Ortho Tribune U.S.

Digital treatment / Ethical and moral scenario planning for orthodontics / Get ready for OTStudyClub.com / Digital treatment (Continued from page 1) / 5 tips to promote your practice on YouTube / A troubled economy and embezzlement / Why you should expand financial options / No more spaghetti marketing / Taking charge of oral hygiene / TMJ disorder and orthodontics / Dentistry meets its ‘cloud computing’ match in DentalCollab / Off to Minnesota

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Table of contents

The World’s Orthodontic Newspaper · U.S. Edition

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ORTHO TRIBUNE

June/July 2009

www.ortho-tribune.com

Vol. 4, Nos. 6 & 7

Time for YouTube

Behind the scenes

The scoop on GORP

How videos can help
your practice grow.

We talk to the doctor
behind Ortho Essentials.

Who’s going to be there
and what they’ll be doing.

uPage

Digital treatment
I

f you are dreaming of growing
your practice, apply to win the 2nd
Levin Group Total Ortho Success™
Practice Makeover. Levin Group
and Ortho Tribune are once again
embarking on a quest to find an
orthodontic practice that is ready to
reap the rewards of a free, year-long
orthodontic practice management
and marketing consulting program.
When was the last time you took
a close look at your practice’s systems? Whether you are in the beginning stage of your career or already
experienced and successful, growth
is always within your reach — even
in this economy.
The winning orthodontic practice will experience improvements
in every aspect of running the practice. This free, one-year management makeover will be a customized
approach based on the orthodontic
practice’s needs, goals and potential.
To apply, go to www.levingroup
ortho.com or www.ortho-tribune.
com. The deadline to apply is Sept.
30. For more information, contact
Lori Gerstley, professional relations
manager at Levin Group, at (443)
471-3164 or lgerstley@levingroup.
com. OT

ulation modalities to assist in case
diagnosis and treatment-strategy
development.
SureSmile patients begin orthodontic therapy with a routine full
banding and bonding procedure.
In many instances, after leveling
and aligning with traditional archwires for a few months, the patient’s
mouth is scanned using an OraScanner, or a CBCT may be performed
instead.
The OraScanner uses non-invasive white light to capture images
of the teeth to create a 3-D model of
them. This step is the only patient
appointment that differs from conventionally treated patients and
takes 20 to 30 minutes in the office.

By Mark Feinberg, DMD, and Adam Weiss, DMD

s we have discussed in the
past two editions of Ortho Tribune, SureSmile 3-D diagnostic and treatment-planning software
provides the basis for high-quality
results because it is coupled with
powerful, customized, prescriptive,
super-elastic archwires.
Sophisticated treatment-planning
and diagnostic software toolsets are
employed using analytical and sim-

Fig. 1a, 1b: Initial frontal view.

g OT page 4

AAO elects Bray as next president
D

uring its 109th Annual Session
held in Boston, the American
Association of Orthodontists elected
Robert James Bray, DDS, MS, its
next president.
Bray, who has a private practice
near Atlantic City, N.J., has logged
nine years of service on the AAO
Board of Trustees, serving three
years as vice chairman of AAO Services, the for-profit subsidiary of
the AAO. Bray is a clinical associ-

Dental Tribune America
213 West 35th Street
Suite #801
New York, NY 10001

Apply for 2nd
Levin practice
makeover

A look at two
SureSmile cases —
high quality, less time

ate professor in the Department of
Orthodontics at Temple University
School of Dentistry in Philadelphia.
“It is a great honor to serve the
orthodontic specialty in this role,”
Bray said. “The AAO Board of Trustees and I will continue to examine
and act upon the critical issues fac-

ing dentistry in general and orthodontics in particular. The issues
include public education, the
recruitment and retention of faculty
members, development of international members and maintaining
strong, effective relationships with
all health care organizations.” OT
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[2] =>

From the Editor

Ortho Tribune | June/July 2009

Ethical and moral scenario
planning for orthodontics
By Dennis J. Tartakow, DMD, MEd, PhD,
Editor in Chief

“Education is
an ornament
in prosperity
and a refuge
in adversity.”
— Aristotle

Part 3 of 3

he purpose of developing the
archipelago for each of the
four quadrants is to gather and
transform information of potential
significance into new and novel
insights for plausible scenario planning. These four archipelagos are
examined by discussing the (a) visible elements, (b) connections and
(c) underlying etiology. Thus perception and basic knowledge about
plausible possibilities that might
exist are depicted.
The development and distribution of informational technology
(IT) around the world is a crucial
component in creating further scientific advances.
Global economy, for example,
or the restriction thereof (X-axis)
will have a tremendous impact on
the quality of life for all individuals,
especially with IT development at
every level. It is through creativity, modernization and distribution
that all mankind will benefit and
be observed in every aspect of life:
health care, welfare, transportation
and, especially, education (Y-axis).
The ability to make educated
choices about our future and to
increase our extensive knowledge
base addresses responsibility, leadership, social justice and ethics, the
power of which will hopefully be
utilized constructively.
Depending upon the relative
positioning of the global economy
and education along the X/Y coordinates for each of the four quadrants,
the associated plausible backdrops

Tell us
what
you
think!

for education will vary considerably; from rising to falling, from
death to a renaissance, to a large
degree the future depends upon
what happens today.
The decisions that we make now
will have a critical impact on our
lives in the year 2020.

