Ortho Help

[Tony Parker]

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I read an earlier thread about not losing hope getting into a ortho residency. One person wrote about getting a M.S. in some type of research making them a stronger applicant. I was wondering if anyone had more helpful hints like this to suggest. Also does every Ortho program requrie a GRE score? If so did anyone take a course through Kaplan. I used them for the DAT's and felt it made me as prepared as I could be going in for the test. And what score range is the min. level you want reach for your ortho application?

 

[antidentite]

if it was me i would find a program that i liked and that had a post doc program like a craniofacial program which is associated with the ortho department. most post-docs working in these departments right out of dental school are there to make connections, show they are dedicated and hoping to get into the ortho program the following year. this is the route i would have gone.

with regards to the GRE. about a 1/3 of the schools i applied to required it. i honestly do not think they put much weight on this test. one school told me it was a requirement of the graduate college. if all things were equal - class rank, boards, GPA, research, recommendations, essays, interviews - then maybe they will look at it - it is part of the total picture. i didn't take a kaplan course. i think most people bought a kaplan book with some practice tests and reviewed 1-2 weeks before the test. now if you are a foreign applicant disregard that - i have no idea how you would prepare for the non-math section. a score - i don't know - i don't recall any school giving a minimum score requirement. maybe indiana said something about 1200 but i am not sure. of all the things to worry about for your application this would be towards the bottom.

 

[dentalman]

It is towards the bottom of priority, but one of the best ways to study for the verbal GRE is to memorize a small stack of GRE vocabulary words. I did this, and it helped boost my verbal score into the 95 percentile (which is totally unnecessary, but good bragging rights.)

 

[gryffindor]

if it was me i would find a program that i liked and that had a post doc program like a craniofacial program which is associated with the ortho department. most post-docs working in these departments right out of dental school are there to make connections, show they are dedicated and hoping to get into the ortho program the following year. this is the route i would have gone.

Didn't Chicago have something like this and discontinued it? Vanderbilt had a similar position but has also discontinued it presently. Opportunities like this are, IMO, rare to come across considering the large number of people who don't match. It's not like they exist at a decent number of ortho programs out there and are well advertised like OMS fellowships or GPR programs. Here's what I can think of:
Florida - an established fellowship program
I heard UConn was trying to do something maybe similar to Florida.
I have heard Nova has something like the post-doc craniofacial you mentioned.
There is the TMJ program at Rochester (Eastman Dental Center) that operates in the same clinic as the ortho program there.
There is the Lancaster Cleft Clinic in PA and they may have something there.

Of course if anyone has heard of other opportunities like this, post them and help the newbies out.

I would try to stay in academia with a fellowship, GPR, AEGD, master's, research, etc. I would look for something that has you interacting with multiple orthodontists. So a GPR at a VA hospital might not be the best bet, neither would doing a full time research gig in the perio or endo department help you. Private practice where you are interacting with orthodontists who are still connected to academia (like they teach part time at the local ortho program) would maybe work. The connections you make after you graduate in any of these scenarios may open more doors for you than the actual work you end up doing.

Doing stellar on the GRE is not as crucial as the rest of the application. If you are scoring 400s in each section, they maybe you should look into Kaplan. That's up to you. If you do really well, someone will probably make a comment during your interview, but I can't see how it would ever be a reasonable deciding factor between trying to accept candidate A vs candidate B. How you dressed and did your hair will probably matter more than your GRE score at an interview. I would definitely recommend taking it, it opens up a lot more places you can apply.

 

[diagnodent]

Please note ortho school isn't the only place to learn ortho.

If you can't get into ortho school and really want to do ortho then learn tip edge ortho. Then move to a rural area where there is lots of small towns and rent chairs in offices and do ortho. It's easily done and done more than you think. Plus, no ortho school.

 

[antidentite]

oh my........
what are all of the orthodontists out there thinking?! all they needed to do was take a tip edege course? damn it. here i was getting fooled about how complicated ortho was in a residency program when all i needed was a coulpe of seminars with tip edge. thanks for the valuable info.

 

[Tony Parker]

The best thing is if anyone had actual programs out there for post docs in academia (MS, fellowship, internship, whatever) tied into the ortho dept. I've tried google searching for some info if anyone can post any links to websites that would help, thanx. Also not all ortho schools need the GRE? I don't think any other dental specialty fields require the GRE just curious why ortho does?

 

[vorosvirag]

Please note ortho school isn't the only place to learn ortho.

If you can't get into ortho school and really want to do ortho then learn tip edge ortho. Then move to a rural area where there is lots of small towns and rent chairs in offices and do ortho. It's easily done and done more than you think. Plus, no ortho school.

Interesting comment. I decided to attend the Annual TipEdge seminar last fall. I was intrigued by their overall philosophy and bracket design. However, I was not overly impressed by the presentation of cases by the big-time TipEdge people. I forget names, but the founder, his son, and others presentated cases, lectured, and conducted a hands-on course. Many of their finished cases were dished in--typical of what people used to see w/ Begg. I'll stop there w/ my critique, though many of us saw more we didn't like. I'll let others make up their own minds about the pros and cons of all systems after experience and/or observation.

Go ahead and do TipEdge--even the new PLUS. Just understand that many orthodontists have looked at TipEdge and are unconvinced. I clearly feel better stuff is out there.

I know a general dentist back home who does TipEdge. I've seen some of his cases. Some turn out fine. Some, however, turned out not so fine if you know what I mean. And I was observing them before I even got into ortho.

