Orthotown August 2017 - 8

embrace progress

The Standard of Care
(Records, Anyone?)
by Dan Grob, DDS, MS, editorial director, Orthotown magazine

I am often amused at the number of writers,
speakers and practitioners proclaiming that the
new standard of care is having a CBCT machine.
I will agree, in many instances the ability to
visualize radiographic images in 3-D helps to direct
care in the correct location and apply the force to
a predictable direction. Often after a panoramic,
I take a cone beam for clarification of issues that
arise in the 2-D X-ray. Why not on everyone, you
ask? Probably habit, convenience and inability to
smoothly link into my office software system. But,
I'm getting there.
In the desire to offer the latest in treatment,
we're gradually implementing and adapting to these
new diagnostic methods. But what about the old
ones? I am a bit miffed by the lack of comprehensive
treatment planning in the dental field. Remember,
we are supposed to be soliciting (begging) general
practitioners for patients when they-after complete
treatment planning-determine that we could be
of service to their patients (or practice). I, like so
many of you, am believing this so less and less
every year.
Prompted by some second opinions, I'd like
to opine about what I've seen lately in a couple of
patients (or, in the case of most of these patients,
what I've not seen). The most egregious was a
comprehensive cosmetic patient in his 60s desiring a
great smile even though he had worn and defective
full crowns, a cross bite and resultant lateral shift.
He was offered clear aligner therapy and after a
couple of years was no different than when he
started, as shown by the mounted diagnostic casts
made at his initial exam.
This is in addition to a patient I met at the
gym who had every one of her upper teeth recently
veneered or crowned, all four lower molars with

8

JULY/AUGUST 2017 // orthotown.com

full coverage and lower anterior crowding confined
to the 10 anterior teeth. After inquiring about
her lower crowding, she was offered, once again,
clear-aligner therapy.
Two general dentists recently approached
me after treating themselves with clear-aligner
therapy. Both had interceptive contacts, shifting
bites and lack of proper tip, torque and interincisal
angle before my visit. Both were evaluated, had
modified treatment plans and were done or in
treatment. These examples are not intended to
trash aligner therapy.
Sleep apnea patients with posterior open bites
are becoming the latest challenge-at least in
my arena. I have about six patients who, after
receiving sleep appliances (paid for by insurance,
of course), had bites so bad that they were willing
to put the CPAP machine back on and get their
teeth aligned.
All the instances above were initiated by the
general dentist without proper documentation such
as cephalometric X-rays, photos or diagnostic casts.
To be clear, I have an interest in articulation and
the effects on dentition and restorative care. As
a prosthodontist in my fi rst life, I was intrigued
and compelled to understand the intricacies of
hinge axis, side shift, guidance and the like. But
even without a gnathological upbringing, when in
the field of dentistry was the goal of restoring to
a reproducible, predictable point lost-or worse
yet, when was the idea of registering some sort
of beginning point tossed out?
I know that the articulation fanatics will claim
that all patients must be restored to an anatomically
registered hinge axis. I am also aware of the group of
dentists who subscribe to muscular positions being
the goal. Quite honestly, there is room for both!
Continued on p. 10


http://www.orthotown.com

Table of Contents for the Digital Edition of Orthotown August 2017

Orthotown.com Highlights
Embrace Progress: The Standard of Care (Records, Anyone?)
Industry News
New Products
Message Board: Girl with Systemic Lupus Erythematosus
Message Board: Inverted Impacted Teeth, Patience is a Virtue
Office Visit: What's Up Doc?
The Speed of Light
What's Your M.O?
Untangling Web Marketing
Ad Index
Orthotown August 2017 - Cover1
Orthotown August 2017 - Cover2
Orthotown August 2017 - 1
Orthotown August 2017 - 2
Orthotown August 2017 - 3
Orthotown August 2017 - 4
Orthotown August 2017 - 5
Orthotown August 2017 - Orthotown.com Highlights
Orthotown August 2017 - 7
Orthotown August 2017 - Embrace Progress: The Standard of Care (Records, Anyone?)
Orthotown August 2017 - 9
Orthotown August 2017 - 10
Orthotown August 2017 - 11
Orthotown August 2017 - Industry News
Orthotown August 2017 - 13
Orthotown August 2017 - New Products
Orthotown August 2017 - 15
Orthotown August 2017 - 16
Orthotown August 2017 - 17
Orthotown August 2017 - 18
Orthotown August 2017 - 19
Orthotown August 2017 - Message Board: Girl with Systemic Lupus Erythematosus
Orthotown August 2017 - 21
Orthotown August 2017 - 22
Orthotown August 2017 - 23
Orthotown August 2017 - Message Board: Inverted Impacted Teeth, Patience is a Virtue
Orthotown August 2017 - 25
Orthotown August 2017 - 26
Orthotown August 2017 - 27
Orthotown August 2017 - Office Visit: What's Up Doc?
Orthotown August 2017 - 29
Orthotown August 2017 - 30
Orthotown August 2017 - 31
Orthotown August 2017 - 32
Orthotown August 2017 - 33
Orthotown August 2017 - 34
Orthotown August 2017 - 35
Orthotown August 2017 - The Speed of Light
Orthotown August 2017 - 37
Orthotown August 2017 - 38
Orthotown August 2017 - 39
Orthotown August 2017 - 40
Orthotown August 2017 - 41
Orthotown August 2017 - 42
Orthotown August 2017 - 43
Orthotown August 2017 - What's Your M.O?
Orthotown August 2017 - 45
Orthotown August 2017 - 46
Orthotown August 2017 - 47
Orthotown August 2017 - 48
Orthotown August 2017 - 49
Orthotown August 2017 - 50
Orthotown August 2017 - 51
Orthotown August 2017 - 52
Orthotown August 2017 - 53
Orthotown August 2017 - 54
Orthotown August 2017 - 55
Orthotown August 2017 - 56
Orthotown August 2017 - 57
Orthotown August 2017 - 58
Orthotown August 2017 - 59
Orthotown August 2017 - Untangling Web Marketing
Orthotown August 2017 - 61
Orthotown August 2017 - 62
Orthotown August 2017 - 63
Orthotown August 2017 - Ad Index
Orthotown August 2017 - Cover3
Orthotown August 2017 - Cover4
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