s it ie s- an d - in s t it u t e s / d e -gree-cou rses/p ostgrad u ate -cou rses.h t m l. Accessed March 17, 2015

49. Postgraduate Inst itute of Medicine, Uni-versit y of Colom bo, Sri Lanka. Doctor of m edicine and board cert i cat ion in or tho-

112

The Educational Role of Orthodontic Boards around the WorldMauro Cozzani and Frank Weiland

Its cer t i cate has no legal standing, but it is a powerful psychological fac-tor in st im ulat ing specialists to acquire increased knowledge and skill in their respect ive branches.

–Albert H. Ketcham , Founder, Am erican Board of Orthodont ics

The num ber of orthodontists and the am ount of orthodontic treatm ent provided grew im m ensely during the second part of the last century. However, standards of orthodontic postgraduate education di er am ong coun-tries and even w ithin countries. Therefore, controlling and improving the quality of clinical care in daily practice has becom e an issue of grow ing importance for the general public, health care policy, and regulatory bodies. Certi cat ion by board exam ination is one m ethod to secure high standards of clinical care, w ith the assessm ent of treat-m ent quality by peer review. The aim of this chapter is to describe the e ect of the board cert i cation process on the quality of post-graduate education, and vice versa.

13.1 The Goal of Board Certi cationBoard cer t i cat ion is a voluntary process that com prises an extensive review of an or thodont ist’s basic educat ion , as well as an in tense assessm ent of h is or her exper-t ise. The goal is to im prove the professional perform ance of the individual clin ician by m eans of a careful and extensive evalua-t ion of all aspects of actual pat ient t reat-m ent—both clin ical perform ance and

13

theoret ical knowledge. The World Federa-t ion of Orthodont ists (WFO) em phasizes that board cert i cat ion is of crit ical im por-tance to im prove the level of or thodont ic t reatm ent that the public receives. It is also felt that board cer t i cat ion encourages self-im provem ent am ong colleagues w ho are recognized specialists in orthodont ics and indicates that an orthodont ist has dem on-st rated a clin ical standard of excellence.

The Am erican Board of Orthodon-t ics (ABO), the oldest cer t ifying board, has existed since 1929 as an independent peer review inst itut ion , supported by the Am erican Associat ion of Orthodont ists. Jam es Vaden, past president of the ABO, has listed som e reasons for sit t ing a board exam inat ion:

• To experience personal grow th as a pract icing clin ician

• To increase one’s self-con dence• To undergo an invaluable learning

experience• To be able to o er bet ter clin ical

care to pat ients

Large di erences still exist am ong vari-ous countries in regard to postgraduate education and public health system s. These di erences have had a m ajor impact on the way orthodontic care is provided and prac-ticed, and on what portion of the population has access to service. Board exam ination m ay enhance the quality of orthodontic treatm ent by providing a standard against which ortho-dontists who so desire can be judged. The board certi cation process, however, di ers am ong countries. Still, a m ajor goal of estab-lishing an orthodontic board is to develop standards and param eters for the profession.

13 The Educat ional Role of Orthodontic Boards around the World 113

13.2 Setting of StandardsThe WFO established an Orthodont ic Board Com m it tee to coordinate the guidelines and standards of various exist ing as well as new cer t ifying boards around the world. Topics that were discussed com prised, am ong oth-ers, the eligibilit y of candidates, exam ina-t ion process, select ion of exam iners, and recer t i cat ion .

Orthodont ics is a clin ical specialt y w ith a sound theoret ical basis. Therefore, the cer t i cat ion process consists of the com -binat ion of a theoret ical exam inat ion and a presentat ion of t reated and docum ented cases. The way these two par ts of the exam -inat ion are handled di ers am ong boards. This issue is discussed in greater depth in the next sect ion .

The basis of board cer t i cat ion is clin i-cal excellence. This should be re ected in the qualit y of the t reated cases. There is general agreem ent that it is m andatory to display various t ypes of cases for the m odel display, t reated to the h ighest clin ical stan-dards. The num ber of requested cases is not uniform and m ay vary between 5 and 10.

It is generally felt that the board cer t i -cat ion process should be open only to edu-cat ionally quali ed or thodont ists w ho have graduated from recognized postgraduate orthodont ic program s. A general problem , however, is that in the m ajorit y of exist ing organizat ions throughout the world that have form ed an or thodont ic board, only a sm all proport ion of their m em bers have becom e cer t i ed. This m akes it di cult for a board to set standards in clin ical care that are w idely accepted. Several reasons for choosing not to pursue board cer t i ca-t ion have been discussed. Som e orthodon-t ists feel that too m uch t im e and e or t are required to prepare for the exam inat ion successfully. Others feel that a direct m on-etary advantage is lacking, so that the cost e ciency of the process is lim ited.

To overcom e th is reluctance to becom -ing board-cer t i ed, the ABO recently established an alternat ive pathway to cer-t i cat ion in w hich recent graduates (w ith in 24 m onths after graduat ion) are given the opportunity to present som e of the cases

required for cer t i cat ion . According to data supplied by the WFO, th is policy raised the percentage of board-cer t i ed orthodont ists am ong m em bers of the Am erican Associa-t ion of Orthodont ists from 28 to 52%. The Aust ralasian Orthodont ic Board star ted a “student pathway” toward m em bership by having students subm it a list of ve cases; two of these are assessed after t reatm ent . Full cer t i cat ion is granted after success-fully com plet ing the or thodont ic course and after successful assessm ent of the post-t reatm ent records of the two Board cases. Within two years the Aust ralasian Orth-odont ic Board re-cer t i cat ion process m ust be star ted. The European Board of Ortho-dont ists uses a sim ilar m ethod. Recently graduated or thodont ists m ay sit the rst par t of the cer t i cat ion exam inat ion . This consists of the presentat ion of two cases t reated during the postgraduate in tern-ship and an oral exam inat ion com prising the diagnosis and t reatm ent planning of two new cases. The successful candidate becom es a provisional m em ber of the Euro-pean Board of Orthodont ists. The rem ain-ing requirem ents for full m em bership m ust be fu l lled w ith in six years.

The idea behind opening m em bership to recently graduated or thodont ists is to get young, enthusiast ic or thodont ists on board, in the hope that they w ill want to rem ain m em bers in good standing for per-sonal and professional reasons. Experience in the United States, Europe, and Aust ralia indicates that th is seem s to be an e cient way of increasing the percentage of board-cer t i ed or thodont ists.

13.3 Di erent Boards— Di erent Certi cation ProcessesThe oldest board of or thodont ics, the ABO, has am ended the guidelines for cer t i ca-t ion several t im es. Nowadays, the process consists of a w rit ten exam inat ion and the presentat ion of case reports. Central to the exam inat ions of all the boards founded in the follow ing decades is the presentat ion


Regional Orthodont ic Boards. It is ant ici-pated that these guidelines w ill encour-age the establishm ent of new cer t ifying boards in orthodont ics. Exist ing cer t ifying boards m ay w ish to com pare their curren t guidelines and procedures w ith those rec-om m ended by the WFO and m odify them accordingly, if they nd that doing so w ill im prove their standards. The WFO should act as an um brella organizat ion to w hich boards can turn for help, cooperat ion, and sharing ideas. In th is way, a board standard is available against w hich any other board can be m easured.

13.4 The Interaction between Postgraduate Education and Board Certi cationBoard cert i cat ion requires a considerable am ount of knowledge and high-quality clinical skills. The basis is laid during the postgraduate residency, w ith the addit ion of clin ical experience and cont inuing edu-cat ion. The im m ediate e ect of the qual-it y of postgraduate educat ion increased in recent years after several orthodontic boards changed their cert i cat ion proce-dures to accept recently graduated ortho-dont ists. The theoret ical exam inat ion is usually the rst step toward cert i cat ion, and the knowledge acquired during post-graduate educat ion is essent ial to pass this exam inat ion. During the residency, the can-didate diagnoses and plans the t reatm ent of the required cases, and t reats them under supervision. The guiding hand of a sta orthodont ist is of m ajor importance dur-ing th is phase. As a consequence, successful board cert i cat ion im plies not only that the candidate has show n a high level of compe-tence but also that the postgraduate educa-t ion program is compet it ive.

As stated on its Web site, the prim ary purpose of the ABO is to elevate the level of or thodont ic care provided to the public by encouraging excellence in clin ical prac-t ice and specialt y educat ion. This state-

of clin ical cases. The num bers vary from 5 to 10 cases. Som e boards require cases from several de ned types of m alocclu-sion, w hereas others use the severit y of the original m alocclusion as a criter ion. All boards require the subm ission of pre- and post-t reatm ent records, but not all require retent ion records.

Several boards require that the candi-date take a theoret ical exam inat ion as par t of the cer t i cat ion procedure. The ABO, Indian Board of Orthodont ics, Philippine Board of Orthodont ics, and Taiwan Asso-ciat ion of Orthodont ists all have a w rit ten exam inat ion . Only after successful com ple-t ion of th is par t is the candidate allowed to present cases. Phase I of the Brazilian Board of Orthodont ics and Facial Orthope-dics exam inat ion consists of an evaluat ion of the diagnosis and t reatm ent planning of cases presented by the board. The Euro-pean Board of Orthodont ists does not have a w rit ten exam inat ion . Unlike in the Bra-zilian Board of Orthodont ics exam inat ion, the required cases are exam ined in Phase I. Phase II, w hich is an oral exam inat ion , follows im m ediately. In addit ion , the cases that the candidate presents can be dis-cussed if deem ed necessary by the exam in-ers. The French Board of Orthodont ics also includes an oral in terview. The advantage of an oral in terview follow ing the exam ina-t ion of the presented cases is that the can -didate can receive feedback about h is or her presented cases. The exam iners m ay point out inaccuracies in the diagnosis, t reatm ent plan , or t reatm ent result . This approach m ay increase the learning experience of the par t icipant during the exam inat ion .

Before being eligible to sit the exam ina-t ion of the Germ an Board of Orthodont ics and present docum ented cases, the candi-date m ust have at tended a fair num ber of cont inuing educat ion classes and par t ici-pated in scient i c work, if possible.

The WFO is aware of the di erences in the requirem ents of the various boards. Consequently, it in it iated the WFO Com m it-tee on Nat ional and Regional Orthodont ic Boards. Since it s form at ion, th is com m it-tee has developed the WFO Guidelines for the Establishm ent of New Nat ional and

13 The Educat ional Role of Orthodontic Boards around the World 115

orthodont ic knowledge implies that pract i-t ioners m ust m ake a lifelong com m itm ent to the improvem ent of skills, acquisit ion of knowledge, and m odi cat ion of pract ice. This is not possible w ithout cont inuing educat ion. The Aust ralasian Orthodont ic Board and the Germ an Board of Orthodon-t ics and Orofacial Orthopedics, am ong oth-ers, see cont inuing educat ion as one of their responsibilit ies. The Germ an board orga-nizes a yearly congress at w hich at tendance by diplom ates is m andatory.

Lifetim e certi cation seem s less appro-priate nowadays than it may have been in the past because of the rapid increase in orth-odontic knowledge. Several certifying boards have changed their certi cation procedure by implementing a recerti cation process. Recer-ti cation for mem bers of the German Board of Orthodontics includes mandatory par-ticipation in continuing education organized or recognized by the board. In addition, ve years after the status of diplomate has been achieved, an active contribution (case pre-sentation, poster presentation, or lecture) is required. The Germ an Board of Orthodontics de nes board certi cation as the voluntary comm itment to lifelong continuing education at a high professional level. The Taiwan Asso-ciation of Orthodontists has implemented a similar recerti cation procedure that involves lecturing, publishing, participating in con-tinuing education, and the like. Recerti ca-tion is obligatory every six years.

The recer t i cat ion procedure for the ABO takes place every 10 years. The proto-col depends on the t im e w hen the renewal is undertaken. At the rst cer t i cat ion renewal, two cases w ith a discrepancy index of 20 or h igher m ust be subm it ted. In addit ion, an online m ult iple-choice exam i-nat ion assesses the candidate’s theoret i-cal knowledge. Subsequent recer t i cat ion exam inat ions include the subm ission of one case and a theoret ical exam inat ion , as described previously.

Cert i cat ion by the Aust ralasian Orth-odont ic Board is for ve years, after w hich the board m em ber m ust undergo recer t i -cat ion , including the subm ission of cases.

The presentat ion of one new case every six years is m andatory to rem ain a m em ber

m ent clearly indicates that excellence of specialt y educat ion is one of the goals of board cert i cat ion. The Taiwan Associat ion of Orthodont ists sets guidelines regarding the quali cat ions of the inst itu tes w here candidates are t rained and their inst ructors for candidates to becom e diplom ates of the board. One of the object ives of the Philip -pine Board of Orthodont ics is to accredit and approve the various or thodont ic pro-gram s and review the exam inat ions adm in-istered. The Indian Board of Orthodont ics clearly states that or thodont ic t rain ing is in tensively reviewed.

Som e postgraduate program s in Europe (e.g., Departm ent of Orthodontics, Medical University Vienna, Austria) require that the two cases that m ust be displayed to ful ll part of the criteria for provisional m em bership of the European Board of Orthodontists be pre-sented at the nal postgraduate exam ination.

Board cer t i cat ion enables an indirect assessm ent of the qualit y of postgraduate educat ion . If a h igh percentage of candi-dates educated in a cer tain departm ent are successful, that fact m ay be used to prom ote the educat ional qualit y of the departm ent .

The board cert i cat ion process is gener-ally open only to orthodont ists who have graduated from recognized postgraduate orthodont ic program s. Som e countries, however, do not o cially recognize the spe-cialt y of orthodont ics. For board-cert i ed orthodont ists in these countries, the dispar-ity between board cert i cat ion and the lack of a legally recognized status as an ortho-dontist m ay pressure health care authori-t ies to recognize the specialty. This, again, m ay help to improve the level of orthodont ic t reatm ent received by the public. The WFO has in it iated a discussion on accreditat ion standards and the criteria used to recognize bona de orthodont ic program s.

13.5 Clinical Excellence and How to Maintain ItAchieving clinical excellence is one thing; m aintaining excellence during pract ice as a professional is another. The rapid increase in


Further ReadingAm erican Board of Orthodont ics. w w w.am eri-

canboardortho.com . Accessed March 30, 2015

Australasian Society of Orthdont ists, Aust ral-asian Orthodont ic Board. w w w.aso.org.au/aust ralasian-orthodont ic-board. Accessed March 30, 2015

Brazilian Board of Orthodont ics and Facial Or-thopedics. w w w.bbo.org.br. Accessed March 30, 2015

European Orthodont ic Society, European Board of Orthodont ists. w w w.eoseurope.org/ebo. Accessed March 30, 2015

French Board of Orthodont ics. w w w.ceor tho.fr/en/french-board-or thodont ics. Accessed March 30, 2015

Germ an Board of Orthodont ics and Orofacial Orthopedics. w w w.germ an-board.de. Ac-cessed March 30, 2015

Indian Orthodont ic Society, Indian Board of Or-thodont ics. h t tp://w w w.iosweb.net /ibo.h tm . Accessed March 30, 2015

Italian Societ y of Orthodont ics, Italian Board of Orthodont ics. w w w.sido.it /ibo.asp. Ac-cessed March 30, 2015

Philippine Board of Orthodont ics. w w w.pbo.ph. Accessed March 30, 2015

Taiwan Associat ion of Orthodont ists. w w w.tao.org.tw. Accessed March 30, 2015

World Federat ion of Orthodont ists. Accessed March 30, 2015 w w w.w fo.org

of the Brazilian Board of Orthodont ics and Facial Orthopedics.

Mem bers of the Italian Board of Ortho-dont ics m ust present a case every second year at the nat ional m eet ing of the organi-zat ion . The case, however, is not evaluated.

In sum m ary, the recer t i cat ion pro-cess aim s to keep the qualit y of t reatm ent at a h igh level by re-evaluat ing the clin i-cal knowledge and skills of pract it ioners throughout their professional careers. This m ay be done by the periodic presentat ion of t reated cases, successful com plet ion of a theoret ical exam inat ion, and/or m andatory par t icipat ion in cont inuing educat ion .

13.6 ConclusionBoard cer t i cat ion , postgraduate educa-t ion, and cont inuing educat ion are inex-t ricably related in securing and enhancing the standards of clin ical orthodont ic care. Only well-educated orthodont ists are able to becom e board cer t i ed. Board cer t i ca-t ion requires that clin icians have achieved a h igh level of postgraduate educat ion and are com m it ted to clin ical excellence based on sound theoret ical knowledge that is kept up to date by m eans of cont inuing educa-t ion. Furtherm ore, the exam inat ions pro-vide a unique opportunity for candidates to review their pract ices and to re ect on the im portance of h igh-qualit y records, m echanical control during t reatm ent , and careful at tent ion to the nal phase of t reatm ent .

117

Structure and Organization of Dental Specialty Education in the United KingdomFraser McDonald, G. Howard Moody, and Dirk Bister

This chapter is aim ed at giving the reader an overview of the st ructure of postgraduate dental specialty education and its regulatory bodies in the United Kingdom . More spe-ci cally, it highlights the standardizat ion of postgraduate specialty education and exam -ination in dent istry throughout the three countries plus Northern Ireland that m ake up the United Kingdom , and the responsibil-it ies and tasks that are undertaken by vari-ous bodies. It emphasizes the importance of the independence of the Royal Colleges in set t ing standards and organizing exam ina-t ions at the postgraduate level.

14.1 OverviewClinical dental educat ion in the United King-dom is divided in to three dist inct ive levels: undergraduate ( ve years), dental founda-t ion (DF; two years), and postgraduate spe-cialt y t rain ing (three years plus an opt ional addit ional two years). Higher degrees leading to universit y careers in specialt ies involve in tercalated PhD/DDS degrees, and the clin ical specialist t rain ing w ill st ill be a three-year full-t im e equivalent .

Postgraduate specialt y t rain ing for dent ist ry has two com ponents: clin ical t rain ing and an academ ic elem ent . The two com ponents are parallel and com ple-m ent each other. Postgraduate courses are therefore usually advert ised as com bined m em bership and MSc/DDS program s (e.g., MOrth/MSc for or thodont ics). Postgradu-ate t rain ing in dent ist ry is di erent from the equivalent specialt y t rain ing in m edi-cine, in w hich there is no dist inct form al-

14

ized academ ic elem ent associated w ith a un iversit y during t rain ing.

The academ ic com ponent itself is split in to two parts: form alized teaching (lec-tures, sem inars, tutorials, pract ical exer-cises) and a research-based thesis at either the m aster’s or doctoral degree level (MSc/DDS). The academ ic com ponent is run by the universit y w ith w hich the t rain ing pro-gram is a liated. The clinical component is organized by local educat ion and t raining boards (LETBs), form erly know n as post-graduate deaneries (please see below ).

Follow ing specializat ion and en t ry in to the General Dental Council’s specialist list , a t rainee m ay undergo two years of further educat ion as a h igher t rainee (form erly know n as a senior regist rar). This t rain ing is in tended to facilitate clin ical pro ciency at a h igher level and is assessed via a h igher quali cat ion (current ly an in tercollegiate fellowship) suitable for a hospital post at the consultan t level. This addit ional t rain -ing is unique to dent ist ry in the United Kingdom and Ireland and is not discussed fur ther. In m edicine, successful specialt y t rain ing and assessm ent alone allow access to consultant level posts.

At the postgraduate level (DF and spe-cialty training), the organization of train-ing is principally national; this ranges from recruitm ent, to the set t ing of curricula and syllabuses, to the provision of training and exam inations. However, recruitm ent to DF training is national for England, Wales, and Northern Ireland; for a variety of reasons, Scotland recruits separately.

Recruitm ent to core training posts is arranged locally, although there is an aspi-rat ion to develop national recruitm ent. It is


currently hampered by the lack of a curricu-lum . Recruitm ent for specialty training posts is national (throughout the United Kingdom ) for orthodontics (specialist t rainees) and pediatric dentistry. For post-specialty edu-cation ( xed-term training of an additional two years leading to a consultant job) posts in orthodontics, Wales is currently excluded. There are plans to extend national recruit-m ent to other dental specialt ies in the future.

14.2 Department of HealthCurrently, the Departm ent of Health (Edu-cation and Welfare) is ult im ately respon-sible for health care regulat ion in the United Kingdom through the Professional Standards Authority (PSA). This includes dentistry.

The aim s of the Departm ent of Health are to help people lead “healthier lives, recover well from illness, and live bet ter for longer.” Its role is to implem ent policies to achieve those aim s. The departm ent is one of the num erous (24) m inisterial depart-m ents, w hich report directly to the o ces of the prim e m inister and the deputy prim e m inister, and it works w ith other depar t-m ents. Their far-reaching responsibilit ies are divided into execut ive agencies, execu-t ive nondepartm ental bodies, and advisory nondepartm ental public bodies. The di er-ent departm ental roles are w ide-ranging and include social care, the Nat ional Health Service (NHS), and public safety. Health edu-cat ion is delivered though NHS Educat ion for Scotland, the Workforce Educat ion and Developm ent Services Wales, the Northern Ireland Medical and Dental Training Agency, and Health Educat ion England. The NHS is a publicly funded body that aim s to provide health care that is free to the public at point of delivery; dent ist ry is part ially funded.

The Departm ent of Health issues guid-ance on how heath care, including dental services, should be delivered. The Depart-m ent of Health guidance speci es working condit ions and cont ractual arrangem ents for the NHS, as well as referral arrange-m ents w ith in the health care system .

A m ajor area of con ict exists between the Departm ent of Health , w hose workforce is t rained and delivered at the undergradu-ate level, and the Departm ent of Educat ion . The in terface of the two departm ents w hen the t rain ing of students is taken in to clin ical areas w ith direct access to pat ients has for m any years been w ithout issue. However, the increase in student num bers, together w ith the expectat ions of pat ients and the increase in adm inist rat ive regulat ion , has m ade it necessary for m ore form al links to be put in place. These include the recogni-t ion that students in t rain ing are covered by the appropriate clin ical indem nity.

14.3 Professional Standards AuthorityAs previously m ent ioned, the PSA regulates and advises health care bodies at a h igher level. The PSA is responsible for overseeing the n ine health care professional regula-tory bodies in the United Kingdom . These include the General Chiropract ic Council, the General Dental Council (GDC), the Gen-eral Medical Council, the General Opt ical Council, the General Osteopathic Council, the General Pharm aceut ical Council, the Health and Care Professions Council, the Nursing & Midw ifery Council, and the Phar-m aceut ical Society of Northern Ireland. It com prises three team s assigned to (1) scru-t iny and qualit y, (2) standards and policy, and (3) governance and operat ions, a per-form ance review body that m akes sure that the n ine regulatory bodies are perform ing according to the standards set .

14.4 General Dental CouncilThe GDC is an independently funded organizat ion w hose aim is to “protect the pat ients and regulate the dental team .” All dental professionals legally working w ith in the United Kingdom m ust be on one of the GDC registers, including den t ists, dental

14 Structure and Organizat ion of Dental Specialt y Education in the United Kingdom 119

Scotland, Workforce Educat ion and Devel-opm ent Services Wales, Nor thern Ireland Medical and Dental Train ing Agency, and Health Educat ion England.

14.5.1 Committee for Postgraduate Dental Deans and Directors

These t rain ing boards are them selves over-seen by the Com m it tee for Postgraduate Dental Deans and Directors (COPDEND). COPDEND and the four agencies deliver and m anage postgraduate dental educat ion for the dental team . Local organizat ion is w ith the four agencies, and nat ional organizat ion is m ainly at the COPDEND level. Som e COP-DEND-linked com m it tees are the standing advisory com m it tees, w hich advise on m at-ters a ect ing the various dental specialt ies.

Postgraduate t rain ing in dent ist ry con-sists m ainly of two par ts: (1) DF for up to two years and (2) postgraduate specialt y t rain ing (three years plus an opt ional addi-t ional two years, the lat ter for consultant t rain ing).

One year of DF t rain ing is com pulsory for all graduates qualifying from a United Kingdom dental school. Th is was previ-ously also know n as vocat ional t rain ing. Successfu l com plet ion of t rain ing allow s the dent ist to apply for an NHS perform er num ber, w hich is necessary to hold a con-t ract w ith the NHS.

A t rainee in the second year (DF2) was form erly know n as a senior house o cer. The second year is not com pulsory but allows the dent ist to prepare for the MFDS (Mem bership of the Facult y of Dental Sur-geons)/MJDF (Mem bership of the Join t Dental Facult ies) exam inat ions of one of the Royal Colleges. Obtaining one of these diplom as puts a dent ist in a good posit ion to apply for specialist t rain ing.

COPDEND also organizes nat ional recruitm ent to specialist t rain ing and hence is involved in specialist workforce planning as well as in qualit y assurance of t rain ing. Nat ional recruitm ent takes place once a year, and the in terviews for all candidates are held in one center over two days. The

nurses, dental technicians, clin ical dental technicians, dental hygienists, dental ther-apists, and or thodont ic therapists. The GDC regulates the dental profession by set t ing standards, including standards to ensure the qualit y of dental educat ion at all levels.

One of the responsibilit ies of the GDC is to take act ions against those w ho work out-side the legal fram ework, and as the m ain regulatory body of dental professionals, it s object ive is to enhance pat ient con dence and safety as well as im prove the qualit y of care. The GDC is m ade up of 12 m em bers: six appointed regist ran ts (dental profes-sionals) and six appointed lay m em bers. It sets up standing com m it tees to look at poli-cies and processes, and statutory com m it-tees, de ned by the Dent ists Act 1984, to carry out delegated regulatory work.

The GDC is funded solely by annual retent ion fees paid by dental profession-als, including dental nurses and therapists, dental technicians, and dent ists. In con-t rast to the European Union regulat ions, w hich recognize on ly two dental special-t ies (or thodont ics and oral surgery) across all states, the GDC recognizes a total of 13 dental specialt ies for the United Kingdom , and it speci es the tasks of each specialt y.

The GDC is responsible for overseeing dental educat ion at all levels: undergradu-ate educat ion , DF t rain ing, and postgradu-ate specialt y t rain ing. However, a large num ber of it s educat ional responsibili-t ies are devolved to universit ies and their respect ive supervisory bodies for under-graduate educat ion , and to postgradu-ate deaneries for foundat ion t rain ing and postgraduate specialt y educat ion . Lately, the postgraduate deaneries have been sub-sum ed by LETBs; som e of these work at a local and others at a nat ional level.

14.5 Postgraduate Dental Training in the United KingdomFour educat ional agencies oversee post-graduate m edical and dental educat ion in the United Kingdom : NHS Educat ion for


The dental council of the Royal College of Surgeons of Edinburgh was created in 1954, and it achieved faculty status in 1982.1 The other dental facult ies were also established in the 1980s, and they hold exam inat ions for all of the recognized specialt ies in the United Kingdom and m any overseas.

The m em bership and fellowship exam i-nat ions function as specialist exam inations. To be accredited as a specialist dentist w ith the GDC, applicants m ust prove that they have the appropriate am ount and level of specialist t raining (con rm ed by universi-t ies and LETBs) and m ust prove that they have successfully passed the specialty exam -ination as determ ined by one of the colleges.

All th is m ust be set against a backdrop of how we have arr ived at the curren t level of regulat ion (Table 14.1).

14.7 Role of the Dental Faculties of the Royal Surgical Colleges of the United Kingdom in Dental Health RegulationThe dental facult ies of the Royal Colleges of Surgeons o er postgraduate career guid-ance, as do postgraduate deans (LETBs). The colleges m ay extol the at t ract ion and vir tues of certain subspecialist disciplines, but they do not , as colleges, t rain anyone in these disciplines. College councils m ay com m ent on NHS or governm ent “discussion papers,” and w hile this is a useful funct ion, it is hardly unique. Specialist associat ions, uni-versit ies, postgraduate and undergraduate deans, and pat ient representat ive groups m ake equally valid contribut ions to such debates. Colleges also provide educat ional events, but so do other health care bodies, such as NHS Educat ion for Scotland, Health Educat ion England, and LETBs, w ith the bene t of m uch larger budgets. The Royal Colleges are well placed as independent evaluators of clin ical competence, w hile the universit ies evaluate academ ic knowledge. The colleges are, however, uniquely quali ed through experience, t rain ing, and logist ical

in terviews are st ructured and standard-ized and are m ore like exam inat ions than in terviews. The in terviews cover several set item s (e.g., audit and research), and m arks are allocated for each sect ion . The cum ula-t ive m ark is used for ranking the candidates.

Postgraduate dental t rainees undergo a large num ber of quality assurance pro-cesses. These include regular appraisals, w hich incorporate inform ation gained from workplace-based assessm ents and other form alized inform ation about the t rainee (e.g., num ber of pat ients in t reatm ent and case m ix). COPDEND and the four agen-cies are responsible for organizing these appraisals, w hich are m ainly, but not exclu-sively, form ative. All specialty t raining posts are subject to inspect ion, and a speci c t raining num ber is issued after recognit ion.

Neither the four agencies nor COPDEND exam ine or set up nal specialt y exam ina-t ions, however. Specialt y exam inat ions are set up by the Royal Colleges. COPDEND has a lead dean, w ho relates to the dental facul-t ies of the Royal Colleges and the standing advisory com m it tees.

14.6 The Royal CollegesExam inat ions at the postgraduate dental specialt y level are supervised by the Royal Colleges. The principal colleges involved in postgraduate dental educat ion are the Royal College of Physicians and Surgeons of Glasgow, the Royal College of Surgeons in Ireland, the Royal College of Surgeons of Edinburgh, and the Royal College of Surgeons of England. The Royal College of Pathologists and the Royal College of Radi-ologists are also involved w here appropri-ate. Originally, the Royal Colleges were m edical and/or surgical in nature, but they now all have dental facult ies.

The Royal Colleges are funded indepen-dently of governm ent by annual m em ber-ship subscript ions, exam inat ion and course fees, and som e generous legacies. The den-tal facult ies of the four Royal Colleges of Surgeons, although ent irely independent , collaborate closely to their m utual bene t .


support to provide relevant and a ordable Postgraduate Independent External Qualit y Assurance (PIEQA).

14.7.1 Postgraduate Independent External Quality Assurance

Postgraduate independent external qual-it y assurance (PIEQA) is the th ird side of the m edical–dental t r iangle (Fig. 14.1). The

rst side com prises all that is encom passed by the word educat ion—from the rst year of undergraduate studies to the com plet ion of cont inuing professional developm ent (also know n as cont inuing professional educat ion) at ret irem ent . The second side is delivery—delivery of every conceivable form of health care in the w idest possible in terpretat ion of care.

14.7.2 Postgraduate Education and Quality Control

The qualit y of undergraduate m edical and dental educat ion in the United Kingdom is controlled as previously detailed. With the advent of the NHS, the h istorical role of the colleges in undergraduate educat ion ended; all undergraduate educat ion nally passed to the universit ies. This relates to the area of unease between the Departm ent of Health and the Departm ent of Educat ion . A speci c exam ple of th is st rategic di culty

Table 14.1 Dates of importance in the formation of the current regulations

Speci c event/body Year

James Rae2 lectures to the Royal College of Surgeons of Edinburgh

1776

William Rae2 lectures at John Hunter’s house in London

1785

University College London (London University)

1826

King’s College 1829

University of London 1836

Royal Dental Hospital 1858

General Medical Council 1858

License of Dental Surgery 1860

First Dental Act (an Act of Parliament)

1878

Scot tish Dental Education Commit tee

1878

Dental teaching linked with universities (10 years of negotiations)

1911

Royal College of Edinburgh higher dental diploma3

1919

Interdepartmental Commit tee on Dentistry

1943

National Health Service 1948

General Dental Council (another Dentists Act)

1956

Fig. 14.1 The medical–dental triangle.


and soon specialist m em bership diplom as closely allied to t rain ing program s em erged. Furtherm ore, thoroughly reputable fellow-ship and m em bership diplom as em erged from sister colleges in Glasgow and Ireland, and a Faculty of General Dental Pract ice (UK), based at the Royal College of Surgeons of England, also cam e in to being.

Meanw hile, cash-st rapped universi-t ies created and taught clin ically oriented m aster’s degree program s, inadvertently adding to the confusion that a plethora of postgraduate clin ical degrees caused.

However, there were positive aspects to all these slightly confusing developm ents. The rivalry am ong the colleges has resulted in diplom as that are continually revised in the light of m odern educational and assessm ent theory, w ith the result that the colleges are now experts in this eld, w ith the support of educationalists and psychom etricians to advise on assessm ent practice. This has been to the great bene t of exam ination candi-dates and indirectly of their patients.

14.8 Standard Setting of ExaminationsAll current specialist dental exam inat ions are aim ed at delivering a valid, standard-ized, reproducible, and fair exam inat ion process. The exam inat ions follow a set protocol and aspire to test the breadth and depth of the knowledge and clin ical skills acquired during specialt y t rain ing. Stan-dard set t ing of the exam inat ion is by peer review and is com petency and criter ion based. Quest ions as well as clin ical scenar-ios are standardized throughout one diet of the exam inat ion. As a result , sophist icated and elaborate m ethods are required, w hich are t im e-consum ing. Results are scrut i-n ized by independent assessors, and feed-back is provided for candidates w ho have not passed the exam inat ion .

However, all this com es at a cost , and the fees for candidates undergoing specialty assessm ents have increased threefold. This increase is m ade even m ore acute by the fact that the exam ination fees are not eligible for

is that em ployed t rainees are m anaged w ith in the fram ework of em ploym ent law rather than educat ional need.

The Royal College of Surgeons of Edin-burgh pioneered the developm ent of h igher clin ical diplom as in dent ist ry w hen in 1919 it in t roduced the h igher dental diplom a. This diplom a assessed the ent ire range of dental disciplines. When the Royal College of Surgeons of England in 1948 in t roduced the fellowship in dental surgery (FDS), w ith its m edical and surgical em phasis, the Royal College of Surgeons of Edinburgh in 1949 revised and upgraded the h igher den-tal diplom a to create its ow n FDS. The Edin -burgh FDS exam ined dent ist ry across the board, thus providing an FDS m ore suited, at that t im e, for those pursuing a career in the nonsurgical aspects of dent ist ry.

It was felt that in a t im e of post-war aus-terity,4 and w ith the proven ability of den-t ists “in the eld” to do m uch m ore than restorat ive dentistry, it should be possible to construct a diplom a that would re ect further training in oral surgery, dental sur-gery, and the associated skills in m edicine, surgery, and pathology and would ren-der unnecessary the t im e-consum ing and expensive acquisit ion of a m edical degree or a fellowship of the Royal College of Surgeons (FRCS). General dental pract it ioners in the United Kingdom were frequently considered to belong to a “reserved occupation,” and during the Second World War, in addit ion to providing dental services, they adm in-istered general anesthesia at several hos-pitals, including Sta ord General Hospital (personal com m unicat ion, H. Moody).4 This was not unique but clearly dem onstrated the acceptance by hospitals and doctors at that t im e that dent ists could perform roles beyond dental surgery per se provided that they had appropriate and relevant t raining.

This for tuitous arrangem ent worked well. With full reciprocity between the colleges for a Par t 1 FDS, the successful candidate could choose between a Par t 2 FDS part icularly suited for those w ish ing to becom e oral surgeons and a Par t 2 FDS bet ter suited for those pursuing a career in or thodont ics and restorat ive dent ist ry. However, specializat ion m oved apace,


re ected by the funding exercises of the Departm ent of Educat ion (i.e., the research assessm ent exercise, now evolved in to the research excellence fram ework). Clin ical pract ice and teaching are no longer the only focus of universit ies, and for th is reason, it is im portant that a t rainee com e under the in uence of several consultants and prefer-ably acquires the experience of working in m ore than one universit y or hospital.

When it com es to assessm ent , the col-leges can draw upon experienced exam -iners from a great variety of inst itut ions, including, if they so w ish , fellows from overseas. If the consensus view of such a panel of exam iners at the end of an assess-m ent procedure is that a candidate has reached the required level, the public w ill have considerable con dence in that deci-sion . It is also a well-recognized aspect of assessm ent pract ice that the m ore varied the pairs of exam iners, the less possibilit y of any bias w ith in the system .

It is believed that all the Royal Colleges would agree that ult im ately they exist for the bene t of the public, and to this end, the concept of PIEQA is not only a worthy and im portant one, but also a vital one, and one w ith w hich the lay m em bers of the GDC w ill resonate if it is clearly placed before them .

With expectat ions of fur ther in terna-t ionalizat ion (already exist ing w ith in the European Union, allow ing the free m ove-m ent of professionals), the public m ust be aware that it m ay not be t reated by prac-t it ioners of United Kingdom origin and/or t rain ing. Evidence shows that there was a period of several years w hen the United Kingdom was a net im porter of dental grad-uates. Having a college quali cat ion of h igh in ternat ional repute (m em bership or fel-lowship), and therefore a “passport” prov-ing to regulators overseas and their public the level of educat ion and t rain ing at tained, w ill allow easier access for professionals seeking em ploym ent and reduce the costs of regulators w ho m ust oversee individu-als applying for ent ry to their country. The Royal Colleges are able to play an im portant par t in th is process w hile at the sam e t im e upholding and enhancing dental standards in m any countries.

taxation allowances in the United Kingdom , adding further pressure to professionals w ho w ill in turn have to pass the costs onto their pat ients, especially w hen it is consid-ered that neither the governm ent nor the public funds the GDC or the Royal Colleges.

Protect ion of the public is the rst duty of the GDC, and success in earning h igher college diplom as provides st rong, t ranspar-ent evidence of com petence at the special-ist level.

14.9 Independent and External CollegesThe colleges are independent of both the governm ent and the GDC. It would be irre-sponsible and arrogant to in terpret th is as m eaning that there should not be coopera-t ion w ith these bodies, but the agenda of a future governm ent or a lay-dom inated GDC is uncertain . The colleges, by retain ing their independence, exam ine and assess on purely clin ical grounds in the best inter-est of pat ients, not prim arily to sat isfy the requirem ents of the governm ent or any of its bodies. This exam ining and assessm ent role is undertaken in the closest possible collaborat ion w ith the specialist associa-t ions. However, the overarching governing body of the profession is the GDC. If the GDC intended to establish a m arker of suc-cessful com plet ion of two years of general professional t rain ing or specialist t rain ing or any other speci ed object ive, the colleges would be able to deliver the appropriate assessm ent . To retain the t rust of the pub-lic and health em ployers, there is nothing to prevent the colleges from m aking their h ighest diplom as, the fellowships, aspira-t ional and totally independent of any gov-ernm ent or GDC “specialist” requirem ent .