Further, a GP attending the TipEdge seminar explained to us over dinner his ability to finish cases with TipEdge more quickly and with better outcomes than the local orthodontists. If he and you can really do that, good for you guys. On average, I just don't believe it happens. Orthodontists would adopt an idea--regardless of its source--if it had merit equal to or greater than what's out there.

 

[diagnodent]

I'm fine with skeptics of tip-edge, almost all ortho are skeptics of the technique b/c they don't understand it. But most orthos don't adopt a better idea or technique like you said. Take Damon brackets for example, they are hugely popular right now but aren't a new idea and aren't a good idea. Orthos love them b/c you can tip teeth more so than before which is something they have never been able to do. But try finishing a case with Damons and you will learn what slop is all about. With tip-edge plus's deep tunnel you can finish a case so much easier and better.

Please note I do not want to debate ortho ideas, I just want you think that not all orthos are like you and do not use better techniques.

 

[Jediwendell]

Instead of Tip Edge you should just buy some cheap Pakistani brackets and power chain the bejeesus out of all your extraction cases. Anchorage is for wusses. Make sure that you do all your space closure on a round wire. That will give you the same effect without having to take a course.

BTW, all my Damon cases are finishing great. Funny what education can do for you. Haha.

 

[vorosvirag]

I'm fine with skeptics of tip-edge, almost all ortho are skeptics of the technique b/c they don't understand it. But most orthos don't adopt a better idea or technique like you said. Take Damon brackets for example, they are hugely popular right now but aren't a new idea and aren't a good idea. Orthos love them b/c you can tip teeth more so than before which is something they have never been able to do. But try finishing a case with Damons and you will learn what slop is all about. With tip-edge plus's deep tunnel you can finish a case so much easier and better.

Please note I do not want to debate ortho ideas, I just want you think that not all orthos are like you and do not use better techniques.

If anyone could understand any orthodontic system it would be orthodontists. One reason many don't know a lot about TipEdge is its virtual absence in orthodontic residencies. Few instructors know about TipEdge. If they know anything about the system it's probably something they've heard--not from first-hand experience.

For many reasons, orthodontists rejected Begg. Some of the Begg disciples tweaked his system somewhat and came up with TipEdge. Most orthodontists rejected these modifications. I wasn't around for those earlier debates. I assume these orthodontists had valid reasons. I imagine all those auxiliary springs must have contributed. Now, TP has come up w/ TipEdge PLUS. I know in theory how it works. We learned all about the deep tunnel. The TP people made sure we got the concept. It's not really that difficult to grasp.

So, diagnodent, why do you think orthodontists reject or ignore TipEdge? They just don't want superior treatment times and outcomes? I'm guessing TP didn't market the stuff well enough and/or orthodontists don't want to try an entirely new system. To run an efficient practice you've really got to go either conventional edgewise or TipEdge. Inventory and other reasons drive the decision. By the way, are you a resident? GP doing TipEdge?

You're right. Self-ligating systems like Damon aren't new. Yet, the advantages are nice. Patients can go for longer periods between visits. Tx time overall decreases. Damon's archwires broaden the smile. Patients like that. I have about five Damon cases now, and therefore can't speak about personal outcomes. What I've seen, however, has been impressive. Wendell seems to manage the "slop" just fine.

Though all orthodontist have slightly different philosophies, they'll all be driven by profit and goals for quality, efficient tx. If you've got the superior technique, why isn't it being adopted by more folks?

You sound like many at the TipEdge course. Many of their head guys were gray-haired old men w/ chips on their shoulders. They had the better system, so they said. In fact, in their minds TipEdge blows the doors off conventional edgewise therapy, but for some strange reason that system wasn't integrating into the mainstream. They just didn't know why. Maybe you do. Maybe TipEdge PLUS is the future. Perhaps the deep tunnel is the answer. Or maybe Dwight Damon should market the TipEdge PLUS bracket.

 

[QCkid]

If anyone could understand any orthodontic system it would be orthodontists. One reason many don't know a lot about TipEdge is its virtual absence in orthodontic residencies. Few instructors know about TipEdge. If they know anything about the system it's probably something they've heard--not from first-hand experience.

For many reasons, orthodontists rejected Begg. Some of the Begg disciples tweaked his system somewhat and came up with TipEdge. Most orthodontists rejected these modifications. I wasn't around for those earlier debates. I assume these orthodontists had valid reasons. I imagine all those auxiliary springs must have contributed. Now, TP has come up w/ TipEdge PLUS. I know in theory how it works. We learned all about the deep tunnel. The TP people made sure we got the concept. It's not really that difficult to grasp.

So, diagnodent, why do you think orthodontists reject or ignore TipEdge? They just don't want superior treatment times and outcomes? I'm guessing TP didn't market the stuff well enough and/or orthodontists don't want to try an entirely new system. To run an efficient practice you've really got to go either conventional edgewise or TipEdge. Inventory and other reasons drive the decision. By the way, are you a resident? GP doing TipEdge?

You're right. Self-ligating systems like Damon aren't new. Yet, the advantages are nice. Patients can go for longer periods between visits. Tx time overall decreases. Damon's archwires broaden the smile. Patients like that. I have about five Damon cases now, and therefore can't speak about personal outcomes. What I've seen, however, has been impressive. Wendell seems to manage the "slop" just fine.

Though all orthodontist have slightly different philosophies, they'll all be driven by profit and goals for quality, efficient tx. If you've got the superior technique, why isn't it being adopted by more folks?

