Pacific Coast Society of Orthodontists Bulletin Spring 2022 - 37

Clinical Practice
Let's Talk About That
Establishing Value in the
Interdisciplinary Patient-Seeing Is
Believing-Part Two
Dr. Patrick K. Turley
PCSO Bulletin Editor-in-Chief
In this issue of " Let's Talk About That, " I have the pleasure
of interviewing Dr. Vince Kokich Jr. for the second part
of his article on treating the interdisciplinary patient. In
part one of this two-part series on establishing value for
the adult interdisciplinary patient, Dr. Kokich discussed
two of the three methods he uses to help educate
patients regarding the need for orthodontic treatment
as a way to facilitate their future restorative treatment
or implant placement. As he mentioned in part one, it's
generally pretty easy for orthodontists to visualize and
plan prerestorative tooth movement. However, it's also
very easy to incorrectly assume that our patients also
have this learned ability. This is why he feels it's critical
to provide patients with a way to visualize the value in
what we do to set the foundation for what's to come
restoratively and ultimately esthetically.
Dr. Patrick Turley (PT): In part one, you talked about
establishing value for the interdisciplinary patient.
Could you briefly explain this again?
Dr. Vince Kokich Jr.
Tacoma, WA
Dr. Vince Kokich Jr. (VK): Sure. Like I said in part one
of this series, I will frequently use the analogy of building
a house: the orthodontics is the foundation that
the rest of the restorative house will be built on. I find
this works well for the simple, wear, or supra-eruption
cases because it's easier for patients to understand
the idea of intruding teeth to create restorative
space. However, it doesn't work as well for complex
interdisciplinary cases that require a specific sequence
of ortho, perio, and restorative treatment. Therefore,
we need other ways to aid patients in visualizing the
importance of proper tooth position prior to realizing
their restorative goals. By successfully educating
our patients, we attach value to the recommended
orthodontic treatment and improve the chance of
establishing treatment value for these patients.
PT: Can you quickly summarize the two methods of
establishing value that you discussed in part one?
VK: There are three options that I will utilize to help
educate a patient as to why they need orthodontic
treatment, especially considering that most patients
believe they are only in our offices to appease their
dentist who told them they needed to have an evaluation.
In my experience, there is generally very little
patient education that happens prior to their orthodontic
exam with regard to why they need it. This is
one benefit of being part of an interdisciplinary team
and having a reasonable restorative background. The
first option I reviewed was the diagnostic orthodontic
setup followed by a restorative wax-up. I often use this
technique for the patient with multiple missing teeth
who requires implants and a full-mouth restorative
rehabilitation. The second option I use involves
exporting screenshots into my presentation software
(Keynote or PowerPoint) from my iTERO scan (pre and
post alignment) and modifying them in layers to simulate
the restorative treatment to be completed. I find
this works well for the patient with worn incisors who
needs restorative treatment post-ortho to recreate
normal tooth shape and ideal esthetics.
PT: Which visualization technique do you use most
often?
VK: The third technique is actually the one I use most
often because I've seen it have the most impact on
patients and provide the greatest educational value.
It's an iPad application you can find in the App Store
called Procreate (Figure 1). It's a drawing program
that I stumbled upon a couple of years ago. After
playing with it for a few months and seeing how
powerful some of the internal tools were, I started
to think about other areas where it could be useful.
This is when I first began using it to simulate future
orthodontic and restorative changes as a way for
patients to realize what was often difficult for them to
comprehend-the value of the orthodontic piece to
this interdisciplinary treatment puzzle. It's an amazingly
powerful way to effectively engage, motivate,
and educate patients on the value of what we do
orthodontically to the overall success of the interdisciplinary
process.
Figure 1
Spring 2022 PCSO Bulletin
37
Pacific Coast Society of Orthodontists Bulletin Spring 2022

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Spring 2022
