The clinical training of orthodontic residents encompasses all aspects of current orthodontic practice including teenage clinic, early treatment, adult treatment, craniofacial anomalies and orthognathic surgery.
The length of the orthodontic program is a minimum of 30 months. The clinical load of patients is chosen to match the teaching goals of the department.
There is an option to extend the program to 36 months. The 36-month option satisfies the European specialty training standards (ERASMUS).
The majority of the cases treated in the graduate department are in the teenage clinic or Core Clinic. The orthodontic resident spends 29 months treating patients within this clinic. During the first year of the program each resident starts up to 50 new patients to be treated on 4 clinic mornings, and 2 afternoons per week. During the fall semester, core clinic patients are the only patients being seen by first-year residents. The philosophy of this assignment is that fixed appliance therapy is the "bread and butter" of private orthodontic practice and a solid grounding in basic diagnosis and treatment planning is necessary to produce a competent orthodontist. It is expected that by December of the first year the resident will have most cases bonded and treatment will be in progress.
To assure equal distribution of orthodontic cases, and a similar experience by the residents, all cases have their severity evaluated using the ABO discrepancy index (DI).
The core clinic half-days are Monday through Thursday mornings with occasional afternoons held as reserved time during the first semester. In addition to the clinical instruction gained by treating patients in the core clinics, a companion seminar serves to provide didactic teaching of clinical orthodontics. These seminars take place from 8:00 am to 9:00 am Monday through Thursday, and from 1-2pm for the afternoon sessions, and are a combination of lecture topics and case reviews.
After the semester break, the first-year residents are introduced to the "sub-specialty" areas of orthodontic practice. These areas are introduced on a lecture basis during the fall in preparation for beginning clinical training in these disciplines in January. Additional cases are assigned to the first-year residents in January to be seen in the sub-specialty clinics. The sub-specialty clinics are:
- Adult Treatment/Sleep Apnea/ Aligner Therapy
- Craniofacial Anomalies
- Early Treatment (Functional Appliances)
- Innovations Clinic
- Orthognathic Surgery
Treatment of cases within the sub-specialty clinics continues for 4 semesters beginning in November of the first year. A description of some of the sub-specialty clinics follows.
Adult Treatment, Sleep Apnea, and Aligner Therapy
The adult treatment clinic concentrates on the special problems associated with mature dentition. Each resident is assigned new cases at the end of the first semester during the first year. These patients are selected based on their need for interdisciplinary treatment. Special consideration is given to patients requiring combined periodontal, restorative, and orthodontic treatment. This sub-specialty clinic involves orthodontic residents, advanced education in restorative dentistry (AEGD) residents, periodontic residents, and endodontic residents. Topics to be covered include treatment with aligners, treatment of periodontally involved patients, implants, and timing of interdisciplinary treatment.
Sleep Apnea patients are seen in this clinic, where the resident will provide and supervise the use of oral appliances as prescribed by a sleep physician.
Treatment of adult patients is coordinated by attending full-time faculty in the orthodontic department. Following the medical model, residents participate in the care of these patients in a one-to-one tutorial with the attending doctor.
The Department of Orthodontics at Case Western Reserve University also offers an accredited Fellowship in Craniofacial Orthodontics and Special Needs. The Case Ortho residents work in conduction with the craniofacial fellows to provide treatment to patients with cleft lip and palate, syndromes, or special needs.
Patients with Craniofacial Anomalies and Special Needs are seen in the clinic each month, along with the craniofacial fellow. In addition to these seminars, a one-semester didactic lecture course taught by the various specialists on the team is given in the fall of the first year and serves as an introduction to the clinical portion of the training. In this way, the resident sees how each specialist evaluates a patient in the CFA clinic.
Modern orthodontic diagnosis and treatment planning divides malocclusions into skeletal and dental components. Given that orthopedic alteration of the growing face is both possible and desirable, some malocclusions can best be treated in the mixed dentition when considerable skeletal growth remains. The early treatment clinic is designed to give our residents experience in treating skeletal problems during the mixed dentition. This clinic begins during January of the first year with the assignment of three new patient starts for each resident. A variety of skeletal problems are treated in this clinic including transverse maxillary deficiency, maxillary skeletal retrognathia, maxillary skeletal prognathia, mandibular skeletal retrognathia, mandibular skeletal prognathia, and vertical facial dysplasia. The instruction in this clinic takes the form of clinical case presentations by the attending instructors as well as actual treatment of patients. Because multiple phases of treatment are generally required to bring a case to completion, meticulous records are kept on all patients being treated and the review of the records is a major teaching resource in this clinic.
