Give Away by yaofenjin

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									CLINICALREVIEW
Orthodontic
                                     Clinician’s Study of Direct
                                            vs. Indirect Bonding
RMO ’s Guide to
       ®


Practice Management
    put the pieces together for growth




                                     Become a ‘Big Deal’
                                     Uncover Your True Identity


        AAO
      Give Away
                                         New Product
                                          Developments
           Inside this issue                 from RMO      ®
                                                                                                                                               TABLE of CONTENTS
                                                                                                                                               OFFICE MANAGEMENT                                                                     MARKETING AND
                                                                                                                                                                                                                                     BRANDING
                                                                                                                                                                                            14 Maximizing Office
                                                                                                                                                                                               Efficiency
                                                                                                                                                                                                   Three steps to operating an
                                                                                                                                                                                                   elite orthodontic office
                                                                                                                                                                                                                                                      32
                                                                                                                                                                                                   Neal D Kravitz, DMD, MS



                                                                                                                                                                                          New Patient
                                                                                                                                                                                          Enrollment Process

                                                                                                                                                                                 24       Ken Alexander,
                                                                                                                                                                                          Millenium Management Group                 Become a ‘Big Deal’
                                                                                                                                                                                                                                     Uncover Your True Identity
                                                                                                                                                                                                                                     Bridgette Owens, 7 Group
Dear Doctor,
I am excited to share some thoughts with you concerning this edition of the Clinical Review. As you know from reading past issues, the
focus has normally been on new products, services and techniques that help to improve clinical treatment results and efficiencies. In
this year’s edition we have selected some of these product related articles. However, we have also decided to include some other themes
related to Practice Management.



                                                                                                                                                                                         34                        r
The reason for this change in content is quite simple – staying abreast of new products and technological improvements does not in
itself guarantee that you will automatically have a successful business. You must also learn how to manage your office as an efficient and
                                                                                                                                                                                                         o cto
profitable company. It is this union of clinical expertise and Practice Management that will lead to true, long term success.
                                                                                                                                                                                              im   e D uling
                                                                                                                                                                                           n-T Sched oup
                                                                                                                                               42
RMO® has been involved with Practice Management for over 40 years. In the early 1970’s we opened a branch of our company called
                                                                                                                                                                                         O
The Millenium Society. This was one of the first endeavors directed solely at the Management/Marketing side of exclusive orthodontic                                                          e ,                 r
                                                                                                                                                                                          TimAlexandernageme
                                                                                                                                                                                                             nt G
practices. The Millenium Society was focused on high volume offices that wanted to become more profitable and efficient, while improving
care and service for the patients.                                                                                                             80/20 Rule- Could a wise use of                      a M
                                                                                                                                                                                                                                     Zenman and the Art of
                                                                                                                                               the “80/20 rule” increase your practice     Ken nium
                                                                                                                                               clinical efficiency and profitability?       Mil
                                                                                                                                                                                                le                                   Web Development
Some of the concepts that were shared include many that have become required components in todays’ best offices. Some examples of scheduling                                                                                         What your website should do for you


                                                                                                                                                                                                                                                                  20
include: Doctor scheduling, staff scheduling, specific chairs for specific uses, time allocation by procedure, etc. Other areas                Ray McLendon, DDS
include: An effective treatment coordinator, patient motivation, reward programs,                                                                                                                                                    Keith Roberts,
                                                                                                                                                                                                                                     Zenman Productions
marketing plans - internal and external, referrals - by patients and dental colleagues.

RMO ® continues to support advances in Practice Management. We are proud of our
                                                                                                                                               CLINICAL
long involvement in this important aspect of your business. We have more experience
in this field than any of our competitors in the world. We are working hard to help
                                                                                                                                                                                                                       The JOE
                                                                                                                                                                                                                  Cephalometric           10
make this expertise available to you. We want to help you to succeed!
                                                                                                                                               6   Clinician’s Study of Direct
                                                                                                                                                   vs. Indirect Bonding
                                                                                                                                                                                                                         System
                                                                                                                                                                                                                Bruce Haskell, DMD, PhD
Tony Zakhem                                                                                                                                        Glenn Burkland, DMD and
                                                                                                                                                   Catehrine Berg, RDH




Chairman and CEO                                                                                                                               18 Liberty Bielle:
                                                                                                                                                  Removable/Fixed
                                                                                                                                                     Eric Marie-Catherine, DDS



                 In this issue I’m also excited to showcase RMO ®’s new
                 image and focus. Please see more about this by visiting
                 the RMO ® Web Page, Facebook and YouTube sites.                                                                               44 Lingualjet
                                                                                                                                                       Pascal Baron DDS, MSc, PhD
                                                                                                                                                       and Christophe Gualana, DDS




                                                                                                                                                                                                                                                        Clinical Review    3
                                                                  rocky mountain orthodonticsTM



                                                                                                                                                                                                                                Contributors

                  Check out
                     RMO’s
                                                    ®

                                                        NEW
                                                          look!
                                                                                                                 Glenn Burkland, DMD
                                                                                                                 Dr. Burkland is a board-certified orthodontist
                                                                                                                 with a private practice in West Chester,
                                                                                                                 PA. He graduated first in his class from the
                                                                                                                 University of Pennsylvania Dental School
                                                                                                                 before receiving his certificate in orthodontics
                                                                                                                                                                    training at the prestigious University of
                                                                                                                                                                    Illinois-Chicago with an M.S. in Oral
                                                                                                                                                                    Sciences. A prolific writer, Dr. Kravitz
                                                                                                                                                                    continues to publish his cases in numerous
                                                                                                                                                                    journals, including the AJO-DO, JCO,
                                                                                                                                                                    JADA, Angle Orthodontist, Orthodontist
                                                                                                                                                                                                                        them into effective marketable solutions.
                                                                                                                                                                                                                        Bridgette received a Bachelor of Fine Arts
                                                                                                                                                                                                                        from the University of Auckland, Elam Art
                                                                                                                                                                                                                        School, New Zealand. With over 10 years
                                                                                                                                                                                                                        experience in Marketing and advertising
                                                                                                                                                                                                                        she is the founder for 7 Group USA which
                                                                                                                 from Harvard University. He subsequently           & Orthodontic Products, among others.               launched in June 2010. Contact Bridgette at
                                                                                                                 taught at both institutions, as well as Temple     Dr. Kravitz lectures throughout the country         bridgette@7groupus.com.
                                                                                                                 University School of Orthodontics. He has          & internationally on modern advancements
                                                                                                                 lectured both nationally and internationally       in orthodontics, including early-interceptive       Raymond McClendon, DDS
                                                                                                                 and has published many research articles.          (Phase I treatment) & invisible lingual braces.     Dr. McLendon is a 1983 graduate of the
                                                                                                                                                                    He has presented numerous times at the AAO,         University of Texas Orthodontic program
                                                                                                                 Catherine Berg, RDH                                dental & orthodontic society meetings, &            at Houston. He is the founding partner
                                                                                                                 Catherine obtained her dental hygiene              orthodontic residencies throughout the country.     of Clear Choice Orthodontic Associates, a
                                                                                                                 license after completing her education at                                                              group practice with 7 locations serving the
                                                                                                                 Harcum College. There she earned numerous          Eric Marie-Catherine, DDS                           greater Houston area. Dr. McLendon is a
                                                                                                                 academic and clinical awards and gained            Dr. Eric Marie-Catherine is a specialist            past president of both the Houston Regional
                                                                                                                 national recognition for her skills. In her        in orthodontics, graduated from the                 Society of Orthodontics as well as the Texas
                                                                                                                 professional career, she is a vital member of      University of Clermont-Ferrand where                Association or Orthodontics. He served as a
                                                                                                                 the orthodontic team at a private practice in      he became an instructor in orthodontics.            Board Member on the Southwestern Society
                                                                                                                 West Chester, PA and has published several         He is a member of the SPPD and the SFODF and        of Orthodontics. He has been a popular
                                                                                                                 research articles.                                 teaches many courses and conferences in Europe.     speaker on the business issues that relate to
                                                                                                                                                                    He is the co-inventor of Liberty Bielle system.     the field of orthodontics at a number of the
                                                                                                                 Bruce Haskell, DMD, PhD                                                                                countries orthodontic society meetings.
                                                                                                                 Dr. Bruce Haskell is Professor of Orthodontics,    Keith Roberts
                                                                                                                 (Part Time), at the University of Kentucky,        Keith founded Zenman in 1998, which has             Pascal Baron, DDS, MSc, PhD
                                                                                                                                                                    grown to one of the top web development             Pascal Baron studied at the University of
                                                                                                                 Department of Orthodontics, where he joined
                                                                                                                                                                    firms. His inventive concepts unfailingly result    Toulouse, where he gained a DDS, an MSc in
                                                                                                                 the faculty in 2010. His prior experience
                                                                                                                                                                    in visually pleasing, informative and provoking     orthodontics, and a PhD in biomathematics.
                                                                                                                 includes orthodontic practice in the U.S. Air
                                                                                                                                                                    designs that penetrate to the target audience,      He is a specialist in orthodontics and titular
                                                                                                                 Force Dental Corps, at the Churchill Hospital
                                                                                                                                                                    ultimately resulting in sales. Keith has been       professor at Toulouse University, head of the
                                                                                                                 in Oxford, England, and Clinical Professor
                                                                                                                                                                    working as a marketing expert and web designer      Orthodontics and Dentofacial Orthopedics
                                                                                                                 at the University of Louisville, School of
                                                                                                                                                                    for 15 years. www.zenmanproductions.com             Department of Toulouse University, and head
                                                                                                                 Dentistry, where he has taught since 1977.
                                                                                                                                                                                                                        of the Clinical Orthodontics Unit at Toulouse
                                                                                                                 Currently, Dr. Haskell also works in his private
                                                                                                                 practice in Louisville with his daughter,          Ken Alexander                                       Rangueil Hospital. He is a member of the
                                                                                                                                                                    For the past 25 years Ken Alexander has been        European College of Orthodontics (CEO), a
                                                                                                                 Jennifer. He is a dental and Arts and Sciences
                                                                                                                                                                    one of the top consultants in orthodontic           member of the French Society of Dentofacial
                                                                                                                 graduate of the University of Pittsburgh,
                                                                                                                                                                    management, serving over five hundred clients       Orthopedics (SFODF), a member of the
                                                                                                                 with a doctorate in Physical Anthropology,
                                                                                                                                                                    in North America and Europe. He lectures            European Society of Lingual Orthodontics
                                                                                                                 majoring in Cranio-facial Biology. Dr. Haskell
                                                                                                                                                                    regularly at the AAO Meetings and across the        (ESLO), Member of the European
                                                                                                                 obtained his orthodontic specialty training at
                                                                                                                                                                    country on every area of orthodontic practice       Francophone Association of Research in
                                                                                                                 the University of Rochester, Eastman Dental                                                            Odontology (AFEERO), CNRS Laboratory
                                                                                                                 Center (The Eastman Institute for Oral             management and practice transitions. If you
                                                                                                                                                                    have not had the opportunity to meet Ken you        of Anatomy Imaging UMR5288, and is on the
                                                                                                                 Health). His publications include works on                                                             editorial board of International Orthodontics.
                                                                                                                 habit modification, bio-mechanics, cranio-         will find him and the Millenium Management
                                                                                                                                                                    Group at the RMO booth at the AAO. Ken              He maintains a private practice in Toulouse
                                                                                                                 facial computer modeling and forensic                                                                  (France) and is a co-inventor of Lingualjet.
                                                                                                                 anthropology.                                      has a wealth of knowledge on every area of
                                                                                                                                                                    orthodontic management and many of his
                                                                                                                 Neal D Kravitz, DMD, MS                            clients have some of the most successful            Christophe Gualano, DDS
                                                                                                                 Neal D. Kravitz, D.M.D., M.S. is a Diplomate       practices in the world. You may contact             Christophe Gualano has earned a DDS and
                                                                                                                 of the American Board of Orthodontics.             Ken at KenAlexander2 @aol.com or visit his          a postgraduate qualification in orthodontics,
                                                                                                                 He is also clinical faculty & research             website at www.KenAlexander.com.                    and is a specialist in orthodontics. He is
                                                                                                                 adviser at the University of Maryland &                                                                ex-assistant professor of the Orthodontics
www.rmortho.com                                                                                                  Washington Hospital Center. Dr. Kravitz            Bridgette Owens                                     Department of Toulouse University, a member
                                                                                                                 received his undergraduate degree from             A combination of skills in the creative, business   of the European College of Orthodontics
      become a FAN of RMO®’s                                                                                     Columbia University, received a D.M.D. at          development and marketing arenas has resulted       (CEO), and a member of the European
      facebook page!                                                                                             the University of Pennsylvania School of           in Bridgette earning a reputation as a creative     Society of Lingual Orthodontics (ESLO). He
      www.facebook.com/rmortho                                                                                   Dental Medicine (where he graduated as             and astute marketer with the ability to not         runs a private practice in Toulouse (France)
                                                                                                                 Valedictorian) & completed his orthodontic         only recognize opportunities, but to convert        and is a co-inventor of LingualJet.


