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Dave Paquette, DDS, MS, MSD, opened the recent HSO Orthodontic Excellence & Technology Symposium in Scottsdale, Ariz, with his lecture on the clinical and practice management benefits of SAGITTAL FIRST orthodontics when treating Class II and Class III malocclusions.

As Paquette, program chairman for the Symposium, put it, “The nice thing about SAGITTAL FIRST is that we immediately address the patient’s chief complaint.” More importantly, this is all done at the beginning of treatment when patients are most motivated to be compliant.

“Traditionally, what would happen is we would go through all the process of leveling and aligning and whatnot, and then, finally, when the kids are completely burned out, say, ‘Hey, you need to wear these rubber bands for the next 3 months until you get done,’ or longer, and they’re just not into it. They just want their braces off and you either end up having to put them in a noncompliance type appliance, or do something else, like jaw surgery, to get them fixed,” says Paquette, who has been using the SAGITTAL FIRST approach in his practice for the last 4 years.

Beyond the benefit of improved compliance, according to Paquette, the SAGITTAL FIRST philosophy turns a complex patient into a relatively straightforward one.

“When we finish the dental alignment with either fixed appliances or aligners, it typically takes a year or less,” he says. “The total treatment time is shortened because we eliminate all the errors. We don’t rely on a burned-out kid to do the things they need to do. We get that done at the beginning. And with adults, it’s interesting because with adults they’re always asking what the next step is. So, it becomes self-motivating because they actually observe the changes early on. We get from A to B much quicker than we otherwise would.”

On the practice management side, Paquette talked with Orthodontic Products ahead of his lecture about how it was his staff that first noticed the impact his shift to the SAGITTAL FIRST philosophy had on the practice. While orthodontists jump from one patient to the next day in and day out, the clinical staff is in a position to see the arc of a patient’s treatment progression. As Paquette says, “They started coming to me and saying, ‘Have you noticed how fast our patients are finishing?’”

Shortened treatment time is key to exceeding a patient’s expectations for their treatment. “If you’re practicing orthodontics and patients are taking 2 to 2-1/2 years to finish treatment, all you’ve done is bred discontent. Those kids are going to go back and tell their friends, ‘My orthodontist lied to me. It takes forever. I hate braces.’ They all want them, but they want them off even more. Doing SAGITTAL FIRST and combining that with the technology we now have, most of my patients are finishing around a year.”

During his lecture, titled “Our Journey to The Ultimate Orthodontic Practice,” Paquette emphasized how the Carriere Motion 3D Appliance is essential to the success of SAGITTAL FIRST.

“The only way we did SAGITTAL FIRST before was with something like a Herbst or a MARA, which has to stay in for a year, and then you take it out and wonder if it did its job. With the Motion 3D , because it’s only treating the segmented parts of the arch, you can actually titrate the treatment as the patient comes in. You know what the process is the first time you see the patient—as opposed to crossing your fingers and hoping that it worked. It’s much more predictable.”

In addition to his opening lecture, on day two of the Symposium, Paquette led a hands-on activity with Jep Paschal, DMD, MS, focused on integration of the SAGITTAL FIRST philosophy into the practice. As Paquette put it, the hands-on activity gave attendees the opportunity to work with the Carriere Motion 3D Appliance and to build their confidence for using it when they return to their offices.

“The point of the hands-on course is to answer any of those subtle questions about placement—what do you think about this, what do you think about that—that are difficult to answer in a big room. [Attendees] get an opportunity to actually pick up [the appliance], handle it, place it on a typodont that then stimulates other questions about it,” said Paquette. OP