Education (Y-axis)
Orthodontic education, for example, is both a critical and uncertain
factor in today’s scenario plan; it
requires both teachers and students
to be an integral part of the future
success for postgraduate programs
and milieu.
Without one or the other, the
future of our educational programs
might not be successful. In addition,
the successful future of our specialty also will rely on IT development
for the next 10 years and beyond.
One of the most challenging
objectives in macro- and microtechnology is the delivery of timesensitive streams of data across
packet-switched networks known
today as the Internet.
Future IT platforms providing
streamed-data will change exponentially, and delivery of postgraduate orthodontic programs as well
as continuing education will more
than likely be provided through distance-learning media centers. This
will obviate the need for the high
costs of tuition and bring new learning and knowledge to our homes or
offices rather than travelling great
distances to sit in classrooms as we
do today.

fluctuations have been a seesaw
ride, and for the past 18 months on a
downward spiral, the housing market has virtually come to a halt, and
our economy in general has been
frozen, not to mention an all-time
high in unemployment.
These problems have had a tremendous impact on education, new
construction and business in general.
The economic crisis here in the
United States has resonated globally. If the current crises continue
at the present rate, where will the
world be in 2020?
Worldwide cooperation is essential for technological advancement and interactions. Therefore,
does the global economy improve/
decline when education is high or
low? Or does education improve/
decline when the global economy is
high or low?
Does the global economy promote education or does education
promote the global economy? How
would you answer these questions?
The word that comes to mind is
“symbiosis,” a state of living together for the mutual benefit of each
faction. Scenario planning, therefore, is taking a peek into the future
to see what tomorrow might bring.
Now try planning for your own
personal and professional lives. You
might be surprised how accurate
and effective such planning can be
for your home or office.
Try being caviler about the future
but passionate about protecting the
present! OT

Corrections

Ortho Tribune strives to maintain
the utmost accuracy in its news and
clinical reports. If you find a factual error or content that requires
clarification, please report the details
to Managing Editor Kristine Colker at
k.colker@dtamerica.com.

Global economy (X-axis)
It is not only critical but also crucial
for macro- and micro-technological
advancement to be developed. In
the past few years, the stock market

Do you have general comments or criticism you
would like to share? Is there a particular topic you
would like to see more articles about? Let us know
by e-mailing us at feedback@dtamerica.com. If
you would like to make any change to your
subscription (name, address or to opt out) please
send us an e-mail at database@dtamerica.com
and be sure to include which publication you are
referring to. Also, please note that subscription
changes can take up to 6 weeks to process.

Image courtesy of Dr. Earl Broker.

ORTHO TRIBUNE
The World’s Orthodontic Newspaper · U.S. Edition

Publisher
Torsten Oemus, t.oemus@dtamerica.com
President & CEO
Peter Witteczek, p.witteczek@dtamerica.com
Chief Operating Officer
Eric Seid
e.seid@dtamerica.com
Group Editor & Designer
Robin Goodman
r.goodman@dtamerica.com
Editor in Chief Ortho Tribune
Prof. Dennis Tartakow
d.tartakow@dtamerica.com
International Editor Ortho Tribune
Dr. Reiner Oemus, r.oemus@dtamerica.com
Managing Editor/Designer
Ortho Tribune & Show Dailies
Kristine Colker
k.colker@dtamerica.com
Managing Editor/Designer
Implant & Endo Tribunes
Sierra Rendon
s.rendon@dtamerica.com
Online Editor
Fred Michmershuizen
f.michmershuizen@dtamerica.com
Product & Account Manager
Humberto Estrada
h.estrada@dtamerica.com
Product & Account Manager
Mark Eisen
m.eisen@dtamerica.com
Marketing Manager
Anna Wlodarczyk
a.wlodarczyk@dtamerica.com
Marketing & Sales Assistant
Lorrie Young
l.young@dtamerica.com
C.E. Manager
Julia Wehkamp
j.wehkamp@dtamerica.com
Dental Tribune America, LLC
213 West 35th Street, Suite 801
New York, NY 10001
Phone: (212) 244-7181, Fax: (212) 244-7185

Published by Dental Tribune America
© 2009, Dental Tribune International GmbH.
All rights reserved.
Dental Tribune makes every effort to report
clinical information and manufacturer’s
product news accurately, but cannot assume
responsibility for the validity of product claims,
or for typographical errors. The publishers
also do not assume responsibility for product names or claims, or statements made by
advertisers. Opinions expressed by authors are
their own and may not reflect those of Dental
Tribune International.

OT Editorial Advisory Board
Jay Bowman, DMD, MSD
(Journalism & Education)
Robert Boyd, DDS, MEd
(Periodontics & Education)
Earl Broker, DDS
(T.M.D. & Orofacial Pain)
Tarek El-Baily, BDS, MS, MS, PhD
(Research, Bioengineering & Education)
Donald Giddon, DMD, PhD
(Psychology & Education)
Donald Machen, DMD, MSD, MD, JD, MBA
(Medicine, Law & Business)
James Mah, DDS, MSc, MRCD, DMSc
(Craniofacial Imaging & Education)
Richard Masella, DMD (Education)
Malcolm Meister, DDS, MSM, JD
(Law & Education)
Harold Middleberg, DDS
(Practice Management)
Elliott Moskowitz, DDS, MSd
(Journalism & Education)
James Mulick, DDS, MSD
(Craniofacial Research & Education)
Ravindra Nanda, BDS, MDS, PhD
(Biomechanics & Education)
Edward O’Neil, MD (Internal Medicine)
Donald Picard, DDS, MS (Accounting)
Howard Sacks, DMD (Orthodontics)
Glenn Sameshima, DDS, PhD
(Research & Education)
Daniel Sarya, DDS, MPH (Public Health)
Keith Sherwood, DDS (Oral Surgery)
James Souers, DDS (Orthodontics)
Gregg Tartakow, DMD (Orthodontics)
& Ortho Tribune Associate Editor

