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Practice Growth and the Future

As I sit down to write this column, I find myself influenced by three major inspirations. The first is this issue's conclusion of our three-part series on the 2013 JCO Orthodontic Practice Study. The second is my attendance at Ormco's annual Damon Forum in January. Last is a fascinating visit I made recently to the laboratory of one of my patients, an associate professor of industrial and systems engineering at the University of Southern California's Viterbi School of Engineering. As disparate as these three topics might seem,they have a common theme that portends an intriguing future for orthodontists.

To begin with, I am delighted to see that the gloom reflected in the previous two Practice Studies seems to have lifted. Most of the indicators of overall practice growth and profitability are finally on the uptick. After four years of little or no growth, responding orthodontists posted their highest median income figures since our first survey in 1981. Practically all other indicators of financial viability are equally encouraging across most regions of the country. The overall economy has improved over the past few years, and it seems realistic to think that the positive trend we observe in our current Practice Study will continue, regardless of the Wall Street glitches of early 2014.

Two seemingly minor findings brought to light in this Study should not be overlooked. First of all, the average age of our respondents was lower than it has been in the recent past. Admittedly, this could be due to a selection bias, considering that the present survey was the first we have administered online. Although we are unable to test this hypothesis, we might presume that younger doctors are more familiar with the Internet and are, therefore, more likely to respond to Internet-based research. On the other hand, it certainly seems plausible that our specialty is getting younger overall. This segues nicely into the other finding: that orthodontists are implementing computer technology into their practices on an ever-increasing basis. The majority of orthodontists now in practice grew up in a world that is much more reliant on computers than any generation before it has been. In fact, that technophilia is the theme I saw running through the inspirations for this Editor's Corner.

The second subject that I listed above was the 2014 Damon Forum, held in Phoenix this year. I always enjoy the Forum, even though I do not personally use self-ligating brackets, simply because it has become a showcase of new technology. Despite my admittedly old-fogey conservatism when it comes to clinical orthodontics, after attending this year's event, I have to concede that the "digital practice" is here to stay.

Intraoral scanners will, more than likely, eliminate the use of impressions--whether alginate, polyvinyl siloxane, or polyether--within the next few years. Digital technology, as demonstrated at the Forum, is becoming more and more user-friendly and affordable. Interfaces of intraoral scanners with digital cephalometrics and with programs for the fabrication of appliances such as aligners are very much a reality. Everything from solid models to retainers to patient-specific brackets with customized prescriptions dictated by the doctor can now be made economically without the need for old-fashioned impressions or printed radiographs and photographs.

Shortly after I returned from Phoenix, I debanded the patient mentioned in the first paragraph. He is a bright guy with a keen mind for engineering, and his research is at the cutting edge of computer-assisted manufacturing. Since there is an ongoing push at our university for interdisciplinary study, particularly if that research has market potential, we both thought we would enjoy some kind of collaboration. And because my patient had read about possible dental and orthodontic applications for three-dimensional printing, he invited me over to see his laboratory. I was immediately excited about what his doctoral students showed me, and I came away from that meeting bubbling with new ideas that might have been branded as lunatic fringe just five years ago. I'm looking forward with great enthusiasm to getting a few of these projects off the ground.

Prior to the time frame covered by the latest JCO Practice Study, the future seemed rather bleak. Given the promising results of our current survey and these exciting new trends in orthodontic technology,however, I could not imagine a more propitious time to be part of this greatest of all professions.



Dr. Keim is Editor of JCO; e-mail: editor@jco-online.com.

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