Full text of DOI:10.1016/S0889-5406(00)70219-8

Orthodontics in the next 100 years: Prediction
or speculation?
Larson R. Kesoa
Oklahoma City, Okla
W
hat is the future of orthodontics? What
will happen in orthodontics in the next 100 years? One
might as well ask what is the future of the world? What
will happen in the free world in the next 100 years?
Orthodontics is an institution. All institutions are sub-
ject to the social, economic, and political changes that
will occur in the next 100 years. Who among us would
be bold enough to speculate on our world in 3000?
Orthodontics as an organized science and art is now
100 years old if we accept the advent of the Angle School
and the teaching of Edward Angle as the beginning.
Let us shorten our scope to a more practical time
frame, say 25 to 50 years. The writer has very limited
knowledge of the present state of orthodontics in the
world outside of North America. Comments, therefore,
are limited to that region. No prescience is claimed, so
comments should be considered part speculation and
part prediction.
Technology will, of course, continue at a pace equal
to or greater than in the past 25 years. Metallurgy will
provide programmed archwires. Ionizing radiation will
be replaced as the primary method of studying internal
structures of the head and neck. Three-dimensional
images will create new diagnostic and predictive
schemes. Electronic and magnetic force systems will
complement and then replace mechanical systems.
Genetic engineering will make possible the elimi-
nation of codings that predispose to inherited dental
and craniofacial anomalies, although these advances
will have low priority behind more demanding physical
and mental abnormalities.
Computerization of repetitious tasks in diagnostic
measuring will continue. Research centers will compile
massive data bases, and new understanding of the range
of variability in normal facial and skeletal anatomy will
result. High-speed retrieval of information will allow
continuous tracking of treatment accuracy and efficiency.
Larson R. Keso
Orthopedic management of specific growth prob-
lems will continue and will increase. However, contin-
ued sophisticated research will make possible specific
treatment modalities for specific problems replacing
the empiricism that presently dominates this part of
orthodontic practice.
The practice of orthodontics will mature. The
present predilection for egoism and elitism will dis-
appear from the profession. Diagnosis and treatment
will become more standardized as more attention
is given to evaluation of posttreatment results 5 to 50
years after the fact. Management of malocclusion
will be recognized as a lifetime rather than a
one-time concern.
aIn private practice in Oklahoma City; Past President, American Association of
Orthodontics.
Reprint requests to: Larson R. Keso, DDS, 3501 Northwest 50th, Oklahoma
City, OK 73112-5603.
Copyright © 2000 by the American Association of Orthodontists.
0889-5406/2000/$12.00 + 0 8/1/106009
doi.10.1067/mod.2000.106009
We presently have in place an inefficient and costly
duplication of educational facilities in the health sci-
ence field. The reason for this is obvious. Institutions,
once established, naturally resist change. Prestige,
autonomy, and employment are at stake.
613

614 Keso
American Journal of Orthodontics and Dentofacial Orthopedics
May 2000
The entire educational system will undergo change.
established for curricula and faculty. Entrepreneurship
will disappear from the scene.
Education at all levels will be restructured. The anti-
quated 9-month model finally be replaced by full-year
programs. Independent institutions of osteopathy, chiro-
practic medicine, pharmacy, podiatry, and dentistry will
be phased out of existence. There will remain a network
of health science universities. These will be largely sup-
ported by federal funds. A core curriculum basic to all
fields will prepare students. Specialization in all fields
will follow, largely by residency. This system will allow
career changes in the field without extreme time loss.
Orthodontic education will also radically change. The
selection of orthodontic students will start during rather
than after completion of dental training. Preference will
be given students with skills in mathematics and com-
puter science as well as in biological sciences. The length
of training will increase. Orthodontics will not escape the
realignment that will take place in dental specialization.
Endodontics, periodontics, prosthetics, and pediatric den-
tistry will disappear from the specialty scene. Orthodon-
tics/dentofacial orthopedics, stomatology/pathology, and
oral/maxillofacial surgery will become specialties of
what is now considered medicine. Dental education as a
separate discipline will cease to exist. Technical schools
will train workers who will provide most restorative ser-
vices under the direction and after the diagnosis by a
stomatologist/pathologist. Routine tasks presently done
by or directed by the orthodontist will also be accom-
plished by technicians. The stomatologist/pathologist
will become the primary physician of the head and neck.
The scope of the orthodontist/dentofacial orthopedist will
continue to increase.
Private third party and governmental subsidy will
increase, replacing traditional fee-for-service practice.
Group practice will replace solo practice as the primary
delivery system. In time, federal health insurance
and/or federally supported clinics will provide most
health care, Small pockets of independent fee-for-ser-
vice practice will remain for an indefinite time.
State and territorial examination boards will give
way to national examination and certification. The
mobility of orthodontists will not be restricted by
political boundaries.
Periodic recertification of practitioners will become
mandatory. National standards of practice will be estab-
lished. Orthodontists who fail to maintain these standards
will lose certification and will be required to retrain
before given another chance to stand examination.
Twenty-five years from now, a license to practice den-
tistry will no longer allow inadequately trained dentists or
orthodontists to treat complex malocclusions. Present day
token peer review will become reality. Teams of ortho-
dontists will periodically review records and examine
treated patients. These boards will function in the same
fashion as present day hospital tissue committees.
A better educated and quality conscious population
will demand this protection if insurance requirements
and dental examination boards do not. The inept, unqual-
ified, and incompetent will be largely weeded out.
The future therefore will be rewarding for the
dedicated, service-oriented, scholar/orthodontist.
The future is dim for the economically driven oppor-
tunistic orthodontist.
The present disarray in continuing education will
end. All continuing education will be under the aegis of
recognized universities and hospitals. Standards will be
Or, as Dennis Miller might say, “That’s just my
opinion...I could be wrong.”