Episode #309: Form Meets Function: The Magic of Interdisciplinary Care, with Dr. Tito Norris

Are you tired of the inefficient back-and-forth communication and guesswork with your specialists? Today’s guest will remind you that it can change! Kirk Behrendt brings in Dr. Tito Norris, creator of The Norris 20/26 Bracket System, to talk about the different ways to enhance interdisciplinary communication using modern advancements and technology. To hear more about the value of an interdisciplinary treatment plan and how to increase efficiency, listen to Episode 309 of The Best Practices Show!

Main Takeaways:

• Orthodontic partners are one of the most important people to your practice.
• Spend time with your specialists to understand what they can and can't do.
• There is a need for talented orthodontists who can tackle challenging interdisciplinary cases.
• To do sophisticated dentistry, you need to change the patients’ oral landscape.
• Interdisciplinary dentistry needs a HIPAA-compliant, cloud-based EMR.
• Be willing to make investments in yourself to increase your skill level and differentiate yourself.
• Ortho doesn't have to be a two-year penalty box; there are many ways to increase efficiency.

Quotes:

• “Something that I picked up a long time ago is, whenever possible, try to get your gingival margins placed at your correct positions in relationship to the CEJ first. In other words, if the patient is going to need some crown lengthening, do it on the front end. Because as an orthodontist, we need one of two things: we either need an accurate CEJ, or we need an accurate incisal edge. And if we can have both, then hallelujah.” (08:39—09:06)
• “If teeth have wear on them, we would much prefer — and this is critical — to do pre-orthodontic bonding. So, what does that mean? That means that I want the teeth to be restored provisionally to their natural shapes and forms that they used to be when the patient was a teenager. And you're like, ‘But Tito, how am I going to do that? The occlusion’s not going to allow that.’ Don't worry about the occlusion. That's my job. Your job as a restorative dentist is to restore those teeth and essentially give me back teenager-looking teeth.” (09:25—10:08)
• “It became apparent to me in a very early time that we needed a bracket slot dimension that was .020, something that would allow an .019 wire to fit in there and then have really great intimate contact and that's going to give you more control. And it just wasn't available. And why wasn't it available? I just didn't understand this. And the answer I got was, ‘Well, it’s just tradition. It’s just the way it’s always been.’ And I was like, ‘This is ridiculous. No one could give me a good reason as to why we don't have a .020 bracket slot, so I'm actually just going to make one.’ And so, I did.” (17:41—18:25)
• “The challenges I had to the previous bracket system was, we were using an .019 wire in an .022 slot. So, we had sloppiness in there. And so, it was difficult to finish the case because you'd have to put in enough torque in the wire to overcome the sloppiness, and then it would start to engage. And then, it was always a guessing game. And so, you'd guess a little too much, and then you'd guess a little too little. And so, there was just all this slop in play and too much tolerance, basically, between the bracket and wire interplay. And that's what made finishing cases challenging.” (19:56—20:35)
• “When you subscribe to restoring the teeth to their natural shapes, what you've done is you’ve created a three-dimensional blueprint for communication between the orthodontist and the restorative dentist. So, you've taken all the guesswork out of the communication, because what you've done is you’ve told that orthodontist, ‘I want these teeth exactly this long. I want these teeth exactly this wide. And I want you to take these teeth and couple them together.’ And so, that in and of itself is incredibly valuable because it eliminates that back-and-forth and, ‘Is this enough? Is this too much? Do you want this here? Do you want this there?’” (21:50—22:33)
• “I'm going to quote Bill Robbins on this. As a restorative dentist, you cannot do sophisticated dentistry by accepting the landscape that the patient has when they first walk in. You've got to be willing to change that landscape, whether it’s broadening the smile, whether it’s levelling your gingival margins, whether it’s correcting your open bite, correcting your deep bite, whether it’s correcting your gummy smile, correcting your cants. And there're so many different things that we can change as orthodontists to change the landscape. And most of those things are helping the airway as well.” (23:40—24:20)
• “It took years of some gentle handholding or arm-twisting, or whatever you want to call it, to finally get restorative dentist to understand the value of — because it’s a little extra work for them on the front end in terms of doing these provisionals. And, hey, charge for it. You charge for your time. You've got to make a living out of this thing. But the thing is, once people subscribe to it, there's really no turning back. It’s, by far, a superior way to treat patients.” (26:17—26:57)
• “There's a deficit in the world of interdisciplinary dentistry in that we don't — yet — have a HIPAA-compliant, cloud-based EMR, electronic medical record, where we can all share a common chart on a patient and we can all put our notes there, we can put all of our images there. And Carestream is actually working on it, and they just released an early version. It’s called ICC, interdisciplinary communication something-something. We’re actually beta testing that right now, and it shows some promise. But it still needs some work.” (28:12—28:49)
• “The advice I would give to a younger dentist is, if you do have an orthodontist that you enjoy working with, be willing to carve out a little time in your schedule to go over to their office, and even after work or during lunch, or something like that, and really sit down and look at these images together with the doctor. Talk about the cases just to throw out ideas, ‘Is there another way we can look at this thing?’” (29:01—29:27)
• “If you're going to dive into this realm of sophisticated dentistry, that's one of the things right now you're going to have to do, is to be willing to spend that time with your specialists to really understand what they can do, what they can't do, how they can best help you, and understand how deep is their bag of tricks.” (29:46—30:08)
• “You've got to find a way to differentiate yourself. And for me, that was by really going and educating myself, and being willing to invest in [myself] to keep raising the bar and keep learning more and more. Because we all came out of orthodontic residency with basically a union card. Right? It’s just kind of a license to practice orthodontics. But it’s at a pretty basic level. Most of what I've learned, I've learned after residency.” (30:56—31:33)
• “I think one of the biggest hurdles that adults have with orthodontic treatment is the fact that historically they’ve always been told, ‘Okay, orthodontic treatment. You're in the two-year penalty box.’ And I think that's perhaps one of the reasons why restorative dentists don't do that. It’s like, ‘Man, I'd like to finish this case. But if I go through ortho, we’re looking at two years.’ Well, it doesn't have to be that way. We’ve got so many other ways to increase efficiency.” (35:26—35:56)