You sound like many at the TipEdge course. Many of their head guys were gray-haired old men w/ chips on their shoulders. They had the better system, so they said. In fact, in their minds TipEdge blows the doors off conventional edgewise therapy, but for some strange reason that system wasn't integrating into the mainstream. They just didn't know why. Maybe you do. Maybe TipEdge PLUS is the future. Perhaps the deep tunnel is the answer. Or maybe Dwight Damon should market the TipEdge PLUS bracket.

Correct me if i'm wrong but I have heard that their is an inherent flaw in Damon because it causes expansion of the arch which is unstable and the teeth end up returning to their original or close to original position.

 

[diagnodent]

You answered your own question about why tip edge isn't done by orthodontists....Marketing. Damon has done a tremendous job marketing the damon bracket b/c there are other self ligating brackets on the market and have been in the past. Most ortho programs are funded through donations, etc by ortho companies who make edgewise appliances. These companies are smart b/c they know if they get the residents to use their products then the residents will continue using them once they are out. Another reason that tip edge hasn't caught on b/c of the lack of "certified" instructors. There just aren't many orthos doing it so when you associate or buy a practice that already has edgewise in place you aren't going to change to tip edge.

The tip edge plus bracket is built for the GP. Pete Kesling has simplified the system and continues to simplify the system b/c he knows his market is GPs.

Ortho isn't rocket science, its just another speciality. I think ortho is much easier that doing a full mouth rehab like a prosth would do. The difference in GPs and specialists is that GPs try to simplify things and specialists try to add steps to make procedures more complex. IMHO

Most older orthos that I work with know that I do good treatment and wouldn't do a case above my head. They appreciate that I do ortho b/c I send them more ortho cases than most other dentists b/c I know what to look for.

Here are a few questions for you. Why do so many edgewise orthos believe that non extraction is a treatment goal? What happens when the child gets 18 and the wisdoms need extracted under sedation? Why not extract bi's early and make room for the wisdom teeth thereby eliminating a much more dangerous surgery? I always thought extracting or not is a treatment plan not a goal--not being sarcastic, I just don't understand it.

 

[antidentite]

Go sell crazy some place else.....we're all stocked up here.

"The tip edge plus bracket is built for the GP."

- Precisely. For those who know nothing about ortho and want to think it is easy. Those who are trained and have references to compare to disagree on its superiority.

"Ortho isn't rocket science, its just another speciality. The difference in GPs and specialists is that GPs try to simplify things and specialists try to add steps to make procedures more complex."

- You are delusional and lost all credibility from anyone who does know anything about ortho with that statement. There is a reason that the best dental students in the nation every year are humbled by their ortho residency programs and the amount of information needed to do orthodontics well. The goal is not to simplify things. It is to understand things nimwit. If you had this ability you could evaluate Tip Edge vs. other systems and not just believe what you are force fed at a seminar. When you are trained in this field, have experience with numerous appliances, listened to hundreds of sales pitches and seminars all trying to pitch an idea which you are capable of critically interpreting with non superficial understanding - then try posting something that is relevant.

What do you know about growth and development and its role in treatment? Let me guess - its not important because it just complicates things.

"Why do so many edgewise orthos believe that non extraction is a treatment goal?"

- Your jealousy of orthos is shining through now. Problem list to treatment goals to treatment plan. Treatment goals dictate extraction which is the treatment plan - not vica versa. It is about the face and profile. This is not just about straightening teeth. This is a dentofacial specialty. Look at the 100 cases that Tweed treated and presented back in the day. Dished in faces are not esthetic. Having said that - there are always cases that indicate extraction - we could discuss it if you weren't so afraid about delving below the superficial and getting past the simplification of things you learned at your weekend seminar.

"What happens when the child gets 18 and the wisdoms need extracted under sedation? Why not extract bi's early and make room for the wisdom teeth thereby eliminating a much more dangerous surgery? "

- You are not up to par on this topic. Not following you. Site some references / research backing yourself up and you'll get a reply.

 

[Jaybe]

Correct me if i'm wrong but I have heard that their is an inherent flaw in Damon because it causes expansion of the arch which is unstable and the teeth end up returning to their original or close to original position.

I have heard the same. However, there are people out there that claim large amounts of expansion can be stable. Sounds doubtful, but they claim it. Still others claim expansion of adult arches. Also sounds doubtful.

One of the greatest clinicians I know told me the secret of his unparalleled retention is that he bends all his own wire (Tweed guy) and therefore never places teeth outside the ridge of bone, especially in the mandible. He's got dudes that have been 35 years out of braces, haven't worn a retainer in 20 years, and have no relapse.

Using a preformed wire without adapting it to the patient's individual arch size/configuration seems likely to place teeth in an inherently unstable position, regardless of the system.

Caveat - I'm not a resident yet. I make most of this stuff up as I go.

 

[Jediwendell]

I have heard the same. However, there are people out there that claim large amounts of expansion can be stable. Sounds doubtful, but they claim it. Still others claim expansion of adult arches. Also sounds doubtful.

One of the greatest clinicians I know told me the secret of his unparalleled retention is that he bends all his own wire (Tweed guy) and therefore never places teeth outside the ridge of bone, especially in the mandible. He's got dudes that have been 35 years out of braces, haven't worn a retainer in 20 years, and have no relapse.

Using a preformed wire without adapting it to the patient's individual arch size/configuration seems likely to place teeth in an inherently unstable position, regardless of the system.

