The winds of change

Abstract

The practice of orthodontics is changing at what appears to be an almost alarming rate. The changes that have occurred during the last 45 plus years, when I first entered orthodontic practice are staggering. Who would have conceived brackets being bonded directly to the enamel surfaces of teeth? At that time, all bands were custom-made from gold strips. Brackets and rotation eyelets were hand-soldered to the bands that were then malleted into position to ensure a snug fit. This, together with the separation of teeth before banding, followed by 8 1-hour appointments a week apart were experiences not particularly relished by patients. Later, stainless steel band material and arches replaced gold. Brackets and eyelets were spot-welded at the office to the steel bands that were still being custom made. Preformed bands sized to fit all teeth subsequently became available, soon to be followed by a variety of brackets prewelded to them. Prescription brackets eliminated second and third order archwire bending. Bonding of brackets directly to teeth was the next revolutionary breakthrough. The more esthetic mono- and polycrystalline brackets, lingual brackets, and advances in orthognathic surgical procedures prompted many adults to seek treatment. Add to this computers in the workplace, in cephalometry and digital photography, and the staffing requirements from perhaps a single chairside assistant to the multistaffed and equipped offices of today, and the contrast from yesteryear becomes even more dramatic. While these evolutionary changes were taking place, there were many episodes of concern by orthodontists, sometimes overly so, about general dentists infringing on their fields of expertise. The most significant period coincided with the dramatic reduction in caries as a consequence of fluoridation causing many generalists to explore other areas of dentistry, one of which was ortho