ADVANCES IN ORTHODONTICS Periodical Publication of the Harvard Society for the Advancement of Orthodontics • Vol. 11 • N° 1

Recognizing the Legacy of the Past to Secure the Promise of the Future

HSAO OFFICERS President: VP International: Treasurer:

James K. Hartsfield, Jr. Carlos Mendez Villamil H. Ivan Orup, Jr.

[email protected] [email protected] [email protected]

Secretary: Editor: Director: Director: Alumni Liaison: AAO Liaison:

Michael Cognata Joseph Ghafari Olivier Nicolay Don Nelson Bella Shen Ivy Chen

[email protected] [email protected] [email protected] [email protected] [email protected] [email protected]

Honorary Patron:

Coenraad F.A. Moorrees

290 Baker Ave. Concord, MA 01742

HSAO PAST PRESIDENTS Olivier Nicolay George Cisneros Gregory King Carla A. Evans Joseph G. Ghafari Jack G. Dale

2006-2007 2003-2006 2000-2003 1997-2000 1994-1997 1991-1994

Editorial note: This issue first went to press in September 2006, but Alexander Moorrees’s sudden and distressing death necessitated this delayed publication. Please send your contributions soon for a timely publication in the next fall 2009 issue. Thank you for your understanding. Cover: Cover photographs: Isabelle and Sophie Nicolay

IN THIS ISSUE

VOLUME 11 – No 1 – FALL 2006 VOLUME 12 – No 1 – FALL 2007

EDITORIAL...........................................................1 The Trust of the Harvard Society for the Advancement of Orthodontics - Joseph G. Ghafari TRIBUTE TO COENRAAD F. A. MOORREES..................................................2 The life and legacy of Coenraad Moorrees: All of useverywhere - Joseph G. Ghafari The life of Coenraad Moorrees - Ze’ev Davidovitch The Boss - Vincent DeAngelis “You can do it” - Jack Dale An extraordinary man - Martin Kean Dr Coenraad F.A. Moorrees as a bridge between American and European orthodontists - Frans van der Linden He set and example of mental discipline - David Khouw To the memory of Professor Coenraad Moorrees: A tribute from Finland - Olli Rönning Congratulations, you are coming to Harvard - David Feuer Coenraad’s “big picture.” - Clement Lear Words cannot express - Dr. Peter Ngan The measure of life - Nil Zenati Remembering Coenraad F. A. Moorrees: Homage to a Mentor and Role Model - Dewitt Baldwin This from Mort Speck - Morton Speck My reminiscence - Shi Sun Peng The last student of Dr. Moorrees - Vicente Hernandez-Soler A man of towering intellect and formidable presence - A.Vincent Lombardi An exceptional leader - Bart Tayer Letter from Crinetz - Victor Crinetz A personal memory - Hima Thomas He was one of my Heroes - Veronica Baker WORTH REPEATING.........................................15 Coenraad F. A. Moorrees, 1916-2003 - Sheldon Peck, Leslie A. Will Interview with Coenraad Moorrees - Sydney Forwistz Tribute to CFA Moorrees at the Forsyth Institute Excerpt from Dr. Dominick DoPaola’s speech ALEXANDER MOORREES 1956-2006.............................................................24 Alexander, son of Coenraad, our brother - Joseph G. Ghafari He filled spaces of life CLINICAL PERSPECTIVE IN LITERATURE PICKS AND LITERATURE WATCH..................26 Advances in the first decade of the 2nd “Orthodontic” century: cone beam imaging and orthodontic implants - Joseph G. Ghafari Literature watch - Joseph G. Ghafari NEWS AND REPORTS.......................................31 Notes from the Program - Leslie Will Information to Contributors

EDITORIAL FROM THE EDITOR

The Trust of the Harvard Society for the Advancement of Orthodontics Joseph G. Ghafari

This issue of Advances combines 2 issues: the special tribute to Coenraad F.A. Moorrees, delayed because of the sudden death of his son, Alexander, and the Fall 2007 installment. I hope that you resume sending your contributions and personal news. With Dr. James Hartsfield and Dr. Olivier Nicolay at the helm, our association is ending its second decade with a will to build on its past legacy to secure the promise of the future. The men and women who serve HSAO have given time and efforts selflessly, in the hope that younger generations will carry us forward with the conviction that the Harvard program deserves nurturing through the commitment of its Harvard-Forsyth alumni. Special thanks are owed our immediate past President George Cisneros, who oversaw excellent reunions and maintained open lines with the Harvard School of Medicine, particularly with the orthodontic leadership, staff and residents, and Dr. David Feuer, who single handedly devoted skills, experience, and sheer love to keep our books balanced and our missions fulfilled. Dave has decided to pass on the baton. No words can ever express with enough justice the depth of Dave’s commitment, the clarity of his vision and the expedience and completeness of his work. His successor in the critical position of HSAO Treasurer is H. Ivan Orup, Jr (DMD, MMSc; 290 Baker Avenue Concord, MA  01742 (978) 369-3690; downorup@ aol.com), who has already stamped his marks by expediting the development of our website, which shall be functioning in the near future. This site will be the first and immediate recipient of more timely distribution of Advances, and the primary means of communication among our members. The Harvard orthodontic program has undergone yet more changes in the past 2 years. Orthodontics became a division within a parent department of Developmental Biology first headed by Dr. Bjorn R. Olsen and presently by Dr. Vicki Rosen. Dr. Leslie Will has moved to Tufts University in the academic year (2007-2008). The HSAO Executive Board and members recognized Dr. Leslie’s efforts and dedication to the residents in the past ten years despite various difficulties, and renew HSAO’s support to the residents through the interim leadership. Changes point out one important fact: life must go on, and so do institutions. Those of us with a call and devotion to serve do so entrusted by the institution to pass on the legacy undiminished, but hopefully enriched. This trust is serious, and in a certain perspective sacred, in that it must at least be preserved. Surely, when we look back, we are fortunate to see that our paths were cleared by great people who loved to teach us: Coenraad Moorrees (CM), remembered on these pages by so many students and colleagues from around the world; Melvin Cohen (MC), a gentleman of gentlemen, whose departure this year reminds us of the man’s educational impact –always with a smile-, and the light he left on our stage. To CM and MC belonged a time that is so removed in days and years, yet so endearing in work ethics, clarity of thought and straight shooting. They are but the title of a book, in which all our other past and present teachers are illuminating chapters. That is exactly my message about the trust of the HSAO: generating more chapters in the original book or perhaps new and more challenging books for Harvard orthodontics to enrich HSAO’s lifeline. The alphabet can be the same, or even different in the context of more advancement in knowledge, technologies, and clinical and research contributions. At the core, a sustained commitment of all of us is necessary. Our common trust in the importance of a unique legacy is the underpinning of a partnership between HSAO and the Harvard orthodontic program to move ahead, proud of both our strengths and the lessons learned from facing past and present challenges. In this move ahead, the advancement we chose in our name, we trust. 1 Advances in Orthodontics

T R I B U T E T O C O E N R A A D F. A . M O O R R E E S

TRIBUTE TO COENRAAD F. A. MOORREES

The life and legacy of Coenraad Moorrees: All of us-everywhere Joseph G. Ghafari

No testimonies or words can fully explore the thoughts, intellect, even beliefs of a human being, let alone the giant educator Coenraad FA Moorrees. This special issue of Advances in Orthodontics sheds strings of light, separate reminiscences which, combined, confirm the strong legacy of the man. Many accounts did not find their way to this publication. Still, the enclosed personal angles help draw and frame the correct canvas as an archive for history. But history fades in time! Time will run away from the man and the legacy, and us, to those who would build on our work and heritage, and then beyond, and beyond. Our words and thoughts will drown in the drizzle and rain of coming years, decades, and centuries. Yet, this fact of life remains a solid truth: for the time we can live and grasp, we owe Dr. Moorrees and his legacy the words, the thoughts, the memories that assert his contribution in the first century of orthodonticdand testify to his impact far and wide. Never mind how indelible this fraction of history may be or might reach in the annals of the relatively narrow canal of orthodontia. Studying with Coeonraad Moorrees and his selected team of teachers was a lifetime reward; knowing the heart of the man behind the exigent tutor was an additional comfort. What made the difference for Coenraad Moorrees ia that humanity had to be at its highest standard. His and our duty was to help reach that goal, a point, if short of perfection, full of dignity. That “mission” made him tough; and it made him care. I do not think that Dr. Moorrees really sought indelibility. He wanted the best within our minds and hands to come through for our patients, one by one, when we treated, and for our students, individually, when we taught. We, his students, and the science of orthodontics, owe him our gratitude. I know that a mere “Thank you” makes him happy. To which he would say, before a sip from the glass of red wine in his right hand: “Cheers to you- all of you, everywhere.” NOTE: The enclosed testimonies truly encompass the world, including The Netherlands, Finland, France, Spain, Lebanon, China, New Zeeland, Canada, and all corners of the United States.

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The Life of Coenraad Moorrees

The Life of Coenraad Moorrees Ze’ev Davidovitch

True leaders are few in number,but their impact is profound and wide spread, transcending far beyond any geopolitical boundaries. Coenraad Moorrees is such a leader, by virtue of his life-long effect effort to craft a curriculum that would provide the best possible education to students aspiring to be educators and researchers in the field of orthodontics. Above all, he instilled in his students and colleagues a perpetual thirst for knowledge, and created an environment that encouraged curiosity and creative thinking. Coenraad Frans August Moorrees was born in 1916 in The Hague, The Netherlands. He received his dental education at the University of Utrecht, graduating in 1939. In the same year he married his wife, Louise. They had met earlier, when both performed in the Royal Circus in The Hague, where he acted as a magician, and she was jumping on to galloping horses. While a dental student, he spent a six-week externship in oral surgery at the University of Berlin. There he learned how to extract third molars, an experience that came handy a few years later. In 1940, he traveled to Philadelphia, and graduated in 1941 with a D.D.S. degree. That same hear he spent 9 months at the Eastman Dental Dispensary, in Rochester, New York, studying orthodontics. During that time, Holland was occupied by the Germans, as World War II was raging in Europe, and Coenraad was called to arms. He traveled with Louise to Indonesia, through the Panama Canal; but in early 1942, a short time after their arrival, the Japanese army invaded. A few months later, all citizens of The Netherlands and other allied nations were rounded-up and placed in internment camps, where they remained until Japan’s defeat in 1945. Here, Coenraad’s talents as an extractionist came into full bloom, as he served his fellow prisoners of war. In 1947, Coenraad and Louise returned to the USA, and landed in Boston. An old friend from Holland,

Dr. Herbert Loeb, introduced Coenraad to the director of the Forsyth Dental Infirmary, Dr. Percy R. Howe. This introduction launched an illustrious career that has lasted more than five decades, and is still unfolding. In the following decade, Coenraad established at Forsyth an educational program in orthodontics, whose hallmark was academic excellence, and meaningful experience in research and clinical training. Swiftly, Forsyth became a magnet to those who aspired to become orthodontic educators and researchers. Students were attracted to Coenraad’s program from every corner of the world, and most have indeed entered academic careers. This achievement can undoubtedly be considered Coenraad’s main accomplishment: the creation of a large cadre of educators who have adopted and propagated the concepts of excellence in education and research as the foundation of specialty training. In 1959, Dr. Roy Greep, the dean of Harvard School of Dental Medicine, invited Coenraad to head the Orthodontic Department at Harvard. Here, he established a comprehensive program, including didactic and clinical components. Prominent orthodontic educators of the day, like Alan G. Brodie and his associates, attacked the clinical exposure in Harvard’s predoctoral orthodontic curriculum, suggesting that such an experience would entice the students to practice the specialty without any further education. However, Coenraad defended his approach by stating that experience and knowledge derived from it would serve to deter those students who have no desire to engage in orthodontic care after their graduation from dental school, while strengthening the determination of those who desire to pursue specialty education. In subsequent years, this hypothesis was found to be correct and has since been adopted by many US dental schools. From the beginning, research was in the center of Dr. Moorrees’s interest and activities. He was engaged in numerous investigations, and was a prolific author of many scientific reports. These facts did not escape the attention of the young National Institute of Dental Research (NIDR),

in Bethesda, Maryland. Consequently, the leaders of that developing institute invited him to join the NIDR in various capacities. First, he served as a member of NIDR’s Program-Project Committee (1964-8). Then he was recruited to be a member of the Oral Biology and Medicine Study Section (1973-7). Between 1983 and 1986, Coenraad was a member of NIDR’s National Advisory Dental Research Council. Thus, for more than two decades, during the crucial early years of the NIDR, Coenraad helped in molding the shape of the NIDR, and guiding its steps in the direction of an exciting future. I arrived at Forsyth in 1963 to study orthodontics under Coenraad’s tutelage. The entire orthodontic curriculum was taught by five full-time faculty members in the department. This capable, enthusiastic and dedicated group of instructors included Drs. Laure Lebret, Anna Marie Grøn, Clement Lear, and Dewitt Baldwin (child psychiatrist). Under Coenraad’s leadership, we collectively adopted the concept that orthodontic diagnosis means evaluation of the patient as a whole, not just labeling one’s malocclusion. Hence, orthodontics was revealed to us not merely as the art of moving teeth, but rather as the science of moving teeth in a human being. The basic science component of the curriculum was enchanting and rewarding, not a surprising discovery in a Harvard-affiliated program. We were offered a rich menu of courses all over Boston. At Forsyth, we learned anthropology from Dr. Ed Hunt, Jr; at Harvard Medical School we attended a histology course by Dr. Don Fawcett; and at Boston’s Children’s Hospital, we treated patients with orofacial clefts under the excellent guidance of Dr. Lennart Swanson. There we were exposed to the outstanding talents of Dr. Joseph Murray, who, in 1990 has shared the Nobel Prize in Physiology and Medicine with Dr. E. Donnall Thomas for their discoveries concerning organ and cell transplantation in the treatment of human disease. In 1965, while at Children’s Hospital, we saw 3 Advances in Orthodontics

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patients whose upper jaw had been advanced by Dr. Murray, years before this kind of an operation was popularized world wide. The research aspect of our program was expanded by Coenraad all over town, at MIT, Harvard Medical School and School of Public Health, Children’s Hospital, Beth Israel Hospital, Brigham and Women’s Hospital, and the Peabody Museum, to name some of the collaborating institutions. One by one he attracted prominent research sponsors for his students, all well funded, active researchers. Among them were Melvin Glimcher and Louis Gerstenfeld at Children’s, and Paul Goldhaber at Harvard School of Dental Medicine. In my own case, I was fortunate to be given an opportunity to conduct research at Forsyth, under the watchful eyes of Leif Johannessen, an orthodontist, John Heeley, a microscopist, and James Irving, a histologist and editor of Archives of Oral Biology. Altogether, we were offered by Dr. Moorrees a dazzling array of opportunities, didactically, clinically, and in research, elevating his program to the highest level of excellence. Undoubtedly, reaching that level and maintaining it was entirely due to Coenraad’s ingenuity, dedication, and perseverance. For his students, he simply created an intellectual and educational paradise. Dr. Moorrees’s publication record is a clear reflection of his brilliant career. Well over 100 articles, books, and book chapters have flowed from his prolific pen. To no one’s surprise, he published original articles after retirement, rather than rest on his multitude of laurels. His books on the Aleut Dentition (1957) and The Dentition of The Growing Child (1959) are still scientifically valuable and useful vehicles for learning the principles of the development of the dentition and dental occlusion. Other contributions by Moorrees and his associates include promotion of the principle of natural head position in orthodontic diagnosis, and the development of the Moorrees Mesh for cephalometric analysis. The community of dental and orthodontic educators has long recognized Professor Coenraad Moorrees’ remarkable accomplishments as an educator and researcher. Consequently, many awards have been bestowed on him, including the Albert H. Ketcham Memorial Award (1977) and the Craniofacial Biology Group Distinguished Scientist Award (1987). These distinguished awards denote recognition, appreciation, and admiration by peers and colleagues. They symbolize the fact that Coenraad Frans August Moorrees, who had started his life as a magician, has continued to perform magic in his long and illustrious career in academia. His many grateful students, who have carried his doctrine of professional excellence around the globe, have guaranteed that his footsteps in the path of history would remain clear and identifiable for many years to come.

