Need help getting into ortho

[Want2BOrthoGurl]

I've applied to ortho twice and want to try again, feeling a bit rejected I'm currently GPR resident and everyone tells me research is important. I've never conducted research and have been trying to contact faculty regarding helping out with their research with no luck. Any recommendations?

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[pietrodds]

ortho, unlike other specialties, seems to get harder to into the longer you're out. Probably because you don't really gain ortho experience by being in a GPR or in pp. You can get into ortho as a GP if you want to do ortho. Do you really want to do ortho or just want the ortho lifestyle? I find it ironic that ortho is the hardest to get into and requires research. Ortho is probably the least changed specialty in the last 20 years and uses the research element to just weed out applicants. As it doesn't change that much, it's also utilizes research the least. I hope you do get in but don't feel like you failed if it doesn't happen. Dentisty is still a nice place to be. best of luck

 

[gryffindor]

You could also try e-mailing or approaching some residents and asking them if they need help with research projects.

How are your stats? The key to getting multiple invites is having competitive stats. Unless you do ground breaking research, it probably isn't going to make a huge impact on your CV and is just going to be something they discuss with you when you get to the interview.

 

[baddog]

Try the "Ortho program in San Antonio at UTHSCSA--they have openings for applicants I believe.

 

[vorosvirag]

ortho, unlike other specialties, seems to get harder to into the longer you're out. Probably because you don't really gain ortho experience by being in a GPR or in pp. You can get into ortho as a GP if you want to do ortho. Do you really want to do ortho or just want the ortho lifestyle? I find it ironic that ortho is the hardest to get into and requires research. Ortho is probably the least changed specialty in the last 20 years and uses the research element to just weed out applicants. As it doesn't change that much, it's also utilizes research the least. I hope you do get in but don't feel like you failed if it doesn't happen. Dentisty is still a nice place to be. best of luck

Interesting assessment of ortho, pietrodds. Are you an orthodontist? It doesn't sound like it to me.

I would say that research--like most other parts of your resume--is used to weed people out. A low GPA, no extracurriculars, no leadership, etc. is just as likely to weed an applicant out as little to no research.

You say ortho is the probably the least changed specialty in the last 20 years. What is your basis for this claim? Some orthodontists may not change much during their career, but the same case can be made for a certain % of GPs, endodontists, and everyone else.

Ever heard of miniscrews, self-ligating braces, straight-wire technique, Invisalign, precoated brackets, Forsus springs, direct bonding, and early treatment? These and other trends have arisen in the last generation of ortho.

New products and treatment modalities are developed quite frequently. Some practicioners stick with what has always worked for them, whereas others adapt and utilize more cutting-edge, current techniques and appliances.

I was speaking with a private practice guy yesterday who was explaining how much work it was to band all the teeth when he was in residency. Times change and this particular practicioner has evolved with the improvements in our speciality.

As long as innovation is rewarded in America with profit, all sectors of society will be driven forward by self-interest--even orthodontics (believe it or not).

 

[Want2BOrthoGurl]

Thanks for all the advice, I'm going to keep trying, thank you for taking the time to respond to my question, I really appreciate it.

 

[pietrodds]

I knew it'd be a matter of time before someone from ortho chimed in.

I'm by no means saying that ortho doesn't change and are living in the dark ages. Yes, they change based on research and implementing new things but not at the rate of other specialties. Yes, they use research based evidence with stuff like damon brackets and implants but when you look at the scope of practice of the average ortho on an average day it doesn't change at the same rate and uses research less. An ortho in private practice is able to practice relatively similar to the way they did 15 years ago as it's more treatment planning concepts rather than materials. Look how NiTi has revolutionalized the endo specialty, implants has totally changed the entire face of of perio/surgery to the point where it is still trying to find it's identity. Perio was all about saving teeth with grafts and now it's all about getting teeth out so there's bone for implants. Endo is moving into the realm of implants as well. I just don't see ortho skipping into other areas of dentistry, perhaps because financially there's no real need to. The reality is that ortho is probably the most difficult specialty to get into because it's also the most lucrative and comfortable lifestyle not necessarily because it requires the highest skill level. Because of the competativeness of getting in though, it also attracts those who happen to have the highest aptitude for learning. I personally believe that ortho is so far removed from general dentistry that I don't see the need for orthodontists to endure 4 years of dental school to do what it is they do. I believe they'd be better served by applying right out of college and just adding a year on to the ortho training for a general background to dentistry. You get such little exposure in dental school to ortho that I can't imagine that you know you want to do ortho anymore after 3 years of Dschool than you would before you even go to dental school. It's like making podiatrists go to school to get their MD first before podiatry school. It'd be less loans and years off of you guys who are in ortho's lives too.

