Orthotown August 2018 - 8

embrace progress

History's Lesson in Ortho
Technology Is a Patient One
Now-common methods of treatment planning were once met
with skepticism and hesitation, so don't write off CBCT so easily
by Dan Grob, DDS, MS, editorial director, Orthotown magazine

O

ne of my recent columns on
CBCT generated many comments
about my call for a new vision for
orthodontics. I had stated that
the introduction of CBCT and its ability
to measure airway and trace its dimensional
change during treatment provided important
advantages when treating young patients as
well as adults.
Many comments suggested that my
intention was focused on financial concerns
rather than the care provided, and that this
was not always in a patient's best interest.
Others thought that I focused on unneeded
services driven by measurements, much
like cephalometrics, which can push one
into treatment for protrusion or crowding.
My call to action based on technology
or observation is not new. I will agree that
early adoption on occasion could lead to
overtreatment-but that concern is not
enough to justify avoiding the newest
technology we have at our disposal.
The topic of Phase I orthodontics remains
controversial. I provide Phase I orthodontics
in a small percentage of my patients. The
conventional thinking was that crooked
teeth at a young age were common, and
eventually we'd fi x them quite well, in one
uninterrupted phase, at a later date. This
idea was supported in literature without too
much controversy. Presently, visualization
of airway and nasal cavities provides an
important piece of information that can be
used for diagnosing the need or advantage
of treatment and the progression of care, as
well as the final outcome.
Advanced diagnostic methods often lead

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JULY/AUGUST 2018 // orthotown.com

to advanced treatments. One need only look
at history-not a detailed, referenced paper,
by the way-to see that many diagnostic
tools have opened the door to treatments
that, over time, provided advanced care.
These diagnostic tools were used to justify
and plan orthodontics for crowding and
stability, TM disorders and occlusal therapy.

Yesterday's tech
Let's start with the cephalometer. After
basing treatment on diagnostic casts for years,
the introduction of the cephalometer gave
us measurements to work from that allowed
for a complete diagnostic picture. We could
now quantify the findings like protrusion,
retrusion and position of incisors, which led
practitioners to initiate treatment based on
averages, means and goals.
The same cephalometer allowed for
progression measurements and the ability
to check on stability and the final outcome.
As many evaluation analyses exist as there
are doctors to invent them. (Ever heard of
the Grob analysis?) Diagnosis of the sagittal
problem was obviously the main point of the
various analyses, as well as position of teeth.
The panoramic X-ray allowed for early
visualization of developing teeth, possible
impaction and, of course, extra or missing
teeth. Tooth positions and root parallelism
came into view.
The question of third molars was
addressed as well as, in many situations,
condylar health. Treatments were often
started with this X-ray with the goal of
making room, allowing for exfoliation and
avoiding impaction.
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Table of Contents for the Digital Edition of Orthotown August 2018
