Editorials Orthodontic Science and Practice – Edition 49

Prof. Dr. Alexandre Moro
Scientific Director

The Last 30 Years of Orthodontics: A Personal Clinical View

When I was in the final year of my undergraduate degree in Dentistry in 1991, the dream of more than half of my classmates was to specialize in Orthodontics.

Some colleagues think that the late 1980s represented the beginning of the golden age of Brazilian orthodontics.

There were few training courses and consequently few orthodontists, who had a large clientele and charged a relatively high price for treatment. I remember visiting the office of 4 or 5 orthodontic professors at the time and it caught my attention. The clinics were large, very beautiful, and had several chairs. The image was very different from my father’s office, who graduated in the 60’s and worked all his life as a general practitioner in a small room with a single team.

In the 90’s the number of specialization courses started to increase and consequently the number of professionals. Competition increased, and mass care clinics began to emerge. The cost of the treatment was not small, but in installments, and the profit came from the volume of care.

In the 2000s, orthodontists realized that to compete with the large clinics they needed to change the form of billing. Many professionals, along with the wave of self-contained rackets, began charging for treatment at closed prices. New graduates began with another form of care. The itinerant clinic, that is, they put their material in a suitcase and served in different offices on different days of the week. From then on, the orthodontist began to lose his role, and often ended up becoming an employee of another dentist, generating profit for him.

In the transition between the years 2000 and 2010 the multiprofessional clinics became fashionable. And then, the orthodontist lost his status and became an employee of a more experienced dentist administratively.

What we see today is that the number of training courses in orthodontics is frightening. Today in Curitiba alone we have over 20 orthodontic courses. In Canada there are only 6. In the undergraduate program we see little interest from students in doing orthodontics. Most seek Implantodontics or Aesthetics, including here the Orofacial Harmonization.

And finally, with the aligners, a new management modality has emerged. According to the number of cases that the professional buys from the aligner company, the price of treatment varies, i.e., the higher the number of cases, the lower the price to be paid for treatment. Due to this ranking that some companies do with professionals, those who manage to buy the cases for a lower price are passing them on and/or reselling them to other colleagues. In this way, the former continue to rise more and more in the company’s ranking, and thus, paying less and less for cases. The latter are able to pay less in their cases, and have an advantage over other professionals, because usually the way they usually use to attract the patient is to charge a lower price. Within this panorama appear the franchises, which although they have existed for some time in the dental market, have not had much commercial success. However, it seems that soon we will have the franchise clinics of treatment with liners, or as a friend of mine says, “popular clinic of liner.

And what’s the good news for you in the middle of this gale? There are a lot of poorly trained professionals in the job market. And, many cases being treated incorrectly. You can be sure that if you are a differentiated professional with a good education, you will not lack service. You will portray many cases.

And let another 30 years come!!!

Prof. Dr. Alexandre Moro
Scientific Director

Prof. Dr. Ricardo Moresca
Assistant Scientific Editor

Diagnosis: the missing link

The advances in orthodontics in recent years are notorious. We have been introduced every moment to a multitude of new appliances, innovative technologies, revolutionary treatment methods, state-of-the-art digital resources and much more. Undeniably, the orthodontics we practice today is much more efficient and simpler than at any time in our history.

However, it is interesting to note that the vast majority of the latest innovations refer to treatment methods, i.e., how we can move teeth more efficiently, comfortably and quickly. Among the main features to which I refer we can highlight the self-contained brackets, mini-implants, aligners and, even with little evidence of their clinical validity, also include the devices and techniques that aim to accelerate tooth movement.

Most recent digital resources also point in the same direction, i.e., they help us in several ways to simplify, precise and predictable orthodontic movement.

It is also interesting to note that the innovations that have brought advances in orthodontic diagnosis are in much smaller numbers. Among them, Cone-Beam Computed Tomography (CBCT) stands out.

Another important point of view to be analyzed is how these new trends have affected the planning of our cases. A typical example was how skeletal anchorage in association with CBCT extended the limits of orthodontic movements, making treatment plans previously impossible.

The point I would like to make after this initial explanation is that, in my opinion, we orthodontists are overvaluing treatment methods by failing to give due importance to one detail that is probably the most important in orthodontic treatment: diagnosis. As a teacher and lecturer, I have had the opportunity to interact with many students and colleagues. I have realized that most of the time the great difficulty of orthodontists, especially the younger ones, is not how to do it, but what to do. Perhaps this perception is a reflection of the emphasis we have placed on treatment methods.

By analyzing the whole situation it is also possible to see that diagnostic methods, in their various sources, are occupying less and less importance and space in the programs of specialization courses and training of orthodontists.

In practice, this is revealed in the large number of cases with unsatisfactory results, with primary diagnostic errors, which knock daily at the doors of the offices of the most experienced orthodontists in search of a second or third treatment.

