Legendary excellence

With a career spanning 40 years, Professor Birte Melsen was the past President of the European Orthodontic Society and has made a huge contribution to the field of adult orthodontics with her pioneering research and papers

Can you tell us a bit about your background?

BM: I have had three fathers; my biological father was expelled from the family in 1943. He had lost his job and was forced to work for a company producing uniforms for the Germans. This was unacceptable in my mother’s family and my parents divorced when I was three years old. My mother married my second father three years later. He died in an accident at the age of 38 when I was 11. Later my mother married my third father. Money was short but they had a good life until my mother’s too early death at 51.

What made you choose a career in orthodontics?

BM: Actually that I did not want to become a dentist. This was determined by my stepfather. Nobody in our family had ever studied and when I confronted my stepfather with my wish of studying mathematics his comment was: ‘At least you should study something by which you can make a good living. Dentistry would be his recommendation. I found general dentistry unacceptable; the focus was on one or a few teeth while orthodontics was broader and Professor E Harvold who was my first professor made orthodontics seem really attractive.

You have written a book on adult orthodontics – can you tell us about that?

BM: The focus on adult patients was born through my collaboration with my good friend Nina Agerbaek who was a periodontist. She asked me to help in the regeneration of degenerated dentitions and she did not know the limitation of orthodontics which I was taught. Here I have to refer to the America philosopher Heinlein who said ‘Listen to the experts, they will tell you what you cannot do and why, and then go ahead and do it’. This is exactly what we did and I realised that orthodontics as an adjunct to the treatment of patients who wanted to maintain even rather degenerated dentitions was crucial and the book is now translated to a large number of languages.

How do you think orthodontics has changed in the past 25 years?

BM: It has become more market driven and more money oriented. More and more aspects of the treatment are being outsourced and taken over by non-specialists or companies. Even customised appliances are offered but considering that there is only one correct line of action for a particular tooth movement, the so-called customised appliance is far from a scientific approach.

I just read an interview with Dr Charles Tweed and although our treatment approach differs a lot, he was also focusing on the individual patient and not on the mass production.

What are your current roles?

BM: I am serving as visiting professor in Lexington, Kentucky, where I am involved in a research project regarding maintenance of bone for later implant insertion. I am also visiting professor in University of West Australia, where I teach biomechanics and is involved in research regarding skeletal widening of arches. We plan to have at least one PhD affiliated with that project.

I am also visiting professor in Hannover, Germany, where I teach tissue reaction to orthodontic treatments. In addition I am working on two books, one on asymmetry and one together with the University of Napoli, Italy on Perio-Ortho and finally still continuing on some ongoing research with some colleagues in Aarhus. Lastly, I have a very part time practice with adult treatment in Lübeck, Germany.

Describe your typical working week.

BM: There is no such thing, as I am also travelling and giving courses or lecturing on conferences.

What do you think about all the controversy today and general dental practitioners practicing short-term orthodontics?

BM: Orthodontics is characterised by increasingly more outsourcing of bending. Wire bending was done for three reasons; 1) to lower the force level. This is overcome today by choosing another material. 2) Bending was also done by adding first, second and third order finishing to the occlusion; this is now done by choosing the correct prescription or by using customised brackets bonded indirectly. 3) Finally, bending was done in order to generate the correct force system for a particular tooth displacement. The latter is to some degree done by adding intermaxillary elastics and sometimes tads as anchorage or the skeletal problems are solved by surgery. Very rarely the treatment is so called ‘force driven’ as Dr Burstone used to call it.

As most orthodontics is performed in growing children, many cases can be solved by a standard protocol approach, what I call ‘fast food orthodontics’ as a large part of the correction is taken over by growth. When, on the other hand, the case is not suited for but yet subject to this approach, it is a disaster. More than 80% of the adult patients I see in my office have received a treatment which was insufficient or wrong. The biggest problem is to distinguish between treatments that are easy or standard and the ones that require customised appliances. Many of those are adult patients where growth and development are not on our side and it is unfortunately often these patients that receive treatment by their family dentists with a sometimes disastrous result. The upper incisors are aligned, but the stage is set for the development of a deep bite as there is no inter-incisor contact.

Do you think general dental practitioners and specialist orthodontists can work in harmony?

BM: Yes the day where both professions accept that there are easy cases and difficult cases and both are able to distinguish so that the general dentist does not try to intervene when it is out of his capacity and the orthodontics accept that there are problems that can be solved with ‘fast food orthodontics’. The problem is to distinguish between what is easy and what require a specialist training.  This requires increased training within the dental education.

How have patient’s expectations changed over the years?

BM: In most orthodontic patients the chief complaint differs considerably from the need. Many patients only want alignment of upper crowded teeth. The dentist/ orthodontist should reject to do these treatments as they often worsen the prognosis for the dentition in the long term. The real task is to explain and perform the proper/appropriate/correct and maintainable solutions. Another problem is that many patients think that implants can solve their problems, ‘another’ big error.

You have had a fruitful career and many achievements – what do you think is the secret to your success?

BM: I have been hardworking and having thought about this question a lot. I think that what I can do is to see the potential solution to problems, to know what the others can do without being able to do it, in other words, define problem and bring the necessary team together. Within dentistry, as within medicine there are so many specialties and we have to work together.

If we want to offer the patients the best solution, then we have to suggest the one we would offer to our best friend. The patients are also our neighbors. The Danish philosopher Løgstrup said ‘When you have contact with a person you are holding some of that person’s destiny in your hand’ We have long term contacts with our patients and this should have a positive impact on this person’s life.

How do you stay abreast of modern techniques?

BM: I look through a large number of journals and read what I think is bringing important news. In addition, I get invited as a speaker to a number of congresses and usually and I sit in on the other lectures.

Professionally, what are you most proud of?

BM: The many good clinicians and academics whose education I have been involved in and of course also the many ‘impossible cases’ we have treated. I am, of course, also proud of the publications that have changed the understanding of the problems we try to solve, influenced the treatment and widened the aspect of orthodontics. The application of skeletal anchorage was first developed in our clinic as we were also the first department in Europe to use CBCT. The NewTom was developed very close to my home in Italy and became useful in the treatment of our patients suffering from craniofacial anomalies.

Where did you get your motivation and drive from?

BM: In the beginning I think it was to prove to my stepfather that I could perform well even when I choose the academic road instead of that of a general practicing dentist. When I told my mother that I wanted to join academics instead of working only clinically she got really worried. She died shortly after so she did not have the chance to see that I did okay. Professor Bjørk had great expectations to my carrier and I could not disappoint him. The same applied later to professor Burstone. So it was basically the fear of disappointing that kept me going.

How do you relax in your spare time?

BM: I don’t have a particular hobby, but I always try to learn something more. I take courses in different disciplines and love opera and art. In an attempt to keep in shape I bike and ski and do gardening. Least and not last I try to see my children and grandchildren, but they also inherited the spirit of curiosity and are very busy.

Do you have any regrets? What is your biggest mistake?

BM: I have always had a bad conscience. The available time is simply not sufficient for doing everything right. When the children were small I should have stayed more at home, but when I was at home I should have done more research or studied more culture etc. I hope for the forgiveness of my children.

What are your plans for the future?

BM: I don’t know how much time I have left. I am working on two books and I hope, I can still be useful to my children, grandchildren and colleagues.

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