When I entered the specialty of orthodontics after some time in general practice, many of my older colleagues were saying that the golden age of orthodontics was over, never to return. I am happy to be able to say, 40 years later, that it is still very much alive. Forty years ago, many orthodontists were still banding most teeth. The concept of the preadjusted appliance was just beginning. There were no temporary anchorage devices or lasers, and the use of computers for diagnosis and treatment planning was in its infancy. There were no webinars and no PowerPoints, and we were still using slide projectors to watch our presentations. There were no digital x-rays or cone-beam scans. There was no intraoral scanning. We were just beginning to understand the potential benefits of surgical orthodontics in the treatment of complex skeletal problems. Little, if any, maxillary surgery was being done. Up to that time, most surgical procedures were mandibular setbacks, regardless of the etiology of the skeletal discrepancy.
The number and variety of appliance systems available today and new technologies have revolutionized how orthodontics is now being taught and practiced. We have gone more to the case-based method of teaching and incorporate evidence-based concepts into the paradigm whenever possible. A word about evidence: just because something is in print, does not necessarily make it good evidence. If a systematic review starts out with several hundred articles, and it comes down to 6 or 8, and 4 of those have questionable quality, the conclusion should be that more research on that subject must be done. Also, if a practitioner does a specific procedure a hundred times and the results are acceptable by recognized norms, that is evidence-based treatment, at least to that practitioner.
Teaching and learning have also become much more interactive, with students participating in the discussions, teaching, and making presentations rather than just sitting back and listening to lectures. Much of the material they need is placed in Web-based programs such as Moodle, which they can access from their computers at any time. Digital use and storage of records have been boons to us in academia, as in private practice. Technology should be embraced, but the temptation to engage in “widget orthodontics” needs to be resisted. My philosophy has always been that the teeth do not know what is moving them. They only respond to the forces applied, either correctly or incorrectly. Consequently, after a firm grounding in basic orthodontic principles, students can be exposed to a variety of appliance systems. That being said, there needs to be greater emphasis on the biologic aspects of treatment and less on creating new bracket systems, some with unsubstantiated claims. In a recent issue of a popular orthodontics journal, there was an ad showing 36 different types of brackets, all somehow related to the original edgewise bracket designed by Edward Angle over 85 years ago. Of course, many more types than that are available. The original edgewise bracket certainly needed to be modernized a bit, but at this time, maybe there should be a moratorium on new bracket designs. For example, maybe we should spend more time looking into some of the still-existing mysteries of the biology of tooth movement and of genetic engineering and tissue regeneration.
That brings us to the problems facing orthodontic education. At the top of the list, of course, is the recruitment and retention of faculty, especially full-time faculty. Although there are many great benefits to working in academia full-time, one must do so for a long enough time in order to realize them. The early years can indeed be difficult, especially financially but also in learning to become an effective teacher and mentor. Future junior faculty members will need a firm grounding in basic pedagogic principles as well as orthodontic knowledge. The days of just sending new faculty members out onto the clinic floor with the charge to “teach” should be over. Individualized faculty development plans must be made for all new faculty members, outlining their responsibilities as well as what they will need to do to advance in the academic arena. These plans must be realistic and monitored periodically to make sure that each faculty member is going in the right direction. What will be required in research, publishing, and clinical and service activities should be spelled out clearly, and the faculty member’s time must be protected so that he or she can stay on track. I think that most people interested in full-time academia are aware of the financial differences between being involved in education and going into full-time practice. The financial burden of many graduating orthodontic residents is onerous and often precludes the possibility of going into full-time education. The American Association of Orthodontists (AAO) Foundation has been helpful in its support of junior faculty, but universities need to better allocate their resources for faculty to enable young people who are dedicated to teaching and research to survive the early years and maximize their potential.
In spite of the many innovations that make it tempting for practitioners other than orthodontists to dabble in the field, I believe that there will always be a need for the thoughtful, skilled, expertly trained young orthodontists who are entering the specialty today. The difference between the orthodontist and the dabbler is the knowledge of the biologic basis of what they are doing. Another difference is that there is a certifying board in orthodontics, the first in dentistry. One way to help protect our specialty is through the American Board of Orthodontics (ABO) certification process. With their forward thinking, its directors have made it possible for all graduating orthodontists to become diplomates of the Board after graduation and have implemented a recertification process that is consistent with the Board’s mission to help protect the public. They also have sponsored an advocacy program through the College of Diplomates to assist all programs accredited by the Commission on Dental Accreditation (CODA) in preparing their students for certification. Approximately 90% of all medical specialists are certified by their respective boards. Approximately 40% of AAO members are now certified by the ABO, as opposed to less than 20% when I became certified. That number is growing as a result of the Board’s actions and will continue to grow in the future. I believe that it is the responsibility of every advanced orthodontic education program to prepare its students for board certification.
A brief word about the CODA: my experience as a site visitor, an Orthodontic Review Committee chair, and a CODA commissioner over the past 24 years tells me that based on what has occurred in orthodontic education and practice over the last 40 years, the issue of program length should be reexamined, and possibly the length should be extended to accommodate current changes and the additions to the curriculum that have occurred over the past 20 years. It is time that we stop being schizophrenic about this issue. How long should it take to adequately train an orthodontist today? It should be put on the agenda of the Society of Orthodontic Educators with an attempt to come to a consensus on the appropriate length. A recommendation could then be made through the AAO to the CODA, and maybe we can finally all get on the same page.
Finally, just a few words about this Journal : this year marks the 100th anniversary of the AJO-DO and its precursors, and I have had the privilege and good fortune to work as a reviewer and an occasional author with its past 5 editors-in-chief. Each of them has taken it to another level. Each has added new and interesting features while keeping a good balance among clinical issues, basic research, and news. Each has left his indelible mark on the Journal .
I do not believe that the “golden age of orthodontics” is over by any means. In many ways, I think it is just beginning. In short, there is so much left to do. What an exciting time this is to be an orthodontist!