How To Alleviate Fear With Orthodontics And Maximise Your Practice

Wired Orthodontics is an orthodontic laboratory and manufacturer of lingual braces, cosmetic and invisible braces for dentists and orthodontists. As well as being an industry leader in providing aesthetic alternatives to traditional braces, they offer orthodontic courses, training and comprehensive support to dentists and orthodontists in the UK and abroad.

At the 3 Day Practice, we look to provide the most up to date and relevant information in our sector, particularly the growth of orthodontics and associated trends. In doing so, we hope to increase business awareness and alleviate some of the fear commonly associated with orthodontics so that dentists can maximise their practice.

Today we have the opportunity to speak with Co-Owner of Wired-Orthodontics Sue Bessant. Find out more about the services they provide, gain detailed insights into orthodontics from the perspective of GDPs and the specialists and discuss industry trends.

Aalok Y Shukla:          Sue, you’re the Co-Owner of Wired Orthodontics, which is a brilliant training and laboratory company for helping dentists that want to really stretch their skills, and grow further in orthodontics. Can you tell us a little bit about what you guys do, and we can go from there?

Sue Bessant:               The company was formed in 2009 by myself and Ian Hutchinson who’s a specialist Orthodontist. We started out with the aim of manufacturing lingual appliances. It’s quite a complex and involved process. We also found out very quickly that people needed to be trained on how to use these appliances properly.

From doing those initial training courses, there was a demand from people wanting to know more about  how to do labial orthodontics properly as well. They might have been doing some short term and started to become critical of the results they’re getting and want to develop a bit more. Just wanting to know little hints and tips to correct the cases that they were doing.

Very quickly we started doing our own indirect labial setups using really high quality components. Also, proper one-to-one hand holding, helping people sort out problems they were having with their labial cases, and just letting them develop at their own pace.

Aalok:               That’s a really critical part. One of the things that GDP’s need is additional support, even though they may have done a few cases. In the last week or so could you describe a recent problem that you have been asked about and the solution that you’ve been providing support with? Just an example of common things that you might find.

Sue:               There is one case, a guy that’s doing an STO case that’s really not going to plan. He’s been asking the mentors of the company that he’s using for advice and although these people are well meaning and have a fair bit of knowledge they are don’t have a depth and breadth of specialist knowledge. He knew the case was getting beyond what he was competent to pull achieve and he didn’t feel confident continuing with the treatment.  

Actually, when he told me the latest advice he had been given, if he followed that through, he would have made the case even worse, he would have got himself in trouble. It was completely the opposite advice to what he needed to do. To rectify the case easily it meant using mini-screws, which he felt a bit out of his depth with.

So, we just had a chat and in the end we decided he would be happier if he could refer it to the orthodontist down the road to complete. I think he really appreciated getting honest advice, and being able to speak to someone and find a solution that suited him.

Aalok:               Totally. This ability to get really clear, directed support and advice in a non-judgmental way, and in a friendly open atmosphere is hugely invaluable. That’s what, I personally found extremely extremely useful.

It’s something which you cannot put a price on. Are you finding that most dentists, when they start doing more cases, suddenly get burned and get put off? What would your advice be to someone that has got a case that’s not going to plan, and they feel that they need to get additional support?

Sue:               I think people’s personalities are a big driver in this. Some people are quite happy to take a risk and want to try and push through it themselves. It’s really about having an honest chat with people, and finding what they’re comfortable with. Especially with problems, and find out how the patient is feeling about it at that moment. Whether the patient is completely on side, and is willing to proceed following advice, even if there is a problem. Or if the patient is starting to lose confidence.

We just try and understand all aspects of the case, and work out what the best plan is. Some people are more than happy once they’ve got the advice to carry on.

Aalok:               I totally get that. On the other hand, if a dentist has some experience with you and then says, “Okay. I’m interested in learning more. I want to take this further.” What would you recommend for them?

Sue:              Okay. If you’ve done a bit of our short term or cosmetic ortho, then the next step we recommend is our 9 Day Orthodontic Core of Knowledge. Which is giving you all the basics. We do have a reading list, and suggested books to read. We’re not going to make you do it. Everybody has busy lives, and some people will be able to devote more time to their learning and studies than other people can.

Obviously, the more you put in, the more you get out of the course. With the nine-day course we also encourage people to use the forum. Which is free for twelve months for the people that sign up to our advanced courses.