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“The Boss”

“You can do it”

Vincent DeAngelis

Jack Dale

Dr.Coenraad Moorrees, aka “the Boss” will be missed by the De Angelis family. The Boss was an accomplished magician in his younger days. He transferred his wizardry to his writing. He had an amazing command of the English language but never lost his charming Dutch accent and wry European sense of humor. His keen eye tested all of my manuscripts (he introduced the art of cutting and pasting), yet he refused recognition for his selfless efforts. This reluctance was “owing to” his humble, gentle nature. He was truly a “rare bird”. I miss our frequent telephone conversations when he invariably asked about the health of my family even as his own health as well as Louise’s failed. We chatted often about the direction his beloved Department had taken in his absence. The education that he bestowed upon us, his “children”, was carefully and affectionately administered. He was proud of each one of us. His personal and professional attributes are inexorably woven into the fabric of his Department, his students and orthodontic education. His legacy will live on through the scores of educators that he nurtured during his distinguished career. Thank you, “Boss”, from the De Angelis’s for your fine example. ”With kindest regards”, à bientôt.

I am sitting at my desk with my pen in my hand, thoughtful, compassionate and inspired, trying with all my heart and soul to find words to appropriately convey my admiration, respect, love, and my gratitude to a man, a genius of a man, who made a profound difference in my life. Dr. Moorrees was the Albert Einstein of orthodontics. He was always “Dr. Moorrees” to me. Because of the reverence that I held for my professor, I could never bring myself to call him “Coenraad”, even though we were colleagues later in our careers. In a thoughtful and comprehensive tribute published in the American Journal of Orthodontics and Dentofacial Orthopedics, Leslie Will and Sheldon Peck talked about the Moorrees family crest with its motto: Absque labore nihilWithout work, nothing. I am confident that Coenraad Moorrees lived that motto for his 87 years. Certainly he lived it for the 64 years since graduating from the University of Utrecht in 1939, with his first dental degree, and before. Certainly he lived it for the 62 years since graduating from the University of Pennsylvania with his second dental degree, his DDS in 1941. Certainly he lived it for the 56 years since being invited to be acting chief in the Orthodontic Department, Forsyth Dental Infirmary for Children in 1947 and, most certainly as I am a witness, he lived it during the 45 years that he was a vital part of my life. I want to share with you some of my personal experiences with him during those 45 years. I have paid tribute to Dr. Moorrees several times,and in those tributes I discussed his incredible achievements and contributions, his involvement and leadership in orthodontics, the crucial and significant results of his research, and more. Here, I wish to discuss, more intimately, his influence as a teacher, colleague, friend, and even as a “father”. My father passed away 30 years ago. I loved my father and when I was a teenager, I thought he was the smartest man in the world. I depended on him for guidance and advice on many occasions. After he passed away, I turned to Dr. Moorrees for that guidance and direction. Since that

time, we talked on the telephone many times. Even now, 43 years after graduation, I will miss my early morning telephone conversations with him at my office before appointments with my patients. It made my day, and it continued to the very end of his life. There is no doubt, he lived up to his family’s motto “Without work, nothing.” I am sure that all his students would agree that he was a tough taskmaster. “Tic. Tic. Tic. You can do it.” How many times did I hear that dreaded statement? I must be honest, I was not happy when I heard it. Now I am eternally grateful. Dr. Moorrees was driving us to learn as much as we possibly could, while we had a golden opportunity to do so. How blessed we were to be taught by this world-renowned scientist and clinician at Harvard University for three intensive and incredible years. I repeat: I am so proud to have been a student of Dr. Moorrees! When I returned to Toronto in 1961, I was determined to use the basic biological principles that I learned from him as a firm foundation for my interceptive guidance, early treatment patients. After 43 years using his meticulous research data, together with his knowledge and his wisdom, I have enjoyed a most rewarding and fulfilling career, and my patients have enjoyed the results of his genius and my labor. The most difficult course that I ever took during my eleven years of university education was the course in “Advanced Statistics” at Harvard School of Public Health. Dr. Moorrees advised me to take the course for a better understanding of the literature, and as an essential part of my research. Of course, it was… “Tic. Tic. Tic. You can do it.” In association with that, I recall our daily seminars with Dr. Moorrees, Anna Marie Grøn, Laura Lebret or with one of the never ending parade of outstanding orthodontists from all over the world who visited Harvard University. With these experts as our teachers, we most assuredly learned discrimination of the literature and then some. On several occasions, I learned how meticulous and critical Dr. Moorrees was of his own work. I assisted him in the editing and correction of his many

publications. We would sit opposite each other for what seemed to be hours at a time, inspecting his writing with a fine toothed comb. I would read out loud and he would listen, and correct. Those precious private moments with him will remain with me forever. Dr. Moorrees was not a procrastinator. If you had a “Case Report” review with him, he would say: “Let’s do it right now.” And we would sit down and get it done. He was always available; he always had time for you. For that, I am eternally grateful. I looked forward to his lectures. Even now, I can remember so vividly many things that he said. There was such a wealth of knowledge behind his statements, and he had a delightful way of illustrating his points with stories. Many years later, at Angle meetings, we all looked forward to his lectures and to his comments during the discussion periods. I was exceedingly proud to have Dr. Moorrees lecture in Toronto at the Toronto Orthodontic Study Club not long after graduation. He was the keynote speaker at the Fourteenth Biennial Meeting of the Charles H. Tweed International Foundation for Orthodontic Research in 1982, when I was president. Again, I was proud to be one of his students. His paper was the changing dimensions in arch width and arch length in the anterior area of the dentition. I refer to that paper, to this day, and I use the information from that paper in my practice constantly as I examine growing patients. I really got to know Dr. Moorrees more intimately when we both participated in “Study Week ‘85” in the Netherlands, his native country. I also observed how highly he was respected by his Dutch colleagues, and I could understand why Queen Beatrice awarded him “The Commander of the Order of Orange-Nassau.” Over the years, I also observed that he was regarded by the specialty of orthodontics all over Europe. Wherever I went his name commanded attention, and I felt good about it. I continue to have a tremendous respect for all Dutch people because of my association with Dr. Moorrees and his wife. Mrs. Moorrees is such a beautiful and gracious lady, and I have always enjoyed my conversations with her. From time to time, I had an opportunity to ask her about their World 5 Advances in Orthodontics

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War II experience in Indonesia and she would talk about it. When dining in Amsterdam one evening after having our meeting in “tulip country”, we were discussing the Dutch people’s ability to grow flowers. I will always remember rising the first morning of our meeting and looking out the window; I couldn’t believe my eyes. Before me were ten acres of the healthiest and most gorgeous purple hyacinths I had ever seen. There was not a weak plant in the field. The next morning, I was shocked to see that they had all been cut down. “Wow”, what a disappointment. Of course they were harvesting the bulbs. Later we saw the blossoms made into huge leis, and they were draped over all sorts of cars in the area. Dr. Moorrees said, during the dinner: “Dutch people could stick their thumbs into a pot of dirt and a green sprout would occur.” I was inclined to believe him. I could write forever about my three magical years in Boston, and beyond, but I will conclude with our final meeting. During my residency program at Harvard last year, Dr. Will and her staff organized a historic luncheon as a tribute to professors Moorrees, Anna Marie Grøn and Laura Lebret. We learned, just before the residency, that both Anna Marie and Dr. Moorrees were leaving Boston. With a very short notice, we had an estimated 100 local alumni and students in attendance. The memory of that event will remain with all of us for the rest of our lives. The education and the training that I was fortunate to receive at Harvard and Forsyth with Dr. Moorrees, Anna Marie Grøn, Laura Lebret, Bill Silver, Mel Andell and other staff members associated with the orthodontic program, including many institutes such as Harvard Medical School, Harvard School of Public Health, Tufts University, Massachusetts Institute of Technology and several hospitals,

all choreographed by the genius of our professor, provided me with a solid foundation for my career in orthodontics. Dr. Moorrees was tough, but he was true; he was demanding, but he was fair; and, underneath it all, he was exceedingly proud of us. Certainly, I am proud to be part of such a distinguished alumni group. Because of that, I wish to include some comments by other colleagues who were included in an earlier tribute to Dr. Moorrees that I did for “Orthodontics at the Crossroads,” just in case they are not a part of our special edition. Anthony Gianelly, Department Head, Ketcham Award recipient. Academic “His professional demeanor and accomplishments made the students with an academic propensity, such as I had, try to emulate him. In short, a suitable epithet would be: “He made Dr. Moorrees proud.” As busy as he was, Dr. Moorrees was always available to his students and was deeply and keenly interested in our development. He combined a quick and incisive mind with an intense intellectual curiosity and honesty. He harbored a healthy skepticism, which made him constantly search for validating information. Ze’ev Davidovitch, Department Head. Research “Dr. Moorrees was deeply engaged in research, which had resulted in the publication of numerous articles and books. He did not send us to the research ‘battlefield’ like a back room general, but was all the time with us in the ‘trenches’.” George J. Cisneros, Department Head. Educator “Dr. Moorrees’s career has been that of the consummate educator. His primary objective was to get the most out of you, to push and prod you far beyond what you thought possible.” James. Ackerman Jr., Department Head. Discipline “I learned more from Coenraad Moorrees than orthodontics. He was a taskmaster.

He expected perfection at every turn. He taught me that inquiry is a courageous journey of discipline.” Mladen Kuftinec, Department Head. The Moorrees Spirit The Moorrees spirit was, and still is very much present in the programs that I have been associated with. Gregory J. King, Department Head. Future The thing that he valued highly was the understanding of craniofacial growth and being a skilled diagnostician. Dr. Moorrees believed that the salvation of our specialty lies in nurturing its theoretical foundations.

And one of my favorites:

Richard Ackerman Jr., Department Head. Teacher “My proudest professional moment occurred nearly ten years after I finished my Harvard fellowship. Several of my students were with me. As I introduced them to Dr. Moorrees, I said: ‘This is my teacher. He is a great man, and it was a great honor to be his pupil.’ Turning to him, I said: ‘They are my students. A part of you is in them, and I am grateful.’”

With Dr. Moorrees’s incredible curriculum vitae in one hand, with my treasured memories in the other, and with admiration and love in my heart, I have attempted to give you some idea of the impact that this man has had directly on my life, on the lives of the countless others and on the lives of millions of patients around the world. “This I learned from the shadow of a tree, which to and from did’st sway upon the garden wall. Our shadow selves our influence, may fall where’er wen’er can be.” James Russel Lowell, Boston And so, he is now in God’s Hands, and he is at peace knowing that he helped to make the world a better place. Mrs. Moorrees, Life is so precious. Enjoy it, and may you receive God’s Blessing every step of the way. We, all of us, are so very, very proud of both of you.

TRIBUTE TO COENRAAD F. A. MOORREES

An extraordinary man

Martin R. Kean

I entered the Clinical Fellowship programme in Orthodontics at the then Forsyth Dental Infirmary in 1956-57 as the holder of a Fulbright Travel Award. I anticipated that the programme would be strongly clinical, and almost exclusively North American in orientation with the major time spent on clinical learning and practice. It was a surprise to realize that I had joined a group of Fellows principally from Europe. It became apparent, too, that the programme itself had a mild European flavour influenced no doubt by the background of the Chairman of Orthodontics, Dr Coernaad F. A. Moorrees, a man unknown to me previously. In my view this added interest to the programme in providing a unique opportunity to compare aspects of the then European approach to the management of malocclusion with the North American approach which I favored, and which was indeed the central objective in being at Forsyth. Coenraad Moorrees, was in the late 1950s, approaching the vigor which marked his research career. He was developing his thoughts about the field of orthodontics and related craniofacial biology in their widest sense. This breadth of interest was reflected in the publication of "The Aleut Dentition" and as he set out on work for "The Dentition of the Growing Child". The seminars and lectures he commissioned for Fellows reflected this breadth also in presentations ranging from biostatistics to paediatrics to odontology. We were most fortunate in having access to first rate visiting clinicians to present their approaches to treatment and to supervise patients. A novel feature of clinical diagnostic sessions was the inclusion of the views of a nutritionist and paediatrician. The mesh diagram was soon to emerge from Moorrees' interest in the historical observations of van Loon, Simon and de Coster and, in a sense, my own work on natural head position formed part of this line of development. He tempered the seduction of technology with the reality of science The programme was run by Moorrees with an unshakeable determination to

temper the seduction offered by the attractions of technology with the reality of related science. One had to be open to the biological and anthropological underpinnings of clinical orthodontics, and to have a sense of the history, and especially the historical debates, on the development of orthodontics in the United States, Britain and Europe. Such an objective influenced Moorrees to bring in visitors not included in many of the more conventional graduate programmes in orthodontics in the US at the time. Thus one had, for example, the chance to meet and listen to Korkhaus, and to befriend Koski, among others, as a means of promoting balance in thinking. Wide reading was encouraged, indeed required, to participate in often lively discussion. Questioning rather than acquiescence was expected. For all this insistence on breadth of background Moorrees did not discourage his Fellows from seeking the latest and best in training in clinical procedures. Although on one occasion he referred whimsically to the full edgewise attack of the time as "Panzer" orthodontics, he encouraged and obtained support for people to attend the Tweed Course, for example, to ensure they had the advantage of the emerging technology while retaining an attitude of questioning toward its biological validity. Questioning rather than acquiescence was expected. He remained open to debate but brooked no careless thinking or intellectual laziness. One came away from this programme with a sense of clinical orthodontics as a field of many facets which would take a lifetime of reading, research and practice to explore. Moorrees was, in his own way, a disciplinarian who expected people to work and especially to think. He remained open to debate but brooked no careless thinking or intellectual laziness. The strength of this academic leadership accounted for the many people from his programme who rose to senior ranks in orthodontics and dentistry. I acknowledge Moorrees' influence on my progression to professor and chair of orthodontics at the University of Otago

in New Zealand and ultimately to the deanship of the faculty of dentistry at the same university. There was in those times a perceptible collegial atmosphere within Orthodontics at Forsyth. Coenraad and Louise Moorrees reinforced this through the hospitality they offered in their own home. Many of us have remained in touch with our then contemporaries for more than 40 years, a tribute to the Moorrees style. In the years since my direct contact with Coenraad Moorrees I have taken greatest pleasure in observing his unique and sustained influence on the development of excellence in orthodontics over such a long period within Harvard, throughout the United States and internationally. This is the true measure of the esteem due an extraordinary man.

