Embrace Progress: 2020 and the 4th Dimension by Dr. Daniel Grob

Categories: Orthodontics;
Future of Orthodontics 

by Dr. Daniel Grob, DDS, MS, editorial director

As we close out 2020, I thought it would be beneficial to highlight some of the issues that I’ve mentioned in my previous columns. I am thankful for those who email me or comment on the message boards and enjoy the discussions! At Orthotown, we try to stimulate discourse on trending topics based on sound orthodontic principles established throughout the years.


My thoughts on the role of schools and advanced education in the new age of COVID-19, high tuition and lockdowns garnered many comments online.

If we are to remain a profession, there needs to be a role for higher education, with peer-reviewed research, publications and continuing education. Technology and information have been changing and advancing so fast, though, that some legacy training programs are struggling to keep up or educate their residents and interns. There needs to be a private industry—an educational program partnership—to make sure that new specialists are truly fluent in the latest technology, treatment techniques and the associated research that accompanies such advances. The AAO has felt attendance being hampered by corporate and private meetings changing the norms. While these narrowly focused meetings are welcome, they do tend to draw visitors away from the big national conferences.


How do I deal with my general dentist regarding non-extraction treatment? That summarizes a post that I came across on one of our online message boards.

Cosmetic orthodontics is in the news and we must be prepared to address the challenge. While orthodontic care has been in the cosmetic arena for some time, the new emphasis on “smile design” brought on by the advancements in cosmetic dentistry has orthodontists working to perfect their treatment plans to meet the demands of all patients.

One only needs to surf Instagram and cosmetic dentists’ websites to see what patients are looking for: great big smiles (often created in porcelain) that could have been shaped with brackets, wires and aligners. Why are they turning to porcelain? Obviously, patients believe that they can’t get that smile from traditional orthodontics. Now, is that because of the results or the time required to get to the desired finish?

Early treatment

Early treatment has been a controversial topic for years, with the pendulum swinging back and forth for all of my career. (My tenure in the profession spans several decades, so I’ve even seen it swing more than once!)

But early treatment is not just putting braces on young children. The rationale for early treatment and its standards are evolving as we speak. Have you been approached by your patients regarding airway, sleep or arch development appliances? Have you written them off as hoaxes or unscientific treatment?

Anyone who’s practiced for long enough has seen their work and treatment either survive the test of time or collapse for some unknown reason. Orthodontics, after all, is a product of appliances, technology and technique. But as we know, growth and cooperation also play a part that’s almost impossible to predict. It’s more difficult to estimate the amount of success or failure based on variables such as growth, soft tissue and airway influences.

Common themes

When one looks to all of the challenges and the opportunities for change, one sees some common tendencies that may provide the answer.

Orthodontists are based in the common disciplines of space analysis, jaw growth, proportions and the functioning temporomandibular joints. We have convinced ourselves that all treatment must adhere to certain norms and traditions that have been passed down through decades of diagnosis, treatment and evaluation of results.

Many of the newer, nontraditional approaches to treatment, however, don’t worship at the altar of cephalometric norms, static space analysis or articulation on a mechanical machine. But we have no other methods to validate our treatments.

Does anyone belong to study clubs centered on orofacial musculature? Over the past 10–15 years, I’ve been interested in what others say about the importance of the soft tissue surrounding the dentition. (Have we all at least heard of Dr. Melvin Moss?)

There’s also no shortage of opposing views about orofacial musculature: On Orthotown’s message boards, you’ll see plenty of questions, lots of comments—and no conclusions, because we have no methods to measure the success of various suggested therapies for what we perceive to be muscle imbalance of the facial muscles and tongue. Therapy for this type of imbalance also often involves cooperation from the entire family: Parents need to buy in, patients need to practice, and providers need to have a system to deliver the care.

It’s sort of like patients going to the family doctor looking for a device, pill or procedure to address their weight problem, when physicians typically recommend starting with lifestyle changes such as a healthier diet and exercising more.

The fourth dimension

In my experience, face and tongue muscle balance or imbalance is what allows some of the newer therapies and orthodontic treatment plans to work and the same therapies and treatment to fail. (This of course is aided by a proper functioning airway, breathing and sleeping mechanism.)

I move to call this influence the “fourth dimension” of orthodontic diagnosis and treatment. As we move forward, more than lip service needs to be paid to this elusive but important dimension of orthodontic care. Let’s hope that research and education into this topic will help enhance our care.

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