The unique challenges of adult orthodontics

Featured Products Promotional Features

  Posted by: Dental Design      28th May 2023

Providing orthodontic treatment to adults poses a number of challenges which are less prevalent when treating younger patients. Adults, for example, are generally looking to achieve excellent aesthetics[i] quickly, using the most aesthetic appliance possible.[ii] Adult orthodontics are constantly rising in popularity, driven by improvements in clear aligner technology, bringing with it high expectations for what can be achieved through orthodontic therapy.

Even though this is an exciting time for the profession, the litigious world we’re living in often encourages clinicians to practice more defensively. As a result, patients often receive more conservative therapies, require more radiographs, more TMJ examinations, fewer extractions, more second opinions, and more note taking.[iii]It is important to find a balance between providing patients with the treatment they desire, and protecting yourself from litigation.

Providing faster treatment

Sometimes, patients expect clinicians to provide them with their ideal smile within a short time frame. To improve compliance in these scenarios, clinicians may look to supplementary surgical measures to accelerate the movement of teeth, so they can provide patients with excellent results faster. Patients are more likely to accept treatment and comply with clinicians’ advice if it will provide them with outcomes that meet their expectations. There are a number of surgical procedures clinicians may consider when looking to accelerate tooth movement. These include piezocision, corticision, rapid canine retraction, periodontally accelerated osteogenic orthodontics (PAOO). Each of these use different techniques which aim to move the teeth more quickly. This accelerated movement can rely on the regional acceleratory phenomenon (RAP) which can be induced by surgery.ⁱⁱ

Even though each of these procedures are proven to be effective, they come with risks. Some produce results which are less aesthetic, as they require an open flap to access the bone (of particular concern in patients with a high smile line), and any surgical intervention can risk damage to the tooth structure, and potentially compromise vitality.ⁱⁱ Nevertheless, these surgeries are useful, with PAOO surgery reducing treatment times to around a quarter of the expected duration, and piezocision surgery by around half.ⁱⁱ When you adopt treatment types which can boost treatment acceptance, and shorten treatment durations for adult patients, you are likely to improve patient satisfaction.ⁱⁱ

What are the risks?

Any surgical procedure presents a number of risks. When manipulating bone in any capacity, there is a risk of damage to the bone, teeth, and surrounding soft tissues. This makes advanced planning especially important, ensuring that you have taken into account any factors which may affect the success of surgery or the final outcome of the orthodontic therapy. Clinical record keeping is especially important here too, making sure to make comprehensive notes of any decisions, discussions, and treatment plans to help avoid any complications. This being said, any techniques which are intended to accelerate tooth movement should not be implemented if their potential benefits do not outweigh any risks.ⁱⁱ

Should complications occur that result in the need for further treatment, or in unesthetic outcomes, it is likely that patients will be dissatisfied with their treatment, making the risk of litigation more likely. This means that it is crucial to carry out treatment you feel confident will produce excellent results, discuss any risks in detail with patients, answer any questions they may have, and treatment plan accordingly.

Creating excellent relationships

Research suggests that patients who have a good relationship with their orthodontist are less likely to pursue litigation than patients who are upset and feel resentment towards them.ⁱⁱⁱ Therefore, to minimise the risk of legal action, it is recommended to establish an empathetic, friendly relationship with patients. This means ensuring clear communication with patients of all ages, helping to ensure patients feel comfortable and cared for at all stages of their orthodontic treatment.

By taking clear and accurate records of each visit, you are able to monitor the progress of your patients’ orthodontic treatment closely, and make decisions with your patients to ensure that the right course of treatment is undertaken at the right time. This is also an excellent way to record any conversations you have with your patients regarding risks and preferences. Kiroku is the digital note taking platform which is designed to make complete note taking easy. With templates specifically designed for orthodontic patients, you can be sure that you are collecting all of the relevant information needed to monitor their progress effectively. The dynamic templates even offer helpful prompts, making suggestions applicable to your case, to make sure you never miss a thing. Plus, this convenient system allows you to take your clinical notes 60% faster than before.

While adult patients will often have high expectations as to what they would like from their orthodontic treatment, it is important to work with them to confirm they understand what is possible with the tools available, and what the potential consequences of any surgical intervention may be. By building a positive relationship with your patients, ensuring you communicate effectively, and make clear notes of any conversations had and decisions made, you protect yourself from litigation, and guarantee that your patients are receiving the most appropriate treatment for them.

To find out more about Kiroku, or to start your free trial, please visit trykiroku.com

[i] Cedro MK, Moles DR, Hodges SJ (2010) Adult orthodontics-who’s doing what? J Orthod 37(2):107–117. https://doi.org/10.1179/14653121042966

[ii] Keser, Elif, and Farhad B. Naini. “Accelerated orthodontic tooth movement: surgical techniques and the regional acceleratory phenomenon.” Maxillofacial Plastic and Reconstructive Surgery 44.1 (2022): 1-21. https://jkamprs.springeropen.com/articles/10.1186/s40902-021-00331-5

[iii] Pour, Hamid, et al. “An overview of orthodontic malpractice liability based on a survey and case assessment review.” Journal of Clinical and Experimental Dentistry 14.9 (2022): e694. http://www.medicinaoral.com/medoralfree01/aop/59785.pdf

 

---