Embrace Progress: The Golden Age of More Patients in Less Time Patient Is It? by Dr. Daniel Grob, DDS, MS, Editorial Director

There will be objections to this statement, and I know that it's been creeping up on us ... but could it be that we're in the new "golden age" of orthodontics?

Advances in digitization, materials, techniques, processes and procedures are rapidly changing the way we render care. As a result, we need to reset the way we approach our practice, staff and facility, and to embrace our newfound ability to see even more patients with the help of these devices and techniques.

Orthodontic specialists could offer straight, healthy teeth to the public in less time at a lower cost. After all, a $1,500 quote for orthodontic treatment wasn't uncommon back in the late 1960s. The fees of that time forced families to make hard choices regarding their children's smiles.

Of course, orthodontics is still a family decision that requires sacrifice and commitment, but technologies have allowed our services to reach a greater percentage of the population. Before you freak out about my fee references, let me remind you of a statement made to me years ago: "Just because fees go down doesn't mean that income needs to."

The digital revolution
For many of us, the digital transition has been a slow one, starting first with X-rays and photo capturing, then moving to CBCT and intraoral scanning, and now 3-D printing. (Soon to be in every dentist's office!) Digital treatment is standard operating procedure for the younger generation of doctors. Just this past Saturday—yes, my practice is open on Saturdays!—two new patients were examined, consulted and placed with appliances within a two-hour time frame.

Material differences
New materials are responsible for many of the innovations we use, and changes to even everyday products can create huge opportunities to save time and money in the practice. Advancements in materials also have helped orthodontists save patients pain, hours in the chair and thousands of dollars—even with inflation factored in.

Most orthodontists are familiar with new wires such as nickel titanium alloys, which allow for longer time frames between visits. Even a development like this could mean that patients save more than 25–33 percent of office visits. The pain and suffering associated with ligature-tying individual teeth into stainless steel wires isn't common anymore—or appreciated by the modern orthodontist or the patient, either!

Duplicating and customizing the smile arc is now possible with the addition of a multitude of arch forms and metal configurations. Bands are rarely used or necessary, except in some instances that require attached auxiliaries. Periodontal health is more likely and examination by the dentist is much easier.

Chain and ties replaced the tedious and time-consuming ligature tying mentioned above. These are time- and effort-savers and fashion statements as well. Placing indirect or direct brackets used to require mixing of A and B resins to effect a cure; light curing is the standard now and, quite honestly, much more forgiving and technique-friendly.

I enjoy the luxury of pre-pasted appliances. The inventory management and easy cleanup and delivery of appliances are things that I've veered from occasionally but return to for my own (and patients') selfish reasons. Flash-free resins that are now making an appearance will likely set a new bar for ease, convenience, oral hygiene and decalcification prevention.

For years, our contribution to the biologic response was applying light, continuous forces. That was about all we could to do. Extraoral forces, of course, were orthopedic but tooth movement pressure was to be light and continuous. The introduction of heat-activated arch wires has brought a new dimension to the "light, continuous" theory. Very flexible at cool temperatures, these wires are activated by varying temperatures in the mouth. From my perspective, they're most effective when working to balance muscle pressure and eliminate oral habits through myofunctional therapy or devices.

The biggest, broadest smiles are delivered with a combination of wires designed to activate and achieve their broad shape when muscle forces of the neutral zone are in harmony with the dental arch.

Techniques and technologies
Manual osteoperforation treatment and vibration technology have taken the profession and public by storm. Sorting through the options, getting compliant patients and delivering results are now becoming commonplace in the orthodontic literature and continuing education circuit.

Functional appliances have been available for all my career, but are now more cosmetic and less obtrusive.

The elephant in the room is of course the aligner technique. Everyone has strong feelings about a certain material or company. Aligners can be a love-to-hate world. Within the past decade, clear aligner therapy has changed from an experiment created by a tech company to a major player in the orthodontic profession. Modern orthodontists ignore the influence of this technology at their peril.

The changes to modern practice cannot be measured just in revenue or patient statistics but also in an overall expectation from patients. The public perception of orthodontics, the need to deliver cosmetic options and the psychology of the modern patient relative to this device are overwhelming. Clear aligner therapy has caused major shifts in not only referral patterns but staff utilization and office protocols as well.

The product is designed to be delegated from the initial exam to the delivery of aligners with attachments. Are you using the product to its full potential?

Lab processes have been altered with the addition of intraoral scanning not only for aligners but also for immediate delivery of retainers and archiving treatment results. At a recent CE meeting, Dr. David Paquette presented a beautifully treated case in which an intraoral scan was gathered to not only fabricate the retainer with virtual bracket removal, but to also create missing lateral incisors—complete with shade scanning. It was a wonderful way to illustrate for patients how their final smile would look.

The business side
With so much time and so many visits being saved, better business planning needs to walk hand-in-hand with the advancements in the practice.

• Staffing, in many instances, requires a new type of team member who's been trained in the art of sales, marketing and digitization. Digital familiarity spills over from social media and computer skills to the operation of new equipment­—equipment that often requires a feel for how the "internet of things" is integrated.


• Staffing is most likely going to get leaner and more productive. The skills highlighted, if wrapped in the right individual, will allow for more production per employee than in the past; assistants will no longer just be assisting or performing tasks.


• Don't overlook office design. Separate areas for digital capture, and placement of aligners and appliances, will require a new ergonomic footprint to be truly effective. Square footage is likely to decrease on a per-patient basis.

Have you got some ideas to share? Have you noticed a change in your practice? We'd love to hear how you have used new materials, processes or techniques that have allowed you more free time.