Charles Tweed is truly a Moses figure for orthodontics. He lead his people out of Edward Angle’s non-extraction realm, opposed the golden calf by stating that there is a limited number of patients one could handle, and – the most striking similarity – his teachings have solidified into the 10 orthodontic commandments.
Last year, I wrote about the Tweed’s 10 rules from the perspective of contemporary evidence-based care. I got pretty ambivalent feedback as a result. Some people would say these are still the great truths, others would disparagingly tell me these are nothing but the ancient prejudices…
I can’t stop feeling that the polarisation is just a matter of interpretation. Today I would like to give you my own interpretation. This is going to be super-concise since I designed this text for my brand-new Instagram account. The commandments are in italics and my interpretations are in bold.
1. Thou shalt not expand.
Do not overexpand.
2. Honor thy patient and strive for perfection and a pleasing profile.
3. Remember that the master has said that the lower incisors must be 90 degrees to the mandibular plane, or 65 degrees to the Frankfort horizontal. Do not deviate.
Do not procline much.
4. Do not hesitate to extract premolars. Only in this way can you achieve the objectives requires by our master.
Extract if necessary.
5. Band as many teeth as possible; to do less indicates sloth, indecision and lack of comprehension of the only road to orthodontic salvation.
Second molars matter.
6. Ignore muscles, particularly those of the tongue, as you strive for the mathematical formula.
Myofunctionalists are nuts.
7. Ignore morphogenetic factors, pattern of growth gradients. Occlusion is the be-all and end-all of our existence.
You can’t control facial growth. Focus on what you can control.
8. Ignore root resorption, but do not show the roentgenograms to your confreres because they might interpret this as a sign of weakness.
Don’t expect everyone to be nice and cheerful.
9. Take your ‘finished’ records as soon as you remove appliances. If you have not achieved the objectives as outlined by the master, the case is not to be considered ‘finished’.
10. Retain the case indefinitely; never discuss failures with non-believers, for you may sow the seeds of ugly suspicion and mistrust.
Post-treatment changes will always take place.
This has been the 10 orthodontic commandments and my interpretation of them. Does this make any sense to you? Drop your opinion in the comments.
Evidence based results supported by long term research supports your comments.
[…] the common sense. Despite the fact that from 1940s “Thou should not expand” is considered to be the first orthodontic commandment, each and every generation of practitioners are coming up with new methods to challenge the status […]