Despite the great emphasis placed on the variety of treatment methods that exist today and with so much propaganda about miraculous appliances, I am convinced that accuracy and security in diagnosis can be the differential for the professional who seeks success in orthodontics. That’s the tip!

Prof. Dr. Ricardo Moresca
Assistant Scientific Editor

Editorial – Digital Notebook Dentistry in Science

Prof. Dr. Mauricio Accorsi

Scientific Director DDS-BR

“Dentistry is neither analog nor digital. It’s intellectual, and sometimes it requires a certain artistic talent.”
Jon Gurrea

Do you have a digital or analog mindset?

This statement by Spanish dental surgeon Jon Gurrea, posted on Facebook by fellow Curitibano Rogério Marcondes, could not be more accurate. As Marcondes said:

…funny how in dentistry everything polarizes, and currently to say that you do dentistry in a “100% digital flow” gives the impression that the dentist is in a much bigger dimension than the others… Bullshit… Dentistry remains 100% dependent on the operator, intelligence, expertise, mastery and good professional sense… (sic).

In fact, Dentistry is intellectual and must be performed with love and wisdom. And it is exactly because of this that the mentality of the professional can be analogical or digital, as we will see below. The pace of digital change is accelerating and businesses and people do need to be tuned to keep up with the changes, or they risk becoming irrelevant in a changing market. But adopting new  technologies automatically without changing mindsets is no guarantee of prosperity; on the contrary, it can be a big headache. As said above, we are seeing many colleagues dazzled by new technologies such as 3D printers, scanners, systems, etc., investing a lot of time and money, doing heavy marketing on social networks, to in practice give more emphasis to super specific technical issues, than to the “big picture”, which is to find a middle ground between what the clinician has to offer using these new features, and what the client really wants and expects as a result of a good treatment. Within this context, it is also necessary to carefully evaluate what makes sense to invest at this time in technological resources and what is worth outsourcing with partners such as diagnostic imaging centers and manufacturers of therapeutic devices such as surgical guides and aligners, for example, which can help us throughout the workflow, especially for professionals and small clinics.

But what does it mean to think analogically or digitally? First, we need to understand the meaning of the term fashion: – mindset, which can be translated from English as mentality, and serves to define a person’s way of thinking and their beliefs. The term comes from cognitive psychology, and focuses on how people process information. Human beings have a limited capacity to absorb and manage information. Mentalities help filter out what is absorbed and how it is all interpreted. Having a certain mindset means acting on that set of information that is being filtered and processed. Therefore, a mindset has a cognitive aspect and an action-related aspect in fact.

It is also known that mindsets are not stable and change over time as a result of new observations and experiences, which is why it is so important to always keep up to date, because a particular mindset can help a professional, or business, to develop their own method – a unique approach to solving problems and making decisions in an increasingly complex, ambiguous and dynamic information context. In other words, having the ability to constantly adapt is today one of the most important virtues that can be desired to remain in the market successfully.

Who has a stagnant thought, who does not make comparisons and does not accept discussions, the famous “hard head”, is someone who can have an analog mindset. Laziness, fear and pride are important factors and, therefore, one of the most obvious consequences of this static mindset is the tendency to avoid challenges, which are seen as risky ventures, and which can reveal inadequacies and a pressing need for change and adaptation. Faced with obstacles, people with a static mentality tend to run away, be on the defensive, give up easily and immunize themselves to criticism, even when it is constructive. Today, thinking in that limited way can bring great harm.

On the other hand, the courage to dare and face new situations is typical of those with a dynamic mindset, a mentality that tends to personal growth and development, whose most striking characteristic is the desire to learn. Challenges are seen as opportunities for learning. Making mistakes means discovering something new that was previously unknown and constant efforts are needed towards progress. Criticism is considered a valuable hint, and the success of others is an example to be imitated. Thus, a dynamic mindset has everything to do with a digital mindset.

This new “world order” needs to be better understood within Dentistry in order to make good professionals even better, aided by new technologies, without the opposite occurring, i.e., without professionals limited by a static mentality being able to serve only as cheap labor of mega corporations that largely exploit business opportunities in Dentistry. Thus, the “brands” must also accept that we live in a new world of responsibility, where ethics, corporate citizenship, service and the quality of their products are under constant scrutiny. We can no longer let large corporations hide their dirty laundry behind a very well structured and millionaire marketing, or soon we will have a subcategory of Dental Surgeons, – professionals trained in higher education courses, but who will act as “technicians in Dentistry” and I’m not talking about technicians in oral health, or technicians in dentures, professions that already exist and are part of the oral health team. This way, we are always alert to the importance of professional knowledge and experience, reasonability and affectivity, taking into account that the main reason for our profession is the client, not the satisfaction of our ego. Working with this digital mindset requires a certain effort, but can transform our practice into an experience empowered by new technologies, in synergy with a world full of opportunities and challenges like the one we are living in.

Dr. Mauricio Accorsi
Scientific Director – DDS Booklet – Digital Dentistry in Science

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