PILLARS IN ORTHODONTICS

Smile because of Dr Robert Murray Ricketts

Private practice, SpAm J Orthod Dent

0889-5406/$36.00Copyright � 2015http://dx.doi.org/1

368

Duane GrummonsSpokane, Wash

n the sciences, scholars emerge from time to time to

Fig 1. Dr Robert Murray Ricketts, the early years.

Ilay down principles and crystallize the information oftheir day. Such a scholar was Dr Robert Murray Rick-

etts (1920-2003) (Fig 1). His influence continues tocontribute to our understanding of the biologic and me-chanical enigmas that challenge us. His writings stimu-late the student and promote advancements in hisbeloved specialty of orthodontics. Dr Ricketts com-manded leading-edge knowledge and was a pioneer inearly treatment and facial orthopedics, temporomandib-ular joint tomography and therapies, esthetics andgolden proportions, orthodontic sectional biomechanicswith biologic and physiologic emphases, lateral andfrontal facial analysis (Fig 2), asymmetry, nutritional in-fluences, airways, world conditions, music and the arts,anthropology, and more.

Robert Ricketts began his life humbly on a farm inIndiana, where unswerving persistence and achieve-ment were expected and valued. He credited “thefarm” for his work ethic, quick laughter, and earthysense of humor. In that community he was an accom-plished athlete, but once he decided to pursue a careerin dentistry, he forged himself into a determined,accomplished scholar.

In January 1943, when Ricketts was in dentalschool at Indiana University, the world was at war;young doctors served in the military, and Dr Rickettswas no exception. LTJG Ricketts served in the U.S.Navy Dental Corps; during this time, he became fasci-nated with orthodontics. In 1947, when his service wasconcluded, he enrolled at the University of Illinois un-der Dr Allan G. Brodie, who had been an early studentof Edward H. Angle, so the curriculum emphasized theedgewise technique. Ricketts wrote: “Dr. Brodie hadthe most exceptional proclivity to instill in his studentsa sense of the importance of orthodontics in their livesand to our whole culture. He expressed a love andrespect for the profession.”

okane, Wash.ofacial Orthop 2015;148:368-73

by the American Association of Orthodontists.0.1016/j.ajodo.2015.04.018

Ricketts earned his master's degree from the Univer-sity of Illinois Graduate School of Orthodontics in 1950.

Clinician and preceptor

After Ricketts' orthodontic training, Dr Cecil Steinerencouraged him to move to Pacific Palisades, California,to start his practice. The practice flourished, and in 1959Ricketts agreed to serve as a preceptor for Dr Ruel Bench,who joined the practice as a partner in 1970 and went onto lecture with Ricketts. Dr James Hilgers joined them intheir clinic as well. In 1977, Ricketts and Bench amicablyended their practice partnership, and Ken Fischer andRichard Jacobsen joined it.

During those busy years of practice and teaching,Ricketts was honing his bioprogressive techniqueand appliances. Bioprogressive differs greatly from

Fig 2. Ricketts' lateral and frontal cephalometric tracings.

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traditional edgewise, Begg, and straight-wire philoso-phies in terms of the possibility doctrine and the modal-ities attending to it (rather than thinking with a doctrineof limitations).

He inspired and challenged other professionals tolearn about biologic and progressive approaches totreatment. He developed key professional relationshipsand followers on all continents. He collected patientrecords and gradually convinced colleagues about hisnew-found approaches, innovations, and reliable re-sults. He established the American Institute ofBioprogressive Education and was instrumental in es-tablishing the Foundation for Orthodontic Research.Today, the Modern Bioprogressive Organization (www.bioprogressive.org) provides a portal for debates and aplace to share research and keep the principles alive.New technologies and materials have been integratedto develop hyperefficient orthodontic clinical therapiesand biomechanical procedures to drive treatment togreater excellence.

Ricketts freely used the proceeds from his privatepractice to help finance his other endeavors, includinga lengthy career in university and original research. Heauthored over 300 refereed articles, chapters, and text-books on orthodontics, all derived from and paid forfrom his private practice, with support from RockyMountain Orthodontics, and personally thereafter.

Areas of interest and accomplishment

Ricketts was a noted authority and expert in craniofa-cial anatomy, physiology, and human facial development.

American Journal of Orthodontics and Dentofacial Orthoped

He was a pilgrim of curiosity and inspired newness of theorthodontic eye, mind, passion, and soul. Some of his ac-complishments include the following.

� Challenging the specialty to learn and understandfacial anatomy and its growth with orthopedic influ-ences on treatment decisions and biomechanics.

� Recognizing orthopedic potential and challenging usto “treat faces, not teeth”; he emphasized jaw ortho-pedics and selective cervical headgear for orthopediccorrection.

