relent or improvement. i n toothbrushes, a cleaning aid with a long and generally noble tradition . In an increasingly ecologically sensitive world fewer trees will be sacrificed for interdental woodsticks, and these cleaning devices will likely be replaced by cotton floss and other materials . Advances in Treatment With the decline in dental caries and in rates of edentulousness apparent in many countries, there has come to be an understandable rejoicing in periodontal circles that with more people having more teeth, the need for`periodontal treatment services was likely to increase . Recent indications however suggest that older people are not necessarily more at risk of severe periodontal disease, although levels of disease susceptibility are maintained into old age . With respect to periodontal treatment the 1980's have seen the development, from a research base, of a technique which allows the regeneration of at least some lost periodontal attachment . When this technique has been refined it may well find acceptance in dental practice . This in turn could create the possibilities for an improvement to the aesthetic consequences of recession . If in the future the public comes to demand greater periodontal aesthetics, the profession will then be in a position to respond appropriately . Of' greater note, however, .is that this therapeutic development has been firmly based on good research . In this case the research preceded the development of the treatment, rather than the reverse, as often had been the case in the past. An increasing reliance on an overgrowing research base heralds the real future direction for periodontology as a dis cipline, a future which we can all, practitioners and academics, alike join together in shaping .
The Future of
An Interview with DR. M .S. COOKF, Senior Lecturer in Orthodontics, Department of Children's Dentistry and Orthodontics, Faculty of Dentistry, University of Hong Kong. The field of orthodontics has made great strides during the last 20 years. What does the future hold in store in general terms? Dr . Cooke : Overall, the orthodontic future looks excellent with more, higher quality, or thodontics likely to be completed in less time using simpler mechanics. Political, economic and demographic factors will modify developments . In many countries the decrease in dental caries combined with an oversupply of dentists has resulted in an increasing number ofgeneral dental practitioners performing orthodontic treatment. How do you see the supply versus demand equation shaping up in the future? Dr. Cooke : Most orthodontists regard orthodontics as a true speciality and feel that the general pub lic would be best served if orthodontists carried out the bulk of the treatment . However, the likelihood is that an increasing proportion of general practitioners will provide orthodontic treatment for their patients in the future . As in other areas of dentistry one of the great challenges we face in the years to come is to create an increase in demand by allocation of resources and by the education of the public to the advantages of orthodontic treatment . It is clear that the need is there . Do you foresee an increase in the number of adult orthodontic patients? Dr. Cooke : Certainly . The development ofmore aesthetic and efficient appliances, if necessary in
Inog nathic surgery, has undoubtedly increased the scope of' and demand for adult treatment . In the United States adult patients now comprise nearly 343% of all orthodontic patients and it seems likely that this number will increase . The demand for adult orthodontic treatment will also grow in relation to the increased public and professional awareness of temporomandibular disorders .
You mention surgery . How will orthodontics relate to this and other dental disciplines in the future?
(and tooth coloured)' will be developed enabling lighter force values which will move teeth quicker with fewer archwire changes needed . It is also conceivable that plastic wires may be developed . The use of small magnets to deliver light forces is also being developed .
Are ary biological likely? developments
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Dr. Cooke: The multidisciplinary team approach to treating patients will become more and more important . The benefits of close liaison between orthodontists and restorative dentists are already well established . The advent of sophisticated orthognathic surgical techniques has enabled more adult patients to be treated successfully. In the future it is likely that more patients with advanced, but controlled, periodontal problems will receive orthodontic treatment and the whole orthodontic/periodontal interface will see a major growth .
What technological advances will the future bring?
Dr. Cooke : Yes, it has already been shown that electric impulses (piezo-electric currents) and certain chemical mediators (for example, aspirin related compounds and some prostaglandins) are able to increase the rate of bone turnover and of tooth movement . In the future the orthodontist may need to recharge the batteries or dispense some pills when your appliance is' checked! Important future hopes are to be able to quantitatively and qualitatively predict facial growth and even to be able to control this growth. For example, microsurgery of the sutural growth areas may be developed . Q:
What do you see as the future role of computers in orthodontics?
Dr. Cooke: Ceramic and synthetic sapphire brackets will play an important role in persuading patients to seek orthodontic treatment . Lingually placed appliances appeared initially to be a major development but they are proving difficult to manage and are unlikely to compete, overall, with appliances. More buccal sophisticated cast brackets are being produced which "pre-programme" information for exact tooth positioning and reduce the need for wire bending. Even more flex-
Dr. Cooke : Inevitably computers will play a big part in future orthodontic treatments . In ad dition to their use in practice management the analysis of facial and dental features using digitised readings will help to standardise orthodontic diagnosis and treatment . The ability to make computer growth predictions comparing alternative treatment options will be a great public education benefit. Dr. Newsome : It is apparent that you are confident that orthodontics has a very bright future . Thank you for sharing your thoughts with us.