7 Advances in Orthodontics

TRIBUTE TO COENRAAD F. A. MOORREES

Dr. Coenraad F.A. Moorrees as a bridge between American and European orthodontists Frans P.G.M. van der Linden

Dr Moorrees has contributed greatly to the interaction between European and American orthodontics. He formed a bridge between the two continents and played an essential role not only in the exchange of concepts and procedures but also in stimulating and helping European and particularly Dutch dentists to benefit from the advantages of a postgraduate education in the USA at the time that formal education in dental specialities was barely developed in the Old World. In that context some historical information is helpful in understanding the development of Orthodontics and the rapid and tremendous progress made after the Second World War. Initially, orthodontic treatments were carried out by general dental practitioners at a limited scale. At the beginning of the previous century, some dentists started to restrict their practise to orthodontics, first in the USA, where Angle was the stimulating central figure and where orthodontics became the first recognized specialty in dentistry. The American Association of Orthodontists (AAO) was founded in 1900. In Europe, national orthodontic scientific associations were set up and in 1907 the European Orthodontic Society (EOS) was founded. In the USA, attention was primarily focussed on the technical aspects of orthodontic treatment and sophisticated methods were developed, particularly in the area of fixed appliances. In Europe, emphasis was placed on the biological aspects of orthodontics, and removable appliances were improved and functional appliances developed. In the third quarter of the 20th century, the increasing exchange between the USA and Europe of knowledge, concepts, treatment methods, procedures and techniques was of great benefit to both sides. At the turn of the century, differences in these aspects are barely existent anymore. In the meantime, the field of orthodontics had made tremendous progress. Indeed, orthodontics has become a highly sophisticated health care service that can provide excellent treatment of malocclusion and facial deformity, based on the premise that this treatment is given by well educated, skilled and experienced specialists. Indeed, Dr Moorrees was able to play a key-role in the exchange between the USA and Europe of orthodontic theory and clinical practice. He was a cosmopolitan in mind, behavior and thinking. His worldwide orientation and mastering, besides English, of the Dutch, German and French language made it easy to establish and maintain contacts with the leaders of European dentistry and orthodontics and also to attend scientific meetings and follow the literature outside the English-speaking regions. Dr Moorrees was an erudite and intellectual with a broad interest not only in dentistry and orthodontics but also in art, literature and history. He had a large interest in eager young man and women who are willing to contribute to the development of orthodontics and dentistry. He was a teacher in heart and soul and interested in increasing the level of education. He served as a valuable advisor to the group of 15 European professors of orthodontics from 15 different countries, who reached consensus on a detailed outline and description of the “Three Year Postgraduate Programme in Orthodontics” that became known as “The Erasmus Curriculum”. 1 With his high standards, motivating and stimulating personality, he was a role model for many students of which a large number became leaders in the field and department chairmen. He was a real scholar with a world wide impact on the development of orthodontics in the second half of the last century. His spirit and intellectual critical approach of orthodontics maintains alive as many of his disciples are passing on his attitude and approach to their students on a global level.

8 Advances in Orthodontics

TRIBUTE TO COENRAAD F. A. MOORREES

He sets an example of mental discipline

To the memory of Professor Coenraad Moorrees: A tribute from Finland

David Khouw

Olli Rönning

Many before me have so eloquently expressed how much his scientific contributions mean to orthodontics and dentistry. He was the consummate educator, setting an example of mental discipline in both research and treatment planning for patients, promoting a strong work ethic and questioning mind, and he inspired many of his former students to follow his lead and become educators and researchers themselves. Many did, not just in this country but throughout the world. In fact he educated more educators than most orthodontic program leaders, as witnessed by the number of professors, chairmen and researchers on both sides of the Atlantic who were graduates of his program at Harvard/Forsyth. In so doing, Dr. Moorrees also indirectly participated and contributed to the clinical care of many more patients than any single practitioner could ever provide. When I decided after a few years of involvement in orthodontic education to go into clinical practice, I felt that somehow I had disappointed him, failed him, for I know how much the quest of knowledge and the sharing of it with others meant to him. But like a father, Coenraad never openly showed disapproval or even disappointment to me. Instead he continued to motivate me to provide excellence in the care for patients, join the Angle Society where an atmosphere of continuous learning and healthy debate is a way of life. Dr. Moorrees continued to encourage me to contribute to the education of future orthodontists in any way I could even if not on a full time basis. I shall forever be thankful for what Dr. Moorrees has done for me in my career. He got me into orthodontics, and instilled a motivation to excel in it to the best of my capability. He was my professor, my mentor as well as a f riend and father. I miss him.

When a very active, accomplished and enthusiastic man leaves us, the sad news comes as a surprise. So for the f riends and former students of Professor Coenraad F. A. Moorrees, his passing has brought sorrow and reflection. Professor Moorrees was an internationally well-known and recognized orthodontist, craniofacial biologist and anthropologist. For orthodontists in Finland, he had a special meaning and significance for a number of reasons. Professor Kalevi Koski, who also has passed away, was a Fellow in Orthodontics at the Forsyth Dental Infirmary for Children f rom 1948 to 1950, during which period he worked in close association with Dr. Moorrees and collaborated in the production of the treatises The Aleut Dentition and The Dentition of the Growing Child, among other projects. His initial experience at Forsyth led to several follow-up working visits in the 1950s, and stimulated a number of other Finns, including the writers, to devote time at Forsyth. Working at Forsyth and in the Department of Orthodontics headed by Professor Moorrees was a superb educational experience in many ways. In addition to the characteristic intensity of university work in the United States, the student’s daily experience at Forsyth was bathed in a remarkably broad intellectual atmosphere. An important aspect of the experience was the internationality of Forsyth. As the students were drawn f rom all over the world, there were opportunities to learn and exchange a multiplicity of methods in dealing with clinical problems. More significantly, it was striking to note that clinical activities in the Department of Orthodontics were as a rule based on solid research findings which to a considerable extent were produced at Forsyth. In other words, unfounded dictatorial concepts of orthodontic treatment had no place in the department led by Dr. Moorrees. Following their return to Finland, the Finnish collaborators and Fellows in the department of Professor Moorrees brought home the Forsyth biologically based disciplines and other qualities f rom their special educational experience. As an example, a Forsyth tradition is maintained today in Finland with the award to each Finnish postgraduate student in orthodontics of a reprinted copy of The Dentition of the Growing Child. (This classic out-of-print volume was reprinted in Finland a few years ago in a 150-copy facsimile edition at the initiative of O. Rönning, Clinical Fellow in Orthodontics at Forsyth 1959-1961, with Dr. Moorrees’s full blessings.) Furthermore, the natural head position method pioneered by Drs. Moorrees and Kean is routinely employed in cephalometry at the dental schools here. It should also be mentioned that Professor Moorrees over the years was always gracious to give his time when asked to be an academic advisor to Finnish professorial search committees and as a very helpful voice in the editing of textbooks. Professor Moorrees visited Finland in the summer of 1977 and lectured in Turku on the findings of the research of his team. This exceptional occasion was remarkably well attended, which is a rare happening during the Finnish summer, a time when the country virtually “closes down”. As a manifestation of the high regard with which he was held in Finland, Professor Moorrees was awarded honorary membership in the Finnish Dental Society in 1977. Thus, Professor Coenraad Moorrees was intimately connected with the evolution of modern academic orthodontics in Finland. His powerful influence will continue to be positively felt in present and future generations of Finnish orthodontists. We are very proud and deeply appreciative of that connection and it forms the basis of our living memorial to him and his great contributions.

Congratulations, you are coming to Harvard David Feuer

It was 6:00 am and I was sound asleep when the phone rang. “Congratulations, it’s Dr. Mo0rrees, you are coming to Harvard…” Of course, he had forgotten that I was in California and he was three hours ahead in Boston, but early or not the phone call and the man would forever change my life. Running into Dr. Morrees in the hallways of Forsyth always meant a deluge of more work, so the trick was to navigate using indirect routes… back stairs, side entrances, and elevators. Nonetheless, it was a true privilege to attend his conferences, in which he would stare at the ceiling with fingers pressed together, leaning so far back in his chair that my concentration was repeatedly assaulted by the image of my professor toppling over backwards. I will fondly remember his clever answers masked in the form of further questions, and his unmatched ability to recall the exact journal issue where I might find much needed information. And then there were his original world renowned studies on twins. I was never quite sure if I was seeing double from not sleeping enough, or if Forsyth had been changed into a fun-house with trick mirrors, but everything was doubled… The twins were everywhere! I will forever be grateful to him for seeing something within me that allowed me to enter into the profession that I have come to love so much. Thirty years have passed since that early morning phone call, and out of respect I still can’t address him by his first name. To me, he is and always will be Dr. Moorrees, Professor, Chairman, Author, Researcher, Mentor and Friend. Although I feel now that somehow he is still watching over us, I will miss him greatly, as will every other Fellow who was fortunate enough to have him in their lives. 9 Advances in Orthodontics

TRIBUTE TO COENRAAD F. A. MOORREES

Coenraad’s “big picture.” To Great Lengths, with scientifically defensible accuracy Clement Lear

Coenraad Frans Augustus Moorrees was the founder of the Department of Orthodontics in what was then known as the Forsyth Dental Infirmary, whose Director was Dr. Percy Howe. Coenraad’s gift was to envision the specialty of Orthodontics in the broadest light, encompassing the physical and psychological growth of the child as a whole. From this wide horizon he then investigated overall craniofacial factors, and finally focused on the specifics of dentitional changes and aberrations, which he set about categorizing with scientifically defensible accuracy. In the 21st century, teaching these general concepts before concentrating on clinical details, is de rigueur in Orthodontic specialty courses. But in the mid twentieth century few others saw this “big picture”. Most in our specialty concentrated narrowly and almost exclusively mechanistically on debating the minutia of different treatment techniques and “extractionism” versus “non-extractionism”. Coenraad’s gift was to envision the specialty of Orthodontics in the broadest light, encompassing the physical and psychological growth of the child as a whole. Another of Coenraad’s major contributions was to establish a link with the Harvard School of Dental Medicine, and having done so, to actively encourage the teaching of a substantial Orthodontic curriculum at the undergraduate level. He had the breadth of vision to insist that it was not the role of a university to withhold knowledge lest the graduates “get themselves into trouble” by attempting difficult treatments beyond their capability. Rather the role of a university is to broaden graduates’ field of view as much as is practical. Then the intelligent general practitioner will have sufficient knowledge to avoid the trap of involvement in cases that belong in a specialist’s office. This open minded attitude was rare, if not unknown in North America at the time. Finally, Coenraad went to great lengths to facilitate, with Dr. John Macdonald, Forsyth’s Director, the development of a program to train individuals who would have not only specialist clinical skills, but also expertise in research of such quality and significance that publication in premier research journals would be merited. His dictum was ‘excellence in Research, Teaching and Patient Care’. Coenraad Moorrees has left our specialty a remarkable legacy.

Words cannot express his impact on orthodontic education

Remembering Coenraad F. A. Moorrees: Homage to a Mentor and Role Model

Dr. Peter Ngan

In many ways, I believe I owe my academic career and accomplishments to Dr. Moorrees. I still say Dr. Moorrees, because I don’t think I ever felt completely comfortable referring to him by his first name. He was someone who always conducted himself in ways that seemed to elicit and merit a deep and formal respect, not only for his knowledge and expertise, but for the way he conducted himself in every relationship and dimension of his life and work. My current research involves studies in the nature, definition, and measurement of professionalism, a concept of great interest and emphasis today in medical education and medicine, as they attempt to insure that the highest standards of ethical and professional behavior continue to be taught and practiced. In my experience, Coenraad Moorrees exemplified the very finest aspects and attributes of professionalism in all he did. He was first of all a gentleman; urbane, courtly, intelligent, charming, sophisticated, a true citizen of the world—or, perhaps one should say, of many worlds; scientific, clinical, academic, cultural, geographic. He helped introduce me to these worlds in many ways. He helped launch my academic career by inviting me to join him in authoring what was my very first peer-reviewed publication. He encouraged me to apply for a Research Career Development Award from the United States Public Health Service that paved the way for a career in research. He enabled me to attend and present at meetings of the European Orthodontic Society, where I met dental scholars from around the globe and enjoyed the company and stimulation of internationally known scientists and clinicians. Together with Jack MacDonal d, he provided financial and collegial support for my expanding research efforts. What initially appeared to me to be a rather limited clinical assignment, soon took wings as I was privileged to join with a superb group of scientists at the Forsyth Dental Institute. He was a true scholar: open-minded, interested and active in fields far beyond his own. He was always the scientist: exploring, questioning, hypothesizing, and clarifying. He was the penultimate mentor to his fellows: available, present, encouraging, leading, suggesting, guiding, critiquing in an objective, constructive way, all done in his unique, prodding, whimsical style. In all of these dimensions he was the very model of what it was like to be a “complete” scientist, scholar, clinician, and human being. He was way ahead of the rest of academia and clinical practice in his early espousal and practice of interdisciplinary and interprofessional education and teamwork in orthodontics; involving pediatricians, anthropologists, nutritionists, psychologists, and many other disciplines in his work and his care of patients. He was always interested in the motivational, emotional, and psychological aspects of orthodontics and encouraged my research and writings on these elements of care. His work on the effect of seasonal and climatic conditions on the growth patterns of Eskimo children was typical of his broad interdisciplinary interests. He encouraged, challenged, cajoled, and enjoined his fellows and colleagues to follow the pathways of clinical and research excellence. At a personal level, he seemed a very private person, pleasant, polite, readily accessible, generous with his time and knowledge, but there was always a certain reserve, which one felt impelled to respect. I ascribed this to his more formal Dutch upbringing. He made me respectfully aware of the science behind the field of Orthodontics, referring frequently to the pioneering work of E.H. Angle and G.V. Black. I find it ironic that a few feet from my door in Chicago today is a statue of Greene Vardiman Black! I am reminded of Coenraad F. A. Moorrees virtually every day!

