Pacific Coast Society of Orthodontists Bulletin Fall 2019 - 40

Let's Talk About That

Dr. Patrick Turley Interviews Dr.
Thomas Pitts
Patrick Turley (PT): You have developed a unique
system of orthodontic treatment that in many
ways contradicts traditional approaches to treatment. How did this approach to treatment come
about?

Dr. Patrick Turley
Editor, Let's Talk About That,
Manhattan Beach, CA

Dr. Thomas R. Pitts
Reno, NV

Thomas R. Pitts (TP): The protocols I have established evolved out of a passion for excellence
and lifelong learning instilled before and during
my University of Washington (UW) training and
shared by many who have accompanied me
along this journey. Having studied and practiced
orthodontics now for 50 years, these protocols
are an amalgamation of insights from teachers,
mentors, and colleagues too numerous to name
and a continuous quest for something "better"
(particularly for the patient).
Over the past 100 years, the orthodontic specialty,
as a whole, has worked under the philosophy that
orthodontic results are centered around stability,
occlusion, and tissue/temporomandibular joint
health. Now aligners are focusing on similar parameters without the use of traditional orthodontic appliances.
What is paramount to me, and what orthodontic
patients are seeking, are outstanding esthetics as
well as a healthy and functional occlusion, and in

Figure	1. Before (a) and after (b) treatment

40	

the least amount of time for active treatment. We
know from decades of research that our results
are not stable whether we extract or not, and
retention is lifelong.
After graduating from UW in 1970, I took as many
continuing education courses as possible, eager
to learn. I studied with Roth, Andrews, Ricketts,
and others. Each mentor contributed to my evolution. Ricketts introduced lighter forces and early
soft expansion in an attempt to avoid extraction
and produce more esthetic smiles and maintain
lip support and more youthful profiles. Still, even
though I achieved a good occlusion and straight
teeth, some patients failed to finish with what I
considered "WOW" esthetics: a beautiful broad
smile showing the entire length of their upper
incisors (vertical incisor display) and a pleasing
smile arc, following the contour of the lower lip
(SAP = smile arc protection).
Traditional orthodontic treatment planning
centered around the lower incisor position, due
to our mistaken assumption that stability was
maintained by not violating this position. We then
managed our treatment around that parameter.
Traditional biomechanical techniques and bracket
placement have a tendency to take the curve out
of the anterior smile line and intrude the upper
anterior teeth, producing a straight, flat smile.
Traditional techniques have a tendency to move
the upper incisors too far back in the face, which
is unesthetic to me and they age the face more
rapidly. My treatment planning is based on where
I want the upper incisors to be at the end of treatment, and my mechanics are designed to achieve
that position to maximize esthetics. Twenty years
ago, I started changing the bracket position of the
anterior teeth to develop a smile arc and full upper
vertical incisor display. Figure 1 shows a patient
who was first treated with a traditional approach
and then again using the Pitts protocol.
Passive self-ligation (PSL) was a game changer that
I embraced in 1985 with the "Activa" bracket from
A Company. I have since used PSL brackets from

PCSO	Bulletin	 	 Fall	2019



Pacific Coast Society of Orthodontists Bulletin Fall 2019

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