Caveat - I'm not a resident yet. I make most of this stuff up as I go.

NO orthodontic treatment is "stable", at least not as Tweed or Angle would have liked it to be. Go read Robert Little's study from 1983 and see what you find. Untreated subjects experience continued arch length shortening over time, which means- more crowding. Treated subjects have about a 10-20% rate of "acceptable" crowding after 20 years. Is that stable? Nope. People grow and change over time. You can see that process in the aging face. Teeth change over time.

Now for the Damon issue. If you look at the website for Dr. Damon's extraction policies, he basically will extract for all the same reasons a modern orthodontist would. The big difference is in the crowding. Only extremely severe crowding is recommended for extraction by Dr. Damon. The problem with Damon is that Ormco is a bunch of shiesters and sends their reps around telling people you don't need headgear or extractions or elastics anymore. Then you go to a course and you do. Damon is fine, it finishes fine, and it works just like anything else.

 

[diagnodent]

Thanks for most of you being cordial on this board except for antidentite who I can tell is an ortho resident. Please tell me how many cases you have treated yourself and how long you have been an orthodontist b/c I don't think it will compare to me. So I'm not going to talk about different techniques b/c this just isn't the forum for that.

By saying that I'm jealous of orthos, had no credibility, among other comments made me laugh. If you think that my statement about specialists making procedures more complex isn't true then you obviously haven't talked to prosthos, endo, most orthos, and perios about what they do compared to GP's. The difference in a GP and a specialist is that specialists inherently have more knowledge in the field and try to take out all inaccuracies. Have you ever seen the steps a prostho takes to mount alginate models on an articulator? There are so many steps involved that most people would go nuts with just taking the alginate impressions that have to be exactly 1/4-1/2inch thick.

Please note that one day you will need all of us lowly GP's to refer you cases. So you might want to step down from your high and mighty pedestal. You are probably like most of those who went to ortho from my class, incredibly intelligent, quiet and socially awkward. But once you are online you can't control your comments about how much you know and don't know how to discuss in a cordial manner hence the social awkwardness. Its ok we all understand.

 

[aphistis]

Nix the personal attacks, please.

 

[Jediwendell]

Thanks for most of you being cordial on this board except for antidentite who I can tell is an ortho resident. Please tell me how many cases you have treated yourself and how long you have been an orthodontist b/c I don't think it will compare to me. So I'm not going to talk about different techniques b/c this just isn't the forum for that.

By saying that I'm jealous of orthos, had no credibility, among other comments made me laugh. If you think that my statement about specialists making procedures more complex isn't true then you obviously haven't talked to prosthos, endo, most orthos, and perios about what they do compared to GP's. The difference in a GP and a specialist is that specialists inherently have more knowledge in the field and try to take out all inaccuracies. Have you ever seen the steps a prostho takes to mount alginate models on an articulator? There are so many steps involved that most people would go nuts with just taking the alginate impressions that have to be exactly 1/4-1/2inch thick.

Please note that one day you will need all of us lowly GP's to refer you cases. So you might want to step down from your high and mighty pedestal. You are probably like most of those who went to ortho from my class, incredibly intelligent, quiet and socially awkward. But once you are online you can't control your comments about how much you know and don't know how to discuss in a cordial manner hence the social awkwardness. Its ok we all understand.

Dude, the reason "orthos" make things "more difficult" is because they have read the literature and know what is best for the patient. It becomes less about making a buck and more about treating the patient. I guarantee you that you have many "roller coasters" out there, and if you don't know what I'm talking about then you should probably not be doing orthodontics. The high and mighty pedestal has nothing to do with who does orthodontics. The entire reason we do this stuff is for the patient, not for your pocket book. Most orthodontists that I know seem to relate themselves with good quality clinicians that care about their patients, not guys that just do ortho because they took a weekend course and think they know more than a highly trained specialist. Are there good clinicians out there that didn't do a residency? Sure, but there are a whole lot more that are NOT.

 

[Jaybe]

NO orthodontic treatment is "stable", at least not as Tweed or Angle would have liked it to be. Go read Robert Little's study from 1983 and see what you find. Untreated subjects experience continued arch length shortening over time, which means- more crowding. Treated subjects have about a 10-20% rate of "acceptable" crowding after 20 years. Is that stable? Nope. People grow and change over time. You can see that process in the aging face. Teeth change over time.

Now for the Damon issue. If you look at the website for Dr. Damon's extraction policies, he basically will extract for all the same reasons a modern orthodontist would. The big difference is in the crowding. Only extremely severe crowding is recommended for extraction by Dr. Damon. The problem with Damon is that Ormco is a bunch of shiesters and sends their reps around telling people you don't need headgear or extractions or elastics anymore. Then you go to a course and you do. Damon is fine, it finishes fine, and it works just like anything else.

For all practical purposes, you are probably correct. However, I think that making that assumption can unfortunately give many people an excuse for their clinical sloppiness. I don't know Little's work, but if it shows ortho relapse to be common, I wouldn't be suprised. My point is, why settle for that. Why not look at the individuals with better retention and try to emulate their results.

Certain orthos are doing things in a way that truly gives them incredible retention. I don't know what is the real secret of the clinician I referenced above. But I will tell you this, his retention is so phenomenal that he will be the keynote speaker at 2 MAJOR international ortho conferences this year speaking about the very topic of retention and relapse. I hope to one day learn what his real "secret" is. As a source of personal accomplishment, I would love for even a few of my own cases to show no relapse 35 years out.