� Developing a hierarchy of anchorage with recognitionthat facial growth, muscles, cortical anchorage, andtooth-based anchorage prevail in biomechanics.

� Developing a “root rating” scale to quantify optimallight forces to move teeth in any plane of space.

� Advancing temporomandibular joint (TMJ) analysis,imaging techniques, and jaw dysfunction therapies.

He stressed individualized treatment planning, keep-ing the planned outcome in mind. For his work, hereceived numerous national and international awards,including the Ketcham and Mershon Awards from theAmerican Association of Orthodontists, a Merit Awardfrom American Society of Dentistry for Children, awardsin oral surgery, and a doctor of nutrition degree.

Although his interests were wide-ranging, he wasperhaps most intensely interested in orthodontic inno-vations, the biology of occlusion, facial analysis andtreatment predictions, TMJ anatomy, and stomatog-nathic dysfunction therapies. He analyzed total patientissues and recognized that function precedes form, since

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Fig 3. Ricketts' sectograph for corrected TMJtomography.

Fig 4. Ricketts' logarithmic spiral describes long-termgrowth of the mandible.

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it influences the biology of living and dynamic tissues—aparamount concept for contemporary orthodontists astrue physicians of the face. In his 1-week comprehensiveTMJ course, Ricketts vigorously taught the importantbiologic functions of human craniomandibular articula-tion and mechanical homeostasis for reflexes of theneuromuscular system. His work in this area lasted43 years, and he produced 3 books devoted to orthodon-tic and TMJ topics.

By 1990, he had treated 6000 patients with temporo-mandibular disorders. The Ricketts' biotemplate was hismost used “splint.” He championed orthodontic correc-tions with occlusally supported results as the most sta-ble. He helped to develop the sectograph for correctedTMJ tomography (Fig 3); it could show TMJ space,structural surface changes, and limits of adaptability inthe joint. He taught about muscular input derivedfrom normal occlusion and function to help preservethe joint and create equilibrium.

He taught clinicians to be fully knowledgeable aboutfacial growth and development, the interrelationships ofocclusion, and the influences of musculature. Temporo-mandibular disorder was his remarkably consistent areaof interest, expertise, and renown.

Innovations with Rocky Mountain Orthodontics

In the 1960s, Ricketts began what would become alifelong association with Rocky Mountain Orthodontics.

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They worked together to develop many useful products,including the following.

� Preformed bands and preadjusted brackets, whichthey first presented at the 1962 American Associationof Orthodontists Annual Session in Los Angeles

� Self-ligating brackets (in the 1970s)� The 0.018 slot early straight-wire bracket concept� The snap-channel concept� Ribbon archwires� Tooth-colored premolar bands for lingual retainers.

Ricketts had always been interested in cephalometricanalysis, and he collaborated with Rocky MountainOrthodontics in this area as well. Their work led to thedevelopment of the following.

� Computer-aided cephalometric diagnostics (RockyMountain Data Systems)

� Ricketts' lateral and frontal cephalometric analyses,so that clinicians could compare patients with normsbased on age, sex, and race

� A cephalometric diagnostic system to integrategrowth (Fig 4) into treatment prediction, known asvisual treatment objective with growth and long-term visual treatment objective. His summary analysisspecifies these changes (Fig 5).

� “Composite tracings” to understand growth patternsin facial types (superimposition on the basion-nasionplane at the CC point and with the Frankfort horizon-tal plane)

� Growth prediction to maturity� Four dimensions: adding the dimension of time to

appliances and treatment parameters

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Fig 5. Ricketts' 4-position summary analysis.

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� Appliance differentiation based on facial type (meso-facial, brachyfacial, dolichofacial) and designed intobrackets and tubes (first version of what becamestraight-wire appliances)

� Five pentamorphic individualized arch forms

Following Dr Downs' suggestions, he developed atechnique of forecasting facial growth for a 2-yearperiod from lateral radiographs. He researched facialgrowth and developed a computer-generated growthprojection to maturity using his growth studies andthose of Bjork, Moss, Scott, Petrovic, and others. Rickettsremained dedicated to prove his growth predictionsystem.

Rocky Mountain Orthodontics closely worked with DrRicketts to ensure that his vision became a reality. Archieand Martin Brusse and CEO Tony Zakhem supported hislectures on the bioprogressive technique in Arizona from1997 to 2003. Rocky Mountain Orthodontics continuesto work with bioprogressive teachers and cliniciansaround the world.

