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Corporate Profile: OrthoSelect Benjamin Lund, Editor, Orthotown Magazine

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A Major Model of a Modern Modelmaker

by Benjamin Lund, Editor, Orthotown Magazine

In 2004 Steven Gardner decided to form a small company specializing in orthodontic study models. In seven years, this side business, OrthoSelect, went from a one-room basement company to a national lab. Today OrthoSelect fabricates thousands of study models for hundreds of doctors each month. "It's a gratifying start, but we feel it's only the beginning," says Gardner. Here he describes the details of what the orthodontic lab business is like, the importance of study models and what is to come for OrthoSelect.

What is your current business philosophy? How does your team embrace your mission?
Gardner: OrthoSelect's philosophy has always revolved around keeping costs as low as possible. However, offering low prices but returning a poor product will quickly destroy a business. So to provide a quality product at a low price, we focus on speed and efficiency. The end result is a quality model, at the lowest possible price, in the quickest possible time. Ultimately it's up to the doctors to decide if we're successful in this mission.

As for team members embracing our mission, they understand and work hard to achieve the balance between high productivity and high quality. They do an excellent job. We've developed good systems for processing large amounts of models, but without a committed staff, none of it would be possible. I need to be careful though since they'll probably read this article and argue they deserve a raise (laughs).

Aside from your excellent team, what sets OrthoSelect apart from the competition? What's so unique about your company?
Gardner: There are a couple of things. First and foremost I'd say our product selection sets us apart. Many of our competitors offer one option at one very expensive price. It's pretty obvious when speaking with orthodontists that they have different study model needs. Some doctors want traditional plaster study models; others have switched to digital models; others desperately need to free up space and digitize all their old plaster casts; or maybe they just want a bare bones price and opt for a one of our "storage" options. We really try to accommodate and customize our study model services to what the orthodontist needs.

Second, (and I don't mean to harp on this,) our fees are really the most competitive of any lab out there. If I had one wish, doctors would download our software and test a couple of sample cases. They'll see the quality and we think they'll be pleased. At the very least, they'll see how much money they can save.

Lastly, because we have developed systems for efficiency and quality, we are able to return models quickly. A typical digital model is returned within a week. That's from the time impressions are shipped to the time models download to the doctor's computer. We believe all these factors combine to set us apart from the competition.

What can orthodontists expect when they call OrthoSelect?
Gardner: They can expect an actual person to pick up the phone. It's always annoying when you call a business and a recorded message picks up. If you're a new doctor calling us, you can expect to talk with me directly. All day-to-day operations have been turned over to team members, but when it comes to new accounts, I take those calls. I like speaking with the doctors and their staff so we can learn what options are best for them. We'll always do the first couple cases for free; this way orthodontists can give us a try then decide whether they want to continue to use our services.

What new technologies impact the way you operate? What challenges have you faced?
Gardner: The proverbial digital revolution has single-handedly changed OrthoSelect. In the early years the goal was to achieve 100 plaster study models a week. Now with the use of computers, scanners and well-trained technicians, we are able to process 800 to 1,000 cases a week. We could never reach these numbers if we didn't invest in new technologies.

Digital technology also presents itself as one of the challenges we face. Honestly, we were somewhat naive when jumping into the digital pool. Anyone can purchase a 3D scanner and begin scanning impressions or stone models – that's the easy part. We quickly found out that there is a great deal of work needed after the scanning. Turning those raw images into acceptable, high quality, digital models is indeed a challenge. Just like plaster models, there are still digital bubbles to remove, holds to fill, rough areas to sculpt and smooth. It's a lot of work and takes some experienced technicians who understand 3D imaging and how to work with both plaster casts and high-end computer software.

Companies selling 3D scanners definitely understate the time, training and costs associated with digital models. If an orthodontist is considering purchasing an in-house scanner, it might be a great purchase. Just make sure to do the research and fully understand the time, money and training needed.

Are study models still relevant? Aren't new technologies making them obsolete?
Gardner: Study models are more relevant than ever for one simple reason – we live in a litigious society. One in 10 orthodontists is sued annually, and that number is increasing.¹ According to an article by Dr. Huie-Ming Hou, "Study models are absolutely essential as starting and finishing records in orthodontic treatment, apart from constituting critical medico-legal evidence. Not having starting study models could be grounds for allegations of negligence."² Many lawsuits are frivolous, but if you can't provide basic records like an initial study model, it gives undue creditability to an otherwise unsubstantiated claim.

In the article "On Legal Issues in Orthodontics"³ in the Journal of Clinical Orthodontics, the author interviews defense attorney Dr. Donald E. Machen who states that avoiding malpractice suits means "taking a little extra time to prepare high quality diagnostic records and document proper treatment records." Study models play a central role in keeping basic, proper records.

