It goes without saying that advances in technology mean the way we bank, shop and run our homes has changed irrevocably. Modern dentistry has not been immune to this paradigm shift and advances in technology have changed the face of modern orthodontics (pardon the pun). Not only have orthodontists become more efficient at achieving better outcomes, at the same time, treatment burden has been reduced, positively influencing patient compliance.
Dr Ciara Scott practises at the Blackrock Clinic and is the current president of the Orthodontic Society of Ireland. In the two decades since she began training in specialist orthodontics, she has observed a shift in healthcare towards patient-centred care that engages patients and parents in their own care. "The wealth of information on the internet and range of treatment options means some patients come to us with a lot of information and questions. This time spent with a patient before any treatment starts is still the most valuable way to ensure they are choosing the right appliance for them." Covid served to heighten the public's awareness of "trusted sources" and quality information, she adds.
According to Scott, the emergence of digital imaging techniques has “transformed” orthodontic care.
“This makes it possible to look at all the digital diagnostic images and photographs together, listen to patients concerns, discuss a range of appliance options and agree the treatment plan together,” she explains.
But while digital transformation has guided disruptive innovations to build a "new better", Scott says the increasing trend for orthodontic treatment to be marketed "direct to consumer" without a physical examination or direct supervision of care by a registered dentist or orthodontist led the Dental Council of Ireland and other international bodies to issue specific advice on this for patients and the profession. "Patients should know the name and qualifications of the orthodontist responsible for their care," she says.
Clear aligners
Dr Christine Smith is the private practice representative for the Orthodontic Society of Ireland, as well as being a specialist orthodontist at Navan Orthodontics in Co Meath. She explains that the biggest shift in orthodontics in the last 20 years has been the development of gentle, flexible wires for use in conventional braces or train tracks, and the arrival of clear aligners such as Invisalign. “Both of these advances make orthodontic treatment a far more comfortable and rewarding experience,” Smith says.
Technology and digital software have also allowed for better communication with patients. “Photographs and X-rays can be viewed immediately, and 3D scans of your teeth can be done in minutes. All this helps with patient education and their understanding of their teeth and bite, and what treatment can be done to correct it,” she explains.
Unsurprisingly, the increasing variety of treatment options has made the job of the orthodontist more complex, she adds; key to this is diagnosis and treatment planning which stems from a full face-to-face clinical examination with the patient and careful analysis of digital scans, photographs and X-rays.
“It should be said that whether it be braces on the inside or outside of your teeth or aligners, these systems are only as good as the orthodontist using them,” Smith notes.
Echoing her colleagues, Smith says compliance is key when it comes to getting better results. “Obviously, the communication between the orthodontist and patient lays the foundation for any course of treatment. This is especially the case when the patient realises that a quick fix is not likely to leave them satisfied with their smile and their end result.” This is where technology such as treatment simulations can be a “remarkable visual tool”, she adds. “This allows the patient to see a virtual simulation of their predicted outcomes.”
Although Scott dislikes the word “compliance”, she agrees that highly motivated patients get the best results. “We get our best outcomes from our best patients.” She studied at the RCSI Centre for Positive Psychology and Health last year to learn how to have better conversations with patients to improve treatment outcomes and health. “This will be the next big area of growth, using technology to support self-management before, during and after treatment.”
Teenagers and apps
This is critical, says orthodontist Dr Finn Geoghegan of Specialist Orthodontic Practice in Glenageary in south Co Dublin. Geoghegan uses an innovative system called dental monitoring, which employs AI to deliver a regular progress report to both orthodontist and patient. Patients use a special app to send in photographs of their teeth allowing for remote monitoring and fewer visits to the orthodontist for busy teenagers (or adults).
“The reality is that you are dealing with a very tech-savvy generation for whom this fits into their everyday lives. These methods are familiar to them from how their lives have changed,” Geoghegan says.
With patients more likely to comply with orthodontic treatment as a result, this means brighter smiles all round. “It promotes greater engagement from the patient’s point of view, and a lot of our treatment is based on their motivations. If they are 12 or 13, and they can see how their smile is developing on their phone, they can track their progress and see how things are getting better and they will keep going.”
It works both ways, he adds; “Reviewing your patient virtually means you can see what level of priority they need. If I see things aren’t going great, I can bring them in.”
Geoghegan says that while members of the profession – and the public – may have initially been dubious about technology-driven orthodontic practices, it is swiftly becoming the norm. “What this artificial intelligence is doing is enhancing what your orthodontist can offer, not replacing it. The core skills of the specialist orthodontist are still the same.”
Technology has undoubtedly enhanced orthodontic practice, but Scott stresses that the appliance has not supplanted the orthodontist in the delivery of high-quality orthodontic outcomes. “Orthodontists understand the biology of tooth movement and how long treatment takes depends on this movement. Suggesting a device is quicker or simpler than ‘traditional’ treatment is often just persuasive marketing,” she warns.