July 20, 2010
Metamorphosis of LLUSD's Graduate Program in Orthodontics: 1960-2010
R. David Rynearson, DDS, MS
One of nature’s marvels is the metamorphosis that takes place when a tiny butterfly egg on a leaf becomes a creeping larval caterpillar and then a dynamic chrysalis cocoon from which emerges a beautiful adult butterfly with the capacity to soar. The story of the initial formation of the School of Dentistry’s Graduate Program in Orthodontics to its current state has involved a progressive metamorphosis orchestrated by many dedicated didactic and clinical orthodontic educators. The goal of these educators throughout the years has been to provide the best possible orthodontic education so that its graduates can soar in their ability to provide quality orthodontic care.
Early History 1955-1969
The School of Dentistry’s founding dean, Dr. M. Webster Prince, recruited excellent dentists to pursue dental specialties at prominent dental schools and then return as faculty in the various departments of the soon-to-be School of Dentistry of the College of Medical Evangelists (CME). Drs. Franklin Nelson and Elizabeth Larsen were slated to head up the proposed Orthodontic Department, which was to be ready by 1955 to correspond with the junior year of the first dental class. Dr. Nelson attended the graduate program in orthodontics at the University of Southern California and subsequently became the first chairman of CME’s Department of Orthodontics. Simultaneously, Dr. Larsen attended the graduate program in orthodontics at Northwestern University and then became a full-time faculty member of the newly formed CME Department of Orthodontics.
CME’s School of Dentistry ‘opened its doors’ to dental students in 1953, although the original structure of the current Prince Hall was not completed until 1955. Thus the School’s first dental class experienced didactic classes and some clinical exposure through ‘doors’ in preexisting buildings on campus during their initial two years of training. Before the completion of Prince Hall, the School of Dentistry’s dental clinic was in Cutler Hall basement, which at that time was principally used for didactic and laboratory teaching in microbiology. Dr. Elizabeth Larsen, the principal didactic and clinical orthodontic educator for pre-doctoral dental students, oversaw the orthodontic clinical training in Cutler Hall for the School’s first dental class.
In 1957 Dr. Elizabeth Larsen opened an orthodontic practice in St. Helena, California, as her husband, a biochemist, had been granted a teaching position at nearby Pacific Union College. Dr. Larsen’s brother, Thomas J. Zwemer, at the time an associate professor at Marquette University with eight years of faculty experience, accepted the School’s invitation to become co-chair of the Department of Orthodontics, joining Dr. Nelson, who was serving in a part-time position. Dr. Zwemer was also given the task of developing a graduate program in orthodontics, which would become the first dental specialty program offered by the School of Dentistry. The initial Graduate Program in Orthodontics developed under his direction included a thesis-based master’s degree to be granted by the School of Graduate Studies of CME, later called Loma Linda University. Dr. Zwemer designed a program to have both clinical excellence and didactic academic credibility. While at Marquette, Dr. Zwemer had been working on electromyography as a line of research. His background in innovative orthodontic research and academics at a prominent school made him the ideal person to develop CME’s Graduate Program in Orthodontics. The School of Dentistry and the School of Graduate Studies approved Dr. Zwemer’s well-planned curriculum, and he became not only its architect but also the first director of the Graduate Program in Orthodontics.
Graduate Program Begins 1960
The first class of the Graduate Program in Orthodontics began in 1960 at a time when the U.S. newspaper headlines ranged from hula-hoops and I Love Lucy to the U-2 spy plane and John F. Kennedy’s ascent to the presidency. The first orthodontic residents, Milford J. Anholm and Howard W. Conley, had been long-time friends. Graduating in 1962, just 21 months after they had begun their residency at CME, their master’s degrees were granted by Loma Linda University, as the CME name was changed to LLU in 1961.
Unexpectedly, during their first year of training, Dr. Nelson died and Dr. Zwemer’s title subsequently changed from co-chair of the Department of Orthodontics to chairman while he continued as director of the Graduate Program in Orthodontics.
The following is a thumbnail sketch listing some of the activities of the orthodontic residents during the early years of LLUSD’s Graduate Program in Orthodontics:
- Dr. Nelson was trained in the Universal technique at USC (just as an aside, a supplier by the name of Unitek got its name from the Universal technique).
- Dr. Zwemer, the founder of the orthodontic graduate program, was trained at Northwestern, which taught Edward H. Angle’s edgewise technique.
- The edgewise technique was the predominant technique taught at LLU.
- Full bands were pinched, spot-welded, and subsequently brackets were soldered to the bands. The band material was stainless steel and gold. There were no preformed bands at the beginning of the graduate program. First-, second- and third-order bends were placed in the arch wires manually.
