288 The I nternaiional Journal of Orthodontia.

will be less liable to attempt t he t reatmen t of cases whic h a pproach theim possible.

The greatest benefits to orthodontia as a sc ience at the prese n t time willbe brough t abo ut by t he ed ucation of the ge ne ral practitione r al ong t helin es above menti oned. The ge neral pr acti ti oner will be ben efited morethan anyone else, as it will give him a better standi ng among hi s patientsa nd fellow practi ti on er s . - lvf. D.

The Inclined Plane.

I N this issue of the J ou rn al a p pears the repor t of a nu mber of interestingcases which Suggett o f San F rancisco treated with the use of the Inch ned

plane . The principle of the inclined plane is well k nown in physics and m e­chanics and has been employed in regulating a pp lia nces for a long- time .The di sr epute into which the applia nce has fall en is not so mu ch the faul tof the applia nce as the mann er in which it has been used . The co ns t ruc ­ti on of the a pp lia nce has a lso been fa ulty a nd so me ha ve overlooke d thenecessary requi remen ts of t he device. Ther e is no doubt b ut th at good re­sults ca n be accomplished by its use if pro perl y co nstruc te d an d appliedin suitab le cases. I t is by no means a uni versal applia nce . The use of theinclin ed plane in co nnection with othe r a pp lia nces as shown in Fi gs. 9, 10a nd 11 of S uggett's a rticle . gives us a n appliance a nd a for ce tha t wo uld beha rd to obtain with any othe r form of a ppliance. These cases of excessiveoverb ite of the a n terior teeth are q uite hard to trea t. So me have claimedthat it is possible to depress the lower anterior tee th , which movement manya u thorities ha ve always been do ubtful of ; bu t if t he depression of t he a n te riorteeth is ever desira ble or possible it can in a ll probability be bes t accom­plished by the incli ned pla ne , a nd whe n th e principle is used with the inter­maxill ary rubber s to elongate the molar, it makes a mos t idea l a ppliance .

When used on cases wh ere t he upp er mol ar is slightly in lin gual occlusion ,a band ca n be placed on the up per molar with a t ube on the buccal surfaceto engage the buccal surface of the lower mol ar a nd t hrow the upper mol a rb ucca lly . In using t his fo rm of the inclined plane , it must be observedwhethe r th e patient is closing the teeth correctly o r biting to one side toavoid the inclined plane . If biting to on e side, the applia nce must be re­adjusted to avoid th e possibility of th e patient fo rc ing some of the otherteeth out of th e line of occl us ion :

The princ ip le of usi ng t he incli ned pla ne as a n extra cus p has beendescribed by many writers in t he past a nd since the advent of the "castingprocess" some new ideas have been advoca ted. In t he " posterior relation "of the lower a rc h in yo ung patients, a band ca n be made for the upper molara nd a "cusp" of wax made to occlude di stall y to the lower molar. The banda nd wax can then be remo ved . in vested a nd cast, t hus making a ve ry stro ngand accurately fitting inclined plane.

In using the incli ned pla ne witho ut the use of inte r maxilla ry r ubbersit m us t be re me mbe red tha t t he applia nce is passive a nd force is only exertedupo n th e teeth during the process of mastica tion or whe n th e pa tient fore-

Editorials. 289

ibly closes the teeth. Therefore the results which are to be accomplishedby the use of the inclined plane depend upon the force of mastication. Ifthe appliance is not properly made or becomes displaced, the efficiency ofthe device is destroyed.

In using the inclined plane, the case must be carefully studied, and itmust be remembered that the force exerted by the appliance is passive andbecomes active only when the teeth are forcibly closed. Taking all casesas we find them, it will be found that an active appliance is to be preferredto a passive one. Nevertheless, such cases as reported by Suggett can betreated very satisfactorily with this appliance, which in a great many in­stances will be found the most satisfactory plan of treatment. -M. D.

Malocclusion in Young Children.

SE VE R AL years ago it was supposed that malocclusion was to be foundonly in the second set of teeth. This theory was soon proven to be erro­

neous, because certain etiological factors which produce maloccl usion inthe permanent teeth would also produce malocclusion in the deciduousteeth. This has been found true by a number of investigators, foremostamong those in Europe being Chapman and Lockett of London, Chiavaroof Rome, and Coebergh of Utrecht, who made extensive studies of mal­occlusion in children. The researches and writings of Bogue, of New York,are well known, but it has been found that such authorities did not call asmuch attention to malocclusion in small children as they should have.

The work done by Johnson, of Louisville, in the examination of babiesfor the American Medical Association in "The Better Babies Contest,"brings to our minds the fact that malocclusion appears much earlier than wesupposed. In his researches along this line he has demonstrated the factthat there is very little to suggest that malocclusion of the deciduous teethis transmitted or inherited. As Johnson has been able to show, even inyoung children the malocclusion exists as a result of environment, improperfeeding, faulty nutrition, adenoids and enlarged tonsils, with the resultingmouth-breathing, and likewise malocclusion which is of congenital origin.

Jn our work among young children, we find a large number of conditionspresent, which, if found in older children, would be set down as abnormalitiesof the labii frenum. The attachment of the labii in young children probablyhas considerable to do with the conditions which we find later in life. Thework of Hellman in examining the different conditions which arise in breast­fed or bottle-fed babies will also produce a large amount of valuable infor­mation bearing directly on malocclusion, as will also the work of Hecker inthe examination of children with rickets and the study of the etiologicalfactors. Rickets has probably been responsible for a large percentage ofthe malocclusions appearing in early life in childhood, and also some of theconditions which are found later in life. We have seen only such evidenceas would indicate that malocclusion is the result of environment; it makesits appearance very early in life and so many different conditions enter in tothe situation that it is confusing unless we have a large amount of data at