August 19, 2019

What do I know about orthodontics?

I am going to retire from the University of Manchester at the end of September and spend more time on this blog.  As a result, I have been reviewing my old lectures and thinking about putting them online.  This has made me think about orthodontics over the past 40 years.   I have been working as an orthodontist and researcher since 1986. But what do I know about orthodontics?  This is a simple list of my academic/clinical knowledge and opinion which I have updated with information from the past years blog posts.

You may not agree with me or call me “old fashioned”, but here we go…

  • Malocclusion is caused by a combination of genetic and environmental factors. We cannot be sure of their relative contributions.
  • There are many ways to treat malocclusion and most of these treatments work
  • Evidence-based orthodontics is a combination of clinical experience, patient opinion and scientific research. The relative influence of these factors varies according to our level of scientific evidence.
  • Arch form and dimensions should generally be accepted
  • Functional appliances and other bits of plastic, pistons and springs do not change or influence facial growth. They simply tip teeth, and they do this very well to treat complex malocclusions.
  • To my knowledge, there is no high-quality scientific proof that orthodontic treatment, extractions, appliances, expansion, myofunctional orthodontics influence breathing, posture, academic attainment, facial growth and sleep-disordered breathing.
  • The Carriere appliance has no scientific evidence to underpin the claims that are made on skeletal correction, treatment times and influence on the airway.
  • Class I molar non-extraction treatment is very straightforward.
  • I wish that I knew how to intercept malocclusion
  • Extraction of permanent teeth is required for the treatment of some malocclusions..but treatment mechanics are as important as the extraction decision.
  • Anyone can treat their patients non-extraction. But not all patients should be treated non-extraction.
  • Temporary Anchorage devices are better than other anchorage reinforcement method by about 2mm
  • Wire and bracket properties do not influence the efficiency of alignment
  • None of the new developments that are supposed to speed up orthodontic treatment seems to work.
  • There is no evidence that Invisalign mandibular advancement appliances, advance the mandible.
  • Self Ligating brackets do not have any advantages over conventional brackets.
  • There is excellent high-quality research being done in orthodontics, and our evidence base is strong.
  • Some Key Opinion Leaders need to consider whether they are ethical when they make claims about the appliances that they try to sell.  They are becoming a threat to the integrity of our specialty
  • Being an orthodontist and treating patients is a great career.  We provide excellent treatment to many people and change their lives.  We must not forget this.  I have really enjoyed myself.
  • Writing an orthodontic blog is a great thing to do in retirement.

That’s about it, does anyone want to add to the list?

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Have your say!

  1. I loved and I agreed with all points! Congrats! Your contribution to the orthodontics community is great and should be continued!

  2. Thank you for your contribution to orthodontics, and sharing your pearls here on this blog.

  3. I would add:
    1. For most, orthodontics is an entirely elective therapy.
    2. Orthodontic therapy creates more dental disease than it corrects or prevents.
    3. There is little data demonstrating the adverse effects of a malocclusion on dental health.

  4. Most patients don’t wear their retainers for life!

  5. It doesn’t matter the appliance used to treat a patient. What makes the difference is the orthodontist behind them. Always!!!

  6. I appreciate your straight forward approach to all topics of orthodontics. Your opinion and summation of where we are in our specialty is right on and I am sure many agree, as I, with all your points. Thanks for addressing some of the controversial topics that seem to keep coming up time and time again. Wishing you the best in retirement and look forward to more of your blogs in the future.

  7. Thanks Kevin. Thank you for your contribution to orthodontic research, education, and culture. And thank you for not turning the switch from ‘on’ to ‘off’. I know that there are many academics/orthodontists and residents who look forward to your blog.

  8. Hello, Kevin. Thanks for this useful “hit list” – a reminder that good evidence is perceived by some as old fashioned, irrelevant and an impediment to the orderly flow of commerce.

  9. Really good summary, Kevin. It has been difficult to fight the charisma of some lecturers, often backed by corporate orthodontics, in their purveying the stuff that does not work. Keep up your great work in truth telling.

  10. thank you sir for all the hard work we learn a lot as residents thanks again

  11. The use of CBCT is not changing the fundamentals and principles orthodontics. It is however, causing us to take a closer look at keeping teeth in bone. It is showing us that a lot of the class II correction devices are possible causing causing harm. Even some of the , straight wire , bracket systems can do harm. Some of the aligner clear plastic appliance can do harm. Some of the expansion appliances can do harm. It is causing us focus on anatomy not analysis. 3D imaging has not changed the basic principles of orthodontics but is causing us to pay more attention to our patients anatomy.

  12. I’m an orthodontic Master degree student
    While I’m reading a journal or article I’m thinking a lot about every word you write in this post
    Really thank you because you have the courage to say that
    And you courage me to say that always ☺😊
    I like your old fashioned
    Thank you

  13. what about: orthodontics is mainly carried out for cosmetic reasons since most “mal” occlusions are really just variations on normal, and do not and will not cause any problems of a medical nature (such as caries , perio disease, TMD etc). Probably the most important fact that should underly all our treatment decisions, assuming you want the patient to be properly informed that is.

  14. Dear Sir,

    I was quite surprised neither Cephalometrics nor the magical number 1.7 made the list!
    I wish you all the best in your next adventure.

  15. Kevin, it’s a great list. I’m just not sure that writing a blog is on everyone’s list, but thank you for making us think and for letting us know that we are not alone.

    Newton’s Third Law always applies, regardless of our appliance of choice, or what the KOLs try to sell us.

    Orthodontic fashion lives on a merry go round. If we stay on the ride for long enough we will see the horse again.

    We are the luckiest professionals and nobody creates more smiles.

  16. Then im an old fashioned too, totally agree.
    The best publish in orthodontics that i have seen in many, many years, congratulations.

