Orthotown April 2023 - 39

FIGS. 1A AND 1B: Orthodontically induced dehiscence of significant magnitude, discounting the relevance of 0.6 mm of
nonvisible bone argument. 1A: Sagittal view, orthodontically induced dehiscence of Tooth #23. 1B: Axial view, orthodontically
induced dehiscence, showing the apical portion of Tooth #23 root entirely outside alveolar housing.
BY DR. JEFFREY MILLER
T
oday more than ever, orthodontists
are concerned about
the future of their specialty.
Although do-it-yourself orthodontics
is not new, more technologysavvy
companies are reintroducing
" DIY " with a precepted " sophisticated "
alternative to orthodontic treatment.
With the oversimplifi ed promotion
of orthodontics to the general practitioner,
and the complacency of our
specialty in fi ghting this trend, it
should not be surprising that for some
providers, orthodontics has been
dumbed down to merely the mechanical
alignment of the clinical crowns.
Considering that the average
young general dentist graduates with
hundreds of thousands of dollars
in student debt, taking a bite at the
aligner orthodontic market to increase
revenue appears to be the correct
fi nancial decision-especially when
one considers the onslaught of aligner
marketing directed at them.
However, even with all the present
market forces, I believe our specialty
is actually headed back in the direction
of the specialist. Th is may sound
counterintuitive at fi rst, based on
current events; however, I believe this
change back to the specialty arena is
happening before our eyes. It may take
fi ve-plus years to fully be recognized,
but for sure it is coming.
A manageable margin of error
Before I begin to explain, let's fi rst
review how the information derived
from CBCT changes the way we evaluate
fi nished orthodontic results.
We've all heard about the 0.6 mm of
nonvisible bone hidden on our CBCT
slices, but few actually understand
what this means for orthodontics.
Does this 0.6 mm margin of error
discount CBCT as a proper diagnostic
tool for dehiscence? Simply stated, the
answer is no.
Most studies that review the
APRIL 2023 | 39 | ORTHOTOWN.COM
accuracy of bone measurements taken
on CBCT slices factor naturally occurring
dehiscence and fenestrations
in their sample, which are generally
minimal and mostly do not have
devastating gingival consequences.
Orthodontically induced dehiscence
(OID), however, is a diff erent category
of dehiscence by its higher magnitude
and generalization (aff ecting cuspid
to cuspid). While natural or minimal
dehiscence and fenestration does not
seem to be a major problem for our
post orthodontic patients, OID does
(Figs. 1a and 1b).
In a study published in the American
Journal of Orthodontics and Dentofacial
Orthopedics, Sun et al. state, " If
there was a severe dehiscence on the
CBCT image, there was probably a true
dehiscence. " 1
was harder to accurately diagnose via
CBCT, larger dehiscence and fenestration
were easily and accurately diagnosed
using CBCT (Figs. 2a-2c, p. 40).
While smaller dehiscence

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