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Due diligence is required of all dentists in reviewing the risks, benefits, and alternatives of recommended treatment.  As new treatment modalities gain widespread acceptance in the profession, it is incumbent upon each dentist to offer patients these options—whether they are available in each practice or by referral.

Not long ago, if a patient lost a tooth, their options were limited to doing nothing, getting a removable partial denture, or getting a fixed bridge.  When implants became a successful alternative, our informed consent discussions broadened to include implants as a viable option.  Before Invisalign, orthodontic consultations were limited to discussions of more traditional approaches.

Until recently, patients with orthodontic problems were only offered orthodontic solutions.  However, properly trained restorative dentists can now successfully treat many conditions previously approached only from an orthodontic perspective.  In postgraduate programs such as those offered at the Las Vegas Institute for Advanced Dental Studies, dentists are trained in advanced orthodontic techniques but are not limited to orthodontic treatment.  In many cases, this is an advantage to the patient who would otherwise endure years of braces only to require restorative care in the end—restorative care that could have solved the orthodontic problem in the first place.  In other cases, when fully informed, the patient may simply choose restorative dentistry over orthodontics.

Diastemas, crowding, over bites, over jets, inadequate vertical dimension, TMD, and other manifestations of malocclusion are currently being treated restoratively, in a relatively short period of time compared to orthodontics.  This is a distinct advantage of restorative care compared to orthodontics.  An additional advantage is that restorative dentists are generally more attentive than orthodontists with regard to adjusting pathologic occlusal interferences after treatment.

Certain orthodontic cases can now be treated without the discomfort and embarrassment that accompanies wearing braces, and without the time and inconvenience involved with Invisalign.  Patients must be informed when alternatives exist that do not require them to wear uncomfortable, unsightly or time intensive appliances.

Adhesives now rival the biological bond of enamel to dentin, and porcelains now rival the strength and appearance of enamel.  Considering the quality of these materials and considering that select dentists are now properly trained to restoratively treat some traditionally orthodontic cases, the time has come to offer restorative treatment as a viable alternative to orthodontics when it is a realistic option. 

There is often more than one option for treatment.  When a restorative dentist consults with a patient who presents with an orthodontic problem, the restorative dentist must present orthodontic treatment as an option.  Similarly, it is now incumbent upon orthodontists to inform patients of the restorative option to orthodontics in order to satisfy the requirements of informed consent.  This will foster greater communication among the restorative dentist, the orthodontist, and the patient–which can only benefit the patient.
 

Dr. Bernstein is a Clinical Instructor at the Las Vegas Institute for Advanced Dental Studies.  He maintains a private practice in Piedmont, California focusing on restorative cosmetic dentistry, smile design, and outstanding guest services.  He was recently awarded “Practice of the Year,” by The Richards Report.  Dr. Bernstein is widely published and he lectures throughout the U.S.