650 West Colfax Avenue, Denver, Colorado 80204            Synergistic Solutions for Progressive OrthodonticsTM
                                                                                                                                                                                                                                             Clinical Review             5
P 303.592.8200 F 303.592.8209 E sales@rmortho.com               800.525.6375 | www.rmortho.com
                                                                                                                                                                                       surface area for better adhesion to the      to gain access to difficult to view teeth
                                                                                                                                                                                       tooth surface. Chairside, NOLA cheek         and all of the teeth are prepped at one
                                                                                                                                                                                       retractors are placed in the patient’s       time instead of by quadrants. The patient
                                                                                                                                                                                       mouth, which provide adequate suction        doesn’t have to strain to stay open, or
    Clinician’s Study of Direct vs. Indirect Bonding                                                                                                                                   to eliminate moisture from all areas,
                                                                                                                                                                                       eliminating the need for antisialogogues
                                                                                                                                                                                                                                    stay open nearly as long, since the NOLA
                                                                                                                                                                                                                                    retractors have a built in bite block for
                                                                                                                                                                                       as suggested in previous studies (17,18).    resting the jaw. NOLAs are only in the
                                                                                        By Glenn Burkland, DMD and Catherine Berg, RDH   Figure 1                                      The teeth are etched and sealed with         mouth for an average of 15 minutes then
                                                                                                                                                                                       RMO ® Bonding Resin**. A small amount        all the braces are bonded.
                                                                                                                                                                                       of RMO ® Flowable Adhesive** is applied
                                                                                                                                                                                       to the back of each bracket and the trays    The chief advantage of indirect placement
                                                                                                                                                                                       inserted (see figure 2). Upper and lower     of brackets is increased accuracy of
                                                                                                                                                                                       trays are seated one right after another     positioning. It is far easier for the operator
                                                                                                                                                                                       then the cement cured, through the clear     to place brackets at their correct height and
                                                                                                                                                                                       tray. Once completely cured, trays are       angulations on a model than it is in the
    A solo dental practice evaluated 200 consecutively treated patients                                                                  Figure 2                                      peeled away, leaving the brackets in their   mouth, especially for molars and premolars.
                                                                                                                                                                                       proper position.
    and compared the resulting treatment of direct and indirect bonding.                                                                                                                                                            Another advantage of indirect bonding
                                                                                                                                         anomaly that exists in many dentitions
                                                                                                                                         (12). If the bracket in its proper position   Data Analysis                                is less bond failure, averaging 6% failure
                                                                                                                                         on the tooth impinged on the gum tissue,                                                   with direct bonding, reduced to 3%
    The study to be shared was undertaken in                                                                                                                                           Even though there are more preparation       failure using indirect bonding (see table 1).
    one dental office by one doctor. It involved    Materials and Methods                                                                the bracket base was trimmed to ensure
                                                                                                                                                                                       steps for IDB, its advantages far outweigh   This is the result of:
                                                                                                                                         comfort and to allow for proper hygiene.
    200 consecutively treated patients who                                                                                                                                             any additional prep time spent. First of
    were randomly and alternatively assigned        The 200 treated patients were randomly
                                                    and alternately assigned to one of the                                               Articulating the models checks for            all, the majority of time that goes into       a. Better tooth isolation
    to two methods of treatment. The first                                                                                                                                             preparing for IDB can be done whenever
                                                    treatment modes, resulting in 100 cases                                              interferences and ensures brackets are not
    involved indirect bonding and the second                                                                                                                                           there is down time or done by the lab          b. Decreased time need to place
                                                    bonded directly and 100 cases bonded                                                 being occluded. If the bite was extremely
    was direct bonding. Treatment times                                                                                                                                                tech; each step is not time intensive. IDB        brackets and maintain isolation
                                                    indirectly. The direct method was                                                    deep and interferences were observed,
    and deviations from the averages were                                                                                                                                              preparation can be stopped and started
                                                    performed on the posterior teeth (the                                                bite turbos were placed on the lingual
    recorded. Bond failure was rigorously                                                                                                                                              at any point, allowing for flexibility if      c. Excellent adaptation of bracket
                                                    molars and premolars), quadrant by                                                   surface on the upper centrals to prevent
    recorded and, to the best ability of the                                                                                                                                           something more pressing comes up                  base to the tooth
                                                    quadrant, with isolation of the teeth using                                          breakages. Then the models were lined on
    clinician, the reason for failure was                                                                                                                                              during the day.
                                                    cotton rolls and dri-angles. The anterior                                            the edges with rope wax and the soft tray,
    determined. The average time to place                                                                                                                                                                                             d. Increased control of bonding
                                                    teeth (canines, laterals, and centrals) were                                         RMO ® Inner Tray material**, was applied
    initial bonds was recorded using both                                                                                                                                              Secondly, the amount of time spent                materials
                                                    isolated with the use of a cheek retractor.                                          to a thickness of about 3 mm over the
    techniques.                                                                                                                                                                        chairside at the initial bonding
                                                                                                                                         brackets. The tray was smoothed using
                                                    Teeth to be bonded were prepared by                                                  RMO ® Tray Finish** and trimmed of any        appointment is almost cut in half. An
    There is a paucity of literature on indirect                                                                                                                                       average of 127 minutes were spent at the
                                                    etching with 37% phosphoric acid for                                                 excess with a surgical blade. The tray and
    versus direct bonding. In this study,                                                                                                                                              initial visit for direct bonding versus an
                                                    30 seconds according to manufacturer’s                                               the brackets were removed as one piece.
    the single treating clinician has over 30                                                                                                                                          average of 66 minutes for IDB. Plus, that
    years experience in orthodontics with a         instructions, then rinsed and air-dried,
                                                    followed by a seal of Unitek MIP*                                                    Finally, the custom pads made earlier         hour is much more comfortable for both
    distinguished clinical career. He wanted                                                                                                                                           the patient and clinician. The clinician
                                                    (moisture insensitive primer). Brackets                                              are micro-etched with a 50-micron
    to re-examine the two bonding modes                                                                                                                                                is not straining his/her neck and back
                                                    were adhered to the tooth with a thin coat                                           aluminum oxide powder to restore
    because previous literature is outdated, did
    not have standard treatment approaches,         of Unitek Transbond XT* (10). Once the
    bonding techniques, or have the same            brackets were positioned and checked for
    operator performing the procedures.             accuracy, pressure was applied to ensure
                                                    complete incorporation of the cement
    These variations make it difficult, if not
                                                    into the mesh pad of the bracket and light                                                               The chief
    impossible, to make conclusions about
    indirect and direct bonding.                    cured.                                                                                              advantage
    To eliminate a significant variable, a single   The indirect method was done as follows:                                                             of indirect
                                                    An alginate impression was taken and
    doctor was responsible for placement of
                                                    poured in green stone for its hardness.                                                            placement
    all bonds, whether placed indirectly or
    directly. Care was taken to ensure accuracy     The models, dried for 24 hours, were                                                                of brackets
    of placement and maintenance of ideal           then painted with two coats of separator
    bonding conditions in either modality.          (liquid foil). The brackets were then                                                              is increased
                                                    carefully placed on the teeth using Unitek
                                                    Transbond XT* cement (see figure 1).
                                                                                                                                                        accuracy of
    He concluded that it was far easier and
    much more accurate to place brackets            The cement, which normally adheres the                                                                 positioning.
    indirectly on a model, which can be             bracket to the bonding surface, in this
    manipulated for easy viewing, than              case creates a custom base for the bracket
    directly while dealing with access,             ensuring proper fit on any tooth, despite
    viewing and isolation challenges.               the presence of a possible structural



6      Clinical Review                                                                                                                                                                                                                                   Clinical Review             7
                                                                                                                                                                                                                                         rocky mountain orthodonticsTM


    Since the braces are initially placed on           A disadvantage to the IDB system,                operator. This study was controlled in
    a model, much more time can be spent               although minor, exists in transitional           that one clinician administered the two

                                                                                                                                                             As good as it gets
    ensuring proper positioning (6, 7, 8, 13).         dentition. No more than two weeks can            treatment modes. Further study needs to
    This allows for shorter overall treatment          lapse from the impressions to the bonding        be completed to see if the results can be
    time. We have seen a 25% reduction in              appointment. Otherwise there can be              extrapolated to more treating clinicians
    treatment time from about 24 months                too many changes in the oral cavity to           with the results remaining consistent.               RMO®’s Energy Chain is the proven leader in elastomeric chain material, outperforming
                                                                                                                                                                                       TM

    to around 18. This is due to less bracket          accommodate the custom fitted trays.
                                                                                                        *3M Unitek, 3M Corporate Headquarters,               other elastic chains in numerous independent clinical tests. Stain resistant, latex free, 4 sizes
    repositioning and fewer bends having to
    be put in the wire, which eliminates the           Conclusion                                       3M    Center,    St.Paul, MN   55144                 and a variety of colors.
    human error factor (2). Treatment time is                                                           www.solutions.3m.com
    also reduced due to less bond failure. When        The results of this study suggest indirect
    the brackets are positioned ideally, there is      bonding as superior due to shorter               **Rocky Mountain Orthodontics, 650
                                                                                                        West Colfax Avenue, Denver, CO 80204
    less stress on the bracket (1, 5, 9, 14, 18).      treatment time, less bond failure and            www.rmortho.com
                                                       increased ease for the patient and
                                                                                                                                                             RMO®’s patented formula provides light, continuous force for weeks resulting in brilliant
    Table 1                                                                                                                                                  closure and very..very..happy patients.
     Failures               Total Brackets           Intact      Failed Bonds     Percentage of
                               Places                Bonds                           Failures

     Direct Bonding              20,246              18,954          1292               6.4%

     Indirect Bonding            20,872              20,235           637               3.1%

    Table 2
     Treatment Time                 Average Months in Treatment             Deviation in Months

     Direct Bonding                 24.2                                    2.1 +/-

     Indirect Bonding               18.4                                    2.6 +/-



    Bibliography:
    1. Aguirre MJ, King GJ, Waldron JM.
    Assessment of Bracket Placement and Bond           Versus Indirect Bracket Placement. AM J          Indirect Technique Versus Direct Placement
    Strength When Comparing Direct Bonding to          Orthod 2004;31:132-137.                          of Brackets. AM J Orthod Dentofacial Orthop
    Indirect Bonding Techniques. AM J Orthod                                                            1989;96:8-15.
    1982; 82:269-76.                                   9. Hocevar RA, Vincent HF. Indirect versus
                                                       Direct Boding: Bond Strength and Failure         15. Moskowitz EM, Knight LD, Shreidan JJ,
    2. Andrews LF. The Straight-Wire Appliance.        Location. AM J Orthod Dentofacial Orthop         et al. A New Look at Indirect Bonding. AM J
    BR J Orthod. 1979; 6:125-43.                       1988;94:367-71.                                  Orthod. 1996;30:277-281.

    3. Collins J. A Precise and Predictable            10. Jost-Brinkmann PG, Schiffer A, Miethke       16. Read MJ, Pearson AI. A Method for
    Laboratory Procedure for Indirect Bonding.         RR. The Effect of Adhesive Layer Thickness       Light-Cured Indirect Bonding. AM J Orthod.
    AM J Orthod. 2000; 34:702-705.                     on Bond Strength. AM J Orthod. 1992;             1998;32:502-503.
                                                       26:718-720.
    4. Deahl ST, Salome N, Hatch J, Rugh JD.                                                            17. Sondhi A. Efficient and Effective Indirect
    Practice-based Comparison of Direct and            11. Kasrovi PM, Timmins S, Shen A. A New         Bonding. AM J Orthod Dentofacial Orthop.
    Indirect Bonding. AM J Orthod Dentofacial          Approach to Indirect Bonding Using Light-        1999;115:352-359.
    Orthop. 2007; 132:738-742.                         Cure Composites. AM J Orthod Dentofacial
                                                       Orthop. 1997;111:652-656.                        18. Thiyagarajah S, Spary DJ, Rock WP. A
    5. Gia K, Dunn W, Taloumis LJ. Shear Bond                                                           Clinical Comparison of Bracket Bond Failures
    Strength Comparison Between Direct and             12. Klocke A, Shi J, et al. Bond Strength with   in Association with Direct and Indirect
    Indirect Bonded Orthodontic Brackets. AM J         Custom Base Indirect Bonding Techniques.         Bonding. AM J Orthod 2006;33:198-204.
    Ortho Dentofacial Orthop. 2003; 124:577-581.       Angle Orthod 2003;73;176-80.
                                                                                                        19. Thomas RG. Indirect Bonding: Simplicity
    6. Hickman. Predictable Indirect Bonding.          13. Koo BC, Chung CH, Vanardsall RL.             in Action. AM J Orthod. 1979; 13:93-106.
    1993;27:215-217.                                   Comparison of the Accuracy of Bracket
                                                       Placement Between Direct and Indirect            20. Wendl B, Droschl H, Muchitsch P.
    7. Hodge TM, et al. The Burton Approach to         Bonding Techniques. Am J Orthod                  Indirect Bonding-A New Transfer Method.
                                                                                                                                                             Energy Chain
                                                                                                                                                                                  TM
    Indirect Bonding. AM J Orthod 2001;28:267-270.     Dentofacial Orthop 1999;116:346-51.              EU J of Orthod 2008;30:100-107.

    8. Hodge TM, et al. A Randomized Clinical          14. Milne JW, Andreasen GF, Jakobsen JR.
    Trial Comparing the Accuracy of Direct             Bond Strength Comparison: A Simplified


                                                                                                                                                         650 West Colfax Avenue, Denver, Colorado 80204                          Synergistic Solutions for Progressive OrthodonticsTM
8      Clinical Review                                                                                                                                   P 303.592.8200 F 303.592.8209 E sales@rmortho.com                             800.525.6375 | www.rmortho.com
                                                                                                                                      established norm. A clear and concise                                  the need for one plan above another.
                                                                                                                                      print-out highlighting the degree of every                             The opposite situation of a patient with
                                                                                                                                      abnormal measurement is a convenient                                   retroclined anteriors and extreme lower
                                                                                                                                      tool for me to send to the oral surgeon.                               crowding requiring the advancement
 The JOE Cephalometric System
                                                                                                                                      This assists decision making as to whether                             of incisors for non-extraction therapy
                                                                                                                                      a one or two jaw procedure is necessary in                             might also be simply and effectively
                                                                                                                                      an individual patient, or how much actual                              communicated with this program.
                                                                                                      By Bruce Haskell, DMD, PhD
                                                                                                                                      surgical correction may be required for
                                                                                                                                      an ideal skeletal or facial balance. I make
                                                                                                                                      certain my oral surgeon has this report
                                                                                                                                      to include in his treatment request to the
                                                                                                                                      insurance company.

                                                                                                                                      I often have my Treatment Coordinator
                                                                                                                                      do a preliminary discussion of the
                                                                                                                                      treatment at our consultation visit. Our
                                                                                                                                      staff was once horrified when I tried to
                                                                                                                                      use a new conventional digital analysis
                                                                                                                                      which came (included), with our office
                                                                                                                                      software. My Coordinator felt that the
                                                                                                                                      free analysis simply showed a “bunch of
                                                                                                                                      numbers” without a proper explanation
                                                                                                                                      and illustration of what was specifically
                                                                                                                                      wrong with the patient. I switched back
                                                                                                                                      to JOE!

                                                                                                                                      The actual use of JOE may be illustrated
                                                                                                                                      here in a few examples. This first patient
                                                                                                                                      illustrates a need for anterior retraction.
                                                                                                                                      The “red” is the computer generated
                                                                                                                                      “ideal” norm while the “gray” shows the
                                                                                                                                      actual anatomy. Anterior retraction of
                                                                                                                                      the dentition together with lip position
                                                                                                                                      reduction is illustrated as is extra lower
                                                                                                                                      facial height. This report may make
 There are many reasons why I would feel lost without JOE.                                                                            the difference between choosing an
                                                                                                                                                                                                             The retraction of the anteriors seen in gray, compared to the
                                                                                                                                                                                                             position of the ideal norm, in red, illustrates an ideal orthodontic
                                                                                                                                      extraction vs. a non-extraction treatment
                                                                                                                                      plan. It easily shows a concerned parent                               treatment plan. The cephalometric analysis is Ricketts.


                                                                                                                                                                                            Mission
 I have been fortunate to use the JOE    This includes showing asymmetric               to highlight exactly where the differences                           To provide affordable orthodontic treatment and education to as many
 Cephalometric System in my practice     discrepancies to your patient (or their        between the ideal and anatomical error                                      financially challenged children and families as possible.
                                         parents), to the referring doctor as well
 for the last 20 (20? not sure!) years. It                                              may lie.
 has allowed clarity and simplicity in   as to insurance companies if they so
 Cephalometric Interpretation, a field   require. It is the application of the unique   This is a really fantastic communication           Dedicated to promoting orthodontic health in local communities….
 unusually complex and often confusing.  RMO ® “visual norm”, a compensated and         tool. In a Class II situation, for example,
                                         individually adjusted image available for      the need of either a functional appliance,                                                           Vision
 Now that tracing can be done directly each patient which makes this a singular         or instead the use of maxillary distalizing                         To foster a greater awareness and understanding among the general
 on the computer screen with digital product for the orthodontist. The “red”            mechanics for classification may be easily                            public about the benefits of orthodontic treatment by doctors that
 radiography, the process has been computer tracing shows an ideal or                   illustrated depending upon which jaw is                           specialize in orthodontic prevention and care. We hope to provide care to
 additionally simplified. It is possible “norm”, compensated for age, race, sex         the problem structure; upper or lower. In                         an underserved community in order to help foster better health, beautiful
 to view the computerized tracing and volumetric size of the patient, and               surgical situations, it also demonstrates                         smiles, and confident children that can become leaders in the community.
 superimposed directly upon a digital compares it through superimposition to            the degree and amount of movement
 cephalometric image.                    an “actual” anatomical tracing image.          necessary in which to plan for improving
                                                         This combined image easily     facial and skeletal balance. I have never
 The use of JOE is one of the best                       highlights any dental and      had an insurance company analyst balk
 communication devices I know of                         skeletal discrepancies. The    at the need for an orthognathic surgical
                                                                                                                                                           The Colorado Orthodontic Foundation is a community focused
 to demonstrate the nature of dental                     orthodontist has the choice    correction when the Joe tracing presents                      organization that is dedicated to promoting superior orthodontic treatment
                                                         of more than a score of        a maxillary or mandibular discrepancy of                                 and care by orthodontic specialists within Colorado.
 and skeletal imbalance.                                 superimpositions in which      two or more clinical deviations from an
                                                                                                                                                                                                                                   www.thecof.org


10 Clinical Review                                                                                                                                                                                                                                             Clinical Review      11
                                                                                                                                                                                           rocky mountain orthodonticsTM



 Another unique feature of
 JOE is in the area of specifying
 ethnicity in your particular
 cephalometric analysis.
 This is one of the very few programs
 that contain norms for Asians, African
 Americans, Hispanics, Mixed Ethnicity,
 Caucasians, etc. This means that calculated
 norms exist for these groups of peoples
 based upon the samples of scores and
 often many thousands of peoples derived
 from sample populations at a number of
 universities. This knowledge is critical is
 being able to communicate with patients
 and referring doctors concerning what is
 “visually” normal for patients of distinct                                                                                                                         In-office Software Package
 or mixed ethnicities. This method helps
 eliminate misunderstandings about what                                                                                                                             On Screen Digitizing
 is actually desired for an individual of a
 specific ethnic background. I have been                                                                                                                            Cephalometric Analyses
 amazed as to how much this has helped
 me communicate in my practice, showing                                                                                                                             Custom Analysis
 concerned parents that I am ethnically “aware”.

 This analysis shows an African American
                                                                                                                                                                    Upper and Lower Arch Analysis
 male. The maxillary base is normal for a
 person of this ethnicity, together with a
                                                                                                                                                                    Visual Norms
 full and mildly protrusive denture. This is
 normal, and demonstrates that the lower
                                                                                                                                                                    Airway Analysis
 anteriors should be advanced in order to          A full profile is normal for this ethnic type. Advancement
 gain proper inter-incisal angulations for         of the lower anteriors for incisal guidance correction is                                                        Excessive Mandibular Growth Alert
 this particular individual.                       appropriate for this patient.                                                                                    24 Month Growth Forecast without Treatment
                                                                                                                                                                    Superimpositions of Different Time Points
                                                                                                                                                                    Management of Patient Images



 There are many reasons why I would feel lost
 without JOE.

