If you have a driving licence, you know that it takes time to acquire the theoretical knowledge required to drive. Then there is the practical handling of the vehicle. It is learnable and once mastered, it usually works out quite well.
Now imagine that you want to learn how to fly one of the big commercial airliners with 700 passengers. Do you think it can be done with a weekend course and review of a few online modules?
Going from being a general dentist to mastering orthodontic treatments with clear aligners may well be comparable from going from being able to drive a car to having to learn how to fly a large aircraft.
It can't be done with a weekend course and a few online modules. There is a reason why it takes 3-4 years to become an orthodontist.
It's possible you're thinking that with limitations in the software, you can get there more safely. You can if you treat as a co-pilot and have an experienced dentist as your guide for many years before you get into the captain's seat yourself. As a rule of thumb, restrictions in the aligner software generally require as much knowledge and experience to master as systems without restrictions.
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It takes time to become competent
It takes 4-5 years to become a pilot and from there you have to take several courses, be certified and have your licences renewed annually by proving good health, a certain number of flight hours in the aircraft you are certified to fly and a number of hours in a flight simulator to be allowed to fly with that many passengers. All this to ensure that pilots manage to follow all standard protocols so that they don't make mistakes and are able to deal with the chaos that occurs when something doesn't go right. For example, if there's a fire, a person has an emergency or the plane has to make an emergency landing.
It is not without reason that I compare a driving licence to an airline licence. Because one is to be a dentist with years of experience in a general practice and to have built up the routines and skills of a general dentist. Another is to work in orthodontics.
There is a reason why it takes 3-4 years in addition to basic dental training to become an orthodontist. It's the equivalent of taking a pilot's licence in addition to your driving licence.
Need for experience and simulation of problems
Just as pilots must have a certain number of flying hours per year to ensure they can deliver safe flights to their passengers. An orthodontist or a general dentist should also be able to prove that a minimum of 100 aligners treatments are performed per year. If this minimum requirement is not met, there is a relatively high likelihood that important details will be overlooked and patients will not be treated to the golden standard.
This is perfectly comparable to the insertion of implants. If you don't place a relatively large number of implants annually, you will never really become proficient at it.
Most dentists I know have a desire to treat their patients in the best possible way. Despite the good intentions, the treatments performed do not always live up to their own ideals. So patients sometimes end up being treated below professional standards. Often without the dentist even being aware of it.
Typical clear aligner trap
If you're unconsciously incompetent, it's easy to get caught up in tasks that are complex and outside your remit. You simply don't realise it, as there are no prerequisites for knowing.
When we as general dentists throw ourselves into extremely complex tasks, like orthodontic treatment, without having the right prerequisites for it, we risk performing treatments as unknowingly incompetent.
There are hardly any treatments more complex to handle than orthodontic treatments. Yet we have come to believe that it is super simple.
For years, the industry has given us the impression that all you have to do is send an IO-scan, some photos and an X-ray to a company that produces some transparent plastic braces. Then the company takes care of everything with the orthodontics and we can sit back and hand the splints to patients and then reap the benefits of a complex treatment that has been made super easy for us.
There's just a couple of problems:
You are responsible for the treatment - regardless of which orthodontic appliance you use.
Clear aligners are an orthodontic appliance on a par with fixed appliances - both types of appliance require extensive orthodontic knowledge to be used correctly and to ensure that the treatment plan is realistic, safe and predictable.
The technicians, or computers, used to make the digital simulations on the computer very rarely have a dental background and have an absolute minimum knowledge of orthodontics.
It is your job, as the treating dentist, to correct the digital plans so that they are biologically realistic, safe and predictable.
Recommendations
If you want to work with clear aligners in your dental practice, our recommendation is that you:
Take everything you can get your hands on in orthodontic continuing education with your team.
Buy 3-4 books on orthodontics with and without aligners, study the content.
Sets aside lots of time to implement your knowledge in practice (minimum 4 hours per month for 1-2 years)
Combined with treatment of about 100 patients over 1-2 years, where you let an orthodontist with knowledge and experience about clear aligners-, or a dentist with extensive knowledge and experience with clear aligners (500 treatments+) help you diagnose your patients, design treatment plans (orto-restorative), modify your setups and support you and your team through the treatments.
Spend time reviewing your books and comparing your experienced colleague's diagnostics, treatment planning and modification of setups. with what is in the books.
Setting aside time to set up a proper, tested and functioning workflow with your team and practicing this with the team (this typically requires several days of internal training, combined with daily goals and daily follow-up on the goals)
Using an external advisor to keep you focused on your goals and to help you implement your vision and knowledge quickly and painlessly in your practice.
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When you use a competent and experienced expert as a sparring partner, it's like letting the expert take the pilot's seat while you act as co-pilot. In this way, you gradually learn to handle simple, moderate and complex cases.
After about 500 treatments, which you follow throughout the treatment process, you start to build up the skills to select and index patients as either: simple, moderate, complex or referral patients.
Do you want to start treating patients with clear aligners?
Are you already treating patients, but want a more efficient and secure workflow with the ability to delegate?
Need a simple tip or two to make part of your workflow better?
Or would you like to share a tip that could benefit other colleagues?
Then send us an email.
We look forward to hearing from you.
Many kind regards
Jesper Hatt DDS