Didactic instruction in the use of orthopedic forces and appliances begins in November of the first year. This coincides with the completion of the first semester of the didactic course in facial growth and development. Beginning this course in January gives the resident both a clinical and scientific basis for understanding the treatment modalities applied in this clinic.
A patient that has completed the first phase of treatment will most likely be assigned to the core clinic for the fixed phase of treatment. In certain instances, the patient may be assigned to the orthognathic surgery sub-specialty clinic if a significant skeletal discrepancy still exists at the completion of skeletal growth.
The innovations clinic focuses on new technologies and in-house printed aligners. The orthodontic residency uses different intra-oral scanners, four different 3D printers and, during this clinic, the resident will learn how to design treatment using both commercially available and open-source software, print models and create and package aligners for patient treatment.
The orthognathic surgery clinic is designed to treat mature patients with combined orthodontic and skeletal deformities. The clinic begins in January of the first year. Additional to clinical patient care, a series of didactic lectures are given to acquaint the resident with the departmental philosophy of combined orthodontic and surgical treatment. Each resident is assigned patients with combined dental and skeletal deformities. These cases are diagnosed and treatment planned in conjunction with the Department of Oral and Maxillofacial Surgery.
Experience in clinical treatment is supplemented by weekly seminars in diagnosis and treatment planning as well as case presentations by the instructors in the sub-specialty clinic. Treatment of orthognathic surgery patients is coordinated by attending full-time faculty in the orthodontic department. Following the medical model, residents participate in the care of these patients in a one-to-one tutorial with the attending doctor.
Along with the need to train residents in the art and science of orthodontics, there is a need to assess the quality of orthodontic education being provided at CWRU. To ensure a minimum standard of competence in clinical orthodontic treatment, each resident is required, before graduation, to finish 50 orthodontic cases. In addition, a comprehensive clinical examination is given as a final evaluation of clinical competence. Because one of the goals of our department is to produce qualified orthodontists, the final examination for clinical competence is patterned after the American Board of Orthodontics examination. This examination takes place during the second, and third years of residency. The clinical examination includes the diagnosis and treatment planning of a surprise case, following the ABO format. The examination is conducted by an assignee by the Program Director.
All finished cases are scored by a calibrated faculty for outcome assessment and quality control, using the PAR index.
The department has an ongoing commitment to maintaining its leadership role in the area of research. Each resident is encouraged to select his/her research topic for his/her Master's thesis. The thesis is to be submitted in partial fulfillment of the Master's degree and should be completed within the first 24 months of the program. All residents are required to produce a Master's thesis, and the department does not award a certificate degree without the Master’s.
Specific areas of ongoing research in the department include:
1. Three-Dimensional Imaging in Orthodontics
2. Craniofacial Anatomy and Obstructive Sleep Apnea Syndrome.
3. Retention in Orthodontics
4. Growth and aging of the human face
5. Outcome of orthodontic treatment
The department functions as a community resource on two levels. First, the treatment of patients within the orthodontic clinic is recognized as a significant community service. The marketing of the orthodontic department to the surrounding community has increased the number and quality of patients being treated in the clinic. Increased visibility in the media and recognition of the department as an outstanding source of quality orthodontic care is essential. We strive to be self-sufficient financially and do not rely solely on resident tuition for departmental support.
In addition to an expanding role in community service, the department acts as an educational resource for the surrounding professional community. To this end we have instituted a visiting lecture series sponsored by the department. Lecturers are brought in approximately every four months to discuss relevant topics in the field of orthodontics. This lecture series is open to all members of the dental community, although special emphasis is placed on inter-specialty meetings and the lectures are advertised to dental specialists and university-affiliated persons.
The Department of Orthodontics may be reached at 216.368.4649, or firstname.lastname@example.org.