Dr J graduated 2 years earlier, but felt ready to increase their clinical offerings. He saw on social media how easy it seemed to provide aligner treatment. Take a scan, wait for the aligners to arrive, and swap them every two weeks. Easy.

With this in mind, Dr J completed a 3-day course in aligner treatment and felt confident he could begin offering it to his patients. He signed up with an aligner company who promised to help him with his cases and offered him a new-provider discount.

With the practice principal’s blessings, Dr J asked his practice manager to help advertise the aligner treatment. As no one else at the practice offered orthodontic treatment, the practice manager used a popular AI image generator to create a series of “before and after” images for social media advertising.

Ms N was one such patient. Enticed by the $500 discount and the “perfect” AI results seen in the adverts, she made an appointment to see Dr J. Ms N had never been to the practice before and had not seen a dentist “for a while” but she was eager to start treatment immediately, to be ready in time for her wedding 12 months later.

During the assessment, Dr J noted caries in the 26 but, keen to meet the patient’s timeline and encouraged by the promise of full payment upfront, bypassed the restorative work and proceeded with a digital scan. 

The aligner company sent Dr J a digital smile simulation, which he and Ms N were happy to proceed with. The aligners were ordered and the initial fit was successful. However, two weeks later Ms N called the practice; the aligners were feeling too tight. She told Dr J that she managed to wear the aligners most of the time, but admitted there were days when she forgot or would remove them for long meetings.

Dr J gently explained to Ms N that to achieve predictable results and complete treatment within the agreed timeframe, she would have to wear the aligners for at least 22 hours a day. He reassured her that with time, she would get used to having the aligners in and speaking would be more comfortable.

Treatment progressed over the next few months, with Dr J often reviewing Ms N by video. Some review appointments were missed and Ms N would frequently admit that she had forgotten to wear her aligners as advised.

Nine months into treatment, Ms N contacted the practice. She had been overseas when one of her teeth broke. She was told that the tooth was unrestorable and needed to be extracted. It was the same tooth that Dr J had diagnosed caries in but, in the urgency of needing to commence aligner treatment, had failed to address.

Ms N was furious. Not only had she lost a tooth, meaning she had a gap which would be visible during her wedding, she was also unhappy with how the aligner treatment was going, as the teeth were still rotated and she didn’t think they would be straight in time.

Dr J reviewed Ms N and asked for some more time to complete her aligner treatment, but Ms N was frustrated with how long treatment was taking, had lost confidence in Dr J and said she wanted to see another dentist.

Dr J contacted Dental Protection for assistance with handling the complaint and, on reviewing the records, recognised several areas of potential vulnerability, so chose to offer Ms N a partial refund and facilitate the transfer of her care to another practice.

Where did it all go wrong?

Lack of support 

Aside from Dr J, no one in the practice provided orthodontic treatment. Dr J also did not have a mentor outside the practice with whom he could have discussed cases or seek advice.

Lack of education and experience 

Dr J fell into the trap of believing that a short 3-day course was sufficient to become competent in providing treatment. While the course would have introduced the fundamentals, many aspects of orthodontic diagnosis and treatment planning require experience and mentorship. Experience treating patients, ideally under mentorship, helps clinicians understand the nuance and complexities involved in orthodontic treatment. 

Patient expectations 

Communication with patients is critical in understanding their expectations and whether these can be met or managed appropriately. Part of the reason for the delay in the completion of the treatment was that there was a breakdown in communication, resulting in Ms N not understanding the importance of compliance with aligner wear.

Rushing treatment 

The pressure to complete treatment before Ms N’s wedding influenced Dr J’s clinical decision-making. While Dr J assessed and noted the caries in the 26, he was convinced by the patient to start the elective aligner treatment before treating and stabilising any active disease.

AI Advertising 

The practice manager created and uploaded a series of “before and after” images using AI. The images were not real clinical cases but created the impression that Dr J had achieved these results personally. The advertising also implied that treatment would help the patient become more confident and created undue urgency to have treatment started.

In Australia, advertising must not be misleading or deceptive. Using AI to create results that were not achieved by him would be a direct violation of this and had Dr J sought advice prior to allowing the adverts to be published, he would have been advised that they were in breach of Ahpra’s advertising guidelines.

Conclusion 

Fortunately, this case was resolved without the need for Ahpra involvement, and Dr J discontinued those specific advertisements on our advice.