Embrace Progress: Measuring Progress in Modern Ortho by Dr. Daniel Grob, DDS, MS, Editorial Director

It was just last week (after reviewing the past three months’ production and office schedule) that members of my team made the comment, “It doesn’t seem that busy.”

Coming off the three best months in our young practice history—including December, I might add—we were organizing schedule grids, planning marketing events, and staffing for the upcoming year. One assistant who’s been with me for more than 20 years knew the total number of active patients and our limited schedule—by design.

“Yes, we’re becoming busy … and finally profitable,” I replied. “And no, I don’t plan on adding any more doctor days.” I work Saturdays and after school, and my golf game sadly shows it!

Those who grew up in the digital age probably have no frame of reference, but those who’ve labored chairside over the past 30 years have seen dramatic progress in the way orthodontic care is marketed and delivered. What has led to this change? Many new processes, improved appliance design and materials.

The power of delegation
In the past few years we’ve begun to see applications of devices and procedures that alter biology and physiology. The advantages: better care for patients, smoother-running office systems and, of course, profitability.

It’s hard to decide which process has most changed over the years—and I look forward to getting some feedback from Townies regarding this—but certainly delegation to competent, well-trained auxiliaries is responsible for a good amount of the change.

Delegation is a trend that improves the swiftness of the appointment process and increases standardization.

Dr. Ron Redmonds’ quote, “I never add a procedure to the office that I cannot delegate,” has guided my practice for years—to everyone’s benefit. I’ve never made excuses for utilizing staff to accomplish many procedures in the office, and I openly allow parents and visitors to witness the clinic operation while I speak to parents and staff.

As we all know, just having assistants doesn’t make the practice run smoothly. To delegate, one must have strict systems in place, procedures outlined and scripts to accompany the same. Without trying to say that we run factories, we can agree that creating a standardized product assembled by talented individuals is what brought automobiles to the masses.

Refining the assembly line
Digital record gathering has sped up the process for consultations, even if you have return patients. The speed and accuracy of digital record gathering has enabled many of the other processes that contribute to a more efficient office.

Not having to retake records and getting instantaneous feedback are key advantages, each one enabling you to real-time viewing and faster evaluations, respectively.

Practice consultants realized this early on and were quick to encourage one-step starts and even same-day banding and bonding in some situations. This advance is responsible for changing the dialogue from, “We’re busy in October,” to, “We had a great July!”

Direct versus indirect bonding is a topic that I’ve been exposed to for my entire practice career. I will admit, 30 years ago it was quite a tedious process. Some doctors love it. Some don’t see the purpose. In the same discussion with delegation, this advancement or technique comes down to your overall practice philosophy.

If you, like many other orthodontists, have a recall schedule packed to the brim with patients waiting for their 12-year molars to erupt so you can initiate care, you’re in luck. Waiting for the right time to pull the trigger is made for indirect bonding in conjunction with in-house lab appliance fabrication and delegations. Also, if you employ lots of Phase 1 treatment to eliminate the skeletal or dental Class 2 or 3 early and wait for the rest of the teeth to erupt, this is great.

Personally, I do a lot of Phase 1½ treatment, starting patients in the late mixed dentition, and it has little benefit for that theory or technique.

However, as I mentioned in previous articles, Phase 1 treatment is being employed more often for airway and myofunctional reasons and this indirect process is likely to become more widespread.

Final notable advancements
I will leave the reminiscing of pinching of bands as a piece of history, but the elimination of the arch turret in favor of preshaped archwires is surely an advancement we could not live without.

Not only convenience but cross-contamination prevention has necessitated the introduction of preformed archwires of varying metallurgical components.

Although I’m not sure many recent grads understand the Tweed arch form (unless they made the pilgrimage to worship at the altar of the bolo tie and wax dental forms), the advancements of standard twin brackets to straight wire appliances has drastically cut down on chair time.

We will acknowledge that wire bending, bite opening and space closure are still issues in practice, but letting the appliance put the teeth in position with minimal chairside adjustments is certainly one of the most beneficial advancements in decades. Kudos to Dr. Larry Andrews!

Variations of the straight wire appliance include tie wing preferences and torque options.

These new bracket designs utilizing the preformed archwires for their prescription have allowed the “tightening” appointments to be stretched from every four weeks to every eight, 10, etc.

Self-ligating appliances are next on the list, with smooth archwire changes, minimal friction and respect for the facial musculature and anatomy. The self-

ligating designs are constantly becoming improved with active and passive ligation and varying methods to increase bracket placement accuracy.

Next month, I’ll discuss materials and biology-altering devices in the quest for shorter treatment times.