The forum is a really useful resource for delegates to use, rather than just asking us how to get out of a situation, what we want to do is encourage you to actually learn, and think about what you’re doing. Post your questions or cases on the forum and Ian will answer. Sometimes other members of the forum will chip in and ask other questions and say, “Well, what about this? I had something similar and he told me to do that. Why was that?”

It gets to be a conversation. It’s much more of a learning tool, rather than just somewhere to go when you’re in trouble. Especially if you can devote a little bit of time, and just go on the forum and look through other people’s cases and see what they’re doing and see the issues they’re having. Hopefully, you’ll get these problems sorted out before they occur for you.

Aalok:               I think this is key isn’t it? Once you’ve been through the course, you then get taught how to assess properly, how to record the case so you can present it correctly, and you’re able to learn what you need to keep on top of to move further forward.

At the same time, if anything was to happen, at least you’ve got the documentation, the backup and the support, to be able to say that we’ve handled this in this way. It’s the safest way of practicing, because you’re always within your zone of competence.

Sue:               Absolutely, yes.

Aalok:          You’re not going to do something which you shouldn’t do. On the other side of things, you guys have been going for several years, and you’ve got many people who have been through your advanced courses. I think a lot of the instructors for many of the systems have been through your courses which is great.

Let’s talk a little bit now about where a GDP can go. You must have some dentists that pretty much only do orthodontics, is that correct?

Sue:              Yeah, several have pretty much gone down that route because it’s dentistry they enjoy. People are coming in, and rather than being in pain or wanting serious cosmetic issues sorted out, which is perhaps related to long-term neglect, these patients are usually fairly healthy. There might be a little bit of hygiene to sort out, but they’re motivated patients. They want to be there, and they’ve made a very conscious decision that they want to improve their appearance. I think a lot of our clients really embrace that more positive working environment.

Aalok:               You’ve also got people who have moved into treating children as well? In your nine day course, it’s not just about how to get out of problems with STO for example, it’s also how to embrace more comprehensive treatment, isn’t it? What kind of doors can that open up for a GDP?

Sue:              Some of our clients based in different parts of the UK are still able treat children’s ortho under NHS contract and this has become a big part of their practices.

In the adult population, people generally becoming more and more conscious of their appearance, it’s a market that’s only going to grow. On the course we do ask people to bring along the study modules, and treatment on their cases. I think some people think it’s all about doing comprehensive treatment plans all the time, but it’s not. It’s looking at a case and thinking over all the possible treatment options so that patients are fully consented.

It’s not just the case that every case will be treated in a comprehensive manner, it’s the whole circumstance around the patient. Obviously, if you’re treating children, you want to be looking at the comprehensive plan.

Aalok:               That’s what I found so valuable, is the very friendly but practical approach of: What was the problem, and what is going to be the most efficient way to achieve that. If you talk a little bit more about where things are going. What do you see two years, three years from now? What are you noticing that is particularly exciting that you would encourage people to look into?

Sue:               I think treating children privately is going to be a massive growth area. Obviously, potentially more litigation, you’ve probably got to be a little bit more careful treating children, and making sure all your consents are absolutely water tight.

What I do see the trend being towards is invisible orthodontics. We’re looking very much at discrete appliances at the moment, with people becoming aware and accepting of clear ceramic braces rather than the old style ‘train tracks’.

I think that’s going to evolve. Quite soon, I think people are going to be demanding invisible. I think lingual orthodontics is where the real demand is going to be in the future.

Aalok:               Definitely. I’ve noticed that myself as well. I used to do a lot of clear-fix braces, and I pretty much do as much lingual as possible. Conversely, are you finding that many dentists are put off by lingual or scared by it? What are the common misconceptions, would you say?

Sue:               I think on a recent course, what came out was that people didn’t realise the scope of treatment possibilities with lingual. Basically, you can treat any case with lingual that you could with labial orthodontics. I think the development of orthodontics in the UK has been a little bit stilted. Within the NHS, price has been a driving factor which has obviously meant a swing towards metal labial braces.

In countries such as Korea, where everything is privately funded,  the motivating factor is the best possible treatment plan and the best possible or the most aesthetic appliances. A lot of the specialists over here almost have a bit of a downer on lingual, because they themselves don’t understand it. They’re not used to it, they’re not experienced in it. They might have done a little bit and not really had great results.

