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Changes in orthodontics due to advances in technology means it’s now more necessary than ever for orthodontists to take a multidisciplinary approach to treatment. By Rob Johnson
According to Professor Qingsong (Adam) Ye, the internationally distinguished orthodontist, educator and most recently Noel Martin Visiting Chair at the University of Sydney School of Dentistry, orthodontics is entering an ICE age.
“By ICE age, I mean individualised, computer-based and evidence-based,” he explains. “Modern orthodontics does not solely depend on sophisticated skills in bending wire. Now you need to be a very good designer. You know how to move the tooth using the technology. But even that’s not enough because the computer can do it. But what does the professional, more specialist knowledge contribute? It should be the accumulated clinical evidence which will inform evidence-based practice.”
Professor Ye, a chair professor of orthodontics and deputy head of the Dentistry/Stomotology Center, The First Medical School, Wuhan University, and director of the Center of Regenerative Medicine at Renmin Hospital of Wuhan University, admits that if you ask 10 orthodontists how the profession is changing, they “will give you 11 answers”. But he sees the common point between all answers lies in the way specialist training creates a scaffold for clinical judgement in each individual case.
The human touch
“Just because you have sufficient data from your technology, it doesn’t guarantee you make the right decision,” Professor Ye cautions. “Patients are very complicated. They are different ages, different ethnicities, different genders, they all have different changes in their structure. So for the growing patient you need to do some growth modification, and there is nothing the data can tell you about that—you have to see the patient’s real situation, talk to them and then understand what they need.”
He says the changes he sees in the profession stem from broader changes in society. As demand for orthodontic services shifts from younger patients to all age groups, the necessity grows for taking a more multidisciplinary approach to treatment. The orthodontic needs of a 70-year-old will be different in many significant ways from those of a teenager. As a result, the specialty in many ways becomes both broader and deeper, as practitioners learn to work with teams of other specialists.
“Generally, when you’re talking about the younger population, their periodontal situation, their oral health habits, and the morphology of the tooth are quite intact,” he explains. “But for adult patients, some of them have very severe periodontal issues, decay issues and breathing and sleeping issues, and so on.
“So we usually need to have a big team, someone taking care of the periodontal situation, someone taking care of the endodontics, and so on.
To pass the orthodontic specialist training in their final examination, they cannot just present a simple orthodontic case with brace and wire; they need to have a case that involves other disciplines.
Professor Qingsong (Adam) Ye
“That’s why I would enrich the orthodontic program. Previously you only needed to follow a tutor, who would teach you how to put the braces on to do the wire banding. That’s all. That was before, a long time ago. Now we need to invite the oral surgeon, and the implantologist specialist to teach in the program, so we have the special program assessment for them. And to pass the orthodontic specialist training in their final examination, they cannot just present a simple orthodontic case with brace and wire; they need to have a case that involves other disciplines.”
The promise of stem cells
While the educational scaffold of orthodontics evolves, Professor Ye’s research interests in the cellular and molecular mechanisms of tooth movement, stem cells, and the reaction of tissue to foreign bodies illustrates an evidence-based path forward for dealing with some of our stickiest problems.
“People are looking forward to stem cells being able to treat many conditions, but most of the evidence has come from animal models,” he concedes. “But that is going to change. If you look at the clinical trial register online for stem cell-related treatment, there are already more than three thousand trials registered all over the world. So that’s changing.”
The most well-known source of stem cells is cord blood and, to a lesser degree, bone marrow. But Professor Ye’s research is focused on dental pulp stem cells, which he says have significant advantages over other types of stem cells.
“One of the bottlenecks in developing regenerative interventions in medicine is getting sufficient numbers of cells that can actually remain in the body without being rejected by the immune system,” he explains.
“With the dental pulp stem cells, these have fairly low immunogenicity. So the baby tooth from your child can be used for regenerative treatments for you, your wife and your grandparents, without any rejection. You don’t need to do the compatibility match. So that will create a great commercialised perspective for these dental pulp stem cells because they can be used for one or all as simple as that.”
He points out that the proliferative capacity of dental pulp is significantly greater than that of cells from other sources. “So that means among all the baby teeth if they are not decayed, they can be used for stem cell banking. Each of us has 20 milk teeth and we just throw these away normally. But that’s a big waste because we don’t understand the secret that is hidden in them.”
Professor Ye was involved in initial moves to start a tooth bank in Australia which could create a repository for deciduous teeth, but the plan was scuppered by the COVID-19 pandemic. Nonetheless, the breakthroughs he is seeing in his lab regularly renew his enthusiasm for the topic.
“I see so many new outcomes, showing how fantastic these types of stem cells are, not only for oral health but the overall health of humans with conditions like Alzheimer’s disease, diabetes, spinal cord injury, and so on,” he says. “We have a lot of new breakthrough results that show that this is really quite unique. And I’m always happy to, apart from my clinic professional activities and the promotion of orthodontics, to promote regenerative medicine. These two should go hand in hand.”