It’s an honor to pay tribute to our late Dr. Coenraad Moorrees. Words cannot express the impact of this orthodontic giant on orthodontic education. I met Dr. Moorrees when I was a dental student at HSDM doing my orthodontic rotation at the Forsyth Dental Center. Little did I know at that time that this great teacher has already published landmark articles in the most prestigious orthodontic journals and textbook. His research on growth and development has been a guide throughout my orthodontic education. Twenty years later,I called Dr.Moorrees if I could borrow his symmetrograph for one of my graduate students’ experiment. He sent the instrument by express mail and offered to proofread the manuscript prior to publication. Dr. Moorrees will be remembered by his students as a mentor who allowed his students to learn. He devoted his time and talents to educating the residents, providing leadership and setting an example for others to follow. Dr. Moorrees’s great work and contributions to the profession shall be remembered. His teaching will be carried on by his students. I am indeed privileged to have been taught by this orthodontic giant.

The measure of life Nil Zenati

"Life is not measured by the number of breaths we take but by the moments that take our breath away."  Having been Dr. Moorrees’ student is one of these moments!

10 Advances in Orthodontics

TRIBUTE TO COENRAAD F. A. MOORREES

This from Mort Speck Morton Speck

Dewitt Baldwin

What recollections come to the mind of a long time clinical instructor in Coenraad’s department? The word discipline comes to mind and the operative meaning here is “training that corrects, molds, or perfects the mental facilities or moral character.” His dedication to the highest academic and professional standards created a rigorous educational experience not fully appreciated by many, I would guess, until long after graduation Coenraad’s ability to write and edit so well always impressed me, particularly since English was not his first language. Many a student honed their own writing skills under Coenraad’s watchful eye and red pencil. He had no allegiance to any one technique; the great freedom he gave to his clinical instructors only served to broaden the information base (and initial confusion) for the students. This legacy of teaching a variety of clinical approaches continues today and remains one of the strengths of the clinical program. On a personal note, I will always be grateful for his hiring me back in ’61, a green and inexperienced orthodontist, barely 3 years out of training. In addition to a thirst for teaching, I realized I had to learn more than my 18-month training program afforded me. There is little question that, over the years, my association with Coenraad as well as with the residents of the Harvard-Forsyth program has not only made me a better orthodontist, but has provided one of the greater pleasures of my professional life. 11 Advances in Orthodontics

TRIBUTE TO COENRAAD F. A. MOORREES

The last student of Dr. Moorrees Vincente Hernandez-Soler

My reminiscence Shi Sun Peng

Dr. Moorrees is one of my heroes and I am sad he passed away. Hearing of the death of Dr. Coenraad F.A. Moorrees, I am with great sadness for the tremendous void in the orthodontic world and at Harvard. In 1988, I joined the U.S.-China visiting Scholar Exchange Program sponsored by the American National Academy of Science to visit The Harvard School of Dental Medicine. I had the opportunity to attend the Postdoctoral Program in Orthodontics. At that time, I met Dr. Moorrees. He gave me more chance to learn and know his 3-year program and become acquainted with his research. Even though I worked with him only several months, I still learned a great deal from him. He was a very warmhearted, open-minded person and rigorous scholar. He dedicated all his life to Harvard. His dedication inspires me to pursue excellence, to go forward. He will always be alive in my heart! Thank you so much, Dr. Moorrees. 12 Advances in Orthodontics

I was the last student of Dr Moorrees. I started the Harvard-Forsyth program in 1981 and defended my Master thesis in 1995. It took me 14 years! It was worth it and I am proud of it. After I finished dental school in 1979, I applied to the Harvard-Forsyth program. In 1980 I was Lieutenant in the Spanish Navy Chief-Doctor of an aircraft carrier in the middle of the Mediterranean during manoeuvres when I received a telephone call from United States. It was from someone whose name was ``Moorrees´´. I did not answer the phone. My English was not good enough for a telephone conversation. I said to the operator that I will call him back. When the ship arrived to the Rota Naval Base (American Base), south of Spain, I looked for an American with a Spanish accent to find out what Dr. Moorrees wanted. Dr Moorrees wanted an interview with me in Boston and a visit the Forsyth Dental Centre in order to evaluate my application. I arrived in Boston the second week of April 1980. Dr. Moorrees arranged for me to be at the Harvard Club. Today it is hard to believe that a chairman of an orthodontic program would pay an applicant’s hotel bill; but that was the case. My interview was on Monday. I arrived the previous Thursday. On Friday, I went to Forsyth to see the face of my interviewer without telling him who I was. I met an orthodontic fellow who speaks Spanish, Dr. Carlos Mendez-Villamill. He was very nice to me, and took me to lunch on Saturday. I wanted to know every thing about my Dr. Moorrees. He told me that Dr Moorrees was an anthropologist besides being and orthodontist and that he emphasized head posture when taking the cephalographs. After lunch, Carlos dropped me at Forsyth and I went to the Library where I conducted an author search (without internet at that time). I found the magic article “Natural head position: a basic consideration for the interpretation of cephalometry” American Journal of Physical Anthropology 1958. I read the article. Of course I did not understand the significance of the content; but I tried to memorize what Dr. Moorrees did with the dental assistant students by taking two cephalometric x-rays one week apart. On Monday morning I met Dr Moorrees for the first time. He picked me up in his car at 8:15 a.m. in front of the Harvard Club on Commonwealth Avenue and we went to the 8:30 morning seminar. It was a case presentation. At the end of the seminar, with his eyes closed and looking upward, he referred to me and asked: “Dr Hernandez, how would you treat this patient?” Of course I said “I do not know.” I realized that it was the answer he was looking for. After the seminar, we went down to his office. He introduced me to Dr. Lebret and Dr Kent, offered me a cup of coffee, and then started my interview. Instead of waiting for his questions, I started to ask him about the AJ Phys Anthropology article. I still remember how he opened his eyes when I said to him: “I want to know more about that article.” He said: Dr Hernandez, you are in the middle of the Mediterranean in an aircraft carrier and you have read my article in the Am J Phys Anthropologist?” I did not realize then that regular orthodontists do not read that type of journals and that natural head position was neglected by most American orthodontists. I had caught his attention. He was in favour for my admission. I misunderstood the date of my interview with Dr. Joseph Henry, and arrived on a different day. In December 1981, we had the traditional Christmas lunch. After lunch, Dr. Moorrees came to me and said: “now you belong to this family.” I will never forget my ForsythHarvard family. I never forget him. Dr. Moorrees, thank you for the invitation.

TRIBUTE TO COENRAAD F. A. MOORREES

A man of towering intellect and formidable presence

Letter from Crinetz Victor Crinetz

A. Vincent Lombardi

I was one of the fortunate few who completed my orthodontic training at the then-called Forsyth Dental Center back in the 1960’s when Fellows actually received a stipend to attend the graduate program. At the time, the sole purpose of the program was to train full-time dental educators. There were two pathways through the program: a well-compensated, federally funded three-year course that led to a Harvard certificate, and a two-year program that was supported less generously and culminated in a Forsyth certificate. Both were probably the best kept secrets in graduate dental education at the time. I had mailed my application in late, and only one two-year fellowship was yet to be filled. My credentials were strong, but probably unexceptional considering the competitive nature of admission. It was not long before Dr. Moorrees personally called me to tell me that I was a marginal candidate and that it would be probably a waste of my money to travel to Boston for an interview, but if I were determined to try, he would schedule the interviews. So as quickly as it could be arranged, I flew to Boston, where I endured grueling interviews where my every inadequacy was exposed, with Drs. Greep and Goldhaber, and of course Dr. Moorrees. I returned home feeling that my quest was ill-fated. Shortly thereafter I called the department secretary to check on the status of my application. The secretary said that Dr. Moorrees himself wanted to speak with me. Dr. Moorrees came on the line and informed me that the purpose of the program and my goals did not seem to coincide and that they were inclined to deny me admission. Then he paused and took a slightly different tack that allowed me to talk. He seemed to be hinting that I should make my case. After what must have seemed to him like unconscionable obtuseness on my part, I finally got the message and worked up the courage to make a strenuous argument for my admission, pleading with all the desperation of one who had not allowed for any alternative. When I had finished, Dr. Moorrees said that he was initially uncertain about my commitment to academic orthodontics, but with what I am certain was a wink in his voice, he told me that I had succeeded in convincing him otherwise. And he admitted me on the spot. It was the beginning of an indelible impression of him that I carry to this day: a man of towering intellect and formidable presence who beneath his formal and forbidding manner had a humanity and wisdom that most of us can only aspire to. It is unlikely that our specialty will see such as him again.

An exceptional leader Bart Tayer

It is a great idea to have each of us remember Dr. Moorrees in our own way. I vividly recall Dr. Moorrees approaching me at an AAO meeting in 1980 (I think) and asked if I would be interested in joining his program as an instructor at Harvard. I had just completed giving a presentation at the convention and had been away from teaching at BU while I nursed a back surgery. At that time, although I was complimented that he should ask me, I had to refuse the invitation. The following year he approached me again and this time I was ready. That started my involvement with him which I shall always treasure. We enjoyed many lunch hours together with Ann Marie Grøn and Laura Lebret discussing all manner of things. I enjoyed it immensely. One aspect of our conversations, that so pleasantly surprised me, was his sense and knowledge of the clinical aspects of orthodontics and the challenges of operating a private practice. For a person who involved himself, primarily, in academics and teaching his understanding and insights were extraordinary. Dr. Moorrees was an exceptional leader and teacher who contributed mightily to our specialty.

Coenraad Moorrees represented whatever could be expected from a head of department at Harvard. From the very first contact, everybody could appreciate his elegance, his distinction and his courtesy, creating a favourabte climate for fruitful discussions. Although he didn’t exempt me from final exams, he did grant me, as Associate Professor at Medical School of “l’Université Paris 6”, a special student teacher status which indeed, facilitated my job at Harvard. His rigour for scientific truth and his constant concern for personalized treatments, have always been used as a point of reference in Orthodontics. Thanks to his approachable and efficient working team, such as Laure Lebret, a model of common sense, and Vincent De Angelis whose innovatory straight wire technic is still topical, I gathered a high level of theoritical and practical knowledge in Orthodontics, which once combined with that of his friend Charles Burstone and my French Professors, Albert Coutand for physiology, and Jean Delaire for orthopedics, made it possible for me to become the head of the Orthodontic Post Doctral Training at “I’UFR de Stomatologie et de Chirurgie Maxillo-Facjalet”, at “l’Universite Paris 6”, as soon as I got back to France in July 1978, till I retired on July 2002. I also created the Orthodontic Speciallty for French physicians and the “Société Médicale d’Orthopédie Dento-Maxillo-Faciale”. No need to say that I have never missed the opportunity to point out publicly, Coenraad Moorrees’s contribution to French Stomatologists Orthodontists. 13 Advances in Orthodontics

TRIBUTE TO COENRAAD F. A. MOORREES

A personal memory: the night my two-year old daughter was ill

He was one of my Heroes

Hima Thomas

Veronica Baker

The news that Dr Moorrees was no more sent shock waves through all of us, his former students, almost as if he was not mortal like the rest of us. To those of us who were privileged to be his students, Dr. Moorrees will be remembered for his brilliant intellect, his instant witty repartees, his strict discipline and, of course, his enormous research contributions to orthodontics. But here I would like to share a personal memory of a very different aspect of his personality. The night before my final oral comprehensive exam, almost three decades ago, my two-year old daughter came down with a severe gastric ‘flu. My husband and I were up all night caring for her, trying to coax her to drink some fluids, but she became increasingly, frighteningly limp with dehydration. Just as we left for the Emergency Room with her early in the morning, I called Dr Moorrees to ask if it would be at all possible for me to come an hour later for the exam, which was scheduled for a couple of hours later that morning. He listened carefully, then said rather abruptly, in his usual customary terse manner of speech, “Don’t come at all!”. The silence of the next moment thundered loud in my ears. I thought he was very annoyed and that this meant I couldn’t take the exam at all. Then he said “You have to be with the baby. Take care of her. We will schedule the exam later”. He said that since I had been up all night and was distraught over my daughter’s illness, I was in no shape to take the exam. He was right of course. I was speechless with gratitude and rushed to the hospital in tears. Later that day he called to find out how she was and suggested some Dutch home remedies for her dehydration, and I remember they worked better than the pediatrician’s advice! It was not often that the stern facade cracked and we saw that soft, paternal aspect of this celebrated Harvard Professor who kept a very close watch over all his students and made sure we did not, could not, go astray. I will always remember Dr Moorrees especially for his kindness. Every one of us instantly remembers studying the deep checkerboard-like creases on the back of his neck, his Mesh Analysis, and his “natural head position” with his head tipped back!  As orthodontists we take so much of his contributions for granted these days; he gave us so many basic truths.  As one often hears said, he was a giant in orthodontics who left huge, deep indelible footprints behind, not only at Harvard and Forsyth in Boston, but all over the world through the legacy of his students, many of whom are leaving deep footprints too.

