Clinical Profile: Observation and Retention Reimagined by Dr. Ed Davis

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Categories: Orthodontics;
Clinical Profile: Observation and Retention Reimagined 

Why orthodontics is undervaluing its most predictable growth engine

by Dr. Ed Davis

Orthodontics has a blind spot—and it’s hiding in plain sight.

While most practices are relentlessly focused on case starts, treatment efficiency, and finishing excellence, two phases of care remain consistently underleveraged: observation and retention. These phases are often treated as secondary, loosely managed and operationally inefficient. In reality, they represent the most controllable and predictable drivers of long-term growth, patient loyalty, and practice profitability.

The issue is not clinical capability. It is structural design.

Observation: The missed growth engine
Observation patients are typically managed through semi-annual or annual visits with minimal engagement between appointments. Retention is frequently delegated to patients with limited visibility into compliance or early relapse. This creates a fragmented model where critical clinical decisions are made with incomplete information.

The consequences are measurable. Observation patients convert at significantly lower rates than adolescent starts—approximately 62% versus more than 82%. At the same time, nearly one-third of patients experience retainer-related issues during retention. These are not marginal inefficiencies. They represent systemic gaps in how orthodontic care is delivered.

DentalMonitoring introduces a fundamentally different approach: continuous clinical visibility.

Using smartphone-based scans analyzed by FDA-cleared artificial intelligence, orthodontists can track tooth movement, eruption patterns, hygiene, and appliance fit between visits. Instead of relying solely on scheduled appointments, clinicians receive ongoing insights and alerts that enable proactive intervention.

This is not simply a technological enhancement. It is a shift from episodic care to condition-driven care.

Observation is where this shift becomes most apparent.

Traditional observation creates blind spots. Growth and eruption occur continuously, yet evaluation happens intermittently. Families receive limited feedback, and the perceived value of observation remains low. Over time, engagement declines, and patients become vulnerable to external influence from competing practices.

This is not a clinical failure. It is a value delivery failure.

At Davis Orthodontics, we restructured observation using DentalMonitoring to create a proactive, structured, and monetized program.

Patients are monitored monthly. Growth, eruption, and hygiene are tracked in real time. Alerts signal when intervention is needed. Patients are brought into the office only when clinically necessary.

The result is a model that delivers greater precision with fewer visits.

More importantly, the patient experience changes fundamentally. Families receive continuous communication. They understand what is happening. They feel guided rather than managed passively. Observation becomes an active phase of care.

However, technology alone does not drive adoption. Structure does.

To operationalize this model, we implemented tiered observation pathways:

1. Observation with future credit
A one-time fee of approximately $350 covers monitoring and hardware and is fully credited toward future treatment. This positions observation as an investment rather than an expense.

2. Observation with locked-in treatment fee
Monthly payments are applied toward future treatment and include monitoring. This creates both financial predictability and early commitment.

3. Traditional observation
Periodic in-office visits without monitoring or financial commitment. While still offered, this pathway delivers the least value and carries the highest risk of attrition.

When given these options, approximately 32% of observation patients elect monitored pathways.
Clinical Profile: Observation and Retention Reimagined
*No cost, however, patients start paying installments toward the full TX at the observation phase at a locked fee.

This is a critical insight.

Patients are not resistant to paying for observation. They are resistant to paying for something that feels passive and low value.

Patients who enroll in monitored observation generate immediate incremental revenue, establish early financial commitment, and convert at higher rates. Observation transitions from a passive administrative category into an active, predictable production pipeline.

The business implications are significant. Practices reduce reliance on external marketing, lower acquisition costs, and increase lifetime patient value. Case starts become more predictable because they are driven by real-time clinical insight rather than periodic evaluation.

Retention: The visibility problem
Retention presents an equally important opportunity.

Historically, retention has been treated as a necessary but low-value phase. Some practices minimize retention programs to avoid additional visits and potential retreatment costs. Others offer extended retention programs but operate with limited visibility into compliance.

Both approaches are fundamentally flawed for the same reason: lack of monitoring.

Clinical reality confirms this. Retainer misfit, compliance issues, and early relapse occur frequently, often without symptoms noticeable to the patient. By the time these issues are identified during an in-office visit, correction—not prevention—is required.

DentalMonitoring changes this dynamic.

With continuous remote monitoring, clinicians can detect retainer fit issues, identify early tooth movement, and monitor patient compliance in real time. This enables early intervention, reduces retreatment, and improves long-term outcomes.

Operationally, the benefits are equally compelling. Routine retainer checks can be reduced or eliminated. Chair time is reserved for patients who require clinical intervention. Staff workflows become more efficient and predictable.

The introduction of a cap fee model further accelerates adoption.

Historically, expanding monitoring across observation and retention raised concerns about variable costs. The cap fee removes that barrier by providing predictable pricing. Practices can now deploy monitoring across the full patient lifecycle without financial uncertainty.

This creates a powerful economic advantage.

Observation and retention programs can generate incremental revenue without adding meaningful cost. Practices can increase production per patient by more than 10% while maintaining strong margins.
Clinical Profile: Observation and Retention Reimagined
*Up to 8-weeks post-debond to decide to move into the DentalMonitoring Retention Plus program

A continuous care model
The true power of this model emerges when observation and retention are integrated into a continuous lifecycle approach.

Observation builds engagement and secures future production. Treatment delivers clinical transformation. Retention ensures stability and creates recurring revenue opportunities.

DentalMonitoring connects all three phases, creating continuity of care and extending patient lifetime value.

There is also a behavioral component that should not be underestimated.

Patients who know they are being monitored behave differently. They are more compliant, more engaged, and more accountable. Visibility drives behavior, and behavior drives outcomes.

Across the practice, the impact is consistent: fewer unnecessary visits, improved scheduling efficiency, better allocation of clinical time, and increased revenue predictability.

This is not an incremental improvement. It is a structural upgrade to how orthodontic care is delivered.

Observation and retention are no longer secondary phases. They are the foundation of a modern, scalable, and profitable orthodontic practice.

The practices that continue to treat them passively will continue to lose value.

The practices that structure, monitor, and monetize them will define the future of orthodontics. 

This content is sponsored by DentalMonitoring. For more information visit dentalmonitoring.com.

Author Bio
Ed Davis, DDS, MS Ed Davis, DDS, MS, is an ABO-certified orthodontist with more than 20 years of experience. A Columbia, South Carolina, native, he earned his dental degree from the Medical University of South Carolina and completed his orthodontic specialty training at Saint Louis University. He is active in organized dentistry, serving as a delegate for regional dental reforms and mentoring aspiring dental professionals at Midlands Technical College. He enjoys spending time with his four children and three dogs, and co-hosts “The Reel Factor” on YouTube.
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