2020, Number 4
Treatment of ''camouflage or compensation'', solution or deception
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Language: English/Spanish [Versión en español]
References: 3
Page: 222-224
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Patients deserve to be diagnosed and treated three-dimensionally.
There is a high percentage of failed orthodontic treatments or with a high amount of recurrence, I am referring specifically to the wrongly called "compensation and/or camouflage" treatments. These are precisely the treatments where what should have been done was not done, especially in cases of orthognathic surgery, as well as in cases where perhaps extractions are required and because of the desire to avoid them, the objectives of organic occlusion, joint health, facial aesthetics, respiratory function, etc. are not met.
In the orthodontic field, we understand the concept of compensation or camouflage to mean something we want to obtain or disguise to achieve a "good result" according to our treatment perspective. However, we are aware that we will never obtain the ideal treatment objectives, i.e. we will remain in an attempt to reach the functional and stability standards according to the required needs. It is worth reviewing the legal consequences of compensation and/or camouflage.
We understand camouflage as something that looks like something it is not and we will try to fool ourselves into thinking that it will "go unnoticed" and no one will notice it. Rather, it is something that is in place of something else. The word camouflage is thought to come from the Venetian origin of camuffare which is to deceive, to trick, to trick, to hide. One of the fundamental strategies of camouflage is to disappear, to become transparent or imperceptible. Like the transparency of a fish at the bottom of the water, camouflage opts for disguise, tragic, and/or satirical expressions.1
A compromised treatment is a result of not performing the indicated procedure according to the diagnosis and correct interpretation of the auxiliary diagnostic methods, for example, treatments where orthognathic surgery is indicated and it is only decided to perform a "compensation" orthodontic treatment, either to reduce costs, avoid surgery, not to take surgical risks, etc. For this reason, the patient must be well informed that if the indicated treatment is not performed, the result will lead to a compromised treatment in many aspects such as lack of function, esthetics, and stability.
Undoubtedly, these terms should be explained as clearly as possible and be part of the informed consent to avoid legal problems due to lack of understanding or clarity in the interpretation of the treatment objectives. The recommendation is to adhere to the quality schemes offered by the different dental patient protection agencies and to the recommendations of the orthodontic collegiate groups that exist nationally and internationally.2
Speaking of camouflage and/or compensatory treatments, it is also possible to refer to situations of doing or not extracting, starting or not the treatment at an early age, applying or not applying facial synthetic fillings, etc. It is necessary to question the extent to which this type of treatment fails to meet the minimum requirements of function, esthetics, and stability.3
Returning to the example of orthognathic surgery I want to mention that the surgical patient is surgical, no matter the age at which the treatment is started or even if you want to treat at an early age, in the vast majority of cases will always be surgical, in other words, there are patients who are born being surgical by genetic factors.
Figure 1 mentions the biomechanics that is generally carried out in compensation and/or camouflage treatment, and also marks the treatment objectives that will be compromised at the end, and that this will probably lead to the patient requiring a new and different treatment. If we explain to the patient the possible consequences of not carrying out the correct treatment plan, he/she will surely think twice before making a decision and we can be satisfied.
For all this, I consider that it is time to change the way we talk to the patient about the result and interpretation of the auxiliary methods of diagnosis in the clearest possible way and avoid the confusion of words so that the patient does not generate unattainable expectations, so I propose to eradicate the terms camouflage and/or compensation for compromised treatment and in this way the patient will decide if he runs the risk that the result of his treatment is far from a functional, aesthetic and stable treatment.
Change is a matter of renovation and updating, which is undoubtedly something we owe to our patients.
REFERENCES
AFFILIATIONS
1 Profesor de Posgrado en la Escuela Militar de Graduados de Sanidad (SEDENA) y en la Universidad Católica de Cuenca, Ecuador.
CORRESPONDENCE
Lorenzo Puebla Ramos. E-mail: lorenzopr_1@hotmail.com