THE EDITOR'S CORNER
"I don't care whether I travel by car, train, bicycle or pogo stick. As long as I have these maps here and know how to read them, I'll get where I want to go. The vehicle I use is the least important part of the trip."
Does that sound like some orthodontists you know? The argument about the relative importance of treatment planning and treatment mechanics is almost as bad as the one on heredity versus environment, and just as fruitless. Anyone who ever treated a case knows that they are both important. And, unless you were an exhibitionist or a masochist, if you knew where you were going and had your choice of vehicles, you'd prefer a car to a pogo stick.
Many orthodontists err in the other direction. Just as soon as anyone comes along with something "better than their present car", they junk the old heap and opt for the better gas mileage and ease of handling of the new one. All of which is a frivolous way of expressing a serious problem. In recent times, we have seen large swings of practitioners from edgewise to Begg to lightwire edgewise.
The next swing in orthodontics may be to straight wire appliances. The idea of building a maximum amount of tooth adjustment into bracket design and positioning, and leaving a minimum amount to archwire design and changes is an attractive one. The seeming simplicity of the idea should gain it many adherents among those who seek to make orthodontic treatment quicker and easier to accomplish. Since that includes all of us, there will be a large population to proselyte from.
As with any swing in adherence to a technique, the bulk of the changers will be those who are not content with their present treatment time and/or treatment results.
The snare and the delusion in all this is the human hope or expectation that we have come upon an automatic appliance. Those of us who can remember Dr. Joe Johnson, one of the great pioneers in orthodontics, will recall that he had an "automatic" appliance that was "foolproof, except in the hands of too big of a fool".
The designers of the current straight wire appliances do not make extravagant claims for them. Indeed, they were the first to point out that these appliances are not automatic; that, frequently, you must make some adjustments in archwires to account for local situations. What they do claim is that they can eliminate a majority of archwire adjustments in a majority of cases.
I am fearful that a potentially good idea is going to be a dismal failure, because of the large number of orthodontists who are attempting to treat cases with light round wires only, with heavier round wires occasionally, with minimal use of auxiliaries with round wires, and with no rectangular archwires.
Control is the name of the game in orthodontics and you have less control with a light round wire than you do with that same wire accompanied by auxiliaries, or with a rectangular wire in an edgewise slot, or with a double wire as in Universal technique. If one were to use only round wires with a straight wire appliance, torque would be juried at best and probably for the most part forgotten. If one were to use light round wires in the edgewise slots, angulation control in a mesiodistal direction would be minimal.
We have a definite disadvantage in orthodontics that treatment takes a long period of time. You can't teach someone the hardware and mechanics and expect that he can take that and apply it to all the cases that he will be called upon to treat. This is true to some extent of all of us. It is especially true of the inexperienced, the untrained, and those trained in one technique. If ever there was a field that required continuing education, orthodontics is it. The emergence of the straight wire appliances should call attention to the fact that this might be a good time to organize a study club in your area or to focus the activity of an existing club on the study of these appliances and to apply some group therapy to the treatment of cases with them. More than an appliance may come of it.
