Orthotown October 2016 - 9

From record-taking
to method-making
In my "Treatment by Twelves" presentations, I refer to how Dr. Robert Keim
traced and predicted the paradigm shift
from static record-taking to functional or
dynamic method-making.
Keim stressed the importance of attempting to predict the changing face over time,
and using these predictions to diagnose and
treat patients. A couple of years later, in an
apparent contradiction, another article in the
same clinical orthodontic journal mentioned
that records weren't being collected as often
as before. Casts were being eliminated, and
even cephalometric X-rays were absent from
the standard repertoire. Clinicians were
"winging it" with a couple of photos and
hopefully a panoramic X-ray.
I've actually heard from a young doctor
practicing in one of the "pop-up" clinics who
has to use a cell phone just to gather some type
of photographic record before placing braces
on a patient that same day.
Recently, an editorial response in another
professional journal took some jabs at the
modern practice of orthodontics in some
corporate settings. "Placing starts above
proper diagnosis and treatment" was the
implied conclusion by the writers, who
documented the hypothetical journey of a
neighbor who was nudged into orthodontic
appliances in one visit with diagnosis,
contract and appliances-apparently placed
all within a single appointment.

We're busy in October!
I remember joking with my staff 20-some
years ago about being "busy in October"
after making it through the summer rush.
For those new to the profession, standard
operating procedure back then was to
perform a certain number of exams during
the morning hours for the initial exam.
Patients were reappointed for diagnostic
records, then reappointed again for the
after-work and school consultation, where
both parents could review the findings
and go over all the diagnostic records with

Digitization has played a part in the
elimination-as well as the acceptance-of
new-record gathering and keeping. While
plaster-soaped casts are falling out of favor
in most offices, digital scanning is becoming
more popular.

to accept more treatment and refer more
patients. (And, yes, sometimes it's difficult
to "code" for these services.)
If the goal of most orthodontic practices
is to start patients, the goal becomes more
attainable. Most restorative dental courses
and study clubs that are taught by leading
practitioners and educators (originating from
the northwestern and southeastern parts of the
country) stress that you can't treat what you
don't see. For instance, CBCT is combining the
cephalometric, panoramic and even periapical
X-ray evaluation into one record. Intraoral
scanning is allowing for almost instantaneous
treatment-outcome predictions.
As I write this column, I'm reminded of
a forward-thinking, experienced orthodontic
practitioner in my area who's driven by his

Many speakers on the circuit emphasize
the importance of modern diagnostic record
procedures and stress that the orthodontic
specialty practice is moving beyond achieving
Class I molars.
If you're paying attention to what's
happening around you, the conclusion is
that we need to be more complete in our
record-gathering system, not less, and do
more with what we gather.
In my experience, patients who choose
a practice that gathers seemingly abnormal
sets of diagnostic information and then
presents patients with objective findings
and some subjective recommendations, tend

patients' desires. Recently he's added the services of a general dentist to not only aid with
some of the duties of orthodontic practice
but also to work with gingival smile detailing
at the completion of orthodontic treatment,
as well as to perform some minor surgical
procedures such as micro-osteoperforation
to accelerate treatment.
Utilizing complete diagnostic record-gathering is the key to adding these services in his
practice. Such things as smile design, airway
improvement, habit correction, cancer detection
and restorative dental planning are all within
the scope of the modern orthodontic practice.
So ... what's in your wallet (records)? n

the child present. Once all objections had
been defused and the father was worn into
submission, an appointment for spacers
was made. One week later, the braces were
placed. Whew!
If you're following along, this moved
an initial exam appointment performed in
July into a start in October. It's no wonder
things have changed-they had to! (Thank
you, practice consultants.)

The evolution of records

Sound off online.
Is records-keeping changing for the worse? How have your habits changed? Leave your
comments on the online version of Dr. Dan Grob's column at orthotown.com/magazine.

orthotown.com \\ OCTOBER 2016

http://www.orthotown.com/magazine http://www.orthotown.com

Table of Contents for the Digital Edition of Orthotown October 2016