Thus, college m em bership and fel-lowship exam inat ions are independent assessm ents, and there are good reasons w hy universit ies m ay not be best su ited to deliver these assessm ents. Universit y departm ents are sm all and are becom ing sm aller because of nancial const rain ts. The focus on research is in tensifying, as


Further ReadingDepartm ent of Health . h t tps://ww w.gov.uk/

governm ent /organisat ions/depar tm ent-of-health . Accessed January 29, 2015

General Dental Council. h t tp://w w w.gdc-uk.org. Accessed January 29, 2015

Health Educat ion England. h t tp://hee.nhs.uk/tag/letb. Accessed January 29, 2015/

NHS. h t tp://w w w.nhs.uk/Pages/Hom ePage.aspx. Accessed January 29, 2015

NHS Educat ion for Scotland. ht tp://w w w.nes.scot .nhs.uk/educat ion-and-t rain ing. Ac-cessed January 29, 2015

Northern Ireland Medical and Dental Train ing Agency. h t tp://w w w.nim dta.gov.uk. Ac-cessed January 29, 2015

Royal College of Surgeons of Edinburgh. h t tp://w w w.rcsed.ac.uk. Accessed January 29, 2015

Royal College of Surgeons of England. h t tps://w w w.rcseng.ac.uk. Accessed January 29, 2015

Royal College of Physicians and Surgeons of Glasgow. ht tp://w w w.rcpsg.ac.uk. Accessed January 29, 2015

Royal College of Surgeons in Ireland. h t tp://w w w.rcsi.ie. Accessed January 29, 2015

Professional Standards Authorit y. h t tp://w w w.professionalstandards.org.uk. Accessed Jan-uary 29, 2015

UK Com m it tee of Postgraduate Dental Deans and Directors. h t tp://w w w.copdend.org. Ac-cessed January 29, 2015

Workforce Educat ion and Developm ent Services Wales). h t tp://w w w.wales.nhs.uk/sitesp -lus/955/page/65980. Accessed January 29, 2015

References1. Dingwall HM. The dental council and fac-

ult y. In : A Fam ous and Flourishing Society: The History of the Royal College of Surgeons of Edinburgh, 1505-2005. Edinburgh, Unit-ed Kingdom : Edinburgh Universit y Press; 2005:247

2. Macint yre I, MacLaren I, eds. Surgeons Lives. Edinburgh, United Kingdom : The Royal College of Surgeons of Edinburgh; 2005:50

3. Dingwall HM. The dental council and fac-ult y. In : A Fam ous and Flourishing Society: The History of the Royal College of Surgeons of Edinburgh, 1505-2005. Edinburgh, Unit-ed Kingdom : Edinburgh Universit y Press; 2005:196

4. Personal com m unicat ion to Dr. Moody from the late Professor J. Boyes, w ho regularly com m unicated w ith the late Sir Robert Bra-dlaw, a driving force behind the Royal Col-lege of Surgeons of England in the creat ion of the FDS RCSEng, 1969

125

International Guidelines of the Erasmus Project and the World Federation of OrthodontistsAthanasios E. Athanasiou and Theodore Eliades

At the nat ional level, accreditat ion bodies and guidelines regarding or thodont ic post-graduate educat ion and the recognit ion of the dental specialt y of or thodont ics have been in funct ion for m any years in m any countries.1,2 In countries w ith st rict and advanced regulatory policies, these accred-itat ion standards for advanced or thodont ic specialt y educat ion are regularly updated by the responsible authorit ies to follow recent developm ents and evolut ions in the scient i c and professional environm ent .3 In addit ion , during the past 25 years, the exis-tence of m ult istate polit ical ent it ies w ithin cer tain geographical borders and the large-scale m ovem ent of or thodont ic special-ists to countries other than the ones in w hich they were educated have led to the need for regional and in ternat ional guide-lines regarding or thodont ic postgraduate educat ion.

In 1992, “Three Years Postgraduate Pro-gram m e in Orthodont ics: the Final Report of the Erasm us Project” was published, providing relevant guidelines for European inst itut ions.4 These guidelines aim ed to reduce the diversit y in length , in tensit y, and content of exist ing program s, and to develop guidelines for countries about to em bark on postgraduate educat ion in or thodont ics. The project was nanced by grants of the European Union (EU), was im plem ented by prom inent professors from European coun-t ries, and took in to considerat ion the exist-ing characterist ics of dental educat ion and the provision of dental services in Europe. Many program s in Europe and other par ts of the world adopted, fu lly or in par t , th is

15

very valid m odel of or thodont ic postgradu-ate educat ion .

For two decades, th is report contr ib-uted sign i cant ly to st rengthening the level of postgraduate t rain ing in or tho-dont ics in Europe and fueled the debate about qualit y enhancem ent and qualit y control. Many program s in Europe used the guidelines outlined in the report as their “gold standard” for the educat ion of future or thodont ists. Since the original publica-t ion , however, the eld of or thodont ics has changed substant ially in regard to diagnos-t ic tools, t reatm ent techniques, in teract ions w ith other dental specialt ies, and m ethods and technologies of teaching.

In July 2006, the European Orthodon-t ic Society in it iated an at tem pt to crit ically assess various aspects of the im plem en-tat ion of the Erasm us project , but it was the Network of Erasm us-Based European Orthodont ic Program m es (NEBEOP), newly established in 2008, that nally updated the 1992 guidelines. In 2010, a task force was form ed to com e up w ith proposals for an update. In 2012, after several rounds of am endm ents, the nal revision was approved by the NEBEOP assem bly. The nal report about the updated guidelines was published in 2014.5

The object ives, general and speci c condit ions, and dist r ibut ion of hours of the or thodont ic postgraduate program rem ained largely the sam e as in the guide-lines of 1992. The theoret ical contents were divided in to eight them es, w hich were rede ned and m odern ized. Furtherm ore, in the 2014 guidelines, essent ial levels were


de ned for the skills and com petencies that residents should have acquired at the end of their postgraduate educat ion. The revision of the Erasm us program should be used as a guideline to assist in the developm ent and m aintenance of h igh-qualit y postgraduate educat ion in or thodont ics. The Erasm us program is not par t of EU legislat ion, and NEBEOP, w hich took the in it iat ive to update the guidelines, is not a legal authorit y that can override the EU direct ives or nat ional laws and regulat ions. Nevertheless, the guidelines serve as a useful m odel for good-qualit y postgraduate t rain ing in or thodon-t ics and have had a proven im pact in m any countries in Europe and around the world.

Because m any countries around the world have sim ilar needs but m ay present di erent characterist ics in regard to dental educat ion , the pract ice of dent ist ry, and the provision of dental services, the World Fed-erat ion of Orthodont ists (WFO) in July 2003 adopted m inim um orthodont ic specialt y guidelines, w hich were proposed by a sub-com m it tee of the WFO Execut ive Com m it-tee.6 In 2006, the WFO Execut ive Com m it tee established a task force on guidelines for postgraduate or thodont ic educat ion . This task force consisted of 10 prom inent indi-viduals w ho were recognized orthodont ic educators and represented regions w ith a h igh level of educat ional and pract ice stan-dards regarding our specialt y. The object ive of the task force was to provide the WFO Execut ive Com m it tee w ith detailed rec-om m endat ions concerning guidelines for postgraduate or thodont ic educat ion . Since it s form at ion, the WFO has increasingly placed em phasis on support , through its a liated nat ional organizat ions, for recog-n ized t rain ing program s in every region of the world, w hile at the sam e t im e providing encouragem ent and expert ise to develop-ing or thodont ic graduate program s in areas w here or thodont ic t rain ing previously did not exist . These guidelines for postgradu-ate or thodont ic educat ion were approved by the WFO Execut ive Com m it tee in 20096

and since then have been used by academ ic inst itut ions and or thodont ic organizat ions in m any par ts of the world.

The recom m endations aim to assist countries, associat ions, and educational institut ions in need to develop or improve orthodontic postgraduate program s. The WFO guidelines m ay be also used by post-graduate program directors worldw ide, at all levels of sophist icat ion, to m easure their cur-ricula against a worldw ide standard.7 (The art icles “World Federation of Orthodontists Guidelines for Postgraduate Orthodontic Education”5 and “The Erasm us Program m e for Postgraduate Education in Orthodontics in Europe: an Update of the Guidelines”7

appear in the Appendix of this book.)The provision of h igh-standard health

services, including or thodont ics, requires com petent personnel. The nal and cen-t ral goal of any postgraduate program is to im prove the services provided to the popu-lat ion seeking orthodont ic t reatm ent . It is the responsibilit y of the or thodont ic com -m unity (e.g., un iversit ies, scient i c soci-et ies, professional groups, specialists) to convince the polit ical bodies that in uence or regulate or thodont ic specializat ion that only educat ionally quali ed and properly t rained orthodont ists can guaran tee h igh standards of delivery of or thodont ic t reat-m ent . In m any countries, the or thodont ic com m unity experienced di cult y in nally convincing polit icians or even colleagues w ith in dent ist ry of the need for establish-ing h igh standards of or thodont ic educa-t ion and specialt y recognit ion. If polit icians w ish to secure the provision of h igh-qualit y or thodont ic t reatm ent , they have to realize that general dent ists or poorly educated or thodont ists cannot accom plish th is m is-sion. The w heel m ust not be reinvented in any country or universit y in w hich spe-cialt y educat ion is in it iated. Excellent stan-dards, accum ulated experience, and r ich knowledge of postgraduate educat ion are available from di erent par ts of the world, and these m ust be ut ilized.

15 Internat ional Guidelines of the Erasmus Project and the WFO 127



6. WFO Execut ive Com m it tee approves or th-odont ic specialt y educat ion guidelines to assist academ ic inst itut ions. WFO Gazet te 2003;8(2):1–2

7. Athanasiou AE, Darendeliler MA, Eliades T, et al; World Federat ion of Orthodont ists. World Federat ion of Orthodont ists (WFO) guidelines for postgraduate orthodontic educat ion. World J Orthod 2009;10(2): 153–166

References 1. DeKock WH, Athanasiou AE, Kuroda T. A

WFO-com m issioned study provides data on the specialt y’s current characterist ics and standards throughout the world. WFO Ga-zet te 2000;1:4

2. Kessel NC, DeKock WH, Phillips CL, Hershey HG. A survey of the status of or thodont ics am ong organizat ions w ith in the World Fed-erat ion of Orthodont ists. J World Fed Or-thod 2014;3(4):146–154

3. Am erican Dental Associat ion Com m is-sion on Dental Accreditat ion . Accreditat ion Standards for Advanced Specialt y Educat ion Program s in Orthodont ics and Dentofacial Orthopedics. Chicago, IL: Am erican Dental Associat ion; 2013

128

The Role of New Technologies in Orthodontic Specialty EducationShazia Naser-Ud-Din

The rst educat ion revolut ion occurred in Mainz, Germ any, in 1450 w ith the invent ion of the prin t ing press, credited to Johannes Gutenberg. This device propagated the w rit ten word faster than had previously been possible. However, to be fair, there is h istorical evidence that t ype prin t ing was developed nearly 500 years earlier in China. The huge t im e lag is, of course, due to the lack of sharing and com m unicat ion that we currently take so m uch for granted. Now, thanks to the e or ts of Sir Tim Berners-Lee (am ong m any others), we are at the cusp of yet another big revolut ion w ith the World Wide Web, w here the t ransfer and exchange of inform at ion are occurring faster than ever before. In fact , w hat is so in terest ing is that a dichotomy—between the “im m i-grants” and the “nat ives” of the In ternet and ar t i cial in telligence—is em erging as a result of the w idespread use of technology and inform at ion sharing by the m em bers of a generat ion (the “m illennials”) w ho have used the In ternet during their form at ive, developm ental years.

As our toddlers spend m ore and m ore t im e w ith tablets and com puters, they w ill be even m ore in sync than the generat ion before them . Therefore, fur ther in it ia-t ives are being m ade to develop online teaching tools because they are in terac-t ive and capt ivat ing, not stat ic and two-dim ensional like prin t . However, the big quest ion rem ains: What w ill technology do for h igher educat ion, w here m ost of the learning is self-directed and in ternally m ot ivated? Can the various learning styles be addressed, and can tailor-m ade educa-t ional packages im prove cognit ion and the

16

retent ion of inform at ion? New studies are cer tain ly reinforcing the e ect iveness of vir tual learning in com parison w ith t radi-t ional teaching.1

The e ect iveness of e-learning has been dem onst rated by random ized con-t rolled t r ials, considered the h ighest level of evidence in contem porary literature. A recent study evaluated face-to-face learn-ing, e-learning, and blended learning styles for or thodont ics.2 The results indicated that face-to-face learning and e-learning com plem ent each other, and that blended learning is the way to go. Di erent m edia address student di erences in learning styles, as alluded to by Kolb.3

Another dim ension to learning is being explored. There is no doubt that em ot ions play a m ajor role in the retent ion of infor-m ation. Inform at ion learned in a pleasur-able, nonthreatening environm ent , w ith rewards and grat i cat ion , is de n itely stored in long-term m em ory.4 So, how do we in t roduce enter tainm ent and educa-t ion sim ultaneously? Of course, work has already begun, and m any resources online discuss the concepts of “gam i cat ion” and “edutainm ent .” The concept of “edutain-m ent” was proposed by Dem irijian and David5,6; essent ially, it is an im portant self-m otivat ing tool (w hat we enjoy we cont inue for a longer t im e), par t icularly for compet ing Web-based portals. Online learning m anagem ent system s are com -m on in m ost universit ies and have been well established since the early par t of the twenty- rst century.7

The younger generat ion is not happy w ith bland paper text . It m ay just be that

16 The Role of New Technologies in Orthodontic Specialt y Education 129

Thom as Edison’s predict ion that “books w ill soon be obsolete in the school”) has com e to pass. This w ill de nitely be the case in future decades and w ill also be environ-m entally sustainable. An interest ing read is the second-order m eta-analysis of the 40-year impact of technology on learn -ing.8 The study compares technology-rich w ith technology-impoverished educat ional environm ents and work extending from 1985 onward. It was really in the 1980s that m any schools in developed countries began to provide computers in learning environ-m ents. However, a surge occurred after the m illennium and the “Y2K” (year 2000) fears. Electronic learning, Web-based inst ruct ion, and in tegrated learning system s are now com m onplace. The m ajor role for technol-ogy in educat ion is to support the didact ic process and to provide a platform avail-able 24 hours a day, seven days a week that learners can access at their convenience.

Perhaps the m ost pressing reason to look seriously into e-learning is the sharp decline in the num bers of teaching faculty world-w ide, particularly in orthodontics.9 This shortage of teachers is projected to becom e worse as nancial cuts are imposed on m any universit ies.

16.1 Interactive MediumHistorically, self-inst ruct ion in dent ist ry w ith com puters was rst discussed by Guild.10 In the m id-1980s, the Universit y of Bristol, United Kingdom , followed w ith it s rst in teract ive or thodont ic m odules.11

Blended learning in dent ist ry has been well accepted and was docum ented in a study from Europe,12 enhancing com petencies and core knowledge and supplem ent ing t radit ional pedagogy.13

In teract ive m odules14 essent ially increase student focus and enhance at ten-t ion, leading to retent ion in long-term m em ory. Im m ediate assessm ent and feed-back w ith open- and closed-ended ques-t ions fur ther reinforce learning, as has been docum ented in the literature.15 However, as m any educat ionists w ill appreciate, plan -

ning and conduct ing educat ional research are challenges in them selves.16

Both form at ive and sum m at ive assess-m ents can be adm inistered online. The advantages are e cient use of t im e, ease of adm inist rat ion , st ructure, and a lack of bias toward candidates (e.g., language bar-r iers). However, it is a challenge to ensure secure student output rem otely. Moreover, predict ive validit y over a period of t im e can be easily evaluated w ith data collected over a series of assessm ents.17 The nature of the specialt y of or thodont ics, requir ing com -plex t reatm ent planning in four dim ensions and variat ions in t reatm ent m ethodologies, m akes it challenging to design a single sum -m at ive assessm ent . Hence, algorithm s w ith m ult iple ows to a par t icular case m ust be designed and credited equally. Overall, th is adds to the com plexit y of online assess-m ents for or thodont ics.

16.2 Advanced E-Learning ToolsIn other disciplines of dentistry, work is in progress to develop virtual surgical train-ing in collaboration with industrial partners o ering sophisticated software (Sim Plant).18

In sum m ary, nonroutine complex proce-dures m ay be sim ulated for hands-on train-ing in which the trainer uses stereoscopic glasses, digital gloves, and real-patient surgi-cal scenarios. Such sim ulations are not easy to develop because complex algorithm s and huge computations are required. However, it is possible that such sim ulated learning m odules w ill becom e m ore accessible in the future as access to technological advances increases.

Another m arket leader is Japan , o er-ing sophist icated t ypodonts and m an-n ikins that can m im ic pat ien ts in pain , w ith tears em erging from their eyes (e.g., the life-like dental t rain ing robot Sim uloid[2007]).19 Special m ater ials are developed, not so m uch for e-learn ing but for a greater appreciat ion of tact ile sensat ions.20 The rate of acceptance by learners and their inst ructors of such nonthreaten ing envi-


Perl, XML (extensible m arkup language), PHP (hypertext preprocessor), and MySQL (st ructure query language). Open sources reduce the cost of the m odules developed.22

16.4 Medical Educationists and Health Professional EducationThere is am ple evidence to indicate that online m odules need to be developed on sound educat ional principles and grounded in psychological theories of educat ion , par-t icularly andragogy (described by Terrell23), for anatomy (Yeung et al24).

It is well established that a virtual learn-ing environm ent provides a strong platform for learning clinical skills and supplem ents t radit ional teaching in orthodont ics and dentistry.25 Sim ulat ion e-learning assists the novice in gaining skills in patient m anage-m ent , diagnosis, and clinical assessm ent . Dent Sim (Dent Sim Lab NYC, New York, New York), one such sim ulation program , had a high sat isfact ion rate in Taiwan.26 Moreover, a virtual learning environm ent tracks life-long learning w ith progress les, cont inu-ing education logs, and updates of career achievem ents as part of a comprehensive e-learning portal. A pilot program run by the University of London27 in the United King-dom shows that such progress les are well accepted by the profession.

It is docum ented that view ing vid-eos of clin ical procedures before m anag-ing pat ients provides greater con dence, im proves clin ical perform ance, and enhances the self-esteem of the novice cli-n ician .28,29 Moreover, w ith advancing tech-nology, three-dim ensional view ing can im prove visual spat ial abilit y. Dual coding theory30,31 states that m ult isensory im agery enhances learning concepts. It was used to assess educat ion w ith videos, as opposed to paper-based learning, and the results were evident; signi cantly h igher overall e ec-t iveness was noted in the group exposed to videos for educat ion .32 Videos can be used successfully to assist in problem -solving st rategies, cr it ical reasoning, com m unica-

ronm ents is h igh , nearly 60%, because they can learn new skills w ithout fear of causing ir reversible errors that a ect a real pat ien t . However, such projects are expensive com -pared w ith e-learn ing m odules, w hich have a h igh in it ial cost but lower long-term costs for software m ain tenance and upgrade.

Many of us in or thodont ics are fam iliar w ith water bath t ypodonts—to accelerate changes and visualize a t reatm ent last-ing an average of 18 to 24 m onths dur-ing a week of sim ulated learning. A m ore sophist icated version, now int roduced, is the elect rotypodont (Savaria Dent Kft , Szom bathely, Hungary),21 w hich uses cop -per conduct ing w ires at the roots of each tooth and brings about m ovem ent w ith heat m elt ing the wax—and in direct view of the observer rather than im m ersed in a warm water bath . Finite elem ent analysis (FEA) does the sam e; however, the elect ro-t ypodont provides the learner w ith tact ile sensat ions and skills acquired in real t im e.

16.3 Literature Review : Computer Science and Health SciencesA m ult iprofessional approach w ith infor-m at ion technology (IT) specialist input is needed to generate h igh-qualit y teaching m odules for m edicine, dent ist ry, and par-t icularly or thodont ics. These program s are w rit ten w ith HTML (hypertext m arkup language), JavaScript , and VRML (vir tual realit y m odeling language), to nam e just a few. Coordinat ion and collaborat ion w ith specialist anim ators can enhance the qual-it y of the teaching program s. There is no doubt that m any in the m edical eld m ay have neither the t im e nor the IT expert ise to develop on line program s on their ow n, and teaching inst itut ions w ill need to pro-vide faculty support for that purpose.

A new generat ion of online educa-tors w ill need to be not only pedagogically sound but also technologically t rained in the use of computers. E-m odules can be program m ed w ith open-source code-based languages like HTML, Java, JavaScript ,


16.7 E-learning—the United Arab Emirates PerspectiveIt is indeed grat ifying to see that a young country like the United Arab Em irates (UAE) has a futurist ic vision and has placed e-learning in the forefront of its nat ional developm ent . Most of the elect ron ic pro-cesses are e cient and environm entally sustainable. The UAE Advanced Network for Research and Educat ion , w ith the m ajor project EduRoam in collaborat ion w ith Ankabut , AUS (Am erican Universit y of Shar-jah), MIST (Masdar Inst itute), and KUSTAR (Khalifa Universit y of Science & Technology and Research), is act ively involved in deliv-ering and evaluat ing e-learning program s across educat ion platform s. UAE has rec-ognized the im pact of sm art learning for fu ture generat ions. The goal is to provide the h ighest qualit y of educat ion through a knowledge-based and highly product ive economy. The e-educat ion vision for UAE is to develop inst ruct ional designs, in ter-act ive content /skills t rain ing, collaborat ive curricula, and state-of-the-ar t educat ional technology and to set up an educat ional cloud—Ankabut—w hich is a global project linking leading universit ies and UAE educa-t ional inst itut ions.36

The e-educat ion collaborat ion w ith the UAE Minist ry of Educat ion is creat ing a nat ional repository of educat ional content , support ing sm art learning init iat ives and nat ional licenses for software. An ongoing evaluat ion of the educat ional m etadata w ill enhance the future developm ent of online program s. HBMeU (Ham dan Bin Moham -m ad e-University) was short-listed for the prest igious HoTEL (Holist ic Approach to Technology Enhanced Learning) by the European Union (EU). The conceptual fram ework is based on crit ical re ect ion and innovat ive creat ivity. An im portant aspect of the project is building personal learning networks in the context of courses. The Internat ional Council for Open and Dis-tance Educat ion (ICDE) awarded a blended learning project to UAE in 2013.37,38

The standards for both health and edu-cat ion are very h igh in UAE, w here the

t ion , and collaborat ion—all essent ial com -ponents of h igher-level cognit ive behavior.

16.5 Medical Education Online LearningFor anatomy and physiology instruction particularly,33 a head in virtual reality was an endeavor to provide a three-dim ensional rollercoaster learning experience w ith dif-ferent depth cues and interactive control features. Innovation with polarized glasses for depth perception was also envisaged in this project. Interestingly, the study docu-m ented that there was no advantage over “learner-controlled w iggle conditions,” but an argum ent can be m ade that perhaps there were issues w ith the learning curve; also, the

nesse of the system m ight not yet have been quite there—technological advances m ay change this in the future. The sam e authors in a m ore recent publication do acknowledge that technology will improve the quality of m odules produced in the future.

Technology w ill perhaps never replace real tact ile sensory input , but visual appeal is perhaps possible. The use of m agnet ic resonance im ages and frozen cadaver over-lays can cer tain ly enhance learn ing and the understanding of key concepts.34

16.6 Where Is Education in General w ith Technology?Phenom enal work on the im plicat ions of tailoring teaching to individual needs has been docum ented in the recent literature. Several ar t icles have recently appeared in Com puters & Educat ion . The use of m ult i-m edia for basic subjects like physics35 has elucidated the fact that concept clearing is linked to r ight and left hem ispheric pref-erences, and th is can assist in developing educat ion that is not “one style ts all,” but w ith prelearning assessm ent provid-ing speci c m odules for the learning to be h ighly e cient in pract ice.


w ith bet ter technology and algorithm s—LEAP adaptive learning on D2L.43 It is the opinion of the author that this has poten-t ial for the orthodontic specialty because postgraduates can gauge their learning and improve their skills through LEAP guidance.

16.9 Patient Education w ith TechnologyHuge in terest has been show n in having pat ients look up inform at ion regarding their probable t reatm ent by health pro-fessionals. Moreover, live updates of t reat-m ent experiences are available on various social m edia. In the rst study of its kind, conducted in New Zealand,44 a qualitat ive analysis was done of or thodont ic-related posts on Tw it ter and concluded that there is indeed in terest in post ing both posit ive and negat ive experiences. Our postgradu-ates not only can learn from this in teract ive m edium but also can acquire an under-standing of the percept ions and expecta-t ions of pat ients in regard to the profession. However, not all inform at ion can be taken at face value,45 and expectat ions should be clari ed during pat ient consultat ions.

16.10 Use of Technology in OrthodonticsAn excellen t recen t m eta-analysis46 has addressed blended learn ing and tech-nology in h igher educat ion . The study com pared t radit ional classroom inst ruc-t ion w ith on line teach ing, and although in teract ion and discussion are the for te of t radit ional classroom inst ruct ion , if com -m unicat ion via d iscussion boards and blogs is included in on line teach ing, the learn ing process is cer tain ly enhanced. Blended learn ing, w hich consist s of nearly 50% of on line inst ruct ion com bined w ith t radit ional inst ruct ion , is considered the best of both worlds. Curren t ly, research is show ing a m odest increase in ach ievem ent w ith blended learn ing (13%),46 and th is

Com m ission for Academ ic Accreditat ion (CAA) has established e-learning stan-dards. CAA encourages h igher educat ional inst itut ions to enhance learning w ith syn-chronous (video conferencing) and asyn-chronous (discussion boards, blogs, etc.) m ethods, e-assessm ents w ith feedback, and the secure delivery of exam inat ion and assessm ent policies. The aim is to provide a st rong blended learn ing platform for edu-cat ional inst itut ions in UAE.39

16.8 Are We Ready for Technology in Postgraduate Orthodontic Education?In the world of education in general so far, m any opportunit ies are available for online users that are not currently available for the specialty of orthodont ics. Som e of these are brie y m entioned here. Massive open online courses (MOOCs)40 are considered the future of online education, w ith interactive forum s for discussion. However, even though MOOCs have a great deal of potential, one needs to assess their future. Major leading universit ies in the United States are o ering online courses in certain disciplines free of charge to provide opportunity to all through MOOCs. Another com m only used acro-nym is MOODLE (m odular object-oriented dynam ic learning environm ent),41 a free software e-learning platform w here users can register and assist in a global collabora-t ion to develop teaching m odules. Also gain-ing m om entum is LEAP (learning algorithm path),42 w hich is a personalized learning pathway for individual learners. A pretest is conducted to establish a baseline for the learner’s exist ing level of understanding. Once this has been established, algorithms are used to generate and adapt a personal-ized learning pathway for individual stu-dents. A student can then learn through the resources prescribed, and reassessm ent can be used to determ ine if the new learning pathway has improved the student’s level of understanding of the subject m at ter. Further improvem ent in this dom ain w ill take place


bene t t ing equally as “Internet nat ives” nd the m edium to be second nature and are very com fortable using it to access inform at ion and learn .

Certain ly the or thodont ic m odalit y, in relat ion to indust ry, has taken full advan-tage of technological and IT advances50 in enhancing the t reatm ent planning process w ith custom ized t reatm ent m odalit ies, such as Invisalign (Align Technology, San Jose, California), Insignia (Orm co, Orange, California), Incognito (3M, St . Paul, Min-nesota), and Harm ony (Harm ony Ortho-dont ics, Logansport , Indiana), to nam e just a few. Indust ry, w ith it s com plex three-dim ensional sim ulated t reatm ent plans, is an excellent portal for teaching and can be included in collaborat ive e or ts to develop e-learning clin ical m odules.

Other applicat ions of technology in or thodont ics are the follow ing:

1. Diagnost ic records and com puter-aided analysis

2. Three-dim ensional m odels, im aging, and warping im ages

3. Scannersa. In t ra-oralb. Soft t issues

4. Wire sim ulat ions and FEA for research

16.11 Scenario-Based Learning InteractiveThe author was fortunate to work on a proj-ect at the Universit y of Queensland, Bris-bane, Aust ralia, in w hich nine interact ive m odules for teaching orthodont ics were developed and qualitat ively evaluated.29 The generic software Scenario-Based Learning Interact ive (SBLi) for online teaching was tailored to orthodont ic skills, knowledge, and syllabus content , target ing postgradu-ate t raining, and there were also three in troductory m odules for dental under-graduates. Four of the clinical applied m od-ules were based on clinical cases included in the m em bership exam inat ions of the form at of Royal Colleges of the United King-dom , selected for complexity and rarit y of

w ill cer tain ly con t inue in the fu ture w ith the m illennial generat ion .15

A decade ago, Marquis47 noted that nearly 90% of inst ructors in higher educa-t ion rated blended learning as m ore e ec-t ive than learning w ith no technological input . Of course, th is dist inct ion is going to blur as technological advances and ease of access m ake online educat ion m ore acces-sible. However, blended learning is e ec-t ive over a period of t im e and needs to be m ade an essent ial com ponent of the cur-r iculum to be successful.

The four pat terns of blended learning, as described by Driscoll and Carliner,48 are the follow ing:

1. Mix of Web-based technologies2. Mix of pedagogical approaches

(const ruct ivism , behaviorism , and cognit ivism )

3. Face-to-face inst ructor-led teaching4. E ect ive learning st rategies

The quest ion is no longer w hether tech-nology is e ect ive or not , but w hat m ode of technological inform at ion t ransfer is best for a par t icular content , skill acquisit ion , and behavior m odi cat ion. Moreover, w hat w ill engage and keep the learner m ot i-vated—in an essent ially isolated m edium of inst ruct ion? This has been the challenge, par t icularly for andragogy. Di erent tech-nological aspects are not only the tools but also the approach based on sound andra-gogic principles to bene t the learner. With the daw n of the m illennium , there has been an exponent ial increase in both the design of on line learning and the research evaluat-ing its e ects and success. It is now docu-m ented that online or thodont ics teaching m aterials should be developed according to the principles of h ierarchical sequenc-ing (HS) for the e ect ive delivery of new conten t .49 There is a need to fur ther inves-t igate the various delivery m odes for their e ect iveness, such as elaborat ion sequenc-ing (ES) and m acro-sequencing (MS), w hich place em phasis on the pract ical applicat ion of knowledge.49

There is no doubt that technology has a posit ive im pact on learning, par t icularly h igher educat ion, although pedagogy is


a nonjudgm ental learning forum and pre-vent discouragem ent from act ive learning.

There was a h igh rate of acceptance of SBLi for or thodont ics, albeit in a sm all group. The st rength of SBLi lay in the in t ro-duct ion of rare clin ical condit ions—for exam ple, cerebral palsy, t ransposit ions, gem inat ions, and tem porom andibular dis-orders—that are not easily presented dur-ing postgraduate t rain ing and can be taught m ore reliably through e-learning.

The m ajor advantage of e-learn ing is the incorporat ion of video content . This has been a driving force to encourage the developm ent of com puter-assisted

condit ions (Fig. 16.1). Five m odules were based on orthodont ic procedures and clini-cal skills orientat ion; examples include orthognathic case VTO (vir tual t reatm ent object ives) as video presentat ion em bed-ded—speci c to the style adopted at the University of Queensland orthodont ic teaching program , indirect bonding, space analysis, etc. Up-to-date evidence in the lit-erature, along w ith open- and closed-ended quest ions requiring crit ical th inking, were posted for the postgraduates to evaluate their ow n learning. Im m ediate feedback w ith pre-answers clari ed the key concepts. No score was allocated purposely to provide

Fig. 16.1 Rare clinical case of a patient with cerebral palsy seeking orthodontic treatment. Previous treat-ment with a functional orthopedic appliance did not correct the malocclusion. Interactive windows allow the learner to collect clinical information and formulate a treatment plan.


( h t t p s : / / w w w .y o u t u b e .c o m / w a t c h ? v=PUIanIl5CFc), were developed. Each m od-ule had an interactive w indow (Figs. 16.1and 16.2) w ith current and contemporary literature (pdf), videos of procedures, and from YouTube the arm am entarium available for current orthodontic use. Each segm ent was followed by a form ative assessm ent and im m ediate feedback. Com binations of open-ended and radio but ton items were placed throughout the m odules to enhance the learner’s engagem ent and alertness. Each m odule was a stand-alone entity, so the m odules did not have to be viewed in any particular order.

16.12.2 (G)nathos Webinars

The style adopted was that of the m uch-loved and enthusiastic speaker Dr. Gerry Sam -son. The topics were enhanced with well-illustrated PowerPoint slides placed side by side w ith the presenter.51 The hum or, lively style, anecdotes, and pdf illustrations (“Loco Motion Mechanics Series,” “The Lineup,” “Deep Bite Corrections”), which could be downloaded, added an enriching experi-ence to the m uch-dreaded biom echani-cal aspect of orthodontics. The day-to-day examples, w ith a tennis racket and lively m usic added, and the am using titles (“Trou-ble in Torque Town”) were intended to keep the learner interested at all t im es, along with the essential cues (ht tp://www .gnathosCE.com ). Perhaps the m ost unique aspect was the introduction of hands-on participation, which allowed the learner to appreciate three-dim ensional changes w ith an overlay of Perspex drawings.

16.12.3 CopestheticCE Module

This on line e-m odule was developed by Dr. Jason Cope and provides PowerPoint presentat ions clarifying aspects of tem -porary anchorage devices along w ith con-tem porary literature.52 Im m ediate on line evaluat ion w ith feedback is provided. The postgraduate students accessed the Copes-thet icCE e-m odule in the second sem ester.

learning packages. Open sources of video content , such as YouTube, and videos devel-oped by m arket ing com panies are already being used by postgraduates. Well-know n presenters of in ternat ional caliber have produced Web sites dedicated to online teaching that are resources for online learn-ing. At tem pts have been m ade at the Uni-versit y of Queensland to in t roduce these m odules from leading nam es, such as Dr. Gerry Sam pson for the (G)nathos Web site at h t tp://gnathosce.com /gnathos.h tm l and Dr. Jason Cope for Copesthet icCE at h t tp://w w w.copesthet icce.com .51,52

The gist of the qualitat ive evaluat ion was that postgraduate students in par t icu-lar are very t im e-const rained and want e-learning to be m ade as “to the point” as possible so they can obtain inform at ion e ciently. Moreover, w hen the m odule provides an overall view com prehensively, students can spend less t im e sur ng the Web. Hence, the feedback from the con-temporary approach to e-learning showed the h igh dem and, par t icularly in current postgraduate program s in or thodont ics and allied health sciences.

16.12 Evaluating Di erent Styles of E-Learning in OrthodonticsThis second project that the author under-took at the University of Queensland was to look at di erent e-learning delivery styles and how they a ect learner m otivat ion and engagem ent . Therefore, four di erent e-learning packages were introduced to the postgraduate program of orthodontics at the University of Queensland.29 A brief overview of the four e-learning packages follows.

16.12.1 Scenario-Based Learning Interactive for Orthodontics

SBLi software was developed for ortho-dontics. Nine di erent topics, sepa-rated into clinical and procedural parts


m inutes. The sem inars covered grow th and developm ent , biom echanics, t reatm ent planning, and cephalom et ric radiography. The discussions and PowerPoint slides allowed the learner to feel like a par t of the session and to glean inform at ion from the references and papers discussed during the sem inar.

The four e-learning m odules were eval-uated by nine orthodont ic postgraduate students at the Universit y of Queensland for the academ ic year 2012. A Likert ve-

16.12.4 American Association of Orthodontists–University of North Carolina Web Program 53

This program was kindly donated to all the dental schools in Aust ralia by the Aus-t ralian Society of Orthodont ists. The m od-ules were m ost ly based on sem inars on a variet y of topics presented by prom inent or thodont ists and videotaped for 60-plus

Fig. 16.2 Past dental and orthodontic history from the patient and prompts in the upper left window for the learner to acquire the process of history taking in a clinical setup. The upper Clark twin block does not have a midline palatal screw, hence the developing posterior cross bite observed in the intraoral photo in the upper right window.


16.13 Technology in Orthodontic Postgraduate Education—the Future!Assessm ent is an essent ial part of all learn-ing and teaching. It is also perhaps a very resource-in tensive aspect of educat ion, necessitat ing the generat ion of a quest ions data bank, the random izat ion of quest ions, the adm inist rat ion and evaluat ion of grades, and feedback. Online learning m anagem ent system s include evaluat ion as part of the learning object ives. The one used at the Ham dan bin Moham m ed College of Dental Medicine, Desire 2Learn (Brightspace 10.3, available at ht tp://w w w.atom iclearning.com /desire-2-learn-10.3-student-t rain ing) is certain ly t im e-e cient once set up for the subject m at ter. Addit ionally, LEAP can assist in the process of self-evaluat ion.

Cont inuing professional developm ent (CPD) is m andatory, and m any professional bodies have legislat ion in place requiring successful com plet ion of a de ned num ber of hours for professional license renewal.

item scale (st rongly agree, agree, unsure, disagree, and st rongly disagree) was used to ensure ease/e ciency of lling in the paper form s for each e-m odule package. Anonym -ity was ensured. Di erences in m eans and standard deviat ions across the four groups were apparent (Fig. 16.3). Interest ingly, in this study the group m eans were signi -cantly di erent from one another, w ith (G)nathos clearly favored and highly accepted. The standard deviat ions for SBLi and (G)nathos were slightly greater than those of the other m odules and m ay re ect the dif-ferent tastes and styles in learning.

Although the num ber of e-m odules available in orthodont ics is lim ited, the SBLi was the rst in teract ive m odule to be developed in Aust ralia. The aim was to prom ote independent self-learning, w hich is essent ial if health professionals are to at tain the rst two goals of Miller’s assessm ent pyram id: “knows” and “knows how.”54 Moreover, it would be an im portant resource for procedures show n on em bed-ded videos for clin ical applicat ions. Hence the signi cance of developing e-m odules on sound andragogy principles.

Fig. 16.3 Acceptability of the various e-programs in orthodontics on a 5-point Likert opinion scale (x-axis). Greater overall acceptability of the (G)nathos style in comparison with the others during the academic year 2012.


literature, form at ive/ sum m ative assessm ent , preferably w ith im m ediate feedback generated by algorithm s)

It has been recognized that the cur-rent generat ion lives at a t im e of instant grat i cat ion , w hich includes instan t m es-saging and the instant acquisit ion of infor-m at ion via the In ternet . The Universit y of Queensland study29 raised the issue of the need for instant feedback, and perhaps a Skype in terface for online webinars would work for such a purpose. A sim ilar at tem pt by the 3M Web site,56 w ith synchronous real-t im e webinars presented by reputable in ternat ional speakers, has gained huge popularit y. The greatest advantage of th is program is the in teract ion at the end of the PowerPoint presentat ions, w ith quest ion-and-answer sessions. Face-to-face discus-sion clears concepts and provides a “not alone in the World Wide Web” feeling, to quote one of the par t icipants. One needs to be m indful that th is m ethod of inst ruc-t ion too would increase const rain ts on t im e and would be resource-in tensive for inst ructors/academ ics.

The higher cognit ive funct ions of analy-sis and synthesis can be encouraged w ith e-m odules. Moreover, st ructured e-m od-ules increase the e ciency of learning because t im e is not wasted during tangent Web sur ng.57 In teract ive m odules enhance learner in terest .58 Built-in quizzes are often used as self-tests before the exam inat ion period. Furtherm ore, cr it ical th inking and problem solving are often easily observed in experts w ho acquire these skills over sev-eral years follow ing graduat ion .59 E-m od-ules provide learners w ith problem -based learning to acquire such expert ise early in their careers. Ideally, it would be preferable to evaluate crit ical th inking follow ing deep learning, but th is can be rather challeng-ing,60 along w ith the lim ited sam ple size of learners in specialist program s.

Subject ive evaluat ion of the e-learning style preference captured in th is sm all study indicates that future e-m odules need to address the “edutainm ent” factor of online learning. Moreover, the style of pre-

Online CPD courses are a convenient opt ion for busy pract it ioners, and recent Euro-pean recom m endat ions22 have once again st ressed the need for sound pedagogi-cal principles in the design of online CPD courses. Webinars o er the synchronous online delivery of inform at ion; however, w ith global t im e di erences, par t icipat ion can som et im es be challenging. Quest ion and answer sessions in real t im e are the for te of webinars, but once again , because of lim ited t im e, not all par t icipants can have their queries answered, w hich is frus-t rat ing after they have lost out on sleep. Therefore, asynchronous online learning is considered m ore user-friendly.

Nothing is m ore sat isfying than deep, m eaningful learning w ith the clari cat ion of key concepts. Biom echanics has always been a challenging concept , par t icularly w hen explained w ith two-dim ensional dia-gram s, and e-learning m odules for th is sub-ject were rst developed in 1992.55 Online version 4, available since 2013, is a very creat ive and engaging software that allows di cult concepts to be clari ed. Nearly 50 dental and or thodont ic program s have sub-scribed, and m ore than 1,000 e-copies of the software have been purchased.

Essent ial guidelines have been pre-sen ted for developing online teaching, and the use of w indows for in -depth learning has been advocated. Videos, anim at ions, and sounds, w hen used appropriately, fur-ther enhance learning and engagem ent . New standardizat ions, m ethodologies, and techniques can be covered by distance e-learning provided that there is no cogni-t ive overload.