Snippets:

• Dr. Norris’ background. (03:37—07:34)
• Why this is an important conversation in dentistry. (08:13—10:42)
• Why this conversation is difficult. (11:16—13:58)
• How pre-orthodontic bonding works/Dr. Norris’ 20/26 Bracket System. (14:47—19:33)
• Challenges with the old bracket system. (19:51—20:35)
• The middle, end, and later on in pre-orthodontic bonding. (21:45—25:03)
• A superior way to treat patients. (25:40—26:57)
• Advice for younger dentists. (28:09—30:33)
• What orthodontists get wrong early in their career. (30:54—33:52)
• The future of interdisciplinary care and last thoughts. (34:39—37:24)
• Dr. Norris’ 20/26 Bracket System sold by DynaFlex. (38:18—39:33)

Reach Out to Dr. Norris:

Dr. Norris’ Facebook: https://www.facebook.com/tito.norris

Dr. Norris’ Instagram: https://www.instagram.com/stoneoakorthodontics/?hl=en

The Norris Experience (October 1-2, 2021): https://www.dynaflex.com/the-norris-experience/

The Norris 20/26 Bracket System: https://www.dynaflex.com/norris2026/

Dr. Tito Norris Bio:

Dr. Robert Norris is devoted to creating smiles for a lifetime. His unique background in mechanical engineering provides him with a distinct advantage in mastering the forces, vectors, and movements inherent in performing orthodontic treatment.

Dr. Norris attended the University of Texas at Austin where he received his bachelor’s degree with honors in Biology and a minor in Mechanical Engineering.

He was salutatorian of his dental school class at the University of Texas Health Science Center at San Antonio Dental School.

He completed a General Practice Residency at the V.A. Hospital in Washington, D.C.

He completed his orthodontics specialty training at Howard University, graduating as valedictorian with the highest GPA in the Orthodontic Department’s 25-year history.

Dr. Norris joined the Air Force and served as Chief of Orthodontics at Misawa Air Base, Japan. Here, he provided orthodontic care to service members and their families.

In 2007, Dr. Norris began work to make his office completely “green.” The office is part of a volunteer renewable energy program with CPS known as Windtricity. In April of 2008, he completed a solar energy project at his orthodontic practice with the installation of 80 solar panels, providing 16 kW of electricity.

In 2010, he completed his office expansion, making it the first LEED-Certified orthodontic office in the world. LEED is Leadership in Engineering and Environmental Design and is the U.S. Government’s stamp of approval on environmentally responsible office construction.

Dr. Norris is a resident of San Antonio, Texas, where he lives with his wife and three children. As a Texas native, he grew up in Kingsville, Texas. He enjoys snow skiing, cycling, swimming, strength training, boating, hiking, and kayaking. Dr. Norris has lectured throughout the United States, Europe, and Asia. His scientific papers have been published in the American Journal of Orthodontics and Dentofacial Orthopedics, Seminars in Orthodontics, as well as Clinical Impressions. To date, Dr. Norris and Simone are enjoying their proudest accomplishments, their three children.