PILLARS OF ORTHODONTICS
Pillars of orthodontics: Dr.
Ronald H. Roth (1933-2005)
Straty Righellis
San Francisco, Calif
It is an honor to pay tribute to Dr. Ronald H. Roth
in the inaugural edition of the AJODO Clinical
Companion. The name Roth is known by virtually
all orthodontists. He was a pillar of orthodontics;
thus, generations of orthodontists and their
patients have benefited from his teaching, ortho-
dontic goal-directed, and the example he set for
everyone who knew him. (Am J Orthod Dentofa-
cial Orthop Clin Companion 2021;1:92-8)
D r. Ronald H. Roth certainly qualifies as one of the truly
great pillars in orthodontics. The dictionary defines a
pillar as someone or something that reliably provides
essential support for society, state, institution, or a build-
ing or monument. Generations of orthodontists and their
patients have benefited from him. From the standpoint of
leadership, he was a member of the Edward H. Angle Soci-
ety, a diplomate of the American Board of Orthodontics;
Fellow, Academy of College of Dentists; Fellow, Interna-
tional College of Dentists; the International Gnathological
Society; and an honorary member of the Chilean Orthodon-
tic Society. For 10 years, he was an associate clinical pro-
fessor at the University of California San Francisco, and
lectured at the University of Pennsylvania, as well as the
University of Western Ontario and University of Detroit
(Fig 1).
This summarizes some of Dr. Roth’s affiliations; now,
let’s look at the contributions he made to the specialty of
orthodontics.
THE EVOLUTION OF DR. ROTH’S TEACHING
When clinicians hear the name Dr. Ronald H. Roth, sev-
eral thoughts come to mind: (1) his goal-directed approach
to diagnosis and treatment and (2) the ‘“Roth’
Division of Orthodontics, University of California San Francisco,
and Orthodontics Department, San Francisco, Calif.
All authors have completed and submitted the ICMJE Form for
Disclosure of Potential Conflicts of Interest, and none were
reported.
Address correspondence to: Straty Righellis, 2220 Mountain
Blvd, No. 204, Oakland, CA 94611; e-mail, straty.er@gmail.com
92
prescription” for orthodontic brackets, but how did it begin
and more importantly, how has it evolved?
Dr. Ronald Howard Roth was born on September 4,
1933, in Chicago, Ill. He did his predental studies at the
University of Illinois before his acceptance at North-
western University School of Dentistry, graduating in
1957. On graduation, he entered the Army as a captain
in the dental corps. He was a good athlete and devel-
oped a love for golf while in the Army. After his 2 years
in the Army, he moved to Los Angeles, Calif, where he
practiced dentistry.
After a year in Los Angeles, Calif, a friend convinced
him to consider orthodontics. He was fortunate enough to
be granted an interview with Dr. Joseph Jarabak, chair at
Loyola University in Chicago. As Ron used to tell the story,
he was the last person chosen in the class of 1960.
Although Ron was very bright, he admitted he had more
fun in college than he probably should have and did not
study much.
However, Dr. Jarabak made a student out of Ron, and
that transformation forever changed his life and his life’s
purpose. He graduated from Loyola in 1962 with a master’s
degree and a thesis on electromyography. He returned to
California in 1962 and started his private practice in San
Mateo.
In 1968, Dr. Jarabak went to San Francisco to pres-
ent a 2-day course. While there, Dr. Roth met with Dr.
Jarabak for dinner and told him he was thinking about
leaving orthodontics. Ron told him he was doing every-
thing that he was taught at Loyola, but he was not
happy with the results. If something did not change, he
would quit orthodontics. Jarabak challenged him by
asking what needed to be changed. Dr. Roth said that
orthodontics had never looked at occlusion and the
temporomandibular joint (TMJ) in the light of its rela-
tionship to treatment.
Dr. Roth told Dr. Jarabak that he would look into
occlusion and take all the courses possible from the
leaders in occlusion at that time, and Dr. Roth did. Dr.