• Concepts (anim at ions, videos, in teract ive)

• Procedures (videos, clin ical footage, and three-dim ensional anim at ions, m any prepared by or thodont ic providers)

• New techniques (text , videos, clin ical footage, three-dim ensional anim at ions, m any prepared by orthodont ic providers)

• Self-assessm ents (open- and closed-ended quest ions, cr it ical th inking, linking w ith evidence-based


th ree-dim ensional learning packages for the future, how can we bridge the gap? That is the big quest ion for the next decade or so. At the level of ter t iary educat ion, par t icu -larly in the health sciences, a large com po-nent consists of hands-on t rain ing and skill learning, along w ith the acquisit ion of vital inform at ion that can be ret r ieved im m edi-ately in case of em ergency. CPD, webinars, skill laboratories, and sim ulat ions are all technological IT advances that have becom e available in the past two decades and are cont inually being re ned for bet ter reso-lut ion , speed of access, and versat ilit y to enhance online learning.

The ideal online learning of the future would be:

• Sim ple (software w ith a m inim al learning curve to conserve the user’s t im e)

• As close to real scenarios as possible• Engaging/in teract ive• Enter tain ing and fun to use• In addit ion , self-evaluat ion would

be included to gauge w hether learning goals have been ach ieved, and crit ical th inking would be encouraged.

16.14 Conclusion and RecommendationsThe developm ent of e-m odules is a resource-intensive exercise w ith large econom ic and t im e implicat ions for creators and Web designers. Therefore, it would be bet ter “not to reinvent the w heel” rem aking the sam e subject m odules and to am algam ate inter-nat ionally available e-m odules for a global orthodont ic learning portal. Doing so would signi cantly add to blended learning and enhance tradit ional teaching.

As aptly described by Luckin and col-leagues,68 “e-learning is the capabilit y required of learners/users in order that they can m anage their ow n learning in the twenty- rst century using technology as appropriate to context and task.” In terest-ingly, the results of popular polls indicate

sentat ion of didact ic m aterials is essent ial not only for acceptabilit y and engagem ent but also for long-term m em ory retent ion because pleasing episodes are recalled for a longer t im e. Ideally, such a variety of styles w ith long-term follow-up, both for personal preference and subject m at ter evaluat ion , could guide academ icians in producing m odules that would have an im pact on m etacognit ion . Outcom e evaluat ions in the future w ill require greater sam ple sizes as nat ional audits of the h igher educat ion delivery process.60

System ic reviews and m eta-analysis, considered a hierarchy of evidence, rein-force that learning is e ect ive w ith e-m od-ules.15,61 The m ajor bene ts are exibility and access 24 hours per day, 7 days per week, 365 days per year w ith no global boundar-ies—providing unlim ited academ ic freedom that is not available w ith other m odes of t radit ional learning. A group study from the United Kingdom st resses that e-m odule quality and design are param ount to engage the in terest and involvem ent of the learner. A recent sm all-scale study has certainly val-idated that .29 A review of e-learning could not reach clear conclusions regarding the e ect iveness of this m edium .62 A relevant orthodont ic study by Kom olpis and John-son63 did not nd a signi cant di erence. Ruiz et al64 stated that there is a higher acceptance of e-learning w ith greater learner sat isfact ion, and that there is som e evidence to suggest increased retent ion of inform ation follow ing e-learning, albeit not stat ist ically signi cant .

Academ icians in m ost leading univer-sit ies are now required to have a diplom a in h igher educat ion (ter t iary) so as to be able to provide inform at ion on sound cognit ive principles and encourage the process of deep learning rather than a super cial or st rategic exam inat ion-based outcom e.65 The e-m odules are therefore required to be produced on sound ter t iary educat ion principles. There is cont inued in terest in exploring the ever-im portant relat ionship of online learning for m edical professionals.66,67

Unt il our toddlers w ith their tablets undertake to put together sophist icated


as par t of the Universit y of Queensland New Sta research star t fund. The cost of the project exceeded and was supplem ented by the author’s consultat ion fee fund.

Acknowledgments

I would like to thank all those involved in preparing this chapter: Professor Athana-siou for providing a unique opportunity—it is indeed a privilege and an honor to work under his guidance and encouragem ent—and Avril Reid and Moham ed Rafeeq at the library of Moham m ed Bin Rashid Academ ic Medical Center for promptly providing lit -erature access, and Dr. Shaim a Al-Naqbi for proofreading in depth .

The original research projects on SBLi and the various or thodont ic teaching m od-ules were also presented at the follow ing in ternat ional congresses:

• 1st E-Lernen vielversprechend für die kieferor thopädische Fachzahnarztausbildung? Wissenschaft liche Jahrestagung der Deutsche Gesellschaft fü r Kieferorthopädie (DGKFO); Septem ber 10–13, 2014; Munich, Germ any

• Evaluat ing di erent e-learning styles in or thodont ics. 28th Brit ish Orthodont ic Societ y Congress; Septem ber 18–20, 2014; Edinburgh, United Kingdom

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Moattari M. Comparing two m ethods of edu-cation (virtual versus tradit ional) on learning of Iranian dental students: a post-test only design study. BMC Med Educ 2014;14:45. h t t p : / / w w w .b io m e d ce n t r a l .co m / 1 4 7 2 -6920/14/45. Accessed February 13, 2015

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Nat ional and in ternat ional collabora-t ion in developing online learn ing is the way to go. It cer tain ly is proceeding at a brisk pace w ith som e didact ics. Orthodon-t ics w ill need to catch up and provide an in ternat ional forum for such e orts. Ongo-ing research and consum er evaluat ion of h igher educat ion w ill provide feedback for the cont inuing developm ent of live online docum ents by subject experts. One needs to be m indful in or thodont ics of pat ient con dent ialit y, and that the m aterial used in e-learning m ust be appropriately de-ident i ed.

With e-educat ion , it is rather chal-lenging to evaluate outcom es and process m easures w ith a lim ited sam ple of post-graduate student in take each year. A recent study29 explored w hat creates in terest for postgraduate students, w ho are often st ruggling w ith t im e m anagem ent . Perhaps it is important to view the bigger picture w ith lateral th inking; second-order m eta-analyses are a bet ter way to evaluate the ever-evolving e-learning landscape. Mate-r ial used less than ve years ago would be either obsolete or outdated technologi-cally and could not provide evidence w ith a large m eta-analysis. Hence, the challenge is to obtain concrete evidence w ith online learning m ethodologies. On the other hand, th is is a very excit ing and liberat ing forum to explore and build . Therefore, the direc-t ion of future learning is to provide m eans for sustainable self-learning.71

Con ict of Interest

There is no con ict of in terest to report . This project was funded by UQN-SRSF–2010000763 (NASER-UD-DIN Shazia)


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144

The Role of Continuous Professional Development in Orthodontic EducationAthanasios E. Athanasiou

Orthodont ic postgraduate educat ion aim s to produce graduates w ho (1) have com -pleted their didact ic and clin ical educat ion at an inst itut ion of h igher learning, (2) have received a broad-based advanced educat ion in or thodont ics and relevant biom edical sciences, (3) have obtained a solid back-ground in or thodont ic diagnosis and t reat-m ent m odalit ies, and (4) are fully quali ed to becom e specialists in th is discipline.

Postgraduate or thodont ic program s around the world usually have a durat ion that ranges from 24 to 48 m onths, w ith the m ajorit y of them being 36-m onth full-t im e courses. Nowadays, residents are required to at tend a goodly num ber of supervised clin ical sessions to establish pro ciency in clin ical or thodont ics. In addit ion , a signi -cant am ount of course work is dedicated to research and addit ional, clin ically related tasks (e.g., t reatm ent planning, preparat ion of tutorials, case presentat ions). The num -ber of new pat ients assigned to each resi-dent m ay vary am ong schools but is usually not less than 30, and an equal num ber of t ransferred cases are also included during the course of study. The program s expose the residents to a variety of contem po-rary t reatm ent m odalit ies, techniques, and appliances, w hile w rit ten and/or oral evaluat ions are conducted to assess post-graduate students’ perform ance. Most of the program s require the subm ission of a disser tat ion, w hich reports original data derived from research act ivit ies in various elds, and/or the preparat ion of a paper in a publishable form at .1,2

When the lim ited num ber of places available for or thodont ic postgraduate edu-

17

cat ion and the disproport ionally h igh num -ber of quali ed applicants are taken in to considerat ion , it is natural that postgradu-ate program s accept as residents those w ith ext rem ely good quali cat ions and outstanding academ ic records. As a result , postgraduate or thodont ic classes consist of very com pet it ive, st rongly m ot ivated, and sharp -m inded students w ho welcom e the opportunity to study or thodont ics, do research that usually leads to publicat ion in refereed scient i c journals, and are greatly appreciat ive of their clin ical t rain ing. Crit i-cal th inking is an im portant par t of their daily educat ional rout ine.

Follow ing graduat ion , orthodont ic specialists m ust cont inue their educat ion and update their exist ing scient i c knowl-edge by reading scient i c publicat ions and at tending refresher courses, as well as by acquiring fur ther technical t rain ing in new clin ical and laboratory techniques. Material is easily accessible and m ay be provided at hom e or abroad. The or thodont ic specialist m ay choose to at tend courses, lectures, or sem inars from a variety of available t ypes to sat isfy theoret ical, clin ical, and techni-cal needs and priorit ies. In m any countries, th is t ype of cont inuous professional devel-opm ent is also m andatory for m aintain ing the validit y of both the dental license and specialt y quali cat ions.

In the past , only scient i c societ ies, pro-fessional groups, and inst itut ions of h igher learning provided cont inuing or thodon-t ic educat ion . Nowadays, the or thodont ic indust ry, indirect ly or direct ly, is heav-ily involved in these act ivit ies. The goal is obvious—nam ely, the m arket ing of their

17 The Role of Continuous Professional Development in Orthodontic Educat ion 145

products. Market ing is de ned as “the the-ory and pract ice of (large-scale) selling” or “the various act ivit ies by w hich goods are supplied, advert ised, and sold.” “Theory” and “advert isem ent” are the two essent ial com ponents of m arket ing, w hich are also an in tegral par t of the cont inuing educat ion act ivit ies provided by indust ry. Although m arket ing is useful for inform ing consum -ers of exist ing products and innovat ions, it is also h ighly biased and clearly involves con icts of in terest .

Although new orthodont ic appliances and techniques should o er som e superior-it y to com pet ing products, exist ing m arket-ing st rategies require that , to be at t ract ive, they also look exclusive, custom -m ade, and special. In th is way, the custom ers w ill feel that they belong to a special VIP group. It is no surprise that the m ost aggressive and e ect ive m arket ing of or thodont ic tech -niques, m aterials, and appliances is pro-m oted as a “total t reatm ent ph ilosophy and appliance system ,” so that clin icians m ust com pletely in tegrate the w hole “package” of products in to their clin ical pract ice.

At present , cont inuing educat ion act ivi-t ies concerning or thodont ic techniques and appliances direct ly organized or indirect ly sponsored by the or thodont ic indust ry are outnum bering those organized by scient i c or professional organizat ions based solely on noncom m ercial criteria. Postgraduate students and young or thodont ic specialists const itute a signi cant com ponent of the “clientele” of these m eet ings organized by the indust ry.

When an enorm ous am ount of clin ical inform at ion is unilaterally given to or th-odont ic pract it ioners w ithout validat ion or veri cat ion ,3 professionals need to scru-t in ize and re ne it . In telligent colleagues, w ith their scient i c background acquired during postgraduate studies, and w ith their com m on sense, should not unquest ion ingly accept claim s of “faster t reatm ents associ-ated w ith less ext ract ions, w ithout root resorpt ion , and w ith m inim al periodon-tal problem s, no relapse, and superb den-tal and facial aesthet ics.” They should ask som e quest ions: Which clin ical studies? Where have they been published? Are their

results ident ical to the corresponding in ter-pretat ions and claim s of the indust ry? Have the con icts of in terest or the com m ercial in terests of the speakers and authors been clearly ident i ed? Does evidence-based m ean random ized prospect ive clin ical t r ial, system at ic review, and/or m eta-analysis of the evidence? What m akes these col-leagues hope that by at tending such m eet-ings, w hich are organized by or thodont ic com panies and w hose speakers are usually on the com panies’ direct or indirect pay-roll, they w ill incorporate in to their clin ical pract ices “predictable t reatm ent , greater pat ien t com fort , consistent and reliable n-ish ing” or “excellent results in fewer visits”?

Is it a m entalit y and/or a con dence problem that causes one to shift in tellec-tually from the com plex, sophist icated, and unpredictable clin ical realit y of or th -odont ic pract ice to the sim pli ed cookbook approach? Or it is an at tem pt to “com pete” w ith colleagues and clin ics using the sam e “exclusive, m odern , and special tech-niques,” w hich nowadays in m any countries are openly prom oted to the general pub-lic w ith all available m eans of publicit y? What happens to the crit ical th inking and the evidence-based scient i c background acquired and developed during postgradu-ate educat ion?

Exist ing scient i c evidence does not support claim s that cer tain or thodont ic techniques, m aterials, and appliances pos-sess ext raordinary biological and biom e-chanical proper t ies and characterist ics, so that the nal t reatm ent outcom e w ill be bet ter, faster, and m ore risk-free w ith their use and applicat ion than w ith others.4–7

Orthodont ics rem ains a dental disci-pline w hose pract ice involves both ar t and science, and regret tably, scient i c docu-m entat ion and evidence are not available in m any areas. However, the t rend is clear. Our specialt y closely follows the path of all other biom edical sciences and disciplines, in w hich scient i c evidence m ust support diagnosis and t reatm ent .8

For the near fu ture, we should expect that the involvem ent of technology in clin i-cal m anagem ent w ill cont inue to increase, especially w ith regard to the diagnost ic and


References 1. Athanasiou AE, Darendeliler MA, Eliades T, et

al; World Federation of Orthodontists. World Federation of Orthodontists (WFO) guide-lines for postgraduate orthodontic education. World J Orthod 2009;10(2):153–166


3. Kau CH. Orthodont ics in the 21st centu-ry: a view from across the pond. J Orthod 2012;39(2):75–76

4. Mavreas D, Athanasiou AE. Factors af-fect ing the durat ion of or thodont ic t reat-m ent: a system at ic review. Eur J Orthod 2008;30(4):386–395

5. Flem ing PS, Johal A. Self-ligat ing brackets in or thodont ics. A system at ic review. Angle Orthod 2010;80(3):575–584

6. Weltman B, Vig KW, Fields HW, Shanker S, Kaizar EE. Root resorption associated with orthodontic tooth movement: a system -atic review. Am J Orthod Dentofacial Orthop 2010;137(4):462–476, discussion 12A

7. Nim eri G, Kau CH, Abou-Kheir NS, Corona R. Accelerat ion of tooth m ovem ent during orthodontic t reatm ent—a frontier in ortho-dontics. Prog Orthod 2013;14:42–50

8. Turpin DL. Im prove care w ith clin ical prac-t ice guidelines. Am J Orthod Dentofacial Or-thop 2009;136(4):475–476

biom echanical therapeut ic aspects. Prog-ress should be ant icipated in understanding the et iology of various cran iofacial anom a-lies, so that their clin ical m anagem ent w ill be enhanced. Standards of or thodont ic educat ion w ill cont inue to rise, and or tho-dont ics w ill be m ore polit ically involved w ith in its social environm ent , thus facili-tat ing the im provem ent of condit ions for the provision of or thodont ic services to the populat ion. In m any par ts of the world, a large proport ion of the populat ion, w hich at present is excluded, w ill obtain access to or thodont ic services. This progress requires the contribut ion of well-educated, m odern or thodont ic specialists t rained in well-st ructured postgraduate or thodon-t ic program s; it also requires the involve-m ent of dedicated, quali ed, and am bit ious teachers w ho w ill act as role m odels for academ ic excellence, clin ical com petence, and professional at t itude.

Crit ical th inking, as related to scient i c docum entat ion and cost–bene t judgm ent , m ust characterize all hum an resources involved in the system s of or thodont ic edu-cat ion and pract ice. The role of cont inuous professional developm ent in or thodont ic educat ion is of great im portance. How -ever, the issues of com pet ing and con ict-ing in terests m ust be clearly ident i ed, addressed, and taken in to considerat ion w hen the object ivit y, substance, and evi-dence-based characterist ics of presented inform at ion are judged.

147

The Role of Scienti c Journals in Orthodontic Specialty EducationDavid L. Turpin

Before 1900, dental publicat ions often included historical ar t icles consist ing of rather crude descript ions of clin ical pro-cedures used to m ove teeth , often called orthodont ia. Evidence found in hum an skulls indicates that crooked teeth have been around since the t im e of Neanderthal m an (circa 50,000 bc ), but it was not unt il 3,000 years ago that we had the rst w rit -ten record of at tem pts to correct crow ded or prot ruding teeth .1 Beginning in the 18th century, the leading country in the eld of dent ist ry was France. This was the result of the e or ts of one m an, Pierre Fauchard (1678–1761), w ho has been called the father of or thodont ia. As such, he was the rst to rem ove dent ist ry from the bonds of em piricism and put it on a scient i c foun-dat ion. In 1728, he published the rst gen-eral work on dent ist ry, a two-volum e opus ent it led The Surgeon Dent ist: A Treat ise on the Teeth.2 In the early 19th century, before the t im e of Edward H. Angle, the t reatm ent of m alocclusions was taught w ith lit t le understanding of norm al occlusion and even less about the developm ent of den-tal and skeletal problem s. Appliances were prim it ive, and there was no rat ional basis for diagnosis and case analysis. It was m uch later that Calvin Case showed rem arkable foresight in di erent iat ing between “dental m alposit ion” and “dentofacial im perfec-t ions,” comparable w ith today’s term s for dentoalveolar and skeletal problem s. Later, he becam e know n for advocat ing ext ract ion to correct facial deform it ies. Case’s 1911 paper provoked an acrim onious debate that cam e to be know n as the great ext ract ion debate. According to Norm Wahl, dent ists

18

today are likely to be am azed at the bit ter, uncom prom ising tone of so-called scien-t i c discussions. Yet , that was the character of the era; in tem perate rem arks and per-sonal villi cat ion were the order of the day, all in the nam e of science.3,4

Norm an W. Kingsley (1825–1896) was the rst of those dental pioneers who m ade the last half of the 19th century a period of great advancem ent. He becam e w idely known after publishing his Treatise on Oral Deform ities as a Branch of Mechanical Sur-gery.5 Later on, the em ergence of orthodon-t ics as a true specialty was largely the result of the e orts of one m an, Edward Hartley Angle (1855–1930), regarded as the father of m odern orthodontics.6 Sheldon Peck studied the career of Dr. Angle for nearly a lifetim e, and after reading hundreds of his personal let ters, he concluded, “Edward Hartley Angle’s dream in 1900 was to m ake orthodontia a self-standing division of medi-cine. He sought to do this in three ways: by creat ing a specialty school of orthodontia, by organizing a society of orthodontic spe-cialists, and nally, by init iating a scienti c journal exclusively for the new specialty.” After Dr. Angle started the Am erican Soci-ety of Orthodontists in 1901, the world’s rst orthodontic specialty association and forerunner of the Am erican Association of Orthodontists (AAO), he started the Angle School of Orthodontia in St . Louis, Missouri. Then, in 1906, he was responsible for init i-at ing the rst scienti c journal dedicated to orthodontics, The Am erican Orthodontist. Material to publish in the rst four issues, released in 1907, was gathered by the newly appointed editor, Martin Dewey, one of


Angle’s m ost accomplished graduates. The rst issue contained papers read at the Angle School alum ni m eeting, held that year in St. Louis. After a year of publication, it becam e m ore and m ore di cult to nd subm issions of high quality for the new specialty journal. Much to the dism ay of Angle, Dewey then resigned as editor. Determ ined not to let the concept of a specialty journal die, Milo Hell-m an, another distinguished graduate of the Angle School, agreed to take on the editor-ship in 1910. Despite continued support by the Alum ni Society of the Angle School and great e ort , as evidenced by the publicat ion of eight m ore issues, the journal closed in October of 1912.7,8

The cost of publicat ions was h igh, and there was lit t le of m erit to publish in those days. Despite these ongoing problem s, Ber-nhard W. Weinberger found support for other new journals of the day and peri-odically subm it ted ar t icles on the h istory of dent ist ry as ller m aterial. After a few years of th is experience, considered suc-cessful, Weinberger was hooked on his-tory. He proceeded to publish 250 books, m onographs, and ar t icles in a landm ark bibliography ent it led An Introduct ion to the History of Dent istry (1948).8 Other popular or thodont ic journals that have taken root since those early days include The Angle Orthodont ist (1930), Journal of Clinical Orthodont ics (1967), and the World Journal of Orthodont ics (2000), recently renam ed under ow nership of the World Federat ion of Orthodont ists as the Journal of the World Federat ion of Orthodont ists (2010).

During the early years of the 20th cen-tury, popular appliances included Angle’s ribbon arch, the Crozat and Mershon lingual appliances, and the McCoy open tube. Dr. Edward Angle completed work on his rst complete edgew ise appliance in 1925, and four years later, Spencer Atkinson cam e out w ith the universal appliance. For the fabri-cation of bands and arch w ires, the m aterial m ost frequently chosen was gold. Bands were pinched and soldered. There were no orth-odontic supply houses, only dental suppliers such as S. S. White and the gold m anufactur-ers. Before 1887, it was necessary to design and fabricate an appliance for each patient individually, which could take hours. Angle

recognized the need to standardize his appli-ance, thus creat ing the Angle system, which could be purchased in various com binations of prefabricated parts. Through his in uence, orthodontics em erged from a speculative state and becam e an exacting science.9

Today, the specialt y of or thodont ics is looked upon by the public w ith respect , even adm irat ion . There are at least 30 English language journals w hose prim ary focus is or thodont ics; m any m ore could be listed if we included journals in related areas, such as oral surgery and periodon-t ics. Most professionals st ill know lit t le about the st ruggles that took place in it ially, w hen the teaching of or thodont ics was not yet welcom e in the dental school curricu-lum . Orthodont ics was new as a specialt y, second only to ophthalm ology. Angle even speculated that or thodont ics was dest ined to becom e a specialt y of m edicine.

Years passed, and in looking back at the early developm ents rightfu lly claim ed dur-ing the 20th century by those dedicated to the specialt y of or thodont ics, one has to be im pressed. The perfect ion of xed appliances was far ahead of the m any con-t r ibut ions m ade in later years to assist in diagnosis and t reatm ent planning. More than 50 years later, the use of adhesives to replace m etal bands and the applicat ion of or thognathic surgery, not to m ent ion a bet-ter understanding of the biology of tooth m ovem ent and the response of grow ing sutures to a variet y of forces, have all had a great im pact on the abilit y of orthodont ists to t reat m alocclusion of the teeth and jaws. One has to believe that the publicat ion of scient i c journals for the past 100 years has also played a m ajor role in helping to bring m any of these ideas to fruit ion .9

18.1 Role of the Journal EditorSeveral years ago, the Am erican College of Dentists devoted an entire issue of its journal to “advice for a young editor.”10,11 That advice is well worth considering if you believe that involvem ent in scienti c journalism adds value to the academ ic curriculum .

18 The Role of Scient i c Journals in Orthodontic Specialt y Education 149

m anuscript preparat ion. Excellent journal-ism can help m erge scienti c ndings w ith patient needs, in uencing t reatm ent plans and improving outcom es. A specialty whose m em bers can express them selves via the publicat ion of properly conducted clinical research can enrich untold num bers of peo-ple throughout the world—both colleagues and the public at large.

18.2 AuthorshipAuthorship credit should be based on (1) substant ial cont ribut ions to concept ion and design, acquisit ion of data, or analysis and in terpretat ion of data; (2) draft ing of the art icle or crit ical revision for im portant in tellectual content; and (3) nal approval of the version to be published. Authors should m eet all three of these condit ions.

The acquisit ion of funding, collect ion of data, or general supervision of the research group alone does not const itute author-ship. When a large, m ult icenter group has conducted the work, the group should ident ify the individuals w ho accept direct responsibility for the m anuscript .12 These individuals should fully m eet the criteria for authorship/contributorship previously de ned, and editors w ill ask them to com -plete journal-speci c author and con ict -of-interest disclosure form s.

All contributors who do not meet the criteria for authorship should be listed in an acknowl-edgments section of the respective journal. Examples of those who might be acknowledged include a person who provided purely techni-cal help or writing assistance, or a department chair who provided only general support.

18.3 Institutional Review Board ApprovalA university’s inst itut ional review board (IRB) has the responsibilit y of developing and approving all research studies involving hum an beings before the in it iat ion of such research. Determ ining w hether or not the design of a project m eets the federal de ni-

The rst responsibilit y of an editor is to the readers. The editor should work to ensure that the conten t is from repu-table sources, factually accurate, balanced, and unbiased. Personal opinion should be labeled as such, w ith potent ial con icts of in terest disclosed. The publicat ion should be readable and based on a standardized style, w ith careful edit ing for gram m ar and clarit y. Opportunity should be provided for alternat ive opinions w hen possible.

The second responsibility of the editor, representing the professional com m unity, is to the authors. The editor should pro-m ote the dignity of the specialty, regularly publishing the standards for the select ion of content and the form at for the subm ission of m aterial. All m aterial should be reviewed by competent experts in the eld, in a fashion that is t im ely, con dential, and constructive. Standards should be set for reviewers and the rules according to w hich they operate enforced for all peer-reviewed art icles.

The th ird responsibilit y of the editor is to the organizat ion publishing the journal. The editor should diligently avoid placing the sponsoring organizat ion in a legally quest ionable posit ion . He or she should respect the term s of em ploym ent , fu lly understanding w hat is expected as both an editor and a par t icipant in various com m it-tees, task forces, annual m eet ings, and so on . The editor should ensure that the adver-t ising is in good taste and does not violate the associat ion’s advert ising guidelines.

The fourth responsibilit y of the editor is to the com m unity of editors. This m eans that the editor should regularly seek advice and be open to guidance from peers. The editor should endorse policy covering re-publicat ion and other use of published m aterial, and be open to incorporat ing new form s of com m unicat ion , such as videos and blogs. In all form ats used, the editor should have the nal say regarding the con-tent of the publicat ion , not the organizat ion or it s sponsoring advert isers.

Writ ing and edit ing are privileges of self-expression and entail ethical respon-sibilit ies to readers. Sound advice to any editor of a scient i c journal is to build and m aintain trust by know ing the process. This also applies to the student in the m iddle of


18.5 Protection of Human Subjects and Animals in ResearchWhen report ing experim ents on hum an subjects, authors should indicate w hether the procedures followed were in accor-dance w ith the eth ical standards of the responsible com m it tee on hum an experi-m entat ion (inst itut ional and nat ional) and w ith the Helsinki Declarat ion of 1975, as revised in 2000.5 When report ing experi-m ents on anim als, authors should indicate w hether the inst itut ional and nat ional guide for the care and use of laboratory ani-m als was followed.

18.6 Copyright Ow nershipWith the increase in the size and num -ber of journals designed to publish scien -t i c ndings, controlling the ow nership of art icles becom es increasingly im portant to m any authors. That leads us to an age-old quest ion: Who ow ns the copyright to your words, and how can you protect that ow nership?

The author of an art icle or other w rit ten m aterial ow ns the copyright to that m ate-rial, even if the copyright has not been reg-istered, unt il such t im e as he or she assigns ow nership to another ent ity. Most publica-t ions have a standard copyright form that the author is asked to sign before a w rit-ten work is published. This form de nes w ho retains ow nership of the work as well as other issues, such as the right to reprin t the work. Editors and authors alike should ensure that all copyright issues are set t led in w rit ing, to the sat isfact ion of both par-t ies, before publicat ion. The copyright t ransfer gives a publisher or the ow ner of the publicat ion the exclusive right to pub-lish the art icle. This right m ay also grant authors certain rights to their own work, including the right to post it on their ow n Web sites for their students and those w ho

t ion of hum an subject research is a two-step process. The invest igator m ust determ ine if the project m eets the federal de nit ion of research and, if so, determ ine if the project includes hum an subjects. Addit ional infor-m ation can be found on the follow ing Web site to help you determ ine w hether or not IRB review is required for a speci c study13: h t t p : / /w w w .fd a .gov/ regu lator yin for m a-t ion/guidances/ucm 126420.htm

The purpose of IRB review is to ensure, both in advance and by periodic review, that appropriate steps are being taken to protect the rights and welfare of hum ans par t icipat ing as subjects in the research. To accom plish th is purpose, the IRB uses a group process to review research protocols and related m aterials.

18.4 Obligation to Register Clinical TrialsThe In ternat ional Com m it tee of Medical Journal Editors (ICMJE) believes that it is im por t an t to foster a com prehensive, publicly available database of clin ical t r i-als. The ICMJE de nes a clin ical t r ial as any research project that p rospect ively assigns hum an subject s to in terven t ion or to concur ren t com par ison in a con t rol group to study the cause-and-e ect rela-t ionsh ip bet w een a m edical in terven t ion and a health ou tcom e. The ICMJE m em -ber journals m ay require, as a condit ion of considerat ion for publicat ion in their jou rnals, regist rat ion in a public t r ials regist r y. There are addit ional bene t s to the regist rat ion of clin ical t r ials. It m ay preven t redundancy in cer t ain research top ics and assist in allow ing subsequen t invest igators to gather data sim ilarly, so that pooling or com par ison of the resu lt s can be m ore easily accom plished . In gen -eral, the purpose of a clin ical t r ial regist r y is to prom ote the public good by ensur-ing that everyone can nd key in form a-t ion abou t every clin ical t r ial in the w orld w hose pr incipal aim is to shape m edical and den tal decision m aking.14


the ow nership of intellectual output , an author should understand the consequences and opt ions.

The issues of access to research ndings and the r ights of authors w ill cont inue to be of concern to authors and publishers as they seek to nd the proper balance. There is every reason to believe that th is balance can be achieved w hen both sides com m u-nicate their deepest concerns and listen to one another as changes cont inue in the publishing indust ry.

In a related issue involving copyright , authors should guard against their work being used im properly. This includes words and graphics, such as char ts and photo-graphs. The term plagiarize is de ned as to “appropriate and pass o as one’s ow n the w rit ings and ideas of another.” Legal resources, including books, ar t icles, and other m aterials, should be consulted to explore th is topic m ore fully. All of th is m eans that credit should be given to, and perm ission obtained from , appropriate sources w hen needed.

18.7 Con icts of InterestA renewed focus on the potent ial for con- icts of in terest in scient i c w rit ing is evident in m any of our periodicals, educa-t ional inst itut ions, and research com m uni-t ies. In scient i c authorship, the term refers to situat ions in w hich nancial or other personal considerat ions m ight com prom ise the in tegrit y of professional judgm ent dur-ing the conduct or report ing of research . Historically, the key stages in the evolut ion of requirem ents for disclosure of in terest began in 1984, w hen Arnold Relm an, edi-tor of The New England Journal of Medicine, proposed that all m edical journals require authors subm it t ing scient i c m anuscripts to ident ify any relevant nancial connec-t ions w ith indust ry. In 1990, the sam e jour-nal im plem ented a policy to forbid authors of reviews or editorials to have nancial t ies w ith com panies w hose products gured prom inently in the ar t icle, although th is rule was often violated.16,17

listen to their scient i c presentat ions. If an author wants to reuse a gure that has been published previously, m ost publishers m ake it easy w ith an online perm issions process.

But w hat if an author wants to retain m ore r ights than the publisher allows? For exam ple, w hat if the author’s funding requires “open source” dist r ibut ion of h is or her ar t icle? In the United States, th is m ay m ean that the ar t icle should be sent to the Nat ional Inst itu tes of Health w ith in 6 to 12 m onths after the original publicat ion date so that it can be posted on the Nat ional Inst itutes of Health Web site and be m ade freely available to all readers. Doing th is could require a change in the original copy-right agreem ent . Is that possible? If so, how can the author ensure that it w ill happen? Most publishers are now very aware of the desire for “open access” to published nd-ings and have o cially agreed to work w ith their authors to provide greater access.

The Scholarly Publish ing and Academ ic Resources Coalit ion (SPARC) is one ent it y that was form ed w ith th is purpose in m ind. SPARC, an in ternat ional alliance of m ore than 800 academ ic and research librar-ies, works toward a m ore open system of scholarly com m unicat ion .15 It believes that to achieve a m ore balanced approach to copyright m anagem ent , authors should consider the follow ing steps:

• Reading the publicat ion’s copyright agreem ent w ith great care. It m ay capture m ore of an author’s r ights than is necessary to publish the work. Ensuring that the agreem ent is balanced and clearly states the author’s rights is up to the author.

• Negot iat ing for the agreem ent that is wanted. Publishing agreem ents are negot iable, and publishers m ay require only perm ission to publish an ar t icle, not w holesale t ransfer of copyright .

• The author should value the copyright in h is or her in tellectual property. A journal ar t icle is often the culm inat ion of years of study, research, and hard work. The m ore the art icle is read and cited, the greater its value. Before t ransferring


In 2001, the editors of 13 leading m edi-cal journals published a join t editorial not-ing the im pact of the com m ercializat ion of m edical research on researchers’ behavior. That was the predecessor of the Uniform Requirem ents for Manuscripts Subm it ted to Biom edical Journals, form ulated by the ICMJE. The ICMJE con ict -of-in terest form is now used by m any journals. It can be im plem ented sim ply by dow nloading it to a computer (h t tp://w w w.icmje.org/con icts-of-in terest /),18 com plet ing and saving it , and subm it t ing it direct ly to the journal to w hich the m anuscript has been sent .

Because we have entered in to a world w ith com plex in teract ions of indust ry and science, w hich are the subject of crit ical in terest because of the potent ial nan-cial exploitat ion of research ndings, the disclosure of any potent ial t ies of authors to th ird par t ies becom es necessary. The reader has the r ight to know w hether an author has an underlying a liat ion w ith the indust ry. It is a right to exercise at h is or her discret ion, and hiding th is inform at ion can only dam age the validit y of the publica-t ion and the t rust of the public in the scien-t i c endeavor. Potent ial con icts of in terest related to the com m itm ents of editors and journal sta , or even reviewers, are m ost often detected by other reviewers. How-ever, in th is age of elect ronic journalism , com panies have developed software like CrossCheck, w hich is a system for detect-ing plagiarism . CrossCheck com pares a new subm ission against a database of m ore than 30 m illion ar t icles from 200 publishers. A “sim ilarit y report” speci es the percentage of the text of the new subm ission that over-laps w ith the text of one or m ore published ar t icles. As convenient as they sound, these and sim ilar program s have shortcom ings. That said, reviewers are st ill our best line of defense. To sum m arize th is issue, edi-tors should avoid select ing external peer reviewers w ith obvious potent ial con icts of in terest—for exam ple, those w ho work in the sam e departm ent or inst itut ion as any of the authors. Editors w ho m ake nal decisions about m anuscripts m ust have no personal, professional, or nancial involve-m ent in any of the issues they m ight judge.

18.7.1 Potential Con icts: Authors’ Commitments

• Con ict of in terest exists w hen an author (or the author’s inst itut ion), reviewer, or editor has

nancial or personal relat ionships that inappropriately in uence (bias) h is or her act ions. Such relat ionships are also know n as dual com m itm ents, com pet ing in terests, or com pet ing loyalt ies.

• When authors subm it a m anuscript , w hether an ar t icle or a let ter, they are responsible for disclosing all

nancial and personal relat ionships that m ight bias their work. Authors should do so in the m anuscript on a con ict-of-in terest not i cat ion page that follows the t it le page, providing addit ional detail, if necessary, in a cover let ter that accom panies the m anuscript .

To rem ain in good standing w ith any journal selected for a publicat ion , authors should always disclose a con ict of in terest involving them or any of their co-authors. The follow ing m ight be considered grounds for such a con ict:

• Possession of shares of stock t ied in any way to the subject of the ar t icle

• Receipt of direct or indirect funding or reim bursem ent from a corporate body, including m oneys as a gift for a lecture or a presentat ion on a m aterial/appliance or a pharm acological agent and funds to cover t ravel expenses, accom m odat ions, and regist rat ion for a m eet ing

• Receipt of gifts in the form of bulk am ounts of free m aterials or appliances for personal use, not in tended for research purposes

• Part icipat ion in networks that are supported by the indust ry or the private sector, regardless of their object ive or scope of form at ion


that peer review not only fails to prevent the publicat ion of awed research but also perm its the publicat ion of research that is fraudulent . Som e have described peer review as arbit rary, subject ive, and secre-t ive. In addit ion, m any crit ics m aintain that it is sim ply unnecessary and slows the com m unicat ion of inform at ion. According to the m ost com prehensive survey of act ive reviewers throughout the scient i c world, such is not the case.

One of the largest-ever in ternat ional surveys of authors and reviewers, the Peer Review Survey 2009, was conducted by Sense About Science . Prelim inary ndings were presented at the Brit ish Science Fes-t ival at the Universit y of Surrey, Guildford, United Kingdom , on Septem ber 8, 2009. Som e 40,000 researchers were random ly selected from the Inst itu te for Scient i c Inform at ion author database, w hich con-tains the nam es of researchers w ith work

18.8 Peer Review of Scienti c ArticlesPeer review is described as the evaluat ion of work by one or m ore people w ith com -petence sim ilar to that of the producers of the work (peers). It const itu tes a form of self-regulat ion by quali ed m em bers of a profession w ith in the relevant eld . Peer review m ethods are em ployed to m aintain standards of qualit y, im prove perform ance, and provide credibilit y. In academ ia, peer review is often used to determ ine the suit -abilit y of an academ ic paper for publicat ion . One m ight wonder w hat would m ot ivate anyone to agree to serve in such capacity … that of agreeing to crit ically review the work of another (Fig. 18.1).

As glam orous as it sounds on the sur-face, peer review as pract iced today is far from perfect . Crit ics often m ake the point

Fig. 18.1 The reasons volunteers most frequently give for agreeing to review scienti c articles before revi-sion and subsequent publication.


for AJO-DO audience (27%). Manuscr ipts rejected for poor study design had the least success in ach ieving subsequent publica-t ion , w hereas those rejected as inappro-priate for AJO-DO had the h ighest rate of subsequent publicat ion elsew here. Area of or igin was found to be sign i can t ly asso-ciated w ith acceptance by AJO-DO, w ith ar t icles from the United States and Canada m ost likely to be accepted (p < 0.01). Mean-w hile, it was found that count r ies w ith the lowest publicat ion rate in AJO-DO had the h ighest publicat ion rate elsew here. The inclusion of stat ist ically sign i cant nd-ings was show n to be sign i can t ly asso-ciated w ith acceptance by AJO-DO (p = 0.013), bu t not w ith publicat ion elsew here. The authors concluded that reject ion by AJO-DO did not preclude publicat ion else-w here. Geographic or igin was a predictor of acceptance by AJO-DO as well as by sub-sequent journals. Authors aim ing to m axi-m ize their chance of ar t icle acceptance should subm it to an appropriate journal, use a well-designed and described study w ith adequate sam ple sizes, and em pha-size the novelt y and relevance of their work (Figs. 18.2 and 18.3).

18.9 Obligation to Publish Negative StudiesFor som e t im e, journal editors have show n a tendency to prefer accept ing m anuscripts for publicat ion w hen the study has a sig-ni cant outcom e. This tendency was veri- ed in 2009 w hen a study of three of the top or thodont ic publicat ions by Koletsi et al was published.21 The percentage of ar t i-cles in the journals included in the study that showed signi cant results was h igher than the percentage of ar t icles w ithout sig-ni cant associat ions (on average, 88% vs 12%). Overall, the three journals published m ore studies w ith signi cant results, rang-ing from 75% to 90%. The ndings indicated that journals seem to prefer report ing sig-ni cant results; th is m ay persist because of authors’ percept ions of the im portance of their ndings and editors’ and reviewers’

published in m ore than 10,000 journals. Altogether 4,037 researchers com pleted the survey.19

The authors of th is com prehensive study concluded that m ost (69%) research-ers are sat is ed w ith the current system of peer review, but only a th ird (32%) th ink that the current system is the best that can be achieved. Most (84%) believe that w ithout peer review there would be no control in scient i c com m unicat ion , and only one in ve researchers (19%) believe that peer review is unsustainable because there are too few w illing reviewers. Alm ost all researchers (91%) believe that their last paper was im proved as a result of peer review, w ith the biggest area of im prove-m ent in the discussion, and 73% of review-ers (a subgroup in the study) believe that technologic advances have m ade it easier to do a thorough job of review ing now than it was ve years ago. Although the m ajorit y of respondents enjoy review ing and w ill con-t inue to review (86%), m any th ink that m ore could be done to support reviewers; 56% believe there is a lack of guidance on how to review, and 68% agree that form al t rain-ing would im prove the qualit y of reviews. Based on an analysis of the data in th is sur-vey, researchers agree that peer review is well understood by the scient i c com m u-nity. However, th is level of understanding is in sharp contrast to the research com m u-nity’s percept ion of the public’s awareness of peer review; just 30% believe the public understands the term peer review .

