R.G.“Wick” Alexander The 20 principles of the Alexander discipline 2008 Quintessence 232 pages; 1000 illustrations (700 in color); $138; www.quintpub.com (also available through www.amazon.com)

Abstract

Reviewed by Alex Jacobson The Alexander discipline comprises 20 principles, all of which are described in the text. Principle 1, “effort equals results,” relates to self-confidence, persistence, pragmatism, and discipline as the keys to success. Principle 2, “there are no little things,” is a discussion of the little things that make a difference in orthodontic practice. Principle 3 refers to “the KISS principle,” derived from the popular maxim “keep it simple, stupid,” with the idea to avoid complexity. “Establishing goals for stability” (principle 4) includes a section that describes 15 keys to orthodontic success. “Plan your work, then work your plan” (principle 5) begins by listing 8 factors aimed at deciding whether extraction is indicated before treatment. The rest of the section briefly describes the information needed to establish a diagnosis for setting goals and establishing a treatment plan. Principle 6, “use of brackets designed for specific prescriptions,” refers to distinctive bracket design concepts that include slot size, single instead of twin brackets, interbracket space, rotation wings, molar offsets, angulation, and torque to achieve esthetics, function, and long-term stability. “Build treatment into bracket placement” (principle 7) is about bracket height, angulation, mesiodistal positioning, appliance variation, banding, and bonding. Principle 8, “exploit growth to obtain predictable orthopedic correction,” places emphasis mainly on the orthopedic correction of Class II and Class III skeletal patterns. The determination of the ideal arch form and clinical arch form adjustments are discussed in principle 9, “establish ideal arch form.” Principle 10, “follow a logical archwire sequence,” briefly describes archwire types, functions, sequencing, appointment scheduling, and treatment duration. “Consolidate arches early in treatment” (principle 11) emphasizes the need to close spaces as early as possible to allow orthopedic forces to create skeletal rather than dental changes. Principle 12, “ensure complete bracket engagement and maintain consolidation,” debates traditional archwire and bracket ligation, self-ligation, and the technique and rationale of archwire tieback to maintain consolidation. Archwires require time to fully express their forces and become passive in the brackets. Allowing time for this to occur in essence is principle 13, “let it cook.” The sequencing of archwires advocated allows each to be optimally effective, thereby improving treatment results; the goal is to get into finishing the arches as quickly as possible. Among the most common malocclusions is the deep bite; this problem is addressed in principle 14, “level the arches and open the bite with reverse curve archwires.” Described are the technique for creating the curve, the amount of curve, and the heat treatment of the archwires. “Create symmetry” (principle 15) discusses the rationale of starting treatment in the maxilla, the sequencing, and the finishing of treatment. “Use intraoral elastics to coordinate the arches” (principle 16) refers to the sequence, force, and positions of elastics to correct vertical discrepancies, crossbites, deviated midlines, and Class II and Class III malocclusions to achieve correct overbite and cusp-fossa interdigitation. Principle 17, “use nonextraction treatment when possible,” addresses the necessity and reasons for treating patients without extractions, particularly in borderline cases. Appropriately following is principle 18, “use extraction treatment when necessary,” the management and mechanics of which are described. “Careful appliance removal, then retention will improve stability” (principle 19) addresses the procedure of appliance removal, posttreatment review, and types of retainers to improve the chances of long-term stability. The final principle (20), “create compliance,” includes suggestions on how to create compliance and improve the patient's willingness to follow instructions. Each chapter includes at least 1 case study designed to reinforce that principle. Each comprises an overview, examination and diagnosis, treatment plan, discussion, and evaluation of each case. This volume is not a how-to text; rather, it is intended for clinical orthodontists who are willing to further improve or hone their skills to achieve even better results. The cases shown are well illustrated and beautifully treated.