straight smile solutions straightsmilesolutions.com
and today we're going to talk about pins and posts in teeth and what happens when
you have invisalign or clear correct or any clear aligner company any clear liner product so this is
lightly lightly discussed in the invisalign and clear correct informed consent which of course you
must have your patients sign before you even deliver any orthodontics i wouldn't even i
wouldn't even do it before they even open the contract you need to make sure that they're on
board with this but in my opinion the informed consent that's designed by these companies is
very nice you know and they don't really go very much into detail so anytime i have
something where i'm like extra worried i'm gonna make sure i discuss it with my patient
and i'm also going to write an additional documentation in the chart and i might even
create my own additional supplemental informed consent form depending on what
i'm seeing so what makes me nervous is anytime i see pins or posts like this like this like this
obviously these are posts these are cast posts there's pins that are screwed in you guys know
what they are they're not used as often now as they were you know way back when but people have
them anytime i see a patient with one of these who wants to do ortho i'm like hey that's cool
that's great but i'm just letting you know this tooth is a very fragile tooth and it is subject
to fracture no matter if you do orthodontics you don't do orthodontics when you do orthodontics
you have a tray that's gonna have to come on and off and on and off multiple times a day
for possibly a year or two and that on and off if the tooth is already a little weak or compromised
listen that fracture was gonna happen whether it happened today tomorrow next month next year
for this patient and and restorative dentists and prosthetists know that teeth with pins and posts
are subject to fracture doesn't matter if you eat on a steak you bite a bagel
you know so unfortunately that fracture is a little bit more likely to happen when you're
pulling this thing on and off a zillion times that was already going to happen anyways if i'm going
to say it so the problem is that when it happens during invisalign treatment the fingers are going
to post point to you the treating orthodontist or the dentist who's doing invisalign and they're
going to blame it on you and the invisalign whereas it really isn't your fault it was already
in poor shape anyways because it had a pin in a post it was it was bound to happen
so i just feel like you're it's borderline are you slightly negligent if you do not specifically
discuss it borderline because it isn't an informed consent but i would discuss it anyways
and make sure your patient knows the plan what's going to happen if this tooth fractures or these
two fractures or this tooth fat fractures and we have to extract it in the middle of orthodontic
treatment what's the plan first of all who's responsible for the cost obviously it's not
the dentist but if you didn't flag it that's borderline you know depending on how they spin
it might become a real pain in your you know what um what are we gonna do how are we gonna change
the treatment plan are we gonna put a pontic in the retainer there's gonna be an implant when will
they get the implant how much is that gonna cost so my suggestion is just as a cya cover your beep
you should definitely discuss it with your patient and document it in chart and you might even want
to create a supplemental form if you're not sure you can always ask your supplemental um sorry
your liability insurance company a lot of times they are on board with all these additional risk
management features and they're great resources and they may have documents already ready to go
and of course as always get your informed consent signed that is like the responsibility you don't
know how often i work with doctors weird things happen like this right like well you
have the informed consent sign right i don't know you don't know even when i was working
as an associate orthodontist in a group practice in a dso in an oso i never ever started a case
unless not even my yes it's not my responsibility to make sure the informed consent was signed
but it is my responsibility to make sure it's signed i won't deliver anything i won't do
anything i don't care if somebody told me it's signed i don't care if the office manager told
me it's signed i want to see it in my own eyes i want to see that it's filed appropriately and
that it's done and i'm going to go to the patient and ask to see if they have any questions because
that's part of my job as the treating doctor is to make sure they don't have any questions
and anything on the informed consent that i think particularly stands out like in this case i want
to make sure we have an additional conversation about it and then i document that so just some
tips and tricks that i've learned along the way yes they can break all right thanks so much