Five mistakes I have done in my first five years after residency

I have been practicing orthodontics for somewhat more than five years and done a plethora of mistakes. In this short post, I am going to highlight the most significant ones. My intent is to help newly graduated orthodontists not to fall into the same trap.

MAR0116-DontWasteMistakes

1. I tried to correct excessive overjets during mixed dentition.

In my first year, I tried to use Twin Blocks and eruption guidance appliances to correct class II relationship in mixed dentition cases (this was the misconception I inherited from my orthodontic residency). The next year, I witnessed complete or partial relapses in all the cases. 

I now wait for the pubertal growth spurt to start class II treatment. The exception is the concerns on the upper incisors trauma or bulling issues. This approach corresponds with contemporary research data [1] and free a child from an unnecessary stress at such an early age.

2. I experimented with different bracket designs and prescriptions.

I used different bracket types and different prescriptions. Apparently, I did it because was unaware of little difference between them [2]. As a result, at some point all my patients had different appliances and it was a complete muddle to find a proper new bracket in case of broken or lost one. I now use the most traditional .022 MBT ligature brackets on all of my patients.

3. I didn’t have time to document well.

I was so busy with unnecessary early treatment and the degustation of new appliances that I was often missing to take progress photos and radiographs. Now I am convinced that without these records it is impossible to fully understand biomechanics and correct your mistakes. 

4. I tried to enhance orthodontic infrastructure in my area. 

Conditions in which orthodontics is practicing in the country I work in were a huge disappointment of mine for years: removable appliances are still much wider used than fixed, no national orthodontic board exists and western orthodontic literature is blocked by self-proclaimed professors [3]. About four years ago, I wrote the proposal for the establishment of the national board, then several times visited the Ministry of Healthcare trying to get my message across and spent uncountable hours talking and writing to different authorities. 

Now I know that there are just so many people I can help. And they are my immediate patients. Today the only orthodontic infrastructure I am enhancing is at the clinics where I work. 

5. I used to talk about orthodontics in Russian.

Language is the single most precious orthodontic tool. How could orthodontists interact with one another without specific orthodontic vocabulary: ‘o-ties’, ‘tip backs’, ‘torque’ and hundreds more words and collocations that sound a discombobulate chatter for a lay person but are the verbal instruments we operate with on a daily basis. Not to mention the scientific literature, which is written exclusively in English.

I think not speaking English well is the most crucial orthodontic mistake one could make. I spent all my five and a half years after residency correcting it.

I now plan and document in English. As a result, I gained some clarity I had been missing before.

I hope this text could help some younger colleagues. I do not know all the answers and never will. However, these five bruises caused me pain which I do not want anyone to experience.

REFERENCES:

1. Orthodontic Treatment for Prominent Upper Front Teeth (Class II Malocclusion) in Children and Adolescents, Klaus Batista et al.

Cochrane Database of Systematic Reviews 2018, Issue 3. Art. No.: CD003452. DOI: 10.1002/14651858.CD003452.

2. A Three-Dimensional Comparison of Torque Achieved with a Preadjusted Edgewise Appliance Using a Roth or MBT Prescription, Mohit Mittal et al. 

Angle Orthodontist 2015 Mar; 85(2):292-7. DOI: 10.2319/122313-941

3. Orthodontics vs Orthodontiya, A Ditmarov

British Dental Journal 2018 Jul 13;225(1):2. DOI: 10.1038/sj.bdj.2018.549.

One thought on “Five mistakes I have done in my first five years after residency

  1. So true! At first you think you can change the world, and the world changes you. I would add the retratments. Most of my practice are retreatments and when i started i remener i thought: this patient was treated by a bad ortho, whit bad result and bad braces and poor biomechanic. Now i know that there are cases that the problem is bad patients.

    Like

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