Roth took courses from leaders in all areas of dentistry,
but the most important were leaders in occlusion such
as Charles Stuart, Peter K. Thomas, and Arnie Laurit-
zen. He joined a gnathological study club led by Dr.
Tom Basta (a leader in occlusion), which changed his
life. Fifty years ago, our understanding of occlusion
came from those restorative dentists who restored
patient’s malocclusions prosthetically, and our imaging
knowledge was the use and interpretation of tomo-
graphic images.
He started applying the principles of occlusion that he
learned from these leaders and the TMJ to his patients. He
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Fig 1. Dr. Ronald H. Roth.
then studied and self-analyzed 100 completed cases and
found that the patients had benefited from this type of
treatment. He saw a difference in his treatment outcomes
compared with his earlier treatments on the basis of what
he learned from the experts at that time.
This led him to make the decision to tell all of ortho-
dontics about his findings. He was amazed that the univer-
sities and most orthodontists were not interested, but Ron
could not be stopped! He persisted in telling the “World”
how to improve treatment for their patients, so this new
message, as some coined at that time, the “Roth Philoso-
phy”, was born. A more accurate description is Dr. Roth’s
approach to “Goal-directed Orthodontics” Going forward,
he devoted the rest of his life to teaching this approach.
Ron’s experience of teaching for 10 years in the ortho-
dontic clinic at the University of California at San Francisco
and teaching a continuing program on occlusion and TMJ
to 10 practicing orthodontists, including Dr. Don Linck,
a future teacher, and leader, caused him to realize that the
best way to teach goal-directed was to have an indepen-
dent teaching center, so he joined with Drs. Basta and Ger-
ald Priener to establish the Foundation for Advanced
Continuing Education (FACE) in Burlingame, Calif. FACE
held its first class in 1974, with 15 orthodontists and 15
restorative dentists and extended for 2 years. The course
objective was to discuss and solve diagnosis and treatment
as a team, using the team concept to treat patients. The
concept was ahead of its time! Now, interdisciplinary
teams are commonplace in dentistry for patient care. Dr.
Robert Williams was in the first group, and Dr. Andrew
June 2021, Vol 1, Issue 1
Righellis
Girardot, Jr, editor of the Goal-Directed Orthodontics text-
book and a future teacher, was in the second group. This
concept of orthodontists and general dentists in the same
group ended after 3 groups were taught because of the
time demands on Roth to teach the orthodontists and
Basta to teach the restorative dentists (Personal communi-
cation, Robert E. Williams, 2021).
Dr. Roth took the Tweed course (1964) to gain more
knowledge about the use of cephalometrics, the man-
dibular incisor position, and treatment mechanics as
taught by Dr. Tweed. The Ricketts’ course (1969) made
a tremendous impression on Ron and had a lasting
influence. Dr. Ricketts was an outstanding leader, and
his concepts of growth prediction and the use of the
computer to visualize treatment objectives (VTO) had
an impact on Ron. While using Ricketts’ concept to
forecast growth and treatment results on his patients,
Ron realized there was a difference in his desired
results vs the goals Ricketts had programmed into the
computer. Ron made modifications by programing his
treatment goals into the VTO, limiting, for example, the
mandibular incisor range of movement, the molar posi-
tion, and facial esthetics. Other contributions Ron
made to the VTO were the insertion of second molars
in the VTO, and eventually, he added orthognathic sur-
gery to the VTO. Next, he added step-by-step treatment
mechanics in the VTO. Ron enjoyed and learned to be
very good with the computer. As a side note, Ron was
the first to make a presentation at an annual American
Association of Orthodontists (AAO) Session using a
computer (Personal communication, Robert E. Williams,
2021).
In 1979, Dr. Roth invited Dr. Robert Williams, a FACE
student from the first group, to join him in teaching the
orthodontists exclusively. The highlight of these early clas-
ses was when Dr. Roth’s mentor and professor, Dr. Joseph
Jarabak, enrolled in the FACE course!