Of the 440 or iginal ar t icles subm it ted to the Am erican Journal of Orthodont ics and Dentofacial Orthopedics (AJO-DO) in 2008, 116 (26%) were accepted for pub-licat ion and 324 (74%) were rejected.20

All accepted ar t icles underwent revision before acceptance and publicat ion . Of the rejected ar t icles, 137 were subsequent ly published in 58 di eren t journals, w ith an average t im e to publicat ion of 22 m onths after reject ion by AJO-DO. Am ong ar t icles not accepted by AJO-DO, the top three rea-sons for reject ion were the follow ing: (1) poor study design /sm all sam ple size (59% of rejected papers), (2) outdated/unorigi-nal topic (42%), and (3) inappropriateness


heavily involved in applying for patents and m anufacturing the com ponents of new appliances, w hile at the sam e t im e star t ing new schools and publishing textbooks—all com m ercial act ivit ies for w hich he received substant ial rem unerat ion. He lived in the age of the “expert ,” and the push to suc-ceed nancially was st rong throughout the early par t of the 20th century. However, quest ionable h istorical pract ices are no reason to turn a blind eye to the injurious e ects that com m ercialism can have on our delivery of pat ient care today.22 Stan-dards for cont inuing educat ion provided by universit ies, professional associat ions, and com m ercial ent it ies cont inue to walk a ne line w hile balancing the prom ot ional “sales pitch” against the current ndings of clin ical t r ials. When the educat ion of our m em bersh ip is concerned, responsi-bilit y for evaluat ing conten t resides w ith each individual. If som eone is lecturing on

preferences for sign i cant results. Based on th is study, editors should:

• Seriously consider for publicat ion any careful study of an im portant quest ion that is relevant for their readers, w hether or not the results for the prim ary or any addit ional outcom e are stat ist ically signi cant .

• Realize that failure to subm it or publish ndings because of a lack of stat ist ical signi cance is an im portant cause of publicat ion bias.

18.10 Advertising and CommercialismFinancial con icts of in terest played a m ajor role in the form at ive years of orga-nized or thodont ics. Edward H. Angle was

Fig. 18.2 Acceptance rates according to country of origin of authors of articles published by the American Journal of Orthodontics and Dentofacial Orthopedics in 2008. (From Farjo N, Turpin DL, Coley RY, Feng J. Char-acteristics and fate of orthodontic articles submit ted for publication: An exploratory study of the American Journal of Orthodontics and Dentofacial Orthopedics. Am J Orthod Dentofac Orthop 2015;147:680–690.)


and elect ronic versions; Web site advert is-ing policy should parallel that for the prin t version to the greatest extent possible. Editors m ust have full and nal author-it y for approving advert isem ents. A well-conceived advert ising policy m ay require the citat ion of published ar t icles in support of quest ionable wording used in an adver-t isem ent for a product or service being prom oted. It m ay be necessary to change words used in the advert isem ent if such proof is not found in the published litera-ture. Review ar t icles, guest editorials, and let ters to the editor have not always been held to th is sam e standard. A change in th is policy was m ade in 2002 by The New Eng-land Journal of Medicine, w hich states, “… the authors of such ar t icles w ill not have any sign i cant nancial in terest in a com -pany that m akes a product discussed in the ar t icle.”23 Many other journals followed suit by m aking th is a par t of their advert ising policy.24

som ething that has been used for years, the appropriate evidence can be located in the literature and referred to. If the level of evi-dence is not st rong, that can also be m ade know n by the speaker. But if the topic is direct ly related to a new product or tech -nique that has not been on the m arket long enough to be tested, then the lecturer has an even greater responsibilit y to disclose any con icts of in terest . When it com es to a relat ionship between the speaker and the com pany that produces the product , th is con ict of in terest m ust be m ade very clear to the audience, w hether the presen-tat ion is to a large audience of experienced clin icians or a sm all class of residents at a universit y.

Most m edical and dental journals carry advert ising, w hich generates incom e for their publishers, but advert ising m ust not be allowed to in uence editorial decisions. Journals should have form al, explicit , w rit-ten policies for adver t ising in both prin t

Fig. 18.3 Six reasons for the rejection of articles submit ted to the American Journal of Orthodontics and Dentofacial Orthopedics in 2008. The most common reasons for rejection included (1) inappropriateness of topics, (2) poor design with small sample sizes, and (3) outdated or uninteresting topics. (From Farjo N, Turpin DL, Coley RY, Feng J. Characteristics and fate of orthodontic articles submit ted for publication: An explor-atory study of the American Journal of Orthodontics and Dentofacial Orthopedics. Am J Orthod Dentofac Orthop 2015;147:680–690.)


18.11.2 Guidelines for the Preparation of Orthodontic Case Reports

Case reports are published on a regular basis in m any or thodont ic publicat ions. These short clin ical com m unicat ions not only are of in terest to clin icians in private pract ice but also provide a unique and im portant forum for the presentat ion and discussion of unusual and perplexing t reat-m ent situat ions. Authors are encouraged to consider using the follow ing guidelines in preparing or edit ing their m anuscripts of case reports that describe the rat ionale for the t reatm ent of dental m alocclusion (revised guidelines for the publicat ion of case reports as im plem ented by Vincent G. Kokich, June 2000, after being appointed Editor of Case Reports for the Am erican Journal of Orthodont ics and Dentofacial Orthopedics).

18.11.2.1 Introduction

In th is sect ion , the author m ust in t roduce the reader to the general topic or problem that is illust rated by the case report . The in t roduct ion should brie y refer to speci c literature that has discussed the topic of the case report . It should end w ith a sentence that leads the reader in to a speci c descrip -t ion of the pat ient’s records.

18.11.2.2 Diagnosis and Etiology

In th is sect ion , the au thor sum m arizes the pat ien t’s skeletal and dental diagnos-t ic ndings. It is im portan t to focus on abnorm al factors and not dwell on nor-m al ndings. The sect ion should include the pat ien t’s age, classi cat ion of the m al-occlusion , speci c unusual dental prob-lem s, hereditary factors, per iodontal or restorat ive com plicat ions, et iology of the m alocclusion , and other criter ia that w ill in uence the t reatm ent plan . The au thor should refer to speci c cephalom et ric data if necessary and should refer the reader to speci c gures contain ing pret reatm ent

18.11 Guidelines for Manuscript PreparationUniform Requirem ents for Manuscripts Subm it ted to Biom edical Journals are a set of guidelines produced by the ICMJE for standardizing the ethics, preparat ion , and form at t ing of m anuscripts subm it ted to biom edical journals for publicat ion. Com -pliance w ith the ICMJE recom m endat ions is required by m ost leading biom edical journals. As of 2014, thousands of journals as listed worldw ide follow the Uniform Requirem ents25: h t tp://w w w.icmje.org/rec-om m endat ions/browse/m anuscript-prepa-rat ion/preparing-for-subm ission.htm l.

This Web site is continually updated to re ect the w ishes of scienti c journal edi-tors regarding art icles subm it ted for publi-cat ion in their m edical and dental journals. The follow ing sect ions are included and should be carefully studied during the prep -arat ion of a new m anuscript: General Prin-ciples, Report ing Guidelines, Manuscript Sections (Title Page, Abstract , Introduct ion, Methods, Results, Discussion, References, Tables, Illustrat ions [Figures], Units of Mea-surem ent, Abbreviat ions and Sym bols). The follow ing form s are also included w ith the ICMJE recom m endations: m odel release and perm ission form s; photographic consent statem ent.

18.11.1 Photo Release (Example)

I, the undersigned, do hereby relinquish any and all r igh ts to photographs, t rans-parencies, negat ives, prin ts, or other pho-tographic reproduct ions captured for use by the (journal nam e). It is my/our under-standing that my scient i c illust rat ions or photos of our son/daughter m ay be pub-lished periodically on the Web site of the (organizat ion nam e) as an exam ple of (research outcom es or related reasons).

(Subject’s nam e, address and signature. If under 18 years of age, parent or guardian m ust also sign .)


18.11.2.7 Discussion

This is perhaps the most important section of the entire case report. The speci c problem that makes the case report unique is discussed, how it relates to the decisions made by the author, and nally how the treatment relates to the published literature on the topic. The dis-cussion must contain references to the litera-ture. It should focus on four or ve points that made the treatment outcome unique. Each point is discussed in a separate paragraph, with reference to the patient’s treatment and the appropriate literature.

18.11.2.8 Summary and Conclusions

This should be the shortest sect ion of the case report . It should consist of one para-graph that sum m arizes the m ost im portant points learned from the pat ient’s t reat-m ent . And of course, all references should be listed in a form at sim ilar to that used for any scient i c ar t icle published in the sam e journal.

In 2000, Vincent G. Kokich designed a standardized m ethod of evaluat ing the qualit y of or thodont ic case reports sub-m it ted for publicat ion , m aking it easier for peers to review them (revised guidelines for the publicat ion of case reports as im ple-m ented by Vincent G. Kokich, June 2000, after being appointed Editor of Case Reports for the Am erican Journal of Orthodont ics and Dentofacial Orthopedics). Each case report being considered for publicat ion is object ively assessed and scored based on ve areas, each one weighted according to it s relat ive im portance. The ve areas are the follow ing:

• Uniqueness of the case: A high priorit y is given to a case that exhibits unique skeletal, dental, or occlusal problem s.

• Com pleteness of the records: Case reports are seldom published w ithout com plete records, including excellent photographs, in t raoral and cephalom etric radiographs, and photos of dental casts. Progress

cephalom et ric and in t raoral radiographs, in t raoral and facial photographs, and pho-tographs of the dental casts.

18.11.2.3 Treatment Objectives

The list of problem s item ized in the sect ion on diagnosis and et iology should naturally lead the author and reader to a list of spe-ci c t reatm ents designed to solve each one. The t reatm ent object ives should include references to the m axilla, m andible, m axil-lary dent it ion , m andibular dent it ion , occlu-sion, and facial aesthet ics. The object ives should include the correct ion of problem s in the t ransverse, vert ical, and anterior and posterior planes of space if appropriate.

18.11.2.4 Treatment Alternatives

The next logical step in the t reatm ent plan-ning process is for the author to ar t iculate the various t reatm ent alternat ives that can be used to accom plish the listed object ives. The author m ust be com plete and refer to all possible t reatm ent plans, and the advan-tages and disadvantages of each t reatm ent alternat ive should be described brie y.

18.11.2.5 Treatment Progress

In th is sect ion , the author m ust describe the step -by-step process of t reatm ent , focus-ing on the im portant details of t reat ing the pat ient’s unique set of problem s. The type of appliances used, length of t reatm ent , in teract ion w ith other aspects of dent ist ry, and special decisions m ade during t reat-m ent should be included.

18.11.2.6 Treatment Results

In this section, the author should describe the results of orthodontic treatment. The results should parallel the objectives of treatm ent and therefore be presented in the same sequence. The author should be careful to identify both expected and unexpected outcomes, and how they a ected the overall treatm ent outcome.


18.12 Advances Possible with Electronic PublicationWhen it becam e possible to subm it and m anage m anuscripts elect ronically, only a few of the m any bene ts were recognized at rst . Of course, there was a dram at ic increase in the ow of m aterial, not to m en-t ion a reduct ion in m ailing costs. Art icles in w hich a plethora of char ts and graphs is needed to describe the data thoroughly can now be published online w ith lit t le added cost . Once reviewed, revised, and accepted, ar t icles can be placed online unt il space is available to publish them in prin t , if that is the goal. As a result , the volum e of scient i c ar t icles published yearly cont inues to soar beyond im aginat ion. Over t im e, other, m ore dram at ic innovat ions have becom e possible as the creat ive ju ices ow in the m inds of both authors and editors. Most journals now have apps that allow readers to dow nload art icles conveniently on their sm artphones or tablets. Authors are able to upload m ul-t im edia les along w ith their subm ission—including m ovies and three-dim ensional im ages. Many journals now encourage the publicat ion of videos by authors, allow ing a t im ely descript ion of the research study

photographs illust rat ing speci c and unique t reatm ent aspects are encouraged.

• Qualit y of the records: The qualit y of all records is given high priorit y.

• Qualit y of the t reatm ent: Again , the qualit y of the t reatm ent re ects on the clin ician/author. Although ideal results are not m andatory, the qualit y of t reatm ent has the second-highest weight ing.

• Qualit y of the m anuscript: Writ ten guidelines for case reports are available to all authors and provide a fram ework for creat ing a well-w rit ten m anuscript to accom pany the pat ient’s records.

• The follow ing form provides the reviewer w ith a m ethod that can be used for the object ive assessm ent of all case reports being considered for publicat ion . Each area is scored as unsat isfactory or incom plete (0), sat isfactory (1), or except ional (2), and the score is m ult iplied by the weight ing for that area to achieve the score. The scores for the individual areas are added to determ ine the total score.


scien t i c ndings has cont inued to thrive. Num erous orthodont ic publicat ions now exist throughout the world, and another 40% of the specialt y’s research ndings are published in other scient i c journals w ith h igh im pact factors. This is a t im e w hen the value of evidence-based dental research is reaching new heights, allow ing clin icians to have greater exposure to a h igher qualit y of published research ndings. It is my hope that the next hundred years of dent ist ry w ill be as product ive as the rst hundred, leading to ever bet ter outcom es of or th-odont ic t reatm ent .

References 1. Weinberger BW. Historical resum e of the

evolut ion and grow th of or thodont ia. J Am Dent Assoc 1934;21:2001–2021

2. Wahl N. Orthodont ics in 3 m illennia. Chapter 1: Ant iquity to the m id-19th cen-tury. Am J Orthod Dentofacial Orthop 2005;127(2):255–259

3. Dewel BF. The Case-Dewey-Cryer ext ract ion debate. Am J Orthod 1964;50:862–865

4. Wahl N. Orthodont ics in 3 m illennia. Chapter 2: entering the m odern era. Am J Orthod Dentofacial Orthop 2005;127(4): 510–515

5. Pro t WR, Fields HW, eds. Contemporary Orthodont ics. 3rd ed. St . Louis, MO: Mosby; 2000

6. Chapm an H. Orthodont ics: ft y years in ret-rospect . Am J Orthod 1955;41:421–442

7. Peck S, ed. Correpondence w ith Dr. Mar-t in Dewey. In : The World of Edward Har t-ley Angle, MD, DDS: His Let ters, Accounts and Patents. Vol 3. Boston, MA: The E. H. Angle Educat ion and Research Foundat ion; 2007:320–322

8. Weinberger BW. Dr. Edward Hartley Angle, his in uence on orthodontics. Am J Orthod 1950;36(8):596–607

9. Wahl N. Orthodont ics in 3 m illennia. Chap-ter 4: the professionalizat ion of or thodon-t ics (concluded). Am J Orthod Dentofacial Orthop 2005;128(2):252–257

10. Cham bers DW, Curt is EK, Fratzke JP, Mark HI, Rosen R, Seward MH. Code for dental editors. J Am Coll Dent 2005;72:5–8

11. Turpin DL. The search for a new editor-in -chief. Am J Orthod Dentofacial Orthop 2013;144:635

and w hy it was undertaken. Blogs are also a frequent feature of m ost online publica-t ions and encourage increased in teract ion between readers and the authors of cur-rent ar t icles. Let ters to the editor can be published alm ost im m ediately on blogs, elim inat ing the t ypical three-m onth delay in norm al response t im e. In addit ion , som e publishers have developed software to allow the publicat ion of three-dim ensional im ages w hen they facilitate the under-standing of research outcom es.

18.13 ConclusionIt is my hope that th is chapter has provided a broad understanding of the role played by a variety of publicat ions in the process of educat ing the or thodont ic resident . Early publicat ions in the eld of dent ist ry were descript ive in design, relat ing the experi-ences of early dent ists w ho dabbled in a variet y of ways to m ove teeth . Diagnos-t ic procedures leading to t reatm ent plans designed to accom plish speci c object ives were rare and often ill de ned. The study of long-term outcom es was unheard of in clin ical circles.

During the last century, the specialt y of or thodont ics has com e full circle as it is now pract iced worldw ide. The ident i- cat ion of the specialt y of or thodont ics has led to a plethora of publicat ions tout-ing a m ult itude of di erent ways to m ove teeth w ith increasing e ciency. Educa-t ion has been form alized in schools that place em phasis on the value of scient i c study as well as clin ical excellence. The applicat ion of cephalom etric analysis has now been expanded by the use of three-dim ensional technology w here indicated, fur ther enhancing the diagnost ic skills of the specialist . The expansion of bonding adhesives to the eventual obsolescence of m etal bands placed around every tooth has been revolut ionary. But of even greater sig-ni cance is the cont inued developm ent and use of new biom aterials in several phases of tooth m ovem ent . Throughout th is ent ire period of change in the way or thodont ists pract ice, the publicat ion of clin ical and


19. Sense About Science. Peer review survey 2009: fu ll report . h t tp://w w w.sensea-bou t scien ce .org/d at a / files /Pee r_Review /Peer_Review _Survey_Final_3.pdf. Accessed March 23, 2015

20. Farjo N, Turpin DL. Characterist ics and fate of or thodont ic ar t icles subm it ted for publi-cat ion: an exploratory study of the Am eri-can Journal of Orthodont ics and Dentofacial Or thopedics. Am J Orthod Dentofacial Or-thop. In press

21. Koletsi D, Karagianni A, Pandis N, Makou M, Polychronopoulou A, Eliades T. Are studies repor t ing signi cant results m ore likely to be published? Am J Orthod Dentofacial Or-thop 2009;136(5):632.e1–632.e5, discus-sion 632–633

22. Turpin DL. Com m ercialism on the rise, again . Am J Orthod Dentofacial Or thop 2007;132(1):1–2

23. Drazen JM, Curfm an GD. Financial as-sociat ions of authors. N Engl J Med 2002;346(24):1901–1902

24. Turpin DL. Authors and their nancial t ies. Am J Orthod Dentofacial Orthop 2002;122(5):449

25. In ternat ional Com m it tee of Medical Journal Editors. Preparing for subm ission . h t tp://w w w.icmje.org/recom m endat ions/browse/m a n u scr ip t - p re p a ra t ion / p re p a r in g- fo r -subm ission.h tm l. Accessed March 23, 2015

12. Internat ional Com m it tee of Medical Journal Editors. De ning the role of authors and con-tributors. ht tp://w w w.icmje.org/recom m en-dat ions/brow se/roles-and-responsibilit ies/de n ing-the-role-of-authors-and-contribu-tors.htm l. Accessed March 23, 2015

13. U.S. Food and Drug Adm inist rat ion . Regu-latory inform at ion . Inst itu t ional review boards frequently asked quest ions – infor-m at ion sheet . h t tp://w w w.fda.gov/regulato-ryinform at ion /gu idances/ucm 126420.h tm . Accessed March 23, 2015

14. Turpin DL. The need to register clin ical t r i-als in or thodont ics. Am J Orthod Dentofacial Orthop 2006;130(4):429–430

15. Turpin DL. Your copyright and the SPARC author addendum . Am J Orthod Dentofacial Orthop 2010;137(1):1

16. Eliades T, Turpin DL. Con ict of in ter-est: always report it , and if in doubt , ask. Am J Orthod Dentofacial Orthop 2008; 134(3):327–328

17. Goozner M. Unrevealed: non-disclosure of con icts of in terest in four leading m edical and scient i c journals. h t tp://cspinet .org/new /pdf/unrevealed_ nal.pdf. Published July 12, 2004. Accessed March 23, 2015

18. In ternat ional Com m it tee of Medical Journal Editors. Con icts of in terest . h t tp://w w w.icmje.org/con icts-of-in terest /. Accessed March 23, 2015

162

The Role of Research in Orthodontic Specialty EducationKee-Joon Lee and Young-Chel Park

19.1 The Rationale of Evidence-Based OrthodonticsThe concept of evidence-based orthodon-t ics, although the m ajority of orthodon-t ists st ill nd it di cult to accept ,1 has been around since 2000.2 Residents in or th-odont ic specialty program s are t rained to acquire technical pro ciency in diagnosing and t reat ing pat ients w ith various t ypes of m alocclusion and/or craniofacial deform ity. In this context , so-called cookbook t rain-ing, in w hich the instructors designate the t reatm ent plans, t ypes of appliances, and sequence of overall t reatm ent , tends to be com m onplace because the protocols were pract iced by num erous predecessors based on individual experience and possibly t r ial and error.

19.1.1 Controversies in Orthodontic Diagnosis and Treatment Planning

The pat tern of educat ion in orthodont ic program s m ay be associated w ith the long-standing history of orthodont ics, w hich dates back to the era of Dr. E. H. Angle, w hen non-extract ion t reatm ent was believed to be the m ain and only goal of orthodont ic prac-t ice. Later, this convict ion was opposed by Dr. C.H. Tweed’s group, w hose m em bers doubted the feasibility and stability of pre-vious non-extract ion t reatm ents and dem -onstrated num erous extract ion cases w ith

19

short-term stability to substant iate their protocol.3 However, neither of these two groups showed scient i cally acceptable evi-dence regarding post-t reatm ent stability.

Apart from th is debate, in the 1980s, num erous clin ical studies from the Uni-versit y of Washington School of Dent ist ry, Seat t le, were published about the e ects of various t reatm ent m odalit ies on the stabilit y of t reatm ent outcom es, leaving rather vague answers to the m ajor ques-t ions. For instance, or thodont ic t reatm ent w ith prem olar ext ract ion , w hich was pro-posed to elim inate possible relapse after non-ext ract ion t reatm ent , was not stable through a 10-year post-retent ion period.4,5

Furtherm ore, serial ext ract ion , w hich had been presum ed to be m ore stable than the ext ract ion of prem olars after full erupt ion , was not show n to be superior to it s coun-terpar t over 10 years of post-retent ion .6A sim ilar nding was reported regarding the t im ing of second prem olar ext ract ion.7Overall, apparently the quest ion of w hether the ext ract ion of prem olars im proves sta-bilit y st ill rem ains unanswered.

19.1.2 The Value of Evidence-Based Education

The preceding exam ples im ply two dif-ferent but not necessarily contradictory aspects—the possible consequences of exper t opinion not supported by sound evi-dence, and the not ion that even “evidence-based or thodont ics” m ay not be able to provide clin ically valuable answers.

19 The Role of Research in Orthodontic Specialt y Education 163

Ironically, w hen the term evidence-based m edicine was coined, clin icians were worried that it would lead to “cook-book” m edicine.8 So far, in the eld of orthodont ics, debates are st ill ongoing in regard to various t reatm ent m odalit ies, such as stabilit y related to ext ract ion or non-extract ion , early t reatm ent and the e ect of grow th m odi cat ion , and so on. For instance, despite am ple evidence that grow th m odi cat ion does not “enhance” the pat ient’s grow th poten t ial,9,10 conven-t ional appliances such as headgear and/or funct ional appliances are st ill in use,11

indicat ing that or thodont ists do not aban-don t reatm ent st rategies that have not been supported by scient i c evidence.

Based on the short h istory of evidence-based or thodont ics, one m ay raise a radical quest ion: Has evidence-based orthodon-t ics been valid in our daily pract ice? If not , the evidence to support or thodont ic prac-t ice would no longer have to be sought . However, it m ust be understood that the evidence-based approach does not provide im m ediate answers to quest ions. Instead, the at t itude is necessary for the clin icians to bet ter understand the clin ical e ects of each approach or appliance. At tached to the study of McReynolds and Lit t le, Boese’s com m entary suggested the m ult ifacto-rial nature of post-t reatm ent stabilit y.7 In fact , a random ized clin ical t r ial of subjects m atched for age, degree of crow ding, and other factors m ight be a solu t ion . Unfor-tunately, appropriately designed studies of hum an subjects tend to be unethical in essence, w hich is w hy evidence-based m edicine is often di cult to achieve. In regard to the use of funct ional appliances, Huang claim ed that anteroposterior correc-t ion should be reassessed before having it s advocates stop using it .1

19.1.3 The Main Body of Research

The curren t clin ical environm ent inevitably includes overw helm ing com m ercialism , in w hich an enorm ous am ount of clin ical inform at ion is unilaterally given to or th-odont ic pract it ioners w ithout validat ion

or veri cat ion .12 The debate on the e ects of self-ligat ing brackets m ay be one of the latest exam ples. Certain ly the profession-als, not the m anufacturers, need to re ne the clin ical inform at ion so that pat ients can have a bet ter idea of w hat is being done.

An addit ional not ion to support the validit y of research in the clin ical eld is the fact that m any of the fundam ental quest ions are raised not by academ icians but by the pat ients w ho w ill be a ected by the clin ical techniques. Lay people want to know if a speci c t reatm ent m odalit y is the best one possible w hen they visit the clin ic, if there is any alternat ive available, and if they w ill face irreversible consequences if they do not undergo the recom m ended t reatm ent at the appropriate t im e; th is applies to such choices in t reatm ent m odalit ies as ext rac-t ion or non-ext ract ion, one-phase or two-phase t reatm ent , or thognathic surgery or cam ou age, and so for th .

Presum ably, one m ay acquire m ost of the previous inform at ion through a lit -erature review rather than by conduct ing research oneself. However, self-ful llm ent cannot be gained solely through a lit-erature review. For instance, one m ay not acquire cer tain clin ical com petencies only by review ing the literature; various t ypes of hands-on pract ice in clin ical subjects are a m ust . Sim ilarly, conduct ing research is in tended not only to gain scient i c infor-m at ion but also to help students enhance their cr it ical thinking and produce cre-at ive solut ions.13 It is therefore bet ter for clin ically oriented research to be conducted m ain ly by postgraduate students than for clin ical educat ion and research act ivit y to be separate.

In sum m ary, to answer clin ical and pract ical quest ions, research act ivit ies are indispensable, and it is the academ ician’s responsibilit y to nd the best environm ent in w hich to perform such act ivit ies. The role of research and the evidence-based approach in the or thodont ic eld can be sum m arized as follows:

1. Evidence-based m edicine or evidence-based or thodont ics does not readily provide pract ical answers to clin ical quest ions. Instead, m ore adequate


bined m aster’s/PhD degrees,16 in addit ion to providing clinical educat ion. Currently, there are a total of 31 orthodontic program s, including 11 university-based departm ents, in Korea, producing approxim ately 45 to 50 specialists every year. To m eet the require-m ents for the specialty exam inat ion, it is m andatory for students to earn academ ic credit based on presentat ions at orthodontic conferences or the publicat ion of art icles in academ ic journals. Most of the program s in Korea encourage residents to conduct vari-ous clinical and/or experim ental research to earn their academ ic degrees. These policies show how m uch importance each program director/organizer ascribes to the orthodon-t ic training course, and indicate that clinical education to som e degree m ust be com -bined w ith research act ivit ies.

19.2.2 Motivational Factors versus Future Plans

In con t rast , the or thodon t ic residen ts considered clin ical educat ion , locat ion , reputat ion , length of t rain ing, and cost as the m ost im por tan t reasons for select ing a program , and on ly 4.6% chose research oppor tun it ies as the m ost im por tan t fac-tor.17 Moreover, few or thodont ic residen ts actually wan ted to stay in academ ia as par t of their p lan for the fu ture (1.76% opted for fu ll-t im e research and a teach -

quest ioning and reasoning can be achieved through crit ical appraisal or system at ic reviews to nd a clin ically valuable answer over t im e (Fig. 19.1). Over the short h istory of evidence-based or thodont ics, it is even natural that “cookbook” or thodont ics has not yet been realized in the clin ical

eld. Ongoing academ ic act ivit ies are encouraged to nd a bet ter st ructure for answering clin ical quest ions.

2. The inst itu t ions and dental schools o ering professional or thodont ic t rain ing program s can be a good environm ent for research act ivit ies for evidence-based or thodont ics. Because som e of the best subjects for clin ical studies are the pat ien ts, orthodont ic t rain ing program s need to provide a com binat ion of research and clin ical hands-on act ivit ies. Currently, the m ajorit y of research outcom es are produced in these program s, and orthodont ic residents are involved both in t reat ing pat ients and in conduct ing various t ypes of research .

19.2 Assessment of Dental Education Programs: Current Status

19.2.1 Research in Dental and Orthodontic Programs

Although dentistry is regarded as an applied rather than a basic science, som e dental schools have a m andatory research require-m ent,14 w ith highly posit ive at t itudes toward the research experience noted am ong stu-dents. In another survey, a “passion for orthodont ics” was identi ed as the single m ost in uent ial factor leading to a choice of orthodontics as a life career, followed by “intellectual st im ulation and challenge.”15

Interest ingly, “earning potential” was the least important factor. Related to this, the m ajority (80%) of the orthodontic program s in the United States lead to m aster’s or com -

Fig. 19.1 Hierarchy of evidence-based medicine.


in an or thodont ic t rain ing course is to be of value, like the follow ing.

From bench to clin ic:– Conduct ing clin ically relevant

research (either clin ical or experim ental)

– Soundly in terpret ing the outcom e of research

– Applying the know n rules to individual cases

– Verifying the clin ical validit y of ndings, m aking suggest ions for

fur ther research– Proposing / establish ing new and/or

creat ive t reatm ent protocols based on the research outcom e

From clin ic to bench:– Analyzing diagnost ic data and

ident ifying problem s– Asking the necessary quest ions for

appropriate t reatm ent planning– Finding evidence, searching the

literature, and th inking crit ically– Applying know n solut ions and/

or t rying creat ive solu t ions in individual cases

– Monitoring carefully, com paring clin ical ndings w ith the evidence found in the literature

– Suggest ing new t reatm ent protocols and verifying them through research

19.4 Clinical Application and TranslationOne of the relevant elds in which the pre-ceding system can be applied is orthodontic biom echanics. The select ion of a treatm ent protocol and appliances presum ably depends on relevant research outcom es. The follow-ing clinical example m ay be illustrat ive.

19.4.1 Clinical Application: Creative Troubleshooting

A description or demonstration of the sig-ni cance of research activity during an orth-odontic training program is beyond the scope

ing career, and 1.76% for fur ther graduate degree or work in research , in the United States; 4.4% opted for fu ll-t im e research and a teach ing career in Canada).11,15 In Nor th Am erica, the length of or thodont ic residency program s is gradually extend-ing from 24 to 36 m onths, bu t th is t rend is related to the increased clin ical case load, w hile the am ount of t im e available for research is decreasing.17 Financial bur-den was presum ed to be another lim it ing factor keeping residen ts from want ing a fu ll-t im e facult y posit ion .15 It m ay be that or thodont ic resident s were not in terested in research in the rst p lace, or that som e clin ical aspects dur ing t rain ing a ected them m ore than the research act ivit y d id in regard to their choice of a lifet im e plan . A grow ing concern is that th is overall pat-tern m ay cause an academ ic cr isis after all.

The discrepancy between m ot ivat ional factors and fu ture plans needs to be over-com e at som e point . Noble et al proposed that or thodont ic program s m ust change their select ion policy to accept candidates w ith a t rue passion for research in or tho-dont ics.15 In fact , it is im possible to force residents to stay in academ ia if they are not w illing to do so. Moreover, it is very hard to ant icipate w hether a par t icular candidate w ill eventually rem ain in an academ ic t rack after the com plet ion of a program .

19.3 Role of Research in the Clinical ProgramTo facilitate research act ivit y and bet ter understand the role of research in the or th-odont ic eld, a sm ooth t ransit ion “from bench to clin ic” and “from clin ic to bench” is essent ial. Because or thodont ics is an applied science, conduct ing clin ically rel-evant research m ay help clin icians bet ter understand the rat ionale of clin ical t r ials, bet ter in terpret the outcom es, and be bet-ter prepared to propose alternat ive solu-t ions in case of t rouble.2 Inst ructors then m ust be ready to accept and apply new ndings in individual cases. This m utual process is essent ial if a research program


The init ial panoram ic radiograph did not show any pathological ndings (Fig. 19.4).

Cephalom etric analysis revealed a hyperdivergent face and related ret rusive pro le (Fig. 19.5). To im prove the facial pro le and relieve the crow ding, e ec-t ive grow th m odi cat ion com bined w ith ext ract ion of prem olars was necessary.

Based on the analysis, ext ract ion of the four rst prem olars was perform ed, in com binat ion w ith the use of a ver t ical ch in cup. In terradicular m iniscrews were also used to secure anchorage during ret ract ion of the incisors. In t raoral views revealed som e bow ing of the arch w ire near the end of the space closure (Fig. 19.6).

What was st riking was the lateral pro- le, w hich st ill showed severe lip prot rusion (Fig. 19.7). According to the cephalom etric superim posit ion , grow th m odi cat ion w ith the ver t ical ch in cup did not appear e ec-t ive, par t ly because of the backward rota-t ional grow th of the m andible. This nding, according to the literature, was not surpris-ing; a review ar t icle suggested very lit t le evidence of ver t ical control during grow th w ith the use of convent ional appliances.18

Because of the clearly uncer tain grow th pat tern , the t reatm ent was provisionally discont inued at age 12 (18 m onths of act ive t reatm ent). Grow th observat ion followed the t reatm ent . The pat ient and her m other wanted fur ther im provem ent of the pro-

of this chapter. However, some clinical exam -ples of the application of creative solutions based on the literature and on evidence may be illustratative.

The ver t ical–anteroposterior relat ion -ship is well described in the or thodon -t ic literature, but lit t le evidence has been show n so far. In par t icular, regarding m olar in t rusion for ver t ical correct ion , it appears that t rue m olar in t rusion has not been sub-stant iated because of the lack of soundness in the study.18 Although it is adm it ted that h igh-pull headgear provides som e ver t i-cal control during grow th, w hether th is clin ical applicat ion gives r ise to a clin ically e ect ive outcom e m ay be another issue. A clin ical exam ple is hereby presented.

19.4.2 Clinical Example

A 10-year-old girl visited the orthodon-t ic departm ent w ith lip prot rusion and crow ding as the chief problem s. The init ial photographs showed a dolichofacial pat-tern, ret rusive chin , and lip protrusion w ith signi cant lip incompetency (Fig. 19.2). The pat ient was prepubertal and had not reached m enarche.

The init ial intraoral views showed m od-erate to severe crow ding (Fig. 19.3). Based on the lateral pro le, extract ion of premo-lars was considered unavoidable.

Fig. 19.2 Initial extraoral views.


Fig. 19.3 Initial intraoral views.

Fig. 19.4 Initial panoramic view.


Fig. 19.5 Cephalometric analysis at initial visit .

le, w hich was considered very challenging because of the lack of ext ract ion space.

The pat ient underwent reassessm ent at age 15. In terest ingly, she had not yet reached m enarche. The lateral pro le st ill showed prot rusive lips (Fig. 19.8). In t raoral views showed m inor an terior crow ding and lack of space, w ith fair Class I m olar rela-t ion (Fig. 19.9). A panoram ic view showed no signi cant change in the condylar posi-t ion and shape (Fig. 19.10). Cephalom etric analysis revealed a constant increase in the anterior facial height and convex pro- le (Fig. 19.11). The situat ion was nearly the sam e as at the end of the rst t reat-m ent . However, it was noteworthy that she showed constant grow th during her act ive grow th phase (between T1 and T2; Table 19.1) w ithout fur ther opening of the sella–nasion plane/m andibular plane angle (SNMP) angle (Table 19.1).

The quest ion then was how to im prove her pro le fur ther. Obviously, w ithout addit ional ext ract ion of prem olars, there were very few solu t ions. Because it was know n that her grow th was not term i-

nated , grow th m odi cat ion w ith or tho-pedic appliances was no longer pract ical. Instead of unreliable grow th m odi ca-t ion , it is noteworthy that m in iscrew s m ay induce predictable m ovem ent of the over-all arch w ith in the given alveolar bone. The latest experim en tal st udy suggested a cen ter of resistance of the w hole arch around the prem olar area (Fig. 19.12).19

In addit ion , sim ultaneous m ovem ent of the en t ire arch was show n to be realist ic.20

Based on these ndings, it was presum ed that it would be e ect ive to com bine the norm al residual grow th w ith arbit rary m ovem ent of the w hole arch , to im prove her pro le. In other words, the m axillary and m andibular arches were rest r icted against the norm al forward and dow nward grow th of the m andible.

Follow ing leveling and alignm ent , m ini-screws were inser ted in the in terradicular area, between the second prem olar and rst m olar. To produce a backward in t ru-sive force vector approxim at ing the cen-ter of resistance of the ent ire arch , a short occlusal cr im pable hook was at tached to


Fig. 19.6 Intraoral views at 13 months of treatment.

Fig. 19.7 Extraoral view at 18 months of treatment with cephalometrogram.


e ect of backward and upward displace-m ent of the m axillary arch against forward and dow nward m axillary alveolar grow th, and vice versa in the m andible, lead-ing to pure forward grow th of m andible w hile the dent it ion was rest ricted in place (Fig. 19.20). This can be called four-dim en-sional total arch m ovem ent because the arbit rary arch displacem ent was conducted w hile grow th took place.

The occlusion and pro le were m ain-tained during the next 5 years (Figs. 19.21and 19.22).

This case dem onstrates how research outcom es can be e ect ively integrated and reinterpreted to produce a creat ive solu-t ion in a challenging situat ion. A rather new concept , four-dim ensional total arch m ove-m ent , was proposed; however, this was just a m odi cat ion of know n rules and regu-lat ions. This kind of t ranslat ion between bench and clinic can encourage interest in various research act ivit ies in orthodont ic pract ice. Therefore, it can be concluded that research in or thodont ic program s is indis-pensable, part icularly research in clin ically relevant areas.

the m ain arch w ire at the distal side of the canine (Fig. 19.13). On the right side, the m iniscrew was loosened after 3 m onths, and the reinsert ion was done on the in fra-zygom at ic crest to produce an equivalent force vector (Fig. 19.13).

In t rusive ret ract ion was done in both the m axillary and the m andibular arches (Fig. 19.14).

The brackets were rem oved after 18 m onths of the second t reatm ent . An appropriate occlusal relat ionship and m idline coincidence were gained (Fig. 19.15, Fig. 19.16).

Com parison of the pro le views in the in it ial and nal photographs showed rem arkable at tening of the lateral pro- le after t reatm ent . A rem arkable change was found in the pro le (Fig. 19.17). The post-t reatm ent panoram ic and cephalom etric views showed accept-able root parallelism and incisor axes (Fig. 19.18, Fig. 19.19).

In the cephalom etric superim posit ion , signi cant forward m andibular displace-m ent was noteworthy. In essence, th is was presum ed to be the result of the com bined

Fig. 19.8 Extraoral views at age 15.


Fig. 19.9 Intraoral views at age 15.

Fig. 19.10 Panoramic view after observation period (at the beginning of the second treatment).


Fig. 19.11 Cephalometric analysis at the beginning of the second treatment.

Table 19.1 Cephalometric measurements

T0(10 y: initial)

T1(12 y: end of 1st treatment)

T2(15 y: beginning of 2nd treatment)

T3(16 y: end of 2nd treatment)

SNA, o 80.9 78.8 77.4 77.2

SNB, o 72.1 72.0 72.1 73.5

ANB, o 8.8 6.8 5.3 3.8

SNMP, o 46.0 47.6 47.7 43.6

Anterior facial height, mm 113.5 124.3 132.9 133.9

U1 to SN, o 102.7 103.0 102.2 104.2

L1 to MP, o 93.0 91.0 89.7 93.2

ANB, A point–nasion–B point angle; L1, lower incisor; MP, mandibular plane; SNMP, sella–nasion plane/mandibular plane angle; U1, upper incisor; SNA, sella–nasion–A point angle; SNB, sella–nasion–B point angle.


