Topics of the day:
1. Re: hin cap validity
The short answer is that RPFM (reverse pull face mask rx) is probably underutilized generally. If it is used at all, it would be best in a confirmed retrusive "A" point patient and is usually proceeded by a short period of maxillary expansion. True mandibular overgrowth (genetics) would not get many votes for RPFM but I have seen it used successfully there as well. All of this treatment assumes a proper workup and proper appliance application with multi phase treatments expected. Some do fail and go to surgery later but it is my belief that it is easier to use than its cousin the headgear.
Look up Dr. Capelozza's work on the matter. He just finished a wonderful book but I don't think it's translated yet, He and Dr. Omar Gabriel from Bauru, Sao Paulo have written in international journals about the matter, it won"t be difficult to find. Good luck,
Dear Dr. Wanono,
I experienced a somewhat similar situation when I purchased a retiring doctor's practice about 7 years ago. In hindsight the most prudent advice I can give you is to remember that no one likes a doctor who disparages the work of their previous doctor HOWEVER you are duty-bound (and legally bound) to inform them of the present condition of their occlusion and you must tell them what you feel still needs to be performed to achieve an optimum end result.
I would suggest you have private consultations to discuss this with the patient and the parents (if the patient is a minor) also have a typodont with an ideal occlusion nearby, show them this first, then with them holding a hand mirror show the patient (with parent nearby) how their occlusion differs from the ideal. Now the "ball" is in their court, so to speak. You have shown them their present condition and what still needs to be achieved is clear. If they decide they are satisfied and still want their appliances removed at the set target date established by the other orthodontist then you simply have them sign a form that clearly states that you have made them aware that their treatment has not been successfully completed and although you have recommended that they continue with care they have decided that they want to terminate treatment. The sticky part of this is conveying all this information without insulting the senior doctor (that just makes you look bad) If you are asked pointedly why he did not have the same treatment standards as you, you can either politely explain that you are not certain why there is a difference or you can say that the standard of care may have changed in the 20 or so odd years since the senior doctor received his training. (I think the first choice is safer and more polite) Remember with the ideal typodont nearby in your hand you can show the family while explaining: this is what we strive to achieve for our orthodontic patients today. It represents the optimum in function and esthetics, etc...
I will be happy to fax you a copy of the form we use when needed (thank goodness, it is needed rarely, but every orthodontist is familiar with the situation where a teenager just has to have their braces off "immediately" (like before the big prom) or they will surely "perish" and if you have a patient and parent who demands that you do remove the appliances, you must. However, without covering yourself the family can later come back and say that they were not informed that treatment was not satisfactorily completed.
I wish you much success and I hope my suggestions have helped a little,
Go ahead and buy it.
However, you will have to be a diplomate. Do the best to finish the cases, not taking to long because patients will doubt your competence, as the the worse cases, the surgery, after you have the patient's confidence, try to tell about how much better a surgery would be, and that the other doctor didn't mentioned because the case had a different evolution, as the one originally expected.
There will be days that you will be very unhappy not being capable to do what you know should be done, but that is the price. Soon you will have new patients and your work will be done as you like. Good luck
Your problem is well-understood. Many so called successful orthodontists know not what they are doing nor why they are doing what they are doing.The less is said about it the better. Coming to your problem at hand:a few suggestions for your consideration, application if possible, with suitable modificationson based on ground realities prevailing in your location:
1.Your listing of the condition of existing cases shows(and makes you learn) what not to do. But try to 'complete' those cases with minimum confrontation/argument, as you will do in any transfer case, compromising whenever required.
2. Try to improve/alter treatment with your suggestions and approvals by discerning patients/parents, whereever possible.
3. Slowly, in phased manner, convert the existing clientele/future clients to your line of therapy(?Objective driven treatment/rational). You may use the newer developments' and techniques' superiority over the traditional(existing) ones.
4. A good majority will agree with you- as everything changes with time like computers,cameras, cars and orthodontics is no exception.
5. If you do not do that, imagine a new graduate may open -up in the vicinity with modern orthodontic outlook informing the community of his latest knowledge and techniques.
6. With your outlook, slowly and difinitely you will be able to transform the existing appliance based(braces for fashion concept of the community) practice to a objective and result driven efficient orthodontic service centre.
7.Easy way is not always the best way out! Do not succumb to 'following' the existing pattern. 8. Wish you Good Luck!
Dear Dr.Jerome Wanono,
I am an Orthodontist practising in India since last 20 years.Is the senior Orthodontist selling his practice to you at a Discount? Obviously no! I strongly feel that if you buy his practice you, should compel him to inform patients about so called pitfalls that you perceive with his treatment plan and extended duration of the treatment. It is better to have your own practice a little late but have it on a Sound, Moral, and Ethical footing.Why sholuld you buy his headaches alongwith his practice.
Dr Rajesh J Kamdar.
I am considering buying new articulators. I started practice with SAMs and then transitioned to Denars. Now the Denars are beat up and I am trying to decide on buying more Denars, a new set of SAMs or Panadent. I know all the Roth groupies swear by Panadent but it seems like a pretty complicated mechanism to me. My needs are simple:
1. record CR to see if there is a CR CO difference
2. the articulator needs to stay "true" meaning that I can shift models from one to another and know they are correct. I think that is a selling point with Panadent. It is a draw back with Denar -- they need to be periodically aligned with a field gauge (PIA stuff). The SAM comes with a check bite and you can check it periodically. If out of alignmnent it has to be returned to GL, not ideal but they seemed to stay true most of the time.
Does anybody know ORBIX's address, phone number or e-mail? Thank you in advance.
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