Pacific Coast Society of Orthodontists Bulletin Spring 2020 - 61

Practice Management

Staff Report

Shifting Orthodontics With Sagittal
First and Digital Technology

Dr. James Paschal
PCSO Bulletin Contributor
Atlanta, GA

Thirty years ago, it was not uncommon for an
orthodontist to retire having practiced only one
or maybe two treatment methodologies for his or
her entire practice lifetime. Today, delivering orthodontic care to our patients requires continual
education and change. Gone are the days when
we could just sit back and depend on what we
learned in school. In fact, some experts claim that
technical education may be outdated as often as
every two years.
With artificial intelligence becoming remarkably
proficient at driving cars, piloting airplanes, performing medical procedures, analyzing radiographic data, understanding speech, and many
other tasks, our profession is becoming increasingly amenable to automation. As such, orthodontics is experiencing radical changes in the
acquisition of patient data, diagnosing, treatment
planning, and even how treatment is delivered to
patients.
Today, clear aligners and digital technologies are
being used to move teeth without the patient
ever visiting a professional's physical office. Treatment is ordered online and delivered by mail. We
may criticize this direct-to-consumer delivery
vehicle and find it dumbfounding that people
accept and trust it as a viable treatment method,
but the reality is our patients desire an easier,
more convenient way to align their teeth. For
today's consumer, convenience is often a priority
when making a purchasing decision.
As professionals with an obligation to our patients and their care, it is incumbent upon us to
continually find ways to deliver high-quality outcomes with a delivery vehicle that they prefer. In
today's world, if you fail to satisfy your patient's
preferences, they will find someone or something
else that will. However, we also must be resistant
to allowing the limitations of a technology or
treatment approach to be used as an excuse to
accept a reduced quality of outcome.

Spring 2020    PCSO Bulletin	

Given the financial interests and motivations
for corporations to deliver direct-to-consumer
options for people, the orthodontic specialty has
to find ways to differentiate itself. Simply being
a clear aligner broker for a manufacturer is not
the answer. Orthodontists and dentists are going
to have to bring greater value to our patients
by improving traditional techniques and blending them with digital solutions in a financially
feasible way. This is the only way we are going to
separate ourselves and provide reasons for people
to seek out care from an orthodontist.
How are we doing this today? Many of us are
already leveraging the power of cone-beam
computed tomography, intraoral scanners,
computer-aided design software, clear aligners,
and brackets as tools for delivering state-of-theart treatment options to our patients. Instead
of applying just one orthodontic technique to
all patients, orthodontics is now defined by how
we select from a palette of multiple techniques
and technologies and deliver unique solutions
to each patient, satisfying not only their dental
needs but also their lifestyle requirements during
treatment.
Four years ago, we began to implement the "Sagittal First" treatment philosophy. This approach
has revolutionized how we deliver care to our
patients and radically improved our treatment
efficiencies by providing the following improvements to our practice:

▫▫ Up to a 50% reduction in treatment time with
patients who need anteroposterior correction

▫▫ A 75% reduction in the amount of chair time it
takes to initiate orthodontic treatment

▫▫ Improvement in patient compliance by shift-

ing elastic wear to the beginning of treatment

▫▫ Reduction in the total number of aligners per
case

▫▫ Reduction in the number of case refinements
with aligners

The Sagittal First approach combined with both
clear aligners and brackets have enabled us to

61



Pacific Coast Society of Orthodontists Bulletin Spring 2020

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