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Wired for Success by Alan A. Curtis, DDS, MS, Editorial Director, Orthotown Magazine

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Knowing When to Compromise

by Alan A. Curtis, DDS, MS, Editorial Director, Orthotown Magazine

It is a frequent thought-battle that used to keep me up at night. The mental struggle went something like this: I know what I can predictably treat and what cases frustrate me. These frustrating cases are not because of my inability to treat or to diagnose. They are frustrating because the way I'd like to treat them is challenging to get patients to accept.

Over the course of my short six-year career, I've changed the way I approach these cases. This article is my attempt to stimulate an online discussion on the topic to see how my peers approach this and other conundrums.

Five years ago, when I looked at a case, the first thing that went through my mind was surgery! The second thing was, there is no way this patient is going to accept costly surgical treatment (implant or orthognathic)! Then my mind quickly dismissed the case as another waste of a precious new patient exam slot! The patient would go to my local wisdom tooth surgeon whose consent discussion would further convince the patient that risky, unpredictable treatment would not help him with his problem.

Today, when a patient comes in, I look at the case and the first thing that goes through my mind is surgery! Then, I ask myself, "Is there any way I can improve this malocclusion?" Rather than positively predicting my own failure at presenting a solution to the patient, I try to help the patient by discussing acceptable compromises to help improve his condition." While surgery is often the first and most important treatment plan presented, it is either quickly determined to be the route taken or we move to other acceptable consent discussions for less ideal treatment plans. Patients who leave the office excited about surgery now go to surgeons who are confident in regularly treating orthognathics.

I think as orthodontists, we often fear being judged only as good as our worst treatment result. This fear often impedes our clinical and financial success. I am not suggesting that we lower our standards of the type of work we are capable of. I am merely suggesting we free ourselves to perform treatment that will improve our patients' lives even if that improvement is shy of the type of result we would ideally like to achieve.

Steps to Effectively Close the Deal:
  1. Make sure the patient understands the ideal treatment plan "If I were you, I'd..." or "If you we're my sister/brother/son/daughter, I'd like to...".
  2. Use animations of the ideal treatment plan to visually conceptualize the end result. (Ortho2, Dolphin Aquarium, YouTube.)
  3. Get a response from the patient and either proceed to surgical consultation or move on to the next "less ideal alternative."
  4. Be a decision coach and discuss "less ideal alternatives."
  5. Make sure that "no treatment" is by far the worst option.
  6. Get specific signed consent.
  7. Discuss the less ideal option with the dentist.
Since adopting this approach, both my comprehensive ideal and "less ideal compromised" treatment plan acceptance has increased.


Click here to view Dr. Curtis' acceptable compromises video.
Orthotown Magazine
September 2025
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