ortho programs that make you do lab work

[dds854]

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Do you think this is a plus or minus in the long run? Obviously no one likes to do lab work, but does doing your own lab work during residency make you a better orthodontist? I mean, I know I became a better general dentist by doing my own lab work in dental school. Any ortho residents or orthodontists want to comment.
Thanks in advance

 

[Doggie]

in oral surgery, they make you do your own lab work. 😴

 

[vorosvirag]

Do you think this is a plus or minus in the long run? Obviously no one likes to do lab work, but does doing your own lab work during residency make you a better orthodontist? I mean, I know I became a better general dentist by doing my own lab work in dental school. Any ortho residents or orthodontists want to comment.
Thanks in advance

A balance is needed for lab work. For example, how does waxing up your 50th crown make you a better dentist? You probably learned all you needed to know about proper reduction, occlusion, etc. after waxing up five or six (or fewer).

Similarly, in ortho I believe programs can take the lab work overboard. And many do. Why do programs still have you do lab work then? Who knows. To save $, to provide you w/ the wonderful experience, and always-done-it-this-way rationale.

In my opinion, such lab activities only serve to make you a more tired and frustrated resident. You have less time to read, relax, or do whatever else you might otherwise accomplish.

 

[vorosvirag]

Some programs allow you to send out the impressions. Those labs then make the plaster models.

Other programs utilize a company such as OrthoCAD (http://www.orthocad.com/).

In using OrthoCAD, the resident sends away the impression and w/in a few weeks gets digital models to evaluate. I believe OrthoCAD downloads these digital model files (after scanning the patient's impressions) from their plant to your school's server. If you wish, you can request actual stone models from OrthoCAD. So, you perform your arch analysis w/ 3-D models on computers in your department and save it. Saves space, saves time.

 

[gryffindor]

Some programs allow you to send out the impressions. Some lab makes the plaster models.

Other programs utilize a company such as OrthoCAD (http://www.orthocad.com/). In a situation like this, the resident sends away the impression and w/in a few weeks gets digital models to evaluate. I believe OrthoCAD downloads these digital model files (after scanning the patient's impressions) from their plant to your school's server. If you wish, you can request actual stone models from OrthoCAD. So, you perform your arch analysis w/ 3-D models on computers in your department and save it. Saves space, saves time.

Costs money.

I don't know how much OrthoCad costs to the private practitioner.

Doing all your own labwork in an ortho program is just like doing it in dental school. The first time you don't know what you're doing, the next few times you get the hang of it, then you become a pro and it starts to feel futile and you start counting the days until you don't have to do it anymore. However, of all the lab procedures I've done in ortho so far, none of them seem to be as tedious, exacting, & time consuming as the stuff I did in dental school (setting up denture teeth, making sure the margin of your crown wax-up stays intact, etc.)

 

[vorosvirag]

Costs money.

I don't know how much OrthoCad costs to the private practitioner.

Doing all your own labwork in an ortho program is just like doing it in dental school. The first time you don't know what you're doing, the next few times you get the hang of it, then you become a pro and it starts to feel futile and you start counting the days until you don't have to do it anymore. However, of all the lab procedures I've done in ortho so far, none of them seem to be as tedious, exacting, & time consuming as the stuff I did in dental school (setting up denture teeth, making sure the margin of your crown wax-up stays intact, etc.)

It does cost some $. However, if the program's priorities include lab-work reduction or elimination, sending out impressions to OrthoCAD or somewhere else will happen. The department will pay for it. I am not sure what the fees are, but I will consider doing it in private practice. Though ortho-related lab work may not be as tedious as the bologna I did in dental school, I now value my time more.

 

[gryffindor]

It does cost some $. However, if the program's priorities include lab-work reduction or elimination, sending out impressions to OrthoCAD or somewhere else will happen. The department will pay for it. I am not sure what the fees are, but I will consider doing it in private practice. Though ortho-related lab work may not be as tedious as the bologna I did in dental school, I now value my time more.

Why do you think residencies have OrthoCAD? They hook you in with the hopes that you will get too used to their system and will go out into private practice and subscribe to them.

 

[vorosvirag]

Why do you think residencies have OrthoCAD? They hook you in with the hopes that you will get too used to their system and will go out into private practice and subscribe to them.

