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The Benefits of Treatment by Twelves by Daniel Grob, DDS, MS, Editorial Director

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During the drive home the other evening, I came across a sandwich board prominently displayed on the street. I knew this particular practice was performing orthodontic care, but the method of marketing was quite surprising. I asked myself: In the eyes of the general public, has the perception of our specialty—historically, the third medical specialty to be established—really been reduced to this?


More than 10 years ago, Roger Levin, the owner of a successful dental-practice consulting firm, proclaimed during a training session that orthodontics was the first specialty to turn “commodity.” Was he right on! Now we “sell braces,” and second opinions consist of how many aligners one practitioner deems necessary to treat a malocclusion, as opposed to estimates by another practitioner. So I asked myself: Does it need to be this way? Can it change? Have we contributed to this apparent problem?

What’s in the future?
I do not feel that the profession is doomed. I am fortunate to have enjoyed many years of successful practice and continue to do so. The young orthodontists who bought my practice are expanding the business and I believe they are thriving with the elements they have in place. Theirs is a strong, patient-centered environment.

The secret to success lies in creative, persistent marketing, coupled with an internal system of diagnostic mechanics. This system allows for comfortable, efficient and profitable treatment of patients and—well, get ready for this—at a more reasonable cost than what’s being charged by those who tread on our turf!

The mechanics pyramid
On p. 10, Dr. Alan Curtis describes a system for growing and maintaining a practice using referrals and lead-generation. I use this model for growing the business and working the practice. This system also allows for selling or transitioning the practice and patients at a later date.

The key element in practice (namely, mechanics, or the steps in treatment for our patients) employs a pyramid approach, as well. Quite simply, it comes down to this: lots of patients in, as one or more patients finish treatment.

One element that has given the profession its commodity reputation is the offering of treatment plans with ultra- specific appliance names and treatment times that minimize the variables in care. However, by instead making orthodontic treatment an ongoing process that’s tailored to each patient’s needs, we enable the creation and maintenance of a freestanding, primary-care orthodontic practice.

Treatment by twelves
The key is to capture patients of all ages and offer specialized attention to every one of them, at each stage of development. Whenever possible, I organize treatment into three categories that I call “Treatment by Twelves.” While the first twelve teeth are erupting, evaluations are encouraged so we can look for medical conditions, identify space for tooth eruptions, and check for obvious x-bites. Extra and missing teeth are found and noted. Emphasis is placed on correcting oral habits. This habit-evaluation phase has the potential to grow practices, as most parents are interested in what they consider a more natural way to attack the problem of malocclusions.

As the next 12 permanent teeth are erupting, we have the opportunity to gradually apply braces to the teeth. We should attempt in all cases to treatment-plan to perfection. The need to remove or leave teeth untouched is not necessary for most patients. I see no point in allowing teeth, especially maxillary cuspids, to erupt into a high or crooked position before correcting their positioning. Using a commonly accepted system familiar to general dentists, we “facially generate” our plan of treatment. We do this by arranging the upper teeth for aesthetics, the lower teeth for phonetics and the posterior teeth for function. Brackets are gradually applied to first the upper, then the lower, and finally the 12-year molars. The need for tooth removals as well as the modality for skeletal correction is assessed during treatment.

For most patients, the eruption and alignment of the 12-year molars marks the end of treatment. Several months of attention to detail here will allow most patients to have their treatment completed by early high-school age, if not before.

In future columns, I will explore in greater detail each of these three categories of treatment.

Many orthodontists prefer to begin treatment only when all of the teeth have erupted. But I believe this sends the message to the patients, parents and referring dentist that there is an absolute right time to begin care and end care. I think our patients deserve better treatment—treatment that is tailored to each patient’s situation, goals and timeline. After all, isn’t that what each of us expects from our doctor?

Retention and beyond
Treatment usually is completed between 18 and 30 months, during which time the importance of retainers is stressed. I generally suggest bonded lower retainers, opposed by a pressure-formed, upper clear splint that should be worn at night.

A very contentious issue in orthodontics is the topic of retreatment. Is the need due to neglect, growth, random bad luck or something entirely different? My policy is to explain the likely cause, but then just get on with the fix: In other words, don’t focus on blame but offer retreatment for a very reasonable fee. This has the dual purpose of not only generating some modest income, but spreading goodwill for the future, as well. You would be amazed at how this policy has grown—and will continue to grow—a practice.

Having a streamlined approach to gathering a multitude of patients into the practice can grow the business, assist in training of staff and help with future transition and sale plans, as well. We’ll explore these topics in greater detail in future columns. Until then, happy marketing



Orthotown Magazine
September 2025
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