Fig. 19.12 Center of resistance of the entire arch.19

Fig. 19.13 Intraoral views at 6 months during the second treatment.


Fig. 19.14 Intraoral views at 12 months during the second treatment.


Fig. 19.15 Final intraoral views after the second treatment.


Fig. 19.16 Final extraoral views after the second treatment.


Fig. 19.17 Comparison of initial and nal lateral pro les (second treatment).


Fig. 19.18 Panoramic view after the second treatment.

Fig. 19.19 Cephalometric analysis after the second treatment.


Fig. 19.20 Cephalometric superimposition before and after the second treatment.


Fig. 19.21 Follow-up intraoral views at 5 years after treatment.

Fig. 19.22 Follow-up extraoral views at 5 years after treatment.


11. Noble J, Hechter FJ, Karaiskos NE, Lekic N, Wiltsh ire WA. Future pract ice plans of or thodont ic residents in the United States. Am J Orthod Dentofacial Orthop 2009; 135(3):357–360

12. Kau CH. Orthodont ics in the 21st centu-ry: a view from across the pond. J Or thod 2012;39(2):75–76

13. Kharbanda OP. Global issues w ith or th-odont ic educat ion: a personal view point . J Orthod 2006;33(4):237–240

14. Nalliah RP, Lee MK, Da Silva JD, Allareddy V. Im pact of a research requirem ent in a dental school curriculum . J Dent Educ 2014;78(10):1364–1371

15. Noble J, Hechter FJ, Karaiskos N, Wiltshire WA. Motivational factors and future life plans of orthodontic residents in the Unit-ed States. Am J Orthod Dentofacial Orthop 2010;137(5):623–630

16. Burk T, Orellana M. Assessm ent of graduate or thodont ic program s in North Am erica. J Dent Educ 2013;77(4):463–475

17. Bruner MK, Hilgers KK, Silveira AM, But ters JM. Graduate orthodont ic educat ion: the residents’ perspect ive. Am J Orthod Dento-facial Orthop 2005;128(3):277–282

18. Ng J, Major PW, Flores-Mir C. True m olar in-trusion at tained during orthodontic treat-m ent: a system atic review. Am J Orthod Dentofacial Orthop 2006;130(6):709–714

19. Jeong GM, Sung SJ, Lee KJ, Chun YS, Mo SS. Fin ite-elem ent invest igat ion of the center of resistance of the m axillary dent it ion . Ko-rean J Orthod 2009;39(2):83–94

20. Bechtold TE, Kim JW, Choi TH, Park YC, Lee KJ. Distalizat ion pat tern of the m ax-illary arch depending on the num ber of or thodont ic m iniscrews. Angle Orthod 2013;83(2):266–273

References 1. Huang GJ. Making the case for evidence-

based orthodont ics. Am J Orthod Dentofa-cial Orthop 2004;125(4):405–406

2. Harrison JE. Evidence-based or thodont ics: w here do I nd the evidence? J Orthod 2000;27(1):71–78

3. Bram ante MA. Cont roversies in or tho-dont ics. Dent Clin North Am 1990;34(1): 91–102

4. Lit t le RM, Riedel RA, Artun J. An evalu-at ion of changes in m andibular anterior alignm ent from 10 to 20 years post reten -t ion . Am J Orthod Dentofacial Orthop 1988;93(5):423–428

5. Lit t le RM, Wallen TR, Riedel RA. Stabilit y and relapse of m andibular anterior align-m ent- rst prem olar extract ion cases t reat-ed by t radit ional edgew ise orthodont ics. Am J Orthod 1981;80(4):349–365

6. Lit t le RM, Riedel RA, Engst ED. Serial ext rac-t ion of rst prem olars—postretent ion eval-uat ion of stabilit y and relapse. Angle Orthod 1990;60(4):255–262

7. McReynolds DC, Lit t le RM. Mandibular sec-ond prem olar ext ract ion—postretent ion evaluat ion of stabilit y and relapse. Angle Orthod 1991;61(2):133–144

8. Harrison JE. Evidence-based or thodon-t ics—how do I assess the evidence? J Orthod 2000;27(2):189–197

9. Pro t WR, Tulloch JF. Preadolescent Class II problem s: t reat now or wait? Am J Or-thod Dentofacial Orthop 2002;121(6): 560–562

10. Tulloch JF, Phillips C, Koch G, Pro t WR. The e ect of early in tervent ion on skeletal pat tern in Class II m alocclusion: a random -ized clin ical t r ial. Am J Orthod Dentofacial Orthop 1997;111(4):391–400

182

Advanced Orthodontic Education: Evolution of Assessment Criteria and Methods to Meet Future Challenges*Theodore Eliades and Athanasios E. Athanasiou

In recen t years, the ach ievem ents of aca-dem ic and research inst itu t ions, con -t roversial as it m ay seem , have been subjected to ranking by independen t orga-n izat ions and var ious elect ron ic m edia. Th is t rend has received w ide acclam at ion and evolved to include undergraduate and graduate sciences, as well as research inst i-tu tes, p rofessional p rogram s, and m edical specialt ies.

The assessm ent of program s direct ly im pacts the reputat ion and academ ic pro- le of schools rated at the top of the list , thus in uencing their nancial grow th.1The econom ic im plicat ions of such assess-m ent m ay be twofold. First , reputable inst itut ions at t ract m ore applicants and are able to choose from a large pool of stu-dents. In addit ion , private and public uni-versit ies seek to secure funds from m any sources, a signi cant com ponent of w hich is the m oney donated by organizat ions, the public, and indust ry. These endow m ents m ay be posit ively or negat ively a ected by the percept ion of the reputat ion of an inst itut ion .2

On a di erent level, the assessm ent process responds to the need to de ne the “gold standard” of educat ion, and to facili-tate the educat ional role m odel in various disciplines.

20

Apart from nancial and educational purposes, other practical issues m ay give rise to the necessity for program assessm ent. For example, the shortage of orthodontic faculty in the United States is expected to reach unprecedented gures during the next decade.3–5 Between the early and late 1990s, the num ber of vacant orthodontic posit ions tripled,5 and high-ranked spots, which require academ ic experience, su er from understa ng. A recent survey showed that the annual incom e of faculty is less than half that of private practit ioners. Faculty also reported working on average 25% more hours per week, whereas incom e per hour for full-t im e faculty is less than one-third that of their colleagues in private practice. In addi-t ion, faculty perceive that they experience m ore stress, encounter m ore bureaucracy, and receive less respect .6 The implicat ion of program assessm ent in regard to the short-age of faculty is that in the future, reputable program s m ay becom e m ore appealing to academ ically oriented professionals.

In addit ion , the establishm ent of a reliable m ethod of assessing or thodont ic educat ional inst itut ions m ay nd applica-t ion in potent ial future projects of relevant organizat ions, so that st r icter cr iter ia for professional recognit ion and educat ional equivalency are proposed on a global scale.

* This chapter is based on the previously published article “Eliades T, Athanasiou AE. Advanced orthodontic education: Evolution of assessment criteria and methods to meet future challenges. Angle Orthodontist 2005;75:147–154.”

20 Advanced Orthodontic Education 183

20.1 Assessment BodiesIn addit ion to governm ental organizat ions, such as the Nat ional Research Council, rankings in the United States are frequently done by various private sources, several professional societ ies, and the press.7 One of the best-know n rat ing sources is U.S. New s & World Report , w hich frequently publishes rankings for a w ide array of inst i-tu t ions. The assessm ent is based on dem o-graphic data, the reputat ion of the school, and its academ ic and social environm ent , presum ably to facilitate an inform ed choice for prospect ive applicants. However, the incorporat ion of an am biguous “reputa-t ion” factor in ranking academ ic inst itu-t ions m ost often results in the sam e group of established élites dom inat ing the top ranks. Newly established universit ies have been underest im ated as a result of the rat -ing of universit ies based on prest ige rather than research achievem ents.2,8

The global trend toward educational program assessm ent and ranking is clearly evidenced by the ranking of the top 500 academ ic institut ions chosen from a pool of 2,000 universit ies from all over the world. These universit ies were assessed based on the follow ing criteria (ht tp://www.shanghai-ranking.com /aboutarw u.htm l): num ber of Nobel laureates in physics, chem istry, m edi-cine, and econom ics (weight 20%); num -ber of highly cited researchers in 21 broad subject categories (weight 20%); num ber of art icles published in the journals Natureand Science (weight 20%); num ber of art i-cles in the Science Citation Index Expanded and Social Sciences Citat ion Index (weight 20%); and academ ic perform ance per faculty (weight 20%).

On a di erent level, the European Acad-emy of Pediat ric Dent ist ry has form ulated accreditat ion guidelines and requirem ents that include academ ic, clin ical, and research components of specialt y educat ion (h t tp://w w w.eapd.gr/E06C0EEF.en.aspx).

20.2 Professional and Clinical Program AssessmentIn the health sciences, professional educa-t ion is assessed by peer surveys addressed to m edical school deans, heads of residency program s, and directors of adm issions. These academ ic and professional experts are asked to rate the qualit y of a specialt y program on a scale of 1 (“m arginal”) to 5 (“outstanding”), indicat ing the qualit y of both research and prim ary care program s on a single survey inst rum ent .

Speci cally, m edical school deans and senior faculty are asked to iden t ify the 10 schools o ering the best program s in each specialt y area. The 10 program s receiving the h ighest cum ulat ive num ber of nom i-nat ions are included in the report . Input variables of academ ic qualit y are m easures that re ect the qualit y of factors brought to the graduate educat ion process, includ-ing academ ic preparat ion of the entering class, faculty-to-student rat io, and level of research funding. The deans, directors, and “experts” w ho are chosen to assess these areas are individuals in academ ia and prac-t it ioners in each profession.2

The m ethod described is not objective and incorporates a high degree of error for the follow ing reasons:

1. The select ion of the responders is biased, and w ith the except ion of academ ic facult ies, the experts and pract icing professionals are chosen based on a subject ively de ned “reputat ion” factor. Also, the criter ia that the experts use in nom inat ing a program m ay vary according to the general econom ic clim ate, degree of nancial stabilit y, and the rater’s personalit y, social status, and personal wealth .

2. The rates of response to the research survey in the form of quest ionnaire range from 35% for faculty to 25% for


20.3 Development of Criteria for the Assessment of Orthodontic Postgraduate ProgramsThe delirious pace of technologic advance-m ents, coupled w ith the h ighly com pet it ive and dem anding environm ent in w hich the or thodont ists of the next decade w ill prac-t ice, necessitates a cont inuous evolut ion of advanced educat ional program s. The authors of th is ar t icle propose a criter ia-driven assessm ent m ethod that incorpo-rates six param eters and assigns a weight factor to each of these basic com ponents of orthodont ic educat ion , thus providing a tem plate for clarifying the standing of program s.

The com ponents of or thodont ic educa-t ion , along w ith the potent ial weight factor for each one, are presented in Table 20.1.Although the actual im portance of each com ponent m ay be judged subject ively, it can be postu lated that academ ic educat ion

prim ary care centers and 56% for deans (w w w.usnews.com ). Such low response rates preclude the ext rapolat ion of data to ach ieve a reliable consensus on the ranking of program s. Actually, if th is survey were to be reviewed as a clin ical study, the project would be rejected because of the low response rates.

3. The responders’ subject ivit y in proposing centers of excellence m ay distor t the reliabilit y of the ranking outcom es. The output of the raters is tem porary and m ay be valid on ly for the speci c period of quest ionnaire subm ission. A person’s im pression of a speci c educat ional program largely depends on various factual and personalit y-related variables. These m ay include tem poral variat ions or occasional “bursts” of reputat ion associated w ith the publicat ion of an im pressive study or a discovery of signi cant m erit . Recent personal acquaintance of the responder w ith a prom inent faculty m em ber or at tendance at an im pressive lecture or conference m ay also in uence output .

4. The fact that the responders are persons at the top of the academ ic h ierarchy does not necessarily im ply that they are knowledgeable about the standing of each specialt y departm ent . If one considers the enorm ous expansion in the num ber of graduate program s and the st r ict ly adm inist rat ive role of deans, it follows that these people have lit t le or no exposure to developm ents in research . Thus, their opinions should be viewed w ith caut ion .

5. The use of weight or signi cance factors in various ranking reports is arbit rary and can be m isleading because schools that have a st rong ranking in com ponents w ith a low weight factor m ay on average score less than inst itut ions that have a m edium ranking in com ponents w ith a h igh weight factor. The assignm ent of speci c weight factors to the various com ponents is subject ive, w ith no criteria support ing the range of h igh- and low -im pact param eters.

Table 20.1 Components of advanced orthodontic education and their potential importance in determining the educational pro le of a program

Component Weight*

Facilities 0.05

Clinical training 0.30

Academic education and organization

0.30

Research 0.25

Teaching 0.05

General 0.05

* The weight factor illustrates the relative signi cance of each component included in the assessment as viewed by the authors of this chapter. Thus, the assignment of weight variances is subjective.


20.3.2 Clinical Training

The const ituents of the “clin ical t rain ing” com ponent of advanced or thodont ic edu-cat ion are the follow ing:

• Hours devoted to clin ic and clin ical sem inars weekly; variety of m alocclusions, t reatm ent m odalit ies, and dental ages of pat ients; qualit y of t reatm ent outcom e (Am erican Board of Orthodont ics discrepancy index)

• Variety of t reatm ent techniques (inclusion of various appliances, ut ilit ies, and t reatm ent auxiliar ies)

• Rat io of full-/par t-t im e clin ical faculty per resident

• Variety of m alocclusions t reated• Adjunct ive t reatm ent

(tem porom andibular join t disorders, or thognathic surgery, clefts, and cran iofacial anom alies)

• Mult idisciplinary therapy (pedodont ics, periodont ics, prosthodont ics, im pants)

• Incorporat ion of new developm ents (m aterials, techniques)

The clin ical t rain ing com ponent is ana-lyzed to its const ituents in the preceding list . This sect ion is the m ost controversial because a quant itat ive assessm ent does not always correspond to the qualit y of t rain ing provided. In the assessm ent of th is com po-nent , the num ber and variety of m alocclu-sions t reated, the num ber of hours devoted to clin ic and clin ical sem inars, and the vari-ety of m alocclusions, t reatm ent m odalit ies, and dental ages of pat ients are considered the key param eters in the program assess-m ent . On the other hand, extensive pat ient assignm ent m ay serve inst itut ional nan-cial needs, and thus a rat io of the t im e spent in the clin ic to that devoted to clin ical sem inars m ay m ore reliably represent the clin ical direct ion of the program .

Em phasis should be placed on the qual-it y of the results of or thodont ic t reatm ent by im plem ent ing the use of appropriate indices (e.g., peer assessm ent rat ing [PAR]; index of com plexit y, outcom e, and need [ICON]; Am erican Board of Orthodont ics

and clin ical t rain ing m ay be of h igh im pact relat ive to the other com ponents. It can also be argued that the arbit rary assign-m ent of values to the various com ponents of the appraisal w ill elicit som e di erences of opinion am ong educators and clin i-cians. However, it was felt that the need to star t from som ew here m ight prevail over the necessit y for object ivit y in de n -ing the exact weight of each com ponent . The com ponents m ay include the facilit ies of the program , the exposure of students to teaching, and general data per t inent to the clin ical and scient i c recognit ion of it s graduates. In the follow ing sect ions, the educat ional com ponents of the or thodont ic program s are analyzed.

20.3.1 Facilities

The const ituents of the “facilit ies” com po-nent of advanced or thodont ic educat ion are the follow ing:

• Library, com puters, and journals (hard copies and elect ronic)

• Clin ic setup (open bay chair arrangem ent), availabilit y of photographic and X-ray facilit ies

• Num ber of chair-side assistants per resident

• Secretarial support• Access to com puters and pat ients’

records in the clin ic

Analysis of the facilit ies com ponent im plies that a h igh degree of im portance is at t ributed to the clin ic arrangem ent and access to photographic and X-ray facilit ies, as well as the num ber of chair-side assis-tants per resident . If t im e-consum ing and t r ivial procedures (e.g., cem ent m ixing, preparat ion of brackets for bonding) are avoided, a m ore e cient m anagem ent of pat ients’ needs m ay be achieved. Although the h ir ing of auxiliary personnel requires that funds be directed to a non-academ i-cally related area, the long-term bene ts of e ciently organizing the clin ical t rain ing of residents and their clin ical experience, potent ially generat ing a h igher earning capacity, m ay outweigh th is cost .


Em phasis is placed on the organiza-t ion of sem inars on current literature and topics (including subjects in the associated elds of biom edicine and stat ist ics, w hich are essent ial for a solid background in the sciences) and on the form at of assessm ents (e.g., exam inat ions, term papers).11 Con-tem porary or thodont ic research involves the extensive use of advanced inst rum ental analyses (biom aterials, biom echanics) and requires the design of epidem iologic stud-ies (clin ical research) and com plex assays (biological research). Therefore, an acquain-tance of students w ith the fundam entals of research techniques in various disciplines is crit ical for their understanding of the literature, w hich has long since undergone t ransform at ion from the standard and sim -plist ic essays of the case report t ype.

20.3.4 Research

The research com ponent of advanced or th-odont ic educat ion is analyzed as follows:

• Requirem ent for a research paper or thesis (som e program s m ay not enroll students in graduate school but require the subm ission of a paper that can be published; m ost lead to a cer t i cate/m aster of science (MS) degree; som e include a specialt y/doctoral (PhD) direct ion)

• Research facilit ies (school or cam pus)

• Laboratory rotat ions, courses on research techniques

• Public (i.e., federal or state) and private (corporate) funding to faculty

• Index of annual publicat ions per faculty m em ber, num ber of citat ions, faculty im pact factor index

In the assessm ent of the research com -ponent of program s, the m ain em phasis is placed on the research act ivit y and creden-t ials of the faculty, as these are inst rum ental in providing the appropriate environm ent for fruitful research .

Tradit ionally, advanced dental pro-gram s have been st ructured around a diar-

object ive grading system ). The qualita-t ive assessm ent of occlusal im provem ents as a result of or thodont ic t reatm ent m ay const itute a feedback for students and inst ructors. A m odel proposed to fam iliar-ize residents w ith the actual condit ions and environm ent of pract ice, including m anagerial and nancial com ponents, was originally in t roduced by Dr. Robert Isaac-son at the Universit y of Minnesota in the m id-1960s.9,10 This plan involved exten-sive auxiliary help, in the form of a m odel group pract ice consist ing of a junior resi-dent , a senior resident , and an assistant . At the t im e of its in t roduct ion, th is schem e consistent ly generated the h ighest incom e relat ive to that of or thodont ic program s operat ing under convent ional rules. Gradu-ally, the increased role of assistants becam e a recognized necessit y, and in a way, the principles of the t rain ing philosophy of th is program have spread throughout the cur-rent st ructure of graduate t rain ing in the United States. Apart from the exchange of clin ical experiences, th is concept exposes future clin icians to aspects of pract ice that are not usually taught on a pract ical level. These include the e ect ive handling of organizat ional aspects of pract ice, such as logist ics of m aterials and ut ilit ies, but m ost im portantly, the system provides expo-sure to the fundam entals of m anaging the

nances of clinical or thodont ics.

20.3.3 Academic Education and Organization

The im portan t aspects of academ ic educa-t ion and organizat ion are sum m arized as follows:

• Syllabuses, handouts, and relevant st ructured m aterials

• Adjunct ive courses (biom edical and engineering sciences, stat ist ics)

• Organizat ion of specialt y sem inars (st ructure, topics, exam inat ions)

• Literature readings: sem inars and journal club

• Cont inuing educat ion , invited lectures


has not yet experienced a st r iking change from th is alm ost decade-long program . It has been proposed that the discrepancy m ay be associated w ith the st ructure of the academ ic system .13 Because facult y act iv-it y is assessed by criter ia used in the asso-ciated biom edical elds, researchers st r ive to have their work published in periodicals w ith a h igh im pact factor. However, th is preference excludes all or thodont ic jour-nals, w hich are character ized by either a low im pact factor14 or no im pact factor at all. Therefore, papers on or thodont ic topics increasingly appear in the Journal of Biom echanics, the Journal of Biom edi-cal Materials Research , Im m unology , the Journal of Anatom y , Bone, and The Journal of Biological Chem ist ry , am ong others,15

and the or thodont ic com m unit y does not bene t from the knowledge published in the broader biom edical literature. To over-com e th is discrepancy, it is proposed that a group of quali ed or thodont ic researchers review the ar t icles of or thodont ic in terest published in associated disciplines and list the issues of in terest in a special colum n in or thodont ic periodicals.

An addit ional explanat ion for the afore-m ent ioned lack of in uence of research in the or thodont ic com m unity m ay be that during the early stages of the DSA program , fellows m ost frequently were supervised by non-orthodont ic faculty. This occurred because by the late 1980s, m ost or thodon-t ic program s in the United States were sta ed by MS-level or recently graduated, junior PhD faculty, w ho could not obtain the required status from graduate schools to serve as advisors to doctoral candi-dates. (It m ay be worth not ing that only recently has the requirem ent for prospec-t ive faculty to possess a term inal academ ic degree becom e frequent in advert isem ents for vacant or thodont ic faculty posit ions.) Therefore, students enrolled in a specialt y/PhD program were assigned to basic science or senior dental facult y w ho ran their ow n research program s in the broader biom edi-cal eld. This tact ic did not always ensure that the candidate’s thesis would focus on an or thodont ic topic. As a result , a large port ion of doctoral research perform ed by

chic rule, specifying a research or a clin ical character. However, it m ust be noted that separat ing specialt y educat ion from a research const ituent m ay be det r im en-tal to the e ciency of educat ion. This is because the absence of any research com -ponent from advanced dental curricula leads to a situat ion in w hich the graduate is unaware of the lim itat ions of m ethodo-logic approaches to research , and so accepts the results of studies indiscrim inately and endorses unsubstant iated claim s inert ly. In the era of evidence-based health science pract ice, th is m ay have devastat ing conse-quences for both t reatm ent providers and pat ien ts.

Research in or thodont ics possesses som e dist inct ive characterist ics. A large num ber of the research ar t icles that appear in orthodont ic journals correspond to stu-dents’ projects subm it ted in ful llm ent of the requirem ent for graduat ion . Although th is m ay increase the product ivit y of departm ents and contribute to the dist r i-but ion of inform at ion to the profession, the fact that residents usually use applied protocols, coupled w ith a lack of t rain ing in research techniques, m ay adversely a ect the caliber of the research perform ed.12

To deal w ith th is de ciency, the Nat ional Inst itute of Dental and Craniofa-cial Research (form erly the Nat ional Inst i-tute of Dental Research) in it iated a program to encourage basic research in the dental sciences. Thus, the dent ist scient ist award (DSA) program was im plem ented w ith the object ive of at t ract ing individuals seeking com bined specialt y/PhD t rain ing. Research e or ts by jun ior faculty were also assisted by the newly in t roduced young invest igator award. Along w ith federal funding, inst itu-t ional and organizat ional grants, such as the Am erican Associat ion of Orthodont ists Foundat ion faculty developm ent award, were designed to provide support to junior orthodont ic researchers.

Nonetheless, concern has been expressed regarding the im pact of these projects on contem porary pract ice.13

Although it is t rue that w ide-scale research program s m ay not direct ly generate clin i-cally applicable evidence, the specialt y


high rat io of applicants to residen ts and a h igh percentage of graduates succeeding in exam inat ions (cer t i cat ion , or thodon-t ic boards, specialt y, fellowships, etc.) or entering academ ics. The const ituents of the “general” com ponent of advanced or th -odont ic educat ion are listed below:

• Percentage of graduates succeeding in Board exam inations

• Num ber of graduates entering academ ics

• Rat io of the num ber of applicants to class size

20.4 Implementation of Criteria: Accreditation and Self-assessmentThe com ponents of the educat ional pro-gram s, discussed in the preceding sect ions, generate a requirem ent for the form at ion of bodies of exper ts to design, direct , and assess the im plem entat ion of criter ia; nat-urally, these w ill correspond to the char-acterist ics, requirem ents, and priorit ies of speci c countries or regions. This process should also re ect the di erent concepts of or thodont ic educat ion . Nonetheless, the accreditat ion processes followed in m any countries present som e fundam ental sim i-larit ies, w hich involve review of curricula, visits to facilit ies, and in terviews w ith fac-ulty, other sta , and graduate students. Therefore, the experience of th is body of exper ts in clin ical educat ion and research is of cr it ical im portance to reveal the actual standing of each program , evaluate the edu-cat ion provided, and highlight the com po-nents requir ing im provem ent or revision .

The m ain m ethods followed for program assessm ent are described schem at ically in Fig. 20.1 . In the United States and Canada, a “cent ral” approach is followed, in the sense that a com m it tee reviews the im plem enta-t ion of a set of criteria w idely recognized to be representat ive of the educat ion pro-vided. This m ethod relies on the assum p-t ion that if the individual com ponents (e.g., program design, facilit ies) are present in

or thodont ists did not direct ly contr ibute to the advancem ent of the research status of the specialt y. Considering that the topic of doctoral research usually determ ines the area of a future scient ist’s in terest , it is clear w hy the specialt y has not w itnessed the fruits of the funded e or ts of som e of it s m em bers during past years. This is expected to change drast ically in the next decade as m ore or thodont ists enter doc-toral degree curricula.

The foregoing issues have provoked a sw ing of the pendulum too far to the other side and led to the proposit ion that or th-odont ic educat ion , to avoid the academ ic im plicat ions, should return to preceptor program s, w hich were com m on at the daw n of our specialt y.13 It should be st ressed that th is arrangem ent would be disast rous for the advancem ent of the clin ical and aca-dem ic status of orthodont ics.

20.3.5 Teaching

Many program s assign undergraduate teaching and clin ical supervision to resi-dents, and som e also include sem inars con-ducted by senior students for the entering class. The const ituents of the “teaching” com ponent of advanced or thodont ic edu-cat ion are listed below:

• Undergraduate teaching and supervision of pre-doctoral clin ic

• Postgraduate teaching (sem inars to entering class)

The experience gained from this act iv-it y m ay be of value later on for both aca-dem ically and clin ically oriented graduates. The lat ter group m ay bene t because apart from the presentat ions to peers, experience in teaching m ay assist them in e ciently st ructuring future lectures to com m unity or professional organizat ions.

20.3.6 General Considerations

Lastly, the overall reputat ion of a program and its role in educat ing leaders for the future m ay be em pirically assessed by a


on a larger scale, it m ay serve as an indi-rect m eans of revealing the e ect iveness of speci c curricula in advanced orthodont ic program s.

In conclusion, the evolut ion of assess-m ent criteria and m ethods for advanced or thodont ic educat ion m ay be an absolute necessit y in the com ing years. Such assess-m ent m ay be required to recognize the com ponents of excellent academ ic perfor-m ance and clin ical t rain ing, as well as to im plem ent st rict cr iter ia for professional recognit ion and educat ional equivalency am ong countries and individuals. The pur-pose of th is chapter has been to provide a st im ulus for relevant discussion w ith in the or thodont ic com m unity, as m any coun-t r ies and organizat ions are in the process of establish ing, im proving, or coordinat ing their standards of or thodont ic educat ion.

the right proport ions, the product w ill be an e cient program that w ill “produce” a com petent graduate. Alternat ively, m any licensing bodies in Europe apply a com -bined approach. In addit ion to com pliance w ith criter ia for curricula (e.g., Erasm us program guidelines11), an exam inat ion of the graduate is in tegrated as a direct m eans to assess the com petency of the t reatm ent provider, regardless of the reputat ion and overall standing of the program in w hich he or she has received advanced t rain-ing. Although th is m ethod was not im ple-m ented to assess the educat ion provided by program s, instead being in tended to evalu-ate the com petency of individuals, it pres-ents two m ain advantages. First , it ensures a m inim um standard in the provision of or thodont ic services by direct ly exam in-ing the quali cat ions of graduates. Second,

Fig. 20.1 Schematic description of the assessment of orthodontic programs used by various accreditation bodies and licensure agents in di erent countries. The central approach assumes that strict adherence to a set of criteria ensures the level of education provided, whereas an alternative method ensures that the product of the educational program is equipped to function as a treatment provider on an individual basis. A merge of these two approaches may substantially enhance the assessment of programs and graduates and serve as a guide to keep specialt y programs abreast of the challenges in contemporary orthodontics.


7. National Research Council. Research Doc-torate Program s in the United States: Con-t inuity and Change. Washington, DC: The Nat ional Academ ies Press; 1995

8. Graham DH, Diam ond N. The Rise of Am eri-can Research Universit ies. Balt im ore, MD: Johns Hopkins Universit y Press; 1997

9. Isaacson RJ. Orthodont ic facult y—a m odest proposal. Angle Orthod 2000;70:4

10. Isaacson RJ. Ethics and econom ics. Angle Orthod 2002;72(3):iv

11. van der Linden FP. Three years postgradu-ate program m e in orthodontics: the nal report of the Erasm us Project . Eur J Orthod 1992;14(2):85–94

12. Burstone CJ. In terview. Hel Orthod Rev 1998;2:99–117

13. White L. A historic t im eline. h t tp://or thocj.com /2001/06/an-histor ical-t im e-line

14. Eliades T, Athanasiou AE. Im pact factor. A review w ith speci c relevance to or thodon-t ic journals. J Orofac Orthop 2001;62(1): 74–83

15. Mavropoulos A, Kiliaridis S. Orthodont ic literature: an overview of the last 2 de-cades. Am J Orthod Dentofacial Orthop 2003;124(1):30–40

16. DeKock WH, Athanasiou AE, Kuroda T. A WFO-com m isioned study provides data on the specialt y’s current characterist ics and standards throughout the world. WFO Ga-zet te 2000;1:4

Addit ional steps, such as the incorporat ion of elem ents of both approaches (i.e., pro-gram assessm ent and individual exam ina-t ion) m ay cont ribute to the achievem ent of th is object ive.16

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4. Tuncay OC. Am erican perspect ive - par t II. St rategies for the survival of the species. Clin Orthod Res 2001;4(2):63–64

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6. Lindauer SJ, Peck SL, Tufekci E, Co ey T, Best AM. The crisis in orthodont ic educat ion: goals and percept ions. Am J Orthod Dento-facial Orthop 2003;124(5):480–487

191

The Erasmus Programme for Postgraduate Education in Orthodontics in Europe: An Update of the Guidelines*

J. HuggareDepartm ent of Dental Medicine, Karolinska Inst itutet , Huddinge, Sweden

K.A. DerringerDepartm ent of Orthodont ics, King’s College London Dental Inst itu te, UK

T. EliadesOrthodont ic and Paediat ric Dent ist ry Clin ics, Universit y of Zurich , Sw itzerland

M.P. FilleulDepartm ent of Orthodont ics, Universit y Henri Poincaré of Nancy, France

S. KiliaridisDepartm ent of Orthodont ics, Universit y of Geneva Dental School, Sw itzerland

A. Kuijpers-Jagtm anOrthodont ics and Craniofacial Biology, Radboud Universit y Nijm egen Medical Cent re, The Netherlands

R. MartinaScienze Odontostom atologicheUniversità di Napoli Federico II, Italy

P. Pirttiniem iOral Developm ent and Orthodont ics, Inst itu te of Dent ist ry, Universit y of Oulu , Fin land

S. RufOrthodont ics, Justus-Liebig Universit y, Giessen, Germ any

R. Schwestka-PollyDepartm ent of Orthodont ics, Hannover Medical School, Germ any

Correspondence to: Jan Huggare P.O. Box 4064Alfred Nobels Allé 8SE-14104 Huddinge, Sweden

*This ar t icle was originally published in The European Journal of Orthodont ics by Oxford Univer-sit y Press. Eur J Orthod (2014) 36 (3): 340–349. © The Author 2013.

Appendix


SummaryIn 1989, the ERASMUS Bureau of the European Cultural Foundat ion of the Com m ission of the European Com m unit ies funded the develop-m ent of a new 3-year curriculum for post-graduate educat ion in orthodontics. The new curriculum was created by directors for orth -odontic educat ion represent ing 15 European countries. The curriculum ent it led ‘Three years Postgraduate Program m e in Orthodont ics: the Final Report of the Erasm us Project’ was pub-lished 1992. In 2012, the ‘Network of Erasm us Based European Orthodontic Program m es’ developed and approved an updated version of the guidelines. The core program m e consists of eight sect ions: general biological and medical subjects; basic orthodont ic subjects; general or thodont ic subjects; or thodont ic techniques; interdisciplinary subjects; m anagem ent of health and safety; pract ice m anagem ent , adm inistrat ion, and ethics; extram ural edu-cat ional act ivit ies. The programm e goals and object ives are described and the competen-cies to be reached are outlined. These guide-lines m ay serve as a baseline for program m e developm ent and quality assessm ent for post-graduate program m e directors, nat ional asso-ciat ions, and governm ental bodies and could assist future residents w hen select ing a post-graduate program m e.

IntroductionThe ‘Network of Erasm us Based European Orthodont ic Program m es’ (NEBEOP) was founded in 2009. It com prises a group of orth-odont ic postgraduate t rain ing program m es in Europe represented by program m e directors or or thodont ists assigned by inst itutes, which deliver a st ructured program m e in or thodon-t ics. The prim ary concern of the Network is educat ion , speci c to the specialt y of or tho-dont ics, and the m ain purpose is the advance-m ent of orthodont ic postgraduate t rain ing in Europe. In 1989, the ERASMUS Bureau of the European Cultural Foundat ion of the Com m is-sion of the European Com m unit ies funded the developm ent of a new 3-year curriculum for postgraduate educat ion in or thodont ics. The curriculum was created by directors for or th -odont ic educat ion represent ing 15 European countr ies. It was published in 1992, ent it led

‘Three year Postgraduate Program m e in Orthodont ics: the Final Report of the Erasm us Project’ (van der Linden, 1992).

The next two decades the orthodont ic profession has undergone substan t ial changes w ith regard to educat ion . New diagnost ic tools, m aterials, and clin ical advancem ents as well as broadened in terdisciplinary dem ands should be re ected in new recom m enda-t ions for the specialt y t rain ing. Therefore, at the general m eet ing of NEBEOP 2010 in Por torož, Slovenia, a Task Force was installed w ith Professor JH (Sweden) as the coordina-tor to m ake proposals for an update of the Erasm us program m e. The com m ission was to update ‘Object ives of com pulsory elem ents of theoret ical educat ion of or thodont ists’, deal-ing w ith obligatory courses for educat ion of orthodont ists. After present ing the proposal to the Council of NEBEOP w here fur ther am end-m ents were m ade, the revision was presented to the general assem bly of NEBEOP 2011 in Istanbul (Turkey) and was nally approved by NEBEOP assem bly 2012 at the m eet ing held in Sant iago de Com postela (Spain).

It should be noted that the revision should be considered as guidelines, not as rules, as NEBEOP is not a legal authority, which can over-ride the regulations and recom m endations of the national boards in each country. The m ain objectives of the program m e, general and spe-ci c condit ions, and the distribution of hours rem ain largely unchanged as compared w ith the 1992 version of the program m e (van der Linden, 1992) and have only been adapted to be in agreem ent w ith the updated and revised content of 2012. A new section has been added about competency levels to be reached. The full guidelines for postgraduate education in ortho-dontics in Europe are presented below.

Programme objectivesThe general object ive of the program m e is to educate dent ists to becom e specialists in orthodont ics w ith a solid and broad academ ic background and adequate clin ical experience in di erent t reatm ent m ethods. Upon com -plet ion of the program m e, the graduate m ust be able to:

1. Diagnose anom alies of the dent it ion , facial st ructures, and funct ional condit ions

193Appendix The Erasmus Programme for Postgraduate Educat ion in Orthodontics

6. Speci cat ion of the m inim al num ber of hours is provided for the obligatory courses, but is not indicated in detail for the preclin ical and clin ical act ivit ies

7. The core program m e requires 75 percent of the available t im e and m ust be supplem ented by addit ional act ivit ies (elect ives)

8. The m inim al num ber of clin ical t reatm ent hours is 16 hours per week (not including clin ical sem inars and discussion of t reatm ent plans). The m inim al num ber of hours over the 3-year period devoted to clin ical pract ice (including preclin ical course works) is 2000

9. Each resident m ust star t a m inim um of 50 well-docum ented pat ient cases

10. Residents m ust t reat pat ients under cont inuous supervision of quali ed orthodont ists

11. The clin ical sta –student rat io in supervising t reatm ent m ust be a m axim um of eight residents per supervisor

12. Dental laboratory work should be lim ited to learning experiences

13. Teaching of undergraduate students can be par t of the program m e, but not for m ore than 10 percent of the t im e

14. Residents m ust conduct a research project leading to a publicat ion or a congress presentat ion

15. Results of research and other act ivit ies under taken in the postgraduate program m e can be used w ithout lim itat ion as par t ial ful lm ent of requirem ents for an advance degree

16. All theoret ical courses m ust be concluded w ith an assessm ent of the acquired understanding and know ledge

17. At the end of the program m e, there m ust be a nal exam inat ion by a com m it tee including at least one external exam iner

18. Par t of the nal exam inat ion is the presentat ion of 10 fully docum ented cases, represent ing di erent m alocclusions and t reatm ent procedures, star ted and com pleted by the resident

2. Detect deviat ions of the developm ent of the dent it ion , facial grow th, and funct ional condit ions

3. Form ulate a t reatm ent plan and predict its course

4. Evaluate psychological aspects relevant to orthodont ics

5. Conduct in tercept ive orthodont ic procedure

6. Execute t reatm ent for all t ypes of m alocclusions

7. Collaborate in the in terdisciplinary t reatm ent of m edically and dentally com prom ised pat ients, pat ients w ith syndrom es and craniofacial anom alies, including or thognathic surgery care and craniom andibular disorders (CMDs)

8. Assess the need for or thodont ic t reatm ent on individual and societal levels

9. Pract ice or thodont ics according to professional and eth ical standards

10. Com prehensively review, understand, and evaluate the literature per t inent to orthodont ics in a w ide array of disciplines relevant to the specialt y

11. Form ulate a research hypothesis, design a m ethodological study, conduct the research , and present the ndings

12. Use available opportunit ies for im proving professional skills and lifelong learning

General conditions1. The educat ion of or thodont ists m ust

take place w ith in universit ies or inst itut ions w ith academ ic a liat ion under responsibilit y of appointed academ ic teachers in or thodont ics

2. The basic object ive of the program m e is to educate clin icians; addit ional educat ion is needed for those who also want to becom e a teacher and/or researcher

3. Candidates m ust be registered as a dent ist in the country w here the degree was obtained or in w hich the candidate is presently pract icing

4. The program m e requires fullt im e at tendance of the residents

5. Residents should receive a st ipend for living expenses


Assignment of the 4800 scheduled hours

Staf /student contact activities

Clinical (and preclinical) practical work 2000 h

Pretreatment clinical conferences 230 h

Seminars on treatment evaluation 100 h

Lectures, seminars, workshops on obligatory academic courses 455 h

Lectures, seminars, workshops on elective theoretical subjects 150 h

Sta /student contact time outside regular classes for individual consultations, research guidance, manuscript preparation, etc.

115 h

3050 h

Non staf /student contact activities

Analysis of records of patients to be treated 120 h

Undergraduate teaching, including preparation time 480 h

Research 100 h

Elective activities (including additional t ime for research) 1050 h

1750 h

7. Research opportunit ies, m ethodological support , and stat ist ical guidance m ust be available

Distribution of hoursThe academ ic program m e is based on a m ini-m um of 40 weeks a year and 40 hours a week, w hich totals 4800 scheduled hours for 3 years.

In addit ion , students are required to put in a considerable num ber of hours of their ow n t im e for studying. For exam ple, for every class hour on academ ic subjects, on an average of 2 hours studying t im e are required.