Surprisingly some orthodontists don't even include study models in their orthodontic care. Why cut corners when the downside could ruin your practice? That's why we provide a bare-bones, low-cost storage model. It's precisely for orthodontists who don't want or use study models but understand the importance of keeping good records for if and when a lawsuit occurs.

What specific products and new services do you offer?
Gardner: I mentioned earlier our variety of products. Specifically, it breaks down to three categories: digital, archival and physical. Within each category there are three additional choices. With these options we can cover just about every study model need an orthodontist might have. On the digital side we provide a 3D "full finish" and "rough finish" model. This rough option is for doctors who don't necessary utilize models in consults or treatment planning, but still want access for clarification or verification. Keep in mind our rough finish models are very rough, but they can be upgraded to a full finish model anytime (see Fig. A). We also offer diagnostic data reports that contain Bolton, space and tooth width analysis, along with palatal and ideal arch measurements.

Of course we still provide traditional plaster models. Here we have three options: full, semi and rough. Each depends on the level of detail the doctor wants.

In the last six months we've added several new products. Under our archival category, we provide storage services, both physical and digital. These options are for doctors we described above who literally never look at or use study models. However, if a lawsuit occurs, they certainly will need that specific patient's study model. We would retrieve the model from storage, upgrade it to full finish quality then send it back to the doctor. Fees for our archival products are extremely low.

We also now offer conversion services where we digitize a doctor's old plaster models into digital files. This frees up a ton of space and is much easier to access than digging through old boxes to find a case. We can also convert a digital study model back into a physical model. This is called 3D printing and something doctors appreciate because it provides peace of mind knowing any digital model can be returned in physical form.

Do you offer ABO certification?
Gardner: Yes, we offer both digital and plaster certification. The cost is higher because additional time is spent ensuring a finished model is as close to perfection as possible. For digital certification we work closely with GeoDigm. They are a great company and we enjoy a terrific working relationship with them. They have developed excellent software for scoring models that the board utilizes and accepts. Traditional certification with plaster models is done in-house at OrthoSelect. However, we only provide ABO certification for doctors already using our services. Unfortunately we don't have the manpower to produce ABO models for any and all orthodontists needing ABO certification.

What about alginate distortion and shipping across the country?
Gardner: All alginates are definitely not created equal. We do see problems with dimensional stability, but it is a solvable issue. Of course, PVS materials are the most stable. You could wait weeks to pour up polyvinyl impressions. Yet, they're more expensive and additional time is needed to create them. We've had great success with five-day (120-hour) alginates too. The alginates we use and recommend are Hydrogum5, Alginmax, Identic and Essix.

To what do you attribute OrthoSelect's success?
Gardner: Working our tails off has contributed! Finding solutions to doctors' needs and obsessing about finding techniques that maximize productivity has helped as well. With better efficiency, costs are reduced, which in turn lower our prices. That's what it always comes back to – high quality and low cost. Good customer service, knowledgeable tech support and a quick turnaround are all factors too. We hope this formula will continue to create consistent growth.

What does the future hold for OrthoSelect?
Gardner: Introducing new technologies has certainly increased our ability to fabricate high quality, low-cost orthodontic study models. Looking to the future we see new technologies that might help expand our line of products – from indirect bonding, to cone beam conversions, to robotic wire bending for appliances; or clear aligners and retainers within hours instead of days. There are some exciting technologies on the horizon. Time will tell which ones will take hold.

Currently, we're focusing on new methods that will help increase our quality and efficiency. Specifically we want to maximize the use of impressions. Kill two birds with one stone where one impression (or intra-oral scan) is used to produce not only a digital model, but also a Herbst, Schwartz, Hawley or corrective aligners. Why take multiple impressions if one will do the trick? We're running a pilot program with half a dozen doctors now. Once we've worked out the bugs, we're looking forward to offering doctors so much more than just study models. Stay tuned.

For more information about OrthoSelect, visit www.myorthoselect.com, call 866-695-3319 or e-mail models@myorthoselect.com.

References
  1. JCO INTERVIEWS Donald E. Machen, DMD, JD (Robert M. Bubin, DMD), on Legal Issues in Orthodontics – Journal of Clinical Orthodontics; Vol 26:06; 347- 353; 1992
  2. Hong Kong Dental Journal 2006; 3:107-15; The uses of orthodontic study models in diagnosis and treatment planning
  3. JCO INTERVIEWS Donald E. Machen, DMD, JD (robert M. Bubin, DMD), on Legal Issues in Orthodontics – Journal of Clinical Orthodontics; Vol 26:06; 347- 353; 1992
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