As the courses developed and grew, so did the
demands for more teaching space. In 1990, Drs. Roth
and Williams opened the Roth-Williams Center for Func-
tional Occlusion in Burlingame, Calif. This state-of-the-
art facility had 8 clinic chairs and an enviable lecture
arena seating over 40 doctors. The course content has
been described in the orthodontic literature.1-7 Guest
lectures from Drs. Tom Basta, David Hatcher, Bill Arnett,
to mention a few, added depth to the team approach
for their patients’ health.
CONTINUING THE ROTH LEGACY THROUGH
WORLDWIDE EDUCATION
The foresight and unselfishness of Drs. Roth and Wil-
liams were key factors in the continuation of his legacy,
but more importantly, in the continuation of his teachings
and benefits to patients. Drs. Roth and Williams taught
together for 31 years. The 2-year course was taught at
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FACE for 14 years and at the Roth-Williams Center for
10 years. Approximately 500 doctors attended these
courses. Drs. Roth and Williams taught the 2-year course in
Spain (the first international course, 1989), Japan, South
Korea, Germany, Italy, and approximately 695 doctors
attended these courses. They taught 2 groups with Dr.
Anka Sapunar in her office in Santiago, Chile. One of these
courses led to Drs. Valesquez and Reyes teaching in Mex-
ico. In addition, Drs. Roth, Williams, and Sapunar were
appointed as associate professors and taught a 3-year mas-
ter’s degree program at the Finis Terrae University in San-
tiago, Chile, and at the Catholic University in Montevideo,
Uruguay. Under the leadership of Dr. Sapunar, the master’s
program continued at Finis Terrae for 2 more classes. In
total, Drs. Roth and Williams taught the Roth goal-directed
orthodontics directly to a minimum of 1525 doctors (Per-
sonal communication, Robert E. Williams, 2021). This is in
addition to their teaching with their former students in their
teaching centers. The results of this process were to iden-
tify key and future leaders to teach this approach to others!
This unselfish characteristic led to ensuing generations of
teachers continuing to spread their approach to orthodon-
tic diagnosis and treatment planning (Figs 2-5).
Fig 2. Dr. Roth with his students at his hands-on course.
94
In addition, during this period, they presented lec-
tures in 40 countries throughout the world and estab-
lished teaching centers in 16 of them. These centers
taught the Roth-Williams goal-directed treatment,
which included all areas affected by orthodontic treat-
ment. These areas included jaw joint health and
stability, smile esthetics, facial form and balance, main-
tenance of periodontal health, airway, and long-term
stability were all key and equally important treatment
goals.
These courses were in addition to many 2-day weekend
introduction courses. From these early groups, luminaries
like Drs. Kazumi Ikeda (Japan), Domingo Martin (Spain),
Renato Cocconi (Italy), and Jorge Ayala (Chile) were identi-
fied early as educational leaders in their respective coun-
tries and were asked to teach the Roth goal-directed
orthodontics to other orthodontists. In addition, as world-
wide teaching centers developed, other leaders emerged:
Drs. Solagne Fantini (Brazil), Oscar Palmas (Argentina),
Claudia Casanova (Columbia), and Claudia Aichinger (Aus-
tria).
In the United States, Dr. Roth designated a number of
other former students to teach at their respective teaching
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Fig 3. Dr. Robert Williams paying tribute to Dr. Roth in Madrid, Spain (2008).

universities. They included Drs. Andrew Girardot, Terry
Adams, John Oubre, Ted Freeland, Robert Frantz, Frank
Cordray, Paul Rigali, Dara Chira, Robert Bergman, Wayne
Sletten, Donald Linck, Joseph Yousefian, Mary Burns, Carl
Roy, L. Douglas Knight, and Straty Righellis (Personal com-
munication, Robert E. Williams, 2021).
Roth continually acknowledged his students and gave
them credit for procedural and technology advances that
added to his core principles. For example, at the 2002
AAO Annual Session in Philadelphia, Dr. Roth was honored
with the Living Legacy lecture. In his introduction, he
highlighted 2 of his former students and now leading
teachers, Drs. Domingo Martin and Kazumi Ikeda, who
were also presenting at the AAO Annual Session. He told
the audience to be sure to listen to their outstanding mes-
sage! (Audio transcript, AAO Session Philadelphia, 2002)
What is remarkable is that from each of these interna-
tional groups, they too have spawned the next generations

Fig 4. Dr. Roth is studying pretreatment records with an articulator.