Objectives of compulsory elements of theoretical education of orthodontistsThe hours indicated in parentheses in the fol-low ing sect ions are the m inim um num ber of hours necessary for the average student to devote to the subject in order to achieve the

Speci c conditions1. The director of the program m e m ust be:

• Registered as a specialist in or thodont ics for at least 5 years

• Act ively pract icing the specialt y• Appointed for at least 80 percent of

the working week2. Besides the director, the equivalent

of one fullt im e posit ion for an or thodont ist m ust be present . When m ore than a total of four residents are present , addit ional or thodont ic sta are required

3. Adequate library, laboratory, clinical, research, and administrative facilities must be available

4. Su cient non-academ ic sta m ust be available to realize an e cient conduct of the program m e and pat ient care

5. An established connect ion w ith cent res for oral and m axillofacial surgery, periodontology, and restorat ive dent ist ry is required

6. Su cient expert ise m ust be available to realize the object ives of the theoret ical courses


Table 1 Subjects and number of hours in ‘Objectives of compulsory elements of theoretical education of orthodontists’.

Part Name Number of hours

A General biological and medical subjects 310

B Basic orthodontic subjects 325

C General orthodontic subjects 340

D Orthodontic techniques 195

E Interdisciplinary treatment procedures 125

F Management of health and safety 25

G Practice management, administration, and ethics 45

H Extramural educational activities Elective

Total theoretical hours 1365

The contents of the programme can be restructured to large modules for which each university may approve European Credit Transfer (ECT) credits.

required level of knowledge equivalent to ‘be fam iliar w ith’ and ‘have know ledge of’ accord-ing to the Associat ion for Dental Educat ion in Europe (Cow pe et al., 2009). The num ber of hours devoted to each of the subjects are show n in Table 1 . In addit ion , the students are required to achieve a level of com petency in the subjects indicated in ‘Essent ial com -petency levels for postgraduate educat ion in orthodont ics’. The term ‘com petent to’ m eans that students should have a sound theoret ical knowledge and understanding of the subject together w ith adequate clin ical experience to be able to independent ly resolve clin ical chal-lenges encountered. The num ber of hours to reach these com petencies is not prede ned.

At least one-th ird of the theoret ical edu-cat ion hours m ust be spent in sta –student contact act ivit ies (lectures, sem inars, work-shops, etc.).

General biological and medical subjects (310 hours)

Paediatrics (20 hours). Knowledge of the im plicat ions of the follow ing to orthodont ics:1. Som at ic grow th and it s variat ions2. Adolescent grow th spur t and

its relat ionship to grow th of the craniofacial com plex

3. Genet ic and environm ental factors that in uence som at ic grow th

4. Concept of biological age, skeletal age, dental age, and stages of sexual developm ent

5. Endocrine-related problem s in grow th and developm ent

6. Allergies related to orthodont ics 7. Eat ing and weight issues in children and

adolescents8. Blood diseases including leukaemia9. Diabetes10. De cits in at tent ion , m otor control, and

percept ion11. Non-accidental injury in children

Anatom y and em bryology of craniofacial struc-tures (40 hours). Knowledge of em bryology of cran iofacial st ructures for understanding of:1. Norm al grow th and developm ent of the

face, jaws, and teeth2. Teratogenesis3. Developm ent of clefts and other facial

congenital m alform at ions4. Grow th of the craniofacial skeleton5. Developm ent of skeletal deform it ies6. Orthognathic surgical correct ion

of facial dysm orphologies and m alocclusions

Genet ics (25 hours). Knowledge of genet ic principles essent ial for com prehension of:1. Norm al developm ent of the cran iofacial

com plex2. Craniofacial m alform at ions


ENT and speech (20 hours). Knowledge of basic principles of norm al function and ENT-patho-physiology related to orthodontics and/or cra-niofacial grow th:1. Of the nose and para-nasal sinuses2. Of the pharynx, epipharynx, and larynx3. External, m iddle, and inner ear4. Norm al and com prom ised nasal

breath ing5. Sleep disorders, par t icularly snoring

and obst ruct ive sleep apnoea (OSA)6. Diagnost ic tools for sleep disorders and

how to in terpret the results7. Norm al and abnorm al speech8. Velopharyngeal funct ion

Craniofacial syndrom es (20 hours). Knowl-edge of the m ost com m on types of orofacial clefts, craniofacial anom alies, and syndrom es in w hich the head is involved w ith respect to:1. Aet iology2. Classi cat ion3. E ect on craniofacial grow th4. Psychosocial developm ent

Psychology of the child, adolescent, and adult (35 hours). Know ledge of concepts and prin-ciples of developm ental psychology essent ial for the understanding of:1. Pat ient m ot ivat ion and assessm ent of

co-operat ion2. Psychological aspects of puberty and

adolescence3. Psychosocial im pact of dental and facial

appearance4. Psychological aspects of or thognathic

t reatm ent5. Developm ent of cognit ion , language and

com m unicat ion

Know ledge of concepts of psychopathol-ogy and m ental disorders essent ial for the understanding of their im pact on orthodont ic t reatm ent:1. Delayed learning, dyslexia 2. Eat ing disorders, anorexia nervosa,

psychiat ric disorders3. At tent ion-de cit /hyperact ivit y and

other behavioural disorders4. Aut ist ic spect rum disorders5. Conduct disorders, opposit ional de ant

disorders, self-harm ing behavior6. Suicidal thoughts and at tem pts

3. Pre- and postnatal diagnosis of craniofacial anom alies

4. Genet ic counselling5. Molecular genet ic m ethods

Cell and m olecular biology, im m unology, and m icrobiology (30 hours). Know ledge of cyto-logical, h istochem ical, and m icrobiological principles essent ial for the understanding of:1. Cell m etabolism under norm al and

abnorm al condit ions2. Tissue form at ion and proliferat ion3. Developm ent of bone, cart ilage, teeth ,

and m uscle4. Bone grow th5. Tooth erupt ion , m ovem ents and

react ions in tooth support ing t issues6. Soft t issue changes related to

or thodont ics7. Mechanism s of root resorpt ion8. Bio lm s

Oral pathology and m edicine (20 hours).Knowledge of the m ost com m on oral patho-logic condit ions and their im pact on the or th -odont ic t reatm ent:1. Oral cancer and pre-cancer2. Oral m anifestat ions in

im m unocom prom ised pat ients3. Oral m anifestat ion of diseases4. Oral ulcerat ion5. Oral candidosis6. Periodontal m anifestat ions of system ic

diseases7. Salivary gland diseases8. Facial t raum a9. Head and neck tum our

Pharm acology (10 hours). Knowledge of phar-m acological agents w ith relevance to or th -odont ic t reatm ent:1. Ant ibiot ics, ant iviral and ant ifungal

agents2. Prostaglandin inhibitors3. Non-steroidal ant i-in am m atory drugs4. Calcium regulators (parathyroid

horm one, thyroid horm ones, est rogens, bisphosphonates)

5. Ant i-epilept ics6. Im m unosuppressive agents7. Grow th horm one subst itutes8. Psychiat r ic drugs and t ranquillizers9. Agents a ect ing salivat ion


3. Norm al and abnorm al behavior of soft t issue st ructures

4. Norm al and abnorm al funct ion of the tem porom andibular join t

Aspects of tooth m ovem ents and dentofacial orthopaedics (35 hours). Knowledge of:1. The process of tooth erupt ion and

spontaneous tooth m ovem ent2. Biological response to di erent t ypes of

force applicat ion3. In uence of force system s and force

m agnitude4. Post-t reatm ent changes

Oral and m axillofacial radiology and other im aging techniques (30 hours). Knowledge of:1. Abnorm alit ies and pathological

condit ions that can be diagnosed on radiographs

2. Health and safety guidelines w ith respect to oral and m axillofacial radiology

3. Digital oral and m axillofacial radiographic and other im aging techniques

4. 3D im aging (com puted tom ography, cone beam com puted tom ography, m agnet ic resonance, stereophotogram m etry) and their indicat ions.

Cephalom etric radiography (45 hours). Know l-edge of:1. Head and neck anatomy as applied to

radiology2. Cephalom etric analyses3. Lim itat ions of cephalogram s and their

analyses

Orthodont ic m aterials (25 hours). Knowledge of:1. Propert ies, com posit ion , and uses of

orthodont ic m aterials

Orthodont ic biom echanics (35 hours). Know l-edge of:1. Force system s produced by di erent

or thodont ic appliances2. Force system s produced by dentofacial

or thopaedic devices

Research m ethodology and biostat ist ics (90 hours). Knowledge of general principles, theory and pract ice or research designs, and com m only used stat ist ical m ethods in :1. Diagnost ic studies2. In tervent ion and experim ental studies3. Aet iological research4. Epidem iologic surveys5. System at ic reviews and m eta-analyses

Knowledge of:1. Philosophy of science2. Ethical and legal aspects in research

involving anim als and hum ans3. Scient i c in tegrit y4. Scient i c m isconduct5. Evidence-based decision m aking

Basic orthodontic subjects (325 hours)

Developm ent of the dent it ion (norm al and abnorm al; 70 hours). Knowledge of:1. Norm al and abnorm al developm ent of

the den t it ion from bir th to adulthood2. Abnorm alit ies in num ber, size, form ,

and posit ion of the teeth3. Genet ic and environm ental factors

relevant to the developm ent of the dent it ion

4. Orthodont ic consequences of abnorm alit ies of the dent it ion

5. The im pact of in tercept ive or thodont ic m easures

Facial grow th (norm al and abnorm al: 50 hours). Knowledge of:1. Grow th sites in the craniofacial skeleton2. Postnatal grow th changes in the

craniofacial region, including soft t issues

3. Variat ions w ith in the craniofacial region relevant to facial grow th

4. In uence of genetic and environm ental factors on facial grow th

Physiology and pathophysiology of the sto-m atognathic system (35 hours). Knowledge of:1. Norm al and abnorm al m ast icat ion and

swallow ing2. Norm al and abnorm al funct ional dental

occlusion


Long-term e ect of orthodont ic t reatm ent (30 hours). Know ledge of:1. The long-term e ect of or thodont ic

t reatm ent in individual pat ients, also in relat ion to ageing e ects on the face and dent it ion

Iatrogenic e ects of orthodont ic t reatm ent (30 hours). Know ledge of:1. The developm ent of dem ineralizat ion ,

pulp necrosis, root resorpt ion , recession, and periodontal disease during orthodont ic t reatm ent

2. Caries r isk evaluat ion and preventat ive m easures during or thodont ic t reatm ent

3. Pain and discom fort related to orthodont ic t reatm ent

4. The possible in uence of t reatm ent of dentofacial aesthet ics

5. The possible in uence or or thodont ic t reatm ent to CMDs

Orthodont ic literature (120 hours). Knowledge of:1. Methods to evaluate the m ethodological

qualit y of scient i c publicat ions

Orthodont ic techniques (195 hours)A level of com petency is required for the top-ics D1–D8. The requirem ents are described in detail in ‘Essent ial com petency levels for post-graduate educat ion in orthodont ics’.

D1. Rem ovable appliances (30 hours)D2. Funct ional appliances (20 hours)D3. Extra-oral appliances (20 hours)D4. Par t ial xed appliances (20 hours)D5. Fixed labial and lingual appliances

(60 hours)D6. Retent ion appliances (15 hours)D7. Skeletal anchorage devices (20 hours)D8. Oral devices for OSA t reatm ent (10

hours)

Interdisciplinary treatment procedures (125 hours)

Adult orthodont ics (20 hours). Knowledge of:1. Indicat ions and speci c aspects of

orthodont ic t reatm ent in adults

General orthodontic subjects (340 hours)

Aet iology and epidem iology of m alocclusions (25 hours). Knowledge of:1. Genet ic and environm ental factors that

in uence postnatal developm ent of the dent it ion and facial com plex

2. Unfavourable environm ental in uences and their in tercept ion

3. Prevalence of m alocclusions and ethnic variat ions

Need and dem and for orthodont ic t reatm ent (15 hours). Knowledge of:1. Validit y of indices in est im at ing need

for t reatm ent2. Models to determ ine the dem and for

t reatm ent3. In uence of society on dem and for

t reatm ent4. Aspects involved in subject ive need for

t reatm ent5. Role played by orthodont ists in

establish ing dem and for t reatm ent6. Factors involved in est im at ing object ive

need

Diagnost ic procedures (15 hours). Knowledge of:1. Taking a pat ien t h istory and perform ing

a clin ical exam inat ion2. Prerequisites for h igh qualit y

diagnost ic records (im pression of the dent it ion , photographs, and necessary radiographic im ages)

Orthodont ic diagnost ic assessm ent, t reatm ent object ives, and treatm ent planning (60 hours).Knowledge of:1. Principles of or thodont ic diagnost ic

assessm ent , t reatm ent object ives, and system at ic t reatm ent planning

Grow th and treatm ent analysis (45 hours).Knowledge of:1. Indices to m easure occlusal and

aesthet ic outcom es of or thodont ic t reatm ent

2. Grow th analyses based on serial radiographic im ages

3. Lim itat ions of analyses of grow th and t reatm ent changes (including com puterized predict ion)


Health and safety in orthodont ic pract ice (10 hours). Knowledge of:1. Guidelines and recom m endat ions for

prevent ing and cont rolling infect ious diseases in or thodont ic set t ings and com plying w ith these guidelines

Mult icultural health and health care behavior (5 hours). Knowledge of:1. Cultural di erences in pat ient

expectat ions2. Cultural di erences in com m unicat ion

skills in a pat ient–care provider relat ionship

Practice management, administration, and ethics (45 hours)

O ce m anagem ent (15 hours). Knowledge of:1. Design of an or thodont ic pract ice2. Equipm ent and inst rum ents needed in

an or thodont ic pract ice3. Recruitm ent and select ion of auxiliary

personnel4. Personal and professional developm ent of

auxiliary personnel5. Financing and adm inist rat ion of an

orthodont ic pract ice6. Public relat ionships7. Qualit y m anagem ent cer t i cat ion

Com m unicat ion (10 hours). Knowledge of:1. Principles of e ect ive com m unicat ion

w ith pat ients, parents, sta , and th ird par t ies

Ergonom ics (5 hours). Knowledge of:1. Principles of ergonom ic posit ioning

of pat ient , or thodont ist , chairside assistant , inst rum ents

Legislat ion (10 hours.) Knowledge of:1. Laws and regulat ions that apply to

orthodont ic pract ice2. Aspects of lit igat ion in or thodont ic

pract ice

Professional ethics (5 hours). Knowledge of:1. Behaviour and conduct expected of an

orthodont ist as a health-care provider

Treatm ent of pat ients w ith orofacial clefts and craniofacial anom alies (25 hours). Know ledge of:1. In terdisciplinary aspects of t reatm ent2. Indicat ion , t im ing, and process of

in terdisciplinary t reatm ent3. Orthodont ic t reatm ent in cleft lip and

palate pat ients

Orthodont ic-surgical t reatm ent (20 hours).Knowledge of:1. Minor surgical procedures in relat ion to

or thodont ic t reatm ent2. Indicat ion and applicat ion of di erent

t ypes of or thognathic procedures

3. 2D and/or 3D t reatm ent planningOrthodont ic-periodontal t reatm ent (20 hours).Knowledge of:1. The e ect of or thodont ic t reatm ent on

the periodont ium2. Speci c aspects of or thodont ic

t reatm ent in periodontally com prom ised dent it ions

Orthodont ic-restorat ive treatm ent (20 hours).Knowledge of:1. Principles of com bined or thodont ic-

restorat ive t reatm ent2. Orthodont ic im plicat ions of im plants

Craniom andibular disorders (20 hours).Knowledge of:1. Aet iology of CMDs2. Methods for clin ical assessm ent of the

tem porom andibular join t3. General m easures to im prove CMDs

Management of health and safety (25 hours)

Managem ent of oral health (10 hours). Knowl-edge of:1. Procedures to detect a h igh risk of

developing periodontal problem s, enam el dem ineralizat ion , and dental caries in or thodont ic pat ients

A m ajor par t of th is subject is incorporated in ‘Iat rogenic e ects of or thodont ic t reatm ent’.


2. Assess the qualit y of evidence and validit y of conclusions

3. Use elect ronic databases e cient ly to obtain the evidence to answer a clin ical or research quest ion

4. Understand and evaluate stat ist ical m ethods and in terpretat ion of ndings in current literature

5. Perform an analyt ical review of research papers

6. Write a protocol for a research project7. Apply data processing procedures8. In terpret ow n research ndings9. Present research ndings in oral and

w rit ten form

Basic orthodontic subjects

Developm ent of the dent it ion (norm al and abnorm al). Com petent to recognize and ident ify:1. Norm alit y or abnorm alit y of grow th

and developm ent2. Developm ental stage at tained3. Potent ial future developm ent4. Possibilit ies for in tercept ive m easures

to im prove the current and future situat ion

Com peten t to:1. Plan and under take in tercept ive

orthodont ic t reatm ent

Facial grow th (norm al and abnorm al). Com pe-tent to recognize and ident ify:1. Postnatal growth changes in the

craniofacial region, including soft tissues2. Variat ion in the funct ion of com ponents

w ith the craniofacial region relevant to facial grow th

3. Individual variat ion in facial m orphology

4. In uence of genetic and environm ental factors on facial grow th

Aspects on tooth m ovem ents and dentofacial orthopaedics. Com petent to recognize and ident ify:1. The process of tooth erupt ion and

spontaneous tooth m ovem ent2. Biological response to di erent t ypes of

force applicat ion3. In uence of force system s and force

m agnitude4. Post-t reatm ent changes

2. Ethical standards that apply to relat ionships w ith personnel, pat ients, and colleagues

Extramural educational activities

It is h ighly recom m ended to:1. Par t icipate in European Orthodont ic

Society (EOC) Dist inguished Teacher’s Lectures w here possible

2. Par t icipate in m eet ings and congresses arranged by nat ional and in ternat ional or thodont ic societ ies

Essential competency levels for postgraduate education in orthodonticsIn addit ion to the theoret ical knowledge of levels indicated in ‘Object ives of com pulsory elem ents of theoret ical educat ion of or tho-dont ists’, the students are required to achieve a level of com petency in the below-m ent ioned subjects. The term ‘com petent to’ m eans that students should have a sound theoret ical knowledge and understanding of the subject together w ith an adequate clin ical experience to be able to independently resolve clin ical challenges encountered.

The m inim al num ber of hours necessary for the average student to devote to the sub-ject in order to achieve the required level of com prehension (= a sound knowledge of and understanding of all subjects) are indicated in ‘Object ives of com pulsory elem ents of theoret ical educat ion of or thodont ists’. The com petency level ‘com petent to’ should be achieved throughout the educat ion w ithout speci ed hours.

General biological and medical subjects

Research m ethodology and biostat ist ics. Com -petent to:1. Apply the principles of evidence-based

m edicine


4. Evaluate in uence of funct ional com ponents of soft t issues on dentofacial m orphology

5. Take h igh qualit y im pressions of the dent it ion

6. Take h igh qualit y photographs7. Take h igh qualit y radiographic im ages

Orthodont ic diagnost ic assessm ent, t reatm ent object ives, and treatm ent planning. Com petent to:1. Arrive at a tentat ive diagnosis and

classi cat ion based on the in it ial clin ical exam inat ion of a pat ient

2. Provide advice after an exam inat ion concerning feasibilit y of t reatm ent , need for a m ore detailed analysis and t reatm ent planning, or further consultat ion w ith other specialists

3. Arrive at a proper diagnosis on the basis of anam nest ic data, pat ient exam inat ion , dental casts, photographs, radiographs, and other relevant data

4. Predict the likely e ect if no therapy is im plem ented

5. De ne object ives of t reatm ent w ith due considerat ion of the alternat ives

6. De ne a t reatm ent plan for various t ypes of orthodont ic and dentofacial abnorm alit ies, including t reatm ent and retent ion st rategies, therapeut ic m easures, t im ing and sequence of their applicat ion , prognosis, and est im ated t reatm ent and retent ion t im e

7. Undertake a cost/bene t assessm ent for di eren t t reatm ent and retent ion procedures

8. Asses scope, lim itat ions, and stabilit y or orthodont ic t reatm ent

9. Com m unicate the t reatm ent plan to pat ients (and their parents if the pat ient is under the age of consent)

Grow th and treatm ent analysis. Com petent to:1. Use indices to m easure occlusal and

aesthet ic outcom es or or thodont ic t reatm ent

2. Undertake grow th analyses based on radiographic im ages

3. Describe t reatm ent changes by analysis of before and near end of t reatm ent records

Oral and m axillofacial radiology and other im aging techniques. Competent to:1. Recognize and ident ify abnorm alit ies

and pathological condit ions that can be diagnosed on radiographs

2. Apply the As Low As Reasonable Achievable principles for radiat ion protect ion

3. Judge and im prove the qualit y of radiographs for or thodont ic purposes

4. Apply health and safety guidelines w ith respect to oral and m axillofacial radiology

Cephalom etric radiography. Com petent to:1. Describe the radiographic anatomy of

the head2. Ident ify relevant anatom ical st ructures

on cephalogram s3. Under take digital or m anual t racings of

lateral and AP cephalogram s4. Under take cephalom etric diagnost ic

analyses and draw appropriate conclusions

Orthodont ic m aterials. Com petent to:1. Select appropriate m aterials for

or thodont ic procedures 2. Handle and use orthodont ic m aterials

appropriately

Orthodontic biomechanics. Competent to:1. Apply principles of m echanics to clin ical

problem s2. Calculate force system s produced by

di erent or thodont ic appliance3. Est im ate force system s produced by

dentofacial or thopaedic devices

General orthodontic subjects

Aet iology and epidem iology of m alocclusions.Com petent to:1. Assess or thodont ic t reatm ent need and

perform screening procedures

Diagnost ic procedures. Com petent to:1. Obtain a relevant pat ient h istory2. Perform a thorough clin ical

exam inat ion3. Determ ine habitual occlusion, evaluate

funct ional occlusion , and di erent jaw relat ionships


3. Design appliances and describe and evaluate their const ruct ion

4. Undertake lim ited repairs

Funct ional appliances. Com petent to:1. Describe the use and the lim itat ions

of rem ovable and xed funct ional appliances

2. Ident ify indicat ions and contraindicat ions


4. Undertake lim ited repairs

Extra-oral appliances. Com petent to:1. Describe the use and the lim itat ions of

various t ypes of headgears, face m asks, chin cups, and com bined ext ra-oral/funct ional appliances



4. Ident ify safet y aspects of ext ra-oral appliances

A m ajor par t of the sect ion is covered in ‘Aspects of tooth m ovem ents and dentofacial or thopaedics’.

Part ial xed appliances. Com petent to: 1. Describe the use of par t ial xed and

sem i-rem ovable appliances2. Ident ify indicat ions and

contraindicat ions, and design appliances

3. Describe the di erent concepts and t reatm ent approaches in part ial xed appliance therapy

Fixed labial and lingual appliances. Com peten t to:1. Describe the use of labial and lingual

xed appliances, including their lim itat ions


3. Describe di erent concepts and t reatm ent approaches in design and biom echanical principles

4. Use at least one xed appliance system

4. Understand the bene ts and lim itat ions of analyses of grow th and t reatm ent changes

Long-term e ect of orthodont ic t reatm ent. Com petent to:1. Describe the potent ial long-term e ect

of or thodont ic t reatm ent in individual pat ients, also in relat ion to ageing e ects of the face and dent it ion

2. Inform the pat ients about potent ial post-t reatm ent changes associated w ith di erent anom alies and t reatm ent procedures

Iatrogenic e ects of orthodont ic t reatm ent. Com petent to:1. Ident ify factors involved in developm ent

of dem ineralizat ion , pulp necrosis, root resorpt ion , gingival recession, and periodontal disease during orthodont ic t reatm ent

2. Prevent or m anage in t ra- and ext ra-oral lesions due to orthodont ic t reatm ent

3. Make a caries risk evaluat ion and apply preventat ive m easures during or thodont ic t reatm ent

4. Advise pat ients how to m anage pain and discom fort related to orthodont ic t reatm ent

5. Describe the possible in uence of t reatm ent on dentofacial appearances and aesthet ics

6. Evaluate the in uence of t reatm ent on CMDs

Orthodont ic literature. Com petent to:1. Detect essent ial publicat ions in the

current literature (taught in speci c literature review sessions)

2. Evaluate the m ethodological qualit y of scient i c publicat ions

3. Develop and present a crit ical appraised topic

Orthodontic techniques

Rem ovable appliances. Com petent to:1. Describe the use of rem ovable

appliances, including advantages and lim itat ions

2. Identify indications and contraindications for rem ovable appliance use


2. Describe aspects of or thodont ic t reatm ent speci c for periodontally com prom ised dent it ions

3. Evaluate indicat ions and contraindicat ions for or thodont ic t reatm ent in periodontally com prom ised dent it ions

4. Collaborate in the diagnosis and t reatm ent planning of periodontally com prom ised dent it ions

Orthodontic-restorative treatment. Competent to:1. Ident ify indicat ions and

contraindicat ions for com bined orthodont ic-restorat ive t reatm ent

2. Describe or thodont ic im plicat ions of im plants

3. Describe aspects of or thodont ic t reatm ent speci c for com bined orthodont ic-restorat ive pat ient care

4. Collaborate in the diagnosis and t reatm ent planning of pat ients requiring orthodont ic-restorat ive t reatm ent

Craniom andibular disorders. Competent to:1. Describe indicat ions and

contraindicat ions for or thodont ic t reatm ent in pat ients w ith CMDs

2. Ident ify possible im plicat ions of orthodont ic t reatm ent in the presence of CMD

3. Collaborate in the diagnosis and t reatm ent planning of pat ients w ith CMD by a team of specialists

Management of health and safety

Managem ent of oral health. Com petent to:1. Inst ruct pat ien ts to m aintain opt ical

oral hygiene as a preventat ive m easure for gingival and dental lesions

Health and safety condit ions in an orthodont ic pract ice. Com petent to:1. Implement guidelines and

recommendations for preventing and controlling infectious diseases in an orthodontic setting and comply with them

2. Im plem ent guidelines and recom m endat ions for m anaging personnel health and safety concerns

Retent ion appliances. Com petent to:1. Describe the uses and lim itat ions of

retent ion appliances2. Ident ify indicat ions and

contraindicat ions3. Design the appliance and describe and

evaluate its const ruct ion4. Describe the m ost appropriate durat ion

of retent ion5. Undertake lim ited repairs

Skeletal anchorage devices. Com petent to:1. Recognise w hen tem porary anchorage

devices or skeletal anchorage devices should be considered as par t of the m anagem ent of a m alocclusion

Oral devices for OSA treatm ent.1. The achievem ent of a com petency level

is encouraged, but is not obligatory

Interdisciplinary treatment procedures

Adult orthodont ics. Com petent to:1. Describe indicat ions and speci c

aspects of or thodont ic t reatm ent for adults

2. Collaborate in the diagnosis and t reatm ent planning of adult pat ients w ith general dental pract it ioners and other specialists

Treatm ent of pat ients w ith orofacial clefts and craniofacial anom alies.1. The achievem ent of a com petency level

is encouraged, but is not obligatory

Orthodont ic-surgical t reatm ent. Com petent to:1. Describe aspects of orthodont ic

t reatm ent speci c for pat ients requir ing or thognathic surgery

2. Collaborate in the diagnosis and t reatm ent planning or pat ients w ho require m inor surgical procedures or or thognathic surgery

Orthodontic-periodontal treatment. Competent to:1. Describe how or thodont ic t reatm ent

m ay bene t pat ients w ho have a h istory of periodontal disease


Acknowledgements

The authors would like to express their grat itude to the m em bers of the Network or Erasm us Based European Orthodont ic Pro-gram m es (NEBEOP) for their valuable input to th is docum ent . Fur therm ore, they are grateful to the European Orthodont ic Society for pro-viding support to the m eet ings.

References

1. Cow pe J, Plasschaer t A, Harzer W, Vinkka-Puhakka H, Walm sley AD. 2009. Pro le and com petences for the graduat ing Eu-ropean dent ist—update 2009. European Journal of Dental Educat ion 14:193–202

2. van der Linden FPGM. 1992. Three years Postgraduate Program m e in Orthodon-t ics: the Final Report of the Erasm us Proj-ect . European Journal of Orthodont ics 14: 85–94

related to infect ion cont rol in an orthodont ic pract ice and com ply w ith them

3. Evaluate system at ically the pract ice in fect ion-cont rol program m e to ensure procedures are followed accurately

4. Control exposure to substances hazardous to health for pat ients and personnel

Practice management, administration, and ethics

O ce m anagem ent. Com petent to:1. Im plem ent a qualit y m anagem ent

system in an orthodont ic pract ice

Com m unicat ion. Com petent to:1. Com m unicate e ect ively w ith pat ients,

parents, sta , other m edical personnel, and th ird par t ies

2. Ut ilize e ect ive com m unicat ions tools and di erent presentat ion m odes

Ergonom ics. Com petent to:1. Posit ion pat ient , or thodont ist , chairside

assistant , and inst rum ents in an ergonom ic opt im al m anner

2. To perform speci c clin ical procedures in the m ost e cient sequence

205

World Federation of Orthodontists (WFO) Guidelines for Postgraduate Orthodontic Education*

Athanasios E. Athanasiou, DDS, MSD, Dr DentProfessor and Head, Depar tm ent of Orthodont ics, School of Dent ist ry, Aristot le Universit y of Thessaloniki, Thessaloniki, Greece.

M. Ali Darendeliler, BDS, PhD, Dip Orth, Certif Orth, Priv DocProfessor and Chair, Discipline of Orthodont ics, Faculty of Dentist ry, University of Sydney; Head, Departm ent of Orthodontics, Sydney Dental Hospital, Sydney South West Area Health Services, Sydney, Aust ralia.

Theodore Eliades, DDS, MS, Dr Med, PhDAssociate Professor, Departm ent of Orthodontics, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece.

Urban Hägg, DDS, Odont DrProfessor and Chair, Depar tm ent of Orthodont ics, Faculty of Dent ist ry, Universit y of Hong Kong, Prince Philip Dental Hospital, Hong Kong, Hong Kong SAR, PR China.

Brent E. Larson, DDS, MSDirector, Division or Orthodont ics, School of Dent ist ry, Universit y of Minnesota, Minneapolis, Minnesota, USA.

Pertti Pirttiniem i, DDS, PhDProfessor and Head, Depar tm ent of Orthodont ics and Oral Developm ent , Inst itute of Dent ist ry, Universit y of Oulu , Oulu , Fin land.

Stephen Richm ond, BDS, DOrth RCS(London), MScD, PhDProfessor of Orthodont ics, Dental Health and Biological Sciences, Dental School, Cardi Universit y, Cardi , Wales, United Kingdom .

Kunim ichi Som a, DDS, PhDProfessor and Chair, Orthodontic Science, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.

Alexander Vardim on, DMDProfessor and Head, Departm ent of Orthodontics, School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.

William Wiltshire, BChD(HONS), MDent, MChD(Orth), DSc Professor and Head, Departm ent of Orthodont ics, Faculty of Dent ist ry, Universit y of Manitoba, Winnipeg, Manitoba, Canada.

CorrespondenceDr. Athanasios E. AthanasiouDepartm ent of Orthodont icsSchool of Dent ist ryAristotle Universit y of ThessalonikiGR-54124 ThessalonikiGreece

* This ar t icle was originally published in the World Journal of Orthodont ics by Quintessence Publishing Co, Inc. World J Orthod 2009; 10:153-166. © 2009 Quintessence Publishing Co, Inc. Used w ith perm ission.


specialists worldw ide, w ho have credent ials that sat isfy the standards set by the WFO.

According to the currently described guidelines, the object ive of or thodont ic post -graduate educat ional program s is to produce graduates w ho have com pleted their didact ic and clin ical educat ion under the auspices and direct ion of an advanced educat ion inst itut ion . Graduates of an orthodont ic program —based in or a liated w ith an advanced educat ion inst itut ion—are provided w ith a broad-based higher level of educat ion in or thodont ics and it s allied biom edical sciences and clin i-cal disciplines. Graduates are t rained in the discipline of or thodont ics and dentofacial or thopedics so they w ill becom e specialists in th is area w ith a solid background in orth-odont ic diagnosis and or thodont ic t reatm ents m odalit ies.

Upon com plet ing the academ ic, clin ical, and research requirem ents of the program , the graduate m ust be able to:

• Diagnose and characterize anom alies of the dent it ion , grow th of the craniofacial skeleton, and funct ional abnorm alit ies

• Form ulate and exercise a controlled and predictable t reatm ent plan

• Conduct in tercept ive and prevent ive orthodont ic procedures

• Treat all t ypes of m alocclusion• Evaluate psychological aspects of

relevance to or thodont ics• Collaborate in the in terdisciplinary

t reatm ent of m edically com prom ised pat ients, syndrom es, and craniofacial anom alies, including orthognathic surgery care

• Assess the need for orthodont ic t reatm ent on individual and societal levels

• Pract ice orthodont ics according to the standards of eth ics

• Com prehensively review, understand, and evaluate the literature per t inent to orthodont ics in a w ide array of disciplines relevant to the specialt y, including m olecular biology, biom aterials, and biom echanics

• Form ulate a research hypothesis and design and conducts and experim ent to test its validit y

• E ciently organize, present , and publish research ndings, as well as present clinical cases in a com prehensive m anner

In July 2006, the Execut ive Com m it tee of the World Federat ion of Orthodont ists (WFO) accepted the president’s proposal for estab -lish ing a WFO task force on Guidelines for Postgraduate Orthodont ic Educat ion .

This task force was chaired by WFO Presi-dent Professor Athanasios E. Athanasiou and had as m em bers Professor M. Ali Darendeliler, Associate Professor Theodore Eliades, Profes-sor Urban Hägg, Professor Brent E. Larson, Professor Pert t i Pir t t in iem i, Professor Stephen Richm ond, Professor Kunim ichi Som a, Profes-sor Alexander Vardim on, and Professor Wil-liam Wiltshire.

The object ive of th is task force was to provide the WFO Execut ive Com m it tee w ith detailed recom m endat ions concern ing guide-lines for postgraduate or thodont ic educat ion , w hich m ay assist countr ies, associat ions, and educat ional inst itut ions to develop or im prove such program s.

Over the past several years, the WFO has placed increased emphasis on support for the recognized training program s in every region of the world through its a liate nat ional orga-nizat ions. At the sam e t im e, the WFO intends to cont inue to provide, w hen requested, encouragem ent and expert ise to developing orthodontic graduate program s in areas w here orthodontic educat ion did not previously exist .

It is anticipated that these guidelines w ill be used by postgraduate program directors all over the world and by related educational, scienti c, and adm inistrat ive inst itutions at all levels of sophist ication to m easure their respec-t ive curriculum against a worldw ide standard.

The follow ing detailed recom m endat ions of the task force on Guidelines for Postgradu-ate Orthodont ic Educat ion are herew ith pre-sented, and they are accom panied by two appendices: (1) Clin ical Care, Study, and Research Facilit ies and (2) Educat ional Topics.

1. Program Goals and ObjectivesThe goal of the program is, in ter alia, to be in accordance w ith the requirem ents of the pres-ent and past WFO docum ents on Orthodont ic Specialt y Educat ion Guidelines to ident ify and recognize appropriately t rained orthodont ic

207Appendix World Federat ion of Orthodontist s (WFO) Guidelines

• Be registered as an or thodont ic specialist for at least 10 years

• Act ively pract ice the specialt y at least 1 day a week

• Dem onstrate excellence in clin ical experience w ith com plet ion of a su cient num ber of cases per year

• Be m em ber in good standing of the country’s or thodont ic specialists’ associat ion

• Be appointed for at least 60% of the working week

• Dem onstrate adm inist rat ive abilit y to coordinate a graduate clin ical program

• Present research abilit y and a proven t rack record in supervising research studies for h igher degrees

In addit ion to the director, a full-t im e posit ion for an or thodont ist (clin ical aca-dem ic) m ust be present . When m ore than six residents are enrolled, addit ional clin ical aca-dem ic sta is required.

It is recom m ended that the clin ical aca-dem ic should:

• Possess a PhD and/or MDSc in orthodont ics or equivalents

• Be registered as an or thodont ic specialist for at least 5 years

• Act ively pract ice the specialt y• Com plete a su cient num ber of cases per

year to m aintain clin ical skills• Be a m em ber in good standing for

the count ry’s orthodont ic specialists’ associat ion

When m ore than one clin ical academ ic is appointed, the appointm ent m ay be also on a par t-t im e basis.

Nonorthodont ic clin icians, such as a research academ ic and/or biostat ist ician , m ay occupy other faculty posit ions.

The research academ ic m ust:

• Possess a PhD w ith experience in graduate-level teaching and graduate student research supervision

• Possess research abilit y w ith an im portant publicat ion record in refereed journals and proven experience in supervising research of Masters and Doctoral students.

External collaborators (orthodont ic spe-cialists or other dental specialists) m ay be

2. Program DurationPostgraduate or thodont ic program s should be a m inim um of full-t im e, 24-m onth dura-t ion . However, it is st rongly recom m ended to have a least 36 m onths of full-t im e specialist educat ion , speci cally to allow residents su -cient t im e to com plete their research projects, the m ajorit y of orthodont ic and in terdisci-plinary cases assigned to them , as well as to plan and m onitor retent ion for at least a few m onths prior to graduat ion.

3. ResidentsTo be adm it ted to the postgraduate program , the candidate should have under taken and passed a full-t im e course in dent ist ry of at least 4 years. The candidate m ust provide proof of regist rat ion as a dent ist in a county in w hich the degree was obtained or in w hich the candidate is presently pract icing.

It is recom m ended that the candidate should have com pleted at least 2 years of gen -eral dent ist ry pract ice experience in a private, governm ent , or universit y-clin ic environm ent before being accepted in the postgraduate or thodont ic program .

Adm ission criteria should include pre-vious academ ic perform ance, clin ical and research experience, foreign language fam il-iarit y as needed, as well as evaluat ion of goals and m ot ivat ion for or thodont ics.

4. FacultyAn appropriately quali ed academ ic sta and program director are essent ial for academ ic success. The faculty m ay be com posed of per-m anent , a liate/adjunct , and full- or par t -t im e academ ic sta .

The clin ical sta –resident rat io in super-vising t reatm ent m ust be at least 1:4–6.

It is recom m ended that the program director should:

• Possess a PhD and/or MDSc (or equivalents) in orthodont ics and present a st rong research and publicat ion record, as well as teaching experience


dental laboratory technician for each six residents is required. Local condit ions, appli-ances’ characterist ics, and available resources should be considered regarding the place in w hich the technical work w ill take place.

VI. Research facilities/supportClinical and laboratory facilit ies and support are required based on research in terest and specializat ion elds of the inst itut ion .

See Sect ion 11 for details on these areas.

6. Required Curriculum

I. Program curriculumResidents m ust be enrolled full-t im e and are required to at tend an adequate am ount of fac-ulty-supervised clin ical sessions to establish pro ciency in clin ical or thodont ics. Twenty-four (24) hours per week of supervised pat ient m anagem ent is recom m ended. The t rainee m ay spend m ore t im e in preparatory work in the form of individual studies, research , or other speci c assignm ents. However, all clin i-cal t rain ing and taught courses m ust t w ith in an 8-hour daily work schedule. Ten to 12 hours per week, 25% to 30% of the program , should be dedicated for research and adm inist rat ion (t reatm ent planning, preparat ion of tutorials, assignm ents, and case presentat ions).

The num ber of new patients assigned to each resident should not be fewer than 30, and equal or m ore transferred patients w ill be assigned during the course of the study. Clini-cal responsibilit ies of the residents should also include supervision of retent ion patients and recall for observat ion of form er patients w ith special clinical interest . A m inim um of 2 hours per week should be devoted to case presenta-t ion and another 1 hour for review of the cur-rent literature in the form of a journal club. Treatm ent m odalit ies and appliances should include rem ovable and xed appliances, grow th m odi cation and orthognathic surgery, guided erupt ion of impacted teeth, craniofacial anom alies, interdisciplinary m anagem ent, and preventive and interceptive case m anagem ent.

Writ ten and/or oral exam inations m ust be conducted in all courses. In addit ion, program s m ay elect ively impose a nal exam ination

appointed to conduct lectures in basic and in terdisciplinary subjects. These lecturers do not have to be enrolled perm anently as fac-ult y sta .

