A Call for Productive Simplicity in Orthodontics
by Shadi Samawi
“The secret to productivity is simplicity.” – Robin Sharma
I believe it was Confucius who once said: “Life is really simple, but we insist on making it complicated.” This notion certainly applies to everything in life, including the practice of Orthodontics. The true reasons why we orthodontists – and humans in general – tend to drift towards more complexity may not be entirely clear; maybe we subconsciously equate complexity to “sophistication” or to an outdated notion that “complex approaches are more comprehensive and well thought-out!”. Regardless of the real reason, the simple fact of the matter is that simple is hard! and it seems that in this day and age, Complexity sells!
“Simplicity is a great virtue but it requires hard work to achieve it and education to appreciate it. And to make matters worse: complexity sells better.”
― Edsger Wybe Dijkstra
For too long, “empirical” treatments using more and more “sophisticated” appliances and numerous auxiliaries have been a mainstay of our profession. Little time and thought was given to “true” efficiency – as opposed to “perceived” efficiency – and all while largely neglecting the true effects our appliances and auxiliaries had on our patients throughout their not-so-short treatment course. Over the course of the last decade, the push towards more evidence-based Dentistry in all dental disciplines, especially in Orthodontics, has been tremendous and a most welcome change from the days of purely empirical treatments and expert opinion. Although to date, there is still not much strong evidence to support many of the treatment modalities and appliances we have been using for so long with various degrees of success, the idea of simplifying the way we practice Orthodontics, in terms of more efficiency and productivity, less chair side time, and less “complexity” in the number and design of appliances and auxiliaries is something I believe we should all strongly strive towards.
On a personal level, this push towards “efficient simplicity” has been a major driving force in my practice management thinking over the past few years. “Less is more. Less but Better.” has sort of become my practice mantra. This way of thinking, of course, has been slowly translating to more streamlined practice processes, patient flow protocols, inventory management, digital filing and even our marketing approach. But the most noticeable change would probably be in the way I actually treat my patients, specifically, the treatment planning approach and the further simplification of my clinical “Straight-Wire” approach for each treatment. The adoption of the MBT treatment philosophy over 10 years ago had a considerable influence on my thinking in this regard, however, the most influential change that fueled the “push towards simplicity” was probably the incorporation of Self-ligating Orthodontic systems into my clinical practice.
I have been using self-ligating bracket systems for more than 10 years now. I have tried several types of different brackets from different reputable orthodontic manufacturers, active, passive, active/passive etc. .. treating a variety of cases in the process. Regardless of the type used or case treated, I always felt they were helping me achieve very good results with minimum complexity throughout the course of treatment. True; a considerable paradigm shift in thinking and managing the case maybe required, along with the initially steep learning curve in some instances, however, the end results and treatment flow always spoke for themselves. That simplicity even started translating into my conventional fixed appliance treatments where I started using less auxiliaries and concentrating much more on lower, gentler forces throughout treatment and avoiding complicated arch-wire mechanics and elaborate configurations for anchorage reinforcement and traction of surgically-exposed teeth. I slowly discovered I could be doing more, with less, and doing it better, while respecting the boundaries of biological limitations and harmonious facial profile considerations, that are supported by reported scientific evidence, naturally.
This post is simply a call for more productive simplicity in orthodontic practice; not a “dumbed-down” simplicity but rather the systematic simplification of over-complicated and redundant approaches, stripping them down to their bare essence in order to achieve maximum efficiency with minimum means.