 There are many reasons why I would
 feel lost without JOE. Some reasons
 include the automated print-out summary
 indicating the type of major discrepancy
 and malocclusion with each cephalometric
 point highlighted. A 2-year facial growth
 forecast, a built in golden proportions
 divider, a ruler, superimpositions of
 progress films, etc. are also reasons I like
 JOE. The actual list of features is very
 extensive. I suggest you contact your
 RMO ® representative for a full display
 of the capability of this unique product,                                                                      JOE Ceph®
 an incalculable asset to my orthodontic
 practice and to communication with
 patient and the referring doctor.


                                                                                                                650 West Colfax Avenue, Denver, Colorado 80204                     Synergistic Solutions for Progressive OrthodonticsTM
12 Clinical Review                                                                                              P 303.592.8200 F 303.592.8209 E sales@rmortho.com                        800.525.6375 | www.rmortho.com
                                                                                                                                               (2) Schedule challenging malocclusions or       As orthodontists, we have systems in place     goal is to always improve and to always
                                                                                                                                               demanding patients in the morning. Not          for preparing the treatment units, bonding     evolve. Mastering product advancements
                                                                                                                                               all malocclusions are created equal. Those      and banding, organizing laboratory cases,      such as the RMbond® Indirect Bonding
                                                                                                                                               patients that require more attention are seen   sterilization and packaging, and so forth.     System, Dual-Top ® temporary anchorage
                                                                                                                                               during quieter times in the day when I can      However, our demanding schedule often          devices with torsion-controlled drivers,
 Maximizing Office Efficiency                                                                                                                  focus on their needs. Sometimes, the most       gives little flexibility to incorporate new    myofunctional retainers, and non-ligating
                                                                                                                                               productive appointment with a challenging       technology, particularly those that may        Synergy-R® brackets with Thermaloy Plus
                                                                                                                 Neal D Kravitz, DMD, MS
                                                                                                                                               patient is to schedule them to return in        require experimenting with a new system.       wires have enabled my office to create
                                                                                                                                               two weeks for a longer appointment in the       Such a folie à deux! We often find ourselves   beautifully finished cases in a comfortable,
                                                                                                                                               morning for extensive evaluation.               too busy to learn to use advancements that     timely manner.
                                                                                                                                                                                               would otherwise enable us to work more
                                                                                                                                               (3) Maximize each treatment appointment.        efficiently.                                   When developing any new system, the
                                                                                                                                                                                                                                              When developing any new system, the
                                                                                                                                               If the patient presents with a broken                                                          first step is to truly make the decision. All
                                                                                                                                                                                                                                              first step is to truly make the decision. All
                                                                                                                                               bracket, I perform all necessary bracket        In my office, I am firmly committed to         members of my office team are informed
                                                                                                                                                                                                                                              members of my office team are informed
                                                                                                                                               repositionings at this time; if the patient     incorporating advancements immediately         that a new product or technique will be
                                                                                                                                                                                                                                              that a new product or technique will be
                                                                                                                                               presents for an emergency wire-poke, I          no matter how steep the learning curve         implemented. My decision is not up for
                                                                                                                                                                                                                                              implemented. My decision is not up for
                                                                                                                                               proceed to their next visit when possible;      with the understanding that my staff           democratic vote. If given the option,
                                                                                                                                                                                                                                              democratic vote. If given the option,
                                                                                                                                               if there is a lull in the schedule, I perform   will soon be able provide an even higher       most people will choose to take the
                                                                                                                                                                                                                                              most people will
                                                                                                                                               as much work as possible for those patients     standard of care in the future. The            familiar route; but changing old habits is
                                                                                                                                               sitting in the treatment chairs. Carpe diem!                                                   never comfortable. Everything will be
                                                                                                                                                                                                                                              hard until it’s easy.
                                                                                                                                               The challenge with patient scheduling
                                                                                                                                               is that any rules are written in sand. At
                                                                                                                                               the last moment, appointments may be                                                           Steps to Maximize
                                                                                                                                               added, canceled, or lengthened; employees
                                                                                                                                               may need meetings for instruction or                                                           Office Efficiencies
                                                                                                                                               disciplining; impromptu phone calls                                                            1. Simplify your inventory by
                                                                                                                                               may need answering; and administrative
                                                                                                                                                                                                                                                 reducing the number of
 Three steps to operating an elite orthodontic office                                                                                          decisions may require immediate attention.
                                                                                                                                               Therefore, to maximize treatment                                                                  product vendors.
 Simply stated, efficiency means finding a better way to work. As the sole orthodontist of two thriving offices that together start
 nearly nine-hundred cases per year, maximizing office efficiency is crucial not only to managing my busy schedule, but also most              efficiency, I cherish my clinical time and
                                                                                                                                               always try to create more of it. “Work when                                                    2. Continually organize and
 importantly, providing a higher standard of orthodontic care to my patients. Operating with efficiency requires working each day
 with organization, time-management, and resolute commitment toward continual self-improvement. The premise of this article is                 at work,” as I like to say.                                                                       reorganize your schedule, so
 to share three steps used in my offices that maximize clinical efficiencies so your team may provide exceptional orthodontic care.                                                                                                              as to take full advantage of
                                                                                                                                               Step 3: Invest in quality and                                                                     each appointment.
                                                                                                                                               advancements                                                                                   3. Constantly improve yourself
                                                                                                                                               The speed of the workplace demands                                                                by staying current with
                                                                                                                                               that systems or proper routines are                                                               advancements in products
                                                                                                                                               established to maximize office efficiency.                                                        and techniques. Commit
 Step 1: Simplify your inventory                                                                                                                                                                                                                 yourself to change. The seven
 As an orthodontist, I strive to produce      by Rocky Mountain Orthodontics,                 creates a lack of control, which is the very                                                                                                       costliest words ever uttered in
 work that is clean and organized.            including fixed appliances, sundries,           essence of stress. As the saying goes, “time                                                                                                       business may just be, “that’s
 Organization of my cases first begins with   adhesives and instruments. (Page 17)            is a wonderful servant but a terrible master.”                                                                                                     the way I’ve always done it.”
 organization of my inventory. Amazingly,
 I find that many offices have inventory      Condensing my inventory to a minimal            Step 2:        Cherish your time
 expenses (excluding laboratory expenses)     number of vendors reduces office
 from more than ten vendors: two or three     overhead, ensures items are delivered           I have three simple rules in regards to
 companies may provide brackets, another      in a timely manner, and enables my              clinical time management:
 two may provide the bands or molar           clinical staff to gain expertise with the       (1) Abide by the Terry Sellke principle
 tubes, another two may provide wires,        orthodontic products. Simplification            of scheduling like- with - like. Long
 another two discount product companies       is fundamental to organization and              appointments are scheduled together in the
 may provide a variety of auxiliaries,        operating at maximum efficiency. What           morning with other long appointments.
 and still others may provide adhesives,      gets organized gets measured; and what          Short appointments are scheduled in
 laboratory materials, and dental sundries.   gets measured gets monitored.                   the afternoon together with other short
                                                                                              appointments. Finishing the appointment
 In my office I order from four companies,    Success in my professional life is directly     on time so the patient can continue with
 with the vast majority of products from      related to my time management. Properly         his/her day is equally important as starting
 Rocky Mountain Orthodontics. I think         managing my schedule is integral to operating   the appointment on time. My time is not
 many clinicians would be surprised to        an office that is efficient and focused on      more important than my patient’s time.
 learn the wide variety of products offered   premium patient services. Lack of time


14 Clinical Review                                                                                                                                                                                                                                                 Clinical Review            15
                                                                                                                                          RMO Inventory List
 RMO Inventory at Kravitz Orthodontics
                                                                                                                                                  ®
              ®



                                                                                                                                          Brackets                                                         IDB System
                                         ®
                                                                                                                                             Synergy-R (bi-dimensional .018 anteriors .022 posteriors)




 1
                          Synergy R                                                  IDB                                        Wires



                                              3                                               6
                                                                                                                                                                                                            RM Bond Indirect           Bonding   Light-Cured      System
           RMO®’s SWLF Synergy R®                         RMO®’s RMBond™                                 RMO® offers a range of              Synergy Lux Ceramic brackets
                                                                                                                                                                                                            (complete set)
           combines the simplicity and                    Indirect Bonding (IDB)                         wires from Elgiloy to Niti
           ease of self-ligating bracket                  system delivers a step-by-step                 and everything inbetween.
           design with the flexibility and                process that allows doctors                    All of RMO®’s wires are
           advanced performance of                        to fundamentally reduce the                    made in the USA and with         Bands                                                            TAD System
 Synergy’s® Friction Selection Control       amount of chair time involved when              the highest quality materials and the most      First molar with occlusal head gear tube
 modes. SWLF Synergy R® provides             bonding appliances to a patient. This           accurate processes. RMO®’s patented                                                                            Dual-Top TAD Kit (sterilization kit and straight driver)
 minimal friction and rapid wire             results in a greatly improved patient           Elgiloy wires remain extremely popular          Second Molar with single tube*                                 and Dual-Top contra-angle driver
 exchange, with cuspid and bicuspid          experience also, as the IDB process             world wide exhibiting ideal properties                                                                         Dual Top TADs: 1.6 x 6.0 mm, 1.6 x 8.0 mm, 2.0 x
 brackets that can be converted into         significantly reduces the patient’s chair       and minimal breakage. RMO®’s nickel                                                                            8.0 mm, 2.0 x 10.0 mm**
 traditional Synergy ® style brackets at     time and discomfort during bonding.             titanium alloys transition at accurate
 any time during treatment. Clinically       The RMbond™ system allows for                   temperatures, providing predictability       Wires
                                                                                                                                                                                                           Instruments
 tested and proven effective, SWLF           extremely accurate bracket placement            and efficiency for the clinician.               Thermaloy Plus Nickel Titanium
 Synergy R® is designed, engineered, and     under convenient setup conditions. The
                                                                                                                                                0.012, 0.014, 0.018, 0.016 x 0.024, 0.017 x 0.025           Schweickhardt surgical-grade Stainless Steel instruments
 manufactured with pride in the USA.         RMbond™ start-up kit is a turnkey                                         Instruments



                                                                                              7
                                             system that includes all of the materials                                                       Tru Chrome Stainless Steel                                        Mathieus
                                             necessary to begin Indirect Bonding                          RMO ’s premium
                                                                                                               ®
                                                                                                                                                0.016, 0.018 x 0.024, 0.017 x 0.025                            Bird-beaks
                                             your patients immediately.                                   Schweickhardt instruments                                                                            Weingarts
                                                                                                          represent the finest quality                                                                         Distal end cutters
                                                                                                          available at any                                                                                     Ligature cutters
                                                                                                          price. Each                     Auxiliaries                                                          Band-removers
                                                                                             Schweickhardt instrument                                                                                          Direct bond removing pliers
                                                                                                                                             O-ring ties, elastic chain (closed Energy Chain),
                                                                                             is precisely manufactured in                    elastic thread (for extrusion of impacted canines)                Crimpable pliers (for crimpable posts)
                                                                                             Germany with hardened                                                                                             Dual-end band pushers/scalers (Guequierre)
                                                                  Energy Chain®



                                              4
                                                                                             inserts that can be                             Open and closed coil springs, warren springs (for                 Direct bonding tweezers
                                                           RMO®’s Energy Chain™              sharpened or replaced,                          added root torque)
                                                           is a proven elastic chain         resulting in a more                                                                                            Apex series instruments:
                                                                                                                                             Steel ligatures (0.010), Kobyashi ties, crimpable posts
                                                           material leader. Numerous         economical product                              (for surgical cases and mini-implant activation)                  Band-seater (bite-stick)
                                                           universities and clinical         over time than                                                                                                    Three-prong pliers
                                                                                                                                                                                                               Step pliers (1.0 mm)
                           Dual-Top ®                      researchers have shown that




  2
                                                                                             disposable instruments.
                                                                                                                                                                                                               Cinching pliers
            RMO ’s Dual-Top
                   ®                         RMO®’s Energy Chain™ outperforms                All Schweickhardt                            Adhesives                                                            Band cap converting pliers (for bands and Synergy-R
                                             virtually all other elastic chains available.   instruments are crafted                                                                                              brackets)
            Temporary Anchorage                                                                                                              Monolok light cured bracket cement (in place of
                                             Energy Chain™ is a tough                        of 100% surgical stainless steel, are
            Device (TAD) system                                                                                                              TransbondTM)
                                             elastic chain material                             forged, finished by hand, and carry a
            provides efficient and
                                             that is stain resistant,                             superb warranty.                           RM Bond flowable (for bonded retainers and
            f lexible biomechanics.
 Dual-Top TADs
                                             tasteless, and                                                                                  indirect bonding)                                             Sundries
                                             delivers a uniform                                                                              RM Bond build-up (in place of Band-lok)                        Ortho-Jel alginate, impression trays, beading wax,
 significantly enhance
                                             continuous force over                                                                                                                                          orthodontic wax, retainer cases, moldable mouthpieces
 treatment capabilities                                                                                                                      RM Bond LC primer (in place of Optibond)
                                             significantly longer
 and can be extremely                                                                                                                                                                                       Polyvinyl siloxane (PVS) dispenser gun, PVS syringe tips,
                                             periods of time in                                                                                                                                             flowable tips
 effective in
                                             comparison to most
 reducing treatment                                                                                                                       *In our office, mandibular first molar bands are used both
                                             other elastic chains.                                                        Bands



                                                                                               8
                                                                                                                                          on the first and second molars. I do not recommend this in        Headgears
 time, surgeries,                                                                                                                         the maxillary arch, as the occlusal headgear tube may irritate
 and extractions.                                                                                         RMO ’s bands are still,
                                                                                                               ®
                                                                                                                                          the buccal mucosa in the second molar region. In addition,        Monolok (37% phosphoric acid) etchant, etchant tips




                                              5
 Appliances can be                                                         Adhesive                       after more than 70 years,       a maxillary first molar band may provide excessive mesial-
                                                                                                                                          out rotation on a second molar creating a light interproximal
 inserted chairside                                       Mono-Lok ® is a versatile bis-                  considered the best bands on    contact.                                                                                  16"          5
                                                                                                                                                                                                            Orthodontic elastics (3/ diameter x 4. oz., 1/4" diameter
 by the doctor                                            GMA adhesive that can be                        the market. The anatomical                                                                            5
                                                                                                                                                                                                            x 4. oz., 1/4" x 32.0 oz. for protraction facemask)
 and forces can be                                        used for all types of direct or                 shape, rolled occlusal edges,   **The two most commonly ordered designs are the button-
 applied immediately.                                     indirect bracket placement.        and unique temper give the best fit for      top design and the bracket-top design with gingival collar.
                                                                                                                                          In the mid-palatal region, 1.6 x 6.0 mm TADs are used. In
 Experience the                                           Because of its ease of use,        any patient. The roughened interior of       the posterior palatal region, 2.0 x 10.0 mm TADs are used to
 next generation of                          predictable viscosity, and excellent bond       the band and precise shape provide a         compensate for the poor bone density. In dentoalveolus, 1.6 x
 appliances: RMO ® ’s                                                                                                                     8.0mm or 2.0 x 8.0 mm TADs are primarily used.
                                             strength, it works very well with metal         snap fit, withstanding years in the mouth
 Dual-Top TADs.                              and ceramic brackets and molar tubes.           without needing an adjustment.


