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To Be a Colleague by Dr. Chad Foster

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To Be a Colleague

by Chad Foster, DDS, MS, editorial director

Dr. Gary Brigham was a fixture in the Arizona orthodontic community, a very highly regarded clinician and world-renowned lecturer on the topic of clear aligner treatment. He unfortunately passed away in December 2023, leaving behind a great legacy of love and service to others. I knew of him but had never actually met him before our first and only conversation.

In 2019, I treated a man in his early 60s who showed mild crowding in both arches along with a mild lateral open bite on his left side. A year into treatment, I came to realize that multiple upper left teeth (from canine to second molar) were displaying clinical ankylosis. By that time, an iatrogenic maxillary anterior cant had developed, and it took me more than a year to recover the cant and occlusion to a marginally acceptable point. In the second half of treatment, the patient became consistently angry and argumentative at each appointment. I worked as hard as I could to communicate what had occurred, where we were at and to remedy the situation. I don’t now and didn’t then fault him for his frustration. While the possibility of ankylosis was briefly mentioned in the treatment plan, in hindsight, I did little more than a passing mention in the exam room. I should have written those words out on paper to help him understand it as a real possibility as well as what the orthodontic consequences might be. I failed in proper communication before treatment. I did not do what is required for true informed consent from the patient. I completed the case with an acceptable but non-ideal outcome, so I refunded the patient his treatment fee. The patient still felt that something better should be done for his occlusion, and I let him know that I would support him if he wished to pursue other orthodontic opinions. It’s hard to summarize this patient’s case to do it justice, but it is on a short list of the most stressful I have ever treated.

About two months later, I got a personal call from Dr. Gary Brigham. Gary explained that the patient had come to see him and wanted to discuss it with me. I let Gary know how grateful I was for the call, and I immediately dove into a long monologue of every clinical detail of the case. After about 60 seconds of fast, nervous talking, Gary politely interrupted. With a little, knowing laugh, he said, “Chad, I need to stop you there. I know for a fact that you are an excellent orthodontist and that you did your very best for this patient.” For what it’s worth, Gary didn’t know me at all. He definitely couldn’t know with certainty either one of those things, but his words and the genuine way he said them touched the shame in me. I believed those words because Gary could believe them. He continued, “If this is the worst-case outcome you’ve had in your years of practice, I’ve got about a hundred or more of my own failures that I’d like to show you.” He went on to talk to me like a loving father for another two or three minutes before we briefly discussed the pertinent case details.

It was the only conversation that I had with Gary. I remember less of what was actually said as time goes on, but I will never forget the way he made me feel. Orthodontists, as a group, are about as competitive and Type A as they get. But we are still human, and we still fail consistently and continually in many areas of our practices and lives. Also, we all universally crave the loving validation, praise, forgiveness and redemption from another who is just like us. I know I do, and that’s what Gary did for me as a true colleague.

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