Yep.. That's why patient education is a big part of what we do-- You have to:
1) scare the patient into being compliant with the floss threaders and 6 month recalls, and
2) remind them that they just made a multi-thousand-dollar investment in paying you to fix them up, and unless they want to shell out another few thousand bucks a year or two from now to do it all over again with a decreased chance of success, they better start taking better care of themselves!
3) and of course, you have to show the patients the proper techniques-- How to use a floss threader, when is the right time to brush, remind them to chew sugarless gum as often as possible, avoid really acidic drinks like OJ, etc. Just help stack the odds in their favor.
ALWAYS, ALWAYS make sure you remind the patient to employ proper home care techniques and regimen during each and every visit. And document everything!
Yes, as you surmised, case selection is important... Gotta take into account patient motivation in presenting the options in the tx plan. Rather than full mouth rehabilitation, some patients might be better suited for full-mouth extraction and complete upper and lower dentures, for instance.