  17. When I was 14 I was privileged to observe my younger sister’s Orthodontic treatment. It was then that i decided that I wanted to be an Orthodontist. What better way to make a living. It’s true, “We Make Smiles!”

  18. Good for you Kevin! I will be a subscriber to your great informative TRUTHFUL Blog. I have been an orthodontist for 47 years and looking forward to the next 47! I plan to work with my two sons and continue my research in Adjunctive Orthodontics and Implant Dentistry. Check out for more information. We are developing new guided surgery appliances and provisional treatment that will hopefully preserve crestal bone in young patients. Please come to the USA again to present to your USA colleagues — Paul

  19. Can we (orthodontists) control facial growth (including mandibular response)?

  20. Amen 🙏

  21. This a great whisdom thought and I agree with all of them

  22. Congratulations, Kevin – a job well done, no doubt –

    I like your opinions, even tho’ I don’t agree with all of them. But I have one specific question, “What is the agreed orthodontic definition of a functional appliance?” Looking into the historical orthodontic literature I found some misnomers, such as periodontal “ligament” and “functional” appliances that likely relate to the fact that these concepts were first put forward in an age where Newtonian physics and Darwinian genetics dominated thinking. Even tho’ both of these approaches have now been largely superseded by quantum physics, digital technologies and sequencing of the human genome, etc., it seems to me that parts of the modern orthodontic specialty are still mired in these outdated approaches.

    Best wishes –

    • Professor Dave, how go you make use of, or evaluate patients or treatments with quantum physics?

      Can we use quantum mechanics when a “functional” appliance is not in the mouth, or if it’s whereabouts is not known?

      Will this action get an equal and opposite reaction to dislodge the evidence mired in reality?

  23. what do you know about tmj disorder and the relationship between malocclusion/female hormone/tmj disorder ?

  24. what about expantion of airway shown by tomodentisometry ? (after bimaxillar surgery, bimaxillar expansion for exemple)

  25. Call me old fashioned too but I agree with all the points you have made. I also enjoyed my career in Orthodontics for 25 years until health issues got the better of me! Enjoy your retirement Kevin and keep Blogging!

  26. Thank you for all you do to help educate and shift through the literature.(the good and bad)
    You are my number one source for understanding EB Orthodontics

  27. Thank you for this amazing blog and most of all thank you for your decision of focusing on your “career” in this blog.
    I could add that the patient cooperation is more effective than the appliences or treatment modalities which we use to treat the malocclusion.

  28. Thanks for always having the courage to “tell it like it is” even when it may be unpopular!
    And for additions to your list, I second the comments of Andrew Sonis and Andy Pearson (see above)

  29. Kevin,

    Great work! I would add one very important source because it’s conclusion is key to orthodontic research:


    Evidence, evidence…evidence!

    Very surprised you didn’t include it.

    Enjoy your down time.

  30. Amen!

  31. Dr. O’Brien, I believe that I speak for many in reading that you plan to continue this most informative blog.
    I recall earlier days at Pitt, your research there and the bright academic future that was evident. Congratulations and keep those blogs coming.

  32. Honesty is the best policy…even if it means we need to admit we have just bought the latest seminar’s gizmo.

  33. Thanks for being the voice in the wilderness. Cannot tell you how much I appreciate your candor and honesty.

  34. Kevin,
    Great list but there is one thing I wish you would have stated more clearly and that is #4: “Arch form and dimensions should generally be accepted”

    I would like to see the words “and maintained” added.

    I find the word “accepted” too passive a term and open for people to “accept” the statement then do nothing to actually do what the statement implies, namely, maintain the arch form and dimensions during treatment. The word “maintained” implies that the orthodontist has to actually participate in the preservation of the arch form and dimensions that he/she has accepted.

  35. Excellent Kevin. keep them coming.
    Did the $20 in cash i gave you in LA AAO meeting push you over the top so you could retire a few seconds earlier 😉 you and your wife are the greatest bill dabney

  36. Congratulations Kevin. You will find that retirement is one of the best parts of your career! I can’t wait for the ‘Blogs in retirement’.

    How about another for your list:

    “Self Ligating Brackets do not know that they’re different”.

    Best wishes in your retirement.


  37. Great words from a great professional orthodontist ..always waiting for your next blog.

  38. Dear Kevin,

    I totally agree with all your points especially the one in which extractions are required in some cases but the mechanics play a huge role in how well you finish the case. Space closure without further deepening the bite or losing Anchorage (in critical anchorage cases) is a dying art as it needs TIME and PATIENCE which very few in this day and age have ( I am talking about patients too).
    Anyways, Congratulations on a very successful career in Orthodontics and good luck for the future.

  39. Love it, thank you Kevin! I will definitely share this with my residents.
    Enjoy your retirement.

  40. Mandibular growth is genetically determined while Maxillary growth is a function of the dental environment the teeth erupt into….

  41. Class II elastics are like sugar. We all know they’re not good for us but we enjoy them.

  42. The question is if beating a dead dog by conducting further research to re-approve these well-known facts is also a form of orthodontic charlatanism?

  43. Olá Kevin, excelente trabalho!

  44. I am working in the field of orthodontics for 10 years. I discovered the biomechanics courses of professor fiorelli and melsen about the same time I discovered this blog. I have understood that only my head and my hands guide the treatment, not the brackets or the prescription or the wires. I am very suspicious about the marketing industry in medicine. I think I am already oldfashion :)))) Thank you very much for your work!

  45. Happy retirement and thanks for your service, in my opinion, one of the most important points in orthodontics is retention and how to keep the results of any orthodontic treatments, I think we need more improvement and studies in that field of orthodontics and I would love to hear your opinion on retention as well. Thanks

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