„There is a major paradigm shift now apparent in orthodontic diagnosis”

Tell us briefly please the main stages of your professional career and scientific work.

A 4-decade long career in dentistry, orthodontics, healthcare administration, national health policy planning, academics and international leadership and consulting. The years in military dentistry were formative in leadership, delivery of services globally, writing and publishing on all aspects of health care and military dentistry. The second phase of my career was defined by academics, research and clinical practice. Developing progressive teaching programs with a front runner position in all the emerging areas, Tads (2002) Lingual orthodontics (2000),MBT , significantly evidence-based dentistry (2000 defined my writing and research. I serve on the editorial board of several journals including EBD – UK, EAPD .

Have the distinction of lecturing and teaching in 48 countries globally . Have a key clinical practice in Delhi with a focus on Digital, Customised adult orthodontics , Sleep medicine and diagnostics. Presently a Professor Emeritus, Distinguished Professor and Advisor to a prestigious Institution in Southern India and to Max Health Care , one of the leading chain of hospitals and healthcare providers in India .I was invited to deliver the Indian Orthodontic Society Oration 2017 , Selected for the Outstanding Professor award by the IOS 2018, received a lifetime achievement award in military dentistry from the FDI-SFDS ,a royal decoration from HM , Sultan Of Oman for distinguished services .An avid reader , writer and keen golfer and currently an entrepreneur and the cofounder of Medeva Knowledge Systems , developing Artificial Intelligence based health analytics and machine learning.

Who or what inspired you to choose a special area in dentistry, Orthodontics?

At a time when dentistry was focused on skill development towards restorative or rehabilitative procedures, Orthodontics offered the challenge of a much wider scope in understanding the entire human developmental perspective, function, airway, occlusion and the ability to modify and transform it. The reason to choose orthodontics was because it was biologic, had a much wider scope in understanding development and function, the unique opportunity to change the face and its craniofacial components

How would you describe the up-to-dateness and professional quality of Orthodontic treatments in India?

Orthodontics in India is contemporary, current and global. The newer technologies and trends are available in both clinical practice as well as orthodontic training and education. We have a strong professional body, the Indian Orthodontic Society, almost 3000 orthodontists are members and we have a progressive and global outlook in our practice and teaching. We cater to global standards and current protocols.

What are the aspects You consider when deciding about necessary and possible treatment options?

There is a major paradigm shift now apparent in orthodontic diagnosis and treatment planning. From a traditional 2 D model focused exclusively on the lateral cephalogram the paradigm has shifted to an outcome-based model from the patient’s perspective both in terms of aesthetics as well as function. Facial ageing, biology and the predictive outcomes now define the treatment plans. The mechanistic, appliance-based model is fading to be superseded by individualized treatment plans with customized appliances and predictive outcomes. The outcomes are defined by the patient and you need to find the technology and appliances to deliver this in the most effective and efficient manner. As practices become more adult based, the challenges of biology, age and compromised occlusions emerge and require an entirely new concept of learn, unlearn, relearn by the orthodontist. The patient matters decides success and failure.

Do you count on speech therapists for the treatment of certain cases (e.g. reverse swallow)?

No, I don’t look at speech therapists to change the functional patterns, for me they constitute an integral part of my treatment plan and I would both integrate, implement and monitor in my practice

Do you think that digital technology gaining territory is going to supremely influence the future of orthodontics?

Technology is creating a paradigm shift and it will overtake the way we practice orthodontics. Digital technologies are evolving and redefining clinical orthodontics. The future is inescapable and the challenge really is to move from a reactive to predictive treatment plan. The creation of a predictive treatment plan requires an intense application of knowledge and training to the analysis, diagnosis, treatment plan, clinical progress and manipulation of the appliances to a precise and predictive outcome. It has made orthodontics more cerebral and intense, the delivery systems are precise, it’s the diagnostic and predictive challenge that is changing orthodontic thought. Our teaching and approach needs a major change. Bias, sustaining the past, maintaining the comfort of status Quo is not workable. Change is inevitable, the question is are we prepared as a specialty or are we going to live in denial??

What is your opinion about the short and mainly „invisible” treatments for cosmetic purposes?

Invisible treatment addresses the social context of orthodontics, its acceptability in adults and even children where metals and visibility now have a serious limitation. The alarming trends is the entire concept of do it yourself orthodontics and the so-called cosmetic outcomes based on just changing the physical character of anterior or social sixes and meeting an immediate need of the patient. Oversimplification and selling of dreams to patients to fill a simple aspirational need is fraught with danger. The fact that the crowding and jaw alignment brings with it serious functional issues of stability is lost in this need /greed/ fixit quick treatments being promoted by some. Most of the adults being retreated in my practice bring serious myofascial pain dysfunction, asymmetric closure patterns of the mandible due to poor occlusal finish with consequent host of serious life quality issues. Orthodontics is responsible for a foundational change for the patient, it is to change the context of life and happiness. Its far beyond snake oil and quick fix treatments being promoted today.