Editorial – DDS


“It must be the ambition and determination of every orthodontist, to treat each of your patients in a way that will produce the best possible results with the least inconvenience for both.” Harold Dean Kesling

Kesling¹ is considered to be the father of clear aligners, at least of the most important concept behind the technique that is most evident in Dentistry worldwide and which has been responsible, to a large extent, for all the good and bad in the profession over the last two decades. Kesling’s conviction, which we vehemently share, can be seen already in the title of his classic 1946 article, published in American Journal of Orthodontics and Oral Surgery¹ — “Coordinating the predetermined pattern and tooth positioner with conventional treatment”. Taking into account the scientific evidence and therapeutic devices available in the post-war period, for the visionary Kesling only 15% of what we do is what actually contributes to the final result of our treatments. That is, an incredible 85% of the time, expenditure, and our efforts are in theory wasted on unnecessary adjustments, diagnostic errors and planning, lack of patient cooperation, among others.

What Kesling realized with great mastery and, which has changed little after eight decades, is that the greatest dilemmas of Orthodontics are the difficulties posed by the challenge of abstracting² how to move the teeth in order to obtain a stable, functional dental rearrangement and in harmony with the aesthetics of the smile and face, considering the significant individual morphological variations both of the skeletal bases, as well as of the soft tissues and teeth³.

To “pour gasoline on the flames”, theories that demystify the classic paradigms of Orthodontics have recently gained strength, which often “force” us to try to fit results into arbitrary norms that were randomly determined, based on intangible ideals and little found in the nature in part influenced by the sectarian theories of Eugenics, notoriously related to the ideals of the Nazi Party² in 1930s Germany. The new “Quality of Life Paradigm”³ frees the orthodontist from the curse of supposedly having to treat “bad” occlusions as if they were “diseases”, a concept that in fact would be better defined as: individual morphological variations, subject to genetic and environmental factors with greater or lesser impact on the lives of individuals. In other words, what must be “treated” are the negative impacts of such “bad” occlusions and this varies greatly, as it is no longer possible to exclude from this equation the socio-emotional issues and the expectations of each person regarding the treatments.

¹ American Journal of Orthodontics and Dentofacial Orthopedics.
² Abstraction is a type of thinking that allows us to reflect on things that are not present in space and in the current moment. It also allows us to reflect on general concepts and principles, both in our daily lives and in a more academic or professional environment.
³ It is know from experience that mechanics applied to dentofacial biology is something of considerable complexity, as it is not about moving a “free element in space” from point A to point B linearly on a flat surface, but to move three-dimensionally several dental elements “trapped” in their alveoli, which in turn are “grasped” in their dental arches that are dependent on the positions of their skeletal bases, one fixed (maxilla) and the other mobile (mandible), which adds an even more destabilizing difficulty factor, which are the relationships between the heads of the mandible and the joint fossa, having between them the soft tissues that form the TMJs, such as the ligaments, cartilages, connectives, muscles, vessels and nerves. All this, occurring many times during the process of growth and development.

Check out the full editorial by clicking here.

Dr. Mauricio Accorsi
Scientific Director DDS-BR

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