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Straight Talk: Paradigm Shifts in Orthodontics Ken Fischer, DDS

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by Ken Fischer, DDS

When I began practicing orthodontics 35 years ago, our profession had just "turned a corner" into a new era in the practice of orthodontics. Customized brackets, bonding brackets to teeth, plastic brackets, functional appliances, computerized cephalometrics, and preformed wires were replacing pre-sized bands, straight sections of wire, welding brackets to bands and headgear as the standard tools of our trade. Today, computer designed and fabricated customized appliances, CBCT scanning, lasers, mini-screws, digital imagery, advances in metallurgy, computerized practice management programs, and even social networking are changing the way we treat our patients.

This is not intended to be a historical review, however, the above emphasizes that things do change, and will continue to change. In the not-so-distant future, not only will the tools we use be different, but the appearance of our profession will be altered. The orthodontist will no longer be seen as an educated, highly skilled artisan respected for limiting their practice to their ability to properly diagnose and treat complicated malocclusions. The image will be of a dental technician responding to a patient's desire to straighten the appearance of their front teeth in order to improve their aesthetics.

This "new-age tooth straightener" will perform an intraoral scan and order customized appliances fabricated to move the teeth of each individual patient. Or, the treatment may simply involve applying tooth-colored plastic veneers, singly or in groups, to make the crooked teeth "look" straight. In the future, the orthodontic technician will be "technique trained" instead of "science educated." The term "specialist" will not be connected to "orthodontist" anymore; any dental graduate will be able to offer all available procedures, primary and adjunctive, for satisfying a patient's desire for the appearance of straight teeth. These adjunctive procedures will include gingival recontouring, restorations for missing teeth, placing miniscrews as temporary "implants," and decalcification restoration.

The dental consumers are becoming more egocentric and demanding immediate satisfaction of their needs; they want their teeth to appear straight now, not in two years. They want to accomplish these improvements painlessly, simply and cheaply. If the dentist does not refer them to a specialist to acquire these procedures, they don't care, nor do they know what difference the referral would make. When given the choice, these narcissistic patients will reject orthopedic treatment, full Class II correction, optimum occlusion goals and treatment plans taking longer than 12-15 months to complete.

Take a look around you at the orthodontists you now know; look at the qualities that make them the people you have aspired to resemble; consider their education, training, dedication to ethical principles, and professionalism. Sadly, you won't see these qualities in the next generation of those we used to call "orthodontists." The transmogrification might not occur in the next 10 years, but it will happen. The paradigm as we know it today will shift. You can depend on that.
Author’s Bio
Dr. Ken Fischer graduated from UMKC for dentistry and UCLA for orthodontics. He is in private practice but devotes considerable time to education and professional service to orthodontics. He has been published in several orthodontic publications and is the forensic odontologist for the Orange County Sheriff's Department. Dr. Fischer is an original member of the Align Alpha Group and is on the Clinical Advisory Board. He is also a member of the Orthotown Magazine Editorial Advisory Board.
Orthotown Magazine
September 2025
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