Course review: OrthoED Mini masters

I recently completed the last module of the Orthoed MiniMasters run by Dr. Geoff Hall. An orthodontist based in Melbourne. I thought the course was well run and a good starting point for someone who is inexperienced in orthodontics. The progression of the courses weren't difficult to follow, basics at the start and more complicated concepts built on top of those basics. He is big on fundementals and concepts and I think an important aspect of the course is identifying risk and mitigating risk in orthodontics. 

There were a few concepts that I took from the course and have unconsciously been applying to other aspects of dentistry namely:

- There are no problems, only solutions. When we are faced with a problem, think of every possible solution to that problem no matter how farfetched and then think of the benefit and risk of each of those solutions. Sometimes one solution to a problem will create other problems and that needs to be accounted for. For example, For a crowding issue, one solution to create space to resolve the crowding may be extracting teeth. However, during the mechanics to close the space created by the extraction, the overbite can increase as the anterior teeth retrocline. If the patient has an open bite then this is beneficial but if they have a deep bite you have to consider how to mitigate this risk of bite deepening. I can easily think of this in terms of crown preparations. If there is a short clinical crown that you want to cover with an indirect restoration, the problem is that there may be insufficient crown height for retention. One solution may be to prep less off the occlusal but the risk of that is that the material is too thin, we can solve that by using a material that can handle thinner sections like gold. Another solution may be to take the preparation subgingivally but the risk of that is invading the biologic width and higher difficulty in capturing the impression. And so on and so forth. Keep listing all the solutions and risks and it forces you to consider every avenue.

- When deciding how to move things, you need to figure out reference points to figure out where you want them to be. The most common problem here are midlines. If the upper and lower midlines are not coincident, and there is a unilateral class 2, the knee jerk reaction is to try to correct the class 2 side perhaps with an extraction elastics or distalisation. However, you need to figure out what your reference is for the midline. If the class 2 is on the right side and the upper midline is already off to the right, removal of a 14 or distalisation of the right side will worsen the midline discrepancy and will be moving the upper midline to match the lower midline which is the wrong reference point. Instead, depending on the facial profile and upper midline discrepancy, you can consider removal of 2 upper premolars and a lower left premolar. Or perhaps consider a functional appliance activated asymmetrically or an asymmetric jaw surgery advancement. The possibilities are multiple but all comes down to choosing the correct reference. In smile design/full dentures, the reference points are the face for the midline, lips for the incisal edge position, ala tragus line for the occlusal plane and so on and so forth. References are critical.

 I still need a lot more practice to cement the key concepts and experience to improve my treatment planning and skills. A big plus is that there is case support for treatment planning and case progression. You can ask up to a few questions at each stage for no added cost. There is an added cost for a zoom call if there is more in depth discussion required. I haven't needed this yet.

 To be honest, learning about orthodontics has been the missing piece of the puzzle and has improved all other aspects of my dentistry. Actually it has made other aspects more difficult because I can see for example how malocclusions are worsening my wear patient's conditions. I can see gingival margin discrepancies that I didn't see previously. What was previously a simple case has an increased treatment cost and time which can be a turn off for patients. I have found that I can treatment plan more comprehensively but the added time and cost can be a turn off for the patient. What was a simple case presentation before takes more time, effort and has lower case acceptance. However, I would much rather have it this way. I can see more problems before they emerge and can turn away the cases that I believe are too complex to take on.