Burn me at the stake if you will, just stating my opinion. Have a nice day.

 

[Dukie]

I knew it'd be a matter of time before someone from ortho chimed in.

I'm by no means saying that ortho doesn't change and are living in the dark ages. Yes, they change based on research and implementing new things but not at the rate of other specialties. Yes, they use research based evidence with stuff like damon brackets and implants but when you look at the scope of practice of the average ortho on an average day it doesn't change at the same rate and uses research less. An ortho in private practice is able to practice relatively similar to the way they did 15 years ago as it's more treatment planning concepts rather than materials. Look how NiTi has revolutionalized the endo specialty, implants has totally changed the entire face of of perio/surgery to the point where it is still trying to find it's identity. Perio was all about saving teeth with grafts and now it's all about getting teeth out so there's bone for implants. Endo is moving into the realm of implants as well. I just don't see ortho skipping into other areas of dentistry, perhaps because financially there's no real need to. The reality is that ortho is probably the most difficult specialty to get into because it's also the most lucrative and comfortable lifestyle not necessarily because it requires the highest skill level. Because of the competativeness of getting in though, it also attracts those who happen to have the highest aptitude for learning. I personally believe that ortho is so far removed from general dentistry that I don't see the need for orthodontists to endure 4 years of dental school to do what it is they do. I believe they'd be better served by applying right out of college and just adding a year on to the ortho training for a general background to dentistry. You get such little exposure in dental school to ortho that I can't imagine that you know you want to do ortho anymore after 3 years of Dschool than you would before you even go to dental school. It's like making podiatrists go to school to get their MD first before podiatry school. It'd be less loans and years off of you guys who are in ortho's lives too.

Burn me at the stake if you will, just stating my opinion. Have a nice day.

I would agree that it is the one specialty that we probably learn the least about in dental school. This is followed by endo surgery/apicos, most OMFS beyond extractions, and advanced perio. I don't know if I would agree with you, however, that you know little more after dental school than before about ortho. Dental school still teaches the foundations of oral health, dental anatomy, etc, that you certainly need in whatever specialty you pursue.

 

[Bodega Do Luiz]

Dental school still teaches the foundations of oral health, dental anatomy, etc, that you certainly need in whatever specialty you pursue.

...and Occlusion...?

 

[Bodega Do Luiz]

I knew it'd be a matter of time before someone from ortho chimed in.

I don't see ortho skipping into other areas of dentistry, perhaps because financially there's no real need to... I personally believe that ortho is so far removed from general dentistry that I don't see the need for orthodontists to endure 4 years of dental school to do what it is they do. I believe they'd be better served by applying right out of college and just adding a year on to the ortho training for a general background to dentistry. You get such little exposure in dental school to ortho that I can't imagine that you know you want to do ortho anymore after 3 years of Dschool than you would before you even go to dental school. It's like making podiatrists go to school to get their MD first before podiatry school. It'd be less loans and years off of you guys who are in ortho's lives too.

Burn me at the stake if you will, just stating my opinion. Have a nice day.

Not going to burn you at the stake; just tell you that you don't know what you're talking about.

Approx. 20 % of orthodontists' practice is made up of adults. That means interdisciplinary care, and that means an orthodontist better know his/her dentistry. Just look at Vince Kokich - one of the greatest orthodontists in the world; why? b/c he is first a great dentist.

 

[pietrodds]

how long does it take to learn occlusion? I'm not talking Pankey/ TMJ occlusion... I'm talking about this tooth touches this tooth crap you learn in dental school. Think about how much studying in dental school is spent studying physiology, medicine, biochem, microbiology...