 

[vorosvirag]

You answered your own question about why tip edge isn't done by orthodontists....Marketing. Damon has done a tremendous job marketing the damon bracket b/c there are other self ligating brackets on the market and have been in the past.

It's got to be more than marketing, however. Damon gets good results. I have relatives in Spokane, WA. Many of them got their ortho done in Damon's office. These kids still look good. They were treated years ago. He markets well because he's dynamic and charismatic. In addition, he's got a solid product and he's an outstanding orthodontist who can achieve superior outcomes w/ that system.

I'd argue that although TipEdge's marketing has failed or has been largely ignored, their problems involve more than a marketing issue. Most likely, there are product- or outcome-related issues at play. For example, people remember what Begg-treated patients looked like. Many of the cases shown at the TipEdge conference had enormous nasolabial angles. The presenters said they didn't usually extract that much. Yet, among the presented cases it seemed around 40-50%. The profiles were often affected. Further, the auxiliaries (Sidewinder springs and other adjuncts needed) were difficult to integrate into practice.

Most ortho programs are funded through donations, etc by ortho companies who make edgewise appliances. These companies are smart b/c they know if they get the residents to use their products then the residents will continue using them once they are out. Another reason that tip edge hasn't caught on b/c of the lack of "certified" instructors. There just aren't many orthos doing it so when you associate or buy a practice that already has edgewise in place you aren't going to change to tip edge.

TipEdge--like any other corporation--must identify its target market (orthodontic residencies) and go after them. TipEdge will remain an outsider unless it can demonstrate its strengths by people who believe in their system who interact w/ residents.

The tip edge plus bracket is built for the GP. Pete Kesling has simplified the system and continues to simplify the system b/c he knows his market is GPs.

Why would one build an orthodontic bracket for the GP? Pete's corporate people should design the bracket that is the best for everyone--orthodontist and GP who chooses to do ortho. Pete would be better off if he could convince orthodontists (who do the most ortho, right?) his system is worth switching to. You're already convinced, but most of us aren't. You never answered my earlier ? about that. Why have they failed in that attempt?

Ortho isn't rocket science, its just another speciality. I think ortho is much easier that doing a full mouth rehab like a prosth would do. The difference in GPs and specialists is that GPs try to simplify things and specialists try to add steps to make procedures more complex. IMHO

Oral Surgery isn't rocket science, either. Yet, I know oral surgeons are light years better at taking out teeth than a few self-appointed exodontists I know. These exodontist guys do a good job at dentoalveolar surgery, but are not close to the level of the average oral surgeon in terms of efficiency and overall management. I'd put GPs doing ortho in a similar category.

 

[vorosvirag]

Most older orthos that I work with know that I do good treatment and wouldn't do a case above my head. They appreciate that I do ortho b/c I send them more ortho cases than most other dentists b/c I know what to look for.

That's good. If I were a GP I'd want to do some ortho, some 3rd molar extractions, and molar endo. But, I'd be sure to send out all borderline stuff. Life is to short to try to squeeze out a few extra bucks from that which will sting you.

Here are a few questions for you. Why do so many edgewise orthos believe that non extraction is a treatment goal?

I don't know why. All avoidable surgeries should be avoided. However, in certain cases you can't avoid removing those little premolars. We're (at least where I'm at) instructed to consider lots of factors relative to extractions. Our director believes extractions should occur between 10-20% of the time. So far in residency I think I'm near 20%. Those who avoid extractions altogether are missing something. You've simply got to remove teeth in certain cases.

By the way, who told you non-extraction treatment is a tx goal? The orthodontists you refer to? Or Kesling? I believe "many" orthodontists are fine in this area, though you think otherwise.

What happens when the child gets 18 and the wisdoms need extracted under sedation? Why not extract bi's early and make room for the wisdom teeth thereby eliminating a much more dangerous surgery?

Removing premolars comes down to orthodontic reasons. Removing wisdom teeth hinges on separate decisions. Perhaps in other countries the standard of care is different. Taking out wizzies under sedation is not dangerous. It's not without risks, but those who are trained to do it well will perform their task predictably. The same thing goes for ortho. Training leads to confidence and sweet outcomes.

I always thought extracting or not is a treatment plan not a goal--not being sarcastic, I just don't understand it.[/QUOTE]

You're right. That decision is part of a broader tx plan for that specific human.

 

[Jaybe]

Now thats what I call a point by point, color coded response!

 

[Kfiles]

I think this post posted by Diagnodent might explain a lot of what is important to him.....

QUOTE
Or you could be a 29 y.o. like me 4 years out and pull in 350k in 32 hours. Not too bad for a dentist. With my practice as is I'll be 32 and making 500k and when I purchase my neighbors practice I'll be 35 earning a million. How many MD's or dentists can say that. I'm not saying I know nearly as much as a MD in terms of bio/chem, etc. All I'm saying is I know more about business systems and customer service than 90% of MD's or dentists which is the difference in MD's and dentists.

How many times have you waited in a physicians waiting room? Every single time. How many times have you waited in my waiting room? Never. How many times does your MD call you at home after they see you? Never. How many times do I call you at home after a procedure? Every single time.

Thats the difference.

If you are too ignorant to understand the business differences, then good luck at owning your practice if its dental or medical.

 

[vorosvirag]

You are probably like most of those who went to ortho from my class, incredibly intelligent, quiet and socially awkward. But once you are online you can't control your comments about how much you know and don't know how to discuss in a cordial manner hence the social awkwardness. Its ok we all understand.

