Retainer Replacement by Dr. Jennifer Bonamici

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Categories: Orthodontics;
Retainer Replacement

The right plan helps patients protect their orthodontic investment— and helps practices grow


by Dr. Jennifer Bonamici

The big day has finally arrived! After years in orthodontic treatment, the culmination of the teamwork between patient and provider has come to an end with the removal of orthodontic appliances and the reveal of the patient’s new smile. We take pride in these great results, and retention is the key to keeping these smiles for a lifetime.

There are numerous types of retainers and retainer protocols. Some offices provide retainers with no follow-up appointments; other offices have annual retainer checks until patients decide they no longer need to come in. Some practitioners use vacuum-formed retainers, while others prefer Hawley retainers and still others use the “belt-and-suspenders” approach with both fixed and removable retainers. But what happens when your patient inevitably loses or breaks a retainer? How do you balance on the fine line of ensuring patient satisfaction while managing patient flow? Having a plan that places value in retainers not only keeps your patients happy but also helps your practice grow through referrals from those patients and their dentists.

When asked how frequently patients need to replace retainers, I often use an analogy about tennis shoes: Some people will buy a pair of shoes and have them last for 10 years, where others who are heavy on their feet may need to replace their shoes more frequently. Same thing with retainers—they may last only six months for heavy clenchers, but could last more than 10 years if maintained well. Having a retainer plan for replacement retainers can provide a more affordable option, leading to less financial strain on the patient.

In the past 15 years, our office has grown from a single location to four, which has allowed us to connect with many patients (and reconnect with them during retention). Over these years, we’ve tried several different retainer plans. Some were successful, some needed work and others were dropped. The key is to have a plan that fits your patients’ needs and your practice’s goals.

Retainer plan options, benefits and drawbacks

A la carte retainers: In this model, the most traditional retainer option, patients pay a fixed fee if they lose their retainer; the average runs between $100 and $400 per arch. The benefit to this plan is that patients pay directly for what they get and nothing more. This direct fee is also a negative, however, because patients have invested years of time, money and energy into orthodontic treatment and just as they pay off the bill, they could be hit with a large payment for a replacement retainer, which is hard to swallow. For the practice, this also comes with additional chair time for scans or impressions and delivery. Patients and parents tend to become unhappy and exhausted, often leading them to discontinue their retainer wear. We ended up ditching this option and implementing a retainer plan.

Lifetime retainers: The plan involves patients paying an initial fee—usually between $500 and $1,000—that covers replacement retainers whenever there’s a need. The major benefit to this plan is that any financial burden is now incorporated into a one-time fee that can be financed throughout treatment. The main negative we noticed was that when the retainers were viewed as “free,” patients saw very little value assigned to them. Also, this plan does not eliminate chair time for impressions, scans or delivery, especially when some patients want replacement retainers on a more frequent basis.

Retainer guarantee: With our in-house retainer insurance plan, an initial premium similar to one with a lifetime retainer plan is charged; however, replacement retainers come with a $20 co-pay per arch. This helps cover the cost of the chair time and materials while instilling value in the retainers. This co-pay is small enough that young patients feel comfortable telling their parents about their lost retainer without fear of being punished. This plan has been successful in our offices because it combines the reduced financial burden of a lifetime retainer plan while also maintaining the value of a retainer that an a la carte option offers.

Retainers for Life: Although our office hasn’t used it, many orthodontists are choosing a third-party membership program called Retainers for Life that offers patients affordable replacement retainers delivered directly to their doorstep. This eliminates the need for an impression and frees up the daily schedule from being bogged down with retainer headaches. Doctors who carry this program are paid a profit-sharing bonus, increasing revenue at the same time as reducing the retainer workload.

Subscription-based plans: In this type of plan, third-party companies such as Invisalign and Retainer Club offer patients the ability to get retainers made on an annual basis for a subscription-based fee. Both programs work with the orthodontic providers; however, Retainer Club is given the patients’ debond scan from the orthodontic practice and mails them directly to their house, eliminating patient visits in the office.

The retainer guarantee process

When discussing retention with patients, I tell a personal anecdote about when I lost my retainer and didn’t get it replaced. Part of me believed that because it had been so long since I’d had braces, my teeth would stay straight. We all know that this isn’t true and that teeth have a tendency to return to their pretreatment position. This relapse is because of varying forces in the elastic recoil of the periodontal ligament; musculature in the cheek, tongue and lip; continued growth; and occlusal forces. Over time my teeth shifted and I ended up back in orthodontic treatment, this time with Invisalign.

In our office, we discuss the importance of retention from the very first appointment. At the new-patient exam, we explain that even though orthodontic treatment ends, they enter a new phase of treatment: retention. We emphasize that daily retainer wear will help protect their two-year orthodontic investment. We use the phrase “nighttime for a lifetime” and explain that at some point in their life they will lose, wear through or break their retainers. This allows the patients to see the value of the retainer guarantee program.

In May, we offered the retainer guarantee plan to 35 Phase II/comprehensive treatment patients and 31 purchased it. Discussing the plan at the initial exam allows us to provide flexible financing options so that when treatment is complete, the patient has already paid for the program, guaranteeing retainers for up to 10 years.

The other effective time to discuss retainer guarantee is at the debond appointment. In May, 77% of patients who didn’t previously purchase retainer guarantee signed up for the retainer program at debond and invested in protecting their smiles.

You can also encourage patients to sign up for a retainer guarantee at retainer replacement appointments. If a patient declines any opportunity to enroll in the plan, they are given the a la carte retainer replacement option.


We’ve found that retainer guarantee not only benefits the patients but also is another source of income for the practice. With advances in 3D printing and the ability to store patients’ final models virtually, practitioners minimize chair time and expenses with retention visits while still managing patients needs.

In our office, at the final retention check, the current retainers are checked for appropriate fit, obvious cracks, scratches or voids, and an intraoral scan is captured. From that day on, as long as no post-treatment relapse has occurred, if a patient loses or breaks a retainer, all we have to do is print the model, fabricate a new retainer and ship it to the patient’s house. No additional chair time or added visits are needed.

Conclusion

Dr. Blair Feldman, orthodontist and co-founder of Retainer Club, said, “Any program that talks about retainers to patients is a good program.” He couldn’t be more right! It’s about finding which retention plan works best in your office. Having a plan in place and emphasizing the importance of retention will not only preserve your patients’ healthy smiles but will also keep your patients satisfied and allow your practice to grow for many years.
  
Author Bio
Jennifer Bonamici Dr. Jennifer Bonamici completed her bachelor’s degree in human biology at Michigan State University, graduating in the top 1% of her class. She then completed her doctoral training at the University of Detroit Mercy. Bonamici earned the National Award of Excellence from the American Student Dental Association for her dedication to patient care and for her involvement in various organizations. For her orthodontic residency, she attended the University of Minnesota, where she obtained a master’s degree and completed research in accuracy of bite registrations with the iTero scanner. She now creates amazing smiles with the Spillane & Reynolds team in Rochester, Michigan.


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