Sir, I recently treated a 14-and-a-half-year-old boy with an overjet of over 12 mm with his lower incisors in contact with the palatal mucosa. He had previously been told by two consultants and a specialist orthodontist that he needed jaw surgery, although one consultant did suggest a 'compromise' result might be achieved with functional appliances. We said in advance that we saw no difficulty in correcting him with the 'postural' system that we use called orthotropics. This was achieved in two years although the postural training continued for a further two years, resulting in a correction of the overjet and substantial forward growth of the whole face.

Overjet correction of this severity has been achieved with functional appliances in the past but uniquely in this instance there was no increase in facial height. One of the greatest concerns in orthodontics is iatrogenic vertical growth which is endemic within all current treatment, reducing the dental arch length and damaging facial appearance, sometimes severely. As I had never before seen such a severe case corrected without an increase in vertical growth, I thought the profession should be aware that changing oral posture may have some merit and wrote a short case report for the BDJ. Unfortunately, the referees strongly rejected this saying 'the quality of the submission is less than I would expect from an undergraduate student' and 'in all likelihood this patient simply grew favourably'. This was clearly their opinion but I do not know of any evidence of conventionally treated cases having achieved an equivalent amount of favourable growth and one might ask 'why not'? The other referee dismissed the result as unremarkable saying 'all orthodontists who use functional appliances will have seen patients who have achieved a similar result', again a matter of personal opinion unsupported by any evidence and certainly the general evidence suggests that functional routinely increase vertical growth.

We should not forget that several hundred children and young adults are sent for surgery in the UK each year, many of them much less severe than this one, and I feel the profession should be allowed to consider alternative possibilities. Patients should have choice and perhaps the personal opinions of these two referees should not prevent this.

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