Picking up from where they left off in Part 1, Dr. David Dana and POS CEO Miles McGann talk about why analyzing all of your orthodontic treatment options, including surgery, is key to providing your patients with the best esthetic outcome.
In case you missed Part 1 of this interview, catch up here.
MILES MCGANN: I see the majority of POS guys are scared of surgery and the concept of doing a surgically assisted orthodontic case terrifies most of them and they refuse. Now the Update is not just about surgery, it is one aspect of what we're talking about, because one of the things that you and I have both had discussions about is the difference in attitude by the specialty towards surgically assisted orthodontics versus our students’ attitude towards it. Explain to the audience a bit more about what you see there.
DR. DAVID DANA: Everybody is resistant to the word surgery. Most of the time it's lack of understanding. One of the things that I find fascinating, and I actually discuss this during the lecture, is whenever I tal==k to dentists, involved in ortho or not, about orthognathic surgery they go ‘oh my patient would not want surgery’ and I'm just blown away because if you look at what's going on in the world today I don't remember how many billions of dollars are spent throughout the world in plastic surgical procedures on lip enhancements, hair enhancements, which I need some...even on facial creams I think the market on creams for esthetics is about 12 billion dollars.
MILES MCGANN: But beyond that, looking at the specialty they do surgical cases all the time.
DR. DAVID DANA: All the time.
MILES MCGANN: That's the norm. Most specialists I know say the norm is to, if the case is too difficult, do it with surgery.
DR. DAVID DANA: Do it with surgery. Here's the thing, that may be because they are afraid of presenting it. My opinion is mostly it's a lack of understanding of what the case requires to have beautiful esthetics. If your objective is just get class 1, I can do that any time but if my objective is to create great function with maximized esthetics, many times the patient's going to need surgery.
MILES MCGANN: Right and the orthodontists, from the orthodontists that I've talked to, they look at surgical cases as making their life easier.
DR. DAVID DANA: Oh it's much simpler.
MILES MCGANN: And this is the thing that I think has been lost in the world of POS is that when we hear surgery, or this is a surgical case, we all think significantly more difficult, run away, refer that case, this is something I don't want.
DR. DAVID DANA: On the contrary.
MILES MCGANN: Versus the surgeon, the orthodontists look at the flip side.
DR. DAVID DANA: I do the skeletal anchorage cases and the corticotomy cases and I do a lot of them because I love the challenge because that's what makes me tick and makes me go to the office, but if I was talking about difficulty levels I'm going to try to treat all these cases with surgery because the only thing I have to do is set up the teeth where they belong and have the surgeon put the bones in the right plane of space and then I'll get a fantastic bite, I get straight teeth and I enhance the facial aesthetics of my patients. This is where I'm trying to bring the focus of our seminar. As you know I do a little preview of the Update every year just so some of our instructors can preview it and look at it and as I was doing the preview a couple of months ago, what I'm talking about is I go and this is not for ortho only guys this is when you're planning to do an implant restoration in the front, this is when you're planning to do porcelain veneers, is it really a veneer case or should you be doing crowns? If you understand the support that you are going to take away or put in excess, then your restorative will be better and talking to general dentists, I think the value of this lecture for the overall work that they do, not only for the ortho, it's going to be phenomenal.
MILES MCGANN: And going back to your prep for it you also went up to see Will Arnett's class up in Santa Barbara for this one. And you know in that course you got to sit around for a week with a bunch of surgeons as well as orthodontists right?
DR. DAVID DANA: Yeah it was about 50 orthodontists and surgeons and one prosthodontist in the class.
MILES MCGANN: And so tell me why you thought that was an important one to go visit as you're doing your prep work for this seminar? What did you learn there, being that you were very out of place as the only non surgeon/non orthodontist specialist...
DR. DAVID DANA: But actually I felt like a fish in water. One of the things is Dr. Arnett has been an icon in orthognathic surgery for many, many years. He's been around since 1975 and he has developed techniques and a lot of stuff that occurs today in orthognathic surgery. I've been wanting to listen to him for five days for a long time. I've read all his literature for years. I found that it was a perfect time to go since I was planning to do this lecture. Actually I had the opportunity to go see him once the lecture was pretty much finished but that's okay because it still made me more aware of things that I might have been missing, but the experience was fantastic. Get an understanding from the other side of the profession. What they need from me in order for them to create better results and also allows me to get an understanding of what they're doing to see if what their plan is really going to get the results that I like. And then you can end up having a very intelligent discussion between you and your surgeon and achieve the maximum results for your patient.
MILES MCGANN: And so by understanding the other side what we try to put together with this lecture is I'm going to be able to see these cases from the prosths side, with the surgical options, with the skeletal anchorage options, with the general orthodontic options and take a step back and view each one of those options based upon the esthetic finish of the case and that is kind of the underlying theme of your lecture.
DR. DAVID DANA: Exactly, the objective is that after you finish with the lecture the way you're going to do your diagnosis for esthetics is going to be much better. You're going to be able to see things that you were never aware of and incorporate into your plan. So whether you're doing ortho, whether you're doing restorative, even if you're doing dentures your final result will be better.
MILES MCGANN: Right, but even if you're not going to do the surgical cases because you're afraid or you don't want to do those type of cases, still having an understanding of what the options are and what the consequences of not doing that is huge to a practice and that's really going to be the focus of it. It's not saying you have to do ortho or you have to do surgical cases.
DR. DAVID DANA: And we have comparisons where if you don't do the surgery what happens?
MILES MCGANN: Right it's an understanding of if you choose surgery this is how the surgeons see it and this is how the specialty does it. If you choose skeletal anchorage, this is what the advantages and disadvantages are. If you choose just basic ortho…advantages and disadvantages and going into each case with an understanding and you don't necessarily have to do all the three different ones, just have an understanding and you'll be a better diagnostician as a result.
DR. DAVID DANA: Exactly the more you know the more responsible you are to your patients, but also the smarter you are and the decisions that you will make will be better. And whatever decision you make you'll be aware of all the pros the cons and limitations that you may have so you're not caught by surprise in the middle of the case, ‘oh my god I did not expect this.’ The focus really, and that's why I didn't put the title surgery into the seminar, is esthetics. It's how can we through our orthodontic knowledge provide the patients with the best facial esthetics? When you talk about ortho regardless of what topic you have to talk about conventional orthodontics (put brackets and wires extract teeth or not) you have to talk about doing corticotomies, you have to talk about putting bone screws somewhere and you have to talk about orthognathic surgery.
MILES MCGANN: Analyzing all options.
DR. DAVID DANA: And all those will be covered so we can make more educated, better decisions but not only with the objective of getting a good bite, anyone can get a good bite, but can you get a good bite and a beautiful face? That would be the objective of the final result.
MILES MCGANN: Alright, well to me I'm excited to see it and I think it should be a fantastic seminar as well as a very fun time. So please sign up for the Update. We'd love to see you there and you know thank you so much for your time.
DR. DAVID DANA: I hope I can get to see all of you and like Miles said I'll be happy to hang out and have a drink with you after the class. See you soon.
Are you ready for Update 2018? Share what you're most looking forward to about the seminar in the comments!