Progress and Tradition

The graying of the profession is a trend that was pre­dicted in the 1994 graduate education survey, where it was noted that the average age of orthodontic faculty members had steadily increased since the early 1980s. By the 1998 survey, the average age of orthodontic profes­sors had plummeted. The authors commented, ". . . dis­cussed in the report on the 1994 survey was the 'graying' of our full-time and part-time faculty. The numbers pre­sented herein seem to indicate that those who were gray­ing in 1994 are now either dead or retired. The over-all experience level of the orthodontic professoriate has noticeably declined." The trend in private practice will, inevitably, mirror that seen in academics. The average age of practicing orthodontists can only go up for so long. Eventually, most likely sometime in the next 10 years, the younger members of our specialty will become the majority stakeholders.

What are we to make of the changing face of our profession? It seems reasonable to assume that the trend toward a more technologically oriented practice, commented on so often in these pages, will continue. This is illustrated nicely in the Treatment Study by the marked increase in the use of computer­ized imaging, tracing, and analysis over the last six years. Fully 65% of all practices now rou­tinely use digital photography, a technology that was too new even to be included in the previous survey. Similarly, digital radiography is now rou­tinely employed by about 8% of practices. This is a considerable number, given the high cost of implementing this technology in a solo practice. The movement toward computer-assisted diag­nosis and treatment planning seems inexorable.

The "progressive" movement is also noted in the shifting tides of orthodontic materials. About 75% of all respondents now routinely use photo-cured bonding cement, a material that was not even considered in the 1986 Study. Another new technology that has caught on big in short order is the use of self-etching primers. These materials, unheard of only five years ago, are now used routinely in almost one-fourth of all practices. The movement toward increasing use of nickel titanium archwires--both the "classic" and thermally activated alloys--continues. The use of more traditional initial archwires such as braided steel and titanium molybdenum alloys is in a steady decline. The overall trend seems to be toward nickel titanium alloys for starting cases and stainless steel for finishing.

Perhaps out of individual bias, I had expect­ed to see an increasing shift toward the use of preprogrammed appliances. I was surprised to see instead that there has been a near doubling in the routine use of standard edgewise appliances over the last six years, bucking the previous trend toward "straightwire" appliances. It seems that this particular finding runs contrary to the gener­al advance of technology. One would expect practitioners who rely more and more on com­puters to assist with diagnosis and treatment planning, and who use the most technologically advanced materials such as photocured bonding agents and thermally activated archwires, to rely more heavily on preprogrammed appliances rather than resorting to the nearly 125-year-old technology of edgewise wire bending. What gives?

Some might think that respondents simply misunderstood the meaning of "standard edge­wise" and included preprogrammed appliances in their personal definition of that term, but I seriously doubt that particular explanation. Most, if not all, of the orthodontists I know are well aware of the differences between the two appli­ance philosophies. If this is not simply a misun­derstanding on the part of the respondents, or a quirk resulting from a change in the question­naire, what is it? My guess is that it reflects a growing concern for quality, among both the more senior members of our specialty--the ones who are "graying"--and their younger counter­parts who are about to assume majority status. Preprogrammed appliances do a wonderful job of getting us into the ballpark, but for the fine ­tuning of both esthetics and occlusion, there is no substitute for wire-bending skills. I would like to think that the development of these skills remains a high priority as our specialty changes.

Future issues of JCO will explore the more subtle findings of the current survey of diagnosis and treatment procedures. We will take a little closer look at specific categories of data and the conclusions to which that data lead us. Stay tuned; there are more surprises to come.