When I think of the first time I met Dr. Moorrees, the thing I remember most vividly is him sitting in what appeared to be a characteristic pose: his head tilted backwards and his eyes half-closed. He listened in full concentration. Almost every day in the HarvardForsyth Orthodontic Program started with a seminar. All of the faculty and graduate students were present.  Form and subjects varied: treatment conferences, research, presentations of guest speakers, faculty or graduate students. In the beginning of the program Dr. Moorrees talked to us about the face and how important it is that teeth fit well within that face. He also taught us never to refer to patients as “cases”. Dr. Moorrees was an excellent speaker and his seminars were always engaging. That could not always be said of seminars presented by others: sometimes I would suspect him to have fallen asleep, as he would assume his characteristic head posture. Then at the end of the presentation he would take some of the facts that were given and turn them a bit, add to them, put them in a different sequence and show how a subject becomes interesting and exciting even when at first it does not appear so. He was a master in relating the different areas of orthodontics between them and to other disciplines. He showed me how to be critical and constructive, to use my mind as a kaleidoscope to put things in perspective. I believe this quality -among others- made him the excellent researcher, educator and chairman he was. I feel privileged and proud that I have been one of Dr. Moorrees’ students, I believe I am a better orthodontist because of it, looking at the entire patient and not just at his teeth, determining short and long term treatment goals, fitting in new treatment concepts and methods after careful and critical consideration in order to improve the treatment of the patient and the profession.

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TRIBUTE TO COENRAAD F. A. MOORREES

Coenraad F. A. Moorrees, 1916-2003 Sheldon Peck, Leslie A. Will

Coenraad F. A. Moorrees, D.D.S., Chief of Orthodontics at the Forsyth Dental Center in Boston from 1948 to 1989 and Professor of Orthodontics at the Harvard School of Dental Medicine from 1964 to 1987, died at age 87 years on October 28, 2003 in London, England after a brief illness. Several weeks earlier, he and his wife Louise had moved from the Boston area, their home for over fifty years, to London to be near their son Alexander. In addition to his wife and son, he is survived by a daughter, Oni Moorrees Berglund,and a granddaughter,Alexandra Berglund, both in California. His ashes were returned to The Netherlands, completing a remarkable life’s journey of adventure and accomplishment where it had begun. It was a perilous time in Europe when Coenraad Moorrees received his dental degree from the University of Utrecht in 1939. His interest in furthering his education in the United States led the newly married Coenraad and Louise Moorrees to the University of Pennsylvania School of Dentistry where he earned a D.D.S. degree in 1941. From there, the Moorreeses moved to Rochester, New York, where Dr. Moorrees entered the Eastman Dental Dispensary to begin a two-year internship, which was abruptly ended by the personal ordeal served them by World War II. After the war, they returned to America, this time to Boston at the invitation of Dr. Percy R. Howe, director of the Forsyth Dental Infirmary for Children. Dr. Moorrees completed his orthodontic studies at Forsyth in 1947 and was asked to stay on as Acting Chief of its Orthodontic Department. In 1956 he became Chief of the Orthodontic Department there and, three years later, was appointed Associate Professor of Orthodontics at the Harvard School of Dental Medicine, advancing to the rank of full Professor in 1964. At the time of his death, Dr. Moorrees held the positions of Professor of Orthodontics, Emeritus, at the Harvard School of Dental Medicine and Senior Staff Member, Emeritus, at the Forsyth Institute. In 1948, Dr. Moorrees was thrust

into a scientific adventure that would set the direction for the rest of his illustrious career. Earnest A. Hooton, Harvard University’s renowned physical anthropologist, asked him to be the odontologist on an expedition from the Peabody Museum to study the dwindling indigenous population on the Aleutian Islands. For three months, the team of scientists recorded detailed cultural and physical aspects of most of the 156 Aleuts who inhabited the island chain at that time. Dr. Moorrees carefully made dental impressions, constructed plaster casts and collected data and observations on the dentitions he examined. Several months later, he presented Professor Hooton with a preliminary report of his findings. Within a short time, an impressed Hooton called him to say, “Take your papers to the Harvard University Press.” Dr. Moorrees spent the next few years refining and expanding his findings in collaboration with some of his colleagues at the Forsyth Dental Infirmary. He often credited his early success in such research studies to the encouragement, resources and independence he was given at Forsyth. His multilingual fluency was another advantage, in this case providing him immediate access to the rich European literature in dental anthropology. The result was his groundbreaking monograph, “The Aleut dentition, a correlative study of dental characteristics in an Eskimoid people,” published by Harvard University Press in 1957. His second important book came in rather quick succession. Moorrees had learned in 1948 of a collection of longitudinal dental casts from the 1930s in the possession of Dr. Harold C. Stuart at Harvard’s School of Public Health. The dental casts were part of a childhealth study following 132 subjects from birth through adolescence. The sheer volume of material defeated all who earlier tried to study this special sample. Unlike his failed predecessors, Coenraad Moorrees saw this longitudinal sample as a key to unlocking the dynamics of childhood dental development, and his disciplined mind was ready and eager

for the job. He augmented the Stuart sample with a smaller one gathered by Dr. Richard H. Stucklen in Delaware. Throughout the 1950s, thousands of measurements were carefully recorded of the teeth, arch conditions and occlusion by Moorrees and his collaborators at the Forsyth Dental Infirmary. Dr. Moorrees shaped this mass of data into the first clear picture of the orchestrated way the human deciduous dentition transitions into the permanent dentition. It was published in 1959, again by Harvard, as his now-classic volume, “The dentition of the growing child, a longitudinal study of dental development between 3 and 18 years of age.” His other pivotal studies resulted in more than 100 original articles, book chapters and reviews. Many have had profound influence on the course of craniofacial biology and orthodontic practice. In 1953, while work was proceeding with his books, the wellknown Moorrees mesh-diagram analysis for the sagittal cephalogram was introduced, based on a study of 50 Forsyth dental hygiene students. A few years later, he and Martin R. Kean validated “natural head position” as the

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key extracranial method to establish true-vertical head orientation for cephalometric analyses. Using earlier Forsyth studies of dental radiographs, Dr. Moorrees pioneered in establishing norms of the development of the permanent teeth with reference both to age and to tooth emergence. The Moorrees toothformation data from the early 1960s have been the standards used by hundreds of subsequent investigators studying dental development and maturation. Results from these fundamental studies by Moorrees were combined with his other data to yield important papers about orthodontic diagnosis and treatment timing. Throughout his academic career, Dr. Moorrees maintained an incredibly broad range of research interests, as typified in the mid-1960s by his guidance of electromyographic studies of lip pressure in relation to incisor position, establishing the frequency of deglutition in man. A longitudinal study of several hundred twins and their age-matched siblings, begun in 1959 and continuing into the 1970s, was perhaps the most ambitious and broad-based Moorrees undertaking. Published results from this massive research effort were limited by funding inadequacies. Later in life, Dr. Moorrees wrote essays often and wisely on the past, present and future of orthodontics and education. Coenraad Moorrees was the recipient of numerous recognitions for his basic contributions to our understanding of the growth and nature of the human dentition and face. His alma mater, the University of Utrecht, conferred on him the degree of Dr. med., honoris causa, in 1971 to acknowledge with pride his remarkable accomplishments. In 1977, he received the Albert H. Ketcham Memorial Award from the American Association of Orthodontists for his “outstanding contributions in the advancement of the science and art of orthodontics.” In recognition of his scientific stature, he was awarded the Medaille de la Ville de Paris from the then mayor, Jacques Chirac, in 1982. Coenraad Moorrees won the 1st Distinguished Scientist Award given in 1987 by the Craniofacial Biology Group of the International Association for Dental Research. The Eastern Component of the Edward H. Angle Society of Orthodontists, 16 Advances in Orthodontics

which Coenraad served as President in 1987-8, presented him with its Harvey Peck Memorial Award in 1993, for high achievement in the pursuit of excellence. His most treasured tribute came in 1985 from Queen Beatrix of the Netherlands who decorated him Commander in the Order of Orange-Nassau, the highest civilian honor in the country. During the elaborate investiture ceremony, Coenraad Moorrees was cited for the great honor he had brought to his native land through his accomplishments in life and work. Coenraad Frans August Moorrees was born in The Hague, The Netherlands on October 23, 1916. He was the second of two sons, the eleventh generation of a Dutch family of patricians that traces its pedigree to the 16th century and whose family crest is inscribed “Absque labore nihil” -- Without work, nothing. His father was a career military officer and his mother was at home with their children. In his youth, Coenraad Moorrees showed ability as a capable magician, a lifelong avocation he passed on to his son; no trip to New York City was complete without his visit to the magicians’ specialty store. Another hobby with roots in Holland was his love and knowledge of flowers. The war experiences of Coenraad Moorrees reveal aspects of his extraordinary determination and ability to focus, qualities of character that helped lead him to great achievement in his academic

years that followed. A few months after Pearl Harbor and the U.S. Declaration of War, the Moorreeses were uprooted from Rochester, New York, where he was studying, on orders from the Dutch government in exile to report to England to serve in the escalating war effort against Germany. In early 1942 with the North Atlantic already treacherous to maritime traffic, they left for the Dutch East Indies, aboard a ship through the Panama Canal, skirting South America and negotiating the South Pacific to Australia and then to Java. His brother was stationed in Jakarta as a military physician, and both Dr. and Mrs. Moorrees had spent years in their childhood there. Coenraad Moorrees enlisted in the Netherlands East Indies Army shortly before Java became occupied by Japanese troops. By the end of 1942, their difficult lives turned into a nightmare: They were separated and sent off to internment camps. As a prisoner of war, Dr. Moorrees was put to work as a dentist in his camp, living primitively, poorly fed, and relying on his ingenuity for survival. He saved a few lives there, administering medicine and making bandages from bicycle tires, although at one point he was close to death with bacillary dysentery. His only treatment, as he later recalled, was “tea, tea and tea. I survived!” The Japanese surrender in 1945 was a momentous event for the Moorreeses. They were soon reunited and

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returned to the post-war Netherlands on a Dutch troop ship. It is likely that the survival tests of his 20s steeled him in his later roles at Forsyth and Harvard as Department Chief and Professor. He appeared as a sometimes fierce taskmaster to his postdoctoral fellows in orthodontics, a clinical specialty that indeed demands much task mastery. Although he did not himself treat patients during most of his academic career, he had a keen interest in the latest clinical methods and principles in orthodontics. This serious interest, coupled with his razor-sharp discipline as a first-rate scientist, became a powerful teaching tool, capable of overwhelming and intimidating even the brightest students or colleagues. Years later, many of his students, as professors themselves, realized that their mentor’s goal was not simply their embarrassment, but to drive home the importance of critical, scientific thinking in clinical problem-solving. The Moorrees methods in differential diagnosis and treatment planning thrive today as vital underpinnings of the training program in orthodontics at Harvard and other universities around the world, and in the minds of a legion of able orthodontists. Professor Coenraad Moorrees truly enjoyed the intellectual challenge of orthodontically related science. It was his life, work and hobby. Whenever he was told of an appealing new project or experiment, his eyes lit up, his quick smile appeared and he would invariably offer a comment like “It will be fun,” a playful admission of his considerable prowess and comfort at work as a leading scientist in his specialty. Orthodontics and anthropology will miss this meticulous investigator, perceptive observer and tireless teacher. Orthodontists, anthropologists and those in allied fields are grateful for his corpus of seminal publications. His students, colleagues, friends and admirers will long cherish the memory of Coenraad F. A. Moorrees as a model and inspiration for their own betterment and their devotion to knowledge. Peck S, Will LA. Coenraad F. A. Moorrees 1916-2003 [obituary]. Angle Orthod. 2004;74:286-268   Reprinted with permission of The Angle Orthodontist www.angle.org © Copyright by E. H. Angle Education and Research Foundation, Inc. 2004

Interview with Coenraad Moorrees Sydney Forwistz

This interview was published in the Journal of Dental Research in 1996 (Volume 75: 1342-5) under the section of “Discovery” edited by Irvin D. Mandel.

Orthodontics, as a discipline, deals with the consequences of a limited number of problems of which relatively little is known; hence, there is an obvious need to consult experiences of investigators in other fields, such as physical anthropology, molecular biology, physiology, human genetics, and others, particularly esthetics, that offer the orthodontist the opportunity to expand the horizons on which the discipline rests. An interview with Coenraad F.A. Moorrees, now emeritus, who directed the orthodontic graduate program at the Forsyth Dental Center in Boston for more than 40 years, provides insight into the thoughts of an educator who is passionately involved in the future of his profession as a participant rather than a detached observer. I have taken the liberty of re-arranging our long conversation so that what follows is part reminiscence, particularly as it relates to Forsyth, and partly responses, in his own words, to particular questions that will be of interest to all research workers in orthodontics. When Professor Moorrees arrived at the Forsyth Dental Infirmary for Children (1947), as called originally, he found a unique institution with a mission that combined research, clinical investigation, and the clinical care of children. It was headed by Percy R. Howe, one of the foremost researchers in dentistry (Brown, 1952). Howe had studied the effect of nutrition on dental caries, and before the word “vitamin” was coined, these supplements were tested in primates housed at Forsyth. He also collaborated intensively with leading investigators at Harvard’s Medical School, and that was the beginning of an in-depth relationship with James B. Conant, the President of Harvard University. Dr. Moorrees remembers Forsyth as a universe of research, coupled from “day one” with children’s dentistry and orthodontics, with a focus on growth and

development.The emphasis in orthodontics was on early treatment, even as young as four years of age, for children with Class II malocclusion. Then, as now, the Forsyth Dental Center was a beehive of research activity. All of the “important people” in Boston at that time were involved in orthodontics, with a staff roster that included Alfred Rogers, A. LeRoy Johnson, C.A. Hawley, Lawrence Baker, and Varstad Kazanjian, the father of plastic surgery in this country. By 1947, Howe was old, but nonetheless had been instrumental in changing the Harvard Dental School into the Harvard School of Dental Medicine, with a whole new faculty to realize the objectives of an ambitious program in dental education. It was a bombshell in dental education and became an example for other universities to update their own curricula. Medical students’ first two years were spent in building a basic science foundation from which they could tackle research projects in areas of dentistry, such as orthodontics, with the discipline of science, and to practice dental “medicine”. Traditionally, the daily routine at Forsyth included a lecture that was attended by all “interns” in children’s dentistry and orthodontics, as well as by the entire staff. Lecturers were invited from Tufts, Boston, Northeastern, and Harvard University, their hospitals, laboratories, and their medical and dental schools. Topics varied widely and covered many areas directly or indirectly related to dental medicine, providing an infrastructure of knowledge. One of the most renowned was Prof. Earnest Hooton, Harvard’s great anthropologist, who was a featured guest lecturer and witty speaker who dealt with all kinds of subjects, ranging from evolution, to physical and cultural development, racial characteristics, and the social studies of mankind. Professor Moorrees’ experiences with Percy Howe and Hooton stirred an interest in William Sheldon’s new program on human physique (somatotype) and its associations with temperament. As we well know, Moorrees says, “Man has assessed his fellow men at first glance 17 Advances in Orthodontics

