Simplicity vs Complexity in Orthodontic Mechanics

by Shadi Samawi

“Knowledge is a process of piling up facts. Wisdom lies in their simplification.” ~ Martin Fischer

Retouching on the idea of productive simplicity in orthodontic treatment, I have decided to present in this post some examples of what I believe to be unnecessary over-complication of orthodontic appliances in treating certain types of orthodontic problems. Such cases often present at one’s practice seeking second opinions about their “lengthy” or “traumatic” experience with fixed appliance treatment in particular. Usually, at the first look inside the mouth, you clearly realize the problem; there are so many different attachments, elastics and wires of different sizes and designs inside the oral cavity that not only is it a playground for various complex contradictory mechanics and force vectors, but can also present a serious hazard to the patient’s safety and oral hygiene.

The mechanical validity of any approach is not – by itself –  justification enough to apply it in the oral cavity unless it also complies with other requirements such as simplicity of use and adjustment, the ability to maintain good oral hygiene around it and overall improved safety. Even in Maximum-anchorage cases, too many attachments and auxiliaries can unnecessarily complicate the situation and may even result in reduced anchorage conservation due to overuse of force vectors in various forms and directions.

As a general rule, we should use the most efficient means possible to achieve the best possible results according to our treatment plan. In this day and age of modern, streamlined appliances and techniques, this means that we have at our disposal more and more ways of achieving orthodontic tooth movement and preserving anchorage than ever before, therefore the less appliances and auxiliaries we use to achieve our desired outcome, the better. This also implies reducing the complexity of any appliance used. By following this simple and basic rule, we:

  • Simplify our treatment mechanics.
  • Reduce unnecessary potential complications, breakages and mistakes, from all the extra auxiliaries.
  • Maximize efficiency and reduce chair-side time, and – often – overall treatment time.
  • Maximize the patient’s safety and ability to maintain a high level of oral hygiene during the course of treatment.
Even for maximum-anchorage cases, too many attachments and auxiliaries unnecessarily complicates the situation and may even result in reduced anchorage conservation due to overuse of force vectors in various forms and directions.

Example 1:  Overuse of auxiliaries and force vectors in various forms and directions.

With efficient sliding mechanics techniques using rectangular archwires, simpler and more efficient space closure can be achieved without the unnecessary "over-complication" of a "make-shift" Power Arm onto the upper canines, with the associated bulk, reduced oral hygiene and possible trauma.

Example 2:  With efficient sliding mechanics techniques using rectangular archwires, simpler and more efficient space closure can be achieved without the unnecessary “over-complication” of a “make-shift” Power Arm onto the upper canines, with the associated bulk, reduced oral hygiene and possible trauma.

It is simpler, more efficient and less traumatic to attempt minor space closure through bodily movement using full size rectangular working steel wires and a simple power-chain. The end result would be the same, minus the gingival trauma and inflammation.

Example 3:  It is simpler, more efficient and less traumatic to attempt such minor space closure through bodily movement using full size rectangular working steel wires and a simple power-chain. The end result would be the same – if not better – minus the gingival trauma and inflammation.

Simpler, cleaner mechanics can achieve great results with minimum of fuss and patient discomfort.  (A page excerpt from my latest ebook " Straight Wire Orthodontics: A Practical Guide to Principles & Technique" )

Simpler, cleaner mechanics in complex cases can achieve great results with minimum fuss and patient discomfort.
(A page excerpt from my latest ebook “Straight Wire Orthodontics: A Practical Guide to Principles & Technique” )

The keys to elegant and successful orthodontic treatment are simple: a thorough clinical history and examination, leading to the correct diagnosis and treatment plan, and then using the simplest and most efficient method to achieve the desired treatment objectives.

Keep it simple.

(For a simplified, consolidated reference to Straight-Wire Orthodontics and some useful clinical tips that can help maximize treatment efficiency, you can download my latest self-published ebook from the Ebooks page on this blog.)