Orthotown June 2020 - 8

graduate from reflect these skill sets in ways we may not
realize, and they influence our initial view of the profession
and how we practice. Philosophies vary from department
or program to another-some emphasize materials,
others clinical treatment, still others a combination of
everything. But your view toward orthodontics is shaped
early on, and it's up to you to continue to learn and grow
and expose yourself to new things.
Like the first college student in a family learning that
there are many other opinions to be respected outside
of the particular neighborhood in which he or she grew
up, orthodontists have been challenged by the advent of
diagnostic devices and new treatment mechanics.

Developing new practices
In the early days of "put your plaster on the table,"
we focused on tooth size discrepancies, mixed dentition
analysis and the decision to extract or leave teeth in place.
We know the story of Charles Tweed regretting his early
non-tooth-removal treatment plans and returning with
re-treated cases to display that almost entirely rejected
the non-extraction approach.
After the rather rudimentary treatment planning
we were able to achieve with plaster, a ruler and perhaps
some photographs, our profession added the input of
cephalometric analysis. This new X-ray device brought
dozens of methods to analyze a patient's facial proportions
and gave us new reasons from which to base our decisions.
Anyone who mattered invented his or her cephalometric
analysis and claimed that the results of utilizing it would
clarify the foggy diagnostic process and solve some
treatment planning puzzles.
Heck, Dr. Sean Carlson-a world-renowned speaker
on CBCT and futurist, to be sure-recently posted an
article from the early years that showed just how many
clinicians of the era were skeptical that this new device
could help us in treatment planning.
My own bias centers on the utilization of articulators-those gadgets some of us used to
analyze bites, occlusal planes and
discrepancies within the TMJ. I can
still remember the heated discussions
between Roth and Rinchuse as they
pointed and counterpointed the
advantages and disadvantages of these
contraptions. (I do still believe they are
very useful, and they are responsible for
my overall respect for treatment mechanics
and stability.)

8

Which brings us to the current state of affairs in
orthodontics.

Expanding the industry
Our profession is rapidly transitioning-from plaster
to two-dimensional, to mechanical three-dimensional,
to radiographic imaging of volumes within the skeleton
and the effects of soft tissue. It's no wonder some of
us are struggling with the transition; many of us have
not been trained in the diagnostic value of cone-beam
imaging and the treatment planning decisions that come
from it. Looking at oral and nasal volumes with teeth
between the muscles and the air space is a totally different
exercise from anything many of us have been taught. It's
no wonder that as I scan the message boards, I can see
those who embrace these changes and those who resist.
It used to be just a question of "Do we extract or not?"
Now, in addition to that decision, we need to ask if we
are to distalize, advance, tip the occlusal plane, expand
lateral or sagittal. Suggestions are made regarding airway
health, muscle habits and tongue position and function.
Some embrace the questions; some say it's none of our
business.
And of course, there is some capitalism mixed in
with the new devices and techniques.
You see, with new diagnostic advances and devices
comes the need to integrate them into one's decision-making
process, so what some clinicians are looking at to help them
with that decision is not a "scam," useless information or
something outside the purview of our specialty.
I encourage all Townies to regularly check and
contribute on the message boards with thought-provoking
cases and questions, taking all of the new information
into account.
We don't want orthodontics to be a forbidden
topic in mixed company-and be sure to
share your opinions respectfully. n

JUNE 2020 // orthotown.com

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Orthotown June 2020

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