June 2021, Vol 1, Issue 1 95

Righellis
Fig 5. Dr. Roth teaching the transfer of the patient’s occlusion to the articulator.
of teachers. From 1990 to 2021, there are now 3 genera-
tions of educators worldwide sharing what Dr. Roth taught,
and they are adding to the principles as new technologies,
and new information emerges.
Over the past 50 years, Dr. Roth’s goal-directed
approach has broadened beyond the TMJ! His second- and
third-generation orthodontic students and now teachers
are using advanced technologies to study the stomatog-
nathic system with jaw motion devices, more advanced
imaging techniques, listening to cell physiologists, and
reading their basic research, myofunctional therapists,
physiotherapists, sleep medical doctors, and otolaryngolo-
gists. It is remarkable that a quest that originated
over 50 years ago has developed into a multidisciplinary
approach to patient care.
THE ROTH PRESCRIPTION
The name Roth is known by virtually all orthodontists
worldwide. Many fixed orthodontic appliances bear his
name, and the Roth prescription has become a household
term in orthodontics. The Roth bracket prescription has
passed the test of time. It is important to know that the
Roth prescription was a hybrid of the Andrews straight-
wire appliance. Ron was always quick to give Dr. Larry
Andrews credit for his revolutionary design. Orthodontists
continually ranked the Roth bracket prescription as one of
the most popular preadjusted prescriptions for years. At
96
one time, more than 75 % of all orthodontists worldwide
used the Roth bracket prescription.8
This bracket prescription was designed to not only con-
sistently provide optimal tooth positions as originally advo-
cated by Dr. Larry Andrews, but when combined with Dr.
Roth’s goal-oriented approach to occlusal diagnosis with
well-planned treatment mechanics, the outcomes yielded
consistently optimal functional occlusal results.9
Although his bracket has stood the test of time, it has
been modified by his students as new technology emerged.
In the ensuing years, such technologies as directly bonded
brackets, self-ligating brackets, thermally activated wires,
and cone-beam computed tomography imaging have cre-
ated subtle evolutionary changes from the original Roth
bracket prescription.
OFF-GRID LEARNING WITH DR. ROTH
Ron’s close friends enjoyed off-grid learning with him,
which propagated many Roth stories and Roth-isms. Usu-
ally, after a long day of teaching, his students would gather
for dinner filled with serious conversation about the day’s
presentations and the sharing of case reports. Of course,
there would always be a bottle of Kendall-Jackson Char-
donnay on the table for all. His students still remember
many of the quotable Roth-isms. My favorite was, “You
don’t know how deep the puddle is until you step in
it.” The graphic metaphor was to “diagnose before you
AJO-DO CLINICAL COMPANION

treat.” We often think the magic to Roth’s success was the
bracket prescription. He would be the first to admit that
the prescription made it easier to achieve his tooth align-
ment goals, but the real key to his success was his goal-
directed approach to diagnosis and treatment.
As with all luminaries, he was surrounded by a bit of
controversy; there were some who tried to challenge his
goal-directed approach. They would say, “It’s too much
work,” or “You are over treating,” or “It doesn’t make any
difference.” Although these comments came occasionally,
they were usually unsubstantiated because there were
very few who could challenge his or his student’s out-
comes.
ROTH’S MOST ENDURING CONTRIBUTIONS TO
OUR SPECIALTY
Dr. Roth’s major clinical focus during his professional
life was the association of TMJ health with functional
occlusion and occlusal stability. He emphasized the impor-
tance of diagnosing from a seated condylar position;
shared techniques to record a stable; repeatable jaw posi-
tion; and if unable to record that position easily, he pro-
vided techniques to stabilize the jaw muscles and joint
position so that there could be a starting point for a com-
plete diagnosis. As Dr. Roth taught this concept, others
have since published the value of a stable condylar posi-
tion in diagnosis, treatment planning, and detecting under-
lying TMJ dysfunction.10-21
He provided countless case reports documenting this
association,1-7 and not only did he present cases, his stu-
dents did too.22 This demonstrates that his teachings were
transferrable! His students, and now their students, teach
this approach worldwide using the acronym FACE, which
now stands for Functional And Cosmetic Excellence. The
goal-directed approach continues to flourish internation-
ally, with annual meetings bringing together the current
teachers and their students sharing cases with the applica-
tion of new technology to the original Roth goal-directed
approach. Courses are currently being taught worldwide.
