Sir, I have read the recent correspondence about short-term orthodontics (STO) with interest. As usual the battle lines are drawn between the specialists and the practitioners of STO who are perhaps most likely to be non-specialists.

There is no scientific evidence that any one appliance is fundamentally faster than another1 and the reason for this is simple – the maximum speed of orthodontic tooth movement is determined by biological factors, not appliance type. A simple case well selected for use with an effective appliance and resulting in a full correction of the malocclusion could be described as fast. However, it is likely that many 'fast' or 'short-term' cases are actually under-corrected or partial treatments, with a much higher degree of post-orthodontic restorative work than 'complete' orthodontic treatments. This almost routine restorative work is dressed up in the term 'minimally invasive dentistry' on the basis that it is less destructive than it would have been had no orthodontics been done at all. But what if a full orthodontic correction had been made? Would any restorative work be required at all? Written consent should show that the alternative benefits of complete orthodontic treatment should have been explained and the resultant risks and limitations of the shorter treatment accepted. Patients have a right to know. It is not enough to record simply that they did not want to wear braces for two years.

Partial orthodontic treatments may have other serious consequences, especially where fixed retainers are to be used. If the teeth are not fully aligned (paralleled) then access for interdental hygiene will be reduced or impossible. Deep overbites take time to reduce and alignment without full overbite reduction will result in higher rates of bonded retainer failure and relapse. Flexible nickel-titanium wires are more likely to produce proclination of crowded teeth without addressing smile width. Black triangles that commonly result from alignment in adults need full paralleling of the teeth before the contact points can be modified and then space closed to eliminate them. This all takes time.

The undergraduate orthodontic curriculum has been so pared down that GDPs attending one or two day courses may be unable to judge that they are being misled by the claims of a company which has an interest in selling them their appliances. A look at the Fastbraces 'university' www.fastbracesuniversity.com is shocking indeed. Although there are scientific references on the website, none of them directly support the stated and implied claims made that Fastbraces are new, faster, move the teeth in a different way to 'old' braces, are less likely to need extractions and require only 15 minutes of retention per day. It is full of pseudo-science and even a name for a new disease, 'orthodontitis'! Despite this nonsense, Fastbraces is the latest system to be sweeping the UK. I wonder if the rates of litigation will go up or down?