The design for the site of an orthodontic office has to encompass a wide variety of heterogeneous concepts that have little or no logical connection with each other including functional and ergonomic requirements, the available existing space, the existing building itself, the flow of traffic, the conduct of the practice, costs, colors, materials, textures, and lighting.

Carrying out this transformation cannot be done without an in depth study of the specifications and characteristics of every phase of the operation, a careful analysis of the needs and mode of operation of the office team. But this plan for a facility remodeling should not respond solely to functional needs; every office location should be designed to house a particular activity. The waiting room and reception desk should encourage communication and empathy. The consulting room should soothe fears and stimulate dialogue. The treatment rooms or area should reflect professionalism. The sterilization area must gleam with an almost virginal cleanliness and demonstrate the rigor of its antiseptic qualities. Throughout, management of space, forms, dimensions, and the choice of materials and colors must flow from a well thought out plan where they all participate in the creation of an atmosphere that sends a message to patients. “Architectural works speak to men’s hearts, awakening emotions. The task of architecture is to stimulate righteous emotions.” [2]

It is commonly accepted that a good practicioner-patient relationship favours good patient co-operation with treatments. However, medical literature and our own research have led us to a more pertinent approach. The body and the mind cannot be dissociated in humans and numerous observations show that therapeutic results are favoured by the human relationship. (Given similar techniques, biological answers differ). Now concerning the environment, the question is:

“How can the clinical framework integrate this research?”

This article reviews the main trends in the evolution of the vertebrate axial skeleton, with special focus on mammals. The structure of vertebrae is exposed according to traditional and current conceptions and several examples of species-specific and topography-specific adapta tions are given. The relationships between stature and the anatomy of the bony girdles surrounding the spine are discussed. Hypotheses on the influence of gravity on axial morphogenesis are formulated.

The tonic postural system controls the equilibrium of posture when the body is completely at rest and when it is moving. It is a complicated mechanism that can call into action a variety of modalities including the assistance of the feet, the skin, the eyes, the masticatory system, the Central Nervous System and the efferent muscles, with all elements working reciprocally. Orthodontists should make a postural assessment before undertaking any treatment. If problems are found they should be dealt with by a multi-disciplinary team. But in every case orthodontists should be aware that their efforts have an effect on posture and can modify the corporal schema of the patient. Orthodontists should pay special attention to patients with scoliosis or any deformity of the spinal column.

Despite having a correct anterior occlusal relationship between upper and lower teeth with canines in perfect Class I, some patients have imperfect posterior occlusal relationships with first molars in positions that are slightly Class II or Class III owing to an arch length discre pancy in the upper and lower buccal segments.

From this study of 62 subjects treated with full banded appliances and no bicuspid extrac tions we were able to determine the ideal relationship of the widths of the lower bicuspid and molar teeth with their upper antagonists, one that make it possible for the attainment of Class I relationships of both canines and first molars. This ideal value is 1.062.

We discuss the therapeutic implications of this finding, notably its influence on extraction decisions and propose solutions for cases of frank disharmony.

Without realizing it, orthodontists may find themselves treating patients suffering from cranio-mandibular disorders, who may be adults, but not necessarily. Both young children and adolescents can also have these problems. Orthodontists often fall into the trap of not recognizing these disorders especially when the clinical signs are discreet or even non-existent. In order to save orthodontists from encountering unpleasant post-treatment surprises, we present in this paper a review of some of the indications of the etiology of craniomandibular dysfunction, how to diagnose it, and the importance of its major clinical signs that can be a great help to them in achieving a keener state of vigilance in this regard throughout orthodontic therapy.

Uncovering the Herbst rods can make wearing the appliance more comfortable for some patients. On the other hand there can be some disadvantages to this procedure:

- it might make cementing or bonding of the appliance, in case of poor cooperation, impossible;

- it might interfere with vertical growth depending on the bearing points;

- it might disturb occlusion because of the wires that would pass over the occlusal surfaces;

- it might impair the retention of the appliance during the period when temporary teeth are being shed.

