Orthodontic treatment: why make it complicated?

I genuinely believe that orthodontics is relatively straightforward. A standard course of treatment should take 2 years, give or take, providing that it is started at the appropriate time and the rate limiting steps are identified every visit.

Admittedly, I had the benefit of a traditional orthodontic education at the Eastman Dental Institute, followed by a lively 5 years as a Senior Registrar at the Royal London Dental Hospital and Southend Hospital, working with some of the best clinicians in the land. During my training, I was taught to thoroughly assess a case, carry out a cephalometric appraisal and a space analysis to allow the problems to be quantified, write a problem list in order of importance and come up with a plan to address each and every problem in the correct order.

During treatment, I learned to reassess the case at every visit, specifically to identify the feature of the malocclusion that was furthest from the finishing line (the rate limiters) and to address that specific issue, if nothing else. I understood that unless that ‘limiter’ was explicitly addressed, then irrespective of whatever else was dealt with during the visit, the patient would be no nearer their debond appointment. Don't talk to me about the centrelines (a complete obsession of a number of dental schools) when the patient is only halfway through space closure and when there are still so many much more important aspects of the malocclusion to address.