What constitutes right in itself may harbor many wrong things. If Shakespeare’s world-renowned saying “Nothing is either good or bad, but thinking makes it so” is applied to the branch of orthodontics, it literally blends itself very well with how the field of orthodontics is progressing.

In the era of evidence-based dentistry, everyone seeks the solution through the published data, for that matter even the clinical reports or the successful clinical outcomes. So what constituted a dogma once is a naked truth now or what was a naked truth then is a mere dogma now. The point which I am going to propose now may seem absurd to many, confusing to some and total scribble to the others. Nonetheless, I would like to make it a point to ponder upon.

1. We all grew up with certain ideologies as a postgraduate student of orthodontics, to open/create the space between the two teeth, pioneers have advised the use of open coil spring in the higher gauge wire at least the main archwire should be .016” Stainless steel.¹ Now you can use coil spring in the .016” copper Ni-Ti wire.

2. Expand the mandibular arch after the growth you will end up in the relapsed case.² These days one can expand both the arches even after the growth period has ceased and you don’t encounter a relapse unless you have a permanent retainer of braided wires. Although we lack the long-term studies to claim the same.

3. The concept of individual arch form has long gone into the winds.³Why? Because we are using the copper NiTi wires which don’t have the arch form of the averagely seeming human beings.

Correction of crowding is done by bonding the lower gauge NiTi wire directly to the lingual surface of teeth which seems so unrealistic to believe. Gone with the winds are the concepts of enamel damage, tip, & torque, etc.⁴

4. Pre-surgical orthodontics followed by surgical orthodontics and then post-surgical orthodontics was the standard protocol. But now surgery first is gaining the speed to beat the earlier concept. So, where is the concept of exaggerating the malocclusion, decompensating the dental compensation, etc.? However, meticulous case selection which is clearly indicated for the surgery first approach can reduce the treatment time drastically.⁵

5. High anchorage case -use the headgears; with the advent of implants each and every case turns out to be an absolute anchorage case and the results of course are excellent. This of course is an advantage that was needed for the benefit of the patients who were non-compliant and it avoids the inconvenience of using the extraoral appliance.⁶

6. Where were we wrong then? In diagnosing the case or is not considering the growth changes; both negative as well as the positive growth or treatment mechanics. The answer is a difficult one and the solution is simple, shouldn’t one use the absolute anchorage for the absolutely necessary cases?

7. Crowded cases with the requirement of individual canine retraction-use Mulligan’s bypass archwire to retract the canine, now we can do the same using lace backs. But, are the results the same? According to a published study, the mulligan arch produced more controlled canine movement than the active lace backs.⁷

8. In the zeal of doing something new, biomechanics and physiology should not be ignored.  Mere production of the results should not matter more than the means of how they are produced. A good example is the treatment of class II div 2 malocclusions; it can be treated using the simple NiTi wire or by the utility archwire or by using an implant-supported archwire. All three are equally capable of producing the results but which one is most beneficial?⁸

9. Class I Molar and Canine relationship was a must. Now, the Class II molar and class III molar relationships are fine.

10. The Management graduate student proposed clear aligners and is gaining popularity. Earlier the same clear positioners were used as retention appliances. Agreed that material availability must have played the role in the rise of the popularity of the clear aligners. Both aligners and pre-adjusted appliances are equally good in correcting the malocclusion, however, when it comes to torque control and the occlusal contact establishment, pre-adjusted edgewise appliances score better.⁹

11. For that matter lingual orthodontics was practiced in selected cases. But the present concept does not support this dogma of limitation in the case selection for the lingual orthodontics.¹⁰

12. The concept of the envelope of discrepancy which was religiously taught in every institution is ever-changing with every new invention in orthodontics. Orthodontic treatment using bone screw has added a new dimension to the envelope of discrepancy. Now surgical orthodontic cases can be handled pretty well-using bone screws.¹¹

13. The irony faced by everyone in the teaching profession is what to teach the Postgraduate student. Should we teach him/her the existing ever-changing, two-faced, instant-based orthodontics or the orthodontics which has withstood the testing of time and has proven their worth in the long run?

14. The enigma of social six for the earlier generation is rather an unsolvable puzzle. For them, the complete strap-up followed by the mutually protected occlusion is the kudos performance. If social six is a valid thing in the lingual orthodontic system, why can’t it be the same for the buccal appliance?¹²

15. If the result-oriented conclusions are the ones that make the impression, then the vigorously opposed veneering of the maloccluded teeth should be praised for producing the same results within no time.

With so much so to evidence-based dentistry, what we are witnessing right now is the decline in the quality of the publication.¹³ With the compulsion of article publication people are coming up with scrap data that neither possess validity nor reliability. And such publication if taken into account for evidence-based dentistry, one can imagine the quality of evidence we possess. Because there is a handful of people who are really interested in such kind of exclusive academic activity.