He might be like those in your dental class. Where did you go to school, anyway? In my opinion, none in my dental class who has gone on to ortho behaved according to your descriptions. Surely, we all have our quirks, but I doubt my classmates would characterize us the way you did your own ortho classmates.

You know, I'm not certain any of the people who got into ortho are a lot smarter than anyone else. I wouldn't say they were incredibly intelligent. The people I know (w/ one exception) were really nice, hard-working people who were exceedingly determined.

We did have two people in my class apply to apply who got no interviews. I'd describe them as more quiet and awkward than the group that got in. I wish they had gotten in, but I guess it just wasn't meant to be. Perhaps they should associate w/ a guy like you to help them knock down a million by 35 (thanks for sharing, K Files).

 

[antidentite]

Please tell me how many cases you have treated yourself -
Finished 0. 40 some active. Majority of which are out of control in my opinion. Despite your "qualified" oppinions - quality ortho is difficult.

And how long you have been an orthodontist b/c I don't think it will compare to me.
- Actually it would compare. 0 years compared to 0 years.

So I'm not going to talk about different techniques b/c this just isn't the forum for that.
And you only know the one you learned at a weekend seminar and deemed to be superior.

If you think that my statement about specialists making procedures more complex isn't true then you obviously haven't talked to prosthos, endo, most orthos, and perios about what they do compared to GP's.

- I never commented on this. Nor do I know what you are talking about. It seems that making things complex means having a firm understanding of the concepts which requires added steps and understanding that you deem unnecessary because you do not possess it.


The difference in a GP and a specialist is that specialists inherently have more knowledge in the field and try to take out all inaccuracies. -

Ok fine. So this is a bad thing? You are right screw figuring out inaccuracies - simplicity is what it is all about. That adds up to the best treatment.

Have you ever seen the steps a prostho takes to mount alginate models on an articulator? There are so many steps involved that most people would go nuts with just taking the alginate impressions that have to be exactly 1/4-1/2inch thick.

- Yeah and I wouldn't want to do it nor do I think I could - don't have the training. Nor would i criticize their techniques which most likely are necessary to produce a quality result. They are not just doing it for complexities sake. Where are you going with this? Did the next sentence that contained the point get deleted on accident.

Please note that one day you will need all of us lowly GP's to refer you cases. So you might want to step down from your high and mighty pedestal.

- Huh? I have tremendous respect for G.P.'s. I have some in my imediate family. I just don't have respect for people that come on a board and in an unqualified manner tell specialists how to do their jobs, that they are using the wrong appliances, that their work is not that difficult, and that they unnecessarily complicate things. Get off your pedestal of thinking you are qualified to be giving orthodontic lessons because you took a seminar.

You are probably like most of those who went to ortho from my class, incredibly intelligent, quiet and socially awkward.

- Riiiight. Your small junk and jealousy is shining through again. By the way Dr. Cool - the above quote cited by K-files makes you sound like the kind of guy qualified to be determing who is cool. Almost as qualified as you are to be giving lessons in orthodontics.

But once you are online you can't control your comments about how much you know hence the social awkwardness. Its ok we all understand.

- No we all don't understand. The only one who understands you is you. No one is buying what you are selling.

The first thing I learned in my residency is that I don't know anything of significance about ortho. What I do know is that it is complicated and to do it well requires more than superficial understanding learned at a seminar. I can now spot others that don't know anything either. It mine as well be written on your forehead - you are fooling no one.

 

[antidentite]

.

 

[Jediwendell]

For all practical purposes, you are probably correct. However, I think that making that assumption can unfortunately give many people an excuse for their clinical sloppiness. I don't know Little's work, but if it shows ortho relapse to be common, I wouldn't be suprised. My point is, why settle for that. Why not look at the individuals with better retention and try to emulate their results.

Certain orthos are doing things in a way that truly gives them incredible retention. I don't know what is the real secret of the clinician I referenced above. But I will tell you this, his retention is so phenomenal that he will be the keynote speaker at 2 MAJOR international ortho conferences this year speaking about the very topic of retention and relapse. I hope to one day learn what his real "secret" is. As a source of personal accomplishment, I would love for even a few of my own cases to show no relapse 35 years out.

Remember that when people show you cases that they are showing you their best cases.

The "secret' is probably something like extensive IPR to flatten contacts and some degree of keeping the lower incisors inside the alveolar housing. Keep a close eye on the types of cases. These guys who show these types of things are often charlatans that screen their cases carefully and only show you the good results.

And you are falling into the trap that orthodontists have fallen into for years, since Angle and Tweed. There may not BE an orthodontically stable position. The idea that you can put the teeth in a certain place and they will then stay there forever is a little quaint. We change all over our bodies as we age. We get shorter, our feet get bigger, our nose gets bigger, and so on. AND, our lower jaw gets bigger and our arch length decreases. What does that mean, particularly when you correlate it with the "fact" that always comes up about malocclusion being a "disease of modern society"? If you look at the photographs of aboriginal teeth in most orthodontic textbooks (which tend to be straight) you will note that there is always extensive wear on the occlusal surfaces, which essentially makes the teeth less wide. In losing width, the teeth are basically compensating for the loss in arch length, or maybe the loss of arch length is a mechanism to deal with the loss of tooth width that you inevitably see. So that is why most of the "no-relapse and no retainers" guys will do extensive IPR, and may be right to do so, to some extent.

