The century behind and the century ahead

We have used many words and many images in 2015 to help readers notice that the world and orthodontics have changed a great deal since 1915. This has been purposeful so that we might realize the ideas and the developments that have been productive and influential in defining orthodontics as it is celebrated today. It was also our intent to point out that some ideas and developments were fads without enduring consequences (and they need not be pursued further in our future). It can only be concluded that orthodontics has progressed a great deal in the past 100 years.

It began with the inspiration of Edward H. Angle and little else. He formed our early scientific, educational, and mechanical heritage. From his early work, and the work of many others to follow, 100 years of progress in the art and science of orthodontics have been documented in our ever-expanding body of literature. The articles and their authors of that literature have in a way invented our present. In this issue of the AJO-DO , you will find a timeline that acknowledges many of the events and accomplishments that have shaped the past of orthodontics and define our present. You will note dramatic changes in education, research methodology, materials, clinical orthodontics, imaging, and the internationalization of orthodontics, to name a few.

There have also been shifting observations and opinions through time. For example, in terms of manpower needs, it has been noted at various times that there were too many practitioners; at other times, it was judged that there were too few. Serious concern has also been expressed regarding the influence of external forces on orthodontics; the influence of governmental regulation, insurance carriers, organized dentistry, dental laboratories, and manufacturers, among other entities, has sparked serious comment and debate. As a result, articles have appeared in the pages of the Journal suggesting that the demise of the specialty was imminent. Despite that occasional pessimism, the specialty continued to advance and thrive.

From the vantage of 1915, no one, not even Angle, could have predicted our present state, and in 2015 no one can envision the concepts, events, inventions, and influences that will be in play in 2115. But anyone with imagination has license to make predictions as to the state of orthodontics when the AJO-DO celebrates its 200th anniversary 100 years from now. So, here are some dreams about the future.

As has been the case in the past, orthodontists will be fascinated with technology in the future. In the near term, it is clear that diagnosis and treatment planning will become more advanced through the use of augmented reality. Augmented reality is a direct or indirect view of reality whose characteristics are augmented by computer-generated input involving still images, video, graphics, sound, and positional information. This future view will be enabled through such things as eyeglasses, contact lenses, and retinal displays. Will x-rays be involved on a routine basis? Probably not, since they could eventually be replaced by imaging with light and sound. Of course, appliances are already being based on intraoral scans, and this application will increase. The computer will also determine when and where tooth morphology alterations (interproximal reductions, buildups, and extractions) are appropriate.

It is also easy to see that one of the next big things will be remote patient and treatment monitoring. Information will be sent right from the teeth, via microsensors that record aspects of patient hygiene, craniofacial growth, tooth movement, and so on. This will allow the orthodontist to communicate with the patient to say “go brush your teeth,” “change your elastics,” “make an appointment,” whatever.

Beyond that, tiny micro and nano machines called microelectromechanical systems (MEMS) and nanoelectromechanical systems (NEMS) are under development. Such devices will be able to function in the wet environment of the oral cavity and can act as sensors or actuators (a motor that converts energy to motion); both are printable. A MEMS is about 50 times smaller than the width of a human hair. A NEMS is an even smaller electronic device (1000 times smaller than a MEMS). “Muscle wire” might even be involved (these wires shorten under the influence of an electrical current), but wire may not be necessary at all. Of course, such machines will not be self-driven. Information will be remotely monitored, and minor adjustments might be made by holding the phone a little closer to the teeth.

Pharmacologic-regenerative protocols will also come into play. They might be used to repair tissues or control the inflammatory process inherent to orthodontic tooth movement and to modify the development or destruction of bone. Of course, the promise of “growing new teeth” will continue to be a goal of current and future research across dentistry. Equally promising, gene reading and gene therapy to predict and perhaps control morphology and tooth movement will come into view. Imagine telling a patient to “spit in the cup” so that the doctor can determine the future size and shape of the mandible and when it will grow.

Orthodontics has accomplished a great deal over the past 100 years. Millions of people have been treated, and many more will be treated in the future. Orthodontists are by their nature “future focused.” They begin a treatment in the present and will finish it in a future that includes years of retention, and they will be remembered for doing so even decades later.

Of course, there will be many challenges ahead. One such challenge will be to meet and increase the demand for orthodontics. In this regard, there is growing sentiment that good health is a right, and good health demands consideration of the psychological, social, and cultural handicaps that are associated with abnormal morphology and malocclusion. Better service to more people is quite possible; there will be new opportunities to improve human health.

Is the demise of our specialty on the horizon? Personally, I don’t see it. There will be new ideas, research, skills, technology, and external challenges to contend with, but we have risen to the challenges many times before. In the past, there have been questions of whether the glass is half full or half empty; for the future, it’s really a question of where we can get a bigger glass.

The true future of orthodontics will depend on the character, qualities, and desires of those who are entering the specialty today. Our devices will not define the time ahead, but, rather, human ideas and ideals will mold and ensure our future. As long as there are practitioners who value knowledge, training, and skill and who continuously desire to close the gap between improvement and perfection, there will be a place for the practice of orthodontics. Likewise, as long as researchers are excited to discover what is yet to be known, there will be new knowledge that can be applied. Our future will not be seen by staring into a crystal ball but will be revealed by looking into a mirror. What you do will determine much of that future.

The future cannot be predicted, but futures can be invented. It was man’s ability to invent which has made human society what it is. The mental processes of inventions are still mysterious. They are rational, but not logical, that is to say, not deductive.

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Apr 6, 2017 | Posted by in Orthodontics | Comments Off on The century behind and the century ahead
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