Orthotown August 2018 - 9

Advancements take time and need to go through a
learning curve, extending for years at times, to arrive
at consensus diagnosis and treatment. It's only with
a few breaking out of the status quo that new techniques
and treatments are delivered.

While not new to dentistry, the static
and unyielding visualization of plaster on the
table was replaced with the more dynamic
measurements of articulated casts in the
1970s and '80s. Diagnosis from centric
relation was thought to be the solution to
occlusal problems and would make you a
better orthodontist. Yet these new casts
were able to show detailed intercuspal
relationships, shifting bites and predicted
interferences during excursive movement.
Many (including myself) used this extra
piece of information to design treatment
around interincisal angles, functional occlusion and, of course, the desired mutually
protected occlusal schemes.
Surgical predictions were done on these
same casts to visualize and set up the casts to
the patients' ideal occlusal positions. (Not all
felt this way, though. The legendary disputes
between Roth and Rinchuse brought heated
arguments and conflict.)
Stethoscopes and Doppler devices were
popular during the 1980s and '90s to
identify early signs of temporomandibular
dysfunction. These devices became mainstays
in diagnosis rooms, and patients were
impressed that a new finding was discovered
by the dentist or orthodontist that could
justify treatment for noisy joints-often not
accompanied by any other disease process.
The Sectograph was an elaborate X-ray
machine that led to many patients having
their noisy joints evaluated for position of the
condyle, often leading to elaborate, extensive
and, need I mention, expensive treatment
to properly position condyles in the fossa.
With X-ray doses off the charts by

today's standards, we found
ourselves defending ourselves
not only to patients but also to
attorneys, because this rarely used
machine was able to seemingly quantify
TM joint position and disease.
The MRI X-ray utilized at the turn
of the century put to rest many of these
treatment justifications when we finally
learned that TMD is a musculoskeletal
problem with joint laxity, disc dislocation
and associated muscular imbalance. These
signs and symptoms were found to be
similar to other musculoskeletal problems
in the body, and treatments adopted at the
time mirrored various treatments for other
parts of the body-namely physical therapy,
medication and other treatments utilized
for orthopedic conditions.
EMG and Myomonitor were offshoots
of the TMJ diagnostic phase. Electronic
devices were used to pulse the masticatory
muscles into a proper position, leading
many treatments into bite opening and
repositioning of the "bite."
Intraoral scanning with cameras and
imaging have become the mainstays of general
dental offices as well as specialty locations.
Whether it's to show patients cracked or
chipped teeth or to diagnose occlusal wear
and tear, these electronic images of dentition
certainly led to more complete care. Not
only can clinicians visualize what needs to
be done but patients are also able to see and
comprehend proposed treatment.
Cerec scanning and milling devices
have taken the general dental field by
storm. Adopted by many but scorned by

others, it's hard to deny that
same-day scanning and delivery
of restorations have revolutionized
the dental practice. For many, this
six-figure piece of equipment is a necessary
fixture in a new or existing practice, allowing
for diagnosis, creation and production of
restorations in record time.

Tomorrow's tech
Which leads us back to CBCT and
the current state of orthodontics. What
I have attempted to describe in this brief,
unscientific and somewhat documented
review of history is the advancements of
our profession through the careful use
of improved diagnostic instrumentation.
Some of these technologies may have been
overutilized at the outset or met with
skepticism during their slow rise to credibility.
I do believe that all of the devices
mentioned contributed to better care of
patients at one time or another. It's plain to
see that advancements take time and need
to go through a learning curve, extending
for years at times, to arrive at consensus
diagnosis and treatment. It's only with a
few breaking out of the status quo that new
techniques and treatments are delivered.
So, let's not be so quick to judge or
make conclusions on the place of CBCT in
modern-day orthodontics. Give it time, and
like so many other pieces of technology that
were once new to the profession, it too will
prevail as a smart and practical choice for our
patients-especially our youngest ones. ■

orthotown.com \\ JULY/AUGUST 2018

9
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Table of Contents for the Digital Edition of Orthotown August 2018
