It’s time to dispel the misconception that by utilizing two different treatments simultaneously in one case, the full benefits of each treatment option decrease. That’s simply not true. When applied correctly, combination treatments can deliver quick and efficient results.
By Craig M. Starling, DDS, and Connie Pomeroy
No two patients are exactly alike, and their treatment shouldn’t be either. In some cases, a single treatment option isn’t always best. As we work with patients individually, we identify what the patient’s desired change is, along with any other additional factors to consider. To get the job done effectively and efficiently, we oftentimes will lean on two types of treatment options that can be implemented at once. For these combination treatments, we’re able to utilize two options that complement each other to deliver results quickly and predictably.
Starting on the Right Foot: Individualized Care
Since there is no singular approach to treatment, it is critical to gauge the needs of each patient individually. Before a patient physically walks through the doors at Starling Orthodontics, the staff asks them questions about their background and what is causing them concern. Some of these questions can include:
- What would you like to change?
- Have you had orthodontic treatment before? If so, how was that experience?
- How important is the visibility of the orthodontic appliances?
- What kind of lifestyle does our patient live? Away from home often?
- How important is speed or comfort in the process?
We do have a large percentage of adult patients, and they don’t always seek our advice about how we can assist their smile. It’s during this initial conversation that we get insight into their personalities and what their day-to-day lives are like, which can help determine things like esthetic needs or potential compliance issues.
While we get a lot of information through those initial conversations, we also take time during the first visit to dig into details about their specific wants and needs. Whether they are most concerned about the time commitment, how long a treatment will take, or the comfort of a treatment, we walk through what’s the most important thing for them. More often than not, the most important thing is esthetics.
Patient compliance is another factor to discuss in this first conversation—are they looking for “better” or for “perfect”? While I always strive for perfect, setting realistic expectations related to the patient’s lifestyle and willingness to follow our recommendations is important. Explaining the limitations of esthetic options such as clear aligners up front is important and another reason why we often recommend combination treatments. The main goal of combination treatment is to maintain the best possible esthetic appearance during treatment, while also shortening the treatment time.
Because most of our patients are adults with 9-5 jobs, they want a treatment option that delivers results quickly, but also inconspicuously. Wearing traditional, metal braces is often not possible for patients who have postponed orthodontic treatment, and clear aligners alone may not fix the problems as quickly as patients expect. That’s why we recommend combination treatment to these unique patients.
Educating the Client
When a patient is a good candidate for combination treatment, there tends to be some level of compromise and education. Though they will likely want a completely clear option, it may not be possible for their case. However, we may be able to shift the treatment to get the job done, but also deliver on the esthetics they’re looking for.
Patients won’t typically be aware of every treatment option that’s available. When they initially come into an office asking for a specific type of treatment, it is up to the orthodontist and the treatment coordinator to educate them on the options that can work for them. As we determine the treatment plan, we walk through what it will look like when implemented.
Unfortunately, many people can’t accurately picture what ceramic brackets mixed with a clear aligner may look like. That’s where the typodont comes in. By providing patients with a physical example, it allows them to better understand how this treatment will look and feel.
An advantage for utilizing aligners in combination treatment plans is the digital aspect of the management, which allows me to work with better precision. I can digitally design a smile upfront and show the patient the end result we are shooting for before even starting treatment. This helps with case acceptance and allows the patient to envision the outcome. This can greatly motivate a patient in terms of aligner compliance, and it serves as a useful guide throughout treatment.
For patients who are especially worried about esthetics, brackets can sometimes be intimidating. But often, they are not as prominent as people think. To explain this, we take a photo of the patient smiling and show what it will look like with the treatment applied to them. More often than not, this will show how unnoticeable the treatment will be to other people.
Combination Treatments: Are They Worth the Hype?
Combination treatments are a common sight at Starling Orthodontics. But that’s not the case for all orthodontic practices. There is a misconception among orthodontists that by utilizing two different treatments simultaneously in one case, the full benefits of each treatment option decrease. That’s simply not true. When applied correctly, combination treatments can work together to treat a patient and deliver the results they—and we—want quickly and efficiently.
For example, one patient at our practice was receiving aligner treatment off and on for about 2 years due to compliance issues. In situations like this, it can be demoralizing for patients. The situation can get even worse if an orthodontist is using an aligner system that isn’t getting the job done. In those cases, patients can go through multiple revisions to get their desired result. Combination treatments can be a great way to help prevent compliance issues because the treatment is designed for that patient’s specific needs and can also be tailored to avoid treatments that don’t fit their lifestyle or commitment expectations.
A common combination we utilize is brackets with clear aligners. We look for products that streamline our process by digitally generating the treatment to ensure precision. With this technology, we can apply aligners in one arch and brackets in another precisely and effectively for the treatment.
One variation of this treatment primarily uses clear aligners to align the teeth and alternates the wearing of aligners with short time periods during which the patient wears clear cosmetic braces. The clear cosmetic braces speed up the overall process and assist in any problems that may not respond as effectively to clear aligners alone.
Figure 2: Progress at 4 months. Maxillary occlusal, retracted anterior biting, and mandibular occlusal shown. Photos courtesy of 3M Oral Care.
Another variation is wearing braces on the top teeth and aligners on the bottom, or vice versa. For example, we will use 3M Clarity Ceramic Brackets on the top teeth, while utilizing 3M Clarity Aligners on the bottom, both from 3M Oral Care. Other orthodontic appliances may be incorporated into treatment, including spacers, retainers, and any other treatments that will help achieve the best result.
Although each patient is different, combination treatment typically reduces the total treatment time and can often reduce the cost of treatment as well. Other benefits of combination treatment include better dental hygiene, less patient discomfort, and improved patient compliance.
Reaping the Benefits
When it comes to orthodontic treatment, there is no one-size-fits-all approach. Even with patients who have similar needs, the same approach to treatment may not be applicable. Because each patient has their own specific needs, combination treatment can offer more control and flexibility to orthodontists while delivering the efficient results patients want. OP
Craig M. Starling, DDS, is an orthodontic specialist practicing in Brentwood, Tenn, a suburb of Nashville. In solo private practice for 16 years, he has a specific interest in adult treatment, esthetic treatment options, and multidisciplinary care.
Connie Pomeroy is the treatment coordinator and new patient specialist at Starling Orthodontics.