16. Researches which are going on in the postgraduate institution are the mere replication of the previously published research, thus giving way to the “cut and paste or copy and paste” culture and most of the people don’t even have objection to that.¹⁴ If this is continued how are we going to sow the seed of inquisitiveness in the minds of these budding orthodontists?

17. Research methodology is a topic that is a must for post-graduate students. It is necessary to build the enthusiasm in the upcoming generation to give due importance to this topic for better scientific research.

18. Does all this, ring the bell in one mind? If not, it is high time and the wakeup call has to be given for each orthodontist to decide where they want to head. Obviously, we have forked road, the one which is most traveled and worn out and the other which is least traveled and least explored. Like the famous poet Robert Frost, one can choose the path which is least traveled and make all the possible differences.

19. our own Bachelor dental surgeons practicing orthodontics, the other group of orthodontists who have successfully completed their private orthodontic training, the group of an orthodontist who holds the certified course from the foreign delegates visiting India, learned orthodontist coming from Russia, orthodontic diploma holders and we the master degree holders in the branch of orthodontia all have to share this burden of the changing tide to come out victoriously with what seems right at this point of time.

So where are we? Are we there at the verge of the sinking of the basic ideologies or the physiology or at the dawn of the era of the ideologies which need the support of the older generation and the embrace of the new generation, most of all the “time”; If the new tide of ideologies and the philosophies can withstand the rough storms of the time, then they are here to stay.

References

1. Saklecha B, Tekale PD, Sonawane SV, Shah PR, Patil HA. A Speedy Yet Simple Tip to Align Imbricated Anterior Teeth. J Clin of Diagn Res.2017; 11(5): ZH01-ZH02. https://www.doi.org/10.7860/JCDR/2017/26291/9858.
   CrossRef
2. Littlewood, S.J., Kandasamy, S. Huang, G. (2017) Retention and relapse in clinical practice. Australian Dental Journal, 62: S1 51– 57. DOI: 10.1111/adj.12475.
   CrossRef
3. Saffar A, Mirhashemi A, Noroozi H, Ghadirian H, Hosseinzadeh Nik T. An overview on dental arch form and different concepts on arch coordination in orthodontics. Indo-Iranian Journal 2011; 6: 46-57.
4. https://www.zerodonto.com/en/2009/05/lingual-orthodontics-without-brackets-active-retainers/.
5. Choi, DS., Garagiola, U, Kim, SG. Current status of the surgery-first approach (part I): concepts and orthodontic protocols. Maxillofac Plast Reconstr Surg 2019; 41. https://doi.org/10.1186/s40902-019-0194-4.
   CrossRef
6. Rastogi N, Kumar D, Bansal A. The role of implants in orthodontics. J Dent Implant 2011; 1:86-92.
   CrossRef
7. Chetan S, Gopal Krishna BR, Shamnur N, Singhvi A. Individual canine retraction: RCT comparing Mulligan bypasses arch and Active laceback ligatures. IOSR Journal of Dental and Medical Sciences 2014; 13: 34-37.
   CrossRef
8. Kun-Feng L, Yu-Chuan T, Hong-Po C, Szu-Ting C. Orthodontic Correction of Class II Division 2 Malocclusion. Taiwanese Journal of Orthodontics 2018; 30: 3. DOI: 10.30036/TJO.201810_31(3).0002.
9. Ke Y, Zhu Y, Zhu M. A comparison of treatment effectiveness between the clear aligner and fixed appliance therapies. BMC Oral Health. 2019;19(1):24. doi:10.1186/s12903-018-0695-z).
   CrossRef
10. Huh HH, Chaudhry K, Stevens R, Subramani K. Practice of lingual orthodontics and practitioners' opinion and experience with lingual braces in the United States. J Clin Exp Dent. 2021;13(8): e789-e794. doi:10.4317/jced.58328.
    CrossRef
11. Ono T. Should the "envelope of discrepancy" be revised in the era of three-dimensional imaging? J World Fed Orthod. 2020 Oct;9(3S): S59-S66. DOI: 10.1016/j.ejwf.2020.08.009.
    CrossRef
12. Shetty A. Social 6 smile with fixed braces. EuroSciCon Conference on Dental & Dental Hygiene March 26-27, 2018 Edinburgh, Scotland.
13. Sarewitz, D. The pressure to publish pushes down quality. Nature 2016; 533; 147. https://doi.org/10.1038/533147a.
    CrossRef
14. Siva, N. Plagiarism: cutting out cut-and-paste jobs. Nat Rev Urol. 2008;5: 351. https://doi.org/10.1038/ncpuro1169.
    CrossRef