Summarizing his achievements, his greatest gift to
our specialty was his ability to inspire and motivate his
students. Comments like “He is the reason I became an
orthodontist,” “He inspired me to do research on the
TMJ,” “He made me a better orthodontist,” and “The
respect he gave patients and his keen vision and high
standards in diagnosis and details has elevated the level
of orthodontics worldwide” are just a few excerpts from
his students and now worldwide teachers (Personal
communication, L. Douglas Knight, Paul Rigali, Domingo
Martin, Renato Cocconi, Jorge Ayala, Alberto Canabez,
et al, 2021).
In the specialty of orthognathic surgery, Dr. Roth made
contributions as well. Dr. Bill Arnett, a maxillofacial sur-
geon, stated, “he was simply brilliant in figuring out diag-
nosis and treatment of dentofacial deformities and
June 2021, Vol 1, Issue 1
Righellis
additionally brilliant at educating young orthodontists to
also be excellent orthodontists” (Personal communication,
Bill Arnett, 2021). His contributions also are documented
in the field of comprehensive restorative dentistry (Per-
sonal communication, Jeff McClendon, 2021).
DR. ROTH, ONE OF THE PILLARS IN
ORTHODONTICS
Dr. Roth is worthy of the distinction of being one of the
pillars in orthodontics. He justifiably deserves such recog-
nition because his impact on orthodontics is a worldwide
phenomenon. His teaching of orthodontists in other coun-
tries has produced professionals who, in turn, are sharing
his knowledge and their treatment outcomes with others
in the specialty. This is an unselfish gift to orthodontists
and patients alike.
Thousands have benefited from his teachings around the
globe. At the AAO Annual Session in Las Vegas, Nevada, in
2006, Dr. Ronald H. Roth was posthumously awarded the
Louise Ada Jarabak Memorial International Teachers and
Research Award. The criteria for this award are as follows:
an orthodontist who has devoted time to teaching and an
unsung hero of our specialty. A fitting award as Dr. Joseph
Jarabak was his original teacher and the person who moti-
vated Dr. Roth to be the contributor he was.
In his early days, his goal-directed approach was
focused on functional occlusion, the TMJ, and dental
stability. Now, evidence-based studies are being pub-
lished about smile esthetics and facial form, integrated
with and expanding his original goals. With cone-beam
computed tomography imaging, we can now more
thoroughly evaluate a patient’s airway and possible
sleep-related breathing disorders; we can see if teeth
are in bone. This is further evidence of the relationship
between orthodontic tooth movement and long-term
periodontal health. If Ron were alive today, he would
be delving into the relationship between functional
occlusion, TMJ, and airway. In fact, many of his sec-
ond-generation teachers are involved at this moment in
such studies.
Dr. Roth’s passion and purpose of educating others is
unsurpassed and has been carried forward for future
generations to build on. Yes, Dr. Ronald H. Roth has cer-
tainly earned the distinction of being one of the pillars in
orthodontics.
REFERENCES
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J Clin Orthop 1981;15:1532–51.
2. Roth RH, Rolfs DA. Functional occlusion for the orthodon-
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3. Roth RH. Functional occlusion for the orthodontist. Part
III. J Clin Orthod 1981;15:174–9. 182-98.
4. Roth RH, Gordon W. Functional occlusion for the ortho-
dontist, part 4. J Clin Orthod 1981;15:26.
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11. Hidaka O, Adachi S, Takada K. The difference in condylar position indicator. Korean J Orthod 2014;44:312–9.
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