REFLECTIONS ON 50 YEARS OF CLINICAL PEDIATRIC ORTHODONTICS By Leonard J. Carapezza, D.M.D., Associate Clinical Professor, Tufts University School of Dental Medicine I have been in private pediatric orthodontic prac-tice in Wayland, MA, for 50 years (Fig. 1) and teaching at Tufts University School of Dental Medicine since 1975. 1 My epiphany about orthodontics occurred in 1972, when I was exposed to Dr. Lawrence F. Andrews’s writings and discovered the revolutionary straight-wire appliance (SWA). 2 Through Andrews, I was introduced to Dr. Waldemar Brehm, an Orthodontist from San Diego, CA. Brehm was one of the original users of the Andrews SWA system, and the two men (Fig. 2) became my mentors. The common interest between Brehm and I was treating malocclusions early and allowing growth, development, and the eruption process (with serial guidance) to be involved in treatment. 3 Together, he and I lectured nationally and internationally for multi-ple years about early treatment, utility archwire (UAW) mechanics, and the Andrews Fully-Programmed SWA. 4 Our passion for early treatment was maintained through the years in our teaching, clinical practice, research, and publishing. 5 Early Treatment Protocol Early treatment, as presented, is unconventional. The focus is on the guidance of eruption—redirection. The term often used is “serial guidance,” meaning the selective removal of the primary dentition under UAW control. Early treatment calls for prioritizing crowding, deep overbite issues, and molar rotation. The treatment approach unlocks the occlusion/mandible, thus allow-ing for a better pattern of growth and, secondarily, Figure 1 22 Summer 2025 JAOS
Journal of the American Orthodontic Society Summer 2025: Page 22
