For most of us, the idea of innovation in orthodontics conjures up some form of technical advance. This reflects the constant search for the most efficient, cost-effective means of moving teeth, which will also shorten the time required for treatment. We want an appliance which will do all this and at the same time give a pleasing alignment of the teeth for the patient.
As an orthodontist I have been happy to take advantage of technical innovations. However, what is striking has been the lack of similar effort to understand the nature of malocclusion. Diagnosis has come to resemble a description of the malocclusion rather than identifying the cause. The emphasis has been on ways to treat the condition, not on the source of the problem.
Meanwhile, orthodontic diagnosis and treatment has to deal with the new ideas sweeping through biology. There are several concepts which have direct relevance for orthodontics. One is borrowed from osteopathy. This is a practical classification of cranial displacement. Combining this with the traditional orthodontic Angle classification of malocclusion gives a sophisticated and powerful understanding of the full extent of a malocclusion and how it relates to the body as a whole. Another innovation is recognizing that the body is “a non-linear, complex, dynamic, self-organizing system, far from equilibrium.” This is a physicist’s description of living systems but has profound implications for orthodontics at a clinical level.
Yet another innovation comes from the application of biotensegrity principles in orthodontics. These support the idea that change anywhere in a living system induces compensatory change through the whole system. For an orthodontist this is particularly interesting. Finally there is the idea that there is a level of force suitable for each individual. Rather than a standard application of force for everyone, it is possible to identify that which is most suitable for the particular patient.
No single appliance system is likely to emerge which addresses all the various aspects of malocclusion. A more rational approach is to understand the implications of the new concepts for each patient and what the clinical possibilities might be, both in the short and long term. Once we have established the new parameters for diagnosis and treatment then we can choose the appliance system which best meets the biological requirements for that patient.
I invite you to join in the search for better answers. For more than a century we have been trying to solve the problems of malocclusion by inventing some variation of appliance. It is time to go back to first principles, think of malocclusion as an integral component of the body as a whole and start from there.
Dr. Gavin A. James B.D.S., M.D.S. F.D.S. (Eng), Dip. Orthodont.
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