- Dr. Zwemer arranged for many of the prominent orthodontists from the surrounding communities to share their clinical skills with the residents. One of those sharing clinicians was Dr. Robert M. Ricketts.
- The residents had courses in tooth-movement, biomechanics, statistics, anatomy, speech pathology, and growth and development among other courses.
- Dr. Zwemer mentored research in the comparative anthropological studies of the face, jaws and teeth of South West Native Americans, in the piezoelectric properties of alveolar bone with in vivo orthodontic tooth movement, and in the use of the Baldwin strain gauge in plotting the efficacy of force application in a variety of extra-oral orthodontic appliances.
- The department then mandated original research, as it does currently.
- One course that seemed unforgettable to the early orthodontic classes required the residents to carve in wax an anatomical likeness to each of the craniofacial bones. While lecturing at Loma Linda University, the famous anatomist, Dr. Harry Sicher, would illustrate anatomical structures on the blackboard ambidextrously with both hands to the delight of the students. Probably the students were even more delighted after he was asked to evaluate the aforementioned wax-carved craniofacial bone project. It is reported that he said in his very German accent, “Vy for you do dat? It still looks gust like vax!” Thereafter, the wax project was terminated.
- During the early development of the Department of Orthodontics, Drs. Nelson and Larsen outlined the pre-doctoral program and Dr. Zwemer created the Graduate Program in Orthodontics. Drs. Alden Chase and Howard Conley gave added strength and cohesiveness to the graduate program, bolstering the foundational work of Dr. Zwemer. Since its first site visit, the Orthodontic Department (and subsequently its advanced education program) has enjoyed continuous full accreditation by the ADA.
Chronology of Departmental Administration
- Franklin Nelson, chair 1955-1958
- Franklin Nelson & Thomas Zwemer, joint chairs 1958-1961
- Thomas Zwemer, program director 1960-1966
- Thomas Zwemer, chair 1961-1966
- Alden Chase, chairman/program director 1966-1967
- Howard Conley, chairman/program director 1967-1969
- Roland Walters, chairman/program director 1969-1989
- Joseph Caruso & Norman Carter, joint chairs 1989-1992
- Joseph Caruso, chair 1992-1993
- Toufic Jeiroudi, program director 1992-1997
- Alden Chase, chair 1994-1996
- Joseph Caruso, chair 1996-present
- Joseph Caruso, program director 1997-2006
- Leroy Leggitt, program director 2006-present
Intervening History 1969-1989
The intervening years in the history of the Department of Orthodontics are punctuated by the presence and departmental activities of Roland D. Walters.
A member of CME’s first dental class of 1957, Dr. Walters had also completed LLU’s Graduate Program in Orthodontics in 1967. During Dr. Walters’ era a number of significant departmental policies changed in both didactic and clinical orthodontics.
The standard edgewise technique had been the predominate technique taught since the beginning of the department; however other variant treatment philosophies such as the Begg technique were also being taught. Dr. Walters had been interested in the bioprogressive treatment philosophy and biomechanics of Dr. Robert M. Ricketts and in fact sponsored his faculty to attend Dr. Ricketts’ short course at his Pacific Palisades office. At Dr. Walters’ suggestion, the Graduate Program in Orthodontics adopted the bioprogressive variant of the edgewise technique as the predominant treatment philosophy to be taught, which by the way is still taught today. In a nutshell, the bioprogressive treatment philosophy entails a tailor-made treatment plan based upon the patient’s skeletal, dental and functional parameters to progressively and logically unlock the patient’s malocclusion. The bioprogressive treatment philosophy encourages the clinician to use light biologic compatible forces and to segmentalize a dental arch when needed, in an effort to allow specific segmental orthodontics to improve efficiency.
In 1972 the American Dental Association encouraged graduate programs to standardize the length of their graduate dental specialty training to 24 months. LLU complied and lengthened its orthodontic program to 24 months; however, with the class of 1998 it was lengthened again to 27 months.
In another innovation Dr. Walters introduced the use of computers in the didactic and clinical teaching of graduate orthodontics. A graduate student, Gunther Blaseio, SD’86, inspired this action. For his master’s degree thesis, Dr. Blaseio developed a computer program, now called Quick Ceph, to aid the orthodontist in tracing a lateral cephalograph digitally rather than by hand. Under the leadership of Dr. Walters other innovations have led not only to the continuing metamorphosis of the Graduate Program in Orthodontics but to a noteworthy pre-doctoral orthodontic program. Wanting his orthodontic graduates to be consummate professionals, Dr. Walters developed a graduate program that was strong didactically and clinically as well as promoting relevant and quality research activities by the residents.
