I received a text a few days ago from a young orthodontist who is a few years out of school. They were distraught over a case that “didn’t turn out the way it should have” and they “didn’t feel good about this and weren’t proud of their results”. They were really worked up about it and feeling bad about their abilities so I asked a few questions:

• I asked them to define a “good finish” in non-relative terms (though everything is relative to where you start and the human being you’re working on).
• I asked them how often this had happened.
• I asked them how many cases total they had treated.
• I asked if they thought they were better at orthodontics now than they were a few years ago.
• I asked them if the parent and/or patient were happy.
• I asked them if the teeth looked better than they did before.
• I asked them if they had treated the patient to the best of their ability and knowledge at the time.
• I asked if they treated the patient the way they would have treated their own child.

After a few rounds of text, we decided to do a call to sort this out in better detail and get to the root of the issue. Turns out this was a latent class III grower and though the orthodontist was able to achieve positive overjet, the upper incisors were flared more than the orthodontist would like (that’s Upper 1 to SN for you ceph nerds). There was no family history and the patient didn’t show any signs of being Class III in the initial records. Stuff happens. I told them to give the money back or put the braces back on and IPR the lower or take out a lower incisor if they feel that bad about it. The orthodontist had treated/was treating about 1000 cases and this was the first one they felt they had failed on – even though the teeth look better than they did to begin with and there was no way to predict this growth pattern. 1/1000 is a pretty darn good “failure” rate. Oh and the patient and the parent were happy with the result…

A quick Google search on the topic of “medical failure rates” shows astoundingly high percentages of medical procedures fail. Not that other people failing justifies a less than optimal result but it should make clear that not every medical procedure has optimal results.

Why does this matter? Why should you care? We should all care because we, as a profession, have lied so long about how all our cases finish perfectly and how we never have retention problems that residents and young orthodontists believe that crap. Nothing could be further from the truth. Everyone has failed cases. Everyone. Our cherry picking nature and habitual on-stage presentation of only our best cases perpetuates the ruse that everyone should finish every case perfectly every time. This has led to the plague of overtime cases our profession suffers as well as an extremely high (and totally unnecessary) stress level for young orthodontists. There are plenty of other stressors in the orthodontic office and we certainly don’t need to add more things for orthodontists to worry about!

I’m not saying that we should do anything other than our best work every day. I’m not saying that settling for less than the best results you can get for any individual patient is the way to go. I am saying that Ideal is Dumb when applied to all patients. I am saying that any of you who dare to suggest that all your cases finish perfectly are outright liars and you’re doing a disservice to your profession – especially to residents and young orthodontists.