16 Clinical Review                                                                                                                                                                                                                               Clinical Review           17
                              Libery Bielle: Removable / Fixed
 The freedom of movement...                                                                                              Eric Marie-Catherine, DDS


                              The Liberty Bielle Fixed / Removable has         Was Removable                   Now Fixed
                              unique configurations that allows it to rotate
                              360 degrees, maximizing lateral movement
                              and providing comfort, flexibility for

                                                                                                         VS.
                              the patient and treatment efficiency to
                              the doctor. The unique components
                              increase the durability of the appliance by
                              minimizing destructive lateral forces and
                              allowing the maximum movement of the
                              mandible in many directions.
                                                                               No Cheek irritation             No Cheek irritation
                                                                               Yes Patient cooperation         No Patient cooperation
                                                                               No Pain                         No Pain




                              Orthopedic




                                                                                                                                               6 Months
                              Changes and
                              Orthodontic
                              Changes




                                                         Initial
                                Patient Comfort | 360 Degree Movement | Lateral Flexibility | Efficient Design




                                                                                           In progress
                              Orthopedic




                                                                                                                                               3 Months
                              Changes and
                              Orthodontic
                              Changes




18 Clinical Review                                       Initial                                                            Clinical Review               19
 Zenman and the Art of Web Development                                                                                                                                                                                                                       Keys to effective web design




 {                                                                       {
                                                                                                     By Keith Roberts, Zenman Productions                                                                                                                        1.Easy to use

            “The site we have had forever is fine.                                                                                                                                                                                                               2.Focus the users attention
            Why should I update the site that we                                                                                                                                                                                                                   (CTAs, animation, etc)
            have had for years?”
                                                                                                                                                                                                                                                                 3.SEO

                             “Why do I need a website?”                                                                                                                                                                                                          4.Current content

                                                                                                                                                                                                                                                                 5.Strong design


 The answer is obvious. Your website is          quickly engage the user and drive them         (example: “clear braces “might sell for
 the first impression that a potential client    to CTAs (calls to action) or key areas         $5.69 in Phoenix, AZ), set geographic                                                                        visitors to a website. Google Analytics        new pages. With current systems like
 has of your practice. Before a phone call       of the site (example: services or contact      specifications so your only appearing in                        Keep it current                              is currently in use in 57% of the top          WordPress the average computer user can
 is made to set up the consultation you          information).                                  your target area and manage your daily/                         Your website can’t become stale. The         1,000,000 websites. This allows you            administer the content of your site via the
 are being researched online. Some users                                                        weekly/monthly budgets. This means that                         content must be updated frequently to        to track visitors from referrers, search       GUI (Graphical User Interface).
 will just look at your website while more       SEO (Search Engine                             you can pay a few extra dollars to appear                       keep users returning to your site. From      engines, pay-per-click campaigns and
 tech-savvy users will read online reviews                                                      when someone searches “orthodontic                                                                           email marketing. By tracking the user          * SEO within CMS – The SEO can be managed
 and browse social networking sites. The
                                                 Optimization)                                  care” in Houston, TX for example.
                                                                                                                                                                tracking rewards program to updating
                                                                                                                                                                the smile gallery or news and events, the    experience you can easily see which            at the individual page level within certain systems.
 website is an online face of your practice      What exactly is SEO? Search engine             This is a much more targeted approach                           website must be current. This doesn’t have   marketing mediums are getting the best
 and must accomplish two things. First,          optimization (SEO) is the process of           to marketing. If you place a traditional                        to be a daunting task. We recommend          ROI (Return on Investment).                    What should it cost?
 it needs to have a design that conveys          improving the visibility of a website          print advertisement or do a direct mail                         planning a few posts throughout the
 the same experience a patient would get         or a web page in search engines via            campaign the audience might not be                                                                                                                          I always make the comparison to food.
 walking into your practice. The look and                                                       looking for your services and your best
                                                                                                                                                                month and have the practice manager          CMS
                                                 the “natural” or un-paid (“organic”                                                                            update the site once a week. With an easy                                                   You can eat fast food for little cost but
 feel of your website should match your          or “algorithmic”) search results. As a         hope is a little brand awareness. With the                      to use CMS, the website updates will         A Content Management System is a               it’s not the best quality. The industry
 brand and office culture. All of your           marketing strategy, SEO considers how          paid search results you know the user is                        only take a few minutes and the impact       software system which provides website         standard would be around $7,000-
 marketing should have a cohesiveness            search engines work, what people search        searching specifically for your specialty                       is dramatic.                                 authoring, collaboration and administrative    $12,000 depending on functionality,
 based on solid brand guidelines and a           for, the actual search terms typed into        and in your town.                                                                                            tools designed to allow users with little      size, and other variables like SEO, copy
 website is no different. Next, the site must    search engines and which search engines                                                                        Analytics – track your results               knowledge of web programming to create         writing, etc. The important thing is to
 be intuitive and easy to navigate. The user     are preferred by their targeted audience.      “Once you have them at                                                                                       and manage the site’s content with ease. The   get a firm that understands your needs
 should be able to get to any page on the site   Statistics show that when a user searches                                                                      Google Analytics is a free service that      CMS will allow you to edit/add/remove          and can develop a website that will be
 with one click making information available                                                    your site keep them...”
                                                 for something on Google they will visit                                                                        generates detailed statistics about the      content and images along with creating         appealing to your target audience.
 with little to no effort.                       the first result 48% of the time, the second   The average bounce rate* is 50%, that
                                                 result 18% and the third result 7%. If         means half the users that find your
 Why are these two things                        you’re not in the top three organic search     website never get past the home page.
 critical?                                       results you are losing potential patients.     If half the customers that walked into
                                                                                                your practice turned around and walked
 The web is the first place a decision           Pay-per-click vs. Organic                      out wouldn’t you make a change? The
 maker goes when looking for a new                                                              photography of your practice should
 service, even if a referring doctor makes       search results                                 be inviting and showcase images of the
 a recommendation the potential patient          Ideally your practice should appear in         staff, patient interaction/lifestyle, and the
 (or mom/dad). The potential customer is         both the organic search results and in         practice interior. The user should be able
 going to Google your practice name, and         the sponsored or paid advertiser section.      to quickly and intuitively find information
 the website must show up. Having a good         Research has shown that if a business          about your experience, services and
 website doesn’t just mean that it looks         appears in both places the user is far         contact information
 cool. Your website needs to be developed        more likely to click on your link…and the
 to the current industry standards in order      best part is 70% of the time the user will
                                                                                                * Bounce rate – Google defines this as the percentage of
 to minimize extraneous code that can                                                           single-page visits (i.e. visits in which the person left your
                                                 click on the organic results so you’re only    site from the entrance page).
 impact the density of keywords used for         paying for 30% of the traffic. Pay-per-
 organic search engine placement. It is          click campaigns like Google AdWords
 also important to have a CMS (Content           work on a bidding system. You can set
 Management System). The site should             a maximum bid for individual keywords



20 Clinical Review                                                                                                                                                                                                                                                                  Clinical Review                21
                                                                                                                                                                               rocky mountain orthodonticsTM



 Social Media                                    you should have 1-3 posts per day. Start
                                                 slow and build your social networking           The sum of all RMbondTM products equal
 If you are not leveraging any means             up as you feel comfortable with the
                                                 maintenance. Facebook is easy to set up
                                                                                                 Happy Patients and Happy Orthodontists
 of social media, it’s time your practice
 embraced the phenomenon.               Social   and would be the best place to establish
 media is the use of web-based and mobile        your network.
 technologies to turn communication
 into interactive dialogue. One of the           Marketing
 key components in achieving highly
 visible brands are the social networks          Effective marketing campaigns increase
 (Facebook, Twitter, Blogs, YouTube, etc).       the awareness of your practice/brand. By
 By creating networks via these tools you        tracking the ROI on different techniques
 can dramatically increase your market           (direct mail, pay-per-click, etc) you can
                                                                                                                                                 Inner Tray Material
 penetration at little to no cost to set up or   maximize your marketing budget. Your
 maintain. The only critical rule you must       campaign should start with a strategy
 follow is that you have to be active in your    for the next year. The plan should evolve
 social media. If you create a blog, which       based on results from each medium.
 is a great way to drive traffic to your site,   Remember, you can be the best but if                                        Dispensing Gun                                     Tray Finish
 I would recommend at least one post per         potential patients don’t know you exist,
 week. For Facebook and Twitter accounts         the practice will not continue to grow.


 www.zenmanproductions.com



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  Mention this Clinical Review article

                                                                                                              bond
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  or Rocky Mountain OrthodonticsTM to
  receive a free consultation with Keith
  at Zenman Productions.




                                                                                             650 West Colfax Avenue, Denver, Colorado 80204                            Synergistic Solutions for Progressive OrthodonticsTM
22 Clinical Review                                                                           P 303.592.8200 F 303.592.8209 E sales@rmortho.com                               800.525.6375 | www.rmortho.com
                                                                                                                            The Pats in the TC world exist, but they                                                      too aggressive and many must go home
                                                                                                                            are few and far between. To be a Pat,          Will You Dance The One                         and talk to Dad before making a final
                                                                                                                            you have to be in love, by actually loving     Step Or Two-Step                               decision.”
                                                                                                                            people, loving your patients, loving your
 The New        Patient Enrollment Process                                                                                  doctor, loving your practice and in love
                                                                                                                            with your job. That love and affection
                                                                                                                                                                           A lot has been made over a relatively new
                                                                                                                                                                           concept of going to a One-Step New
                                                                                                                                                                                                                          There is one more thing that really messes
                                                                                                                                                                                                                          things up with a One-Step and that is that
                                                                                                                            comes through in hundreds of verbal and        Patient Exam process. All this means           too often “everything but the kitchen
                                                                  By Ken Alexander, Millenium Management Group                                                             is that the practice tries to cut out the
                                                                                                                            non-verbal ways, and the results are that                                                     sink” is thrown into the discussion; tooth
                                                                                                                            the patients Start, and they refer their       Consultation, or Treatment Conference          brushing, wearing retainers, taking your
                                                                                                                            friends. Often not because of anything         and the doctor does his diagnosis at the       fair share of appointments during school
                                                                                                                            more than the fact that they have fallen in    first visit and gives a clear and relatively   hours, paperwork galore. The patient’s
                                                                                                                            love with Pat and the joy she exudes!          accurate treatment approach. Records           head is spinning by the time the visit is
                                                                                                                                                                           can be taken the same visit, and if the        done. After putting the patient’s mind
                                                                                                                            One time I videotaped Pat to use the tape      doctor’s suggested approach at the Exam        into overload we then wonder why she
                                                                                                                            as a training tool and when I left the room,   Visit matches his diagnosis, all proceeds      doesn’t remember anything about what
                                                                                                                            I left the camera on the table filming the     as planned. In the 10% of cases that           we just told her.
                                                                                                                            patient and parent paging through the          the doctor is unsure as to a treatment,
                                                                                                                            Before and After Album. All of a sudden the    especially if extractions or surgery may be    All the patient cooperation information and
                                                                                                                            patient blurted out, “I like this doctor!”     required, the doctor punts back to a two-      risks and limitations and other facts of the
                                                                                                                                                                           step approach and asks that the TC set         case are vital and must be communicated,
                                                                                                                            The Mom retorts, “She is not                   up the patient for a separate Consultation     but it is best to give only the bare
                                                                                                                            the doctor. She is just the nurse.”            Visit to discuss the treatment options.        minimum of facts on the first date and
                                                                                                                            “I know,” replied the patient, ‘but I really   In the very rare case after the review of      focus on the benefits of orthodontics and
                                                                                                                            like her!”                                     records the doctor discovers something         all the reasons why they should desire …,
                           The Art Of Relationship Selling                                                                                                                 in the records that makes him second
                                                                                                                                                                                                                            A Beautiful Smile that Lasts a Lifetime!
                                                                                                                            Needless to say, the patient signed up to      guess his original treatment plan given at
                           One of my best friends has sold everything       “Five exams and two consults are on the                                                        the Exam Visit, he asks the TC to set up         and w h y ,
                                                                                                                            start that day. It was their third opinion
                           from real estate, custom computer chips,         books today,” Sandy blurts out as she                                                          a phone consult or a separate consultation       Dr. Alexander is the Best Orthodontist in
                                                                                                                            and Pat’s practice was charging $500 more
                           and wealth building accounts. His secret         shakes her head. “When will it ever slow                                                       so that he, or the TC, may review the new        world for their little Suz y!
                                                                                                                            than the others for the treatment. Having
                           to fabulous success has always been to           down?” she thinks to herself as she walks       the right TC who loves others and knows        findings with the patient or parent.           One-Step, Two-Step or Three-Step,
                           capture the moments where the little             towards the Exam Room to get ready for          her stuff, and most of ALL knows how                                                          whatever dance you want to do for your
                           things mean a lot in a relationship. Each        battle. Sure she loves her job as Treatment     to win over new patients with a smile, a       One-Step Exams work great for many of          New Patient Enrollment Process is A-OK
                           time he would visit a prospective buyer or       Coordinator. She especially loves the           laugh, praise and appreciation; this TC        my clients, but they are not for everyone.     with this consultant as long as each step is
                           client he would listen carefully, not for the    thrill of getting the Start and making the      is worth her weight in gold. For great         As a matter of fact, no matter how hard        well-choreographed and it works to take
                           sale, but for the little personal things that    numbers each month. But really? “When           sales is all about relationships and there     some consultants push for a One-Step to        the patient from a point of an inquiring
                           the person would say to him about life,          would I ever have time to listen, to care,      is so much more to selling orthodontics        be done in the practice…,                      mind to a happy, satisfied patient who
                           love, and the things that were important         and to respond in a personal way that           than just giving information or getting a                                                     sings your praises and cannot wait to
                           to him. This listening was about all he did      builds a relationship? I am just too busy!”     patient to Start.                              “There is actually no real statistical         get started. To achieve this goal, it will
                           the first meeting and then he would jump                                                                                                        difference in exam-to-start percentages        require Relationship Selling from a terrific
                           into his BMW at the end of the visit, and        I have seen it over and over again in           Great practices have super stars who fill      between a One-Step or Two-Step                 TC with every step and every line of the
                           instead of scurrying off to the next sale,       practices large and small. TCs who see          all of the key positions in the practice.      Exam when both approaches are done             process must be properly choreographed
                           he would write down everything he could          three exams a day and others who see ten        Find a Super Star TC who loves her             correctly…and, in some communities,            and scripted for maximum effectiveness.
                           remember about the new potential buyer,          and few feel they have the time or energy       job because she loves people, and great        a One-Step will kill a practice’s exam-
                           especially those things that were personal.      to build a relationship that will be not        success is bound to follow.                    to-start ratio as the Moms perceive it as




                                                                                                                                                [                                                                                         [
                                                                            only the foundation for the Start, but also
                           “Yes, my wife just had a baby and there were     for future referrals.
                           some complications so she cannot come home
                           for three to four days.”                         There is one TC who used to see 8-10
                                                                            New Patient Exams a day. We will call
                           Immediately after writing such things            her Pat, just because that is her name. Pat
                           down he flew into action by calling his          is a master of relationship selling from the
                           secretary, and the next day flowers arrived      very first smile that she gives as she greets
                           at the hospital with a note remarkably           the patient and parent in the reception                                       There is actually no real statistical difference
                           written with wonderful praise and                area to the time that she gets the signature
                           appreciation telling the new mother how          on the contract. Pat can have the patient                                     in exam-to-start percentages between a
                           much her husband glowed when he spoke            and parent smiling and laughing with                                          One-Step or Two-Step Exam when both
                           of her and their new baby daughter.              her in less than five minutes, and when
                                                                            she goes to get the doctor she just has to                                    approaches are done correctly…
                           The sales tools of listening and responding      whisper to him with a smirk, “They’re
 Find a Rockstar           in a caring manner with praise and
                           appreciation are a lost art, especially in the
                                                                            sold, so don’t screw it up!”

 TC who loves the job      busy orthodontic practice.