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throughout time, leading to inferences about background, physique, and character. We can go back 20 centuries and already find various systems of visual assessment. Sheldon combined the three factors that had been recognized before (muscle, fat, and linearity) in a three-digit combination weighted on a seven-point scale for each factor. It was an interesting development.” Inherent in Sheldon’s method was a dysplasia factor, “an uneven distribution of a component in different regions of the body”, which suggested that facial dysplasias-such as a tremendous open bite or marked mandibular proor retrognathism in the Class III and Class II face-could be associated with other dysplasia factors in the body. Somatotyping provided an avenue for defining the constitution of the people orthodontists treat, and permitted body type to be analyzed, rather than teeth alone. A year after Dr. Moorrees took up his responsibilities at Forsyth, Harvard’s Peabody Museum sent an expedition to the Aleutian Islands to study the last surviving Aleuts. “Prof. Hooton asked me to go along,” but Moorrees replied that he knew absolutely nothing about racial morphology of the teeth. Hooton’s answer was short and to the point, “I like to have people who know nothing, because people who know it all always say the same thing. You go.” And Moorrees did. It took about a year to

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write up the findings which he brought to Prof. Hooton. Hooton called a week later to say, “Take your papers to Harvard University Press.” The text that Professor Moorrees and his collaborators published in 1957, The Aleut Dentition (Moorrees, 1957), remains to the present day one of the most comprehensive investigations to bridge the peopling of the New from the Old World. Family relationships, the Aleut diet, morphological characteristics of the teeth, torus mandibularis, odontometry, tooth emergence, tooth position and occlusion, as well as the prevalence of dental disease were some of the topics covered. Few racial groups have ever received such a thorough review of dental traits (Mehmet, 1989). Moorrees remembers his next research adventure as “the day of a great discovery”. Mrs. Howe had told him that Prof. Harold Stuart and associates had been following children from birth to 18 years in the School of Public Health. Moorrees asked, “Was it just height and weight?” Fortunately, they had also included dental impressions and radiographs, nutrition data, and a battery of other records. Moreover, Forsyth had helped and supported this research. When Moorrees went to Harold Stuart and asked, “Could 1 collaborate with you on this project?”, he said, “Why don’t you look at the material first? I am a little depressed about collaboration. About 25 or 30 orthodontists wanted to do something with the material but after one month they all disappeared without doing anything.” Dr. Moorrees replied simply, “I shall do it, because longitudinal material is scarce, and only from follow-up studies can we get some of the necessary facts and figures about child growth.” The text that reports findings from this study-The Dentition of the Growing Child. A Longitudinal Study of Dental Development between 3 and 18 Years of Age (Moorrees, 1959)-was completed with a number of collaborators and stands as a classic contribution to the methodology of determining dental development. Of particular importance are chapters on spacing/crowding in the dentition and the difficulty (because of low or moderate associations between various

dental characteristics) of accurately predicting dental development in the individual child. Nevertheless, Moorrees elegantly describes the value of observing children during the transition from the primary to the secondary dentition as a means of predicting the occlusion of the permanent dentition. In recounting the high points of his long career, Dr. Moorrees includes his current work, a longitudinal twin study. The small listing of twins at the Forsyth Dental Center had provided limited material, and the research proceeded slowly, until Elizabeth Fanning, who had studied tooth formation from radiographs of the children in the Stuart study, clipped a very short announcement from the Boston Globe about the founding of the first “mothers of twins association” in a suburb of Boston. Moorrees and his co-workers moved in overnight, and when “mothers of twins” associations mushroomed in and around Boston, they eventually enrolled as many as 412 pairs of twins between 4 and 9 years of age. It was a heavy load, but eventually samples from about 200 identical and 200 fraternal twin pairs with complete longitudinal records between 6 and 16 years were assembled. In 1956, the Forsyth Dental Center and the Harvard School of Dental Medicine joined forces and were affiliated, providing an environment that strongly influenced both Moorrees and his postdoctoral education in orthodontics. The Harvard-Forsyth program was established as a three-year program rather than the conventional two years. The program was linked to a training grant. It meant that “we had to produce not merely clinicians, but clinical orthodontists with an interest in science and in asking questions! ‘Why do teeth move? Why do the teeth go back after they have been moved? When should we start treatment, and who needs such treatment?”’ The affiliation with Harvard broadened the horizon of the teaching program and provided access to top research sponsors, first-class laboratories, and teaching hospital clinics in a multitude of disciplines. At Forsyth, orthodontics was an independent department and had to “float” on its own.Tuition, research money,

and clinical income were combined to support four or five fulltime staff members, all in research and teaching, and to pay salaries for support personnel and buy supplies as well. A recurring theme among research workers in orthodontics is the importance of the basic scienceclinical interface, and the relevance of calcification mechanisms, tissue, and inflammation repair to treatment procedures. Dr. Moorrees responded to my questions about basic research with characteristic frankness: “Tissue changes enable us to move teeth and are obviously of great importance. The tooth-periodontal membrane-bone model is readily accessible, has great potential to study resorption, bone formation, cellular changes, and interaction between the cell membrane and the extracellular matrix that reflect changes in gene expression. These aspects of tooth movement are also high on the ladder of basic research in cell biology and cell kinetics. To participate in these studies, our skills and background must be updated. When collaboration of basic scientists is possible, such projects should become very interesting undertakings.” Many basic scientists do not readily contribute their manuscripts to orthodontic and dental journals, because they want to publish where their peers will read the results. That means that the orthodontic fraternity

must transfer its knowledge through their own publications to enhance an understanding of the subject at hand. In any case, much is going on outside the field, and orthodontists should become well aware of advances and seek to participate in such studies. Anthropology obviously continues to have a place in orthodontic research as an umbrella that covers growth and development, aging, and many other aspects of the study of man related to orthodontics and to patient care. Additionally, inheritance factors are of special interest in orthodontic research, even though phenotypic expression of traits that concern the orthodontist must be inferred rather than measured directly. One approach to this problem is the twin study method, which provides an efficient means of investigating the relative contributions of heredity and environment to phenotypic variation, particularly of polygenic traits. In particular, the method lends itself to statistical techniques required for the analysis of continuously variable traits. The Forsyth twin study is unique in that Moorrees and his co-workers have been able to utilize pure longitudinal twin samples between 8 and 16 years to study the formation and emergence of teeth, the sequence and pattern of tooth emergence, and also the maturation of hand and wrist bones as well as somatic growth. Much information has been gathered on the development of the dentition and facial growth, and findings have been published in a variety of journals. After a lifetime in the field, Professor Moorrees shared some of his views on diagnosis in orthodontics. Briefly, the three categories of information that he advocates are: *Anatomical aspects of occlusion and the development of soft and hard facial tissues and architecture *Physiological considerations, including growth and development, maturation, breathing, swallowing, speech, and function of the tongue, lips, posture of the mandible, susceptibility to disease, allergy, etc. *Psychological considerations,

including personality, mental reaction time, capacity for self-adjustment, self-image, emotional maturity, overall well-being, assets, and liabilities. Cephalometric analyses have been available to orthodontists for more than 60 years and, for better or worse, have become a routine datum in orthodontic diagnosis, but Dr. Moorrees believes that cephalometrics practiced in orthodontics is somewhat crude and unsophisticated. Investigators measure a few parameters and make sweeping conclusions. “These findings may be erroneous, owing to the reliance on intracranial reference lines to define traits such as prognathism or retrognathism of the jaws and the inclination of the palate and mandibular plane, as well as the growth direction of the maxilla in its descent from the skull base and of the mandible in its descent from the maxilla.” Not much of what we call “cephalometric analysis” is clinically valuable. In general, the eye can get the information by simple inspection of the radiograph without an array of computer measurements. Regrettably, Dr. Moorrees continued, the classic anthropologic examination of the face is not routinely conducted and is not even taught anymore. The lateral projection on the radiograph is obviously tied to the Angle classification of malocclusion, based solely on the sagittal relation of the mandibular dentition to the maxillary dentition. The patient in “norma frontalis” shows the presence and extent of facial asymmetry, which is also usually neglected in orthodontic diagnosis. Methods to study man’s face have been designed and used during the past 20 centuries. They all pursued various ways of determining “facial proportions”, starting in Egypt, then Greece, India, Tibet, the Byzantine Empire, and Europe (Leonardo da Vinci, Albrecht Diirer, Peter Camper, and others). At best, orthodontists should attempt to achieve harmonious facial contours for an individual-an individual norm, so to speak. Thus, “disproportionate proportions can be made more harmonious and sometimes better than ever before, by combining orthodontics and orthognathic surgery.” Since orthodontic treatment is

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relatively expensive, the practical importance of establishing acceptable guidelines remains a problem. Moreover, the quality of treatment is also related to stability: While results may look fairly good initially, they may not be stable in the long term. Hundreds of patients were treated with the labiolingual technique before Dr. Moorrees came to Forsyth. “You can imagine what happened at age 9-10-11. Crowding of teeth and Class II malocclusion were prevalent again, and a second phase of orthodontics was needed. We now know that treatment can be undertaken in many instances when the first premolars have emerged. The leeway space of dm2-Pm2 can be preserved with lip bumpers. Other approaches can be used as well-such as rotation of maxillary first molars, and activators and head gears-to avoid extraction for the correction of Class I and Class II malocclusion. And,” he added, “we also have the blessing of orthognathic surgery for major skeletal corrections at a later date.” Societal changes are having a direct effect on orthodontic education and practice. Many patients now are adults who bring specific attitudes toward esthetics. What about aging and orthodontics for adult patients, I asked. His reply was brief: “Orthodontists make a contribution to the happiness and image of people because teeth, as sense organs, enhance the perception of others about them. The issue is not ‘beauty’, which is in itself difficult to define, but attractiveness. Harmonious facial features and a row of wellaligned and preferably white teeth help to conquer the world. That is of course an oversimplification, because in the final assessment, the eyes, supposedly 20 Advances in Orthodontics

reflecting ‘the soul of a person’ as well as man’s spirit and wit, contribute to, if not determine, his ‘image’.” Health care has become a priority item. What we do costs a lot. Is it worth it? What are the results? The question, then, is the quality of what orthodontists deliver. This is a whole new issue, and Prof. Moorrees has already been intimately involved in developing standards for orthodontic specialty education in Europe. Standards of treatment are difficult to enforce when education and goals vary greatly. Trials to assess the delivery and thereafter the outcome of orthodontic treatment will be conducted soon in The Netherlands, where specialty education has been relatively uniform. Stability of results is another aspect of any evaluation program, because initial results may look fairly good, but not necessarily in terms of stability, which can be determined only over time. Everything, Dr. Moorrees strongly believes, comes back to education. Research is needed in terms of surveying what we are teaching specialists in orthodontics. There is a wide variation between and among schools in the design and content of existing programs. Some are not only academically marginal but also clinically limited in their method(s) of therapy. Neither the American Association of Orthodontics nor the ADA and its committee on dental education have taken much leadership to encourage, let alone demand, educational reform. The majority of postdoctoral programs are limited to two years, and treatment cannot be completed because patients cannot be assigned to novices on day one of any program. In many instances,

program directors are not really involved in the educational process, and fulltime staff are minimal or lacking. “The time has come to evaluate post-doctoral education stringently. One gets an impression that the powers that be are not doing anything because it is politically undesirable. Moreover, the high yield of orthodontic clinics is absorbed to cover the deficit of the dental schools, particularly in private universities. Let us not forget that it is our responsibility to educate students at our premier institutions who can stand up and be leaders in orthodontic health care delivery.” Professor Moorrees, as he makes clear in this interview, is willing to challenge dogmatic assumptions to make his point, and to support his educational standards with personal affirmation. His influence on the field as a role model is unparalleled, and many of his former students are now themselves department chairs all over the world. Most importantly, Professor Moorrees is someone who believes in enduring values, that the power of knowledge is to enhance personal experience, to enrich the lives of his students, and to contribute to the public good (Osler, 1951). As one of his former students told me recently, “Moorrees was a demanding taskmaster. We all thank him for teaching us to think!”

TRIBUTE TO CFA MOORREES AT THE FORSYTH INSTITUTE

Tribute to CFA Moorrees at the Forsyth Institute Excerpt from Dr. Dominick DoPaola’s speech Thank you for joining us this evening to celebrate the life and achievements of Dr. Coenraad Moorrees. I would especially like to welcome Dr. Moorrees’ son, Alexander, who is joining us from London on behalf of the family. We feel that it is particularly fitting that the members of the Harvard Society for the Advancement of Orthodontics, many of whom were students of Dr. Moorrees, have gathered this evening at Forsyth, his research home, in tribute to this leader of orthodontics. As you know, Dr. Moorrees was a beloved and respected senior member of the staff and Chief of the Department of Orthodontics here at Forsyth from 1948 to 1990. His passion for learning and the implications of his work are evident in his scientific legacy. According to Dr. T. M. Graber, editor-in-chief of the publication the World Journal of Orthodontics, “there are few worldwide leaders in orthodontics and anthropology who have had the profound impact Dr. Moorrees has had on colleagues and students and the development of these fields of endeavor.”

References -Brown RW (1952). Dr. Howe and the Forsyth Infirmary. Cambridge, MA: Harvard University Press. -Mehmet YI (1989). The emergence of dental anthropology. Am J Phys Anthropol 78:1. -Moorrees CFA (1957). The Aleut dentition, a correlative study of the dental characteristics in an Eskimoid people. Cambridge, MA: Harvard University Press. -Moorrees CFA (1959). The dentition of the growing child, a longitudinal study of dental development between 3 and 18 years of age. Cambridge, MA: Harvard University Press. -Osler W (1951). A way of life and other selected writings from “The Student Life”. Mineola, NY: Dover Publications Inc.