 

[Jaybe]

Remember that when people show you cases that they are showing you their best cases.

The "secret' is probably something like extensive IPR to flatten contacts and some degree of keeping the lower incisors inside the alveolar housing. Keep a close eye on the types of cases. These guys who show these types of things are often charlatans that screen their cases carefully and only show you the good results.

And you are falling into the trap that orthodontists have fallen into for years, since Angle and Tweed. There may not BE an orthodontically stable position. The idea that you can put the teeth in a certain place and they will then stay there forever is a little quaint. We change all over our bodies as we age. We get shorter, our feet get bigger, our nose gets bigger, and so on. AND, our lower jaw gets bigger and our arch length decreases. What does that mean, particularly when you correlate it with the "fact" that always comes up about malocclusion being a "disease of modern society"? If you look at the photographs of aboriginal teeth in most orthodontic textbooks (which tend to be straight) you will note that there is always extensive wear on the occlusal surfaces, which essentially makes the teeth less wide. In losing width, the teeth are basically compensating for the loss in arch length, or maybe the loss of arch length is a mechanism to deal with the loss of tooth width that you inevitably see. So that is why most of the "no-relapse and no retainers" guys will do extensive IPR, and may be right to do so, to some extent.

Actually, he tells me it has everything to do with where he puts the teeth in relation to the bone. I doubt he's doing more IPR than average.

And no, I'm not really falling into any "traps" here. My guy is no charlatan, by any means. He doesn't claim to be a "no-relapse and no retainer guy". I was referring to 35 year follow ups he sometimes does on patients. These people have usually lost their retainers years ago.

He is a Program Director, in fact. He writes chapters in well know Ortho textbooks. When I met Tom Graber up at UIC last Fall, Dr. Graber told me that my guy is "The best clinician he has ever known." I'm not making that up, nor am I exaggerating. I was impressed with Dr. Graber's assessment, since its obvious the 89 year old ortho guru has met most of the best clinicians in the world over the course of his career. That comment made me a little disappointed that I won't be training under this guy. But proud that I know him and can call him a friend.

Anyway, my whole point is that I have much to learn. I am sure I will see charlatans come and go during my career, but shouldn't I be looking for the clinicians that ARE getting superior results. Shouldn't I be trying to discern the importance of their techniques as related to their superior results? And don't worry, I'm not the sort of person that will get caught up in some fad or hype with respect to my treatment philosophy. But I do think there are probably Better and Worse ways of doing orthodontics.

 

[vorosvirag]

My guy... ...this guy.



Jaybe, please tell us who your guy is. Are you in Memphis doing Tweed? Or somewhere else doing Tweed? Maybe you're not even doing Tweed.

 

[Billy Gilmore]

why don't you just reveal who this fantastic clinician is? if graber thinks he is great that's terrific, just let us know how he is...

 

[drben]

Some of the best orthodontists out there are Tweed guys...Vance Dykhouse (ABO Pres), Jimmy Boley, etc...

When I was a resident we had Tweed clinic every Tuesday afternoon with Bob Stoner...I haaaated Tuesdays. However, the disclipline I learned from bending Tweed archwires with tipbacks, omega tiebacks, etc. has helped tremendously in private practice. Stoner was one of the biggest pricks I have ever had to deal with but that's a different story.

As for the statement about "non extraction being a treatment goal"...wait until you guys get out into private practice because there are SO many orthodontists that are telling people that "advances in the field" make the extraction of permanent teeth unnecessary. Honestly, the mistake that I make the most is not extracting ENOUGH teeth because you want to try to treat non-extraction because it's a much easier sell. There are many borderline cases that I wish I would have extracted teeth on...live and learn I guess 😳

Ben

 

[Jaybe]

Okay, 'my guy' and 'this guy' . . . I guess that sounds unnecessarily cryptic. Sorry about that.

I just don't want to throw his name around on message boards. I'll just stop making reference. Sorry.

By the way, I am in Memphis, but not doing Tweed. 😉

 

[vorosvirag]

Some of the best orthodontists out there are Tweed guys...Vance Dykhouse (ABO Pres), Jimmy Boley, etc...

I won't argue that the Tweed guys are not great orthodontists. But are these same orthodontists productive? What I mean by that is do they run a thriving private practice?

Most residents' goals include a private practice that is efficient and can serve the community's needs. In contrast, my impression of the average die-hard Tweed guy is that he has a flattop and only sees six patients a day. But, boy, does he get good retention on those six!

Any number of ortho systems (TipEdge, Damon, Alexander, Bioprogressive...) allow for "conventional" tx of patients. Tweed seems best and only suited for an academic setting where time and inconvenience are less of an issue to patient and doctor. I'd guess virtually all residents trained in Tweed-heavier programs take the skills they learned, but reject the overall philosophy as they head into private practice. Do your boys--Dykhouse and Boley--practice in the real world?

When I was a resident we had Tweed clinic every Tuesday afternoon with Bob Stoner...I haaaated Tuesdays. However, the disclipline I learned from bending Tweed archwires with tipbacks, omega tiebacks, etc. has helped tremendously in private practice. Stoner was one of the biggest pricks I have ever had to deal with but that's a different story.


This is one reason why I want to go the Tweed course during residency. It will help, especially during the finishing, wire-bending phase.

However, practicing Tweed-style on patients from start to finish is ridiculous in my mind. Preadjusted brackets save you from virtually all those bends. Why drive a Model-T when today's cars do the same thing much better?

