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Embrace Progress: Changes Galore by Daniel Grob, DDS, MS, Editorial Director

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Technology and orthodontics
Those of us who have been practicing orthodontics for a long time no doubt occasionally feel our heads are spinning from all of the innovations that have appeared over the past several years.

The digital revolution started in the early 1980s with the emergence of the desktop computer, floppy disks and MS-DOS command prompts. Packaged as a calculator in a box, this early computer cost tens of thousands of dollars. Offices ponied up in order to more accurately count the money and—if they were truly adventurous—schedule patients.

Imaging came later, with the various aids for tracing cephalometric X-rays and systematically overlapping them for superimposition purposes. Charlie Tweed, who was rumored to trace X-rays late into the night in the back of his Tucson, Arizona office, would be proud. (But knowing him, he would have spent the increase in his available free time to labor more in the profession he loved.)

Digital X-rays were next, their adoption slow due to installation costs and the necessity of converting offices to new servers with advanced software. Many practitioners used work-arounds, including scanning film sensors into computer software. However, the overall adoption took time to catch on.

I think it is safe to say that these days, no new offices are built or remodeled without installing cabling provisions in every nook and cranny to accommodate the present and the future of digital convergence.

Getting better
Aided by digital advances in other medical specialties, diagnosis of occlusion and temporomandibular disorders became a bit easier during the 1990s. (Notice I did not say that they were any easier to treat.) CAT scans and MRI allowed us to visualize the disc, or the lack thereof, and put to rest (for most of us) the cause of TMD.

The problems remain, but recognizing that this dilemma is a medical and physical- therapy issue allows us to focus on more concrete, specific treatment of the dentition.

Articulation became the topic of discussion with the Rinchuse/Roth disagreements that spanned several years. There is still no clear-cut solution. More sophisticated diagnoses from the articulation, and advances in X-ray technology, led to more treatment and procedures.

Various surgical procedures introduced in the early 20th century were perfected, and many new ones added with the advent of mini plates and screws. During this era, insurance helped defray the cost of these procedures, leading to rapid advances in the number and types of offered procedures.

This golden era of surgery was short-lived, thanks to the restructuring of medical insurance plans that only included the procedures to a small degree, or wrote them out of major medical insurance plans altogether.

The first truly disruptive technology that I can recall on the clinical side of orthodontics would be aligner therapy. Tracing its roots to digital technology, this therapy gives non-orthodontists the ability to completely change the face of our profession, and its impact has been staggering.

I have documented my transformation on this topic to anyone who had an ear, whether it was patients, other doctors or even Invisalign representatives. The fact is that clear-aligner therapy benefitted from the digital revolution and is the first dramatic product to offer a distinctly different method of treatment as a result of technological advances. This represents the most significant advancement, in my opinion!

If I were to ask you what you think is the most significant advancement in the field of orthodontics during the past 50 years or so, what would you say? If you said colored rubber bands or elastic ties, you need to keep reading. I daresay that adhesion dentistry has transformed and brought more treatment to a larger segment of the population, while changing the way we practice, than any other advancement.

My experience shows that today, almost 50 years since first being offered orthodontic care, the cost to patients has hardly kept up with other medical procedures. The percentage of disposable income out of patients' pockets for orthodontic care is nowhere near what it was in the 1950s and 1960s. Heck, it has changed the face of the general dental practice as well, and we are constantly reaping the benefits from researchers in their field.

Some facts and thank-yous
For more than 50 years, orthodontists have benefitted from etching enamel and applying a resin bonding agent. First proposed by Dr. Michael Buonocore in the 1950s, the procedure was subsequently perfected. Widespread use was adopted in the 1970s. I can attest to this transformation because my orthodontic program was still allowing us—and requiring—a fully banded case in the early 1980s. (By the way, that was the only case I treated in a conventional pinched-band manner.)

With a bond failure rate well below 5 percent, it can safely be said that bonding, with its attendant chemical and light-curing initiators, is here to stay.

We now routinely bond practically all teeth and utilize bonding material for bite opening as an adjunct to treatment of malocclusion. Also, clear-aligner therapy has been enhanced through the use of bonded attachments, thus moving the bar higher for completed treatment and excellence of results.

So to the inventors of modern-day adhesion dentistry, here's a shout out of thanks for all of the fringe benefits for the practice of orthodontics. To the manufacturers of modern-day resins and bonding agents, thanks for continuing to perfect the procedures, and creating smaller, simpler and less time-consuming light-curing devices that encourage precision of the bonding process.

And to the digital-delivery device manufacturers, our thanks for the continuing improvements in indirect bonding procedures that, dare I say, will become more and more prevalent as ease of use and digital convergence become commonplace.

As all these changes in technology and products occur, one thing remains consistent: the importance of trusting yourself to decide which changes will benefit your practice.

In the midst of change, you are the constant. Your skills and education can carry you through any changes the industry sees and will give you the wisdom to adopt the technology and products you need to improve your practice—and the wisdom to ignore anything that won't.


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September 2025
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