21 Advances in Orthodontics

TRIBUTE TO CFA MOORREES AT THE FORSYTH INSTITUTE

22 Advances in Orthodontics

TRIBUTE TO CFA MOORREES AT THE FORSYTH INSTITUTE

23 Advances in Orthodontics

ALEXANDER MOORREES 1956-2006

WORTH REPEATING

Alexander, son of Coenraad, our brother Joseph G. Ghafari

There can never be, for a family, a loss like this. “He was a man with a very kind spirit, a wonderfully warm personality and great devotion to his mother, his sister Oni and his beloved niece.”1 In a big circle we join hands around this family to tell them how much we know they ache, and that we too barely hold our tears. Dear Alexander- we hold your sweet memory with reserves of good will, and as we throw the red roses and white tulips on your incomplete life path, we hope that the Harvard-Forsyth extended family can make one of your dearest dreams come true, namely the Coenraad Moorrees memorial that you helped initiate. With the power of the fiction you wrote, I wish that we can deny your departure, that you would visit us in another trilogy- make it a single volume of your imagination, a plot that could defy for moments the big blanket of time that shall cover all of us, and everything. Yet, in a tranquil corner of our minds, that space where we reject the bitter reality of your farewell, a smile filters through our lips interacting with your gentle presence, integrity, humor, and generous disposition. As long as we shall live to remember, that smile shall remain. As long as the Coenraad Moorrees legacy shall live, you shall remain its lasting youthful reflection. There can be a father-son union, beyond life, like this. 1- Quote from Kathleen Hill Zichy, President/Chief Executive Off icer of The Forsyth Health Foundation (October 17, 2006).

We never predicted sadness like this: Alexander Moorrees, in whom we found the comfort of a common foundation, the mind and heart of his father Coenraad Moorrees, and thus the core of a moral brotherhood, passed away in September 2006. Almost one year earlier, in October 2005, Alexander attended the HSAO Moorrees scientific day at Harvard, and we celebrated with him at Forsyth his dad’s life and legacy. Then, we thanked him, his mother Louise, and his sister Oni for sharing a father and husband with us, the Harvard-Forsyth graduates that Coenraad Moorrees also called “his” children. Alexander touched our lives in ways he and we have not fully known. We are certain of one matter: Dr. Moorrees was proud of him and his achievements in business and in authorship. When he spoke of the trilogy Alexander crafted in London where he lived, Dr. Moorrees divulged lovely details revealing his approval as both the tough editor and the gratified father. Alexander’s passing broke our hearts and numbed our minds. It is not given to any mortal of us to know, to even wonder why a father’s journey was longer than his son’s. Reality crushes all questions when death conquers. We and his family are left with the unpredicted sadness, a shackle of grief, and a want to mourn. 24 Advances in Orthodontics

ALEXANDER MOORREES 1956-2006

He filled spaces of life First Home: Lexington, Mass.

Alexander Moorrees was born in Lexington, MA on January 20, 1956. He attended the Shady Hill School in Cambridge, MA, and later Buckingham, Brown and Nichols, from which he graduated in 1974. He earned a BA degree in Economics (1978) at Trinity College.

Manhattan and Africa

Alexander moved to Manhattan to work at Chemical Bank. As part of his training, he worked in Monrovia, Liberia for 6 months. A Coup d’Etat abruptly ended this assignment. For 3 days, his family did not hear from him, and he was able to leave when an American Airline sent a plane to evacuate its stranded crew. His African experience was, in his words, a wonderful cultural adventure, witness a collection of tribal art (minus the spears that were confiscated at the airport), and a photograph of himself participating in an African ceremony. After receiving his MBA from Columbia University (1982), he landed his “dream job” as a portfolio manager for Scudder Stevens and Clark.

Back to ancestral Europe

In 1984, Alexander moved to Brussels to work with Drexel Burnham Lambert, and later to London, which he described as a “pleasure dome.” His career in finance was very successful, and included global equity marketing and fund management for such companies as Hambrecht and Quist and Lehman Brothers, where he had primary marketing, client service and business development responsibility for Continental European, Nordic and Saudi Arabian clients. At the time of his death, Alexander was Vice President of Business Development Europe AIG Global Investment Group, which he had joined in 2000. He was responsible for developing relationships with institutional investors in the Benelux region, whereby he established AIG’s European “Billion Dollar Club”, and was the first person to bring in a $1 bn mandate.

The creative writer

In the late 1990’s, Alexander took a brief break from the business world to author The Terzaghni Trilogy: Strange Happenings at the Independence Club, The Deadly Superchip, and A Ring of Roses. In these mysteries (www.moorrees.com; www. spydaweb.net/moorrees), his semi-biographical character, Sander, is pitted against the evil of Dr Terzaghni, a “man who changes his political alliances in order to join whichever terrorist group will permit him to wreck the most carnage.” In a thrilling account of espionage and action, Sander’s race to catch up with the doctor takes him on a chase around the diplomatic capitals of the world. In 2000, Alexander co-authored with Ben Banta a Reinventing ketchup- How Heinz created a global brand, a comical look at branding.

Games, fun, and philanthropy

He also developed a children’s board game: SHARK PIT- A day in the life of a shark. The UK Shark Trust supported the game and 8% of sales are donated to the trust. Many games were donated to hospitals and schools in the UK and USA. Alexander was in the process of developing other card and board games, as well as setting up a weekly backgammon evening and a Fine Wine Club with some London friends. Alexander’s philanthropic efforts included his childhood school, Shady Hill, the Forsyth Institute, and other alumni and volunteer efforts for the Columbia Business School.

The person, the gentleman

A memorial was held for Alexander in the Shady Hill School on November 11, 2006. Following are excerpts of the reflections presented at the memorial. “My brother lived life to the fullest, and did so much for so many. I hope he will live on in all of us, and that we will continue his legacy to not only help those in need, but to make all those around us happy.” “Oni” Louise Moorrees Berglund Alexander was actively involved in the planning for the [Coenraad F.A. Moorrees Fund for Young Innovators in Research], the “intellectual architect” of the fund. Days before his passing, he was communicating enthusiastically with members of the Honorary Committee of the gala at which his father was honored, discussing his thoughts and ideas for the fund.” The Forsyth Institute He was a man with a very kind spirit, a wonderfully warm personality and great devotion to his mother, his sister Oni and his beloved niece Alexandra. Kathleen Hill Zichy, The Forsyth Health Foundation A young, urban professional, Alex enjoyed his life in New York City to the fullest. Within a few years, however, the lure of Europe proved too compelling... and he relocated to London. The city, with its global personality and great professional opportunities, seemed best suited to his broad interests. A world traveler, he thrived in his international settling. Remarks from friends

Alexander Moorrees’s website 25 Advances in Orthodontics

CLINICAL PERSPECTIVE IN LITERATURE PICKS / LITERATURE WATCH

CLINICAL PERSPECTIVE IN LITERATURE PICKS Incidental findings in the maxillofacial area with 3-dimensional cone-beam imaging

Advances in the first decade of the 2nd “Orthodontic” century: cone beam imaging and orthodontic implants

JU Cha, J Mah, P Sinclair Am J Orthod Dentofacial Orthop 2007; 132:7-14

Joseph Ghafari

High-resolution multislice computerized tomography with multiplanar and 3-dimensional reformation imaging in rapid palatal expansion K Habersack, A Karoglan, B Sommer, KU Benner Am J Orthod Dentofacial Orthop 2007; 131:776-81

The authors illustrate the effect of rapid palatal expansion (RPE) in 3-dimensional images that indicate the extent of resultant sutural opening. The authors evaluated two patients, ages 10 and 16 years, after RPE with spiral CT scanning. In the short time between appliance removal and repositioning, a degree of relapse occurred prior to taking the CT. Of interest is the visualization of the median dissection of the incisal foramen at the point of unification of the 2 nasopalatine channels (patient 1Fig. 1) and the opening of the internasal, nasomaxillary and frontomaxillary sutures (patient 2- Fig. 2). The authors emphasize the indication of CT imaging in “borderline cases (juvenile and adult patients with questionable sutural response).” Although this indication seems unwarranted when clinical signs of midpalatal split (opening of incisal diastema) are not present, the valuable contribution of this report is the illustration of sites of opening other than the median split, whereby the inclusion of the findings in this section.

3-D reconstruction from CT image of midpalatal suture opening

A

B

Fig. 1. Patient 1: A- Occlusal view: opening from incisors to posterior nasal spine B- Frontal view: opening from intermaxillary suture to posterior nasal spine; median opening of lower nasal cavity (vomer attached to left palatal process). Arrows indicate canines

A

B

C

Fig. 2. Patient 2: A- Occlusal view: opening with “jigsaw” rupture line indicating great degree of interdigitation in posterior part of suture B-Frontal view: Opening involves internasal, nasomaxillary and frontomaxillary sutures (vomer attached to right palatal process) C- Lateral view: Detail of nasomaxillary (1) and frontomaxillary (2) sutural opening

The authors evaluated the effect of this implant-supported maxillary expansion device (Dresden distractor-DD, Fig. 3) in 10 patients (age: 18-26 years; mean: 25.3 years) through axial computed tomography scans. Compared with surgically assisted tooth-borne appliances, the DD caused less tipping (nearly half ) of the molars and premolars. The average opening between the maxillary central incisors (4.57+2.13mm; range: 2.44-6.7mm) represented 63% of the transmitted expansion of the screw (7.25mm = 100%). A research worth conducting regards the possibility of obtaining palatal split, which is difficult or unachievable in adults, through implants without surgical cuts. The

Advances in Orthodontics

From 500 consecutive cone-beam scans taken with Newtom QR 9000 volume scanner for orthodontic [n=252 patients], implant [n=172], endodontic [n=33], temporomandibular joint disfunction [n=34] and other [n=10] diagnosis, the authors found 123 (24.6%) incidental findings. The highest rate of these observations was for the airway area (18.2%), followed by TMJ (3.4%), endodontic (1.8%) and other (1.2%) findings. In the orthodontic group, the incidences were 21.4% for airway, 5.6% TMJ, and 2.3% endodontic findings. Only 22% of the airway findings (mucosal thickness, polyps, retention cysts)

Editor’s comment

With the progressive introduction of cone-beam imaging in orthodontics, much research still needs to be conducted to sort out differences in cephalometric norms and responses to various therapeutic modalities.

Joseph Ghafari

E Tausche, L Hansen, V Hietschold, MO Lagravere, W Harzer Am J Orthod Dentofacial Orthop 2007; 131:00, S92-99

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were correlated with clinical signs and symptoms. The authors caution that the data should be interpreted with a full history and detailed communications with the radiologist and other specialists.

LITERATURE WATCH

Three dimensional evaluation of surgically assisted implant bone-borne rapid maxillary expansion: A pilot study

Editor’s comment



hypothesis1 is that the necessary pressure to open (fracture) the midpalatal suture is directly applied against the bone, avoiding the buccal overtipping of buccal teeth. Such an approach may prove more successful in adults with signs of midface deficiency2 and possibly apertognathia. 1. Ghafari J. Therapeutic and developmental maxillary orthopedics: Evaluation of effects and limitations. In Biological Mechanisms of Tooth Eruption, Resorption, and Replacement by Implants, Z. Davidovitch, J. Mah (eds.). The Harvard Society for the Advancement of Orthodontics. 2004167-81. 2. Chalala C, Ghafari J. Evaluation of potential predictors of palatal split in adults. J Dent Res 2007;86:776 (Abst).

Topic 1: Open bite treatment and molar intrusion against temporary implant anchorage

Open bite correction (n=28)

American Journal of Orthodontics and Dentofacial Orthopedics with the following caveat showcased on the issue cover: “Think about stability when planning open bite treatment.” In the Editor’s Choice, Dr. David Turpin wrote about the corresponding featured case report (Park YS et al, 2006;130:391-402) whereby molar intrusion was overcorrected “to overcome relapse”: “Even with notable success, the authors stress the need to develop a proper retention protocol for molar intrusion when treating open bite problems [possibly including the maintenance] of the miniscrew implants for a while after treatment.”

28.6%

Implant anchorage (n=8)

Editor’s comment

71.6%

Non-implant anchorage (n=20)

The rationale for using temporary anchorage devices (orthodontic screws or plates) for molar intrusion is to decrease posterior height and deepen the bite in hyperdivergent skeletal patterns with anterior dentolaveolar open bite. A potential result is also a degree of mandibular forward rotation. A review of the literature between 2002 and 2007 on the use of implants to intrude posterior teeth is shown in Table 1. Table 1: Published studies and reports between 2002 and 2007 on molar intrusion (mostly maxillary) with temporary implant anchorage JOURNALS American Journal of Orthodontics and Dentofacial Orthopedics

Screws

Plates

6

1

4

4

Angle Orthodontist

Other journals (JCO/WJO) TOTAL

4

1

16

6

Noteworthy is the percentage of publications on open bite correction in the Angle Orthodontist reporting on use of implants. The great majority of the publications report intrusion of the maxillary molars, but some reports involve the mandibular molars (see below). The remarkable success of molar intrusion against implanted anchorage is counterweighed with potential risks, which include implant failures or complications (that can be often avoided if careful technical procedures are followed) and stability of the results. The latter has gained prominence since impressive results on intrusion eventually showed relapse. The seriousness of the issue was brought f ront stage in the September 2006 issue of the

Reasons advanced for relapse deal mostly with function and muscular forces. In the aforementioned case report, the authors advocate “muscle exercises to equalize the functional force”, as well as longer retention periods. A critical reason for relapse may be the periodontal surrounding of impacted teeth, specifically the demands of what is termed the “biological width”. An optimal band of soft tissue is required at the cervical level of a tooth above its bony crest; any impingement on that space may lead to movement of the tooth toward its reestablishment. In a study on 10 27 Advances in Orthodontics

LITERATURE WATCH

beagle dogs, Kanzaki et al (Am J Orthod Dentofacial Orthop 2007;131:343-51) demonstrated resorption and remodeling of the alveolar crest after molar intrusion against a skeletal anchorage plate. Intrusion was carried out with or without fibrotomy around the intruded teeth. In the fibrotomy group, the amount of intrusion was greater, but the resorption less than in the non-fibrotomy group. Stability of the results could not be investigated in this study. The proposed “biological width” hypothesis may be tested in animals through experimental crown lengthening procedures by removing the residual bone that results from tooth intrusion and deficient vertical bone remodeling around the tooth. The possibility of testing the surgical procedure against no surgery on a control side would preclude implementing the regimen in humans at this time.

Anterior open bite with temporomandibular disorder treated with titanium screw anchorage: evaluation of morphological and functional improvement S Kuroda, Y Sugawara, N Tamamura, R Takano-Yamamoto Am J Orthod Dentofacial Orthop 2007; 131:550-60

In this case report of the treatment of a 19year-11month-old woman, the anterior open bite was closed by intrusion of the posterior teeth through mandibular implants (Fig. 4). To prevent buccal crown torque of the posterior teeth, a lingual arch was placed between the first molars. After 36 months of treatment, these molars were intruded 3mm, the retrognathic chin and convex profile improved by upward rotation of the mandible, and the pretreatment symptoms of temporomandibular disorder were reduced.

