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I was recently introduced to the term ‘inflection point’, by my friend and colleague, Nik Pandis, which refers to ‘significant advancements or paradigm shifts in techniques, technology, or approaches to treatment’. I thought it would be interesting to ask Chat GPT to list notable inflection points in orthodontics, and I have listed 10 of the many points highlighted, with my thoughts about each.
Development of the edgewise appliance (1900s)
Why, in the 21st Century, anybody would teach students of orthodontics to use removable appliances for tooth movement (with the notable exception of twin blocks, clear aligners and Essix retainers) completely mystifies me…but I hear they still do!
Cephalometrics
This led to an understanding of facial growth and more rational and justifiable approaches to treatment planning.
Functional appliances
This approach was aimed at influencing jaw growth. It was shown to be particularly effective in growing children. When studied in detail, using randomzed controlled trial (RCT) methodology in the late 20th century, the effects were shown to be largely dento-alveloar (75%), although there was a small, but worthwhile, skeletal improvement (25%).
Biomechanics and anchorage
For sure, they have sounded the death knell for orthodontic headgear. My feeling is that every orthodontic trainee should be allowed to do 5–10 of their own TADs cases during their postgraduate training, and they should be insisting that their trainers afford them this opportunity.
Self-ligating brackets
These new ‘bracket and archwire’ systems claimed many clinical advantages over straight wire brackets, because of their ability to ‘reduce friction’. However, when the high-quality RCTs were finally conducted, not one of the original claims stood up to scientific scrutiny
Aesthetic orthodontics
The introduction of Invisalign (Align Technology, Tempe, AZ, USA) in the late 1990s has been the quintessential market disruptor and has changed orthodontic treatment, possibly forever.
Kevin O'Brien's blog4 recently drew the orthodontic community's attention to all the potential harms to human health and also the environment, created by the microplastics generated by the half a billion or so aligners (and associated working models) produced so far.
Digital orthodontics
The introduction of 3D scanning, printing and CBCT imaging has led to enhanced diagnosis, treatment planning and appliance creation. Digitally designed smiles, digitally created implant guides, as well as metal-printed appliances are now commonplace in an increasing number of 21st-century practices.
AI and machine learning
The use of AI has made orthodontics appear deceptively easy, particularly to the uninitiated. It beggars belief that apparently the vast majority of ClinChecks are ‘approved’ with little real thought as to the feasibility of the suggested movements.
Accelerated orthodontics
To my knowledge, there is little scientific evidence to support the claims made by their advocates, and many much more predictable, less expensive methods are currently available to reduce treatment times, should this be a priority.
Tele-orthodontics
This delivery model tried to create a shift in patient access. However, (thankfully for the poor unsuspecting victims) this method of care delivery has now ‘crashed and burned’.5
Reflection
So you can see from the above list, some of these innovations have created a real change for the better for our patients. Others have been shown to be the ‘snake oil’ that we all suspected.
This now leaves us to consider DentalMonitoring,6 which uses AI and smartphone technology for remote patient check-ups, claiming many advantages to clinicians and patients, including reducing overall treatment time. To date, the science shows this not to be the case. However, the number of patient visits to the surgery can certainly be reduced.
We are at an early stage in the development of this technology, and whether DentalMonitoring turns out to be our latest orthodontic inflection point remains to be seen. Watch this space!