Impact of Technology on Our Practice Future Dr. John Grubb An orthodontist must aspire to deliver the highest quality of care. Each of us needs a mission statement. Our offices should be comfortable and have a caring environment. We must keep technologically abreast of the industry. Dr. Grubb described his office. He has an excellent intra-office communication system. A management computer is used to make appointments, send letters, and store patient data and records. A television set with headphones and a channel changer that selects pre-screened channels is available for patients. A computer is used to show patients and parents the pretreatment and post-treatment records. Photographs of a patient are given to the patient on the day the photos are taken in order to involve the patient with treatment. The records information is archived on the mainframe computer and can be sent through e-mail to a dentist or to the parents. Photographs are taken with a digital camera; radiographs are taken with a digital x-ray machine. Digital photos and x-rays eliminate developer, fixer, and film, decrease radiation, decrease time, decrease cost, and increase quality. Digital images can control for brightness, contrast, size, and color. By measuring and zooming, more information can be easily taken from digital images. (The ability to alter digital images has legal implications, however, methods are presently available to safeguard original images). Casts can be digitized, but the process destroys the original casts. Digital cast images can be communicated to others easily, the images are easily portable, require less storage space, and may improve the ease of diagnosis. Electronic casts can be reproduced in three dimensions. Three-dimensional radiography may become commonplace in future orthodontic record taking. Two-dimensional radiographs have poor spatial accuracy, magnification, position error, and represent a static position in time. Three-dimensional radiography can accurately locate and measure facial and oral structures. Improved accuracy, which means a better grasp of the truth, should lead to improved diagnosis and treatment. New three-dimensional diagnostic standards for normal subjects must be developed for use with this new technology. At present, three-dimensional radiographic techniques are used in medical diagnosis: (1) computed tomography, (2) circular tomosythesis or cone-beam CT, a method to examine small areas of the body, and (3) magnetic resonance imaging. A newly developed head holder can create a three-dimensional image of the head, in which structures such as porion can be accurately located. A three-dimensional scanner can capture images of the upper and lower arches. From these digital images, measurements and diagnostic set ups can be accomplished. In surgical orthodontic treatment, new techniques such as distraction osteogenesis and macropore plates with screws that resorb in 6 months, and are completely removed from the body in 12 months, hold promise for improved treatment.