for malocclusion is correctly shifting away from genetics to a disturbed myofunctional environment. The modern perspective demands a shift to include comprehensive evalua-tion of the functional matrix. The frequent and common problem of relapse from traditional orthodontic care, as well as common temporo-mandibular joint and airway prob-lems, decreases as a result. A specific, singular treatment focus can be on the airway. Patients likely benefit from their care providers simply considering occlu-sion and esthetics, but we would again be failing if we did not exam-ine the rest of the functional matrix, both during the initial diagnosis and treatment planning and during treatment, where progress records and clinical findings must be exam-ined to be certain the elements of the functional matrix are improving rather than worsening. The addi-tional perspective gained by priori-tizing research and the latest clinical case reports on improving the airway can change many aspects of care, including treatment timing, referrals, staging and appliance selection. Providers may need to prioritize different goals and include surgical, restorative and myofunc-tional therapy stages in their comprehensive treatment plans. Simulation Versus Reality The change in perspective orthodontic practitioners must embrace will require considerable and persistent effort in this specialty area of dentistry, as well as all of dentistry. The time has come for functional matrix-focused comprehensive dental treatment planning. In dental school, students are conditioned early by a focus on restorative care. The field adopted a “chief complaint” and “problem-focused philosophy” from the medi-cal education model: Replace or repair the broken tooth, eliminate infection and halt or reverse peri-odontal disease. Today, patients’ expectations are that care providers will improve their healthy lifespan, rather than simply fix singular, acute dental problems. Practitioners must remain aware of and incorpo-rate the different perspectives gained from focusing on the func-tional matrix. Treatment planning in modern orthodontics requires continuously examining every change we plan. It is not enough to focus on the obvious clinical or imaging change; we must focus on the impact the change is likely to have on the functional matrix. Using the newest and evolving digi-tal tools can help us collaborate as teams, sharing opportunities to plan and execute complex care. www.orthodontics.com Winter 2025 15
Journal of the American Orthodontic Society Winter 2025: Page 15