I think there is that misconception that lingual is not such an effective treatment, and you can’t do as many cases. Which isn’t the case. You can do any sort of treatment, and you can get the same results that you do with labial orthodontics.

Aalok:               I think we’re in a very exciting time at the moment, because what’s happening now is more and more of the population are actually having orthodontic treatment in some form or the other. Over time, I feel this will progress to a point whereby everybody at some point will have had some form of orthodontics.

This is going to create a whole new focus where you’re going to have GDP’s doing some simple interactive stuff on kids, then you’re going to have people, for example, doing simple ceramic brackets. Then, you’re going to have more advanced dentists and specialists doing more lingual orthodontics.

What would your recommendation be to someone that’s trying to leave behind this fear mentality, and look forward to life as a specialist. They may be feeling a bit insecure because NHS contracts aren’t there, but yet there’s this huge scope of opportunity. What would your recommendations be to a specialist?

Sue:               I think actually there’s already started to be a bit of awareness with the young newly qualified ortho’s, and a swing away from chasing after an NHS contract, that they need to do something different. I think it’s probably getting a little bit more in track with what general dentists do, the amount of training they do outside their specialty.

It’s business development, it’s being aware. I think orthodontists are going to need to start having an appreciation of cosmetic dentistry, even if they don’t practice it. I think they need to be aware of what a referring GDP might be trying to achieve, and have conversations with them. The forward thinking orthodontists are doing courses on occlusion and cosmetic dentistry so they are able to either offer or understand a fuller treatment plan.

Aalok:               What about lingual? Are you finding more and more of them are now coming into lingual? In Korea for example, would you say most cases are lingual?

Sue:               Yeah, they are. I’d advise clients to start slowly and systematically. Get a few simple cases under your belt, and work up. A company such as ours will help you all the way in guiding you and having conversations, and making sure that you’re successful with those early cases and building your confidence. Just gradually build and build and build, until you’re doing everything. With lingual, there’s no reason why you shouldn’t.  Yes, as you say most cases in Korea are lingual.   

Aalok:               Wow. It’s nice to see different places which allow you to imagine how things will go here. I’ve noticed when you start offering lingual, suddenly people aren’t bothered about time anymore, because you can’t see the braces anyway. It comes to the question of what’s the best thing you can do? Other things I like about lingual, are the fact that you can also do some bonding if you wanted to simultaneously, you can whiten simultaneously and it’s a cleaner more robust, and transformative service.

The more people that are able to do it, and the more people that are able to get the right training and support and understand more comprehensive orthodontics, it’s just going to help. I don’t know if you feel the same? I feel that orthodontists really need to embrace the more complex side of things, and then at the same time work downwards by understanding more of the cosmetic side of things. By doing this they can solve what people are actually wanting.

Sue:               I think with the lingual orthodontics, because we do do the Kesling setup, you’re actually seeing the outcome before you start the treatment. I think if you’re working in a multi-disciplinary team, then you need to be communicating that outcome with the patient, to the technicians that are going to do the orthodontics side, and the restorative side and also the restorative dentists. There’s a lot of people that need to okay that setup model before we start.

Really I think doing some lingual cases would help specialists have a more transparent treatment plan and objective, and probably be more effective in what they’re doing rather than just direct bond and labial brackets and seeing where it goes.

Aalok:               Is there any book they could read, so they can learn how to get what they want from orthodontics?

Sue:               Actually we have produced a couple of books in house that do just that. Letting you know what your next steps would be in orthodontics generally. Then we’ve got a more specialised version specifically for lingual orthodontics going a little bit more in depth showing some cases, and the sort of things that you can do and the sort of support and backup that you can expect from us.

Aalok:               Okay, cool. What about digital orthodontics? What are the trends that you’re seeing now because you’re able to do these digital setups, and how can this help your general dentist or specialist move into the more aesthetic arena?

Sue:             I think it helps with cases that are potentially problematic, and by doing the digital setup we can analyze the space to see if there’s a discrepancy. Sometimes it’s easier treating both arches, because you can say for example you just want to improve the upper arch. The teeth in the lower arch might be in the way, so it’s actually advantageous sometimes to be able to treat the lower arch as well. If you have everything right in the lower and then the upper can fit around it.

