Industry Insights: Maximizing Practice Efficiency by Dr. Bill Dischinger

Innovative changes can help orthodontists treat patients with fewer appointments

by Dr. Bill Dischinger

Flatten the curve. Social distance. Stay-at-home order. Paycheck Protection Program. Virtual meeting. Virtual happy hour. Virtual. ... 2020 will certainly be a year never forgotten. My grandparents used to tell me stories about the Great Depression they lived through. My parents talked about the 1960s. Myself? Well, the ’80s were totally awesome. Our kids will be the pandemic generation.

During times of tribulation, people and businesses go one of two directions: They either innovate and change or fall by the wayside. Sometimes they have no choice, but many times they do. At the beginning of the coronavirus pandemic, most orthodontists had a period of time that their offices were closed. Mine was for six weeks, which allowed me to look at a number of aspects in my practice and evaluate what had been working well and what needed to be changed, added or eliminated. Efficiency has always been a key focus in our practice and in a time where we couldn’t see our patients, I realized even more how important this was. Once we returned to seeing our patients and tried to recover all that lost time, the importance of efficiency was reinforced even further.

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Innovation leads to efficiencies

I have tracked efficiency in our practice for more than 20 years. Efficiency can be tracked and looked at in many ways, but at the bottom line I want to deliver the best treatment result possible in the fewest number of appointments and least amount of time in treatment—both in terms of months and in minutes in the office. Over the past few years, we’ve been able to get our average number of appointments for treatment down to just under 14. (My goal is 12.) I thought my efficiency was doing very well, but during and after our shutdown, I realized we still had much room to improve.

Fewer wire changes and longer appointment intervals help us free up time and either grow our practice or work less. I want both of those! (OK, maybe I am greedy.) In our practice, we studied what self-ligating braces did in terms of number of appointments, time in treatment and appointment intervals. I never published the results of our internal studies, but we found all improved. I know many orthodontists who have achieved all of these with conventional brackets as well, but in my hands, in my office, with my patients, I was just better at all of these with self-ligating brackets.

We use the Damon Q2 bracket (Fig. 1) from Ormco in our office. We find that the rigid door allows our wires to work longer and more efficiently with great rotational control because we don’t see the “slipping” of wires out of slots. Again, all I can report is our experience. Due to this, when we were shut down for six weeks, I knew our patients would keep tracking along very nicely; I wasn’t worried about detrimental effects of wires not being monitored.

With self-ligation, I use wires with much lower force levels than what I used with conventional brackets. Using light forces, I felt some of the worries other orthodontists expressed in the online forums I read were not going to be an issue with my patients. Upon returning to practice, my lack of concern was validated. I saw no detrimental effects. In fact, the progress of the patients was beyond what I was expecting. For the most part, we basically lost no time as our patients’ treatments kept progressing.

Another technology that helped me have fewer wire changes and longer appointment intervals is the new SmartArch wire from Ormco (Fig. 2). This is the first innovation I’ve personally seen in wires since copper nickel titanium was invented. SmartArch customizes the force level for each individual tooth along the wire. This allows me to skip wires in my archwire progression and get into finishing wires in much less time.

The difference is clear (aligners)

The biggest change in our practice is that we’ve been doing more and more new patient treatments in clear aligners. There are many reasons for this: Patient demand, of course, is one of the main factors, but I am finding my life is just so much better with more patients in clear aligners than braces. How many broken brackets did you have to repair after your shutdown, or convince patients and parents they weren’t going to die from a broken bracket during the shutdown? The appointments with clear aligners in our office are easy and quick. The hygiene is night and day better in my patient population. The hygiene of our braces patients after our shutdown? Let’s just say that was a wake-up call to my desire to increase appointment intervals. The shutdown made me realize how much more efficient and easy to manage clear aligner patients were compared with our braces patients. Now, if the quality of the treatment wasn’t as good as braces, I would not be heading in this direction. The quality, though, is excellent.

I changed over to Spark Clear Aligners (Fig. 3) from Ormco in December 2018. In my hands, this product was far superior to what I had been using. I was not a very good clear aligner practitioner before, but Spark changed that for me. I found the software much easier for me to use, and the teeth tracked much more predictably. Again, this was just my experience, in my practice. I only use products if they work well for me regardless of what company makes them. I went from a practice treating less than 10% of our patients with aligners to more than 50%, and my intention is to continue increasing that percentage. I would only do that if my treatments were being completed successfully and on time.

The pandemic’s shutdown and the subsequent reopening showed me how important this trend toward aligners was for my practice (and my personal sanity). These patients kept progressing along with their aligners without missing a beat. I was able to monitor their treatments virtually with the web-based OrthoScreening virtual consult tool—I have no affiliation with the company, I just like the product—to ensure teeth and aligners were tracking along together. Upon the return to seeing patients, I decided to continue using OrthoScreening to monitor our aligner patients virtually, rather than schedule them in the office. I am able to see clear pictures taken from home and monitor the fit and tracking of their aligners or elastics. Patients have loved this during the continued restrictions in my town. I truly believe more teledentistry is the future of our practices. And clear aligners makes this easier to achieve, in my opinion.

Looking ahead to more of the same

When I learned I was required to shut down my office for 12 weeks (which eventually turned into six weeks, thankfully), I was in a complete panic for 12 hours. I then caught my breath and got to work on game-planning the future. Working on a strategy allowed me to push aside my fears and worries and focus on the process of making this work. Through that process and the subsequent shutdown and reopening, I was forced to evaluate my entire practice. I chose to change and innovate. To look to improve. To look to the future.

In my opinion, the future involves more treatments utilizing Spark aligners, more virtual visits with the web-based OrthoScreening virtual consult tool and a sleek, efficiently run office. Braces are not going away, so those cases need to be as efficient as possible to keep up with my aligner cases. Damon Q2 passive self-ligating brackets and SmartArch wires have helped my practice with that.

I am an optimist by nature. For those of you who know my father, Terry Dischinger, you know where I learned that from. I truly believe the future of orthodontics is very bright, but only if we learn to adapt and change to a new world that is looking for a different way of doing things. For those of us who embrace that rather than feel threatened by it, I believe we will thrive and take this great specialty to even newer heights. This has always been the best profession in the world. We have the chance to make it even better. Stay safe!