24 Clinical Review                                                                                                                                                                                                                             Clinical Review           25
 Welcome To Our Home                                                                                                                           being used for consultations. We had                 average staff member has been here for         should be the TC’s show and the doctor
                                                                                                                                               to carefully extricate ourselves from the            7 years.”                                      comes in with just enough time to look in
 No you did not misread the line… it does                                                                                                      room one-by-one as the doorway was                                                                  the mouth, dictate his or her findings and
 say, “Home,” not “Practice.” The TC and                                                                                                       blocked with one assistant at the top of             OK, you don’t have to say that your office     make recommendations. Ten to twelve
 all staff should think of a New Patient                                                                                                       the attic stairs throwing toilet tissue              manager and lab person have been with          minutes is usually enough time to show
 as if they are a welcomed guest in their                                                                                                      down to another assistant impeding the               the doctor for 25 years, skewing the           off a warm, caring and knowledgeable
 home. Think about it for a second, but                                                                                                        passageway. Within months we had built               stats, but find all the great things about     doctor without having the doctor screw
 do you ever recall a time when you met a                                                                                                      a beautiful TC Room by bumping out                   the doctor and the practice that you           up the sale. Anything longer than fifteen
 person coming into your home and you                                                                                                          into the parking lot and the exam-to-Start           can artfully communicate in a genuine          minutes and an assistant should come to




                                                                                                                                                                                                    [                                                                             [
 did not pause for a moment and welcome                                                                                                        percentages rose 15% the next year.
 them with a smile? Yes, even your son                                                                                                         OK, it wasn’t just the room as we
 Joey’s friends who you do not really like                                                                                                     changed many things about the New
 all that much, you pause, you give them                                                                                                       Patient process, but if you are going
 a smile and hello, then head back to the                                                                                                      to sell a million or two in braces, you
 kitchen or to wherever you are going.                                                                                                         really should have the right place to
                                                                                                                                               do it properly, and the right tools.                          “Dr. Alexander is a warm and friendly doctor
 Should we not expect at least the same                                                                                                        And if you are less than a million,                           who treats his patients and his staff with
 from every one of our team members?                                                                                                           you need the room more than the                               kindness and excellence. It is not by accident
 When the office tour begins it is not                                                                                                         next practice does.                                           that the average staff member has been
 just for the front staff and the TC to be                                                                                                                                                                   here for 7 years.”
 welcoming, but every assistant should                                                                                                         Show And Tell
 lift her head and smile, or say “hello” or
 “welcome”; especially an assistant who is                                                                                                     I mentioned that you need the right
 running by the new patient on a mission                                                                                                       tools, but no tool is more effective
 to seat her next patient or stir the doctor                                                                                                   than a Before and After Album when
 from his office. Our practice must be                                                                                                         used properly. Would you ever buy
 welcoming, and if Dad sits in his big Lazy                                                                                                    a car without first test driving it and
 Boy with only a frown as he watches the                                                                                                       kicking the tires? What makes you
 tube when guests come over, few friends                                                                                                       think patients want to buy a beautiful               way, and spill the beans with each and         the door and stand quietly and smile, until
 want to come to visit, or they just tip-toe                                                                                                   smile without first seeing what it has done          every New Patient. Are these glowing           the doctor acknowledges her and quickly
 up away to a bedroom.                         least be warm and inviting when they do           The Right Room And                            for your other patients? I particularly              comments not the things you want said          wraps things up.
                                               come to visit?                                                                                                                                       about you in the community? If so, start
                                                                                                 The Right Tools                               like it when I walk into a TC Room and
                                                                                                                                                                                                    the rumor and you will soon find Moms          If the TC has done her job properly of
 Being a welcoming practice takes lots of                                                                                                      all around are beautiful pictures of your
 time and energy, but it is the foundation     L’Image De Mark                                   Not every office facility can be a WOW,       best finished cases. Sometimes I see                 coming to the practice repeating what          showing off the doctor’s work and telling
 on which all great customer service and                                                                                                       monstrous pictures up and down halls                 they have heard,                               the patient and parent wonderful things
                                                                                                 but every New Patient Room can be.
 marketing rests. Don’t stop with just         I love the way this sounds, “L’Image de                                                         and in the operatory, all professionally                                                            about him, the doctor does not need to try
                                                                                                 Whatever you do when designing your
 New Patients but welcome every patient        Mark !” It’s the French way of kind of                                                          taken and showing off the practice’s                 “I heard that Dr. Alexander has a super        too hard. Just spend a few minutes talking
                                                                                                 facility never skimp on the TC Room, or
 at every visit with big smiles and warm       saying “trademark” but it encompasses                                                           terrific work. There’s so much more to               reputation for quality.”                       about things you may have found out you
                                                                                                 on getting all the right tools to sell your
 hellos. What the heck, we only see them       so much more in that your “L’Image de                                                           selling orthodontics than just saying the                                                           have in common with the patient; sports,
                                                                                                 cases. I am constantly amazed at how
 once every six to eight weeks, can’t we at    Mark” sets you apart from others in an                                                          right things and smiling. Knowing when               “And Mrs. Jones, whom may we thank for         hobbies, etc. Then have the patient hop
                                                                                                 poorly designed many TC rooms can be
                                               exciting way. I just visited a practice in                                                      and how to use your Before and After Album           saying such nice things about us?”             up into the exam chair. Yes, I much prefer
                                                                                                 and that they do not have the fabulous
                                               Lincoln, Nebraska where the doctor has                                                          can be just the thing to get your patients                                                          not to have the patient in the exam chair
                                                                                                 ICAT or Dolphin Aquarium programs                                                                  “My sister Gloria had her daughter Taryn
                                               captured this concept of L’Image de                                                             begging for what you have to offer, instead                                                         until the doctor invites them to jump in.
                                                                                                 that make selling orthodontics so easy.                                                            start in your practice two months ago and
                                               Mark” so beautifully in her Harrewood                                                           of you begging them to Start!                                                                       Then a few more seconds of banter about
                                                                                                 Your TC Room should have a long, narrow                                                            she told me all about you guys.”
                                               practice. The theme is Hollywood and the                                                                                                                                                            the flavored gloves and off the doctor goes
                                                                                                 table that allows at least the patient and
                                               movies, with a built in theater and lots of                                                                                                                                                         dictating the clinical findings while the
                                                                                                 parent, and perhaps two parents, to sit       Dr. Who?                                             Look at that… positive rumors about the        TC types furiously. Anything the doctor
                                               movie stars posted all around. When the           comfortably across from the TC. There
                                               patients walk through the front door they                                                                                                            doctor can be a powerful marketing tool        forgets in his dictation the TC can ask the
                                                                                                 should be an Exam Chair in the room so        Well, Dr. Who is a great TV series in                to create confidence in the practice. Who
                                               know they are in for something special                                                                                                                                                              questions. “But really doctor?” Within just
                                                                                                 you do not have to switch rooms or go         the UK, but that is not what I mean.                 better to start the rumor with than the
                                               in this place, and it truly is special, but                                                                                                                                                         an hour you can memorize the dictation
                                                                                                 to the operatory to do the clinical exam.     One of the most effective sales tools in             New Patient?
                                               especially because of the fabulous glassed                                                                                                                                                          sequence and so not to keep forgetting
                                                                                                 Having the right TC, TC Room, and the         orthodontics and in all of dentistry is
                                               in New Patient Room and a relationship                                                                                                                                                              things. It is quite impressive if you can get
                                                                                                 right tools can easily increase the exam to   when your terrific TC says nice things
                                               selling TC, named Suzy. Really… her name          Starts by a good 7-12%.                       about the doctor and the practice and                Dr. Who Has Arrived                            the teamwork with the dictation to match
                                               is Suzy.                                                                                                                                                                                            up perfectly.
                                                                                                                                               actually means it! This is one of those areas
                                                                                                 Years ago I watched an exam being done        that is so weak in most New Patient Exam             We almost got through an entire article
                                               Suzy has a huge advantage over other TC’s                                                                                                            on New Patient Enrollment without              Then all that is left is to show the patient
                                                                                                 with the right TC and no exam room.           presentations and yet can be so powerful in
                                               because the office facility is a WOW, and                                                                                                            having the doctor even come in the room.       and parent what is going on in the patient’s
                                                                                                 It was one humorous interruption after        getting the Start if it is just scripted well, and
                                               then with Suzy’s warmth and experience,                                                                                                              Yes, the doctor plays an important role,       mouth and what will be necessary to
                                                                                                 another. The coup de grâce was just after     done in the right timing. “Dr. Alexander is
                                               getting patients to Start is normally a breeze.                                                                                                      but in most of my clients’ practices, and      lasso the teeth to bring them into their
                                                                                                 the patient signed the contract using         a warm and friendly doctor who treats his
                                                                                                                                                                                                    most are seeing over 75 patients a day, the    proper place in the mouth. This is
                                                                                                 a Good Housekeeping magazine to               patients and his staff with kindness and
                                                                                                                                                                                                    doctor needs to play just a small role. This   where taking photos prior to the doctor’s
                                                                                                 write on in the computer room that was        excellence. It is not by accident that the



26 Clinical Review                                                                                                                                                                                                                                                      Clinical Review            27
                                                                                                                                                                                                                                               rocky mountain orthodonticsTM


 arrival is indispensable for excellent
 communications. Seat the patient back
                                                creative in overcoming objections and
                                                you will find cases you never thought
                                                                                                 Hands down nothing else comes close.
                                                                                                 That is why being a TC is the most fun job
                                                                                                                                                                              Why wait for the
 around the consult table and show them
 on a big 24”-28” screen exactly what is
                                                would Start coming back into the office
                                                for braces. Unfortunately, many TCs are
                                                                                                 ever in orthodontics. Thank you Frank
                                                                                                 Edwards, Dean Bellevia and Ellen Grady                                       perfect smile?
 happening with their teeth and what            on to the next Exam and have no time             for designing the original TC role and
 you would like to correct. Answer any          for this relationship business that requires     allowing doctors to save oodles of doctor
 questions then get out of there to keep        persistence in getting follow-up patients        time while giving TCs the opportunity to
 the assistants on time, leaving the TC to      into treatment.                                  help others. If it is only about the sale, you
 do her job selling the case.                                                                    will often lose the sale. But if it is about
                                                And yet we will spend a lot of time,             the relationships, you will be creating a
 When “No” Means                                money and energy trying to get another           foundation where your happy, satisfied
                                                                                                 patients and their parents go back to your
 Maybe                                          New Patient into the practice before
                                                                                                 community and to their family dentists
                                                using some of that energy to love a busy
                                                parent enough to check in on them to see         shouting your praises. Now, isn’t that
 In sales we are taught to be a little hard
                                                how we can help move them into a Start.          a lot more fun than advertising in the
 of hearing. When someone says “No, I
                                                Follow-up work is not the glamorous part         newspaper or taking on a discounted
 am not interested” or “I need to talk to
                                                of the job, but it can pay the entire salary     insurance plan? Get your New Patient
 my husband,” the best TCs take this on as
                                                of a good TC each year with the extra            Enrollment Process in tip-top shape and
 a personal challenge to find out if “No”
                                                Starts she gets going in the practice, all       watch your practice grow by adding to
 really means “Maybe.” Often a parent
                                                because she cared.                               your family of happy patients who you
 is not prepared to make the decision
                                                                                                 have given something to smile about.
 that day, or really does need to go home
                                                                                                 Always remember what my a ten year old
 and discuss it with their spouse, yet the      It’s All About                                   told me one day and you will never take
 TC’s head starts hanging and her throat        Relationships                                    your eyes off of what counts in life:
 starts tightening up as she thinks that the
 doctor wants the Start and I am a failure      If you have been one of Ken Alexander’s          “If you are not helping others, you are not
 if I do not get it today!                      terrific clients over the years you know that:   helping yourself.” Cassi Alexander
 No, not everyone will Start in your
 practice, especially not at the first visit.         Relationships are
 Besides, we believe in relationships and             the Most Important
 so we maintain our smile and enthusiasm              Things in Life!
 all they way through the exam. Hey,
                                                                                                                                                  Functional Education
                                                                                                                                                                                                          TM

 many patients do come back, so give it
 your best shot and don’t take “No” for
 an answer. Instead look at how you might
 overcome any objections. You will never
 know the objections if you do not ask, and
 then you must have the right scripts to be
 able to overcome the objections without
 fumbling around for the right words. The
 TC position is a sales job, and great sales
 people know how to turn a “no” into a
 “yes” in an intelligent and caring manner.
                                                                                                                                                               Multi-S                     Multi- T                      Multi-P                      Multi-TB
                                                                                                                                                                         TM                           ®                        ®                                 TM




 Track’em & Follow’er Up!
                                                                                                                                                           2                    16+    2                       16+   2                   16+      2                      16+


 Anyone who gets out of the New Patient
 Exam without making an appointment
 needs to get onto a tracking system and
 then followed up within 7-14 days.

 “Mrs. Jones, I came across Suzy’s chart on
 my desk today and I was just wondering if
 there is anything I can do to help her get                                                                                                           The Multi Family TM System,
 started with her beautiful smile?”                                                                                                                   Functional Education Appliances, is an
 Now you are back to listening and to
                                                                                                                                                      integrated system of appliances that
 finding those things that will regain the                                                                                                            allow the doctor to choose the ideal
 relationship and bridge the gap between                                                                                                              appliance according to the age and
 the buyer’s needs and what the practice                       ...And that is why being a TC is the                                                   the malocclusion of the patient.
 has to offer them. Listen well and be                          most fun job ever in orthodontics.

                                                                                                                                                  650 West Colfax Avenue, Denver, Colorado 80204                                   Synergistic Solutions for Progressive OrthodonticsTM
28 Clinical Review                                                                                                                                P 303.592.8200 F 303.592.8209 E sales@rmortho.com                                      800.525.6375 | www.rmortho.com
                                                                    rocky mountain orthodonticsTM




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30 Clinical Review                                    800.525.6375 | www.rmortho.com
                                                                                                                                              It’s not too late                                   out the other end with a solution that         you can begin to develop a strategic road
                                                                                                                                                                                                  exceeds everyone’s expectations. That’s        map – improving your touch points and
                                                                                                                                              Yes, sometimes brands do lose their way and         the element of surprise!                       cultivating your message through any
                                                                                                                                              can be seen as being unloved! However,                                                             given media. It is essential to find the
 Become A ‘Big              Deal’ - Uncover Your True Identity                                                                                the good news is that with a little care            Plan ahead                                     right resources to make your ‘BIG Deal’
                                                                                                                                              and attention you can initiate the road to                                                         dreams a reality. Source an agency that
                                                                                                By Bridgette Owens, 7 Group Advertising       recovery. Begin small by updating your              Developing strong campaigns take time          will engage you in an open and honest
                                                                                                                                              business card; this will ‘start the ball rolling’   and effort, so give yourself the opportunity   relationship, willing to take on the hard
 The ‘7 Group’ Guide To                                                                                                                       reminding you of your commitment to                 to participate by setting your projects and    tasks, and with the experience and vision
 Brand Development                                                                                                                            change every time you present it.                   deadlines ahead of time i.e. start planning    to say ‘how it is’. An independent and
                                                                                                                                                                                                  your Valentines day promotions at the          objective view on all marketing decisions
 And Strategic Planning                                                                                                                                                                                                                          will help you to be that one step above
                                                                                                                                              Be consistent                                       beginning of January. By clearly defining
                                                                                                                                                                                                                                                 the rest.
                                                                                                                                                                                                  your goals you allow time to strategically
                                                                                                                                              It’s easy to become absorbed in the design of       plan and cross promote your marketing
                                                                                                                                                                                                  initiatives, giving you the best value for     So understand it, believe in it and get out
                                                                                                                                              each marketing piece, but ask yourself, how
                                                                                                                                                                                                  your dollar.                                   there and promote it in everything you do!
 “So what is a brand?                                                                                                                         does this relate to my other campaigns?
 I already have a logo -                                                                                                                      Am I maximizing my marketing dollars                                                               *Anchorman: The Legend of Ron Burgundy, Dir.
                                                                                                                                              spent by cross advertising? Investing a             “I don’t know how to put this                  Adam McKay, Will Ferrell, 2004
 isn’t that enough?”                                                                                                                          little thought in your marketing initiatives        but... I’m kind of a BIG deal”*
                                                                                                                                              will create a whirlpool effect, leading your                                                       www.7groupus.com
 A brand is the sum of the subconscious,                                                                                                      efforts full circle.
 sensory and emotional elements that make                                                                                                                                                         In today’s competitive market it’s more
 up the total experience of your medical                                                                                                                                                          important than ever to deliver a fresh,
                                                                                                                                              Consistency is the key to great exposure.           inspiring brand identity. By defining your     Mention this Clinical Review article or Rocky
 practice. It encompasses every touch-                                                                                                        Assign a brand guardian in order to sustain                                                        Mountain OrthodonticsTM to receive a free
 point you have with the world, patients                                                                                                                                                          unique proposition and market position         consultation with Bridgette at 7 Group Advertising.
                                                                                                                                              campaign coherence. Seek someone who
 and prospective patients, making it so                                                                                                       has the experience, the knowledge and
 much more than a ‘logo’ or an advertising                                                                                                    most importantly the passion to provide
 campaign.                                                                                                                                    you with this service.
 Everything you do reflects upon your                                                                                                         For example, your business card, magazine
 brand. The moment a patient intersects                                                                                                       advertisement, direct mail, Facebook fan
 with any part of your practice they are                                                                                                      page, online banner advertisements etc.
 forming an opinion of their experience                                                                                                       should all correlate to one another.
 and the services to follow.
                                                                                                                                              The consistency of your product along
 Therefore, the positioning of a brand in                                                                                                     with the frequency and visibility of your
 the minds of the target market happens                                                                                                       campaigns greatly increase your chance
 whether you’re pro-active, reactive or                                                                                                       of a prospective patient choosing YOU
 passive, making it important to take                                                                                                         when the time is right.
 charge and actively manage at every
 step. The world is a stage, so let’s start
 performing!                                                                          Uncover Your True Identity                              Make your marketing
                                                                                                                                              dollars work
 It’s an attitude thing                           It is a promise of value to different
                                                  audiences and the manifestation of your
                                                                                               R&D                                            Creativity drives innovation, inspires
 No matter how different you make the                                                                                                         actions and provokes reactions. It is the
                                                  mission and strategic priorities.            In order to strengthen your brand and          art of selling, not telling. Be creative!!! It
 logo it will not reflect your brand unless
 you change the attitude and put life back                                                     improve campaign validity you must             doesn’t always have to be costly in order
                                                  Think about the things that make you and     ‘do your research’. Who is your target         to grab attention; with modern social
 into the brand at all levels. Brands are         your practice unique. Is your marketing
 experiences that live in the hearts and                                                       market? What are their values? Spend           media products such as Facebook, Twitter
                                                  material clearly portraying the attention    some time understanding what drives this       and YouTube you can obtain maximum
 minds of people and this starts with your        to detail you posses in your work? Is your   demographic to make decisions and/or
 team and core beliefs. It is difficult for a                                                                                                 exposure with minimal costs.
                                                  material current and up to date? Out of      instigate change.
 potential customer to buy into your brand if     date material suggests that you are out
 your team does not reinforce it’s core values.                                                                                               In our experience the best results are
                                                  of touch, opening the door for doubt         Make sure to keep an open mind as              always achieved through a stimulating
 A strong, well loved brand breeds pride.         regarding future services.                   the answers may differ from your               combination of pleasure, pain and open,
                                                                                               personal values. By correctly targeting your   honest communication.
 Defining your brand                              Defining your brand ultimately unites        demographic the probability to ignite buzz
                                                  your team in a common goal and vision.       and create the desired response from your      There’s nothing more enjoyable than
 By not clearly defining a brand personality      It informs your audience how to react,       campaigns increase significantly.              taking a bunch of communication goals,
 or a relationship with all stakeholders the      presenting them with the tools needed to                                                    giving them a good shake-up and coming
 major potential of the brand is ignored.         participate and the vision to identify.


