I hear disparaging comments all the time from orthodontists when they talk about anything other than what they consider “comprehensive treatment”. But this begs the question, what exactly is the definition of comprehensive when applied to orthodontics? I think you’d have a hard time getting consensus on this were you to ask a room full of orthodontists. As with most things in our profession, we tend to define words, ideas and concepts in relation to what we each do in our own practice setting. Comprehensive treatment is a term used by orthodontists to defend the decisions we make and impugn what others do (if they do it differently than we do) and is similar to the word QUALITY in terms of the deleterious effects it has on the profession.

“Everyone knows what comprehensive treatment is, Burris”, I can hear you saying. “Comprehensive treatment is doing it right and banding second molars and not settling for a bad result or doing shoddy treatment in a mill where you see too many patients and don’t spend enough time with them and the mesio-buccal cusp of the maxillary first molar…”.

Ok. Sure. So if that’s the best “definition” you can come up with, how applicable do you think your definition is to your peers’ offices? Do you think everyone will agree with your definition? Orthodontists never agree on anything – if you show ten orthodontists a case to DX and TX plan you’ll get at least 15 options! Also, attempts to define comprehensive treatment are confounded when you consider a case where the orthodontist is very satisfied with the result but the patient is not happy with the outcome. Is this comprehensive? Is it a success?

Since we can’t effectively define comprehensive treatment in traditional terms, perhaps we can look at what is considered “not comprehensive” and get a clue from these concepts? Here are a few terms off the top of my head:

  • Limited Treatment
  • Compromise Treatment
  • Phase I Treatment
  • Camouflage Treatment
  • Tooth Alignment/Straightening

All of these terms are meant to describe cases where the orthodontist doesn’t fully address what we orthodontists see as the problems with a customer’s face/jaws, right? But if that is the definition of “not comprehensive” treatment, then how many cases in our offices actually qualify as comprehensive (i.e. are perfectly treated with a perfect result)? If we are honest, the answer is very, very few despite the bravado and swagger we all put fourth when it comes to proclaiming our technical prowess and showing our awesome cases to our peers. I’ve never seen a case that couldn’t be improved in one way or another. NEVER. And I’ve seen more than a few cases. If you have one that you think is perfect, feel free to send me the records and I’ll point out what I see (and I’ll be glad to be proven wrong if that is the case too). Furthermore, though we orthodontists act like every case in our offices finish perfectly, but we all know that is not the case. It’s amazing to me that we all still pretend that all our cases work out and relapse is not a problem! I guess it comes from the culture of only talking about and showing off our successes while ignoring our failures? But I digress. The point is that if our definition of comprehensive treatment is, well, “comprehensive” (i.e. addressing each and every thing we orthodontists see wrong in with given consumer) then we ALMOST NEVER render comprehensive treatment.*

The way I see it we have two choices. We can continue to lie to ourselves and one another in the online groups and at meetings about the results we say we get in our offices or we can realistically redefine comprehensive and speak more openly about what actually happens on a daily basis in our offices.**

“Ok, smart guy, how would you define comprehensive treatment and what gives you the right to do so?”, I can hear from most of you.

Well to answer your second question, nothing and no one gives me any authority to do anything other than share my opinion. And that’s all this is. As to how I’d define comprehensive treatment and it’s antonym, here goes:

Comprehensive orthodontic treatment – Manipulation of the teeth and/or jaws and rendering a result that 1) does not harm the customer 2) makes the customer better off than they were 3) elicits a significant enough change to merit the time and money the customer spends 4) is, at minimum, a satisfactory result in the eyes of the customer.

Limited orthodontic treatment (call it by any of the above names you want) – The consumer is not satisfied with the process/result for any number of reasons.

So what is the key to rendering comprehensive treatment in this context? Of course you must make sure you do no harm and render a substantial benefit but the most important factor is to avoid starting cases where you are not reasonably sure you can make the consumer happy no matter the level of difficulty of the case!

We orthodontists are service providers who work for and at the direction of consumers. We are much more like beauticians than medical doctors for any number of reasons but primary because what we do is elective, non-invasive and aesthetic in nature the vast majority of the time. Instead of raging against this fact, why not recognize and own who and what we are and insure that anyone who wants a better smile has access to our skills? Most of the orthodontic profession’s collective problems would be solved if we’d only recognize the difference between the way things are and the way we wish they were and perhaps we would treat more than 1% of the US population if we did so!

 

* The last time I asked this question there was practically a riot online but in this context I’ll ask it again… Can anyone show me a study that proves that a Class I bite is better than a Class II bite? You might think you can but you cannot and this fact alone proves that the arbitrary decision made by Angle over a century ago that has become orthodontic theology and the basis for all our fallacious beliefs about occlusion and what we do is not such a good idea in this day and age. Besides if more than half of the population is Class II, how can Class I be “normal”?

** I’m often challenged to “lay the plaster on the table” to compare cases with those who disagree with my position but I don’t believe in cherry picking cases to show what went right while ignoring what went wrong. We all have cases that don’t work out so I’ve had a standing offer for years to those who want to compare orthodontic prowess in order to prove me wrong. I’ve always offered to have the upset doctor show up at my office unannounced with a camera to see what walks in my door on an average day and then I’ll do the same at their office. I’ve never had anyone take me up on this but I’ve hundreds of doctors visit my offices over the years to witness my successes and failures. WE ALL HAVE CASES THAT DON’T WORK OUT.

2 thoughts on “What Is Comprehensive Treatment?

  1. Let the pt./parent /client/customer decide how much they wish to pay,how much time they are willing to spend and receive a reasonable expectation management of the final result .The clinician can also input as to what she /he would consider the “ideal”.It really is that simple.
    Sometimes , “good enough is good enough “.This can be very difficult for us to accept given our OCD tendencies reinforced by lousy academic role models.

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