[3] =>

News

Ortho Tribune | June/July 2009

Get ready for OTStudyClub.com
Ortho Tribune creates an online community specifically for orthodontists

rtho study clubs help increase
interaction, providing orthodontists with the opportunity
to gain knowledge about products
through their colleagues’ experimentation and analysis, and to hear
from respected opinion leaders
directly. Focused study clubs provide an unparalleled opportunity for
orthodontists to “meet with” other
like-minded individuals and their
team members and to learn in a
friendly, non-threatening environment.
Ortho Tribune is taking this concept to the next level by bringing
the study club online, extending the
realm of interaction to a worldwide
arena. This allows for a variety
of fresh perspectives from different cultures to further enhance the
educational mix, inspiring new possibilities and creating higher expectations in online learning.
OTStudyClub.com
is
solely
focused on today’s orthodontist and
offers an exciting mix of possibilities, including:
• C.E. lectures that are live and
interactive, as well as archived,
bringing local events to national
audiences.
• Focused discussion forums that
allow orthodontists to stay up to
date.
• Ortho product reviews with
recordings of opinion leaders’
first impressions.
• A growing database of case studies and articles featuring topics that are important to today’s
orthodontists.
• Networking possibilities that go
beyond borders to create a global
ortho village.
• Contests with chances to win
free tuition for ADA/CERP C.E.
accredited Webinars and much
more!
Ortho Tribune is very excited
about officially launching this initiative and would like to invite you
to join us in breaking new ground in
e-learning. On Aug. 15, from 9 a.m.–
5 p.m., Ortho Tribune will introduce
the Ortho Tribune Study Club via a
full-day online symposium.
The OTSC Online C.E. Festival —
V.I.P Launch Party will feature five
one-hour Webinars in succession,
followed by a 20-minute live Q&A
session between the online audience and each speaker.
Participants will receive seven
ADA/CERP C.E. credits, and attendance is free for the first 100 registrants. After the first 100 spaces
are filled, the cost of the full-day
symposium is $49, a mere fraction
of what one would pay if traveling to
an event. Attendees also have 30-day
access to the recorded Webinars to
review at their convenience. Additional details and registration can
be found at www.OTStudyClub.com.

Registering as a Study Club member is free and provides access to
accredited C.E. Webinars and other
beneficial tools that cater directly to orthodontics. For example, in
today’s world of orthodontics, new
products, concepts and techniques

are brought to light with amazing
speed, so it’s not surprising that
many orthodontists are finding it difficult to stay up to date.
In an effort to make the most of
practitioners’ time, www.OTStudy
Club.com will feature “First Impres-

sions,” a series of five-minute video
vignettes. These will present various
ortho products with the support of
demo videos and will be archived
in an online product library to be
viewed at any time.
Please keep in mind that the site
will be officially launched on Aug.
15. Register early, and mark the date
on your calendar!
Please contact Julia for full details
and for the OTSC launch registration
by phone at (416) 907-9836 or by
e-mail at j.wehkamp@otstudyclub.
com. OT
AD

[4] =>

Trends

Ortho Tribune | June/July 2009

f OT page 1

An orthodontic assistant trained by
OraMetrix staff performs the scan.
From this 3-D model, the occlusion is treated in the virtual world
(on the computer).
While the setup of the occlusion
is performed in conjunction with
the company’s digital lab technicians, the orthodontist has total control over the final result. The teeth
are moved in the virtual world on
the computer screen to completion.
This information drives the SureSmile robot located in Richardson,
Texas. This robot bends wires made
of CuNiTi shape memory alloy to
a level of precision well beyond
human abilities.
The robotically-bent wire is sent
back to the orthodontist’s office for
placement in the patient’s mouth
as in a standard archwire change
appointment. The gentle forces of
the CuNiTi wire move the teeth precisely into the desired final position.
This precision adds efficiency to the
treatment, which, in most cases,
results in shorter treatment time
— typically by 30–40 percent.
Here is a closer look at two cases
treated with SureSmile.

Fig. 1c: Initial lateral view.

Fig. 1d: Initial upper occlusal.

Fig. 1e: Initial lower occlusal.

Fig. 1f: Initial right occlusion.

Fig. 1g: Initial anterior occlusion.

Fig. 1h: Initial left occlusion.

Figs. 2a, 2b: Progress front view; Fig. 2c: Progress lateral view; Fig. 2d: Progress upper occlusal.

Case 1, by Dr. Adam Weiss
An adult female presented with a
Class III skeletal pattern with a
Class III malocclusion requiring
surgically assisted orthodontic correction (Fig. 1a–1h).
The patient began treatment on
Oct. 23, 2006, had her SureSmile
scan on Nov. 30, 2006, and had her
surgery in March 2007. Her braces
were removed July 18, 2007.
Total treatment time from bandAD

ing to debanding was nine months,
whereas a conventional treatment
time estimate would have been
18–24 months. Figures 2a–2h show

the patient pre-surgery, and figures
3a–3h are the final.
g OT page 6

From left, Fig. 2e: Progress lower
occlusal; Fig. 2f: Progress right
occlusion; Fig. 2g: Progress
anterior occlusion; Fig. 2h: Progress
left occlusion.

[5] =>

[6] =>

Trends

Ortho Tribune | June/July 2009
From left, Figs. 3a, 3b: Final front
view; Fig. 3c: Final lateral view;
Fig. 3d: Final upper occlusal.

