By News Europe / Dental Tribune International

Orthodontic specialist Dr Raffaele Spena runs a private practice in Naples in Italy and is a well-known speaker in the field. Ahead of this year’s congress of the European Orthodontic Society (EOS) in Montreux, Dental Tribune Online had the opportunity to speak with him about his EOS lecture, which will address a highly debated topic in the field right now: approaching tooth movement with conflicting priorities.

Could you briefly summarise your EOS lecture, “Fast, efficient or comfortable: How do you desire tooth movement for your patients?”, for our readers?
My lecture, in the limited time I have, will try to address some aspects of a hot topic in orthodontics today. Speed, acceleration and reduced treatment time have become an increasing focus in advertising, literature and lectures. These are what patients want from us. Can we honestly offer these? How? Can fast treatments be delivered without waiving the quality of the end result?

The title of your lecture refers to different priorities in addressing tooth movement. Which approach is dominating orthodontics right now?
We have to differentiate between what patients desire and what orthodontists generally wish to achieve. Patients request short, aesthetic and non-extraction treatments, possibly with little effort on their part. Orthodontists strive for standardised, efficient and minimally invasive appliances and procedures. In routine “simple” cases, it may be relatively easy to satisfy both the patient and the orthodontist. In complex, unusual and unpredictable cases, we still have difficulties and need to work hard in diagnosis and planning proper treatment and biomechanics.

It seems that the specialty is currently being propelled by promises of faster and easier tooth movement. In your opinion, is this trend primarily patient-driven or is this just the spirit of our time?
I think that this trend is primarily related to unscrupulous advertising by some companies and clinicians. There is a constant effort to impress patients with “revolutionary” appliances and procedures. Unbiased scientific and clinical studies are greatly needed, but they are not easy to carry out.

Has this development come at a cost?
The risk is that patients may receive poor, non-satisfying, unstable treatments. Moreover, young, inexpert dentists may start delivering treatments that are unable to fully accomplish. The entire profession will pay in terms of respectability and reliability.

What are the most important trends that have influenced the field in recent years, and what have the consequences been?
This question requires a very long, complex answer. I will just mention 3-D imaging for diagnosis and treatment planning, mini-screws for skeletal anchorage, self-ligating brackets and associated archwires, clear aligners and surgical procedures—from surgery first to alveolar corticotomy. They have deeply influenced modern orthodontics.

We still need further scientific information to define indications, benefits, contra-indications, and risks of their abuse and misuse. The good and the bad of our profession is that most likely there will never be a final unique answer because there may be one diagnosis, but there are still many roads that lead to Rome: a clinician takes the one he or she prefers according to his or her education, experience and actual need. We all know that the shortest route is not necessarily the best one.