32 Clinical Review                                                                                                                                                                                                                                                       Clinical Review               33
                                                                                                                                          It is important that assistant time is         and is perceived of being too busy?
                                                                                                                                          managed appropriately. Nothing eats            Those who fail in the timeliness of each
                                                                                                                                          away at assistant time more than a doctor      appointment make an implicit declaration
                                                                                                                                          who cannot, or will not, get to his/           to their clients that they are at their
 On-Time                  Doctor Time Scheduling
                                                                                                                                          her chair in a timely manner. While
                                                                                                                                          consulting, I often ask the question, “If
                                                                                                                                                                                         maximum capacity. Worse yet, many
                                                                                                                                                                                         scheduling templates do not allow the
                                                                                                                                          you could have the doctor at your chair        practice to capture all of the new patients
                                                                                  By Ken Alexander, Millenium Management Group
                                                                                                                                          the instant you needed him/her, how            and Starts who would want to join the
                                                                                                                                          much time could you save each day?”            practice because the delay in the peak
                                                                                                                                          Would it astonish you to know that the         months pushes some Starts off to other
                                                                                                                                          typical answer is 2 hours and sometimes        more efficient practices.
                                                                                                                                          3-4 hours of lost or less productive time...
                                                                                                                                          per assistant!?!                         There is no number of patients per day that
                                                                                                                                                                                   will dictate if a practice can stay on time. I
                                                                                                                                          For some scheduled days, commitment have worked with practices who were not
                                                                                                                                          can overcome a poorly designed Template, able to stay on time at 30 patients a day,
                                                                                                                                          but when the Template is poorly planned and yet some of my shining stars see
                                                                                                                                          and executed every day, then frustration 120-150 patients and stay relatively on-
                                                                                                                                          turns to apathy and both doctor and time. Many factors play into developing                   then organized in the most effective
                                                                                                                                          staff may give up on trying staying on the right Doctor Time Templates and the                manner to win the game, and winning
                                                                                                                                                                                                    ideal scheduling system             means achieving the doctor’s goals. Yes,
                                                                                                                                                                                                    that is customized for each         it requires experience, an analytical mind
                                                                                                                                               Most of the time the scheduling                      practice to stay on time.           and proper planning, but if the consultant
                                                                                                                                               problem is not that the lack of                      Here is a quick look at             has done his job correctly at the end of
                                                                                                                                                                                                                                        the process he often hears from a staff
                                                                                                                                               assistants, but that the doctor and the main components for                              member,
                                                                                                                                                                                                    designing an On-Time - Doctor
                                                                                                                                               assistant time is poorly planned.                    Time Scheduling system.
                                                                                                                                                                                                                                               “This is so easy, why
                                                                                                                                          time. Obviously if you have given up           It’s a Chess Match                             didn’t we think of that?”
                                                                                                                                          on your schedule you have reached your
                                                                                                                                          maximum and your potential for growth          One of my greatest assets as a consultant      Working with the right consultant who
                                                                                                                                          is being squandered. The only way to           is that I was a big chess player all the way   has been properly trained and has visited
                                                                                                                                          reach your peak performance and greatest       through college. I once was challenged         hundreds of other practices is vital to
                                                                                                                                          potential is to plan for it with On-Time –     by a dorm mate that he could beat me if I      getting the most out of your practice
                                                                                                                                          Doctor Time Scheduling.                        did not look at the board. Three days later    scheduling system. Some practices can get
                                                                                                                                                                                         I said: “checkmate” and won the match.         good at it, but I have yet to find a practice
                                                                                                                                          Being on Time is Vital to                      OK, I got really lucky. Consulting is          where the scheduling system could not be
                                                                                                                                                                                         much like a chess game with many pieces        greatly enhanced. Remember, the goal
                                                                                                                                          Practice Growth                                that must be discovered and understood,        is not to complicate things but to make
                                                                                                                                          Maintaining an efficient scheduling                                                           things as simple as possible. As Albert
                                                                                                                                          system is the single most important                                                           Einstein rightfully stated,
 I find no greater challenge or enjoyment
                                 difference between what a practice can                    with the doctor time built into them and       factor in growing and sustaining an
 as a consultant than in helping my clients
                                 do in designing a Template and what any                   make sure that the doctor is not needed at     orthodontic practice. The goal of every                                                            “Everything should be
 develop a scheduling system that gets
                                 of the top scheduling consultants can do                  more than one place at one time. This is       doctor should be to not only reach their                                                      made as simple as possible,
 them on time, keeps them on time and
                                 for you, is the difference between a sharp                easier said than done and often requires       peak potential, but also to practice each
                                                                                                                                          day at their highest level of efficiency
                                                                                                                                                                                                                                        but not one bit simpler.”
 allows the practice to grow. Creating
                                 axe and a dull one. Many doctors cave                     the experienced consultant to coach
 such a system takes time, usually a day’s
                                 in to a short-term solution of throwing                   the orthodontic team towards healthy           and competence. Practices tend to grow                                                                           Albert Einstein
 worth of consulting, but as Abe Lincoln
                                 another new hire at the scheduling                        standards and habits. For the growing          to their level of maximum capacity, or
 once said,                      problem instead of taking the time to                     practice the challenge may hit big             should I say slight incompetence, and                                                         Make it too simple and it’s not very
                                          work through a complete system                   obstacles as the fish may have outgrown        then stop growing. The understanding                                                          effective, make it too complex and no one
                                          with an experienced consultant; a                the aquarium and the practice needs 8          of the key components of On-Time -                                                            can follow it or make it work. To make
    “If I had eight hours to chop         system that will often last them                 hours of doctor time in a 7 hour work          Doctor Time Scheduling is the first step                                                      it effective means getting every team
    down a tree, I’d spend six            their entire career, with just a few             day, or the office does not have enough        towards building your foundation for                                                          member on board with understanding
    hours sharpening my axe.”             sharpening sessions.                             treatment chairs, or maybe the size of         peak performance and sustained success.                                                       their individual role in staying on time.
                                                                                           the office is too small. Proper planning
                                                       Over the past 28 years I have       requires good decisions as to where the        A Doctor Time Schedule will keep the
 Most practices have heard of a Doctor        been a large part of popularizing the        doctor can delegate more, speed up or          doctor and team on time, but just as
 Time Scheduling and most computer            concept of Doctor Time Scheduling            improve efficiency, but nothing can hold       importantly it gives the signal to patients
 systems can easily pre-code each day to      that is used in a majority of orthodontic    a schedule back more than a lack of the        that you can handle more growth. Why
 allow for the Templates to juggle doctor     offices. The concept is simple... plan out   basic resources so that the fish can fit and   would a patient send their friends to a
 time for maximum efficiency. But the         an entire day for all necessary procedures   survive in the aquarium.                       practice that cannot meet their needs



34 Clinical Review                                                                                                                                                                                                                                           Clinical Review            35
                                                                                                                                                                           rocky mountain orthodonticsTM



                                                 Steps to Scheduling                           right with the number of scheduling codes
                                                                                               needed per day is a set of math equations
                                                 Success                                       that only an experienced consultant best
                                                  Step #1: Look at all your procedures         understands.
                                                  and develop an assistant/doctor/
                                                   assistant time for each procedure you       Step #4: Now go ahead and design the
                                                    see routinely. Determining accurately      Templates. If you know all of your puzzle
                                                     exactly where the doctor time falls       pieces or scheduling codes, and you know
                                                      in each and every procedure and          how many you need each day in your
                                                       for how long in exact minutes is        Template, armed with a pencil and large
                                                        vital to developing any workable       eraser you can begin to create your game
                                                         Scheduling Template.                  plan by putting together your puzzle in
                                                                                               such a way that the doctor time is juggled
                                                         Step #2: Try to combine as            properly. Ideally, the doctor time never
                                                        many treatment procedures into         conflicts and the doctor is never needed
                                                                                               at more than one place at a time. This job

                                                                                                                                                     Treat the
                                                 as few scheduling codes as possible
                                                 while insuring the doctor time and            can be greatly enhanced by the Millenium
                                                 assistant time matches up relatively          Template Designer software program

                                                                                                                                                     parents like you
                                                 well. Remember, we are not looking            that I have used for the last eight years to
 The Puzzle Pieces                               for perfection, but something that is         greatly simply Template design, it may hit
                                                                                               the market soon.

                                                                                                                                                     treat their kids...
 The first step is to determine the puzzle       workable. So keep it simple by having
 pieces. The vast majority of practices that     fewer than 25 total scheduling codes that
 stay on time are those that have identified     will serve your hundreds of procedures        Oh! by the Way!
 each of their routine procedures in             by appropriately taking into account the
                                                 doctor and assistant time.                    Did I forget to tell you that you really should
 treatment and established an appropriate                                                      calculate if you have enough of the practice
 amount of doctor and assistant time, at                                                       resources of assistant time, doctor time
 the right times, to complete the work, on       Step #3: Determine how many of each
                                                 scheduling code you will need to see          and total number of chairs before you start
 time.                                                                                         designing your Templates? Designing a
                                                 each year, each month and finally each
                                                 day. Many of the computer systems today       Template that is missing a key resource, like
 The top companies such as airlines and                                                        not enough chairs, or not enough doctor
 factories schedule for success to stay on       will tell you how many of each procedure
                                                 you have seen for a month or year, and        time in the day, can lead to the futile exercise
 time. Imagine Continental Airlines not                                                        of rearranging the chairs on the Titanic. It
 having gate agents arrive on time to check      you simply must divide the procedure
                                                 numbers by the number of days worked          might be a little better when you are done
 passengers onto the plane, the food truck                                                     than had you made no attempt to improve the
 being late, the gas man forgets to come,        in the period surveyed to determine how
                                                 many of each procedure, or scheduling         scheduling system, but it will sink each day
 pilots showing up at the last minute,                                                         because your problem is the lack of necessary
 and the list goes on. Hundreds of little        code, you will need on your daily template.
                                                 Barring that, count up two months worth       resources. You will just keep bailing water
 things must all be scheduled properly for                                                     until you discover the missing resources and make
 the flight to take off on time, and this        of scheduled patients and divide by
                                                 the number of days worked those two           the right decisions that will resolve the deficits.
 must happen over and over again for the
 thousands of flights each day. If airlines      months. For the consultants, you can
 can stay relatively on time, except for         tell us your treatment technique and we
 the occasional bad weather, so too must         can get pretty close to planning the right
 the orthodontic practice juggle its many        numbers if we know how many patients
 pieces to develop a daily game plan that,       the practice wants to Start. Getting it
 if followed each day, will lead to daily
 success. With a little hard work and
 proper planning, the orthodontic practice
 can determine its many puzzle pieces and
 get them all to fit properly into a daily on-
 time schedule.




 You will just keep bailing water until
 you discover the missing resources...


36 Clinical Review                                                                                                                                                                      Clinical Review    37
 It’s Not Evolution... It’s by Design                                                                                                         training in your scheduling principles will    throughout the day. Everyone must be          patients, or as Betty Sanders rightfully
                                                                                                                                              allow patients to participate in keeping       disciplined enough to do their jobs or        points out in her book Fabled Service,
 It is in the actual design of the Templates                                                                                                  you on time with calling in advance with       their part of the teamwork to make the
 that most practices fail. What often                                                                                                         breakage, arriving five minutes ahead of       scheduling system run on time. About          “After all, service is nothing more than the
 happens is that the Template starts looking                                                                                                  their scheduled time to be brushed and         60% of a great scheduling system is           reflection of esteem in which you hold others.”
 really good with 50 codes and then the                                                                                                       ready to go, and being courteous to call       properly designed Templates, but the          Betty Sanders
 designers realize that there still are 10                                                                                                    early if they must cancel an appointment.      final 40% is the teamwork needed from
 more codes that have to get in but they                                                                                                                                                     all parts of your village to make things go   Do you love your patients and parents,
 are out of resources! So the extra codes                                                                                                     Critical to staying on time is to have         smoothly and to stay on time.                 and most importantly do you esteem
 get shoved into a column with no chair or                                                                                                    scheduling coordinators who will fill in                                                     them and their time? Then you have no
 assistant, or placed in columns where the                                                                                                    the Templates as designed and use the          Discipline is Another Way of                  choice but to get on-time and stay on-
 doctor time is overbooked. Worse yet, the                                                                                                    proper substitutions if they cannot find the                                                 time. Running consistently more than ten
                                                                                                                                              appropriate code that meets the patient’s
                                                                                                                                                                                             Saying “I Love You!”                          minutes behind tells your patients that
 new Template may not plan any breaks
 for the assistants as each appointment is                                                                                                    needs. Obviously long procedures during        It makes the consultant a bit crazy when      you are either too busy for them or you
 stacked one upon the other with no time                                                                                                      school hours and short procedures after        he arrives at a practice that has a big       do not highly esteem them as you should,
 for a late patient or breakage patient. The                                                                                                  school is the only way to meet the majority    scheduling problem and he watches the         or could. Sure mistakes or unplanned
 consultant is a realist and he will guide a                                                                                                  of patient needs without working until         clock strike 8:00 a.m. and the morning        occurrences will happen that may set you
 practice into how to overcome the lack                                                                                                       8:00 p.m. Too much deviation from the          huddle discussion continues on. Finally       behind by 20 or 30 minutes in a day, but
 of resources so that the practice can stay                                                                                                   Template and its legal substitutions will      at 8:03 a.m. the assistants scurry to their   it is no worry, if you can consistently stay
 on time and continue to grow. Planning                                                                                                       put a practice right back to where they are    positions to grab the 8:00 a.m. patients,     on time with the vast majority of your
 an extra 8-10% more codes each day                                                                                                           eating mincemeat pie.                          yet one or two still have some coffee to      appointments.
 than the practice needs will insure not                                                                                                                                                     finish, restrooms to use and to chat in
 only continued growth, but also room                                                                                                         The doctor must be on his/her best             a corner while their patient is waiting.
 for rebooking cancellations, repairing                                                                                                       behavior throughout the day to focus on        Discipline is all about love, because
 breakages and seeing patients in 3-4                                                                                                         being on time, and talking to patients and     without discipline you cannot show your

                                                                                                                                                                                                                                                           I
 weeks to finish them up.                                                                                                                     parents is quite acceptable and a part of      patients that you truly esteem them and


                                                                                                                                                                                                                                                         Heart
                                                                                                                                              the job, but most of the talking must be       value their time. I find it ideal when
                                                                                                                                              done when the doctor is not needed at a        instead of being late to the operatory in
                                                                                                                                              chair. Assistants must work to the time        the morning, the morning huddle finishes


                                                                                                                                                                                                                                                          You
                                                                                                                                              allotted them for the procedure and be         five minutes in advance and at least two
                                                                                                                                              aware of when the doctor is to arrive in       assistants who are ready to go, run into
                                                                                                                                              their chair. They must always be at the        the waiting room and grab the early
                                                                                                                                              chair when the doctor gets to their chair      arrivals to take them back to the chairs
                                                                                                                                              so as not to cause any loss of doctor time     to get started. That is honoring your




