What are the orthodontic values and could we have them back?

I recently returned from Italy. Just as a couple years ago, in a Jungian mood. It’s probably the weather… Anyway, I decided to put together a short text on orthodontic values…

Our modern orthodontic landscape looks very much shaped by the market. It seems like the pursuit for novelty has heavily eclipsed the traditional values. But what are the traditional orthodontic values?

Two years ago, I narrowed down my answer simply looking at the 10 orthodontic commandments. Today, I want to have a more general perspective.

No doubt, it is a vital requirement for the manufacturers to bring to the market new appliances and techniques. In many cases, this is very good. We have better adhesives, better diagnostic equipment, and – given an abundance of brands – often at the reasonable prices. However, it is also undeniable that the constant flow of the new products becomes overwhelming at times. It seems to me that many treatment plans today look unnecessary overcomplicated because the clinicians are eager to incorporate “the latest and greatest” technologies in their practice. But are the traditional technologies any worse? Or could it be that some of them are actually better? Just because they stood the test of time, we have a sufficient research data on them, and occasionally they are simpler, less risky, and more time-effective. A great example, is the bone-borne expanders. We know that if the expansion is done at the right time, the difference between the traditional and bone-borne expanders is just 2 mm

So, the first value that looks forgotten to me today is simplicity. Simplicity is not easy. Simplicity is hard. It takes experience, ingenuity, and the guts to resist the crowd. What are the benefits of simplicity? The next two bygone values are… In my view…

Efficiency 

It seems obvious that orthodontic treatment should be efficient. It should solve the clinical problem. However, many times by pursuing the trends de jour efficiency is gotten sacrificed. Look, for example, at class II correction with aligners. Recent research unequivocally states that this is not efficient. Although major brands keep up fervently painting their own alternative picture of reality. And some clinicians keep believing in it. Certainly, no one dies from a cusp to cusp molar relationship. But imperfect occlusion inevitably leads to poor stability… If this, of course, is a concern…

Stability

Stability is the outcome of the marriage between simplicity and efficiency. Stability is the expected outcome of any orthodontic treatment. We expect stability. Our patients hope for it. But is this target getting hit often enough today?

No doubt, post-treatment changes will always take place. But our goal – if all we do still have any meaning – is to minimise the amount of these changes. If we don’t aim at this, we are simply getting trapped rolling Sisyphean rock up and down.

Could a work without meaning be justified by the facade of putative novelty, positivity, and social media publicity?

This is the question everyone has to answer for oneself. Certainly, many times young clinicians find themselves under the peer pressure and prefer to go with the flow. Everyone does it, why shouldn’t I? Such stance might first look safe and reasonable. But what looks like the lukewarm and comfortable waters tends to lead to the most treacherous waterfalls.

And you better start swimmin’ or you’ll sink like a stone

Looking back, the mentioned values are tightly dependent on one another presenting a sort of a trinity. The trinity that now seems to be traded off for overcomplicated, compromised treatment modalities with not-stable-enough results. We fall into this behaviour simply because it is easy. Everything has been already decided for us and we just have to stay where we are now and consume what we are given.

But are we happy the way we are now? Or maybe we need some of our values back? Sometimes, I just don’t have an answer… What do you think?

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