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Buyers’ Guide Checklist by Joseph Ross

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by Joseph Ross

The adage “you get what you pay for” has never been truer. Sacrificing quality for cost may initially save you money up front, but in the long run, quality keeps your overall final costs low and your investment moving along.

A higher cost does not always reflect higher quality products, however. Simple evaluation and analysis of the equipment choices prior to purchasing could save you thousands of dollars. Ask lots of questions; make sure you are getting what you are paying for.

Here is a break down of the basic equipment needed to start up an orthodontic office, as well as a hypothetical cost comparison over a ten-year time period:

Low initial investment cost:
  • You spend $20,000 on equipment.
  • You will need to spend $10,000 on service over 10 years.
  • You will lose $10,000 in lost production due to down time.
  • Resulting final cost over a 10-year time period is $40,000. More than likely at the 10-year period the equipment will need to be replaced.

Higher initial investment cost:
  • You spend $25,000 on equipment.
  • You will need to spend $2,000 on service over 10 years.
  • You will lose $2,000 in lost production due to down time.
  • Resulting final cost over a 10-year time period is $29,000. Because of buying some good quality equipment initially, the equipment should be in good shape and ready to last another 10 years.

Patient Chairs

When looking at patient chairs, first and foremost you should consider the durability. Manufacturing materials known to last, such as steel and aluminum, should be used as the framework or bones of the chair. All moving parts should have bearings or bushings to allow for smooth and long-lasting movement. Avoid plastics and fiberglass as framework as they were used a lot about 25 years ago, but tend to weaken and cause breaks or cracks over time.

The cushions or body of the chair should be several layers of quality foam, wrapped or covered with a commercial-grade vinyl or urethane product. All seams should be triple stitched to prevent any tears or separations (Fig. 1). Cushions seamed with a single stitch or double stitch will not be as resistant to separation as a triple-stitched seam (Fig. 2). Seamless upholstery should be smooth but not stretched, as the stretched upholstery tends to act like a balloon. One small hole from a pen can quickly cause the vinyl over the cushion to become a large tear.

Electrical components should be kept to a minimum and easily accessible—the more parts, the more potential problems. Fluctuations in electrical current, surges and even power failures can cause problems. Keep it simple. Delivery Systems

Traditional dental delivery systems are intended to be used four-handed and have little or no storage for chairside supplies. Unless you will be working this way or doing some general dental as well, try to avoid this type of delivery system.

Most operations in an orthodontic office are performed two handed. Ergonomically, everything should be located within the operator’s reach, with minimal amount of twisting and reaching. Cabinets designed by orthodontic companies were designed to do just that; instrumentation at your fingertips and supplies and storage within reach without having to get up.

Quality delivery systems are manufactured with a minimum of ¾ in. cabinet grade plywood and laminated with a high-pressure laminate (Fig. 3). Cabinets constructed of inferior materials such as MDF, particleboard, half plywood or even plastic should be avoided. MDF and particleboard are actually sawdust and glue (Fig. 4). Sometimes the inferior products are hard to see, as these companies tend to conceal these products by laminating all exposed surfaces (Fig. 5). Hiding the lower quality products, yet claiming it’s a benefit to have all surfaces laminated.

Tops of the cabinets vary as much as the cabinets themselves; laminate, quartz, solid surface, marble, glass and even molded plastic. According to the consumer reports website, quartz is ranked highest for countertop materials, followed by laminate. Most companies manufacturing cabinets use laminate as a standard anyway, but have options for the upgraded materials.

One big question we have been asked over the years concerns acid etch. When dripped on standard laminate it will wash out the color. It will eat plastic and discolor and etch solid surface, granite, as well as marble. Both quartz and laminates that are treated with a chemical-resistant additive will prevent any marking or staining.



Drawers should be constructed of wood or metal and attached to the drawer slides with screws. Full-extension ball-bearing slides will give the longest life as well as the best access to the back of the drawers (Fig. 6). Lower quality cabinets have plastic drawers or a drawer stock material (generally particleboard). Drawers attached with pop rivets, epoxy or even pins do not allow for adjustment. Some drawer slides are epoxy-coated and don’t allow full access to the back of the cabinet (Fig. 7), as well as pull out of the cabinet completely when not intending to do so. All are indications of lower quality to save on cost.

Doctor Stools

Stool mechanisms and bases should be constructed of steel or aluminum. Some companies use plastic as a base material. Plastic bases tend to wear quickly, show signs of fatigue and flex, making them difficult to roll. One thing to be sure of is that the base has at least five legs. Bases that have four are awkward and will tip over easily.

A minimum of 2in quality foam for cushioning on both the seat and back (Fig. 8) will prevent sitting on the actual framework of the chair. This will last longer than a single thin layer of foam (Fig. 9).

Lighting

Lighting is a major concern in an orthodontic office. There are two commonly used types of lighting: ambient or indirect, and task lighting or directed. Ambient lighting is the light available in all of the clinic areas as well as in the patient’s mouth. A task light will be a directed beam into the patient’s mouth, illuminating the working area brightly. Try keeping the ratio of ambient light candlepower versus the task light candlepower to a maximum of 5:1 (Fig. 10). Simply put, if the ambient light in an office registers 100 candlepower and the task light puts out 1500 candlepower, the ratio is 15:1 (Fig. 11). This will cause eye fatigue and strain. For orthodontics, one major overlooked fact is the color temperature of the bulbs, whether ambient or task. Because most bonding cement is activated by a blue light, it is best to stay away from anything above 5,000K, as this is the start of the blue spectrum of light.

Mechanical Room

One costly error orthodontists make is over-compensating with the mechanical equipment. Someone who doesn’t understand how an orthodontic office functions will look at a floor plan of an orthodontic office and see six chairs; they immediately advise using a vacuum pump and compressor for six-users. In reality, for an orthodontic office we recommend only a three-user system, as we would never be using six handpieces or six high vacs at one time. Typically we recommend the users to be half of the number of treatment chairs. The difference in cost from a three-user system to a sixuser system can be as much as $8,000, depending on the brand. When all is said and done, you alone have the final say on where your money goes and what you really need or want. Do you prefer a quality product over a cheap price?

Joseph Ross is the current President and Chief Operations Officer of Ross Orthodontic, a premiere orthodontic equipment manufacturer and office design firm. The leader in efficient and ergonomic office design, he is recognized as one of the specialists in orthodontic office design.

Joining his father Robert Ross at Ross Orthodontic in 1982, Joseph has hosted roundtable discussions at the AAO annual sessions, written articles on office design, equipment, lighting, sterilization, laboratory design and ergonomics, all specifically for the orthodontist.

After attending the University of Texas for architecture and interior design, Joseph began specializing in the design of orthodontic offices. He is an Allied Member of the American Society of Interior Designers.

Realizing the need for a more efficient and ergonomic need for orthodontic equipment, Ross Orthodontic introduced the Saturn equipment line in 1988.

In 2010 Ross Orthodontic introduced the Elite Equipment line incorporating orthodontics, ergonomics, and computers for the future orthodontists.

Ross has designed more then a thousand orthodontic offices all over the world and assisted in design of the orthodontic clinics in the universities of LSU, University of Texas Houston, University of Texas San Antonio, Roseman University, University of Tennessee, and Louisville.

Ross Orthodontic is headquartered in Midlothian, Texas.

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October 2025
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