Of course. Everyone wants our $. We all have to weigh the pros and cons. I may go straight to OrthoCAD right out of residency. If I decide against it, I'll certainly at least send the impressions and appliances out to a lab.

The same can be said for cone-beam technology. As much as I may enjoy having this technology at an ortho program, I'd consider not spending the $ to purchase such a machine immediately after residency. That is, I might stick w/ conventional 2-D digital x-rays for a time. I might wait for the the price to come down and the systems to improve (get smaller, less radiation, etc.).

All of us must realize, though, that cone beam is on the horizon. Similarly, I think OrthoCAD or technology similar to theirs will be accepted by more and more orthodontists as time passes.

Here's an article on cone-beam CT from The Angle Orthodontist in 2005:

http://www.angle.org/anglonline/?request=get-document&issn=0003-3219&volume=075&issue=06&page=0895

 

[Jediwendell]

The same can be said for cone-beam technology. As much as I may enjoy having this technology at an ortho program, I'd consider not spending the $ to purchase such a machine immediately after residency. That is, I might stick w/ conventional 2-D digital x-rays for a time. I might wait for the the price to come down and the systems to improve (get smaller, less radiation, etc.).

Or, you might decide (and rightly so) that you really don't need cone beam CT to treat 98% of your patients that you will see in private practice. Heck, for a lot of patients you don't really need a ceph. The real usefulness of Cone Beam CT for ortho seems to be in the realm of impacted canines. Buck the system! Don't let Dolphin and their cronies make 3D standard of care.

 

[Jediwendell]

Oh, to answer the original question, we have to do Baylor and Houston's lab work in addition to our own here at San Antonio. Well, not really. Just during first year. Actually, I can make a palatal expander in about 10 minutes now, which is pretty handy.

 

[vorosvirag]

Or, you might decide (and rightly so) that you really don't need cone beam CT to treat 98% of your patients that you will see in private practice. Heck, for a lot of patients you don't really need a ceph. The real usefulness of Cone Beam CT for ortho seems to be in the realm of impacted canines. Buck the system! Don't let Dolphin and their cronies make 3D standard of care.

Wendell,

What is wrong w/ making 3D the standard of care? I believe it will take a while (maybe 10 years or so) before cone beam catches on and progressively becomes a standard technology. It's already in a handful of programs in the country. When the price lowers it will be a natural choice over digital.

Yeah, you can kinda tell what tx you'll do just by looking at the kid. However, going through the diagnostic motions (models, photos, and x-rays--pa, ceph, and pan) you do get finely tuned into the patient's unique situation.

 

[Jone]

Cone Beam CT can expose a patient to as much as 25x the radiation given by a panoramic. Unless the CBCT is absolutely necessary, I think it is simply irresponsible to routinely use it on every patient who you are going to start tx on.

 

[gryffindor]

Oh, to answer the original question, we have to do Baylor and Houston's lab work in addition to our own here at San Antonio. Well, not really. Just during first year. Actually, I can make a palatal expander in about 10 minutes now, which is pretty handy.

I heard UT Memphis pays their residents $25 per Hawley they make. If they send those Hawley's over to Vandy, we'll make them for $20!

 

[Jediwendell]

I heard UT Memphis pays their residents $25 per Hawley they make. If they send those Hawley's over to Vandy, we'll make them for $20!

I gotcha at 15$. Anybody else?

Any of you OMS guys wanna get in on this action? I know you don't got nothin better to do in the wee hours of the morning.

 

[Firm]

Doing some of your own lab work, or at least gaining the skills to do it is of some benefit. It's nice to be able to run back to your own lab and fix something rather than sending it back to the professional lab. I'm in the process of building an office now, and cone-beam is way too expensive. I would like to use the Dolphin 3-D imager, but that might be cost prohibitive also.
Jedi- Be careful treating cases without cephs. A lot of GP's will want you to do it, but if it ever goes to court, you are screwed.

 

[gryffindor]

I gotcha at 15$. Anybody else?

Any of you OMS guys wanna get in on this action? I know you don't got nothin better to do in the wee hours of the morning.

Don't OMFS residents have to do all the model surgeries prior to their orthognathic cases? Or are there "country club" programs who send that stuff out too? Why aren't those guys complaining about lab work?

Now I have to go trim 5 sets of models, make some retainers, and mount some stuff. How's that for lab work? I think I'll still be home by 5, so it's all good.