Ortho is virtually completely non-invasive done on mostly healthy patients, aka kids. Most orthodontists I've come across don't even like treating adults because it throws off their office flow, treatments take much longer, and many of these cases are being shifted to Invisalign cases anyways. I'm not looking to discuss whether or not that that is good thing just making a point. Ask an ortho when was the last time they gave an injection. I'm not trying to knock the profession by any means as I believe it does take some serious brain power to do it well but it's just that quite far removed from dentistry. In terms of interdisiplinary approach, ortho is slowly coming to terms with implants as the younger orthos are replacing the older generation. I hope that you never have to be involved with a case where the patient is debanded and the roots are not positioned to accomodate an implant.

 

[gryffindor]

I gave an injection last Friday to place some TADs in the palate. Twenty people watched me and the poor patient as they tried to learn along (the TAD placement part, not the injection part) - nerve wracking indeed. We did agree that to do injections on a regular basis in the ortho office, you'd need a private room to avoid being known as the "orthodontist that gives shots." TADs have a lot of potential in ortho, although it will take a while for practitioners to catch on because of the "whoa we might have to give a shot" barrier.

 

[pietrodds]

I'll be the first to admit that ortho is my weakness but from the little I know I would think that having a solid anchor to direct forces from intraorally would be a huge advantage in ortho treatment.

 

[vorosvirag]

A few random thoughts:

I gave an injection last week to place a miniscrew to intrude upper molars. The kid has a ~4 mm anterior open bite. We are having success on the right, but the miniscrew fell out on the left. So, we put another in its place. He's a good sport. It's either miniscrews or a maxillary impaction. He--like so many others--do not want surgery.

I think treating adults will provide a good change of pace for my practice. I'm treating a bunch of them in residency now. Two are getting implants for missing upper laterals. A few others have miniscrews to protract lower molars (first molars extracted years ago). Closing spaces sure beats the drawn-out sequence and cost of graft & implant. Adults don't need to take longer.

Invisalign is extremely limited in what it can do (predictably and well). The results are compromised (compared to braces). My approach will be to use Invisalign only if I could fix the occlusion in under a year with fixed appliances.

Anyway, there is a lot to ortho. Many keep things simple by doing things the old-fashioned way(s), but surely limit their mechanics and efficiency by not trying new things (miniscrews, self-ligation, etc.).

As I said earlier, some practicioners--dentists, endodontists, and all the rest in dentistry--innovate and others don't. You can move or fill teeth with new or old materials/devices. As always, the choice is yours.

 

[vorosvirag]

I'll be the first to admit that ortho is my weakness but from the little I know I would think that having a solid anchor to direct forces from intraorally would be a huge advantage in ortho treatment.

It is huge. I'm correcting a class II with two miniscrews on the upper. It's much more predictable and faster than any other mechanics I could use. Retraction coils anchored to screws in bone is a great advantage.

This returns me to my point above. Much has changed in orthodontics. And much research has gone into these bone anchors. Pietrodds, I don't know why you can't see this single development as an enormous innovation for orthodontists (who choose to use them). As you mentioned, ortho is your weakness. Your strength appears to be the making of unsupported claims.

Without question, those who don't use miniscrews can get the job done. They've been doing so forever. However, they're simply missing out in some cases. To get a handle on anchorage is invaluable.

In conclusion, patients just must understand these miniscrews may get loose, may need to be replaced, etc. And the doc can't be squeemish about injections or managing these temporary anchorage devices (TADs).

 

[pietrodds]

I commend you on your use of cutting edge technology/ innovation. Keep in mind you're also in an environment conducive to doing so. You can't possibly comprehend what I'm saying until you drift away from the confines of dental school and make your way in the real world. Go talk to 10 orthodontists who have been out for more than 10 years and ask them what a TAD is? I'm willing to bet that 8 out of 10 will guess that is some tax-sheltering retirement scheme. You may believe I'm throwing out completely unsubstantiated claims but I'm merely speaking from my experience in private practice over the last few years.

On a side note, if the periodontists have their way you're gonna need to get a CAT scan before you put in those TADs to make sure you're doing standard of care.

 

[Jyaki]

I've applied to ortho twice and want to try again, feeling a bit rejected I'm currently GPR resident and everyone tells me research is important. I've never conducted research and have been trying to contact faculty regarding helping out with their research with no luck. Any recommendations?

