I was introduced to this term early in my orthodontic education but it took several years to fully understand what Herodontics is, why we engage in it and the results thereof. Herodontics is the act of treatment planning and proceeding clinically in a way that values “ideal outcomes” over all other considerations. “What’s wrong with that?” I can hear you asking.
Our job is to use our knowledge, skill, experience and resources to get the best possible result for each and every patient given their unique set of circumstances. Furthermore, we must treat each patient on their terms – time, money, compliance, hygiene, you name it. In the simplest cases this creates a morass that can be difficult to navigate but when genetics and environmental factors conspire to give the patient a challenging or compromised presentation, things can spin out of control quickly. What do I mean? Let’s look at a few situations.
Don’t Turn a Pros Problem into an Ortho Problem.
- Closing missing lower premolar space can take forever and tends to upright the lower incisors. In some situations, this is acceptable but in many it is ill advised at best.
- I know you love TADs but biology, not anchorage, determines how fast a tooth can move so it still takes forever PLUS placing TADs is not a practice grower no matter how cool you think they are.
Impacted Canines are not always worth saving.
- Sometimes patients are better off having severely impacted canines removed.
- If you have practiced any length of time then you have had the experience of fighting a canine forever and wishing you’d TX planned differently. If you haven’t, give it time.
- Patients HATE the mechanics it takes to put traction on an impacted canine.
- I know this is heresy but the sooner you come to grips with this truth the better off you and your patients will be.
Impacted lower second molars are not always worth uprighting.
- The idea that we should save every single tooth is a holdover from a time when people routinely lost all their teeth but most of our patients will keep their teeth for their entire lives.
- There is no proof that 2nd molar occlusion is superior to 1st molar occlusion.
- If a lower second molar is severely mesially impacted then we should consider removing it AND the opposing 2nd molar and the 8s.
In a case of missing lower 7s, the idea of moving lower 8s into the 7 position is generally contraindicated.
- Again, this takes forever and working in this area of the mouth is very uncomfortable for the patient.
Take a minute to recover from the shock of the above. I am sorry to upset you. I am not asking that you agree with any of these but I would like you to consider what I’m saying while looking at cases you have treated and diagnose in the future. My goal here is to suggest a more pragmatic approach to some the most common situations in which Herodontics are employed. Believe it or not, Herodontics is more about us than about what is good or right for patients. Our ego is what drives us to strive for ideal even when accomplishing such is unlikely. This puts us at odds with what is best for the patient. When practicing Herodontics, we hold our perception of our reputation above the good of the patient because we refuse to consider all factors, and instead, we focus solely on our perception of ideal. I know this mindset is “normal” for orthodontists. I understand this is what we are taught. I also totally get that we all like to show off our triumphs over difficult cases when we orthodontists gather in groups. The problem with all of these rationalizations is, again, that they neglect the most important part of the equation – the patient! Not to mention that no one shows the 4 out of 5 times that their attempts at Herodontics failed before they got that awesome, cherry picked result that they proudly display as “their norm”.
Think about it.