Letter To Orthodontists
Dear Orthodontic Colleagues
I am writing to share some tips on how to best manage our surgical orthodontic patients. This note is a response to feedback I’ve received regarding the challenges of scheduling consultations and surgical cases. It also serves to update you and your staff on some changes and strategies we have implemented to improve access to our services.
Firstly, I would like to thank you all for your referrals and ongoing support. I am truly grateful for your trust. Working with such a wonderful and supportive group of specialists is the ultimate professional satisfaction. I would also like to publicly express my immense gratitude to my hospital booking manager, Christine Stillisano. She works tirelessly—literally around the clock—to manage and care for our patients.
Consultations for Orthognathic Surgery: Consultation wait times for orthognathic surgery can be up to 4-6 months from the date of request. If you or your patient require an earlier assessment (such as for transverse issues, significant functional deficiencies, or craniofacial timing), please let us know. Some orthodontists reach out because their previous surgeon is “unable to do so,” “lacking OR time,” or “has a long waitlist.” Unfortunately, these requests are difficult to accommodate. Additionally, changing the treating OMFS mid-treatment should be rare, as it introduces too many potential complications.
Adjunctive treatment: I have limited my practice to orthognathic surgery and facial trauma. Therefore, if a patient requires extractions, TADs, or other adjunctive treatments, I will be referring them to my colleagues—my former partners at Crescent, my associates, or other trusted surgeons in your area. I hope you understand this shift. I know some of you prefer me to perform second molar uprighting, and I will consider these requests on a case-by-case basis.
Operating time: although I have about 8-12 OR days per month (which is unusual) with the volume of patients I have, currently the wait is 10 months. I need you to help us let families know that we cannot do all the 19-year-olds in June “after exams and before camp”. Surgery may need to be done during the school year.)
Sleep Apnea: These patients will be carefully triaged. I am slow to endorse the MARPE trend. I will only perform MMA on patients who have been followed by a Sleep Centre with a polysomnogram proven moderate to severe OSA. Furthermore, I request from the respirologist to perform a DISE to ascertain whether an MMA will be useful. There has been a deluge of referrals for orthognathic surgery for “Sleep Apnea” without a clear indication. This is too big a surgery to jump into without complete information. Social media and Reddit I’m sure have caused a flood of cases to you as well.
Preparation for surgery; Last year we made a video that all patients must watch before they visit me. I would encourage you to watch this as well. It is quite relevant, and it shares what our patients go through. It does not sugar coat nor diminish the seriousness of the surgery. We do send out reminders of ortho mechanical support when we book the surgery and please review these.
Attached is a publication of preparation tips, an article on clear aligner OGS and here is the video for you, your staff, and your patients to view.
- Orthodontic Goals for Ideal Orthognathic Surgical Outcomes
- Orthodontic Surgery Combined with Clear Aligner Therapy
- Introduction to Corrective Jaw Surgery:
My Articles and Publications page also has some additional articles which may be of interest to you. If you have any questions, please don’t hesitate to contact me and I will get back to you as soon as possible.
Regards,
Marco Caminiti