 Consistency is the Road to                    and when the doctor or an assistant            of Templates may not contain enough of
                                               can take a break, but it also allows the       these missing codes. It is also possible
 Success                                       practice to know where modifications           that the assistants may be requesting an                                                                      Run your day on time...
 When I go into a practice I am often asked    are necessary. If the schedule is always       incorrect code, and with a little retraining
 to try and “fix” the scheduling without       falling behind at 9:00 a.m. and it is slow     to get all the assistants to select the ten
 significantly changing the basic system. I    at 11:00 a.m., sometimes just taking           minute “A” Activation code for reties
 usually ask, “Which schedule do you want      an observation patient out at 9:00 a.m.        instead of the 20 minute “AW” Archwire
 fixed, Tuesday’s or Thursday’s; a week ago    and moving it to 11:00 a.m. makes the          Code, this could solve the problem as it
 Tuesday’s or Wednesday’s?” Any practice       Template flow beautifully again. It takes      gets everyone back to using the Template
 that does not fill in a defined Template      a few hours to design a great Template,        as designed. But if more AW’s are needed,
 essentially is asking the receptionist to     but most often, it takes only minutes to       all one has to do is look for where there are
 bake a different cake or pie each day and     properly modify well designed Templates        consistently unused codes in the Template
 then in the morning huddle she says,          to keep them humming at maximum                and place some extra AW’s in these excess
 “Surprise, look what I have baked for you!    capacity and efficiency.                       code spots making sure to properly juggle
 It’s upside-down cake or mincemeat pie!”                                                     doctor and assistant time. Viola! Another
                                               Another attractiveness of a well designed      3-6 months of an effective Template.
 So what if your practice could see the same   Template is that it is somewhat “self-
 number and the same types of procedures       regulating” in that it will tell you if you    It Takes a Village to Run a
 at the same time every day. Don’t you         have planned too many or too few of
                                               any particular scheduling code. If the
                                                                                              Practice On-Time
 think you might get good at it? Seeing the
 same Template’s worth of patients each        receptionists are constantly searching for     Everyone must participate to effectively
 day allows a practice to not only get good    a specific code that is not available within   run an On-Time – Doctor Time Scheduling
 at knowing when the doctor is needed,         the normal rotation then the weekly set        system, even the patients.       Proper



38 Clinical Review                                                                                                                                                                                                                                               Clinical Review             39
 The Principle of Patient                       occurrence under control and avoid           trampling on the needs of your good         Isn’t it Always About                        On-Time – Doctor Time Scheduling is the        timeliness of each appointment and total
                                                the nuclear meltdowns that often occur       cooperators. Whatever you decide to                                                      secret to the super success of most of my      treatment time.” Ken Alexander
 Cooperation                                    because we panic and are not properly        do, make sure the parent is completely      Relationships?
                                                                                                                                                                                      busiest clients because no matter how
  Every good team needs to know the             prepared to make quick repairs. If there     informed, especially if they must wait as   No system in the practice will affect the    many patients want into the practice we        So now you know how to build an
 rules, but some rules are not rules at         is not extra time to do the planned          they may have other errands, or a child     relationships more than poor scheduling.     figure out a way to keep them on time.         effective scheduling system. Give it a try
 all, but simply principles and good            procedure, make the patient comfortable,     who needs to get to ballet, or soccer       The stress from being late often filters     Sure it takes hard work and discipline, but    and spend some time sharpening you axe
 guidelines. Ask this consultant what to        change their ties and then reappoint for     practice.                                   into the relationships between doctor and    the system itself has been turned into a       so that you can easily cut through your
 do about a patient that arrives late or has    the procedure a few weeks down the road.                                                 staff and staff members with each other.     science by this consultant and with a set      work load each and every day. If you need
 something broken and he will always say,                                                                                                Needless to say, patients and parents        of mathematical equations then coupled         help, call on an experienced consultant
 “It depends.” There is no hard fast rule       Late patients are another natural disaster                                               do not look fondly on the practice that      with great principles and the right mix        who understands On-Time – Doctor
 that governs these moments of truth, but       in the practice that again must be handled                                               cannot meet their needs by staying on        of discipline and goodwill. Soon each          Time Scheduling, and do not give up until
 rather a principle that says,                  with the best customer service while not                                                 time, and some may stop referring their      client finds a stress free day that allows     you are once again running your practice,
                                                                                                                                         friends. Referral sources hate to look bad   for rescheduled appointments, breakage,        instead of your practice running you!
   “No regularly scheduled                                                                                                               by sending one of their valued patients to   and practice growth, but most of all they
                                                                                                                                         a practice that is regularly tardy. I have   are able to meet the patient’s definition of   Mention this Clinical Review article or
   patient should be kept                                                                                                                often quipped to my clients,                 being on-time, which is:                       Rocky Mountain Orthodontics TM to receive
   waiting because of a                                                                                                                                                                                                              a free consultation with Ken at Millenium
                                                                                                                                                                                                                                     Management Group.
   poor cooperator!”                                                                                                                     “In orthodontics, staying on time is close   “Meeting or beating the expectations
                                                                                                                                         to godliness.” Ken Alexander                 of the busy patient and parent in the
   Ken Alexander

 Too often assistants want to establish a
 rule that says arrive more than ten minutes
 late, or break a brace and get reappointed.
 When it comes to great service it is not so
 easy or obvious as to how to handle poor
 cooperation and each circumstance takes
 thinking through the best approach to           “Mrs. Jones, it looks like Joey is running ten minutes late
 both stay on time with regularly scheduled      today and has a bracket that needs repaired. No worries,
 patients while still meeting the needs of       we can take care of him, but it will be about 20 minutes
 the poor cooperator. Also, if it is the
 first offense it will be treated differently    before we can work him back into the schedule and
 than if it is the fourth broken bracket in      another 20-25 to have him repaired. If he had told you
 three months. Each situation needs a            about the breakage you could have called us and we
 Clinical Coordinator who will explore
 the options while insuring that the final
                                                 could have given you a more convenient appointment
 decision maintains the principle of patient     time. Are you OK with being here for 45-50 minutes as we
 cooperation stated above. Keep the poor         work Joey back into the schedule and stay on time with
 cooperator waiting and move on with             our regularly scheduled patients? Or would you rather
 regularly scheduled patients, squeezing the
 offender back into the schedule as best you     reappoint to a more convenient time?”
 can while staying on time.

 It’s a Natural Disaster
 Breakage is a natural disaster in any busy
 orthodontic practice but its effects are
 often compounded by the rescue team’s
 panic. I have watched one assistant run to
 another, who then runs to the doctor, and
 then all three waste five minutes looking
 at the schedule, while during this time the
 repair could have already been done. In
 today’s world of one-step etch and seal
 with light cure, a bond can be replaced in
 minutes and often the regularly planned
 procedure can still be performed. Having
 everyone alerted to the breakage and
 having disaster repair trays ready to go
 in case of breakage, can keep this natural


40 Clinical Review                                                                                                                                                                                                                                      Clinical Review           41
 80 RULE
  20
                                                                                                         By Ray McLendon, DDS


 Could a wise use of the “80/20 rule” increase your practice
                                                                                                                                                                           Routine
 clinical efficiency and profitability?


                                                                                                                                                                                                                       Custom
                                                                                                                                                                                                                       Treatment

                                       Efficient treatment planning of routine        come in often?” What I mean by this is
                                       orthodontic cases as well as a wise choice     that although every patient and every
                                       of orthodontic appliances can help keep        treatment is “special” it could be that the
                                       a practice more competitive by keeping         “80 / 20” may apply to orthodontics as it
                                       the cost to start the case lower as well as    seems to apply to so many other parts of
[Get your ducks in a row so...[        keeping the effort to finish the case lower.   life. A strategy that defines up to 80%
                                                                                      of cases as routine cases, and as we define
 when your team knows in               Although there are many different clinical                           in advance how we
 advance the routine way that          treatment philosophies, a common
                                                                                                            will treat them every
                                       interest is treatment efficiency. Rather
 you approach ”normal” cases,
                                       than debate various philosophies, I would
                                                                                                            time, may create
 the less stress and effort that all                                                                        a specific strategy       High quality companies do not attempt a “one offering fits all” approach.
                                       like to propose that once you have chosen
 of you can expend.                    the one that you like the best; it would                             to help make sure         approach. As an alternative, they commit        the cost of the actual appliances. We         these competitive times. Some cases
                                                       be helpful to the efficiency                         that our practices        to a level of quality, but still have several   like high quality appliances and we like      can be treated with as few as three wires
                                                       of your practice to identify                         will attract all cases    offerings to stay competitive. It may           indirect bonding as well. If, however,        and with much longer intervals than
                                                       and treat routine cases in                           that are available        even be possible that a good volume in          we forced every patient to accept indirect    were ever thought before. I fear that
                                                       the same way. This same                              to be treated, and        the lower priced “good sellers” allow the       bonding, we would have a higher fixed         some orthodontists were not introduced
                                                       or “routine” treatment         at the same time maximize our clinical          company to sell a much smaller number           cost than if we did not. If we forced every   to this wire technology until they were
                                                       plan idea will help you and    efficiency. Increased clinical efficiency       of the “high end” models that they have         patient to accept clear brackets (rather      introduced to much more expensive self
                                                       your team deliver the care     helps us be more profitable, more               every reason to be proud of.                    than metal ones) we would have a higher       ligation systems.
                                                       in a more predictable and      efficient, and more affordable.                                                                 cost of doing business and our fees would
                                                       efficient way. When your                                                       In our practice we value a detailed written     need to be higher.                            Even if a doctor felt that there were
                                                       team knows in advance          Some practices (and not necessarily             treatment plan for each patient. With                                                         some advantages to SL brackets (which I
                                                       the routine way that you       specialist practices) offer “low” or at least   modern software we have the ability to          Back in the 1990’s RMO® introduced the        personally do not) I must wonder if they
                                                       approach “normal” cases,       the appearance of lower fees, as well as        save these treatment plans and apply them       first low or no friction Synergy ® bracket    make sense for the 80% of cases that are
                                                       the less stress and effort     low or no down payments. A practice can         to other similar cases. The more often          system. This idea was very attractive         routine. I also wonder if offering only
                                                       that all of you can expend.    put itself into a competitive disadvantage
                                                       This idea in return can                                                        that we can use a “saved” treatment plan,       to me and I have used this system for         this option could cause a practice to loose
                                                                                      by having a high cost of starting a patient.    the more efficient I believe that we can        almost 20 years now. There have been a        competitiveness due to much higher cost
                                                       help you and your entire
                                                                                      If a practice has a significantly higher        be. If 80% of our cases can be treated          number of imitators and of course, other      to just start the case.
                                                       team expend the needed
                                                       extra time, effort and
                                                                                      cost of starting a case due to much higher      with our “routine” written treatment            “systems” that claim great results due to
                                                       expertise needed to treat      cost of the appliances or other lab or          plans on file, we can use our expertise         low friction qualities. Although there is     Since there has been an old business
                                                       the “non routine” cases.       technology fees associated with treating        to treat those “20%” of cases that need         debate over how scientifically significant    concept to compare the difference
                                                                                      the case, the less options that they can        absolute custom treatment plans. These          the lower friction may be, there is little    between “buy” versus “build” when it
                                                      Many specialists have           offer the patient. As a fair analogy, even      are by definition, more difficult, higher       debate that orthodontist can pay well over    comes to a business. I would suggest
                                                      told me over the last 25        the “highest quality” car companies offer       fee cases. If these cases do not have a         $50,000 per year for more expensive “low      that it is much more cost effective to decide
                                                      years “I wonder who is          many different models. All of the models        higher fee, they are not profitable cases.      friction” appliance systems compared to       how to “build” your own clinical system to
                                                      treating all of the Class I     are considered high and good quality,           We believe that this concept is fair to the     the Synergy ® system.                         treat cases rather than “buy” someone else’s
                                                      cases, because I am not         and yet the highest trim model might            patients and fair to the practice.                                                            system of clinical orthodontic treatment.
                                                      seeing them anymore?”           literally be priced at twice as much as the                                                     I personally believe that much of our
                                                      as well as “I wonder why        basic model. High quality companies             My final thought is to discuss the costs        clinical efficiency with less appointments
                                                      the simple cases do not         do not attempt a “one offering fits all”        associated with starting a case, including      and less wire changes is necessary in



42 Clinical Review                                                                                                                                                                                                                                       Clinical Review            43
                                                                                                                                                  The Lingualjet                         A new manufacturing process creates
                                                                                                                                                                                         pierced pores of a specific geometric
 Lingualjet
                                                                                                                                                  bracket (LJ bracket)                   shape within the pads. This improves
                                                                                                                                       The main objective of the system                  bond strength and decreases the quantity
                                                                          Pascal Baron, DDS, MSc, PhD and Christophe Gualano, DDS      is to give the practitioner all of the            of adhesive needed near the gingiva (Fig.
                                                                                                                                       clinical advantages of a reliable lingual         3). The practitioner can begin treatment
                                                                                                                                       attachment.                                       mechanics including rapid correction
 The Lingualjet Appliance: a one-piece                                                                                                                                                   of rotation and dystopic positioning
 customized lingual bracket incorporating                                                                                              1. Optimized bond strength: retention             of the teeth without fear of the bracket
 the straight-wire technique.                                                                                                          is substantially increased by the larger          loosening or debonding.
                                                                                                                                       than normal surface area of the pad and a
                                                                                                                                       specific treatment of the pad, along with         2. Control features are built into the bracket
                                                                                                                                       special design features.                          instead of the archwire: the computer
                                                                                                                                                                                         generated numerical process creates a
                                                                                              The combination of these                 The pad of the bracket is manufactured            precise arch slot which incorporates the         Figure 1A: Brackets designed by CDA
                                                                                              four technologies results in             to fit the lingual surface of the tooth           3 orders of control. The arch slot, with a       Figure 1B: After bonding at levelling step
                                                                                              a unique appliance which                 exactly. The large surface area of the pad        cross section of .018 x .025, is positioned
                                                                                                                                                                                                                                          Figure 2: Comparison between
                                                                                                                                       is designed to cover a major part of the          so that the center is positioned more
                                                                                              creates many advantages.                 lingual surface area of the crown. This           gingivally. Thus, the application point of
                                                                                                                                                                                                                                          Conventional and LJ Bracket
                                                                                              Some of these include:                   facilitates correct positioning as well as        the orthodontic force is closer to the center    Figure 3: The LJ Pores (patent pending)
                                                                                                                                       enhances bond strength. (Fig. 1A)                 of resistance of the tooth, compared to          avoid the composite fusing towards the
                                                                                               •	 A	high	degree	of	                                                                      techniques using standard brackets (Fig          gingival margin
                                                                                                  individualization for each patient   Direct Bonding procedures can also be             4). These features help to enhance
                                                                                                                                       utilized according to the doctor’s preferences.   treatment mechanics while taking                 Figure 4: The LJ bracket slot (left) is
                                                                                               •	 The	orthodontist	has	the	            (Fig. 1B)                                         anchorage considerations into account.           closer to the center of resistance than a
                                                                                                  freedom to adjust the clinical                                                                                                          conventional bracket (right)
                                                                                                  outcome                              Another feature which results in better           3. The bracket is adapted to each individual
                                                                                                                                       bond strength relates to the amount               tooth: it takes into account the anatomy
                                                                                               •	 The	orthodontist	maintains	          of adhesive that is required. The LJ              of each tooth. It works on all types of
                                                                                                  his/her preferred methods of         bracket is connected to the tooth as two          surfaces, including enamel, metal, resin, etc.
                                                                                                  treatment                            isotropic bodies of comparable resistance.        By creating customized brackets with CDA
                                                                                                                                       Conventional lingual brackets require             technology, different geometric factors
                                                                                               •	 Ability	to	use	standard	arch	        a thicker zone of resin, which can be             are incorporated and designed for optimal
                                                                                                  wires and ligatures                  deformed and weakens the bond. (Fig. 2)           results. This includes things like the actual
                                                                                                                                                                                         position of the arch slot compared to the
                                                                                               •	 Helps	to	lower	clinical	costs        In addition, the pad design minimizes             position of the bracket relative to the pad
                                                                                                                                       interference with the opposing teeth              and tooth surface.
 Lingualjet Technology has recently            3. A flat archwire: the archwire has            •	 Features	combine	to	allow	for	                                                                                                                                           Figure 2
                                                                                                                                       during mastication.
 developed a new appliance concept             a standard shape and is adjusted to fit            enhanced sliding mechanics and
 including customized lingual brackets, a      exactly in the center of the arch slots. The       reduced friction
 straight wire technique and 3D numerical      archwire is fixed to one plane and results
                                                                                                                                                                       Figure 1A                                         Figure 1B
 processes. These technical improvements       in a very precise and accurate straight         •	 High	bond	strength
 are combined into a unified bracket           wire system.
 system by Lingualjet™ providing a highly                                                      •	 Ability	to	combine	Straightwire	
 advanced tailor-made appliance.               4. 3D Imaging: As an option, the                   concepts with custom made
                                               patient’s facial details can be captured via       brackets and 3D numerical
 The principle of Lingualjet™ is built on      CT Scan or Cone Beam technology. A                 technology                                                                                                                                                               Figure 3
 four advanced components:                     3D image report utilizing individualized
                                               parameters can then be generated.               •	 Option	of	3D	imaging	to	
 1. A numerical set-up: A set-up of the                                                           improve diagnostic and
 final positioning of the teeth is generated   Similar ideas have been described by other         treatment protocols
 after obtaining 3D information of the         inventors regarding specific components
 dental arches.                                of this system including: straight-wire
                                               1, 2, 3, numerical set-up 4, customized
 2. A custom made bracket: The                 brackets 5, 6 or imaging applications
 brackets are manufactured utilizing           7,8,9. But Lingualjet™ is the only method
 CAD/CAF technology. 3D software is            which combines all of these hi-tech
 used to design each individual bracket.       advances into one system 10, 11.
 Features include low profiles, smooth
 contours and special pad surface design.                                                                                                                                                                                                                                  Figure 4




