"Orthodontics continues on a path of great evolution and transformation"
Doctor and dentist Helena Afonso Agostinho, who took over as president of the Portuguese Orthodontic Society (SPO) a few months ago, notes that developments in the field of digital orthodontics are taking place on a daily basis, but believes that the key to good orthodontic treatment “is and will continue to be the health professional, whatever the medium involved in the treatment”. In an interview with Maxillaris, the professor at the Faculty of Medicine of the University of Porto and the University of Barcelona argues that the basis for success in investing in new technologies is training. In this context, given the growing range of training on offer, “you have to be careful when choosing and opt for credible and preferably certified training,” stresses Helena Afonso Agostinho.
How would you comment on the panorama of orthodontics, an area in full evolution?
Today’s orthodontics reflects the trend that the choice of technique to use, in a context where digital media have taken up an ever-increasing space, is vital. The power of choice – the theme of our congress this year – is therefore fundamental: treatment with so-called “conventional” appliances, whether fixed with brackets or removable, is and will continue to be the option in many situations. “Invisible” aligners, with countless options on the market, have introduced a new paradigm. The use of skeletal anchors is more widespread, as is artificial intelligence. Hybrid systems using the different techniques together and leveraging the best that each has to offer, providing greater safety, quality and shorter treatment times. With these options, coupled with the great enthusiasm in the class for the huge number of studies and scientific articles on these topics, leads me to conclude that orthodontics continues on a path of great evolution and transformation.
Do you think we’ve managed to return to the momentum (which was building up before the pandemic) in terms of appreciation, adherence, early intervention, excellent aesthetic results, etc.?
Patient compliance is increasing because they feel that the proposed treatments are successful and this feeling is passed on to society in general. Since the reopening of the country in May 2020, after the first wave of Covid-19, patients have realized that dentists/stomatologists were very well prepared and equipped and could carry out their treatments without increased risks. The answer is yes, normality has returned in a constant evolution.
What essential criteria or values should dentists who focus their practice on orthodontics observe?
The values are those that define bioethics: beneficence, non-maleficence and justice; in other words: the duty to treat, to do no harm and not to discriminate. In short, the same as all other health professionals. You must provide the patient with the best oral health care you can. Dentists should focus their professional activity on the patient and the best treatment they can offer in order to provide physical, social and mental well-being.
In your opinion, what precautions should professionals take when approaching patients before opting for a particular orthodontic treatment?
Personally, I really value the medical history. As a teacher and because of the short time professionals have, there can be pressure to focus only on the reason for the consultation. Personal and family history are guides for further exploration in the objective examination, understanding of the aids and for the diagnosis and treatment plan. Successful treatment depends on diagnosis. And then inform patients and their guardians of the treatment options, taking into account their right to autonomy.
How would you comment on the evolution of orthodontic appliances in contemporary orthodontics?
As an area of activity that involves aesthetics, it is very appealing to new and innovative treatments and means of diagnosis. Developments in the field of digital orthodontics are taking place on a daily basis with the increasing use of 3D technology, CBCT, high-precision intra- and extra-oral scanners. Artificial Intelligence technology is increasing, particularly in the area of invisible aligners with very realistic and reliable simulations and forecasts. It’s a whole technological world in evolution and expansion. The future of orthodontics is today! But… looking to the future, not forgetting the past.
It is indisputable that new technologies result in greater efficiency, speed, precision and comfort in orthodontic treatment, but this requires a high investment in material. In your opinion, what are the “pros and cons” of digital dentistry?
The basis for success in investing in new technologies, particularly digital technologies, is training. With more and more training on offer, you need to be careful when choosing and opt for credible and preferably certified training. Then consider whether the investment made in digital orthodontics will be an added value for the patient and the Oral Health Unit or just a way of attracting “customers”. When properly applied, digital technology can have a number of comparative advantages, such as reducing errors, cutting diagnostic times and providing a better and more realistic forecast of the final result. The introduction should be gradual because the investment can be extremely high and it takes time to learn. It is not, however, a panacea for good orthodontic treatment. As I have already said, the key to good orthodontic treatment is and will continue to be the health professional, whatever the medium involved in the treatment.
In an era of technological innovation and new treatment methodologies, what importance do you attach to the “diagnosis” factor and the concept of a “multidisciplinary approach” in an orthodontic context?
Of course, our past baggage always ends up weighing on our decisions and attitudes. The subject of my doctoral thesis was “Morpho-clinical changes in children with chronic respiratory pathology and mouth breathing”. These were children from the Pediatric Stomatology consultations at the Centro Hospitalar Lisboa Norte (Hospital de Santa Maria). The interaction with Pediatrics, ENT and Immunoallergology was essential. I have always valued the multidisciplinary approach in the different areas, whether dental or medical. As I mentioned earlier, diagnosis is one of the keys to successful treatment. New technologies are yet another tool.
How do you rate the state of orthodontics in Portugal, in terms of education and training, particularly post-graduate training?
Continuous training is essential. There are more and more organizations providing training. It’s up to the professional to choose the course that best suits their needs. There are courses run by non-university organizations and aimed at a very specific area. Here the option is only for knowledge and not for credits. If you opt for postgraduate university training, there are postgraduate and master’s degree options. With ECTS. And training with access to the specialty by the OMD. In medicine, a specialist title is a clinical title and doesn’t mostly come from universities. It’s different in dentistry. And it follows European standards. I specialize in pediatric dentistry at the OMD. A recent specialty. Orthodontic treatments are part of the treatment of the pediatric population. I wish you a safe path as a specialist. According to the OMD statute, there is no impediment to any dentist practicing in a certain area of expertise.
As president of the Portuguese Orthodontic Society (SPO), what priorities have you set for your term?
I invite everyone to read my message on the SPO website in which I say that the aim is to unite, to create bridges so that we can all go further in a space for dissemination, discussion and training in orthodontics. Betting on the future without forgetting the past and present. We want to reach the youngest, the new technologies, the integration of all orthodontic enthusiasts. A proximity mandate. We have to work together. And think about establishing national and international partnerships with other scientific societies. My motto is always “together we are stronger”.
What innovations can we expect from this board of the scientific society in order to mobilize the class and increase membership?
We took office a few months ago. And it takes time. We have made a new website integrating the congress into the society’s website, which has been revamped. We invited Dr. Cristina Faria Teixeira as president of the organizing committee of the XXIX congress. We have a program of excellence. We’re working for everyone. We’ve reduced our membership fees with younger colleagues in mind, and we want to count on everyone who wants to make orthodontics their world. We want to add, to unite, to be a factor of aggregation. Contribute to the advancement of orthodontics, stimulate the study and publication of articles and studies. We are counting on all orthodontic lovers.