 

[Jediwendell]

Doing some of your own lab work, or at least gaining the skills to do it is of some benefit. It's nice to be able to run back to your own lab and fix something rather than sending it back to the professional lab. I'm in the process of building an office now, and cone-beam is way too expensive. I would like to use the Dolphin 3-D imager, but that might be cost prohibitive also.
Jedi- Be careful treating cases without cephs. A lot of GP's will want you to do it, but if it ever goes to court, you are screwed.

I would never treat a case without a ceph because it is standard of care. BUT, do you really need it in a lot of cases when you have been in practice for twenty years? No, not at all. I was simply illustrating what happens when something becomes "standard of care" which is what Dolphin is pushing for with their 3-D software. This cannot happen.

 

[vorosvirag]

Cone Beam CT can expose a patient to as much as 25x the radiation given by a panoramic. Unless the CBCT is absolutely necessary, I think it is simply irresponsible to routinely use it on every patient who you are going to start tx on.

Actually, I recently (a few months ago at a seminar) heard from an expert in ortho-related technology that at least one Cone Beam CT machine has cut the radiation levels down to the level of a single pan.

The expert explained that watching a football game in Mile High Stadium would expose you to more radiation than sitting through an exposure w/ cone beam. So, your 25x figure is either old or associated w/ a model that has been surpassed by improved machines.

 

[kato999]

Actually, I recently (a few months ago at a seminar) heard from an expert in ortho-related technology that at least one Cone Beam CT machine has cut the radiation levels down to the level of a single pan.

The expert explained that watching a football game in Mile High Stadium would expose you to more radiation than sitting through an exposure w/ cone beam. So, your 25x figure is either old or associated w/ a model that has been surpassed by improved machines.

I think I heard that too somewhere, but if I remember they were comparing a digital cone beam to an old-school film pano. I still feel like I was told a cone beam was around 16x the radiation of a pano.

 

[vorosvirag]

I think I heard that too somewhere, but if I remember they were comparing a digital cone beam to an old-school film pano. I still feel like I was told a cone beam was around 16x the radiation of a pano.

I'll ask around and look things up, but I'm fairly sure this guy wouldn't have compared today's cone beam CT w/ pans of yesterday. That just doesn't make sense or reflect today's concerns. This guy who spoke to us was constantly comparing digital to cone beam--not old-school film to cone beam. I'll see what I can find out.

By the way, somebody out there on SDN has cone beam at their school and could easily ask about it. Please do and get back to us. I'll do a little homework myself on the question.

 

[Jediwendell]

Actually, I recently (a few months ago at a seminar) heard from an expert in ortho-related technology that at least one Cone Beam CT machine has cut the radiation levels down to the level of a single pan.

You should always be suspicious of things you hear in seminars and look up information for yourself.

 

[Typo]

By the way, somebody out there on SDN has cone beam at their school and could easily ask about it. Please do and get back to us. I'll do a little homework myself on the question.

We actually just had a lecture on CBCT today (my school is getting a couple of Planmeca machines very soon). For what it's worth, this is from the powerpoint put together by our department chair: "1/30 X-radiation exposure in comparison with the conventional X-ray CT (almost the same as the conventional panoramic x-ray unit)."

 

[vorosvirag]

You should always be suspicious of things you hear in seminars and look up information for yourself.

You're right. However, the guy I'm talking about is no fake. He's the Editor of Techno Bytes, the technology section of the AJO/DO. Though I'm usually skeptical about a lot of things, I did not feel the need to look up for myself information presented by him.

I have looked up articles on the subject to learn more, but not to question what this guy said about radiation levels. Such a leading figure in the ortho-technology field most likely has his facts straight.

Here's a link to a powerpoint he put together on the subject:

http://www.orthoii.com/drbob/conebeam/Conebeam_files/frame.htm

 

[vorosvirag]

We actually just had a lecture on CBCT today (my school is getting a couple of Planmeca machines very soon). For what it's worth, this is from the powerpoint put together by our department chair: "1/30 X-radiation exposure in comparison with the conventional X-ray CT (almost the same as the conventional panoramic x-ray unit)."

Thanks, Typster. The expert I referred to said several machines were getting close to single-pan levels, but listed one (likely was Planmeca from what you've got above) that was right on one pan.

I don't know what publication might verify this. I'd bet the manufacturers of these cone beam CT machines must first verify the radiation #s per cone-beam exposure before the marketing the product.