From left, Fig. 3e: Final lower
occlusal; Fig. 3f: Final right
occlusion; Fig. 3g: Final anterior
occlusion; Fig. 3h: Final left
occlusion.

f OT page 4

Case 2, by Dr. Mark Feinberg
• Fig. 4: An adult female presented
with a mild bimaxillary protrusion,
minimal overbite and overjet with a
partial anterior crossbite, mild open
bite in the right canine area and
mild-moderate upper and lower
dental crowding.
The smile line characteristics
were acceptable, and buccal occlusion was Class I with posterior
dentition well-interdigitated and
acceptable.
The patient’s main complaint
was, “I don’t like my crooked teeth,
and can you correct my smile?”
The original treatment plan
involved a non-extraction, comprehensive approach involving both
upper and lower arch treatment,
aligning the upper and lower anterior segments and idealizing the
posterior occlusion but limiting
potential side effects through pretreatment tooth planning strategy
and precision wire-bending therapeutics.
The patient’s records were
scanned into the SureSmile system,
and diagnostic software toolsets
were employed to plan treatment.
The most critical objectives were
to maintain and enhance the overbite and overjet while aligning the
dentition and correcting the right
canine open bite.
In terms of soft tissues, pre-treatment structures would be maintained as they were deemed acceptable and regional focus would be on
smile line improvements through
dental alignment.
• Fig. 5: Class I bimaxillary protrusive with minimal overjet and
partial anterior crossbite.
• Fig. 6: Initial cephalometric
radiograph and tracing.

• Fig. 7: At the appointment for
appliance placement, the patient
inquired if she could change the
treatment plan and treat the upper
arch only.
Understanding and appreciating
the power of SureSmile technology
to titrate and control tooth movement to an unprecedented degree,
the plan was seamlessly and efficiently modified. 0.022” pre-adjusted brackets were placed at that
time, and a scan was performed.
• Fig. 8: Seven weeks after placement of the first wire, a 017” x .025”
CuNiTi wires upper arch wire, the
patient elected comprehensive orthodontic treatment involving upper
and lower fixed appliances. At this
time, lower brackets were placed
and a therapeutic scan of the teeth
with brackets was performed.
• Fig. 9: In this instance, at
the bracket placement appointment, the patient’s brackets also
were scanned, and subsequently,
two treatment plans were designed
involving 3-D simulation software
and 3-D diagnostic toolsets.
Based on minimal posterior tooth
movements and focused strictly on
anterior arch length dynamics, the
first plan involved 3.9 mm of interproximal reduction (IPR) as a function of more retraction of the upper
central incisor teeth.
• Fig. 10: The second plan
involved more lateral incisor and
left central incisor advancement
and consequently less IPR as the
arch length deficiency using this
method was 0.2 mm. This would
be more of a typical “straight wire”
effect.
• Fig. 11: A comparison of plan
1 vs. plan 2 with respect to buccal/
lingual movement of upper anterior
teeth.

Fig. 4

Fig. 6

Fig. 5

Fig. 7

Fig. 8

Fig. 9

g OT page 8

Fig.
11

Fig.
10

[7] =>

[8] =>

Trends

Ortho Tribune | June/July 2009

Fig. 13

Fig. 12

Fig. 14

Fig. 15

Fig. 16

Fig. 17

Fig. 18

Fig. 19

Fig. 20

Fig. 21

Fig. 22

Fig. 23a

Fig. 23c

f OT page 6

• Fig. 12: The occlusal contacts
depicted in the final plan 2. Contacts are depicted by color coding
— green, yellow and red, based on
degree of contact.
• Fig. 13: Virtual setup based on
clinician’s prescription and detailing.
• Fig. 14: Computerized ABOstyle score for quality check.
• Fig. 15: Based on the plan
2 setup and the clinician’s therapeutic prescription, the lab manufactured a robotically-bent upper
0.017” x 0.025” CuNiTi archwire
with passivity (no tooth movement
bends) in the buccal segments and
tooth movement bends limited to
the upper incisor area only. The
ability to titrate and optimize tooth
movement in specific areas, as
deemed appropriate based on individual circumstances, is one of the
many core strengths of this therapeutic technology.
• Fig. 16: Comparison superimposition performed based on tooth
movement, which occurred over
a seven-week interval. The green
teeth represent tooth position after
the first archwire placement and
the white teeth present tooth movement prior to the first archwire
placement. The top right image
shows the initial wire insertion, and
the bottom right image shows six
weeks post-wire insertion.
• Fig. 17: A comparative superimposition was performed, which
revealed the fidelity of the tooth
movement desired in plan 2 to the
clinical reality of what occurred.
The green modeled teeth represents our clinical tooth movement
goals vs. the white modeled teeth,
which reveal what occurred in clinical actuality.

Fig. 23b

Fig. 24

Fig. 23d

Fig. 23a: July 2006; Fig, 23b: September 2006; Fig. 23c: December 2006; Fig.
23d, January 2007.
• Fig. 18: 100 percent activation.
• Fig. 19: Six weeks into treatment, the patient was so impressed
with the rapid improvement in
tooth appearance that she re-elected to treat both upper and lower
arches.
An additional 15-minute therapeutic scan was performed after
placement of lower fixed appliances, and additional treatment
strategizing was undertaken. This
would not only involve lower arch
treatment/mechanics strategy but
upper arch modifications as well.
The flexibility and robust nature of
SureSmile technology in this regard
was critically valuable.
• Fig. 20: Comprehensive treatment/lower movements
• Fig. 21: Diagnostic software
revealed 1.8 mm of lower arch
length deficiency based on the
treatment parameters established,
and the requisite degree of IPR was
performed in the lower arch.
Four and a half months into
treatment, a .019” x .025” fully
active CuNiTi wires was placed in
the upper arch and a .017” x .025”

copper nickel wire in the lower
arch. Seven months into treatment,
additional .019” x .025” CuNiTi
upper and lower arch wires were
placed. Triangular elastics were
worn from month 4.5 through
month 8.
• Fig. 22: Archwire prescription
form representing the minor modification of the final 019” x 025” copper

nickel titanium wire to enhance the
upper right canine and upper left
central incisor position. This necessitated 0.5 mm of upper right canine
extrusion and -3 degrees mesial out
rotation of the upper left central
incisor tooth. All wire bending was
performed virtually first on the computer screen and than implemented
robotically.
• Fig. 23a: The patient on July
25, 2006.
• Fig. 23b: Sept. 8, 2006.
• Fig. 23c: Dec. 14, 2006.
• Fig. 23d: January 2007.
• Fig. 24: Final treatment was
completed in 11 months. OT

