EDITORIAL
Advances in orthodontics
Advancement, we were taught to believe, is an ortho-
dontic tradition. But what did we advance in? What
does advancement mean in orthodontics? One could
think of it as the understanding (of the tissues we seem
to affect) that we did not possess a few years ago. Or it
could mean easier and quicker ways of doing things.
But it could also mean discovering our mistakes – not
to be repeated again.
Clearly, advances are made in response to a need.
Need is the precursor of advancement. But how does
one go about identifying a need? What are our needs in
orthodontics? Did our needs ever evolve over a century
of existence?
If the question is asked: ‘What are our needs in
clinical orthodontics?’ Even the most sanguine profes-
sor would declare: ‘we need to control tooth movement
better, and we need to correct the pathology of over-
grown or undergrown facial parts.’ Hearing such
statements would make us feel warm and fuzzy and
comfortable because they are familiar. There is comfort
in the familiar.
In our daily lives feelings of comfort and coziness are
associated with the smell of the brewing coffee. Coffee
making went through a life of its own. Only a few years
ago none of us yuppies could afford to be seen in a
kitchen without a coffee grinder. What yuppie could
possibly face the embarrassment of serving coffee not
freshly ground? Certainly, the guests would notice if
their coffee came out of a can. Yet, we gradually, lost
interest in our newest toy and started to buy, and even
serve, ground coffee from a can or a vacuum packed
bag. To our amazement, no one said anything. Were
they just being polite, or simply did not notice? Or could
it be the freshly ground coffee does not particularly
make better coffee? Our old system was working fine,
why did we buy the grinder then? Who knows. Perhaps,
we were caught in the mass hysteria, or it sounded too
good to miss, or it was just something different to do.
Yet at the end of it, we are still glad that we lived through
the experience because we now know introducing a
computer-controlled grinder gives no better results
than the earlier method. Meanwhile, we heard about the
history of coffee, types of blends, and the like. None-
theless, the experience was a good review.
Often, we would sit for an entire day listening to a
lecture just to conclude the day with similar feelings.
While the lecturer might have talked about how he/she
does things with things he/she might have invented,
and at the end of the day we will leave the lecture hall
knowing our system works just as well and we still do
not have any good means to control tooth movement or
to make jaws shrink or grow. Yes, there may be com-
puterized ways to put on braces, bend wires or balance
our checkbook, they are no better than the manual
systems. Nonetheless, the lecture was a good review.
After hearing these statements, we would look, smirk
and give knowing nods at each other. We would be
elated for knowing that we are no more ignorant than
the rest of the crowd. Then it would be time to head for
the bar to have another beer with a buddy whom we
had not seen in a while. After the first sip, we would
comment: ‘I am glad the residents were there, it was a
good review for them. Perhaps, it should be alarming
that the repeat performance of this scenario happens
much too frequently. While we were kids in ortho
school no matter what the professor said in her/his
lecture, we chose to believe the real clinician out in the
trenches saving her/his neighborhood from crooked
teeth, who said to us: ‘there is nothing new in ortho-
dontics.’ There you are, the statement was right then
and it is right now; things have not changed a bit. What
then, happened then to advancement? Did the speci-
alty not advance at all? Do we do things better than we
did 40 years ago?
Industry has capitalized on some of the research
data. When academia said lighter forces are better, they
produced the product. When academia said continuous
is better, they delivered the product. When academia
said smaller is better for oral hygiene, they made the
braces so. True research data gave our clinical work a
big boost. It is technically easier to do orthodontics
today than it was 40 years ago. But does easier mean
better control of tooth movement? Did we figure out
how to shrink or grow the jaw bones? Unfortunately,
these two questions share the same answer: no.
What happened then, to all that research carried out
in orthodontics in the last 40 years? Is this it? Is this all
there is? Why is our money wasted on trivial things?
Orthod Craniofacial Res 5, 2002/129–130 129
Editorial
How come there are no new things? Should academia
be accused of laziness?
Science deals with the unexpected, and with a
deliberate pace. It starts with the fundamentals. It
cannot afford to make a mistake. When science gives a
progress report with a caveat, the caveat is forgotten
quickly. Subsequently, a myriad of treatment systems
are proposed, applied to the patient, but with no dis-
tinguished benefit. Academics spend much energy,
time and money just to prove this was a mistake never
to be repeated. Subsequently, just like automobiles, the
once-fashionable systems are recalled.
It appears that we spend much of our resources on
disproving things rather than advancing the field. Our
miniscule-in-size academic manpower is busy putting
out brush fires, while product testing is becoming a
major preoccupation. Discovering our mistakes is what
we do best in orthodontic research. This is an awkward
place to be. Out-of-control reckless proposals of alter-
nate treatment systems simply interfere with the
advancement of our specialty.
130 Orthod Craniofacial Res 5, 2002/129–130
The scientist does not make up questions just to
entertain herself/himself. It is the clinician who must
formulate the questions for the scientist to answer.
Unfortunately, the clinician orthodontist has not been
able to formulate serious questions and provide guid-
ance for the scientist. Instead, the clinician orthodon-
tist criticizes the scientist for messing around with
things that have no immediate benefit. Perhaps, we
have no particular needs in orthodontics. Life is good
right now – no reason to advance the field. We are
content with the review lectures. All we need from
science is for someone to tell us if our treatment
methods (however, bizarre) are effective or not. If they
are no better than the previous methods, then we will
call it a mistake and recall the coffee grinder. There are
many other appliances waiting to be discovered, no
need to understand the tissue systems just yet. One can
only hope this is not the defining characteristic of our
specialty.
Orhan C. Tuncay
Editor-in-Chief