hey it's doctor amanda with street smile solutions straight smile solutions.com and today we're
going to talk a little bit more about compromise cases eg taking cases that you can't make perfect
we all once you start doing more ortho get patients to come in they're like look i know
i have to have jaw surgery to make this perfect but can you just make it look better so i wanted
to kind of dip into that a little bit and i have kind of a unique viewpoint because you know i am
an actual orthodontist almost 20 years of experience i've seen done been a part of
tens of thousands of cases at least if not more um in one way or another and i've also been part of
some expert witness situations um situations with dental boards not against me against other people
where perhaps my advice was given i can't really speak to those um i really find it fascinating
um to tap into liability insurance companies and a lot of general dentists that are doing ortho
really have no idea what kind of hot water they can get themselves into certainly orthodontists
have more of an idea because we've all dealt with second opinions and cleaning up someone else's
masses and we know what the insurance company can say and we know what the dental board can say
if you don't if you miss that so let's talk about compromised cases first of all you need to have
compromised release form now i have one in my store that you can purchase it's 20
it's free for our actual vip or concierge clients they get unlimited access to our database of forms
it's just a template um you can use it i'm not an attorney so you can run it by your attorney
you can use it just as a jump start at least in terms of the dental terms
but you got to have that that's the first thing you got to do you do not take compromise cases
without compromise release form that's standard because that's going to help protect you but
in essence if you're not going to make a case perfect then you need to be explaining in you
know verbally but in writing and also grabbing a signature for that patient as to the risks
benefits and alternatives of this compromise treatment plan in comparison to an ideal treatment
plan now you can't just say okay i'll do it unless you have all those dots you know everything
checked you know because unless you cover yourself cya cover your you know you know what
you are leaving yourself at risk if there's ever a complaint and you know maybe it's just
a refund but maybe it's also getting your license taken away so it could be a very expensive amount
practice suit it happens and these type of cases are dangerous i'm just letting you know so let's
talk about i'm gonna talk about class three cases right now and then i'm gonna do a subsequent video
right after this that i'll post it probably back to back about overjet so let's talk about this
first of all class three cases first thing i'm gonna do is i'm gonna find
out the age of the patient and where they are in their pupil pubertal growth spurt obviously
the patient is over age 20 they're an adult but if they're between the ages of you know
um i would say six and 16 or 18 even there's a potential for growth still so
you need to call a spade a spade and you need to treat it based on what's right if the
patient still has growth potential you need to be factoring that in that would be standard of care
and i don't think doing compromise on kids is standard of care you're gonna have a hard time
holding that one up because it's not standard of care on an adult over age 18 okay you can make
your own decisions i'm fine with that i don't i personally don't do compromises on kids that's
where i i put my foot in the ground saying nope go to someone else sorry um because i don't feel like
kids can make their own decisions for that um for let's say that let's say this is an adult if it's
a kid you know i'm gonna try to do whatever i can to encourage the growth and fix it the right way
you know there's face masks there's all kind of stuff you can do all right we won't get into that
because i have a zillion videos on that already let's talk about the adult let's say it's an adult
adult is over 18. clearly not growing what do we do now next step is going to be often in class 3
cases like this this is actually not the bite this is the crco shift they have an interference and
they shift to a more comfortable place so you need to try to get the actual bite this is not the bite
often when you see the midlines off like this um it's not the bite so i have a good video on how to
how to understand a crco shift how to detect it if you want it i can send it to you if not if you go
into my videos and just look up cr or co it should pop up it's from about a year or two ago it's an
old video but it's you it's good um you'll want to find this the actual cr and take photos in that
you know even if it's like a funky bite with an interference and then that's your starting point
so it may not be as bad as you think right so that would be my first step with this
once you know exactly where it is of course you're going to have to get a ceph
you have to get a cf so if you don't have access to a set machine or you don't know how to get
access from somewhere you should have no business taking this case don't take it you need a baseline
set get baseline staff numbers you need to know where the deficiency is or where the excess
is is it a big mandible is it a deficient maxilla or is it a combination of the two
then easiest way honestly to play with it for me is i mean i have a pretty good idea when i look at
a case based on what i've done in my eyeballs and stuff but i always like to to scan it and
put it in invisalign you can always do these cases invisalign if they're doable you know
but they've got great software um and it's a great way to mock it up um yes maybe you want to do
braces but you know it's a great way to simulate the movements and everything as far as i'm
concerned everything can be done and invisalign you just need to know how to do it so that's what
i do i throw it in vision line and i play around with it obviously this one is missing a lateral
you know it's got a pig lateral here it's probably a crco shift it's probably not as hard
as you think because if you consolidated the space made space for an implant here retracted this um
get it into cr it actually may not be that hard as you think maybe you can't fix the posterior
crossbite but i'm pretty sure you could fix the anterior fully as long as you're willing to get
an implant here so sometimes a compromise might be pulling out some teeth either an incisor or
two lower bias not really my preference normally but you know it might be maybe an option for sure
or opening up spaces around the lateral incisors if you know they're pegs that'll help out a lot
too right um so yeah pretty much that's that's my spiel for class three cases you need to be careful
you need to treat it the right way you need to give options you need to explain risk benefits
and alternatives the patient needs to be fully educated all that needs to be put into a document
along with a compromised paperwork that they need to sign um and again if you don't understand what
perfect is you know send them to an orthodontist just for a second opinion they need to know what
perfect can be they need to know that it's they can get that and often the one of the biggest
mistakes i've seen is that if you don't do that and you don't encourage them to do that you can't
force them to do it but you can encourage it they get them to a point where you fix them to
a compromise point maybe by taking out some teeth and then they realize later hey i could have done
this job surgery and oops it would have been fully covered by insurance because i'm having issues
with my jaw joints or my airway or my ability to eat or speak you know and orthodontics and
oral surgeons together they can do magical things if the if the patient needs it for health reasons
often it can be fully covered and it transforms their face and their airway and their you know
their functionality and their lifespan and by you doing that compromise case i know i'm pushing it a
little bit but this is true by you just jumping to conclusions that that this is best for the patient
and this is what the patient wants because this is what the patient's asking for but not fully
explaining the risk benefits and alternatives you are putting this patient at a possibly shorter
lifespan and a disadvantage you're damaging this patient you didn't fully explain the
risk benefits and alternatives so if you can't explain it then you probably shouldn't be doing
the compromise case if you can't explain it or you don't strongly encourage them to go get that
orthodontic consult and find out if that's what they want if they go and they get all
the information and they still are adamant i saw i understand i saw the you know the ortho work
up i saw the oral surgery work up i know what my copay is i still don't want to do it fine you know
but i need to be able to sleep well at night i need to be able to know that what i'm doing
is not going to damage the patient and sometimes when you do a compromise on these you put them
at a very unhealthy position for their teeth their bite and you're actually doing more yes maybe they
like the way it looks better but you're doing more damage to their airway their jaw joints their bite
the stability of their teeth it's going to cause breakdown abstractions attrition if and when there
was a complaint 10 years down the road you're going to lose in court so that's why i want you
not to be pressured by these patients so hopefully this was inspiring alright thanks so much