Orthodontic Practice Succession Specialists

By: Mary Beth Kirkpatrick, Founder of Kirkpatrick & Associates

From a practice management view, today’s self-ligating brackets may have one of the most significant impacts on the orthodontic industry since the introduction of bonding or Nitinol™ wire.

These self-ligating brackets “open the door” to frictionless, sliding mechanics – and the effect on treatment is remarkable. Just as remarkable is the potential to increase profitability through more efficient treatment delivery. This efficiency comes through more rapid tooth movement, the need for fewer visits, the ability to increase the interval between appointments, and adjustments that require less chair time due to bracket design. Engineered to allow archwire engagement without the need for steel or elastic ties, these unique brackets reduce friction on the archwire, allowing teeth to move more freely. From the days of stainless steel archwires with 4 week treatment intervals, to the Nitinol and Titanium wire families with 6 to 8 week intervals, this self-ligating technology allows intervals of 8 to 12 weeks in certain treatment stages.

Whether using a Damon,™ Innovation™ or SmartClip™ bracket, popularity has increased as orthodontists see crowding unravel and teeth move more rapidly into position. To further increase treatment efficiency, many practices have implemented an indirect bonding technique in conjunction with these brackets. Indirect bonding offers the ability to achieve a more exact bracket placement. A more ideal bracket placement in the beginning means less bracket repositioning later. With improved bracket positioning, fewer wire adjustments that require complex wire bending are necessary, which frees up the schedule. With certain self-ligating brackets, arch expansion is achieved by the archwire – the ability to expand without the need for an adjunctive appliance creates less stress for the patient and reduces lab costs.

All of these factors play a role in increased profitability with an opportunity to schedule additional patients in the appointment slots that have opened or to see all active patients in fewer clinical hours. As an example, assume that a practice starts 300 full cases per year with an average of 20 visits per patient during active treatment. If the number of visits can be reduced from 20 to 17, the practice would eliminate 1,800 visits over 24 months, or 75 visits per month. If the average number of visits can be reduced from 20 to 16, the practice would eliminate 2,400 appointments over 24 months, or 100 visits per month. For many practices, this could eliminate one clinical day per month. Reducing the number of active treatment visits equates to greater clinical efficiency and increased profitability. With consistent monthly record keeping of the number of visits required for each patient debanded, the results are readily apparent.

Treatment efficiency is directly related to the number of visits. A commonly used measure of efficiency is to divide the treatment fee by number of visits during active treatment. With fewer visits, a practice whose efficiency quotient was previously $240 per visit is now reporting that value to be upwards of $350. The efficiency quotient continues to rise as the practice becomes more proficient in the vital aspects of successfully using these brackets – bracket placement, archwire sequencing and selecting the most appropriate treatment intervals.

A significant means of determining practice profitability is the relationship between net collections per month and number of doctor hours worked. With a goal of $1,800 per doctor hour and $150 per staff hour, it is important to make every visit count, accomplishing as much as possible at each visit. With the unique opening and closing mechanism of these brackets, staff report less time required to remove and replace archwires thus the ability to see more patients is increased.

Once this bracketing system is in place and orthodontist and staff are proficient with its application, there are great benefits for the patient as well -- fewer visits, less time away from school or work, and reduced treatment time. Reduced treatment time lessens the risk of compromising tooth enamel as a result of poor hygiene. The impact of positive patient response is practice growth.

Practices who have consistently used self-ligating brackets for one year or more report the following results:

• Collection/Production per doctor hour increases
• Cost to complete treatment per patient is reduced
• Staff report adjustments are more quickly accomplished
• Schedule is less stressful
• Patients are pleased to finish in less time
• Referrals increase

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