THE EDITOR'S CORNER
How many orthodontists, including myself, have dismissed the whole idea of computerized orthodontic analysis with the statement--"I don't treat my patients to averages". It is true enough that some of us did not and do not, but that most of us did and do. Nor is it such a mark of distinction that some of us did not, because included here are those who would never, ever extract. If an orthodontist were always to keep the lower first molars where he finds them and arrange the full complement of teeth from them, there are no considerations of treating to averages. Everyone else makes a conscious or unconscious judgment about where his treatment is putting the teeth and what the face will be like when treatment is done. If the patient starts out in Class II or Class III, what is the orthodontist doing but making those teeth and that face less Class II or Class III? And, what is that but treating to a more average, more socially acceptable, more expected appearance? So, we ought to abandon the security blanket of "I don't treat my patients to averages".
One of the deterrents to orthodontists embracing computerization is that it is in a rather confusing state at the present time. Maybe not to people who are working at it, but to those who may, for example, sit and listen to a panel discussion on "Computerized Cephalometrics". At risk of having my own ignorance further confuse the subject, let me try to create a thumbnail sketch of what seems to me to be going on.
There are various people in the country who have become orthodontic bankers. They maintain computer banks into which is fed orthodontic information. Part of the confusion is that the information they feed in is different and the use to which that information is put is different. Dr. Walker at Michigan is feeding orthodontic cases into his bank with the idea that a student may go to the bank and find the case in the bank that most closely resembles a case he is diagnosing, to see how that case grew and/or was treated and what the results were. Or, as an exercise, he can request a certain case from the computer, diagnose it and then have the computer tell him how it was treated. He may also learn how the case would have turned out if treated according to his diagnosis.
Dr. Sassouni has a bank into which treated orthodontic cases are similarly fed according to Dr. Sassouni's cephalometric criteria. His aim is to subject a new case to these same criteria and ask the bank to come up with a diagnosis and treatment plan.
Dr. Ricketts' ideas have been incorporated into the Rocky Mountain Data Systems bank which has been fed information on treated and untreated cases and has stocked data on growth, ethnic norms and appliance biases. It has become associated with the term "growth prediction" which has confused people about its role. Growth prediction has been one of Dr. Ricketts' abiding interests and contributions to orthodontic research; and growth prediction has proven to be a valuable tool to permit the separation of the effects of growth from those of orthodontic treatment and to picture for the orthodontist what the patient will look like some time down the road with treatment and without treatment. But, there is more than growth prediction involved. There is pretreatment and post-treatment analysis to identify what the treatment alternatives may be, what the potentials of a particular case may be and were they achieved in treatment. This is determined not strictly according to the average for age, race or other factors, but according to such individualizing factors as E-line and lower incisor to APo and a whole list of limitations which the individual orthodontist can give to the computer as his guidelines in diagnosis and treatment planning. Then the computer can tell him what his alternatives and options are in treatment, what his percentages are. He can then finalize his plans, knowing the odds.
Now, Dr. Johnston says that the computer doesn't do anything that a person could not do with his own pencil and that computerization has made things unnecessarily complicated. He may be correct. But, if the cost of doing this work at the bank is comparable to or less than what it costs in time and will accomplish the same thing or better, then you have to give strong consideration to the bank. There was once no need for the wheel, because one could walk to where he wanted to go. The wheel was adopted when one wanted to go a little farther than he cared to walk. We may be in that situation with computerization in orthodontics.
I have undoubtedly oversimplified and done violence to the ideas of the men mentioned, and I offer them more than equal time. This has been what I got from listening to them. JCO intends in the future to present material that will inform more fully about the capabilities of computers in orthodontic diagnosis, treatment planning and practice administration.
