Komura Pediatric & Orthodontic Clinic. Toyonaka, Osaka. Practising since 1995; treating with clear aligners since 2012.
These pages are written for colleagues, not for patients. They set out how we decide — the reasoning behind the treatment, rather than the treatment itself.
We write them for a simple reason. Clinical judgement is usually transmitted by apprenticeship, and apprenticeship does not scale. Written reasoning does. If our thinking is sound, someone can use it without ever meeting us; if it is unsound, someone can show us where.
What we are
One clinic in a residential suburb of Osaka, treating children and adults. Paediatric dentistry and orthodontics under one roof, which is less common in Japan than it sounds — and which is the reason this clinic exists in the form it does. The child who comes in at three for prevention is the same person we may treat at nine, and again at fifteen.
We intend to grow, from five chairs to eight. Not into a chain: to the largest size at which the same standard still reaches every chair.
Three commitments
1. The patient is the child, not the guardian
The guardian decides. The child is who we are protecting. When those two pull in different directions, we do not soften what is medically correct in order to make the appointment more comfortable. We try to say it without blame — but we say it.
2. Do not remove more than the situation requires
Two habits shaped this clinic. Not drilling more tooth structure than the lesion requires, and not extracting more teeth than the skeleton requires. They are the same habit applied at two scales: what is removed does not come back, so removal is the decision that deserves the most evidence, not the least.
This is why we build the case around diagnosis — CBCT, cephalometric analysis, the airway — before deciding anything irreversible.
3. Decide before moving
We would rather spend an hour on the plan than a year correcting a movement we did not intend. This is the property that led us to an aligner-only path in 2012: the movement can be designed and inspected — including root position relative to bone — before the first aligner is worn.
What we are not trying to do
We do not compete on volume. We do not publish annual case counts, and we do not treat sales-based certification tiers as evidence of clinical quality. Those numbers reward the clinics that produce the most cases, and we do not think that is the same question as who treats a given child well.
We also do not solicit reviews. If every clinic asks its patients to write one, patients lose the ability to tell a real reputation from an organised one — which makes the whole signal worthless, including ours.
The test we apply before publishing anything is simple: if every clinic did this, would the world be better or worse? It is a crude test. It is also surprisingly hard to fail honestly.
The notes
- Why we design without extraction — and how we decide when extraction is necessary. The diagnostic sequence, the levers we use instead, and the four situations in which we do extract.
- Before orthodontics: what we try to settle in the first years. Why we treat diet, function and caries risk in early childhood as orthodontic groundwork rather than as a separate discipline.
If you disagree
We would rather be corrected than agreed with. If you design cases differently and think our reasoning fails, please tell us. Our cases have been listed on the Align Global Gallery since 2018, where they can be examined by people qualified to disagree.
Komura Pediatric & Orthodontic Clinic · 5-14-4 Nakasakurazuka, Toyonaka, Osaka 561-0881, Japan · komura-ortho.jp · Consultations are conducted in Japanese.
These pages describe how our clinic approaches treatment planning. They are not clinical advice for any individual patient, and outcomes differ between patients. Treatment decisions require examination and diagnosis.