The “Big Picture Approach”: Orthodontic Problem Solving From a Bird’s Eye View

“When the only tool you own is a hammer, every problem begins to resemble a nail.” ~ Abraham Maslow

When facing critical problems and difficulties in our case progression and mechanics during orthodontic treatment, we sometimes struggle with finding the right solution and seem to be going deeper into complexity, and often, nothing seems to be working! In such situations, it’s always useful to remember to see the big picture of the situation first, before drowning further in the little details.

In order to do this, I’d like to share with you a simple approach, which can help us achieve a Bird’s Eye view of the problematic issue at hand. Let’s call it: the S.S.S Approach (does not refer to my initials; Shadi S. Samawi, by the way!) :

The S.S.S Approach


Once the realization has set in that things aren’t going as planned , Stop everything you are currently doing, immediately. Our natural tendency is to always keep pushing. That would not be the wise approach at this stage.

When you’ve dug yourself into a hole, the first thing to do is to STOP digging!


Look at the overall situation objectively and ask yourself:

  • What has happened? How did I get here?
  • How far away am I from the ideal situation I initially planned?
  • Did I give enough time for my archwires to work?
  • Was I a bit hasty or careless in applying my forces? (Hint: usually, we have been!)


Again, Our natural instinct or tendency when facing a problem is almost always to start “adding” more things to try and solve it; to add more complexity in our misguided belief that “more is better”, or that a complicated issue must require an equally complex solution!.. In reality, this couldn’t be further from the truth. I have talked about the importance of productive simplicity in Orthodontics in a previous popular blog post.

“Simple can be harder than complex: You have to work hard to get your thinking clean to make it simple. But it’s worth it in the end because once you get there, you can move mountains.” — Steve Jobs

Often, the issue is simpler than it first appears , we’re just not fully aware of it! Instead of adding more complexity and/or auxiliaries, we need to simplify our approach and go back to the Basics;

  • First, Check bracket positioning. Is there anything wrong with our bracket positioning that could have contributed to this problem? If yes, rectify immediately as a first step. The importance of a Pano/Repo session has been emphasized in my eBook: From Good to Great: The 4 Keys to Mastery of Orthodontic Finishing.
  • If our brackets are positioned correctly, the next step would be to check our arch wires: have we allowed them to work and express themselves fully?.. Most problems, abnormal tooth movements and delays we face during Orthodontic treatment are a result of NOT allowing each and every archwire to become completely passive in properly-leveled brackets slots before moving on to the next stage…. check for yourself and you’ll be amazed how often this IS the source of your problem!.. A good mantra to remember is: Re-position, Re-level, and simply attempt again. The significance of being patient has been emphasized in a previous blog post, as well as in my eBook: Straight Wire Orthodontics: A Short Guide to Principles and Technique – 1st Edition.
  • Reapply forces in a lighter, milder and more consistent way. Heavier forces lead to binding as well as undermining resorption and are almost always counterproductive!… “Less is More. Less, but Better. “ – Dieter Rams.
  • If it’s still unclear to you what the real issue is or what needs to be done, take a set of extra and/or intraoral clinical photos- and possibly Xray views if absolutely necessary – and simply sit and review the case in your free time! You will surely be able to see the issue more clearly and come up with a reasonable solution before the patient’s next appointment; Much better than struggling with on-the-spot decision making and causing unnecessary delays in treatment! And your patient will definitely appreciate it!

“Common sense!..”  I hear you say!.. well, of course! but how many of us actually apply it this way?!.. you’ll be amazed how often we forget and simply react and keep pushing in the wrong direction!

“Perfection is achieved, not when there is nothing more to add, but when there is nothing left to take away.” — Antoine de Saint Exupery

Finally, for every problem we face, we simply need to remember to repeat the above approach, and not be in a hurry; Drive slowly and you’ll arrive on time!

N.B: My freely-available eBooks  – containing many useful tips and shortcuts to streamline our treatment progression right from the start – can be downloaded from the eBooks page on this blog. You are welcome to check them out and freely share them if you found them useful.

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