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A case of malalignment

15 October 2018

Dr S, a young practitioner, was looking to broaden the nature and type of treatments she offered to the patients at her practice. A number of her peers had undertaken courses on the provision of aligners.

Diligent in nature, Dr S sought advice on a Facebook forum about ‘which courses were best’ and read around the subject herself, to ensure she selected an appropriate course and updated her orthodontic knowledge before she attended.

The course furnished Dr S with the capability to treatment plan using clear aligners, an exciting prospect for practice growth and patient satisfaction. It offered ongoing training and mentorship, and assistance with treatment planning. This was important for Dr S as her principal and other colleagues at the practice did not offer aligner treatments.

Dr S tentatively commenced a few treatments, most of which proceeded in line with her pre-treatment expectations. But for one, the teeth just did not move as anticipated. As the treatment time progressed the patient became more upset with Dr S, as the treatment was not progressing as originally planned. This case remained her nemesis, and she began to dread the patient’s appointments as every time she saw their name in her book, her heart sank.

As the case continued to worsen, the promised mentoring fell away, with ‘compliance issues’ blamed for the unpredictability and poor tooth movements. As the principal and other colleagues were not familiar with the aligner treatment, they were unable to provide advice.  Shortly afterwards, the patient requested a copy of her records, followed by a letter of complaint. They wanted ‘proper braces’ to get the result they were promised. They claimed to have been told by an orthodontist that ‘proper braces’ would have moved the teeth by now, and they wanted Dr S to change their braces for ‘proper fixed ones’. Dr S was only trained in one treatment type, with one company, and could not offer the patient what they wished.

Learning points

This case highlights the importance of the following:

  • A thorough history is taken to understand the patient’s concerns and whether the expectations can be met with the orthodontic system offered.
  • Thorough preoperative orthodontic assessment, to ensure all the treatment options are discussed with a patient. One of the options being a specialist referral.
  • When treatment is not going as planned, advice is sought from a specialist as soon as possible.
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These case studies are based on real events and provided here as guidance. They do not constitute legal advice but are published to help members better understand how they might deal with certain situations. This is just one of the many benefits dental members enjoy as part of their subscription. 
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