OT About the authors
Adam J. Weiss, DMD, is a 1988 graduate of Temple University
School of Dentistry and received his certificate in orthodontics in
1990 from the University of Medicine and Dentistry of New Jersey.
He is a diplomate of the American Board of Orthodontics and a
member of the AAO and the Middle Atlantic Society of Orthodontists. Weiss is in private practice with offices in King of Prussia
and Collegeville, Pa. Contact him at www.orthodontists.com.
Mark Feinberg, DMD, graduated from the University of Connecticut School of Dental Medicine in 1982 and completed his orthodontic residency at Columbia University in 1984. He is a diplomate
of the American Board of Orthdontics and a member of the AAO
and NESO. He maintains a full-time private practice in Stratford,
Conn. Contact him by e-mail at drdmd123@gmail.com or at www.
feinsmiles.com.

[9] =>

Practice Matters

Ortho Tribune | June/July 2009

Total Ortho Success Practice
Makeover — the road to growth
By Kevin Johnson & Emily Ely

social engagements, etc.
• Handling all the details for
announcements, public relations,
invitations, scheduling, etc.
• Serving as the doctor’s coach
— for example, by determining
which lunches need to be set up
and with which referring doctors.

fter winning Levin Group’s
Total Ortho Success™ Practice Makeover in late 2008,
Dr. Brian Hardy of Hardy Orthodontics and his team have hit the
ground running in their year of
management and marketing consulting. The practice kicked off its
Levin Experience™ at our Advanced
Learning Institute in Baltimore with
flying colors and returned home in
high spirits.
It was a good start, but there is
much left to do.
Now, the goal is to start implementing practice systems to kickstart production. Key areas to be
addressed first: scheduling and
referral marketing.

Dealing with the schedule
Dr. Hardy had stated before beginning his consulting programs that
his schedule “was approaching
the point where hard and fast scheduling rules need to be implemented.”
He was very upfront when he
stated that he needed “more guidance.” In fact, he had rated his
scheduling and case acceptance as
“fair.”
Few other dental specialists see
nearly as many patients in a day as
an orthodontist does. As a result, no
other specialist is as dependent on a
highly efficient schedule.
To address a core practice issue,
we introduced Hardy Orthodontics
to Levin Group’s Power Cell Scheduling™ system, which includes the
following two key components:
• A scheduling template must be
designed. Understanding how
each day should operate for Hardy
Orthodontics is the basis for creating the scheduling template.
Levin Group recommends that
mornings be reserved for more
involved appointments such as
records and banding appointments. Get the tough stuff out
of the way first when everyone
in the office is “fresh.” Save the
afternoon for more routine adjustments. Doing so goes a long way
toward easing doctor and staff
fatigue levels.
• All scheduling interactions must be
scripted. To properly communicate with all their patients, team
members are receiving verbal
skills training. We have instituted
scripting throughout Dr. Hardy’s
practice to build value for each
appointment, confirm appointments two days in advance and
communicate to patients that the
schedule has been designed to
serve not only their unique needs,
but also the needs of all other
patients.

PRC Catherine will seek out
untapped revenue and add value to
his practice by carrying out these
and other critical marketing functions. By doing so, she takes pressure off Dr. Hardy.

The state of the practice

Levin Group Senior Consultant Kevin Johnson, left, works with Dr. Brian
Hardy during the Levin Experience in Baltimore.

Total Ortho Success

Pr actice

A new start with referral
marketing
We reviewed the practice’s previous marketing endeavors. Dr. Hardy
had told us that his referral marketing strategies were “given a lot of
thought, but only some were followed through with over time.”
In the past, he has regularly met
with dentists for lunches and has felt
comfortable doing so. However, he’s
disappointed that he hasn’t seen
greater success with these efforts.
To generate the level of response he
wants, we are constructing referral
marketing strategies that begin with
the creation of a marketing calendar
for the year.
One example of a new marketing
initiative is a patient party tentatively scheduled for the fall. This
was actually an idea that Dr. Hardy
had considered for several years but
had never found time to make happen. With the help of his capable
team, this effective marketing idea
is becoming a reality.
The patient party is an excellent
example of the need for taking some
responsibility off Dr. Hardy’s shoulders and placing it into the hands of
the most critical person in referral
marketing — the professional relations coordinator, or PRC. This new
position in the practice drives the
practice’s referral marketing.