As for the statement about "non extraction being a treatment goal"...wait until you guys get out into private practice because there are SO many orthodontists that are telling people that "advances in the field" make the extraction of permanent teeth unnecessary.

I can see how that happens. Mom does not want junior's teeth out and may search for the orthodontist in the community who won't remove his teeth. What advances do they cite? Even Damon takes out teeth.

 

[Firm]

Some of the best orthodontists out there are Tweed guys...Vance Dykhouse (ABO Pres), Jimmy Boley, etc...

When I was a resident we had Tweed clinic every Tuesday afternoon with Bob Stoner...I haaaated Tuesdays. However, the disclipline I learned from bending Tweed archwires with tipbacks, omega tiebacks, etc. has helped tremendously in private practice. Stoner was one of the biggest pricks I have ever had to deal with but that's a different story.

As for the statement about "non extraction being a treatment goal"...wait until you guys get out into private practice because there are SO many orthodontists that are telling people that "advances in the field" make the extraction of permanent teeth unnecessary. Honestly, the mistake that I make the most is not extracting ENOUGH teeth because you want to try to treat non-extraction because it's a much easier sell. There are many borderline cases that I wish I would have extracted teeth on...live and learn I guess 😳

Ben

I would love to hear some of your experiences when you feel that you should have extracted more teeth. I am taking over for a guy who I feel extracted too much on borderline cases. Cases are taking 30 months, not finishing on time, spaces aren't closing, spaces re-open, and the worst is the cases finish like they started (Class II's remain Class II's). I understand this has a lot to do with the orthodontist I am taking over for, but I am a big believer that the more time I am in treatment the more bad things can happen. It seems like you lose a lot of control in extraction cases, especially if you run a high volume practice. Thanks for your input.

 

[Jediwendell]

I would love to hear some of your experiences when you feel that you should have extracted more teeth. I am taking over for a guy who I feel extracted too much on borderline cases. Cases are taking 30 months, not finishing on time, spaces aren't closing, spaces re-open, and the worst is the cases finish like they started (Class II's remain Class II's). I understand this has a lot to do with the orthodontist I am taking over for, but I am a big believer that the more time I am in treatment the more bad things can happen. It seems like you lose a lot of control in extraction cases, especially if you run a high volume practice. Thanks for your input.

This guy probably has a lot of cases that should have had upper bi's only, then, or none at all. The Class II's remaining Class II seems to be pretty common in cases where the only goal is Class I molar. You chase your tail.

 

[Jediwendell]

Actually, he tells me it has everything to do with where he puts the teeth in relation to the bone. I doubt he's doing more IPR than average.

And no, I'm not really falling into any "traps" here. My guy is no charlatan, by any means. He doesn't claim to be a "no-relapse and no retainer guy". I was referring to 35 year follow ups he sometimes does on patients. These people have usually lost their retainers years ago.

He is a Program Director, in fact. He writes chapters in well know Ortho textbooks. When I met Tom Graber up at UIC last Fall, Dr. Graber told me that my guy is "The best clinician he has ever known." I'm not making that up, nor am I exaggerating. I was impressed with Dr. Graber's assessment, since its obvious the 89 year old ortho guru has met most of the best clinicians in the world over the course of his career. That comment made me a little disappointed that I won't be training under this guy. But proud that I know him and can call him a friend.

Anyway, my whole point is that I have much to learn. I am sure I will see charlatans come and go during my career, but shouldn't I be looking for the clinicians that ARE getting superior results. Shouldn't I be trying to discern the importance of their techniques as related to their superior results? And don't worry, I'm not the sort of person that will get caught up in some fad or hype with respect to my treatment philosophy. But I do think there are probably Better and Worse ways of doing orthodontics.

What you are explaining to me is what is known as a "case report". The value in these is essentially zero. If you have treated a fair number of cases you will begin to understand that relapse is a funny thing. Most of the "guys" like your "guy" that are famous and like to say their method is the best tend to push case reports or case series.

The point is that you don't need to get so bent out of shape. Make sure you look at everything from every angle and you won't get in trouble. If whatever technique this guy is pushing sounds good to you, use it. It can't be any worse than a bonded lingual retainer.

 

[drben]

To the poster with the model T comment: When people talk about doing "Tweed orthodontics" everyone gets the same impression that you do...somebody spending hours bending archwires. The reality is that Tweed is a philosphy that includes certain treatment mechanics and is NOT a particular appliance. For instance, one of the doctors I referenced (Jim Boley) uses preadjusted appliances.

That being said, would I ever use 0-0 appliances or extract as many teeth as the Tweed guys...absolutely not!

Ben

 

[Maxillicious]

Not to jack the thread but no need to start another. I was just wondering what your opinions regarding ortho externships/observerships are? helpful? waste of time?



Also, know any programs that have them?

So far Ive seen:

Montefiore (observership)
VCU (externship)

Thanks for your help.

 

[Jediwendell]

Not to jack the thread but no need to start another. I was just wondering what your opinions regarding ortho externships/observerships are? helpful? waste of time?



Also, know any programs that have them?

So far Ive seen:

Montefiore (observership)
VCU (externship)

Thanks for your help.

Probably a waste of time if you want to "impress" the program. It is an okay idea if you want to get to know about a particular program, but there is always the risk of them finding a reason to not interview you. Externships in ortho are weird. It is tough to get to do much on many of them. San Antonio gets externs a lot and we actually let the externs bond cases and do just about everything that a resident will do if they are interested. I think an "observership" is a complete waste of time.