I’ve engaged in discussions on this topic many times in multiple forums – both online and in person. I’m always shocked by how firmly orthodontists hold to the FACT that one should adjust jagged or worn incisal edges BEFORE placing brackets in order to facilitate “ideal bracket placement”. The commentary and supporting facts are always amazingly consistent and, because most orthodontists agree, the consensus (i.e. THE TRUTH in orthodontic circles) is that one should adjust incisal edges before the initial bond.
I guess that is all well and good except for a few pesky details that are almost always neglected and/or ignored in these discussions:
- No one places brackets perfectly or even “ideally” in every case. We need to get over ourselves.
- Using a bur to remove tooth structure is a permanent alteration not to be undertaken lightly.
- Irreversible procedures are always best deferred if one can gain more information or a chance for a better outcome by delaying.
- The likelihood of adjusting incisal edges “ideally” is much greater once the teeth are de-rotated, leveled and aligned. What we think is ideal may change after allowing a couple round wires time to do their magic.
- In cases where significant incisal edge adjustment is necessary, the “ideal adjustment” may not be as obvious as we believe it to be pre-treatment.
- The entire idea of Ideal is Dumb. It’s all a sliding scale. We want the best possible outcome. Perfection is unattainable due to all the variables and the inherent asymmetries in the human body. The result is the end product not the bracket position or treatment plan.
What’s my point?
It may be a good idea to think about what we say instead of just acting like a parrot repeating what we have heard or what we were taught in school. Democracy has zero dominion over truth. Doing what everyone else does or says is not a guarantee of success or “rightness”. We need to think about why we do what we do and proceed in a way that protects the best interests of our patients instead of our own convenience, comfort or our egos…
Question everything. Your patients will thank you.
Want to interact with other Pragmatic orthodontists and advance your skills? Dr. Derek Bock’s Pragmatic Orthodontic Clinical Discussions is a great place!