I would contact someone in your school's ortho department and ask them exactly WHAT you could do to improve your CV. If it's not your CV, maybe it's your interview skills. Find out what your weaknesses are and improve on them. Another important aspect of doing research is the possibility of obtaining a great letter of rec. Most ortho residents are required to do a master's thesis. Often times these projects are supervised by a research oriented ortho faculty. Why not assist some residents wither their project, do some sort of a poster presentation at a dental conference, get to know the ortho facutly and get a strong letter of rec?

 

[vorosvirag]

I commend you on your use of cutting edge technology/ innovation. Keep in mind you're also in an environment conducive to doing so. You can't possibly comprehend what I'm saying until you drift away from the confines of dental school and make your way in the real world. Go talk to 10 orthodontists who have been out for more than 10 years and ask them what a TAD is? I'm willing to bet that 8 out of 10 will guess that is some tax-sheltering retirement scheme. You may believe I'm throwing out completely unsubstantiated claims but I'm merely speaking from my experience in private practice over the last few years.

On a side note, if the periodontists have their way you're gonna need to get a CAT scan before you put in those TADs to make sure you're doing standard of care.

Interdisciplinary tx does not require the deathly slow pace and bureaucratic nonsense of a dental school. In fact, an efficient practice should be much more able to satisfy the needs of patients than a school-based residency. I'm sure your dental practice is more efficient than the one you experienced in your 4th year of D-school.

Neither do TADs require the "safe" confines of a residency. With more and more residents placing miniscrews, more and more practicioners will do so.

I attend enough continuing ed and local district meetings to know that many practicioners (virtually all older guys) will not place TADs. And I'm not at all surprised. These old fellas have already defined their practice brand. Only the few open, adventurous ones will try new things.

Nobody feels one needs a CAT scan to place a TAD. The hypothetical periodontist you reference is another individual who needs to be updated and step into reality. CAT scans aren't required for dental implants. Why would a 1.4mm x 6mm TAD need a CAT scan? Miniscrews--like everything else--involve a learning curve. Composite or porcelain veneers are the same way. It takes time, but will definitely benefit your practice.

I repeat, the old guys don't like to innovate. We both make that point. I, however, go further by saying that most old GPs, periodontists, and all other human beings hesitate to innovate, apply research, etc.

My impression is that you continue your mantra that orthodontists are uniquely slow at adapting and either don't really need or want new research. You seem stuck on that point. It's a human--not an orthodontic--tendency to resist change when one is comfortable. Please acknowledge that.

 

[servitup]

Pietro, your generalizations could apply equally to GPs. I know some GPS still use rubber base and green stick compound for denture impressions, for example. Many older GPs have no clue about dental implants. Your point applies equally to all specialties and GPs.

 

[vorosvirag]

Pietro, your generalizations could apply equally to GPs. I know some GPS still use rubber base and green stick compound for denture impressions, for example. Many older GPs have no clue about dental implants. Your point applies equally to all specialties and GPs.

Thanks, servitup. We could list lots of "behind-the-times" examples for GPs and each speciality. Orthodontists are not the only dental practicioners stuck 20 years in the past. It's a personality--not speciality--issue.

 

[pietrodds]

I can't disagree with you about some older GPs...

 

[gryffindor]

At the risk of sounding clueless, but I have to ask - what's better than rubber base and greenstick? That's what we learned in school. When I got out, I learned there were less smelly impression materials and convenient border molding stuff that squirted out of a gun to take denture impressions, but apparently alot of that stuff is a lot more expensive. I want to be aware if there is some super awesome denture technique these days that I wasn't aware of. I hope I never have to make a denture again, but I did have to make a temporary crown this morning so you never know.

 

[Jone]

i know some dentists who swear by the Massad technique

At the risk of sounding clueless, but I have to ask - what's better than rubber base and greenstick? That's what we learned in school. When I got out, I learned there were less smelly impression materials and convenient border molding stuff that squirted out of a gun to take denture impressions, but apparently alot of that stuff is a lot more expensive. I want to be aware if there is some super awesome denture technique these days that I wasn't aware of. I hope I never have to make a denture again, but I did have to make a temporary crown this morning so you never know.

 

[pietrodds]

Kind of off topic but....

the massad technique is pretty slick but it does take more chairside time, the flip side is that you save a second app't and don't need a custom tray. Personally, I like the accudent alginate system which is similar to Massad as I don't think you get the displacement of tissue like you do with a PVS.