Sometimes the patient doesn’t want that, or there’s other circumstances, so it can be quite nice to do the digital setup and just see what our space is like and what the results are going to be like. How much the over-jet is going to increase by if the patient doesn’t want extractions. If it’s a case where we’re deciding whether we’re going to do extractions or not, then we might do two setups seeing what the situations going to be if we round out non-extraction and see what the situations going to be if we do extractions. See how the over-jet is affected.

Aalok:               I think that’s very important, the scenario planning, to be able to see option one or option two. Essentially they’re buying a smile which they want, but they’re not entirely sure how it’s going to be. This allows you medically, legally to be able to communicate in a more transparent way about what’s possible. You mentioned single arched treatment. From your experience are you still finding a lot of people are doing single arched versus dual arch?

Sue:               I’d say it’s probably about 30 percent doing single arch.

Aalok:               Out of that 30 percent, what percentage truly could be single arch versus should have been double arch?

Sue:             Probably about half.

Aalok:               Half and half? It’s interesting isn’t it, because you say it’s about people not wanting to do double arch, and it’s understanding how to explain in a very succinct way, so that they understand and they buy into it, so that they don’t think that single arch is their only solution?

Sue:              Yeah. Again that’s up to us to communicate. When cases come into the Lab, Ian sees all the fixed cases and advises on them. That comes back to my communication with the dentist, so it’s about  educating them. Then they’re able to educate the patient.

Aalok:               One thing I found really helpful, when we’re doing consultations, is using the intraoral camera at an angle to have an upward view of where the lower teeth are meeting upper teeth, showing them where the upper tooth is displaced and saying, “Can you imagine where this tooth needs to be?” I’ll literally point that it needs to be backwards, and explain, “Can you see what’s blocking its airspace? It’s the lower tooth.”

Once they’ve seen that, it’s no longer a conversation about this or that. I think that the more dentists can learn about simple ways to communicate what’s actually needed. Courses like yours help with this. Just to touch finally on TADs. What kinds of things can you do with TADs? What possibilities does this open up that you couldn’t do before?

Sue:               It makes a lot of adult treatments more acceptable, cases perhaps where you traditionally would have needed headgear. You can just about make your kids wear it at night, but there’s no way an adult is going to wear it. Cases that require that amount of anchorage can be treated.

Also, they mean that sometimes a sectional appliance can be used rather than a whole arch bonded up. Invaluable in some restorative cases as well, imagine you’re just trying to sort out a space in the six region for an implant perhaps next to upright a tipped in seven, you can probably do quite a small sectional appliance just posteriorly, which is going to be invisible to people. You don’t need to have the whole arch bonded up. Sometimes you don’t even need any brackets at all, you can do direct pulling from one tooth from the TAD, just using that composite button or a piece of wire stuck to the tooth.

Aalok:               Yeah. For example, if somebody was bracing the bottom arch and they were missing a lower left six for example, but they had a seven and eight, you could pull the seven and eight forward with a tad couldn’t you? So then you avoid the implant.

Sue:               Yeah, absolutely.

Aalok:               That’s very interesting. If a dentist or a specialist wants to learn more about what you guys do, where would be the best place to start?

Sue:               I think the best place to start would be to go and have  at  our  website. There’s lots of information you can read, there’s testimonials from some of our clients, so you can hear what they say about our courses. You’ve also got the opportunity to actually sit in on the course for five minutes via a video preview. You get a bit of a feel for what we do. Of course, if you’ve got more questions, you can either ring me or email me at the Lab.

Aalok:         If somebody hasn’t been on your course, can they join your forum?

Sue:               They can, yes. For people who are outside their free 12 month membership, then there is a monthly or 6 monthly payment option.

Aalok:               Or a dentist that had done some STO and was getting into trouble, and they wanted some advice, could they join?

Sue:              Yeah, they could. I do get people emailing me direct or phoning me direct if they’re having an issue. If you do have an issue, then they’ll send pictures and I’ll have Ian take a look at it anyway, because it builds the relationship and trust for the future. You know the odd one or two cases, then I’m happy to get Ian to have a look at and help people get sorted anyway.

Aalok:               Perfect. I think that sums everything up, because you guys really are trying to help provide the very best materials, the very best results, and the very best support to help more dentists and specialists transform smiles in the nicest, most aesthetic way. Thank you for your time Sue.

Does the content of this post resonate with you? What insights into orthodontics can you share with us? We would love to hear your thoughts please comment below.

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