Orthotown December 2021 - 10

a voice in the arena
his remaining teeth and setting up for an
" all-on-4 " implant-supported prosthesis!
While there were certain treatment
limitations to work around (not a perfect
case in many ways), after 36 months of
tough sledding, it was enough to make
those of us involved feel like we had been
able to serve the role of " specialists at the
end of the road " for a guy who thought he
was out of options.
At the finish line, seeing how much the
treatment meant to him is enough to make me
want to be that specialist for every orthodontic
rehabilitation case that walks through my
office door. But, as Lee Corso of ESPN's
College GameDay says: " Not so fast, my
friend! " More valuable than me just showing
one meaningful case, I'd like to discuss some
of the " keeping it real " hard-learned lessons
I've taken away from treating these types of
cases over the past 11 years.
Profitability. It's prudent to consider
price per chair/appointment for our treatments.
However, in my experience, if you're
expecting to see anything near your practice
averages when you dive into these financial
metrics at the end of a rehab case, you're
likely to be disappointed-even if you
increased your fee significantly above average.
This is not to assume where motivation for
profitability should rank on your priority
list when you evaluate these types of cases,
but for your own sanity, it's good to consider
this realistically and ahead of time.
The restorative dentist's expectations.
I'm much more deliberate about this nowadays.
For example, does the referring doctor
fully understand how difficult it would be to
rehab vertical dimension in a patient who has
seven missing posterior teeth, lower incisors
impinging on the palate and bite strength
that would scare off a brown bear? Or after
30-plus months of attempted orthodontic
heroism, would they be complaining that the
case took too long, the patient wasn't happy
and the orthodontic work still left something
to be desired for a perfect restorative setup?
10 DECEMBER 2021 // orthotown.com
" When planning with
your restorative partners,
always highlight the
compromises and
limitations, undersell the
best possible outcome,
then try to overdeliver
within your ability. "
If proper expectations and potential
limitations of orthodontic treatment are
not thoroughly outlined before teaming up,
the dentist may actually think less of your
abilities after all the blood, sweat and tears
shed on the case than if you hadn't taken it
on in the first place! When planning with
your restorative partners, always highlight
the compromises and limitations, undersell
the best possible outcome, then try to
overdeliver within your ability.
The patient's personality. Let's be
honest. A large percentage of patients who
need complex pre-restorative orthodontic
rehabilitation have something in common:
They've been quite willingly and actively
negligent about reasonably caring for their
dental health over the years. While some
may have had a " come to Jesus " moment
that made them ready to now be an excellent
patient and partner in the arduous journey
you're about to embark on together, the
reality is that many are the exact same
people who got themselves into this dire
situation to begin with.
My strong advice: Look for any red flags.
Do they seem bothered to be meeting with
you, the orthodontist, in the first place? " I
don't even understand why I am here at
the orthodontist. I just want my dentist
to fix my front tooth! " Do they seem like
someone who is happy and prepared for a
long, and at times unknown, road? Or are
they demanding guarantees, balking at
cost and time in treatment, or otherwise
coming across as grumpy? Or even worse,
are they playing the role of victim in their
own version of how they came to become
an orthodontic rehabilitation patient?
My " musts " for accepting
adult orthodontic rehab cases
After finding myself married to a number
of the wrong type of patients in these cases
over the years, I now have four prerequisites
before I'll accept a case. In the initial exam,
I specifically look for:
* A generally happy person I enjoy
having a conversation with.
* Someone who is willing to
realistically accept the severity of
their situation and the extent of what
will be required to properly remedy it.
* Someone who is willing to
acknowledge their own responsibility
in the previous decline of their dental
health/condition.
* Someone who understands that the
only guarantee I can offer is my
commitment to do my very best to
attempt to deliver a good result from
a very compromised situation.
If any one of those criteria is missing,
I politely inform the patient that I don't
believe I'm the best doctor for their care.
To be totally honest, I must admit that
nowadays I'm much more nervous when a
person meets all of the criteria and I agree
to take on their rehab case! I just hope that
I won't look back a few months into their
difficult treatment and realize there was a
fifth criteria that I should have seen staring
me in the face and waving a red flag in the
exam room. ...
What are your " musts " when agreeing
to treat an adult rehab patient? Verified
members of the Orthotown community are
free to share their thoughts and opinions in
the Comments section under this column at
orthotown.com/magazine. n
https://www.orthotown.com/magazine/article/8508/a-voice-in-the-arena-adult-orthodontic-rehab-cases http://www.orthotown.com
Orthotown December 2021

Table of Contents for the Digital Edition of Orthotown December 2021