Orthodont ic experts w ith a h igh degree of clin ical experience and dedicat ion in teaching not enrolled in the faculty m ay be invited to conduct lectures or sem inars.

5. Clinical Care, Study, and Research FacilitiesA specialist course in or thodont ics needs to provide adequate clin ical, building, adm in-ist rat ive, inform at ion technology (IT), and research facilit ies.

I. ClinicClinics should include waiting room, reception area, consultation/disabled/special-care room, operatory (main clinic) rooms, oral hygiene room/cubicle/corner, sterilizing room/area, mix-ing area, and a photography area.

II. Radiology areaShould be in the sam e depar tm ent or building.

III. O cesDepartm ent’s head and program director o ces, lecturers’ o ce(s), adm inist rat ive sta o ce, residents’ o ce/study area, and lec-ture/tutorial room .

IV. StorageStorage is required to store teaching, research , and clin ical m aterials, as well as o ce stat ionery.

V. Technical laboratoryTechnical work can be perform ed in-house and/or in cooperat ion w ith external or th-odont ic laboratories. If technical work is perform ed exclusively in -house, a full-t im e


C. Special orthodontic subjects• Biom echanics and tooth m ovem ent• Obstruct ive sleep apnea and or thodont ics• In terdisciplinary t reatm ent (e.g.,

prosthodont ics-periodont ics)• TMD and orthodont ics• Orthognathic surgery join t clinics and

sem inars• Face asym m etries• Class I m alocclusion• Class II m alocclusion• Class III m alocclusion• Vert ical problem s• Maxillary const rict ion • Orthodont ic diagnosis in 3 dim ensions of

space• Orthodont ic techniques• Cleft lip and/or palate t reatm ent• Adult or thodont ics• Noncom pliance t reatm ent• Tem porary anchorage device (TAD)• Pract ice m anagem ent

7. Sponsoring Institution and Institutional CommitmentsAdvance orthodont ic specialt y educat ion pro-gram s m ust be sponsored by inst itut ions (uni-versit y/ school/hospital), w hich are properly char tered and licensed to operate and o er inst ruct ion leading to degrees, diplom as, or cer t i cates w ith recognized educat ion valid-it y. It is recom m ended that hospitals that sponsor advanced orthodont ic specialt y edu-cat ion program s should be universit y-a li-ated. All educat ional inst itut ions that sponsor advanced or thodont ic specialt y educat ion program s m ust be accredited by an agency recognized by the nat ional or regional govern-m ental educat ion and/or health authorit ies.

I. Academic and quality assurance

A. Compatibility of standards, e.g., w ith subject benchmarking statements and meeting the requirements of the professional and statutory bodies

• The sponsoring inst itut ion m ust provide a com m it tee st ructure to oversee the

upon completion of the program . The lat ter is necessary, especially in countries w here ortho-dontics is not an o cial dental specialty recog-nized by the local educat ion, health , and other professional authorit ies, w hich usually orga-nize independent assessm ents of competence.

As a requirem ent for successful com ple-t ion of the program , residents m ust subm it a thesis in the form of a t ypical Master’s docu-m ent , w hich reports original data derived from research act ivit ies in various elds, and/or prepare a paper in publishable form at .

II. Speci c conditionsOrthodont ic curriculum m ust be assessed independently. However, act ive in teract ion w ith adjunct dental disciplines, including restorat ive dent ist ry, oral and m axillofacial surgery, pediat ric dent ist ry, and periodontol-ogy, is essent ial in providing a thorough per-spect ive on t reatm ent planning.

III. Course work/topics to be covered

A. Biomedical sciences w ith emphasis on biological and medical subjects

• Grow th and developm ent• Anatomy of the head and neck• Genet ics• Em bryology of the head• Cell and m olecular biology• Oral im m unology and m icrobiology• Oral physiology• Biostat ist ics• Research m ethodology

B. Basic orthodontic subjects• Developm ent of the dent it ion• Physiology of the stom atognathic system• Orthodont ics as it relates to grow th• Biom echanics• Dental radiography• Int roductory or thodont ic sem inars/

diagnosis and t reatm ent planning• Cephalom etric radiography• Orthodont ic m aterials• Occlusion and TMJ• Iat rogenic e ects from or thodont ics


II. Regulations and program administration

A. Program regulations• The orthodont ic regulat ions should be

incorporated w ith universit y/school/hospital docum entat ion and be consistent w ith nat ional and in ternat ional guidelines.

B. Program management and reporting structures

• There should be a robust m anagerial st ructure that in tegrates fu lly w ith the universit y/school/hospital st ructure so that m inutes of m eet ings are repor ted/referred to the appropriate universit y/school/hospital com m it tees.

C. The contribution of residents to the program-management process

• The residents should be encouraged to provide feedback and develop suggest ions on all aspects of the course, resources, m anagem ent , and sponsoring inst itut ion.

III. Support for residentsA. Academic support for residents• The universit y/school/hospital should

provide the infrast ructure to support teaching and learning w ith state-of-the-ar t facilit ies: clin ical, laboratory, personal workspace, and inform at ion technology. There should be excellent library support w ith In ternet access to relevant academ ic journals.

B. Mechanisms to be employed for monitoring the academic progress of residents

• Monitoring should be under taken on a frequent basis w ith regular form al docum ented m eet ings w ith the residents every 3 to 6 m onths.

C. Pastoral support for residents• The universit y/school/hospital should

provide form alized system s for personal support for the resident . This support can be provided by m em bers of the

course taught in or thodont ics to ensure that it delivers w hat it is supposed to and provides a h igh standard of teaching and learning com pat ible w ith the course provided at the universit y and other universit ies nat ional and in ternat ionally.

• The sponsoring institution m ust facilitate visitat ions from other professional and statutory bodies nationally and internationally to ensure that course standards are being m aintained and that resources (e.g., sta , environm ent, and

nancial) are above the accepted m inim um .

B. The communication of those standards to sta and residents

• The sponsoring inst itut ion m ust provide docum entat ion of st ructures that set out standards of teaching and learning consistent w ith nat ional and in ternat ional standards, ensuring that these are clearly stated and com m unicated to both sta and residents.

C. An account of the school’s quality-assurance arrangement applicable to the program, including school quality manual.

• The sponsoring inst itut ion m ust provide a protocol of how the orthodont ic program is m anaged and in tegrated in the universit y/school/hospital qualit y m anual.

D. Monitoring and review arrangements in accordance w ith institutional requirements and opportunities to ensure continuous enhancement (accreditation)

• The sponsoring institution m ust provide a m echanism of review of the provision of the orthodontic course (every 3 to 6 m onths) and facilitate a period of self-assessm ent and external assessm ent (1 to 3 years).

E. The involvement of residents in the quality-assurance process

• Residents should be form ally invited to contribute to the review and developm ent of the orthodontic program and quality-assurance init iat ives.


orthodontic course, although the provision of the course should not cause a nancial strain on university/school/hospital resources.

B. Sta resources to support the program

• There should be su cien t adm inist rat ive, clin ical, and technical sta support to cover the postgraduate program .

C. Resources to support learning and teaching, including library, IT, and other resident support mechanisms

• There should be adequate resources to support teaching and learning.

D. Recruitment• The universit y/school/hospital should

provide support for the recruitm ent process for orthodont ic postgraduates.

E. Ful lment of legal responsibilities• The universit y/school/hospital should

ful ll and ensure that nat ional and in ternat ional legal responsibilit ies are m et .

F. Training of sta • The universit y/school/hospital should

provide the t rain ing of sta to keep them up -to-date w ith legal m at ters and in ternat ional and nat ional policies per t inent to the t rain ing of residents.

G. Health and safety• The universit y/school/hospital should

com ply w ith appropriate in ternat ional and nat ional law and policies. In addit ion , the or thodont ic program m ust com ply w ith local ru les and regulat ions.

V. Research governanceA. Research ethics• Any research under taken in the

universit y/school/hospital should follow and com ply w ith in ternat ional/nat ional/regional ru les and regulat ions on eth ics.

orthodont ic sta , but it m ay be m ore appropriate if the support is provided by sta not associated w ith the orthodont ic teaching (essent ial in cases w here there is potent ial orthodont ic sta /resident con ict). The university/school/hospital should provide occupat ional health and safety facilit ies to ensure total well-being throughout the educat ion period.

D. Personal tutor system• Residents should be allocated personal

tu tors to m entor them throughout their t rain ing period. The tutors should follow the role of tu tor guidelines set out by the inst itut ion .

E. Personal development planning for residents

• A detailed personal-developm ent plan (PDP) m ust be provided for each resident. It m ay be either paper- or electronically based. Financial support should be allocated to at tend conferences and other continuing professional educational courses.

F. Support for residents studying away from the institution, including placement settings

• The universit y/school/hospital should support t ravel expenses for work under taken outside the host inst itut ions. Facilit ies sim ilar to the host inst itut ion should be available.

G. Support for overseas residents• Overseas residents often need extra support

to ease the transit ion into the postgraduate course (e.g., language and cultural), and the university/school/hospital should provide these supporting m echanism s.

IV. Corporate governance ( nancial, physical, and human resources)

A. Financial and resource plan for the orthodontic program

• The university/school/hospital should provide and support facilities for the


th is area. This w ill result in a cont inual pro-cess of program evaluat ion and im provem ent as diagram m ed in Fig. 1.

This program evaluat ion could be inst i-tuted on several levels.

Internal. All program s are expected to engage in this t ype of ongoing assessm ent w ith data collect ion and evaluat ion at least annu-ally. Docum entat ion of the process should m inim ally include evidence of data collected, evidence of discussion by faculty, recom m en-dat ions for program changes (as indicated), and t im etable for repeated data collect ion .

Country or region. In areas where formal accreditation exists, site visitors could review this program evaluation. Speci c emphasis should be placed on identi cation of program weaknesses, institution of suggested changes, and follow-up data collection to evaluate the changes.

Worldw ide/WFO. The program evalua-t ion m aterials could be subm it ted on a peri-odic basis to a WFO review com m it tee to dem onstrate com pliance w ith the program evaluat ion process. This could be of value especially in countr ies/regions that do not have accreditat ion processes in place.

B. Research management• The universit y/school/hospital should

m onitor and m anage research and ensure that research follows st r ingent guidelines set out by the appropriate in ternat ional and nat ional bodies.

8. Program EvaluationEach program is expected to m aintain an ongoing assessm ent of it s e ect iveness based on the program ’s de ned goals and objec-t ives. The goals and object ives m ust m ini-m ally address the areas of didact ic educat ion (including biom edical and clin ical sciences), pat ient-care experience, and research experi-ence. The object ives should be m easurable by one or m ore indicators.

The degree to w hich the program objec-t ives are m et should be assessed on a regular basis (at least annually), and de ciencies that are noted should lead directly to program changes designed to im prove perform ance in

Fig. 1


Examinations/evaluationsDuring the program

After completing a subject/m odule/course, and depending on the subject/m odule/course, this assessm ent should include theoretical exam i-nation (e.g., w rit ten essay or m ultiple-choice test), practical evaluation of residents’ capabili-t ies (e.g., w ire bending, typodont exercises), or assignm ent of independent review paper writ-ing or presentation. Other inform al assessm ents for resident feedback w ill be based on direct observation of clinical perform ance, as well as on perform ance at problem -based sem inars.

Final examination

After com plet ing the program , residen ts should part icipate in the nal exam inat ion(s), w hich w ill involve assessm ent of their over-all knowledge regarding or thodont ics and related clin ical disciplines.

If external exam iners are used in the nal exam inat ion (recom m ended) a viva-voce exam inat ion w ith an in ternal and an external exam iner using set quest ions m ay be ut ilized.

Final exam inat ion(s) should include an in it ial exam inat ion , diagnosis, and t reatm ent-planning exercise on a set of pat ient records that are not know n to the residents. The exam iner(s) w ill have previously exam ined the record(s) and agreed on quest ions and solut ions. The residents w ill exam ine these records for a speci c period (e.g., 45 to 60 m inutes) and then be exam ined by the exam -iners on their diagnosis and t reatm ent plan .

If a National Orthodontic Board exists in the country, it is recommended that this Board should be involved in the nal examination; if the resident passes the exam, he/she should receive the Board’s certi cation and become eli-gible for re-certi cation every certain number of years in order to maintain a high standard of care.

Should unsat isfactory outcom es charac-terize the perform ance of a resident , a resit evaluat ion should be held w ith in a reasonable t im e period. In case of another failure, repet i-t ion of the subject/m odule/course at the next academ ic sem ester or year should be consid-ered. In cases of serious and repeated unsat -isfactory perform ance by the resident , the situat ion should be discussed w ith in the fac-ult y and the resident m ay be advised that h is/her regist rat ion be suspended or term inated.

The process relies heavily on program -speci c goals and object ives. The goals and object ives m ust be com plete and well-de ned for the process to be e ect ive.

9. Resident EvaluationBy evaluat ing the program , it m ay be assum ed that if the individual com ponents (e.g., pro-gram curriculum , facilit ies, and sta ) are present in the r ight proport ions, the product w ill be an e cient program that w ill pro-duce com petent graduates. However, exist-ing in ternat ional pract ices suggest that apar t from curricula com pliance exam inat ion of the graduate, there should be a direct approach to assess the com petency of the t reatm ent pro-vider, regardless of the reputat ion and overall standing of the program from w hich he/she has received advanced educat ion . This m ethod secures a m inim um standard in the provision of or thodont ic services by directly exam ining the quali cat ion of the graduate. In addit ion , taken in large scale, a resident’s evaluat ion m ay serve as an indirect m eans of revealing the e ect ive ness of speci c advanced or th-odont ic program curricula.

Evaluat ion of residents should take place on a regular and prescheduled basis through-out the program , as well as on com plet ion . The residents, teachers, and in ternal and external exam iners should under take th is evalua-t ion . The program should enable cont inuous assessm ent of residents’ perform ance, thus recognizing individuals’ st rengths and ident i-fying areas of im provem ent through personal-developm ent plans.

There should be a process of appraisal for all residen ts, consist ing of an in form al discussion bet ween residen t s and their aca-dem ic sta at least in every sem ester, dur-ing w hich they are encouraged to re ect on their p rogress and set goals for the rem ain -der of the course. The residen t s are encour-aged to review their progress in ach ieving these goals. The appraisal process provides an oppor tun it y to iden t ify poten t ial prob-lem s early and provide appropr iate suppor t and guidance. With su cien t st a suppor t , the problem s m ay be d iscussed and resolved expedit iously.

Evaluat ion of residents m ay take place at the end of each sem ester, year, or speci c m odule.


to com e w ith in the eld , as well as through in teract ion w ith other dental and m edical disciplines. This im plies that postgraduate orthodont ic educat ion providers and gradu-ate orthodont ic specialists should be com m it-ted to the cont inuing process of expanding orthodont ic knowledge. This com m itm ent m ay be facilitated by WFO-sponsored act ions, act ivit ies, and program s that aim to expand academ ic sta know ledge (e.g., educat ion exchange program s), acknowledge students and academ ic sta research (i.e., awards), and recognize cont inuously updated educators (e.g., cer t i cat ion).

11. Clinical Care, Study, and Research Facilities

ClinicClinics should consist of a wait ing room , recept ion area, consultat ion/disabled/special care room , operatory (m ain clin ics) room s, oral hygiene room /cubicle/corner, sterilizing room /area, m ixing area, and a photography area. The details are h ighlighted below.

Waiting roomSpaceHigh capacity (chairs and tables, etc.)Relat ive com fortToilets/accom m odat ions for disabled*

Reception areaVisible / rst contact*Provide record accessAdm inist rat ive tasks*Scheduling*Clin ical coordinat ionCenter for deliveries*Media center (screens in recept ion and

wait ing room )IT equipm ent

Consultation room (s)Dental chair*Parent/pat ient discussion desk w ith light box

incorporatedMult im edia facilit iesIn teract ive and educat ive softwareDisplay cabinetAccess for disabled*

Practical requirementsResidents are expected to attend all scheduled sessions punctually. Attendance and active par-ticipation by the residents in all seminars orga-nized by the postgraduate program is mandatory.

To acquire su cient know ledge and capabilit ies regarding orthodont ic laboratory work, each resident should fabricate a spe-ci c num ber of study m odels, diagnost ic set -ups, retainers, and rem ovable and funct ional appliances assigned by the program .

Each resident should be ready to present a m inim um num ber of n ished and fully docu-m ented cases (5 to 10 cases) that were t reated ent irely by the resident during the course of the program . Docum entat ion should be m ade according to the guidelines of the country governing authorit y (e.g., Am erican Board of Orthodont ics).

Dissertation or Master’s thesisEach resident should undertake a research proj-ect for which its m ethodology, as well as the results, should be presented in the form of a dis-sertat ion. The resident should produce a bound dissertat ion of 20,000 to 50,000 words by the required subm ission date and be able to discuss and defend the research in an oral exam ination. Residents are expected to publicize the ndings of their research in a variety of ways, including (a) presentation at research sem inars, (b) pre-sentation at national/international m eetings, and (c) publication in a refereed journal.

Subject to achieving a sat isfactory perfor-m ance in all elem ents of the program , he/she w ill be awarded w ith the degree.

With regard to the level of educat ional award and assessm ents (e.g., MSc, profes-sional doctorate, PhD—m erit and dist inct ion), local rules in universit ies/inst itut ions/coun-t ries should apply.

10. Outcome AssessmentOrthodont ics, like any m edical discipline, is a dynam ic eld. Orthodont ic specialists and sci-ent ists working in th is eld are com m it ted to im proving t reatm ent results and stabilit y, and m inim izing the side e ects. The m ot ivat ion and in it iat ive for these advancem ents have


Safety featuresLead lin ings*Blinds*Glasses*Warning labels/lights*

O cesHead of departm ent’s o ce*, lecturers’ o ce (can be open set-up)*, adm inist rat ive sta o ce (can be open set-up)*, residents’ study o ce (can be open set-up)*

Lecture/tutorial room *Meeting-sized table/seat ing*Mult im edia/IT equipm ent*

Com puter/server roomWorkstat ions*Server and IT hardware*Peripherals (prin ters, scanners)*Back-up disks/drives*Com m unicat ions: network stat ions*

SoftwarePract ice m anagem entIm age analysis (radiographic and

photographic)In ternet*Em ail*Word processor*Database m anagem ent (Microsoft Excel, SRL,

SPSS)*Rem ote accessSecurit y*FinancialPat ien t database

StorageConsum ables* and study m odels

Technical LaboratoryPlaster-m ixing equipm ent*Plaster storage*Sinks w ith plaster t rap*Working benches w ith necessary technical

accessories*Model t r im m ers*Bench tops*Laboratory jobs in /out storage*Steam source*Wax rem oval*Sand blasterFum e cupboard*

OperatoryDental chairs* (at least one chair per two

residents) in a cubicle, clin ical room , or open set-up

Utilit y/storage*Working drawersHygienic ooring*Sharp disposal*Bins*Com pressed air*

Oral hygiene areaSink*Mirror*StorageBin*Display cabinetHygienic ooring*

Sterilizing areaClean/dir t y area*Bins*Sharp disposal*Sink/tap*Cold sterilizer*Packing area*Sterilizer*Dying area*Clean inst rum ents storage*Consum ables storageHygienic ooring*Light ing*IT equipm ent

Mixing areaAlginate m ixerPVS m ixerTray storage*Consum ablesSink/tap*Bins*Hygienic ooring*

Photography areaIm age background*Controlled light ingMirrors and accessories*2D or 3D digital photography unit ( xed or

rem ovable)*IT equipm ent

Radiology AreaIn the sam e depar tm ent or building: or thop -antom ograph, cephalom etr ic, and/or 3D diag-nost ic radiographic im aging m achines*; chair; IT equipm ent; storage/accessories.


GeneticsThe genet ic basis of diseasesGenet ic diseases – syndrom esCancer genet icsGene therapy and bioeth icsDevelopm ent of m alform at ionsGenetic and epigenetic control of grow th

Em bryology of the headDevelopm ent of jaws, teeth , and faceTeratogenesis and syndrom esDevelopm ent of clefts

Cell and m olecular biologyCell m etabolismTooth m ovem ent and react ion to forceBiochem ical pathways of force t ransduct ion

to cellBiological mechanisms of root resorptionBiological events accom pany force

applicat ion to car t ilage, bone and periodontal ligam ent

Oral im m unology and m icrobiologyOral im m unologySaliva and the form at ion of acquired pellicleOral m icrobiologyBio lm s

Oral physiologyPhysiology of speech, swallow ing and gestationPhysiology of TMJPhysiology of breath ing and swallow ingNorm al and abnorm al breath ing and

obst ruct ive sleep apnea

General and oral pathologySystem ic diseases (grow th and sex horm one

im balances, hepat it is, HIV, leukem ia, osteoporosis, and endocardit is)

Oral m anifestat ions of diseases (radiat ion , cysts, herpes, and aphtha)

BiostatisticsRegression and correlat ionParam etric and nonparam etric analysesAnalysis of varianceMeta analysisApplicat ions in orthodont icsBiostat ist ic-epidem iologic surveysClin ical research in or thodont ics

Research m ethodologyEthics and in tegrit y in researchDesign of a studySubm ission of a protocolStat ist ical analysis of ndings

Curing light boxVacuum curing (for therm oplast ic m aterials)*Dust ext ract ion*Laboratory m aterials*Com pressed air lines*Bins*Welding equipm ent (laser and gas)3D laser scanner for 3D digital m odels

StorageIT equipm entJob booking and follow -up softwareLighting assorted w ith m agnifying glassHygienic and nonslip ooring*Adm inist rat ive desk

Research Facilities/SupportClinic*

Laboratory w ith equipm entOrthodont icITBiom aterialsHistologyMolecularMicroscopyAnim al facilit ies

SupportUniversit y*Governm ent/hospitalProfessionalPrivate/corporateExperienced m anpowerAdm inist rat ive

Item s m arked w ith an aster isk (*) const itute m inim um requirem ents.

12. Educational TopicsBasic Medical SubjectsGrow th and developm entSom at ic grow th and variat ionDevelopm ent of the craniofacial com plexGenet ic/environm ental factors and grow thDeterm inat ion of skeletal and biological ageStages of sexual developm ent

Anatomy of the head and neckCraniofacial st ructuresSkeletal deform it iesCraniofacial m alform at ions


Measurem entsNoninvasive techniquesAnalyses (Steiner, Wits, Downs, Hasund,

Coben, Bjork, Sassouni, Tweed, Ricket ts, McNam ara, and Pancherz)

Superim posit ions (overall, regional)3D im aging

Orthodontic m aterialsAlloysPolym ersCeram icsBonding to enam elBonding to restorat ive m aterialsEnam el side e ects

Occlusion and tem porom andibular disorders (TMD)

Anatomy and funct ionGeneral TMJ conceptsNorm al occlusion and funct ionDi erent ial diagnosis of TMDTMD in children , adolescents and adultsManagem ent philosophies

Iatrogenic e ect from orthodonticsClassi cat ion of undesirable t issue, organ,

and system e ectsEnam el e ects during bonding; debonding

and t reatm ent w ith xed appliancesRoot resorpt ionDam age to tooth-support ing t issuesRisk-m anagem ent principles

Special Orthodontic SubjectsBiom echanics and tooth m ovem entMethods of studyApplicat ions to clin ical pract ice

Obstructive sleep apnea and orthodontics

Interdisciplinary treatm ent (prosthodontics, periodontics, etc.)

TMD and orthodontics

Orthognathic surgery joint clinics and sem inars

Face asym m etriesClassi cat ionEt iologyDiagnosisTreatm ent opt ions

Basic Orthodontic SubjectsDevelopm ent of the dentitionDevelopm ent of norm al occlusionTooth erupt ionDevelopm ent of abnorm al occlusionLocal and genet ic factorsDeviat ion from norm alit yAgenesis and supernum erary teeth

Physiology of the stom atognatic systemConst ituent m uscles, bone, and car t ilageAbnorm al funct ionTMJ physiology and funct ion in health and

diseaseDiagnost ic proceduresTherapeut ic protocols

Orthodontics as it relates to grow thTypes of grow th in bone, condyle, and suturesAdaptat ion of t issues to st im uliMechanical st im ulat ionDentofacial or thopedics

Biom echanicsEquilibrium of bodiesMechanics of solidsViscoelast icit y

Oral and m axillofacial radiographyPeriapical radiographs [in t ra- and ext raoral

technique]Variables a ect ing the qualit y of radiographsAnatom ical landm arks in in t ra- and ext raoral

radiographsCaries diagnosis through radiographsPeriodontal diagnosis and radiographsOral and m axillofacial applicat ionsOrthodont ic applicat ionsDigital im agingCone beam com puted tom ographyRadiat ion safety

Introductory orthodontic sem inars/diagnosis and treatm ent-planning

Medical/dental h istoryRecordsExtra- and in t raoral exam inat ionDiagnost ic sequelaePhotographic assessm entModel analysis (crow ding/space assessm ent ,

Bolton analysis, set-up)

Cephalom etric radiographyLateralPosterior - anteriorLandm ark ident i cat ion


Adult orthodonticsEsthet icsEm ergence pro lePeriodontal considerat ionsTreatm ent planning com plex casesLim itat ions of reconst ruct ive techniques

Noncom pliance treatm ent

TAD

Accelerated osteogenic orthodontics (e.g., Wilckodontics)

Practice m anagem entSterilizat ion and disinfect ion protocolsOrthodont ic pract ice: set t ing up/the design

processOrthodont ic pract ice: engaging w ith the

team /the building processMedical and legal aspects of or thodont ic carePract ice visits and discussion w ith private

pract it ionersProfessional eth ics

Acknow ledgementsThe authors of th is docum ent express their appreciat ion to the m em bers of the WFO Execut ive Com m it tee: Professor Athanasios E. Athanasiou, president , Thessaloniki, Greece; Professor Abbas R. Zaher, vice president , Alexandria, Egypt; Dr. William H. DeKock, secretary-general, Cedar Rapids, Iowa, USA; Dr. Jam es E. Gjerset , Georgetow n, Texas, USA; Professor Ju lia F. Har n , Buenos Aires, Argen-t ina; Professor Roberto Justus, Mexico Cit y, Mexico; Dr. Larson R. Keso, Oklahom a Cit y, Oklahom a, USA; Dr. Jung Kook Kim , Seoul, South Korea; Professor Francesca A. Miot t i, Padova, Italy; Dr. Richard J. Olive, Brisbane, Australia; Dr. Som chai Sat ravaha, Bangkok, Thailand; Dr. Allan R. Thom , London, England, United Kingdom ; and Dr. B. Ian Watson, Gle-nelg, South Australia, Australia for appoint ing them to the WFO Task Force on Guidelines for Postgraduate Orthodont ic Educat ion , for providing valuable editorial com m ents and accept ing on March 29, 2009, these guidelines as WFO policy.

Class I m alocclusion patientDiagnosisEt iologyTreatm ent planning

Class II m alocclusion patientDiagnosisEt iologyTreatm ent planningHeadgearFunct ional appliances

Class III m alocclusion patientDiagnosisEt iologyTreatm ent planningFace m ask, chin cup

Vertical problem sOpen biteDeep biteDiagnosisEt iologyTreatm ent planning

Maxillary constrictionRapid m axillary expansionDiagnosisAppliances (Quad-helix, Haas and Hyrax

expanders)E ects on periodont iumE ects on airway

Orthodontic diagnosis in 3 dim ensions of space

Sagit talTransverseVert icalAppliances

Orthodontic techniquesStraight-w ireTweedRicket tsStandard edgew iseTip -edgeSelf-ligat ing techniquesClear sequent ial appliances

Cleft lip and/or palate treatm entIndicat ions, t im ing, protocolsIn terdisciplinary approachSpeech therapyPsychological involvem ent

219

Index

AAAO. See Am erican Associat ion of

Orthodont istsABO (Am erican Board of Orthodont ics),

44, 112–115Aboriginal and Torres St rait Islander

(ATSI) dental specialt y workforce, 77academ ic educat ion and organizat ion ,

assessm ent criteria and m ethods for, 186

academ ic inst itut ions, ranking of, 182–190

academ ic research. See researchaccreditat ion , 37, 73, 74–79, 188–190.

See also Com m ission on Dental Accreditat ion (CODA); Com m ission on Dental Accreditat ion of Canada; regulatory organizat ions

ADA. See Am erican Dental Associat ionADC (Aust ralian Dental Council), 73ADC/DCNZ (Aust ralian Dental Council/

Dental Council of New Zealand), 74–79

ADC/DCNZ Accreditat ion Com m it tee, 73ADC/DCNZ Accreditat ion Standards:

Educat ion Program s for Dental Specialt ies, 74–79

ADEE (Associat ion of Dental Educat ion in Europe), 18

Adelaide, Universit y of, 73adm issions policies and procedures,

ADC/DCNZ Accreditat ion Standards on , 76

advanced e-learn ing tools, 129–130Advanced Network for Research and

Educat ion (UAE), 131advert ising and com m ercialism , in

scient i c journals, 155–156Afghanistan– lack of inform at ion on , 106, 109– as SAARC m em ber, 88Africa, 83–84Ahm ed, Ra udin , 88AJO-DO (Am erican Journal of

Orthodont ics and Dentofacial Orthopedics), acceptance rate for, 154

Alberta, Universit y of, 52

All India Inst itute of Medical Sciences (AIIMS), 99–102, 105

Am erican Associat ion of Orthodont ists (AAO)

– board cer t i cat ion and, 112, 113– CCGOPD and, 54– Council on Orthodont ic Educat ion , 11– forerunner of, 147– founding of, 3– preceptorship program , 6–8, 10– precursor to, 9– standardizat ion of m em bership in , 3–5– Web program , 136–137Am erican Board of Or thodont ics (ABO),

44, 112–115Am erican College of Dent ists, on young

editors, 148–149Am erican Dental Associat ion (ADA), 7,

11. See also Com m ission on Dental Accreditat ion (CODA)

Am erican Journal of Orthodont ics and Dentofacial Orthopedics (AJO-DO), acceptance rate for, 154

The Am erican Orthodont ist (journal), establishm ent of, 147–148

Am erican Society of Dental Surgeons, 1Am erican Society of Orthodont ists,

2, 147Am erican Universit y of Beirut , 86Am erican Universit y of Sharjah (AUS),

131andragogy, 130, 133anesthesiologists in turf wars, 14Angle, Edward Hart ley, 1–2, 9, 73, 147,

148, 155The Angle Orthodont ist (journal),

establishm ent of, 148Angle School (later College) of

Orthodont ia, 2, 3, 9, 147“The Angle System of Regulat ing Teeth”

(Angle), 1anim als, protect ion of, in research, 150Ankabut (educat ional cloud), 131annual review of com petence

progression (ARCP), 40appliances (dental)– Angle’s knowledge of, 3

– Begg appliance, 100– in Canadian curriculum , 55– com m ercialism and, 145– con icts of in terest and, 152– in early 20th century, 148– Erasm us program on, 29– in Middle East /African curr icula,

83–87– in Nepal, 107– research and, 163– Tw in Blok appliance, 100– undergraduate know ledge of, 17, 18ARCP (annual review of com petence

progression), 40area of origin, for journal art icles, 154,

155Argent ina, postgraduate program s

in , 63asepsis and infect ion control, U.S.

standards on , 47–48Asian Paci c Orthodont ic Conferences,

103Asian Paci c Orthodont ic Society, 103,

107, 108, 109ASO (Aust ralian Society of

Orthodont ists), 73, 79–81, 136–137assessm ent(s)– assessm ent bodies, 183– by colleges, UK, 123– of dental educat ion program s, current

status of, 164–165– external, of postgraduate program s,

31–32– of graduat ing classes, in East and

Southeast Asia, 70– of learn ing m ethods, 19–20– Miller assessm ent pyram id, 137– in online learn ing m anagem ent

system s, 137– self-assessm ent process, ADC/DCNZ

Accreditat ion Standards on, 78– standard set t ing of exam inat ions, UK,

122–123– of students, ADC/DCNZ Accreditat ion

Standards on, 77– in UK, 36–37– at W VU, 44–45


CDAC (Com m ission on Dental Accreditat ion of Canada), 52–53, 55–56

Centre for Dental Educat ion and Research (India), 101

Cert i cate of Com plet ion of Specialt y Train ing (CCST), 40

cer t i cat ion , by or thodont ic boards, 112–116

certi ed registered nurse anesthet ists, 14CEX (clin ical evaluat ion exercises), 37Chile, postgraduate program s in , 63China. See East Asia, Southeast Asia,

and ChinaClark, William , 100clear aligner therapy, 57clinical and research data, U.S. standards

on im aging equipm ent for, 48clin ical applicat ion and t ranslat ion , of

research , 165–166clin ical evaluat ion exercises (CEX), 37clin ical exam ple, for research, 166–180clin ical excellence, m aintain ing,

115–116clin ical facilit ies, guidelines on, 81clin ical inform at ion, sources of, 145clin ical sciences curriculum , U.S.

standards on , 49–50clin ical supplies, U.S. standards on , 47clin ical t rain ing, 35, 80, 165, 185–186clin ical t r ials, obligat ion to register, 150CODA. See Com m ission on Dental

Accreditat ionCollege of Dent ist ry (Universit y of

Illinois Chicago), 3College of Physicians and Surgeons

Pakistan (CPSP), 103, 105colleges, independent and external

(UK), 123Colom bia, postgraduate program s in , 62Colom bian Society of Orthodont ics, 62Colom bo, Universit y of, Postgraduate

Inst itute of Medicine (Sri Lanka), 109Colum bia Universit y, 1, 2, 9com m ercialism , 145, 155–156, 163Com m ission for Academ ic Accreditat ion

(CAA, UAE), 132Com m ission of the European

Com m unit ies, European Cultural Foundat ion , Erasm us Bureau , 26

Com m ission on Dental Accreditat ion (CODA), 11, 12, 42–43, 52–53. See alsoUnited States, CODA standards

Com m ission on Dental Accreditat ion of Canada (CDAC), 52–53, 55–56

Com m it tee of Postgraduate Dental Deans and Directors (COPDEND, UK), 39, 119–120

Com m it tee on Nat ional and Regional Orthodont ic Boards (WFO), 114

com m unity interface, ADC/DCNZ Accreditat ion Standards on, 76

Berners-Lee, Tim , 128Bhore, Joseph, 91Bhutan– lack of inform at ion on , 106, 109– as SAARC m em ber, 88biom echanics, e-learn ing of, 138Biom ed 2 Project (EURO-QUAL II), 26, 32biom edical sciences curriculum , U.S.

standards on , 49blended learn ing, 19, 129, 132–133blogs, elect ronic journal publishing

and, 159board cer t i cat ion , 112–116Bolivia, postgraduate program s in , 63BOS (Bangladesh Orthodont ic Society),

106, 107B.P. Koirala Inst itute of Health Sciences

(Nepal), 108Brazil, postgraduate program s in , 62Brazilian Board of Orthodont ics and

Facial Orthopedics, 114, 116Bristol, Universit y of, 129Britain . See England; United KingdomBrit ish Colum bia, Universit y of, 52, 54Brit ish India, 88, 91Brit ish Orthodont ic Society (BOS),

36, 40Brit ish Science Fest ival, 153Brodie , Allan G., 3, 23BSMMU (Bangabandhu Sheikh Mujib

Medical Universit y, Bangladesh), 107Burki, Wajid Ali, 103

CCAL (com puter-assisted learn ing), 19Californ ia San Francisco, Universit y

of (UCSF) School of Dent ist ry, “Curriculum II,” 10

Canada, 52–58– graduate curr iculum , 55–56– graduate educat ion , challenges facing,

56–57– graduate program s, 54–55– m atch system , 54– regulatory organizat ions, 52–54– residents’ program evaluat ions, 56Canadian Associat ion of Orthodont ists

(CAO), 54, 55Canadian Council of Graduate

Orthodont ic Program Directors (CCGOPD), 54

Canadian Dental Associat ion , 52Case, Calvin, 147cases– case-based discussions (CBD), as

assessm ent m ethod, 37– case logs, guidelines on , 80– case presentat ions, in UK, 37– case reports, 69, 157–159– num bers of, guidelines on , 80CCGOPD (Canadian Council of Graduate

Orthodont ic Program Directors), 54

assessm ent criteria and m ethods, evolut ion of, 182–190

– academ ic educat ion and organizat ion , 186

– accreditat ion and self-assessm ent , 188–190

– assessm ent bodies, 183– clin ical t rain ing, assessm ent of,

185–186– facilit ies, assessm ent of, 185– general considerat ions, 188– overview, 182– postgraduate program s, assessm ent

of, 184–185– professional and clin ical program

assessm ent , problem s of, 183–184– research, assessm ent of, 186–188– teaching, assessm ent of, 188Associat ion of Dental Educat ion in

Europe (ADEE), 18asynchronous online learning, 138Atkinson , Spencer R., 3, 148ATSI (Aboriginal and Torres St rait

Islander) dental specialt y workforce, 77

AUS (Am erican University of Sharjah), 131Australasian Orthodontic Board, 113, 115Aust ralian Dental Council (ADC), 73Aust ralian Dental Council/Dental

Council of New Zealand (ADC/DCNZ), 74–79

Australian Societ y of Orthodont ists (ASO), 73, 79–81, 136–137

authorship credit , for scient i c journal ar t icles, 149

BBaker, Charles R., 3Balt im ore College of Dental Surgery, 1Bangabandhu Sheikh Mujib Medical

Universit y (BSMMU, Bangladesh), 107Bangladesh– educat ion in , 104, 106–107– form at ion of, 91– as SAARC m em ber, 88Bangladesh College of Physicians and

Surgeons, 106Bangladesh Journal of Orthodont ics

and Dentofacial Orthopedics,establishm ent of, 107

Bangladesh Orthodont ic Society (BOS), 106, 107

Barts and the London School of Medicine and Dent ist ry (Queen Mary Universit y), 35

“Basic Principles of Or thodont ics” (Johnson), 2

Begg appliances, 100Beirut Arab Universit y, 86Belgium– educat ion in , 27– EFOSA and, 27

Index 221

– and t reatm ent planning, cont roversies in , 162

diagnost ic tests assessm ent , in UK, 37diplom a in or thodont ics (DOrth, India),

101direct ives, of European Union, 24–26direct observat ion of procedural skills

(DOPS), 37directors. See program directorsdiscussion , in case reports, 158disser tat ion/research theses, 37–38, 70do-it-yourself or thodont ic kit s, 57Dom inican Republic, postgraduate

program s in , 62DOPS (direct observat ion of procedural

skills), 37DOrth (diplom a in or thodont ics, India),

101double doctoral degree program

(China), 67, 68DSA (dent ist scient ist award) program ,

187DSATP (dental specialt y assessm ent and

t rain ing program s), 53–54DSCKE (dental specialt y core knowledge

exam inat ion), 53–54dual coding theory, 130due process, U.S. standards on, 51

Eearly predoctoral and specialt y

educat ion , 9–11East Asia, Southeast Asia, and China,

66–72– applicants, quali cat ion of, and

select ion criter ia, 67– conclusions on , 71–72– cont inuing educat ion , 71– dental school program s, 66–67– departm ent facilit ies, 71– double doctoral degree program , 67, 68– eight-year program s, 68– graduat ing classes, assessm ent of, 70– or thodont ic courses, 68–69– orthodont ic residents, requirem ents

for, 70– PhD and SMD degrees, 67–68– research, 69– status of educat ion in , 66– teaching team s, quali cat ions of,

69–70– three-year m aster’s degrees, 67East Pakistan , 91Ecuador, postgraduate program s in , 62Edgew ise Technique, 100Edison, Thom as, 129editors, of journals, role of, 148–149educat ion . See also cont inuing

educat ion; curr icula; program s of educat ion

– assessm ent cr iteria and m ethods, evolut ion of, 182–190

– in Iraq, 84– in Middle East , 83–87– in Nepal, 108– research papers for, 186– in Sri Lanka, 109– in UK, 34, 35, 40, 117, 122– in U.S., 49, 164– in U.S., for faculty, 187De’Montm orency, Geo rey Fritz Harvey,

103De’Montm orency College of Dent ist ry

(Lahore, India), 88, 103Denm ark, EFOSA and, 27Dental Board of Aust ralia, 73Dental Council of India (DCI), 88, 91, 99,

