Four-Sentence Treatment Prescription
Hello there, my name is Dr Andy Toy, and welcome to the next in the series of Keep Calm & Carry On Aligning.?
I'm speaking to you today from the beautiful town of Les Houches: Chamonix. I have some mountains behind me, and I'm out on my morning run. It's just a fantastic place to spend time, and I'm very lucky that I have a chalet here.?
Anyway, what I'd like to talk to you about today is the Four-Sentence Treatment Prescription.?
This tactic is something that I devised along with the great Dr Raman Aulakh, and it really is there to help general dentists get control of the Invisalign cases. It's been born out of real-life, hard experiences that I've had with bringing on dentists who want to get control and get better Invisalign results. Yet they don't have the orthodontic terminology that they think they need.?
In order to achieve this, well, actually, you don't need it. And one of the reasons for that is Invisalign is creating and still creating this incredible algorithm that's going to assist us in creating beautiful smiles with a healthy bite, and no recession risk.?
If you want a great aesthetic result, you want to control the occlusion, and you want to avoid the recession, you can sometimes get with fixed appliances, then read on…
4STP- Four-Sentence Treatment Prescription
I got inspired to develop this some more because I was teaching it over in Scandinavia. And I went back after about six months. A Norwegian dentist came up to me, and she said, ‘since I use the Four-Sentence Treatment Prescription, I love Invisalign.’
And I thought we’ve really got something here. So we now teach it on the Postgraduate Diploma in Clear Aligner Therapy at the City of London Dental School and many of you will have been taught it in your Invisalign Certification throughout Europe from Raman Aulakh’s fantastic team.?
So what is the 4STP- Four-Sentence Treatment Prescription? Well, it's four sentences, funnily enough!
4STP #1: The first sentence is, about what your treatment aims are or what's the patient's chief complaint. And then you have three reference points. And this is the key. The reference points help you control what the algorithm does.?
4STP #2: Sentence two is the upper anterior reference point.?
The first reference point is where do I want to finish my upper front teeth? Now all of you general dentists have been brought up with facially driven treatment planning. And this is exactly in your court.?
You already think like this! Just imagine that patient came in with no front teeth. Where would you finish the upper front teeth to give you a good lip support? You want nice incisor show, but avoid a goofy smile, right? Avoid lip catch. Where would you put those teeth??
Well, you're going to give the ClinCheck technician a reference point with that upper anterior tooth.?Use an upper central incisor if you can because it gives the ClinCheck technician the best chance of getting a symmetrical smile.?
4STP #3: Sentence three is how much expansion you want. Generally, here I use upper second molars because that fits the shape of the patient's face. It's where the zygomatic arch comes in. So by putting in some expansion, you're creating space, obviously. And you're also buildng out that smile, and it's going to look quite natural because it fits in with the shape of the patient's face.?
4STP #4: Sentence four is your lower anterior reference point. So, where do you want to finish the lower front teeth? Now you can describe this in terms of overjet and overbite, but here's the key…?
If they've got a recession risk, you do not want to procline those lower incisors too much, right? So you tell the ClinCheck Technician where to finish those lower incisors.?
So there you have it. State your treatment aims plus three reference points, that's all you’ve got to work out.?
And then you will have control of the aesthetics, you'll have control of the occlusion, and you'll also have control of the recession risk.?
Those of you who are doing Invisalign comprehensive, or the full portfolio, you can write this in your special instructions, and that will help drive the initial ClinCheck.?Those who provide Invisalign Go, then you will get an automated ClinCheck back, but you will be able to match what you see on the 3D study model against what you wanted from the patient's own mouth.?
Because remember, the 3D study model does not take into account the soft tissue profile or the recession risk. I have found about two-thirds of the automated Go ClinChecks are actually fine, and I'm confident we can go ahead and provide a great case for the patient. But those ClinChecks that don't fit those three references - then we can easily change it because we have a simple way of describing what we want to the ClinCheck technician.
So there you have it, the Four-Sentence Treatment Prescription. I'm going to include a link to an article Raman and I wrote about this to give you a bit more information. You can also go to the Aligner Global Community, I've got a series on there all about the Four-Sentence Treatment Prescription as well. And I hope that you get the chance to love doing Invisalign.?
Write the 4STP with the Patient!
I write the Four-Sentence Treatment Prescription with the patient. I give them a mirror. And I say, ‘let's have a look, is there a tooth that you liked the position of in the front?’.?And some of them will say, ‘Yeah, I quite like this one’.?
Others haven't got a clue. And that's great because I can then talk about where I want to finish the top front teeth, to give them good lip support, without looking too goofy, and talk about recession risk and talk about the importance of a good bite. I'm basically telling the patient what's going through my mind.?
And by the way, I'm raising their dental IQ, I'm raising their appreciation of what I know and what I can do. And I'm also including them in the treatment plan.?
Now, once you've included them in the treatment plan, whose treatment plan is it? It's the patients! So you see that, not only have they raised their appreciation of what I can do and what I'm thinking, but I've also included them in the planning process. And if they've got clear ideas, I want to know that, and they want to know that I know that. And if they had no idea, they now realise there’s a lot more to it than sending scans off for a computer to do the work. This sets us apart from direct-to-consumer aligner companies.
By writing the Four-Sentence Treatment Prescription with the patient in the chair, you have suddenly boosted your consent and ethical sales process!
Why do you do the Four-Sentence Treatment Prescription? Two More Benefits…
Benefit number #1. Because you don't need any orthodontic jargon. You can just think and talk and communicate just like a general dentist doing facially generated treatment planning. And you're going to reduce the risk of occlusal issues, of lip catch and of recession risk.?
Benefit number #2. And you also find you're going to speed things up. I find that 93% of my ClinChecks are either right first time or just need one correction. How much time have I saved by not having to do several modifications of the ClinCheck? When you're in your 60s, like me, time becomes very precious!?
Finally, I'm hoping that you will get into the Four-Sentence Treatment Prescription, read the articles, go on the Aligner Global Community and get to know about it and start to use it, and I'm hoping that you will love Invisalign just as much as I do.?
Here’s to great aesthetic results, improved consent, speed things up, control occlusion and avoiding recession.
Here is the article I promised https://tiny.ie/orthopdf
Andy Toy
Dental Business Academy
P.S. Alpine Ski Con23 Early Bird Ends 15 October. See my previous email.
P.P.S.Please can you do me a favour and pass the webinar below to a TCO, nurse or your PM? It will do wonders for your practice!
'TCOs Need Some TLC!' Study Club
Hosted by (Tiny T) Tracie Barnett?
from The Aligner TCO Network?
Thursday 27 Oct @1.15-2 pm
(Keeping It Simple)- iTero Scanning Round 3
Keeping It Simple- Round 3- iTero scanning, how to use your simulated outcome to convert more cases.
Last, in this short iTero scanning series, let's weave everything together and finish off with how to use your simulated outcome to achieve more case acceptance for Invisalign. Join me, Tiny T, and many other TCOs for a lunchtime of deep learning. FREE CPD!