As the goals of orthodontic treatment have broadened, improved clinical evaluation and three-dimensional imaging have become important parts of modern diagnosis and treatment planning. Genetic analysis is just becoming available and is likely to be increasingly important in the future. Clinical data to document treatment outcomes with skeletal anchorage are slowly going past isolated case reports but are not yet adequate to decide important questions as to the chance of success with treatment. Skeletal anchorage certainly will be widely used in the future. At present alveolar bone screws are receiving more attention, and miniplates less attention, than perhaps they really deserve. As data from clinical trials of new brackets and wires accumulate, it is clear that laboratory data often are not good predictors of clinical performance. Most of the claimed advantages of the new materials have not been verified by the clinical trials, and clinicians need to keep that in mind when exposed to marketing campaigns.
As orthodontics developed in the late 19th and early 20th centuries, its goal was to correct the appearance of the teeth and thereby improve the patientís acceptance in society. Concepts of dental occlusion developed in prosthodontics were first applied and extended to the natural dentition around the turn of the 20th century by Edward Angle. To Angle, if treatment achieved ideal occlusion (which required the presence of all the teeth), ideal dental and facial esthetics and ideal stability of the result also were achieved automatically. By the mid-20th century, this concept had been discredited and teeth were frequently extracted for orthodontic purposes.
At present, once again there is a renewed focus on dental and facial appearance as the primary goal of treatment for most patients. The reason is simple: for patientsand parents, the reason for seeking orthodontic treatment is to prevent or diminish psychosocial problems created by an unfortunate dental and facial appearance. That means, of course, that if the esthetic result of treatment is not satisfactory, it does not matter how ideal the dental occlusion is.