28 Advances in Orthodontics

Topic 2: Canine guidance. Canine Eruption. A contemporary and evidence-based view of canine protected occlusion DJ Rinchuse, S Kandasamy, J Sciote

Am J Orthod Dentofacial Orthop 2007; 132:90-102

The authors advocate revisiting and perhaps abandoning some old experience-based perfunctory approaches to functional occlusion. The vehicles to more comprehensive research include more sophisticated methods to record functional occlusion and parafunction that are dynamic, rather than static. Specific conclusions include: 1- A single type of functional occlusion has not been demonstrated to predominate in nature 2- Canine protected occlusion (CPO) is unsupported as the optimal type of functional occlusion and may only be one of several possible functional occlusion types 3- Group function occlusion and balanced occlusion with no interferences apparently are acceptable schemes of functional occlusion 4- The stability and longevity of CPO is questionable 5- Reestablishing a functional occlusion through orthodontic treatment back to the type that existed before treatment is problematic particularly when treatment is started in the mixed dentition.

Factors associated with the duration of forced eruption of impacted maxillary canines: A retrospective study G Zuccati, J Ghobadlu, M Nieri, C Clauser

Am J Orthod Dentofacial Orthop 2006; 132:349-56

The authors provide information on the number of visits required to complete the phase of forced eruption of impacted canines. Data from diagnostic and treatment notes, as well as radiographs of 87 consecutively treated adult and adolescent patients were analyzed by stepwise regression analysis. Variables included were sex, age, side, overjet, overbite, distortion, distances between canine cusp tip and occlusal reference planes, and inclination of the canine to vertical and occlusal planes and to the adjacent lateral incisor and premolar. The number of visits needed to align the impacted canine into the arch is subject to great variability. The conditions for prediction (Table 2) may serve as guides in planning treatment, though more studies are needed. Table 2: Required number of visits relative to significant variables Condition (Predictor)

Required number of visits

Age: patients more than 25 years old

30 additional visits on average

Cusp tip distance farther from the occlusal plane

1 additional visit if the distance increased by 0.63mm on the ic radiograph

Canines with cusp tips located mesially to the axes of the lateral incisors

10 more visits than the distally located canines on average

Less inclined canines

1 additional visit required if the angle between canine and lateral incisors decreased by 4.55o

Above predictors account for 42% of observed variations

LITERATURE WATCH

Topic 3: Frontline research: smart brackets, gene therapy; TMD; clefts; fluoride; Smart bracket for multi-dimensional force and moment measurement BG Lapatki1, J Bartholomeyczik, P Ruther, IE Jonas1, O Paul J Dent Res 2007;86:73-8

Abstract: Atraumatic, well-directed, and efficient tooth movement is interrelated with the therapeutic application of adequately dimensioned forces and moments in all three dimensions. The lack of appropriate monitoring tools inspired the development of an orthodontic bracket with an integrated microelectronic chip equipped with multiple piezoresistive stress sensors. Such a ‘smart bracket’ was constructed (scale of 2.5:1) and calibrated. To evaluate how accurately the integrated sensor system allowed for the quantitative determination of threedimensional force-moment systems externally applied to the bracket, we exerted 396 different force-moment combinations with dimensions within usual therapeutic ranges (± 1.5 N and ± 15 Nmm). Comparison between the externally applied force-moment components and those reconstructed on the basis of the stress sensor signals revealed very good agreement, with standard deviations in the differences of 0.037 N and 0.985 Nmm, respectively. We conclude that our methodological approach is generally suitable for monitoring the relatively low forces and moments exerted on individual teeth with fixed orthodontic appliances.

The cranial base in craniofacial development: a gene therapy study S Kirkanides, P Kambylafkas, JH Miller, RH Tallents, JE Puzas J Dent Res 2007;86:956-61

Abstract: The etiology of midface retrusion remains largely unclear. We hypothesized that the cranial base synchondroses play a key role in the development of the craniofacial skeleton in the Sandhoff mouse model. We observed that developmental abnormalities of the crania base synchondroses involving proliferative chondrocytes are important in craniofacial growth and development. Neonatal restitution of _-hexosaminidase in mutant mice by gene therapy successfully ameliorated the attendant skeletal defects and restored craniofacial morphology in vivo, suggesting this as a critical temporal window in craniofacial development. Analysis of our data implicates parathyroid-related peptide (PTHrP) and cyclo-oxygenase-2 (COX-2) as possible factors underlying the development of the aforementioned skeletal defects. Hence, timely restitution of genetic deficiency or, alternatively, the restoration of PTHrP or cyclo-oxygenase activity by the administration of PTH and/or non-steroidal anti-inflammatory drugs or COX-2 selective inhibitors to affected individuals may prove beneficial in the management of midface retrusion.

Randomized effectiveness study of four therapeutic strategies for TMJ closed lock EL Schiffman1, JO Look, JS Hodges, JQ Swift, KL Decker, KM Hathaway, RB Templeton, JR Fricton J Dent Res 2007; 86:58-63

(SSI) for jaw function and TMJ pain respectively. Using an intentionto-treat analysis, we observed no between-group difference at any follow-up for CMI (p 0.33) or SSI (p 0.08). Both outcomes showed within-group improvement (p < 0.0001) for all groups. The findings of this study suggest that primary treatment for individuals with TMJ closed lock should consist of medical management or rehabilitation. The use of this approach will avoid unnecessary surgical procedures.

Defining subphenotypes for oral clefts based on dental development A Letra, R Menezes, JM Granjeiro, AR Vieira J Dent Res 2007;86:986-91

Abstract: Individuals with clefts present considerably more dental anomalies than do individuals without clefts. We used dental development to subphenotype clefts with the goal of identifying cleft subgroups that could have specific genetic contributions. We examined 1000 individuals, 500 with clefts and 500 without. We used several clinical features, such as cleft completeness or incompleteness, laterality, and the presence of dental anomalies to assess each individual’s cleft status. We performed chisquare and Fisher’s exact tests to compare the f requencies of observed anomalies between individuals with and individuals without clefts, and among individuals with different cleft subphenotypes. Agenesis of the lateral incisor on the non-cleft side was the most remarkable observation, and may suggest that such cases could be considered incomplete forms of bilateral clefts of the lip.

Abstract: For individuals with temporomandibular joint (TMJ) disc displacement without reduction with limited mouth opening (closed lock), interventions vary f rom minimal treatment to surgery. In a single-blind trial, 106 individuals with TMJ closed lock were randomized among medical management, rehabilitation, arthroscopic surgery with post-operative rehabilitation, or arthroplasty with post-operative rehabilitation. Evaluations at baseline, 3, 6, 12, 18, 24, and 60 months used the Craniomandibular Index (CMI) and Symptom Severity Index

29 Advances in Orthodontics

LITERATURE WATCH

Risk-Benefit Balance in the Use of Fluoride among Young Children LG Do, and AJ Spencer J Dent Res 2007;86:723-8

Abstract: This study aimed to evaluate the risk-benefit balance of several fluoride exposures. Fluoride exposure history of randomly selected children was collected for calculation of exposure to fluoridated water, toothpaste, and other fluoride sources. We evaluated the risk-benefit balance of fluoride exposure by comparing dental fluorosis on maxillary central incisors, recorded at the time of the study with the use of the Thylstrup and Fejerskov Index, and deciduous caries experience, recorded at age six years, of the same group of South Australian children who were from 8 to 13 years old in 2002–03. Population Attributable Risk for fluorosis and Population Prevented Fraction for caries were estimated. Fluorosis prevalence was found to be 11.3%; caries prevalence, 32.3%; mean dmfs, 1.57 (SD 3.3). Exposure to fluoridated water was positively associated with fluorosis, but was negatively associated with caries. Using 1000-ppm-F toothpaste (compared with 400- to 550-ppm-F toothpaste) and eating/licking toothpaste were associated with higher risk of fluorosis without additional benefit in caries protection. Evaluation of the risk-benefit balance of fluoride exposure provides evidence to assist in the formulation of appropriate guidelines for fluoride use. The authors further stated: Unlike water fluoridation, risk and benefit of toothpaste use can be dependent on patterns of its use and the oral health status of the children using it. The efficacy of fluoridated, as compared with nonfluoridated toothpaste in the prevention of caries has been clearly established. However, fluoridated toothpaste is one of the main sources of fluoride intake, thus contributing to a risk of fluorosis. Components of fluoridated toothpaste use might be modified to create a more favorable risk and benefit balance. Those components were: age when the use of toothpaste began, type of toothpaste, after-brushing routine, and an eating/licking toothpaste habit. These findings suggested that there was an opportunity to refine fluoridated toothpaste to lower the risk of fluorosis without significantly reducing its effectiveness in caries prevention. The measures might include encouraging commencement of toothpaste use in the 19- to 30-month age period, use of 400- to 550-ppm fluoridated toothpaste when toothpaste use starts, encouraging spitting after brushing, and (especially) preventing an eating/licking toothpaste habit in young children.

30 Advances in Orthodontics

Topic 4: biodegradable fixation

NEWS AND REPORTS

TRIBUTE TO COENRAAD F. A. MOORREES The Life of Coenraad Moorrees

Notes from the Program Leslie A. Will

One-year postoperative stability of LeFort osteotomies with biodegradable fixation: A retrospective analysis of skeletal relapse KD Kiely, KS Wendfelt, BE Johnson, BS Haskell, RC Edwards

Am J Orthod Dentofacial Orthop 2006; 130:310-6

Twenty-three consecutively treated patients (ages 19-39 years) were treated for excess maxillary excess or maxillary deficiency with LeFort 1 impaction or advancement osteotomies. Fixation was achieved with screws and plates of a biodegradable copolymer (poly-L lactic and poly-L glycolic acid; Lactosorb, Biomet-Walter Lorenz Surgical, Jacksonville, Fla). Findings on relapse over a 1-year observation period were within 1 mm, consistent with previously published reports on postoperative stability. Biodegradable copolymers appear to yield results at least similar to rigid internal metallic fixation.

Much has happened in the Orthodontic Program since the last issue of the Advances. Of course, we lost our long time leader and inspiration, Coenraad Moorrees, more than three years ago. We were so fortunate to be able to celebrate his professional life with him before he moved away. The gathering we had at the Countway Library was a magical occasion, with many, many alumni f rom around the country and around the world coming to pay their tributes. Below are some pictures f rom this lovely event (see Advances in Orthodontics Vol 10 (1) m Fall 2003). The following year, 2004, marked an important milestone for HSDM: the opening of the long-awaited Research and Education Building. Those of you who remember the old, corrugated metal Interim building (‘interim’ since 1973!) will realize how momentous this accomplishment is. The building houses a wonderful, spacious resident room with floor-toceiling windows, as well as new faculty offices and basic research laboratories. 2004 also saw a reorganization of the departments at HSDM, putting clinical programs such as orthodontics together with the appropriate basic sciences to encourage collaboration.

We joined Oral Biology to become the Department of Oral and Developmental Biology, which has more recently been shortened to Developmental Biology. After more than a year’s planning by several alumni (Carla Evans, Greg King, Jim Hartsfield) along with Leslie Will, a symposium on Growth and Development in honor of Dr. Moorrees was held as the annual HSAO meeting in October, 2005. The symposium was international, both in terms of the speakers and the attendees. Martin Kean made it all the way f rom New Zealand, and other alumni came f rom the Netherlands, California, and many other locations. Dr. Moorrees’ son, Alexander, also came on behalf of the Moorrees family. Research continues to be a major focus of the program. We currently have 6 DMSc candidates among our fellows, and both basic and clinical research is underway. One important theme is the use of cone beam CT imaging – as this technology becomes more and more accessible, we need to learn to use it to best advantage for our patients. Three projects are currently investigating various clinical applications – look

for Harvard’s name connected with this topic soon! Our newest class, those who will matriculate in July 2007, is highly diverse: its members were born in Cuba, India, Iran, Korea, and Kuwait. Two members will enter the DMSc program, one is currently at the Kennedy School of Government studying Public Policy, and one is currently earning a PhD in Dental Public Health. We have high hopes that we can contribute some newly minted academicians f rom this class as well as those above it. In conclusion, the orthodontic program is strong at Harvard. I am indebted to our many dedicated part time faculty who regularly give their time, pouring out their hearts, minds, and souls to educate our young scholars. I am gratified by our enthusiastic students, committed to becoming the best they can be in preparing to be our colleagues. Finally, I am grateful for our many loyal alumni, who want to contribute to our program in order to ‘give back’ for the many gifts they received here. I look forward to building on our past accomplishments to improve every year, and I look forward to keeping in closer touch with all those reading this journal.

31 Advances in Orthodontics

INFORMATION TO CONTRIBUTORS

Information to Contributors All papers submitted to ADVANCES IN ORTHODONTICS are subject to assessment by independent referees and to editorial changes. The text should be typewritten on one side of the paper only. The lines must be double spaced and the margins wide (one inch). The title page should bear the names of all authors, a short running title, and the address for correspondence. The paper should begin with an abstract (on a separate page) of not more than 250 words, followed, where appropriate, by these sections: Introduction, Material and Methods, Results, Discussion, Acknowledgment(s) and References. References: In the text, references are indicated by numbers. When a paper is written by only 2 authors, both are listed in the text; when written by 3 or more authors, the listing in the text should include only the first author plus et al. Accuracy of the quoted references is the responsibility of the author(s).

References to papers: - Brodie AG. Eighteen years of research at Illinois. Angle Orthod 1948;18:3-8. If pages are from 13-18, they are listed as: 13-8. References to books: - Moorrees CFA. The dentition of the growing child. Harvard University Press, Cambridge, 1959. - Dale JG. The American Board of Orthodontics. In: Orthodontics at crossroads, JG Ghafari, CFA Moorrees (eds.). The Harvard Society for the Advancement of Orthodontics, Boston, pp 25-34, 1993.

Illustrations: Figures should be kept to a reasonable number, and the legends typed on a separate sheet. Tables should be typed on separate sheets of paper, and the number and headings of table typed at the top of the table. All illustrations should be referred to in the text. Authors will receive proofs of their papers for correction.

ADVANCES IN ORTHODONTICS IS THE OFFICIAL PUBLICATION OF THE HARVARD SOCIETY FOR THE ADVANCEMENT OF ORTHODONTICS. ARTICLES REFLECT THE OPINIONS OF THE INDIVIDUAL AUTHORS AND ARE NOT TO BE CONSIDERED AS OFFICIAL VIEWPOINTS OR POLICIES OF THE SOCIETY.

32 Advances in Orthodontics

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