44 Clinical Review                                                                                                                                                                                                                                            Clinical Review          45
           Straighwire
                                                                                                                                        A numerical setup
           technique
 The advantages of using a straight-wire                                                                                      After the patients’ malocclusion has             The numerical set-up is a very user          preparing anchorage by inputting the
 technique with lingual brackets are                                                                                          been recorded, the numerical setup of            friendly and precise tool for defining the   desired tip-back on molars and second
 obvious:                                                                                                                     the final occlusion can be prepared. The         final positions and relationships of the     premolars at the mandibular arch (Fig 9).
                                                                                                                              PVS impressions must be broad enough             dental arches. With a few simple clicks
   •	 No	bending	needed	in	the	                                                                                               to include all of the crowns and sufficient      of the mouse, the therapeutic prescription   The same modifications can be done on
      archwires                                                                                                               gingival surface. The details that are           can be personalized for the ideal set-       upper incisors for instance, by increasing
                                                                                                                              obtained are used in the optical scanning        up. The dental axes can be modified          aesthetic tipping in the case of dento-
   •	 Use	of	preformed	archwires	at	                                                                                          phase and provide a numerical capture            and adjusted without difficulty until the    dental discrepancy. All of these possibilities
      each phase of treatment                                                                                                                                                                                               provide complete management of anchorage
                                                                                                                              of the malocclusion. On the resulting            desired occlusion is obtained.
   •	 Different	wire	materials	can	be	                                                                                        virtual model each tooth will be separated                                                    thereby facilitating the achievement of the
      utilized                                                                                                                from adjacent teeth by using specialized         Before manufacturing the brackets, it is     treatment goals.
                                                                                                                              software to manipulate three dimensional         possible to add or modify the position
   •	 Different	wire	sizes	can	be	used                                                                                        objects. Once the segmentation is made,          of one or more teeth to adjust the end of
                                                                                                                              the composition of the set-up can begin.         treatment occlusion.
   •	 Reduction	of	costs	and	chair	                                                                                           A separate software program allows the
      time                                                                                                                    construction of the final set-up which           Mechanical effects can be anticipated as
                                                                                                                              incorporates the practitioner’s preferred        well. Effects of V-bends or anti-rotating
   •	 Better	control	of	transverse	and	                                                                                       prescription (Fig 7).                            bends can be simulated and thus can be
      vertical movements                                                                                         Figure 5A                                                     integrated into the bracket slot prior to
                                                                                                                              The practitioner can check the final occlusion   the manufacture of the bracket.
   •	 Control	of	leveling	and	                                                                                                on his/her own computer. The images can
      alignment without interference                                                                                          be reviewed from different perspectives and      The ability to individually position each
      of the canine offsets                                                                                                   magnification levels (Fig 8).                    tooth also includes the possibility of                          Figure 7: Set-Up phase
   •	 Enhanced	sliding	mechanics

   •	 Saves	anchorage	because	of	the	
      reduced friction between the
      wire and the slots

 Using transversal scanner slices, it’s easy to
 demonstrate the justification of a lingual
 straightwire. Figure 5A shows that at half
 height of the crowns, the guide line of
 the arch describes a mushroom shape.
 Repositioning upward of the level of the
 arch-wire plane, an appropriate location
                                                                                                                                                                                                                                                                Figure 7
 can be found to be compatible with a
 standard straight wire form (Figure 5B).

 Bringing the arch closer to the crown                                                                           Figure 5B
 root junction eliminates the requirement
 for a canine off-set. This is because the
 difference between the palatine side of                                Figure 6A                                 Figure 6B
 the canine and pre-molar disappears.
 There is thus no need for offset bends in
 the arch. Preformed arches can be made
 for this technique. A new arch shape has
 been developed, and the 3 sizes – narrow,
 medium and large, will cover all clinical
 situations.                                                                                                                                                                                                                                         Figure 9

 A guide line chart is generated and will                                                                                                                                                                        Figure 9: Anchor preparation on L6 and
 be helpful during treatment to check and                                                                                                                                                                        L7 by modifying the numerical set-up
 control the exact position of each tooth.        Figure 6A: LJ Chart               Figure 6B: Corresponding location of                                                                             Figure 8
 The crossing point between the bucco-                                              the brackets
 lingual axis and the guide line of the wire                                                                                  Figure 8: Numerical set-up can be displayed by shareware program i.e.
 is the same as the center of the bracket slot.                                                                                         TM
                                                                                                                              Meshlab enabling the practitioner to verify the intra-arch and inter-arch
                                                                                                                              relationships.



46 Clinical Review                                                                                                                                                                                                                               Clinical Review             47
                                                                                                                                                 Anchorage can be reinforced by moving
           Clinical outcome                                                                                                                      back the upper lateral sectors, substantially
                                                                                                                                                 reducing Class II malocclusion situations
                                                                                                                                                 as shown in Figure 13A and 13B. This
 In certain cases, the treatment could be        Appliance fabrication is customized for                                                         result can be obtained with a straight-wire
 optimized if a CT scan or a cone beam                                                            helps to reduce chair time (wire activation
                                                 the anatomy of the patient as well as the        takes about 5 minutes). Light forces           appliance because the bracket is free to
 acquisition is available. In that case, a       orthodontist’s treatment parameters.                                                            slide back along the archwire.                                                                             Figure 13A             Figure 13B
 complete 3D imaging could be computerized                                                        improve the periodontal acceptance.
                                                 The practitioner chooses the desired
 - including 3D cephalometrics and other         mechanics based on the clinical situation.                                                      Another situation indicating the use of
 valuable diagnostic information.                                                                 The benefits of Lingualjet straight-wire
                                                 Different types and sizes of wires can be        appliances are enhanced when TADs are added.   TADs would be when anchorage can be
                                                 used based on the doctor’s preferences.                                                         saved or increased using either rigid or
 Lingualjet achieves a high level of             RMO ® suggests wires such as Orthonol ®                                                         non-rigid connectors (Fig 14).
 individualization of the apparatus using        (NiTi), Thermaloy ® and Bendaloy®
 sophisticated numerical techniques. The         (TMA). Many sizes of wires could be used                                                        Conclusion:                                                                                                Figure 13C             Figure 13D
 system has already had several improvements     including .012, .014, .016, .018, .018 x .018,
 since its introduction in 2008. The current     .016 x .022, .017 x .025, etc.                                                                  The clinical examples cited here show              Figure 13C: After 6 months, Class II is almost corrected
 version 2.0 offers a smaller size bracket. It                                                                                                   some of the possibilities of Lingualjet.           Figure 13D: Only mechanics using TADs has been used on upper arch
 is very comparable to the smallest existing     Figures 12 A-B-C-D show how a two-wire                                                          The appliance is constantly evolving in
 lingual brackets (Fig 11A and 11B).             sequence can align an upper arch. This                                                          order to provide the practitioners who
                                                                                                                                                 use it with ongoing innovations. The
                                                                                                                                                 goal is to make lingual orthodontics more
                                                                                                                                                 efficient and easier to use.

                                                                                                                                                 For ordering information please contact the
                                                                                                                                                 exclusive distributor of Lingualjet, RMO Europe.
                                                                                                                                                 www.rmoeurope.com




                                                                                                                                                                                                                                     Figure 14A                                    Figure 14B

                                                                                                                                                                                                    Figure 14A: TADs have been inserted distally to the second molars
                                                                                                                                                                                                    Figure 14B: Leveling step with rigid connector

                                                                               Figure 12A                                     Figure 12B


                                  Figure 10
  Figure 10: 3D Cephalometric
                                                                                                                                                 Bibliography :
  Figure 11A                     Figure 11B                                                                                                      1. Takemoto K, Scuzzo G. The straight-             5. Wiechmann D. A new bracket system           9. Nabbout F, Faure J, Baron P, Braga J,
                                                                                                                                                 wire concept in lingual orthodontics. J            for lingual orthodontic treatment.             Treil J : Tooth anchorage in orthodontics:
                                                                                                                                                 Clin Orthod.2001;35:46-52.                         JOrofac orthop/ Fortscr Kieferorthop           scannergenerated data. Intern Orthod
                                                                                                                                                                                                    2002; 3: 234-245                               2004; 2 : 241-256
                                                                               Figure 12C                                     Figure 12D         2. Takemoto K, Scuzzo G, Lombardo
                                                                                                                                                 L, Takemoto Y . Lingual straight wire              6.Wiechmann D. The new Top bracket:            10. Baron P, Gualano C . Anchorage
                                                 Figure 12A: Day of bonding; Orthonol .012        Figure 12B: Metal ties at canines              method. Intern Orthod 2009; 7 : 335-353            a step forward in lingual orthodontics?        control performed with mini-screws and
                                                 Figure 12C: After 6 weeks; Orthonol .016         Figure 12D: Result after 3 months
                                                                                                                                                                                                    Intern Orthod 2003; 1 : 119-138.               the Lingualjet Appliance. in: Echarri P,
                                                                                                                                                 3. Scuzzo G, Takemoto K, Takemoto Y,                                                              Takemoto K et al: Nuevo Enfoque en
                                                                                                                                                 Takemoto A, Lombardo L. A new lingual              7. Treil J, Borianne P, Casteigt J, Faure J,   Ortodoncia Lingual. Ed. Ripano, Madrid,
                                                                                                                                                 straight-wire technique. J Clin Orthod.            Horn A. The human face as a 3-Dimensional      España 2010; 15-26
                                                                                                                                                 2010; 64:114-123.                                  Model : the futur in orthodontics. World J
                                                                                                                                                                                                    Orthod 2001; 253-7                             11. Baron P, Gualano G, Sempe L, Sciacca
  Figure 11A: STb Bracket                                                                                                                        4. Fillion D. Computer generated                                                                  AJ, Hall G. The Manufacturing Process
  Figure 11B: LingualJet Customized                                                                                                              conception and fabrication of transfer             8. Nabbout F, Faure J, Baron P, Braga          for LingualJet in: Romano R (ed). Lingual
  Bracket                                                                                                                                        trays for indirect bonding of lingual              J, Treil J : Centers of resistance of tooth    and esthetic orthodontics. Chicago:
                                                                                                                                                 attachments: The Orapix system. Rev.               segments and orthodontic mechanics.            Quintessence Publishing, 2011
                                                                                                                                                 Orthop. Dento-Fac. 2007; 41 : 61-75                Intern Orthod 2007; 5 : 437-446


48 Clinical Review                                                                                                                                                                                                                                                       Clinical Review        49
                                                                                                                                                                                                          rocky mountain orthodonticsTM

                                                                                                                   New Manufacturing
                                                                                                                   Advancements
                                                                                                                        ®
                                                                                                                   RMO has always been at the forefront
                                                                                                                   of manufacturing technologies. This will
                                                                                                                   continue. Some of the technological areas
                                                                                                                   that will receive special attention are:

                                                RMO
                                                             ®
                                                                                                                   Microsoft Dynamics AX – ERP System

         Putting our                                                                                               Laser Welding




           BEST
                                                                                                                   Advancements in Metal Injection Molding
                                                                                                                   CNC – Updated Technology
                                                                                                                   Laser Product Etching

     foot forward                                                                                                  Automated Product Identification/Marking


                                                                                                                   Continued Legacy of
                                                                                                                   Innovative Products and
  RMO® would like to invite you                                                                                    Services
  to join us in the excitement and                                                                                 This will include ongoing efforts
  buzz generated about the new                                                                                     related to:
  RMO®! Our Executive Group and
                                                                                                                   SWLF Synergy®
  our entire company staff, with
                                                                                                                   FLI ® Family Systems – Twin Brackets,
  an average tenure of 15 years,                                                                                    Ceramic Brackets, Bucal Tubes
  share our enthusiasm for this
                                                                                                                   Diagnostics – Moving to the Global
  new corporate re-launch. RMO®                                                                                     Internet delivery model
  continues to be privately owned,
                                                                                                                   Functional EducationTM – Multi Family TM,
  and this will enable us to maintain                                                                               Liberty BielleTM, Wilson® System
  flexibility to make decisions based
                                                                                                                   IDB – Indirect Bonding System
  on current orthodontic needs and
                                                                                                                   Dual Top Temporary Anchorage
  visions for the future.                                                                                           Device System

                                                                                                                   Focus on the Total Customer
                                                                                                                   Service Experience
                                                                                                                   This starts with the first contact with
  New Look:                                in Colorado. We know that these
                                                                                                                   our Sales Reps and Inside Office
                                                                                                                   Support. It continues with order entry,
                                                                                                                                                                                                               Tony Zakhem & Jody Hardy

  You will see a new slogan, a new         mountains will continue to endure –                                     delivery of products and clinical use.      conventions, seminars and study clubs      long time customers, and also look
  logo, and new colors to reflect our      and this is a characteristic that RMO®                                  Feedback mechanisms regarding               will also be focused on providing useful   forward to forming new relationships.
  current and future directions. This      wants to emulate.                                                       product design and quality, as              information and interfacing with the       We are committed to keeping RMO®
  will be incorporated in our Web                                                                                  well as customer service, feed into                                                    as a privately held company and to
                                                                                                                                                               orthodontic community.
  Page,     E-mail    Communications,      RMO® believes strongly in orthodontic                                   an ongoing loop to enhance our                                                         maintain our manufacturing facilities
                                                                                                                                                               In summary, we would like to reiterate
  Social Networking Sites, Brochures,      systems, and how their component                                        continuous improvement philosophy.                                                     in the USA. We are excited about
                                                                                                                                                               that we are proud to be the new
  Company Letterhead, Booth Exhibit,       parts when used together create a                                       We are expanding our channels                                                          our continuing involvement in the
                                                                                                                                                               owners of RMO®. We are proud of our
  and so on, moving forward. This          result that is greater than the sum of                                  of communication to include the                                                        stimulating and ever changing world
                                                                                                                                                               past and what it has taught us. We
  will help to identity and unify our      their individual effects.                  “Synergistic Solutions for   new RMO® Website, E-mail, and               are equally excited to be moving           of orthodontics!
  products, services and projects.
                                                                                      Progressive Orthodontics ”
                                                                                                              TM
                                                                                                                   Social Networks. Our attendance at          in new directions. We value our
                                           Progressive Orthodontics refers to
  The majestic mountains are a key         looking ahead, and keeping the
  feature of our new logo. They tie in     big picture in mind. Orthodontics is                                    Tony Zakhem,                                Jody Hardy,
  to the name that we are still known      about treating the patient as a whole                                   Chairman and CEO                            President and COO
  by in many parts of the world “Rocky     – not just straightening their teeth.
  Mountain® Orthodontics”. We see          Treatment options and protocols
  the mountains from our home office       continue to evolve and improve –
  everyday, and they help to remind us     and this is what makes the profession
  of our history and development here      as challenging and stimulating as it is.




650 West Colfax Avenue, Denver, Colorado 80204                                                                                                                                                    Synergistic Solutions for Progressive OrthodonticsTM
P 303.592.8200 F 303.592.8209 E sales@rmortho.com                                                                                                                                                       800.525.6375 | www.rmortho.com
        650 West Colfax Avenue
        Denver, Colorado 80204




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52 Clinical Review

								
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