I know the knee jerk reaction when you aren’t getting results and the patient says they are wearing elastics is to just use a class II corrector because “they don’t require compliance”. That sounds good but I believe that class II correctors are terrible for us individually and as a profession (not to mention patients generally hate them). I’ve done thousands of Herbst appliances, hundreds of the springs you snap on to braces and hundreds of those appliances that are a bar between the canine and first molar (but still require elastics and an LLA) and when they work they are great but when they don’t, nothing is more of a pain. Patients and parents hate the first two as much as I do because of the size and discomfort. The third one makes no sense because you still need elastic wear and it’s no different than wearing Cl II elastics on braces. The good news is all three significantly increase your overhead.
When we decide to use class II correctors, we are taking non-compliant patients and putting all the responsibility for growth and results and long term stability on ourselves. I know vendors and experts love to show the cases that work and they look beautiful but no one tells you about the other 3 or 4 out of 5 of these cases that don’t work or don’t hold up long term (yeah that pesky detail). PLUS if there is an issue with these appliances it’s a real orthodontic emergency and requires that everyone heads up to the office on nights and weekends and patients have better things to do.
In my experience, anything you can do with a class II corrector, you can do with elastics and a compliant patient. Getting kids to comply is at least 50 percent of our job as orthodontists! You gotta learn how to do that and take some responsibility for the overall level of compliance you get in your practice (remember to ignore the outliers, because they are outliers). If you aren’t getting good compliance overall then perhaps it’s time to hone your skills by visiting an office that does this well and learn from a colleague? Knowing that patients have to take responsibility for their treatment and their compliance and knowing when they are being compliant or not is also an important skill you need to learn.
Look, you didn’t make patients the way they are, their genetics and environment and habits did. If a patient is a surgical case then they are a surgical case and everything else is compromise. If they don’t want surgery then we do the best we can. If you prescribe elastics and the patient doesn’t wear them and they don’t want surgery and they don’t want to wear elastics, what are you supposed to do? How are you responsible for this? Does it make sense to put on a class II corrector out of desperation and then get taken to task when that fails? I think not.
Think about this. What if a patient is told they have cancer and the oncologist suggests they take oral chemo but the patient refuses to comply because they don’t like the taste or they lie and say they took the meds. What happens to that noncompliant patient? Something a lot worse than a class II canine or a centric slide I assure you. You can’t force people to do what you suggest and it’s not our responsibility to do so. I know it takes courage to stand your ground and let thing play out when patients refuse to do their part but taking it personally and feeling like their chronic lack of compliance is your burden is bad for everyone involved. This is a tough topic and I expect a good deal of debate.
On Tuesday, I’ll post tips and scripting to help you evaluate compliance so you can be sure of what is going on.