Recent and Continuing History 1989-Present
For approximately seven years after the retirement of Dr. Walters, the Department of Orthodontics was the beneficiary of a series of short-term chairpersons. Also, under the able leadership of Dr. Toufic Jeiroudi as the Graduate Program director and with a very focused and cohesive orthodontic didactic and clinical faculty, the orthodontic program continued to flourish during those years.
In 1996 Dr. Joseph Caruso became the current chairperson of the Department of Orthodontics. Some of the key innovations to the Department of Orthodontics as a direct result of his influence are listed here:
- A strong interest in computer technology as applied to didactic and clinical based orthodontic teaching.
- ZeroBase diagnostic orthodontic software for aiding the resident in performing a thorough and methodical gathering of initial patient data. The program included an analysis portion that promoted digitizing a scanned lateral cephalometric radiograph to create a T1 tracing, an arcial growth forecast and a visual treatment objective (VTO). Among other diagnostic functions the program would allow superimpositions of various tracings from different time points to evaluate growth modification and orthodontic and orthopedic changes over time. Today the department uses Dolphin Imaging and Ortho II as diagnostic and recording digital tools.
- In March of 2001 the NewTom 9000 Digital Volumetric Scanner from Italy was installed at LLUSD’s Department of Orthodontics. This was the very first Cone Beam Computed Tomography (3D CBCT) machine sold and used in orthodontics in the United States. This very innovative instrument affords the residents unparalleled anatomical information about their patients’ craniofacial anatomy. Traditional orthodontic skull films are 2D and show anatomical structures superimposed on other structures, whereas the 3D CBCT reveals the craniofacial anatomy as it actually is in relationship to adjacent structures. The residents today are thoroughly trained in the use of the NewTom 3D CBCT machine. This aids them greatly in evaluating skeletal and dental relationships along with evaluating the airway, TMJ and other anatomical associations.
- In June of 2009 the Department of Orthodontics moved into a new facility (Loma Linda University Center for Dentistry and Orthodontics) about three miles from the School of Dentistry. This facility’s second floor houses the Graduate Orthodontic Clinic (the Milford J. Anholm Clinic) and its many supporting areas, including a state of the art conference room (the Thomas J. Zwemer Conference Room) along with various personnel including the faculty, students, and staff and their respective offices. The Graduate Orthodontic Clinic is very innovative with provision for the residents to have their laptop computers at their chairs so that they can bring up some of the following fully digitized records: Photos, radiographs including NewTom images and their patient’s chart. The clinic is moving toward a ‘paperless’ system of patient record keeping. The Faculty Dental Offices from the School of Dentistry will be occupying the first floor of the building sometime during the summer of 2010.
- The classrooms are on the “penthouse suite” third floor. This floor also houses a library and a high tech research laboratory. The classrooms (the Alden B. Chase classrooms) are state of the art with high definition large screen monitors and a high quality ceiling mounted digital projector. The technology in this room allows for ‘distance learning’ through ‘video conferencing.’ The capability exists for lectures from as close as the School of Dentistry to somewhere in another part of the world.
- A mobile ‘Teledentistry’ unit in the new building allows for an audiovisual consultation evaluation of patients in the new building by doctors in Prince Hall, some three miles distant.
- The Department faculty continually evaluate and update the didactic and clinical curriculum in an effort to provide the best possible orthodontic education.
- The Department encourages and facilitates the pursuit of certification by the American Board of Orthodontics.
- There are other high tech advances on the horizon—stay tuned!
The Department of Orthodontics has been blessed by a very long line of excellent residents who are eager to learn and to share their talents with their classmates and under classmates, creating a growing and nurturing climate.
Also, the Department has been blessed with a very caring and supporting clinical and academic faculty and staff who have the resident’s best interests at heart.
Just as the life cycle of an adult butterfly entails laying its tiny eggs on a leaf with the progression from a creeping larval caterpillar to a dynamic chrysalis cocoon to the emerging beautiful butterfly—just so, the Department of Orthodontics at Loma Linda University has gone through a series of transformations. In the analogy, the emerging butterfly not only represents the transforming department, but it also represents its transformed product, the graduate. The department is the dynamic chrysalis that is designed to produce the best possible graduate, one that can soar in his or her ability to provide the best possible orthodontic care. Just as exciting as it is to see a beautiful butterfly emerge from the rigors of its cocoon and unfold its wings to fly, it is also very exciting to watch our residents develop over time into competent orthodontists enabled to soar into the wonderful world of orthodontics.
The author would like to acknowledge the following individuals for sharing their insights into the history of LLUSD's Graduate Program in Orthodontics: Dr. Milford Anholm, Dr. Willis Schlenker, Dr. Richard Simms, and Dr. Thomas Zwemer.