Dr. Hardy’s future has a lot
to do with the PRC

The PRC is key to running a successful orthodontic marketing pro-

gram for Dr. Hardy’s practice. This
individual will conduct marketing
activities at least 16 to 20 hours a
week, instituting many activities the
practice had considered but never
moved forward on.
As already mentioned, Dr. Hardy
doesn’t have enough time to personally administer a marketing program and carry out all the required
tasks. An estimated 95 percent of
the practice’s marketing efforts will
be managed and carried out by Dr.
Hardy’s new PRC, Catherine.
The role of the PRC actually
encompasses several jobs, all of
which will bring a great deal of
value to Dr. Hardy’s practice. The
main responsibilities include:
• Helping to design the marketing program by establishing and
monitoring calendars, timelines
and deadlines.
• Supporting relationship-management activities with key referring
doctors by staying on top of Dr.
Hardy’s notes, phone calls, letters,

As Dr. Hardy’s consulting programs
unfold, everyone in the office has
had to deal with a common issue —
fear of change. This did not surprise
us. It’s perfectly natural to feel this
way. Dr. Hardy’s energetic and talented staff, however, was quick to
step up to the plate.
“Although we might be apprehensive about some suggested
changes,” says Treatment Coordinator Lee Anne, “our consultants help
us see the balance and work with us
until we feel comfortable and can
own it.”
PRC Catherine sees the value of
the effective feedback we at Levin
Group provide, remarking that the
team’s concerns are answered “in a
way that we can believe and practice.” The assistant, Lindsey, concurs, stating, “The ideas and plans
that were demonstrated to us will be
very beneficial.”
As Dr. Hardy’s systems are implemented, things are going to really
heat up at Hardy Orthodontics. “I
look forward to seeing the results
from Levin Group’s systems,”
remarks Dr. Hardy.
Join us in our next installment
when we explore case presentation
and scripting in Dr. Hardy’s practice. OT

OT About the authors
Levin Group Senior Consultant
Kevin Johnson has spent the last
eight years working as a Levin
Group orthodontic management
and marketing consultant. He
manages a team of consultants
and is a frequent lecturer at the
Levin Advanced Learning Institute. Johnson earned his degree
from Towson University in 1996.
With many years of marketing experience, Levin Group Consultant Emily Ely joined Levin
Group in 2005. Ely uses her unique
knowledge and experience to provide
marketing solutions for orthodontic
practices. She earned her degree in
business from Towson University.
Both Ely and Johnson are members
of the Ortho Expert Team, a specialized
group of consultants who are trained in

the needs of orthodontic practices.
For more than two decades, Levin
Group has been dedicated to improving the lives of orthodontists. Visit
Levin Group at www.levingrouportho.
com. Levin Group also can be reached
at (888) 973-0000 and by e-mail at
customerservice@levingroup.com.

[10] =>

Practice Matters

Ortho Tribune | June/July 2009

5 tips to promote your
practice on YouTube
By Mary Kay Miller

ideo is the most powerful
Internet tool available today
to market your practice. With
the rise of YouTube and other video
sites, any size practice can take
advantage of video as an Internet
marketing tactic to deliver your
own personal PR message about
who you are and what you are all
about.
YouTube has the largest audience of all the video sites and will
give you the most leverage. More
than 100 million viewers watch
video on YouTube every month.
Engage and educate prospective
new patients with video as well as
keep your current patients up to
date on office events and instructions to enhance their treatment
experience.
Video will also increase your
exposure and page ranking on
the search engines through SEO
(search engine optimization), if promoted correctly.
• Brand your video: Use a video
to push your practice brand, just
as you would on TV, radio or in
newspaper ads. Online videos are
better at promoting brand awareness than traditional TV commercials. Why? Because online viewers are searching for treatment
providers and dental services at
the exact moment they are watching your video. They are highqualified, targeted viewers.
• Promote your services: Discuss individual products such as
Invisalign™, SureSmile™ and the
Damon System™. Describe the
features and benefits of the product, while educating and entertaining to create an emotional
response. Brand your video correctly to link back to your own
Web site. Always include an intro
and exit slide with your logo and
practice information along with
contact information throughout
the video to direct prospects to
your Web site or to have them
contact your office to schedule a
new patient exam.

OT Attend the Webinar

Mary Kay Miller is offering a sixpart series of Internet marketing
Webinars, geared toward helping you
discover what you need to know to
get your dental Web site working correctly on Google and help you build
your practice for the future on the
Internet. Each module is offered live
and is interactive, as well as recorded
and archived for review.
Take advantage of this opportunity
to improve your Internet presence
with your current Web site and Web
2.0 marketing strategies while earning ADA/CERP credits. Register for
the live broadcast on Aug. 6 of Part 6,
“YouTube ... The Video Granddaddy
of Social Media,” by logging onto
www.DTStudyClub.com and clicking
on Online Courses.

• Office tour: New patients gravitate toward office tours. Studies
show it is one of the first tabs a
patient will click on in your Web
site. Create video that promotes
you and your practice as warm
and friendly. Script a brief overview on who you are and what
you are all about. Highlight individual services, amenities and the
benefits of treatment to engage
your audience. It’s all about them,
not you.
• Promote treatment expertise:
Create a short video from before
and after photographs of beautiful smiles and narrate a script
describing the benefits of treatment. In today’s skeptical society,
consumers want verifiable proof
of treatment expertise. Videotaping frequently asked questions

also can be a very powerful tool to
promote your expert knowledge
and skills.
• Treatment: Put new patients at
ease before they enter your office
by videotaping the most common
treatment procedures or walk
them through the new patient
process in your office. Debanding,
placement of brackets and how
to remove an arch wire are good
examples of video content. Oral
hygiene, placing elastics, what to
do in an emergency and wearing
retainers make great instructional video. Drive patients to your
Web site to view the video. Content is delivered exactly the way
you want it, 24/7, day in and day
out. Not only is this informative,
it helps improve your video ranking on Google and your Web site
ranking with SEO.
Whether you outsource video
services to a professional or produce it yourself, it is critical your
video is set up correctly to be found
on the search engines.
Video doesn’t work as a marketing tool if patients can’t find it. You
don’t know what you don’t know
until you know it.
Consult with an Internet marketing expert to maximize your video
marketing efforts if unsure on how
to proceed. OT

OT About the author

Mary Kay Miller of Orthopreneur™
Marketing Solutions is an Internet
marketing coach specializing in SEO
(search engine optimization) and
Web 2.0 Internet Marketing solutions
to build your practice. With more than
30 years experience in orthodontic
marketing and practice management
and 10 years in Internet marketing, she has mastered the attitudes,
skills and knowledge necessary to
take your practice to the next level.
Access her free marketing e-Guide,
“Marketing Your Practice Through
Different Eyes,” at www.ortho
preneur.com. You may contact her
by e-mail at marykay@orthopreneur.
com or call toll-free (877) 295-5611
for a complimentary demographic
evaluation of your Web site.