American Journal of Orthodontics and Dentofacial Orthoped

Teaching, publishing, and lecturing

During the 1970s, Ricketts made writing, lecturing,and developing his thoughts and ideas his priorities. Herecognized that by promoting his ideas widely he wouldalso be opening himself to challengers, but he believed inwhat he was doing and he persisted. With expansive andbrilliant teaching influences by world-wide teachers, andwith the help of Ruel Bench and Carl Gugino, Ricketts'ideas spread around the world. Their message empha-sized thorough differential diagnosis and individualizedtreatment, based on the degree of difficulty and deliv-ered in a systematic approach. Ricketts was a perceptiveman, a prolific writer, and a vigorous lecturer. In many ofhis books, he aimed to establish, transform, and improvethe bioprogressive philosophy and therapy. He wroteBioprogressive Therapy with Drs Bench, Gugino,Hilgers, Schulhof, and Engel. He published an exhaustivebook, Provocations and Perceptions in CraniofacialOrthopedics, in 1989, with 2 volumes cosponsored byRocky Mountain Orthodontics.

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Fig 6. Dr Ricketts: brilliant, inquisitive, courageous, confi-dent, influential, principled, and masterful.

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His writings on cephalometrics, growth, and biome-chanics have become standards for aspiring orthodon-tists. His 2-week in-office course was almost a rite ofpassage for orthodontists in the 1970s and 1980s. Hetaught by neutralizing students to accepted core truthsand rebuilding them with new knowledge and height-ened curiosity. It became the stuff of true believers.

He was concerned about the roles that facial beautyand proportionality should play in the treatment ofdental and skeletal problems. After discovering facialgnomic growth and arcial growth of the mandible, hebecame fascinated by geometrics and mathematics. Hevisited Dr Melvin Moss in New York and was inspiredto learn more about the Divine Proportion and Fibonaccinumbers and to apply those principles to his work. In1980, Ricketts began to lecture about this to orthodon-tists and plastic surgeons.

Dr Ricketts is vividly remembered by orthodontistsaround the world as a thought-provoking lecturer(Fig 6). He inspired his audiences to think, seek the truthin all things, and verify beliefs through clinical studies.He emphasized education and broad experience, aware-ness and self-discipline, inquisitiveness, and persistencein the search for truth. He challenged traditionalthinking, claiming that it was good to disagree, butnever to be disagreeable; and that it was good to criticizethe topic, but not to condemn the person. He was quickto replace old knowledge with new but stood strong oncore principles that do not change. His captivating deliv-ery captured the hearts and minds of those in the audi-ence and instilled in them a desire to pursue knowledgewith an open mind, because once stretched by a newidea, a mind will never return to its original dimension.

Mentor and friend

“Rick,” as he was known to friends, was a giver,driver, wise thinker, researcher, and master philosopher;he was an explorer, innovator, processor, inspirer, andmusical crooner; he was all of these things and a uniquecharacter indeed. He thirsted for knowledge throughouthis life. He loved people and readily shared his friendshipand respectful love. His passion for orthodontics wasunmatched as he piqued interest in a most alluringway. Noteworthy were his hearty laugh, sharp sense ofhumor, and authentic joy for life.

This universal mentor and mind took colleagues onhis shoulders and elevated them to higher levels withhis nondogmatic thinking, teaching, and innovations.Rick loved to regale his passionate followers with storiesof Angle, Brodie, Downs, Tweed, Steiner, and the otherorthodontic giants he knew, respected, and often dis-agreed with. He was a strong clinician with imagination

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and innovation, an inquiring researcher who was bril-liant to the end. Ricketts was a quintessential and some-times controversial figure; he was bold, sometimesslightly arrogant, provocative, lofty, and incisive attimes, but also genuinely warm, loving, and nurturingtoward others. Colleagues can still sense him teaching;hear his gusto and laughter, his directives and bold con-victions, his singing and cephalometric superimposi-tions; and remember his style and personality, hismoments of tender grace and intimate concerns, andhis love and consideration.

He captured the imagination. When Rick smiled, peo-ple smiled back. He sang well, and danced, and was oftenheard crooning “I did it my way,” “Unforgettable,” or“Smile” during a lecture. While lecturing in Brazil, hewon a professional talent show, singing “New York,New York.”

CONCLUSIONS

Rick concluded his Pacific Palisades, California,specialty orthodontic practice in 1995. From 1997 to2002, he launched 13 manuals on bioprogressive ther-apy at the American Institute for Bioprogressive Educa-tionin Scottsdale, Arizona. He published and vigorouslylectured until he passed away in June 2003.

Throughout his life, he was quick to replace oldknowledge with new, and yet he defended and stood

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strong on the principles that do not change. He led or-thodontists on a relentless pursuit of knowledge andtruth. His innovations were many, and his influencewill be felt by generations to come. He indelibly influ-enced our lives and thinking, and shaped hearts, careers,and lives to reach higher personal levels, with

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American Journal of Orthodontics and Dentofacial Orthoped

professional advancements and contributions. We smilebecause of his heartfelt life, his ardent teachings, and hisclinical methodology. He taught us to love our patientsand to treat with grace, style, and class.

Don't cry because his life is over; smile because hehappened.

1979 issue of the Journal

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