Risk Management in Orthodontics

As an orthodontist, for approximately 20 years of my career, I had orthodontic cases which treated out exceptionally well and with no issues during treatment. All orthodontists and general dentists doing many orthodontic cases have experienced numerous patients where treatment did not go to plan– and the usual excuse has been “we are dealing with
a patient’s individual biology”

Over the last eight years of my career, through guidance from my mentor Dr Rohit Sachdeva, I now know that with proper planning and proper risk management , 99 % of patients can undergo orthodontic therapy with no surprises.

In order to understand managing risk in orthodontic cases– a thorough understanding of the bracket/wire geometry and orthodontic biomechanics is required. Once this knowledge is learnt – orthodontic tooth movement and treatment can be very easy and predictable. There is a total fallacy with the straight wire appliance – that all you do is put the brackets in
place and the wires do the rest– in fact depending on the bracket/ wire geometry, it can be quite common for more problems to develop than on initial presentation— problems such as open bites developing, developing cants of the occlusal plane and even crossbites occurring. All these issues can be prevented with proper guidance, knowledge and understanding of the bracket /wire geometry and biomechanics.

Below is an example of a case (Case1) which we performed the typical straight wire orthodontic approach and engaged all the brackets – with the expectation that the teeth would miraculously align to the shape of the wire.

In fact, as you can see from the initial to the progress photo for Case 1 this did not only occur – but the situation became worse.

To demonstrate this is not a one-off occurrence as you can see with the second case. Case number 2 demonstrates that the normal straight wire alignment process in this case caused a significant worsening of the posterior occlusion.

“Today with my knowledge, both cases would have been managed totally differently from a risk assessment point of view – and the problems that I experienced would not have occurred”

With the proper knowledge and training, orthodontic cases CAN be treated very efficiently, predictably and profitably. Case 3 below demonstrates this and shows excellent control and improvement in only 4 months of treatment


This to me is the foundation of good clinical, predictable and profitable orthodontics – and this can be taught to anyone but requires sound proper training by an orthodontist who fully understands biomechanics and bracket/ wire geometry.

If you wish to practice stress-free orthodontics, risk analysis and management is absolutely essential in your training process – and if you are a general dentists who has been doing orthodontics for a while and having cases that are causing you problems, I urge you to take the next step in learning– and remember, “the definition of stupidity is doing the same thing and expecting a different result”.

We now have the knowledge and skills to perform orthodontic treatment for each patient successfully and stress-free – and this CAN be mastered by any dental practitioner. To learn how to avoid these situations and understand “risk assessment”, I highly recommend you consider our OrthoED Mini Master’s program — and all of this process and knowledge will be shared with you.

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