[11] =>

[12] =>

Practice Matters

Ortho Tribune | June/July 2009

A troubled economy and embezzlement
By Scarlett Thomas, President of Orthodontic
Management Solutions

ccording to a survey by the
Association of Certified Fraud
Examiners, small companies
with less than 100 employees are
three times more likely to experience embezzlement. Believe it or
not, it has happened to one out of
every three dental offices last year.
In fact, it has been proven that 30
percent of any workforce will steal
from you.
There are many ways of embezzling, and it may not always mean
the involvement of stealing money.

ADS

It could be something as insignificant as long distance phone calls,
using your postage meter to send
out personal mail, adding a few
extra hours to the time card or perhaps borrowing a few dollars from
petty cash that never gets repaid.
Over time, these items can add up
to a considerable amount of money
and should never be overlooked.
The profile of an embezzler is
often times an employee you trust
and someone who has been with
your practice for a long period of
time. The person generally knows
what is checked by the practitioner,
bookkeeper and/or CPA and what
is not. He or she also knows the

computer system better than anyone else in the office. The person is
generally very territorial or intimidated by other people looking into
the accounts. He or she will often
work long hours, through lunch,
before the office is open or after the
office is closed, in order to keep you
or other employees unaware of the
thievery.
There are many different ways
to protect your practice from fraud.
The following are a few simple
checks and balances to implement:
• Assign everyone who uses the
computer to have his or her
own login password. This way
you can track who is doing what
in your practice.
• Never have a signature stamp in
the office as this can lead to thousands of dollars in embezzlement.
• Make sure all cash transactions
have duplicate receipts. One
goes to the patient, one gets stapled to the cash and one stays in
the receipt book to keep the numbers in order for the month. When
the cash is taken to the bank, the
receipt is taken from the cash and
placed with the deposit summary.
All cash receipts should be signed
by three people: the patient giving
the cash, the employee receiving
the cash and one witness of the
money.
• Three
different
employees
should be in charge of all deposits. One person opens the mail
and makes copies of all incoming checks. The live checks stay
with that person. The copies are
given to another person to post,
and then the deposit is reconciled
with the practitioner making all of
his or her own deposits.
• All bank statements should go
directly to the practitioner’s
home and never the office.
• Finalize all deposit summaries
at the end of each day. Keep
these deposit summaries in a safe
place. At the end of the month,
you want your CPA or bookkeeper
to compare all deposit slips to the
actual posted money in your computer system. Many CPAs and/or
bookkeepers only compare the
actual deposits to the bank statements. When the computer system’s generated revenue does not
match the bank statement and/
or deposit slips — it needs to be
investigated.
• Check all credit card bank
statements monthly for refunds.
Employees can often times run
their own credit card through
your credit card terminal services, refunding themselves money
to spend in the future. You can
notify your merchant services that
you want all “credits” password
protected and that you are the
only one who can issue a credit to
protect yourself.
• Every day an adjustment report
should be run and checked
thoroughly. You will be looking
for decreases in contract charges

OT About the author
Scarlett Thomas is an orthodontic practice consultant
who has been
in the field for
more than 23
years, specializing in case
acceptance,
team
building,
office
management and marketing. As a
speaker and practice consultant, she
has an exceptional talent to inform,
motivate and excite.

OT Contact
Scarlett Thomas
Orthodontic Management Solutions
Phone: (858) 435-2149
scarlett@orthoconsulting.com
www.orthoconsulting.com

or increases in payments and/
or balance write-offs. This report
should be kept in a safe place, and
when these items are seen they
should be questioned. The report
should be run again for the entire
month and checked against what
has already been turned in. This
will make it impossible to change
transactions after the fact.
• A report that should be checked
monthly but is often overlooked
is the back-dated check reports.
This area is often what is used to
embezzle money. Pay close attention to this area especially when it
comes to cash payments.
• The insurance area in a practice is a common ground for
thievery. Oftentimes, procedures
are billed out that were never performed, and the money received
is pocketed.
• Also, look for erroneous transactions with names of employees or their relatives. They often
use these accounts to transfer
money to and from zeroing balances as they go.
During these troubled economic
times, it has been reported that the
number of dental practices experiencing a loss of income due to
thievery has climbed to a terrifying
30–40 percent in the last year, with
the average theft being $30,000 or
more. Any theft more than $400
is considered a felony. Crimes of
embezzlement and grand larceny
are considered federal crimes with
a maximum punishment of 30 years
in prison, $1 million in fines or both.
Just posting the punishment alone
in the break room should help deter
someone from stealing!
If you would like more information regarding embezzlement issues
and/or management concerns, you
are invited to attend one of my
monthly Webinars. Please visit
orthoconsulting.com and register
under events and seminars. OT

[13] =>

[14] =>

Practice Matters

Ortho Tribune | June/July 2009

Why you should expand financial options
By Roger P. Levin, DDS

he current economy is having a
negative impact on nearly every
industry and profession, including orthodontics. Starts are down
for nearly three out of five orthodontists (59 percent), according to a
recent study by the American Association of Orthodontists.1
Other troubling trends include:
• Nearly half of surveyed orthodontists said collections declined.
• Net income decreased for 55 percent of responding doctors.
• 43 percent have postponed the
purchase of significant equipment or technology.
• 31 percent said they had pushed

back retirement to later than originally planned.
Fortunately, not all is doom and
gloom. Some orthodontists (21 percent) are seeing increased starts
since January 2008, and 25 percent
are experiencing an upswing in
income. Even in a difficult economic environment, these orthodontists’
offices are finding a way to grow.