This article will also present other modifications, relating to the pivots, to the elimination of the anterior portion of the device, and to the use of springs on the branches. Their respective benefits and limitations will also be presented and discussed.

Stating the problem and its ramifications

The rapid changes that have affected the practice of orthodontics in recent years make it necessary for us to re-examine the traditional ways we have managed our offices. Our basic training, essentially technical in nature, never prepared us to direct the operation of an enterprise that has important business as well as orthodontic treatment components. In today’s world we should properly consider our practices as veritable full scale health care delivery organizations. The accelerating rate of change in modern medicine and in the way both patients and referring dentists perceive it and the exponentially rising flood of information about business administration, finance, and law, have all contributed to the block of time that orthodontic offices must devote to management concerns. These details must be dealt with appropriately to allow orthodontists to practice their profession under optimal conditions. And among those essential non-clinical tasks, there is little doubt that proper direction of human resources is the most difficult. And that is entirely understandable because in serving as team leaders orthodontists must interact with a host of individual personality issues. This new challenge is monumental. To confront it successfully orthodontists must become more than skilled technicians, they must perform as successful managers. In this article we propose to present practical rules for efficient office management.

Many derangements in the cranio-mandibular relationship can contribute to the etiopathogenesis of tempero-mandibular disorders and postural anomalies. Orthodontists should understand their characteristics in order to prevent their development or correct them if they appear during the course of orthodontic treatment. Occlusal splints for re-positioning the mandible to restore it to a healthy physiological position are an invaluable tool in dealing with this aspect of orthodontic therapy.

The aim of this study was to observe the effects of treatment with a Trainer T4K® myofunc tional appliance of thirteen late mixed dentition patients. We conducted thorough clinical examinations that included assessment of breathing and swallowing capabilities and took profile cephalograms and study models for each one. We also selected a control group that had been treated only with palatal expansion so that we could distinguish the effects of myofunctional therapy from those of expansion. We observed significant mandibular growth (p<0.05) of 3.24 mm on the average and a significant decrease in overjet, essentially linked to dento-alveolar effects, in the Trainer T4K® group. Swallowing and breathing function also improved in these patients. The two groups had similar maxillary and mandibular expansion.

So we conclude that use of a Trainer T4K® myofunctional appliance results in improved antero-postero dental relationships and an improvement in oral functioning.

Change is inevitable: it occurs in every domain and we should realize that it doesn’t work as a one-time leap forward but is, instead, an on-going process. And as an underlying principle we should also understand that planned and well executed development is always preferable to abrupt changes that are imposed by external forces. By exercisingceaseless vigilance we can prepare in advance for the improvements that we must make to keep our offices up to date.

In all organizations, resistance to change is built into the behavior of every staff member. Management should take this factor into account and establish ways of dealing with it in each pro ject that is undertaken. Every activity requires the voluntary and active participation of all members of the office team. As the group leader, the practitioner must define the needs, outline the fra mework of the action, dissolve resistance, and provide the breathing room that is indispensable in stimulating voluntary and motivated cooperation of participants.

The relationship between occlusion and posture has been a continual source of interest to all participants in the delivery of health care. But a certain amount of confusion still beclouds the subject because of the wide diversity of therapeutic approaches designed to deal with it and the weakness of methodological design in the scientific studies that have been published on it to date.

This article addresses the questions raised by that correlation between occlusion and posture as well as the therapeutic implications of a clinical approach integrating treatment of corporal posture into orthodontic care. A review of the literature shows that there is a dearth of reliable experimental data dealing with this subject. The data that is available points to the existence of this correlation and also asserts the prevalence of associations between idiopathic scoliosis and cranio-facial anomalies in adolescents.

The published facts appear to support our clinical impressions and subjective convictions. In order to enlarge our vision to encompass patients as entire human beings instead of compartmentalized biological segments each to be treated by an appropriate specialty it would be helpful if members of the various medical disciplines improved the lines of communication with each other. An equally desirable development would be the establishment of fundamental research and clinical programs that would help to establish causal relationships that would put therapy on evidence based foundation.