100, 101, 102Dental Council of New Zealand (DCNZ),

73dental educat ion program s, current

status of assessm ents of, 164–165dental foundat ion (DF), 117, 119Dental Gold Guide (UK), 39dental health regulat ion (UK), role of

dental facult ies in , 120–121“Dental Health Services in Canada”

(Canadian Dental Associat ion), 52dental schools– in East Asia, 66–67– relat ionship w ith educat ion provider,

ADC/DCNZ Accreditat ion Standards on , 75

dental specialt y assessm ent and t rain ing program s (DSATP), 53–54

dental specialt y core know ledge exam inat ion (DSCKE), 53–54

dental specialt y students, relat ionship w ith educat ion provider, ADC/DCNZ Accreditat ion Standards on , 75

dental t rain ing robot (Sim uloid), 129DentEd project (European Union), 21dent ist ry– h istory of, in Lat in Am erica, 59– turf wars and, 14– workforce issues, 13Dent ists Act (India, 1948), 91Dent ists Act (UK, 1984), 119dent ist scient ist award (DSA) program ,

187dentofacial or thopedics, 42DentSim (e-learn ing program ), 130Departm ent of Health , Educat ion and

Welfare (UK), 118, 121, 123Desire 2Learn (online learn ing

m anagem ent system ), 137Dewey, Mart in , 2, 147–148Dewey School of Orthodont ia, 2DF (dental foundat ion), 117, 119Dhaka Dental College and Hospital

(DDCH, Bangladesh), 106diagnosis– et iology and, in case reports, 157–158– theory vs., in educat ion , 20

com petencies, assessm ent of, 20com puter-assisted learn ing (CAL), 19com puter languages, for e-learn ing, 130Com puters & Educat ion (journal), on

m ult im edia learning, 131con icts of in terest , 13, 151–152, 155cont inuing educat ion (cont inuing

professional developm ent , CPD), 71, 115–116, 137–138, 144–146

cont inuous im provem ents, ADC/DCNZ Accreditat ion Standards on , 74

“cookbook t rain ing,” 162, 163COPDEND (Com m it tee of Postgraduate

Dental Deans and Directors, UK), 39, 119–120

Copesthet icCE Web site, 135–136, 137copyright ow nership, for journal

ar t icles, 150–151corporat ions, program support and

con icts of in terest , 13Council on Dental Educat ion, 7–8courses. See program s of educat ionCPD (cont inuing professional

developm ent , cont inuing educat ion), 71, 115–116, 137–138, 144–146

CPSP (College of Physicians and Surgeons Pakistan), 103, 105

crit ical th inking, 145–146CrossCheck (plagiar ism detect ion

software), 152curricula. See also program s of

educat ion– in Canada, 55–56– in China, 67–69– h istor ical aspect s of postgraduate,

1–8– in India, 91, 99– intercollegiate specialt y curr iculum

program , 40– in Lat in Am erica, 61–63, 64– in UK, 34–35– U.S. standards on , 48–50“Curriculum II” (Universit y of Californ ia,

San Francisco (UCSF) School of Dent ist ry), 10

Cyprus, educat ion in , 27

DDCI (Dental Council of India), 88, 91, 99,

100, 101, 102DCNZ (Dental Council of New Zealand),

73DDCH (Dhaka Dental College and

Hospital, Bangladesh), 106degrees– in Aust ralia and New Zealand, 73– in East Asia, Southeast Asia, and

China, 67–68, 70– h igher, lim ited num ber of educators

w ith , 57– in Indian subcontinent, 88, 91, 101–104,

106, 108, 109


evidence-based or thodont ics– educat ion , value in , 162–163– im portance of m ethods for, 12– m arket ing vs., 145– rat ionale for, 162exam inat ions, 81, 122–123exam iners (for CODA guidelines), 12–13exchange program s, in Lat in Am erica,

64external assessm ents, of postgraduate

program s, 31–32

Ffacilit ies– assessm ent of, 185– guidelines on , 81– for or thodont ic departm ents, in

China, 71– U.S. standards on , 46–48faculty. See also sta – in China, quali cat ions of, 69–70– DSA program and, 187– incom e, vs. pract it ioners, 182– inst itut ional assessm ents by, 183– in Lat in Am erica, 64– shortage of, 21, 129, 182– U.S. standards on , 45Faculty of Dental Surgery of the

Nat ional Postgraduate Medical College of Nigeria, 84

Faculty of General Dental Pract ice (UK), 122

father of or thodont ia (Pierre Fauchard), 147

Fauchard, Pierre, 147FEA ( n ite elem ent analysis), 130Federal Drug Adm inist rat ion (FDA), IRB

review guidelines, 150Federal Trade Com m ission, 13fees– for Canadian graduate program s, 55– for DSCKE, 54– for or thodont ists from non-accredited

program s for RCDC fellowship, 54– for RCDC exam inat ions, 53– for specialt y assessm ents in UK, 122– for t raining in UK, 38– for U.S. graduate program s, 55fellowship in dental surgery (FDS, UK),

122Fellowship of the College of Physicians

and Surgeons (FCPS, Pakistan), 103, 104, 106

fellowship of the Royal College of Surgeons (FRCS), 122

nal exam inat ions, 27, 31, 70 nancial resources, ADC/DCNZ

Accreditat ion Standards on, 75 n ite elem ent analysis (FEA), 130four-dim ensional total arch m ovem ent ,

170

Erasm us program (European Com m unity Act ion Schem e for the Mobilit y of Universit y Students)

– about , 26–27– on aim s of postgraduate educat ion,

17–18– Erasm us-based European program s,

external assessm ent of, 31–32– guidelines on education, sum m ary of, 30– guidelines on theoret ical contents of

postgraduate educat ion , 28–29– init iat ion of, 21– internat ional guidelines on , 125–126– origins of, 26– purpose of, 23– on research in educat ion , 21ES (elaborat ion sequencing), 133eth ics, 149, 163Europe, 23–33. See also Erasm us

program ; European Union– conclusions on educat ion in , 32–33– European Federat ion of Orthodont ic

Specialists Associat ions, 27, 31– European Union direct ives, 24–26– overview of educat ion in , 23– program qualit y and consistency,

approach to, 14–15– undergraduate hours on or thodont ics,

17European Academy of Pediat ric

Dent ist ry, 183European Board of Orthodont ists, 113,

114, 115European Com m unity Act ion Schem e

for the Mobilit y of Universit y Students. See Erasm us program

European Cultural Foundat ion , Erasm us Bureau , 14, 26

European Econom ic Area (EEA), 24European Federat ion of Orthodont ic

Specialists Associat ions (EFOSA), 23, 27, 31

European Orthodont ic Society, 31, 125European Orthodont ic Teachers’

Forum s, 31European Union. See also Erasm us

program– dent ist ry, recognit ion of specialt ies

in , 20– direct ives, 24–26– HoTEL, 131– on standards for undergraduate

educat ion , 21European Universit y College (form erly

Nicolas & Asp Universit y College, UAE), 87

EURO-QUAL II (Biom ed 2 Project), 26, 32

evaluat ion. See assessm ent(s)evidence-based dent ist ry, 48–49evidence-based m edicine, 163

educat ion (cont inued)– in Canada, 52–58– cont inuous professional developm ent ,

role of, 144–146– in East Asia, Southeast Asia, and

China, 66–72– Erasm us Project and World Federat ion

of Orthodont ists, 125–127– in Europe, 23–33– general aim s of, 17–18– h istorical aspects of, 1–8– in the Indian subcont inent , 88–111– in Lat in Am erica, 59–65– in the Middle East and Africa, 83–87– object ives of, 66– in Oceania, 73–82– orthodont ic boards, educat ional role

of, 112–116– postgraduate program s, 9–22– research, role of, 162–181– scient i c journals, role of, 147–161– technologies, role of new, 128–143– in the UK, 34–41, 117–124– in the U.S., 42–51Educat ion Departm ent (U.S.),

recognit ion of CODA, 43educat ion providers, ADC/DCNZ

Accreditat ion Standards on in terface w ith , 78

EduRoam , 131edutainm ent , 128, 138–139EEA (European Econom ic Area), 24EFOSA (European Federat ion of

Orthodont ic Specialist s Associat ions), 23, 27, 31

Egypt , educat ion in , 83eight-year program (China), 68elaborat ion sequencing (ES), 133e-learn ing– advanced, tools for, 129–130– bene ts of, 139– e ect iveness of, 128– evaluat ions of styles of, 135–137– interact ive m odules, 138– popularit y of, 19– in UAE, 131–132elect ronic publicat ion , of scient i c

journals, 159–160elect rot ypodont , 130eligibilit y and select ion of students and

residents, U.S. standards on , 50–51em ot ions, learn ing and, 128endodont ists in turf wars, 14England. See also United Kingdom– DF recruitm ent in , 117– EFOSA and, 27– Health Educat ion England, 118, 119English language t rain ing, in Lat in

Am erica, 63Erasm us Bureau (European Cultural

Foundat ion), 14, 26

Index 223

– Nat ional Workshop, “Postgraduate Orthodont ic Educat ion in India,” 101

– postgraduate dental educat ion , 88, 91, 99–100

– as SAARC m em ber, 88Indian Board of Orthodont ics, 103,

114, 115Indian subcont inent , 88–111– Bangladesh, 106–107– Bhutan , Maldives, and Afghanistan ,

109– Dental Council reform s, 101–102– India, 88–103– Nepal, 107–108– Pakistan , 103, 106– postgraduate program s in , 104–106– Sri Lanka, 108–109individualized learn ing, new technology

and, 131infect ion control, U.S. standards on ,

47–48infectious disease control and biohazards

com m ittee (W VU), 46, 47–48inform at ion t ransfer, speed of, 128in it ial accreditat ion status (U.S.), 42Insignia (t reatm ent m odalit y), 133Inst itute for Scient i c Inform at ion ,

author database, 153–154inst itut ional com m itm ent/program

e ect iveness, U.S. standards on , 43–45

inst itut ional review boards (IRBs), 149–150

inst itut ions, ranking of, 182inst ructors. See sta ; teachinginst rum ent sterilizat ion, U.S. standards

on , 47in teract ive m edia, 129in tercollegiate specialt y curricu lum

program (ISCP), 40in tercollegiate specialt y fellowship

exam inat ion (ISFE), 40in terdisciplinary team work, in Lat in

Am erica, 63–64internal program evaluat ions,

guidelines on , 81Internat ional Associat ion of Dental

Research, 2In ternat ional Com m it tee of Medical

Journal Editors (ICMJE), 150, 152, 157Internat ional Council for Open and

Distance Educat ion (ICDE), 131in ternat ional m ovem ents, contents of

undergraduate educat ion and, 20–21Internat ional School of Orthodont ia, 2in t roduct ion , in case reports, 157An Introduct ion to the History of

Dent istry (Weinberger), 148Invisalign , 133IOS (Indian Orthodont ic Society), 101,

102–103

hazardous m ater ials m anagem ent , U.S. standards on , 46–47

Health and Care Professions Council (UK), 118

Health Educat ion England, 39, 40, 118, 119

Health Pract it ioner Regulat ion Nat ional Law Act (Nat ional Law, Aust ralia, 2009), 73

health services, for dental specialt y students, 77–78

Hebrew Universit y Hadassah School of Dental Medicine, 85

Hellm an, Milo, 148Helsinki Declarat ion (1975, 2000), 150hierarchical sequencing (HS), 133high-im pact scient i c journals,

or thodont ic topics in , 187high-pull headgear, 166history– of dental educat ion in Indian

subcont inent , 88–91, 99–100– of dent ist ry in Lat in Am erica, 59– of postgraduate curriculum

form ulat ion , 1–8Holist ic Approach to Technology

Enhanced Learning (HoTEL), 131Hossain , Zakir, 106, 107HoTEL (Holist ic Approach to Technology

Enhanced Learning), 131HS (h ierarchical sequencing), 133hum an subjects and anim als, protect ion

of, 150

IICDE (In ternat ional Council for Open

and Distance Educat ion), 131Iceland– educat ion in , 27– in EEA, 24ICMJE (In ternat ional Com m it tee of

Medical Journal Editors), 150, 152, 157

Illinois at Chicago, Universit y of, College of Dent ist ry, 3, 23

im aging equipm ent for clin ical and research data, U.S. standards on , 48

Incognito (t reatm ent m odalit y), 133independent and external colleges

(UK), 123India, 88–103– chronology of signi cant dental-

related events, 89–90– Dental Council of India, educat ion

reform s by, 101–102– Indian Orthodont ic Society, 101,

102–103– inst itut ions grant ing MDS

quali cat ion , 92–99– Nat ional Board of Exam inat ions,

100–101

France– educat ion in , 27– EFOSA and, 27– as leader in early dent ist ry, 147FRCD(C) designat ion, 53French Board of Or thodont ics, 114full xed or thodont ic t reatm ent ,

providers of, in Canada, 57future goals, in Lat in Am erica, 63

Ggam i cat ion , 128GDC (General Dental Council, UK),

34–35, 38, 40, 118–119, 123General Chiropract ic Council (UK),

118, 123General Dental Council (GDC, UK),

34–35, 38, 40, 118–119, 123General Medical Council (UK), 118General Opt ical Council (UK), 118General Osteopath ic Council (UK), 118General Pharm aceut ical Council (UK),

118geographic origin , for journal ar t icles,

154, 155Germ an Board of Orthodont ics and

Orofacial Orthopedics, 114, 115Germ any– educat ion in , 27– EFOSA and, 27(G)nathos Web site, 135, 137Goldschleger School of Dental Medicine

(Tel Aviv), 85Governm ent Dental College and

Hospital (India), 91graduate educat ion . See also entries

beginning “postgraduate”– in Canada, 54–57great ext ract ion debate, 147, 162Great Lakes Society of Orthodont ists,

3–4grow th m odi cat ion, 163, 168Guatem ala, postgraduate program s

in , 62Guidelines for the Establishm ent of New

Nat ional and Regional Orthodont ic Boards (WFO), 114

Guilford, Sim eon H., 1Gutenberg, Johannes, 128

HHam dan Bin Moham m ad e-Universit y

(HBMeU), 131Ham dan Bin Moham m ed College of

Dental Medicine (UAE), 86, 137hapū , 77Haq, Em adul, 106Harm ony (t reatm ent m odalit y), 133Harris, Chapin A., 1Harvard-Forsyth , graduate program in

or thodont ics, 9


Mem bership of the Faculty of Dental Surgeons (MFDS)/MJDF (Mem bership of the Joint Dental Facult ies), 119

Merchant , H.D., 102Mershon, John V., 2–3Mexican Academ y of Orthodont ics, 63Mexico, postgraduate program s in , 63Michigan, Universit y of, 2Middle East and Africa, 83–87m illennials, 128, 131Miller assessm ent pyram id, 137Minist ry of Educat ion (UAE), 131Minist ry of Health (India), 102Mishra, Praveen, 108MIST (Masdar Inst itute), 131m obilit y, undergraduate educat ion and,

20–21m odel group pract ices, 186m odular object-oriented dynam ic

learn ing environm ent (MOODLE), 132Moham m ed Bin Rashid Universit y of

Medicine and Health Sciences, 86Moham m ed V Universit y (Morocco), 84molar intrusion for vertical correction, 166Montreal, Universit y of, 52MOOCs (m assive open online courses),

132Morocco, educat ion in , 84MOrth (Mem bership in Orthodont ics),

34, 38MS (m acro-sequencing), 133m ult im edia tasks, use in learn ing, 19m ult iple-source feedback (MSF), 37

NNair Hospital Dental College (India), 91Nanda, Ram , 100Nat ional Academy of Medical Sciences

Bir Hospital (Nepal), 108Nat ional Board of Exam inat ions (NBE,

India), 100–101Nat ional Dental Exam ining Board of

Canada (NDEB), 53–54Nat ional Inst itute of Dental and

Craniofacial Research (U.S.), 187Nat ional Inst itutes of Health (U.S.), 151Nat ional Law (Health Pract it ioner

Regulat ion Nat ional Law Act , Aust ralia, 2009), 73

Nat ional St rategic Fram ework for Aboriginal and Torres St rait Islander Health , 77

Nat ional Workshop (“Postgraduate Orthodont ic Educat ion in India”), 101

NBE (Nat ional Board of Exam inat ions, India), 100–101

NDEB (Nat ional Dental Exam ining Board of Canada), 53–54

NEBEOP (Network of Erasm us-Based European Orthodont ic Postgraduate Program m es), 14–15, 23, 26–27, 31–33, 125–126

– future goals, 63–65– h istory of dent ist ry in , 59– or thodont ic societ ies, 59– postgraduate program s, 59, 61–63– subregions, 60learn ing algorithm path (LEAP), 132,

137learn ing m anagem ent system s, 128learn ing m ethods, evaluat ion of, 19–20.

See also e-learn ing; vir tual learn ingLebanese Universit y, 86Lebanon, educat ion in , 85–86lectures. as UK teaching m ethod, 36LETBs (local educat ion and t rain ing

boards, form erly postgraduate deaneries), 117, 119, 120

let ters to the editor, elect ronic publicat ion of, 159

library resources, ADC/DCNZ Accreditat ion Standards on , 76

Liechtenstein , in EEA, 24lifet im e cer t i cat ion , 115Lim popo, Universit y of, 84local educat ion and t rain ing boards

(LETBs, form erly postgraduate deaneries), 117, 119, 120

log books, use in assessm ent , 20London, Universit y of, 130Luxem bourg, educat ion in , 27

Mm acro-sequencing (MS), 133Maldives– lack of inform at ion on , 106, 109– as SAARC m em ber, 88Malm ö Universit y (Sweden), 87Malocclusion of the Teeth (Angle), 1m anagem ent st ructure, ADC/DCNZ

Accreditat ion Standards on , 75m ana Māori principles, ADC/DCNZ

Accreditat ion Standards on , 77Manitoba, Universit y of, 52m anual skills, as par t of undergraduate

educat ion , 18–19m anuscript preparat ion , for scient i c

journals, guidelines for, 157m arket ing, de n it ion of, 145Masdar Inst itute (MIST), 131m assive open online courses (MOOCs),

132Master of Dental Surgery (MDS) courses

(India), 91m atch system s, 13, 54McCoy, Jam es D., 3McCoy, John, 3Medical Council of India (MCI), 101m edical-dental t r iangle, 121m edical educat ionists, new technology

and, 130–131Melbourne, Universit y of, 73Mem bership in Orthodont ics (MOrth),

34, 38

Iraq, educat ion in , 84–85IRBs (inst itut ional review boards),

149–150Ireland– EFOSA and, 27– exam inat ions in , 31– Northern Ireland Medical and Dental

Train ing Agency, 118“Irregularit ies of the Teeth” (Angle), 1Irregularit ies of the Teeth and Their

Treatm ent (Talbot), 1Isaacson, Robert , 186ISCP (in tercollegiate specialt y

curriculum program ), 40ISFE (in tercollegiate specialt y fellowship

exam inat ion), 40Israel– educat ion in , 85– EFOSA and, 27issues (qualit y issues), 81Italian Board of Or thodont ics, 116Italy, EFOSA and, 27iw i, 77

JJapan– advanced e-learn ing tools in , 129–130– m edical degrees in , 67JIOS (Journal of Indian Orthodont ic

Society), publicat ion of, 103Johnson, A. LeRoy, 2Jordan Universit y of Science and

Technology, 86Jordan, educat ion in , 86Journal of Clinical Orthodont ics,

establishm ent of, 148Journal of Indian Orthodont ic Society

(JIOS), publicat ion of, 103Journal of the World Federat ion of

Orthodont ists (form erly World Journal of Orthodont ics), establishm ent of, 148

journals. See scient i c journals, role of; t itles of individual journals

KKathm andu Universit y, 108Ketcham , Albert H., 112key ridge, or igin of term , 3Khalifa University of Science & Technology

and Research (KUSTAR), 131Khartoum , Universit y of, 84Kingsley, Norm an, 1, 147KL Wig Centre for Medical Educat ion

and Technology (India), 101Korea, academ ic research in , 164KUSTAR (Khalifa Universit y of Science &

Technology and Research), 131

LLagos Universit y Teaching Hospital, 84Lat in Am erica, 59–65– descript ion of, 59

Index 225

PGIMER (Post Graduate Inst itute of Medical Educat ion and Research , India), 102, 105

Pharm aceut ical Society of Northern Ireland (UK), 118

Philadelphia Dental College, 1Philippine Board of Orthodont ics, 114,

115photo releases, for journal ar t icles, 157PIEQA (Postgraduate Independent

External Qualit y Assurance), 121, 123PKUSS (Peking Universit y School of

Stom atology), 68–71plagiar ism , journal ar t icles and, 151plast ic surgery in turf wars, 14Poland, educat ion in , 27postgraduate deaneries (later local

educat ion and t rain ing boards, LETBs), 117, 119, 120

Postgraduate Independent External Qualit y Assurance (PIEQA), 121, 123

Post Graduate Inst itute of Medical Educat ion and Research (PGIMER, India), 102, 105

Postgraduate Inst itute of Medicine Universit y of Colom bo (Sri Lanka), 109

“Postgraduate Or thodont ic Educat ion in India” (Nat ional Workshop, India), 101

postgraduate program s, 9–22– assessm ent cr iteria for, 184–185– com parison w ith other selected areas

of dental specialt y educat ion, 11–12– conclusions on , 15– curriculum for, in Lat in Am erica,

61–63– early predoctoral and specialt y

educat ion , 9–11– in Indian subcont inent , 88, 91–100,

104–106– in Lat in Am erica, 59, 61– learn ing, evaluat ion of, 19–20– orthodont ic educat ion, general aim s

of, 17–18– orthodont ic specialt y program s,

challenges to, 12–13– program qualit y and consistency,

European approach to, 14–15– teaching, developm ents and t rends

in , 19– turf wars and, 14– in UK, 119–122– undergraduate educat ion and, 17–21pract ical and technique courses, as UK

teaching m ethod, 36pract ical assessm ents, in UK, 36pract it ioners, recognit ion of, in EU, 24preceptorships, 3–8, 10, 27, 188prem olars, ext ract ion of, 162, 166prerequisites for applicat ion to specialt y

program s, guidelines on , 79–80Pretoria, Universit y of, 84

optom etrists in turf wars, 14oral and m axillofacial surgery, 11, 12, 14Orthodont ic and Dentofacial

Orthopedic Associat ion of Nepal (ODOAN), 108

or thodont ic biom echanics, exam ples of research on , 165–180

Orthodont ic Journal of Nepal, publicat ion of, 108

or thodont ics (or thodont ia). See also educat ion; nam es of individual countries

– de n it ion of, 42– early history of, 147– rst textbook on , 1– set t ing for, 11– turf wars and, 14– use of new technologies in , 132–133or thodont ic societ ies. See nam es of

individual societ ies, e.g., Pakistan Associat ion of Orthodont ists

or thodont ic specialt y educat ion . See educat ion

orthognath ic surgery, 11orthopedics in turf wars, 14OSCE (object ive st ructured clin ical

exam inat ions), 37osteopathy in turf wars, 14Otago, Universit y of, 73otolaryngology in turf wars, 14

PPaci c, Universit y of the, School of

Dent ist ry, 3Pakistan– educat ion in , 103–106– as SAARC m em ber, 88Pakistan Associat ion of Orthodont ists

(PAO), 103, 106Pakistan Orthodont ic Journal,

publicat ion of, 106Panam a– English-language t rain ing in , 63– postgraduate program s in , 62Papadopoulou, Alexandra K., 66Parikh , Naishadh, 102pat ient educat ion , new technology

and, 132pat ient m anagem ent , guidelines on , 80PBL (problem -based learn ing), 19, 35pediat ric dent ist ry, 11–12peer review, 74–75, 153–154, 155Peer Review Survey (2009), 153–154Peking Universit y, 67Peking Universit y School of Stom atology

(PKUSS), 68–71Pennsylvania, Universit y of, 2Peradeniya, Universit y of, Faculty of

Dental Sciences (Sri Lanka), 108periodont ics, 11–12, 14personalized learning, 132Peru , postgraduate program s in , 63

negat ive studies, obligat ion to publish , 154–155

Nepal– educat ion in , 104, 107–108– as SAARC m em ber, 88Nepal Medical Council, 108Netherlands– educat ion in , 27– EFOSA and, 27– postgraduate program s in , 23Network of Erasm us-Based European

Orthodont ic Postgraduate Program m es (NEBEOP), 14–15, 23, 26–27, 31–33, 125–126

neurosurgery in turf wars, 14The New England Journal of Medicine– con ict of in terest policy, 156– editor of, 151new technologies. See technologies,

role of newNew York Universit y, 2, 9New Zealand. See also Oceania– pat ien t educat ion study, 132NHS Educat ion for Scot land, 118, 119Nicolas & Asp Un iversit y College

(later European Universit y College, UAE), 87

Nigeria, educat ion in , 84Noble, Henry Bliss, 1North Am erica, academ ic research in ,

165. See also Canada; United StatesNorth Carolina, Universit y of, Web

program , 136–137Northern Ireland– DF recruitm ent in , 117– Pharm aceut ical Society of Northern

Ireland, 118Northern Ireland Medical and Dental

Train ing Agency, 118, 119Northwestern Universit y, 3Norway, in EEA, 24Noyes, Frederick B., 3Nursing & Midw ifery Council (UK), 118

Oobject ive st ructured clin ical

exam inat ions (OSCE), 37Oceania, 73–82– Aust ralian Dental Council/Dental

Council of New Zealand accreditat ion standards, 74–79

– Aust ralian Society of Orthodont ist educat ion com m it tee guidelines, 79–81

– overview, 73ODOAN (Orthodont ic and Dentofacial

Orthopedic Associat ion of Nepal), 108online learn ing, 36, 128, 130–131, 140.

See also e-learn ingopen source dist r ibut ion, of journal

ar t icles, 151ophthalm ologists in turf wars, 14


Sat tar, Mostaque Hasan, 107SBLi (Scenario-Based Learning

In teract ive), 133–135, 137Scandinavia, postgraduate program s

in , 23Scenario-Based Learning In teract ive

(SBLi), 133–135, 137Scholarly Publish ing and Academ ic

Resources Coalit ion (SPARC), 151scholarship and expert ise, ADC/DCNZ

Accreditat ion Standards on, 77scholarships, in Lat in Am erica, 64School of Graduate Dentist ry at Ram bam

Health Care Campus (Israel), 85science, in or thodont ics, 10, 12. See also

entries beginning “evidence-based”scient i c journals, role of, 147–161– advert ising and com m ercialism ,

155–156– authorship credit , 149– clinical t r ials, obligat ion to register,

150– conclusions on , 159–160– con icts of in terest , 151–152– copyright ow nership, 150–151– elect ronic publicat ion of, 159–160– hum an subjects and anim als,

protect ion of, 150– inst itut ional review boards, 149–150– journal editor, role of, 148–149– m anuscript preparat ion , guidelines

for, 157– negat ive studies, obligat ion to publish ,

154–155– orthodont ic case reports, guidelines

for, 157–159– overview, 147–148– peer review and, 153–154– photo releases, 157Scotland– DF recruitm ent in , 117– NHS Educat ion for Scotland, 118, 119select ion of students and residents, U.S.

standards on , 50–51self-assessm ent guide (NEBEOP), 37self-ligat ing brackets, debate over, 163sem inars and problem -solving sessions,

as UK teaching m ethod, 36Sense About Science (charitable t rust),

153–154set t ings, for specialt ies, 11Sim Plant , 129Sim uloid (dental t raining robot), 129Singh, Sham bhu Man, 108Sir CEM Dental College (Bom bay), 100Skype, 138SLOS (Sri Lanka Orthodontic Society), 109SMD (stom atologic MD) degree, 67, 68social workers in turf wars, 14Society of Orthodont ics (U.S.), 9Society of Orthodont ics of Venezuela, 62South Africa, educat ion in , 84

– in Asia, 69– assessm ent of, 186–188– in China, 68, 69– com m ercializat ion of, 152– environm ents for, 164– lack of in uence of, 187–188– in Lat in Am erica, 61, 63, 64– as par t of educat ion, 21– in specialt y areas, 12– student acquaintance w ith , 186– in UK, 34–35, 37–38, 117– U.S. standards on , 48, 51research , role of, 162–181– clin ical applicat ion and t ranslat ion ,

165–166– clin ical exam ple for, 166–180– clin ical program s and, 165– dental educat ion program s, current

status of assessm ents of, 164–165– evidence-based educat ion , value of,

162–163– m ain body of research , 163–164– orthodont ic diagnosis and t reatm ent

planning, cont roversies in , 162residents (m edical graduates)– board cer t i cat ion and, 114– in China, 70– at congresses and m eet ings in Lat in

Am erica, 64–65– evaluat ion of Canadian program s, 56– in India, 99– in Lat in Am erica, 61– m atch system for, 13– U.S. standards on , 50–51resources and facilit ies, U.S. standards

on , 46–48retainers, vulcanite plates as, 1Royal College of Dent ists of Canada

(RCDC), 53, 54Royal College of Pathologists, 120Royal College of Physicians and

Surgeons of Glasgow, 120Royal College of Radiologists, 120Royal College of Surgeons, 34, 38, 39,

40, 120–121Royal College of Surgeons in Ireland, 120Royal College of Surgeons of Edinburgh,

86, 87, 108, 120, 122Royal College of Surgeons of England,

120, 122Royal Colleges, 23, 31, 120, 123RVOE (Reconocim iento de Validez

O cial de Estudios, Recognit ion of O cial Validit y of Studies), 63

SSAARC (South Asian Associat ion for

Regional Cooperat ion), 88, 103, 107, 109

Sain t Joseph Universit y, 85salaried specialt y regist rar (StR)

t rain ing, 38–41

prin t ing press, 128private o ce facilit ies, U.S. standards

on , 48problem -based learning (PBL), 19, 35professional and clin ical program

assessm ent , 183–184professional developm ent . See

cont inuing educat ionProfessional Standards Authorit y (PSA,

UK), 118program directors, 11, 45, 57, 64, 79program s of educat ion . See also

curricula; degrees; program directors; sta ; students; teaching; nam es of individual countries

– content , guidelines on , 80– course object ives, guidelines on , 79– durat ion of, U.S. standards on , 49– e ect iveness/inst itut ional

com m itm ent , U.S. standards on , 43–45

– evaluat ions of, by Canadian residents, 56

– outcom es evaluat ion , ADC/DCNZ Accreditat ion Standards on , 78

– qualit y and consistency of, European approach to, 14–15

– st ructure of, guidelines on , 80– in UK, applying for, 38–41prosthodont ists in turf wars, 14PSA (Professional Standards Authorit y,

UK), 118psychiat rist s and psychologists in turf

wars, 14

QQueensland, Universit y of, 73, 133–137,

138

Rradiology, at W VU, 46RCDC (Royal College of Dent ists of

Canada), 53, 54recert i cat ion , 64, 115Reconocim iento de Validez O cial

de Estudios (RVOE, Recognit ion of O cial Validit y of Studies), 63

regulat ions on educat ion (UK), 121regulatory organizat ions. See also

Com m ission on Dental Accreditat ion– Aust ralian Dental Council/Dental

Council of New Zealand accreditat ion standards, 74–79

– in Canada, 52–54– Professional Standards Authorit y

(UK), 118rejection, of journal art icles, 154, 155, 156relapse phenom enon, 2–3Relm an, Arnold, 151research– ADC/DCNZ Accreditat ion Standards

on , 78

Index 227

– dem ands on , from current postgraduate educat ion , 20

– in East and Southeast Asia, 66– future perspect ives on , 21– internat ional m ovem ents and

contents of, 20–21– postgraduate program s and, 17–21– by specialt y students, standards and

guidelines on , 78, 80– in UK, 121Uniform Requirem ents for Manuscripts

Subm it ted to Biom edical Journals, 152, 157

United Arab Em irates (UAE)– educat ion in , 86–87– e-learn ing in , 131–132United Kingdom , 34–41. See also United

Kingdom , st ructure and organizat ion of educat ion in

– addit ional inform at ion , sources of, 41– assessm ents and exam inat ions, 36–37– clin ical pract ice, 35– exam inat ions in , 31– General Dental Council curriculum ,

34–35– learn ing types, study of, 19– Mem bership in Orthodont ics, 38– program applicat ions, 38–41– research thesis/disser tat ion ,

presentat ion of, 37–38– teaching m ethods, 35–36– t rain ing, costs of, 38– t reatm ent planning assessm ents, 37– UK Com m it tee of Postgraduate Dental

Deans and Directors, 40– UK Visas and Im m igrat ion, 40– undergraduate educat ion in , 18United Kingdom , structure and

organization of education in, 117–124. See also entries beginning “Royal College”

– dental health regulat ion , role of dental facult ies in , 120–121

– Departm ent of Health , 118– exam inat ions, standard set t ing for,

122–123– General Dental Council, 118–119– independent and external colleges, 123– overview, 117–118– postgraduate independent external

qualit y assurance, 121– postgraduate t rain ing, 119–120– Professional Standards Authorit y, 118– qualit y control in postgraduate

educat ion , 121–122United States, 42–51– Commission on Dental Accreditation, 43.

See also United States, CODA standards– eligibilit y and select ion of students

and residents, 50–51– evidence-based dent ist ry, 48–49– overview of educat ion in , 42–43

– m ethods of, in UK, 35– by specialty students, guidelines on, 80teaching facilit ies, ADC/DCNZ

Accreditat ion Standards on , 75–76teamwork, interdisciplinary, in Lat in

Am erica, 63–64technique courses, as UK teaching

m ethod, 36technologies, role of new, 128–143– advanced e-learning tools, 129–130– com puter languages for teaching

m odules, 130– conclusions and recom m endat ions

on , 139–140– e-learn ing, evaluat ions of styles of,

135–137– e-learn ing, in UAE, 131–132– fu ture of, 137–139, 145–146– individualized learn ing and, 131– in teract ive m edia, 129– online learn ing, 130–131– overview, 128–129– pat ient educat ion and, 132– possible addit ional technologies, 132– scenario-based in teract ive learn ing,

133–135– sim ulat ion e-learn ing, 130–131– use in or thodont ics, 132–133– vir tual realit y, 131theory, diagnosis vs., in educat ion, 20thesis presentat ion , in UK, 37–383M Web site, 138three-year m aster’s degrees, 67“Three Years Postgraduate Program m e

in Orthodont ics: The Final Report of the Erasm us Project” (NEBEOP), 14–15, 26, 125

t ip edge technique, 100Toronto, Universit y of, 52t rain ing, inform at ion and orientat ion

on , in Lat in Am erica, 65Treat ise on Oral Deform it ies as a Branch

of Mechanical Surgery (Kingsley), 147treatm ent details, in case reports, 158treatm ent planning, 37, 162Treaty of Waitany, 77Tribhuvan Universit y (Nepal), 108turf wars am ong specialt ies, 14Turkey, EFOSA and, 27Tweed, C.H., 162Tweed edgew ise technique, 100Tw in Blok appliance, 100Tw it ter, 132typodont courses, 36, 69typodonts, use of, 7, 129, 130

UUCSF (Universit y of California San

Francisco) School of Dent ist ry, “Curriculum II,” 10

undergraduate educat ion– contents of, 18–19

South Asian Association for Regional Cooperation (SAARC), 88, 103, 107, 109

Southeast Asia. See East Asia, Southeast Asia, and China

Southern Californ ia School of Dent ist ry, Universit y of, 3

SPARC (Scholarly Publish ing and Academ ic Resources Coalit ion), 151

specialist associat ions, in Europe, 27specialist dental t rain ing. See educat ionSpecialt y Advisory Com m it tee for

Orthodont ics, Royal College of Surgeons, 39

Sri Lanka– educat ion in , 106, 108–109– as SAARC m em ber, 88Sri Lanka Dental Associat ion , 108Sri Lanka Orthodontic Society (SLOS), 109S. S. White (dental supplier), 148sta . See also faculty– academ ic, guidelines on , 79– ADC/DCNZ Accreditat ion Standards

on , 75, 76stat ist ics, in specialt y areas, 12stom atologic MD (SMD) degree, 67, 68straight w ire appliances, use in India, 100st ructured clin ical reasoning,

assessm ent of, in UK, 37students. See also residents (m edical

graduates); undergraduate educat ion– ADC/DCNZ Accreditat ion Standards

on , 77–78– num bers of, guidelines on , 80– support m echanism s for, guidelines

on , 79– U.S. standards on , 50–51subregions, of Lat in Am erica, 60Sudan, educat ion in , 84sum m ary and conclusions, in case

reports, 158–159support m echanism s, for specialt y

students, guidelines on , 79The Surgeon Dent ist: A Treat ise on the

Teeth (Fauchard), 147Swedish Nat ional Board of Health and

Welfare, 87Sw itzerland– educat ion in , 27– postgraduate program s in , 23SWOT analysis, ADC/DCNZ

Accreditat ion Standards on , 79Sydney, Universit y of, 73

TTaiwan, DentSim in, 130Taiwan Associat ion of Orthodont ists,

114, 115Talbot , Eugene S., 1teachers. See facultyteaching. See also faculty– assessm ent of, 188– developm ents and t rends in , 19


WFO. See World Federat ion of Orthodont ists

w ire-bending skills, assessm ent of, 36Witwatersrand, Universit y of, 84workforce, supply and dem and issues

of, 13Workforce Educat ion and Developm ent

Services Wales, 118, 119workplace-based assessm ents (WBAs),

37, 40World Federation of Orthodontists (WFO)– on aim s of postgraduate educat ion , 17– on board cer t i cat ion , 112– Com m it tee on Nat ional and Regional

Orthodont ic Boards, 114– guidelines for postgraduate

or thodont ic educat ion, 126– m em bers of, 103, 107, 108, 109– Middle East , de n it ion of, 83– m inim um orthodont ic specialt y

guidelines, 126– Orthodont ic Board Com m it tee, 113– program guidelines, 17, 34, 59, 115World Im plant Or thodont ic Society, 103World Journal of Orthodont ics (later

Journal of the World Federat ion of Orthodont ists), publicat ion of, 148

World President Orthodont ic Sum m it Meet ing, 107

World Wide Web, 128w rit ten assessm ents, in UK, 36Wuerpel, Edm und, 2W VU. See West Virgin ia Universit y

vir tual learning, 36, 128, 130, 131. See also e-learn ing

visit ing specialists/lecturers, guidelines on , 79

vulcanite plates, as retainers, 1

WWaitany, Treaty of, 77Wales– recru itm ent in , 117, 118– Workforce Educat ion and

Developm ent Services Wales, 118, 119Washington , Universit y of, School of

Dent ist ry, 162water bath t ypodonts, 130Waugh, Leum an M., 2WBAs (workplace-based assessm ents),

37, 40webinars, 135, 138, 139Weinberger, Bernhard W., 148West African College of Surgeons, 84Western Aust ralia, Universit y of, 73, 109Western Cape, Universit y of the, 84Western Ontario, Universit y of, 52West Virgin ia Universit y (W VU), 43–51– curricu lum and program durat ion ,

48–50– facilit ies and resources, 45–48– goals and object ives, 43–45– program director and teaching sta ,

45– student/resident research, 51– student select ion , 51

United States, CODA standards– asepsis and infect ion control, 47–48– biom edical sciences curriculum , 49– clin ical sciences curr iculum , 49–50– curriculum and program durat ion ,

48–50– due process, 51– facilit ies and resources, 46–48– hazardous m aterials m anagem ent ,

46–47– hazardous wastes, 47– im aging equipm ent for clin ical and

research data, 48– infect ion control policies, 48– inst itut ional com m itm ent/program

e ect iveness, 43–45– inst rum ent ster ilizat ion , 47– private o ce facilit ies, 48– program director and teaching sta , 45– program durat ion , 49– research, 51– student r ights and responsibilit ies, 51universit ies. See nam e of speci c

locat ion (e.g., “Toronto, Universit y of”)U.S. New s & World Report, inst itu t ional

rankings by, 183

VVenezuela, postgraduate program s

in , 62vert ical-anteroposterior relat ionship,

166–180videos, 130–131, 134–135, 158–159

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