Dr. Richard Hartley, Dentolegal Consultant at Dental Protection, explores the factors practitioners should consider before undertaking short-term orthodontics (STO), a rapidly growing treatment option popular among adult patients.

The Appeal of Short-Term Orthodontics

STO has gained significant traction, driven by advertising and social media, as well as the increasing demand for aesthetic and convenient alternatives to traditional orthodontics. Many adults now favor aligner-based systems over fixed appliances, attracted by their discreet appearance and shorter treatment durations. The added benefit of STO being offered by general dental practitioners (GDPs) further contributes to its appeal.

However, while GDPs are eager to meet this demand, providing STO without formal orthodontic training comes with challenges. Recognizing these challenges and addressing them proactively is critical to ensuring successful outcomes and minimizing potential risks.

Challenges and Considerations

1. Case Selection and System Knowledge

• Challenges: Poor case selection often stems from limited knowledge about the workings and limitations of specific STO systems. Training in these systems may be brief, sometimes limited to a single day, focusing on their benefits without adequately addressing their constraints.
• Solution: Dentists should expand their training to include multiple systems and develop a deeper understanding of the indications, contraindications, and limitations of each.

2. Comprehensive Orthodontic Assessment

• Challenges: STO is still orthodontic treatment, requiring a thorough assessment and diagnosis. Many cases involve insufficient documentation, which makes defending clinical decisions challenging.
• Solution: Conduct a full orthodontic assessment, including detailed records, to establish a robust foundation for treatment. This documentation is vital for patient care and any potential reviews.

3. Treatment Planning and Vision

• Challenges: Successfully planning STO requires the ability to foresee the end result and anticipate potential challenges, such as achieving a stable occlusion. If treatment deviates from the plan, the practitioner may lack the skills or tools, such as fixed appliances, to address complications.
• Solution: Invest in training to improve diagnostic and planning skills and collaborate with specialists when needed to achieve the desired outcomes.

4. The Consent Process

• Challenges: Consent issues are a common problem. Alternative treatment options, such as referral to an orthodontist, are often discussed but rarely documented, leaving practitioners vulnerable to criticism.
• Solution: Clearly document discussions about alternative options and obtain informed consent that outlines the risks, benefits, and limitations of STO.

5. Managing Patient Expectations

• Challenges: Patients seeking STO often have high expectations and may be new to the practice, leaving the dentist with little prior knowledge of their compliance or motivation. This lack of rapport can lead to compliance issues, especially since retention requires long-term commitment.
• Solution: Set realistic expectations from the outset and emphasize the importance of compliance and retention to ensure patient satisfaction.

6. Retention

• Challenges: Patients often underestimate the importance and duration of retention, leading to dissatisfaction post-treatment.
• Solution: Educate patients thoroughly about the retention process and the commitment required to maintain their results.

Lessons from Dentolegal Cases

Many STO-related cases Dental Protection encounters involve issues with consent and retention. Patients may seek financial compensation to cover corrective orthodontic treatment after a poor outcome, leading to additional risks such as root resorption, time, and financial burdens.

To avoid such situations:

• Recognize when a patient’s needs exceed your clinical capabilities.
• Be cautious about treating patients with unrealistic expectations or low compliance potential.
• Ensure thorough documentation and transparent communication at every stage.

Conclusion

STO offers significant benefits to patients and practices, but it also presents risks if not approached with care and competence. By recognizing your limitations, pursuing comprehensive training, and maintaining open, well-documented communication with patients, you can navigate STO successfully and avoid potential complications.

Remember, the best protection for both practitioners and patients lies in careful case selection and an honest appraisal of your skills and knowledge.

This article is sourced from: https://www.dentalprotection.org/australia/publications-resources/dentolegal-articles/articles/short-term-orthodontics-aus