Advances 2006/07 - Harvard Society for the Advancement of

Transcription

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.
2
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
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.
4
“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
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.
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
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
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
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
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
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
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.
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
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.
14
W O RT H R E P E AT I N G
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
15
WORTH REPEATING
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
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
WORTH REPEATING
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
WORTH REPEATING
WORTH REPEATING
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
18
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
19
WORTH REPEATING
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
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
22
23
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
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
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
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
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
26
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
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
Topic 2: Canine guidance. Canine Eruption.
A contemporary and evidence-based view of canine
protected occlusion
DJ Rinchuse, S Kandasamy, J Sciote
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
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
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
Topic 4: biodegradable
fixation
NEWS AND REPORTS
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
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
ALUMNEWS
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SHARE YOUR NEWS
on these pages with your fellow alumni and friends of
THE HARVARD SOCIETY FOR THE ADVANCEMENT OF
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MAILING ADDRESS:
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