Sir, there is now a significant body of literature that questions the basis of current orthodontic diagnosis and treatment goals and I propose the diagnostic terms of 'orthodontosis' and 'orthodontitis' to address these deficiencies. Emerging literature exposes the lack of evidence for the Angle's classification of Class I (ideal), II or III since there is no verifiable scientific validity that ideal occlusion provides significant benefits in oral or general health.1,2,3,4

Clinical observations after two decades of orthodontics practice lead to proposing the establishment of a new classification for malpositioned teeth based on the clinical morphology and appearance of the alveolar bone and ridge.5 Orthodontosis, defined as the non-inflammatory deficiency of the alveolar bone caused by the displaced root(s) of the tooth resulting in marginal chronic soft tissue inflammation called orthodontitis. This classification is diseased-based and follows accepted diagnostic criteria found, for example, in periodontics. Our proposed classification is consistent with differences in the microbial composition of subgingival plaque of malpositioned vs. non-malpostioned teeth.

If orthodontic disease presents as a deficiency of alveolar bone around malpositioned roots, treatment should mimic the continuation of natural eruption thereby restoring the architecture of alveolar bone and eliminating soft tissue inflammation. This new technology of orthodontic tooth movement (Fastbraces) contemplates that light forces may possibly stimulate bone remodelling around the area of displaced roots. Consequently, non-extraction therapy is almost always achieved through this bone 'growth' remodelling as the alveolar bone reacts to a tooth erupting in its correct place in the arch and follows accordingly.

Furthermore, orthodontic diagnosis based on the morphology of the alveolar bone accepts the patient's natural dentition within its own hard tissue and soft tissue substrate. Therefore, patients are diagnosed and treated accordingly based on their own individual genetic and morphologic appearance and not based on arbitrary ideals. As a result of the proposed new concept, people's faces are accepted de facto and would not be subject to alteration from extractions that would mutilate the natural facial and alveolar morphology.