 

[Bodega Do Luiz]

just out of curosity, please let us know what programs anybody knows of that are currently using CBCT. Thanks.

 

[vorosvirag]

just out of curosity, please let us know what programs anybody knows of that are currently using CBCT. Thanks.

Here's the list that Dr. Scholz (the CBCT expert) provided us with:

Loma Linda: 100% of patient starts cone-beamed in last 3 years
Ivan Dus: 100% of patients last 7 years (I think this is an international guy)
USC: selected certain patients for 3 years, now 100%
Michigan: not 100%, select certain patients
UCSF: also select certain patients to cone beam
UNC: select based on treatment, such as surgery or to evaluate condyles

This info can be found on this site I listed earlier: http://www.orthoii.com/drbob/conebeam/Conebeam_files/frame.htm

Other schools are in the process of ordering and/or installing their cone beam technology. I think I heard UAB is one of these.

 

[vorosvirag]

Here's some info I got this morning in an email from Dr. Scholz. This is what he had to say about CBCT exposure:

"James Mah in my opinion is the best expert on this topic so I attach his yet unpublished paper on it. I think we need to get away from comparing cone beam exposure to any old single standard and begin comparing it to relative exposures, eg.,: Many orthodontists will take some version of the Mah table for diagnostic purposes, which will come very close to a cone beam exposure according to Mah."


Examination Effective RadiationDose (µSv)
Equivalent Natural Background Radiation for:


Panoramic 3-11 Half to One day
Cephalogram 5-7 Half to One day
Occlusal Film 5 Half day
Bitewing 1-4 Half day
Full mouth series 30-170 4-21 days
TMJ series 20-30 3-4 days
CBCT exam 40-135 4-17 days

Medical Examinations

Chest X-ray 100 10-12 days
Mamography 700 88 days
Medical CT 8000 1000 days

Hope this helps. PM me if you want to read the Mah paper. I'll email it to you. I didn't want to post the whole thing here.

Hope you like colors. This was the best way I could think of to make the table work. The SDN format wasn't allowing me to simply paste the table the way it appeared in the email and article.

 

[vorosvirag]

We probably should have started another thread on technology.

 

[Firm]

Thanks for sharing all the info. It's is useful. I am still questioning the cost/benefit ratio for such a device. For an Oral Surgeon/ Periodontist, I see it, but not for an orthodontist.

 

[vorosvirag]

I really enjoyed the seminar by Dr. Scholz. This was a diversion from the original topic (lab work), but I learned a lot as I tried to find some answers. Glad to hear you liked some of the stuff.

I think the machines are still pretty pricey. I bet prices will continue to drop, but it'll likely be years before many in private practice utilize something like this.

 

[Jediwendell]

Here's the list that Dr. Scholz (the CBCT expert) provided us with:

Loma Linda: 100% of patient starts cone-beamed in last 3 years
Ivan Dus: 100% of patients last 7 years (I think this is an international guy)
USC: selected certain patients for 3 years, now 100%
Michigan: not 100%, select certain patients
UCSF: also select certain patients to cone beam
UNC: select based on treatment, such as surgery or to evaluate condyles

I find these rates REDICULOUS for a basic class I, mild crowding case. There is no reason to take a cone beam CT on patients that are relatively straight forward.

 

[Firm]

I find these rates REDICULOUS for a basic class I, mild crowding case. There is no reason to take a cone beam CT on patients that are relatively straight forward.

Not only that, but can you imagine how this will raise the standard of treatment. Class I molar +canine, roots parallel in 3 demensions, no rotations, fully seated joints while in occlusion, proper root torque, and tip. 😱

 

[vorosvirag]

Not only that, but can you imagine how this will raise the standard of treatment. Class I molar +canine, roots parallel in 3 demensions, no rotations, fully seated joints while in occlusion, proper root torque, and tip. 😱

We can always raise our fees to the $10K neighborhood to adjust for the increased pursuit of perfection .

 

[NUKE]

As with any imaging device, you are responsible for everything the images give you. Not saying this is a bad thing, however, if I've had no experience with a conebeam CT then how can i be expected to interpret all the information the scan provides! I think it definitely has its advantages in a few select cases, however most of these cases require an interdisciplinary approach or can be sent to a university for proper interpretation. People without a strong background in radiology may get in over their heads if they listen to what dolphin says.