Overcoming the ‘shopper’
mentality

In today’s consumer society, orthodontics is often viewed as a commodity, differentiated more on price
than on value. To parents in this
frame of mind, orthodontic practices are more or less interchange-

able. Parents will often seek out the
least expensive orthodontic care to
achieve what they think will be the
same result as the pricier options.
Due to this mentality, orthodontic
care is now being differentiated by
one criterion alone — cost.
In this economy, orthodontists
must recognize that practice success depends on offering the right
financial options. The majority of
orthodontic practices rely on some
variation of an in-house payment
plan as the main financial option.
As the economy continues to
sputter along, many parents/
patients may have difficulty coming up with the initial down payment (usually around 25 percent) of

OT About the author
Dr. Roger P. Levin
is founder and chief
executive officer of
Levin Group, the
leading orthodontic
practice management firm. Levin
Group provides Total Ortho Success™, the premier comprehensive
consulting solution for lifetime success to orthodontists in the United States and around the world.
For more than two decades, Dr.
Levin and Levin Group have been
dedicated to improving the lives
of orthodontists. Levin Group may
be reached at (888) 973-0000 and
customerservice@levingroup.com.

the projected treatment cost. Levin
Group recommends that orthodontic practices offer several financial
options, including outside financing, so patients/parents can choose
the one that best fits their needs.

An option that works
for patients and practices

Patient financing is increasingly
popular in general practices and
other specialties. An outside financing company approves the parent or
patient for a line of credit or a loan.
These approvals can be achieved
today within approximately five
minutes by phone or through the
Internet.
While orthodontic practices may
not want to absorb the processing
fee to provide patient financing,
some patients cannot accept treatment otherwise. The true benefit to
patients is that they do not have to
come up with a down payment and
can extend their payments beyond
the actual treatment time, if needed.
Levin Group’s orthodontic clients
are finding increased success by
offering outside financing to prospective patients.

Conclusion
Your orthodontic practice is the best
investment you ever made. Maximize that investment by offering
patients several financial options.
That way more parents/patients can
say “yes” to orthodontic treatment.
In today’s debt- and credit-oriented
world, orthodontic practices must
begin to think along the lines of
other businesses. Those that do
will experience significant growth,
higher production and increased
profitability.
Ortho Tribune readers are entitled
to receive a 20 percent courtesy on
Dr. Roger Levin’s next Total Ortho
Success™ Seminar being held Oct.
8–9 in Cambridge, Mass. To receive
this courtesy, call (888) 973-0000
and mention “Ortho Tribune” or
e-mail customerservice@levingroup.
com with “Ortho Tribune Courtesy”
in the subject line. OT
1. “Economic slowdown affecting many orthodontic
practices.” The Bulletin, V. 27, No. 2. April 2009.
Pub. by American Association of Orthodontists.

[15] =>

[16] =>

Practice Matters

Ortho Tribune | June/July 2009

No more spaghetti marketing
By Angela Weber, OrthoSynetics

intended for print publications.

No. 5: Measure up

paghetti marketing refers to
advertising with no clear plan —
simply throwing ideas against
the wall to see what sticks. A recent
AAO survey reported that 50 percent of orthodontists are launching
new marketing initiatives such as
direct mail, print or Web advertising programs. The question is: Are
they prepared to enter the business
of marketing?
As a new marketer with a limited
budget, you cannot afford a spaghetti marketing plan. With more
than 10 years marketing experience
in the orthodontic industry, I would
like to touch on some key points
that will give your marketing program a much higher success rate.

Deciding what to do
Direct mail, print campaigns, payper-click, search engine optimization … Oh my!
With so many advertising options
available, what is a practitioner to
do?
My answer: A little bit of everything will go a long way.
The worst thing you can do is
put all of your eggs in one basket.
While orthodontists have typically
relied on referrals, many are realizing they cannot afford to have the
fate of their practice lie in the hands
of the referring dentist or patient,
especially when dentists are keeping more of the business in-house
and not referring out to orthodontists.
The goal is to cover all of your
bases in a few key areas: community, referrals, Internet, direct
marketing and internal marketing.
When you have a consistent and
integrated plan that covers each of
these key areas, you can sit back
and watch your marketing plan produce like a well-planted garden.
A strategic plan that complements each marketing tactic will
elevate your practice to a power
position in the marketplace.

Out with the old
and in with the new?

Well, not necessarily.
I am a firm believer that traditional “tried and true methods” in
AD

marketing still have a place in your
marketing plan. Television, direct
mailer, print and other traditional
advertising all have their strengths
and weaknesses. An understanding
of which to do and when will serve
you well when trying to achieve
maximum response.
That said, now is also the time
to get on board with more current marketing practices such as an
online marketing campaign. With so
many people receiving their news
and current events on the Web in
place of more traditional venues, it
only makes sense to include Web
marketing in your toolbox.
Once you have determined what
you are going to do, you may think
you are all set.
Not just yet.
Advertising is the most expensive form of attracting a new
patient. Avoid these classic mistakes
that can cost you money.

No. 1: It’s not as easy as it looks
Now that you have decided to implement a marketing campaign, who
will develop and implement that
campaign? Your marketing campaign will be a big investment for
your practice, and you need to make
sure you have an experienced marketer with proven success running
it. Don’t leave it to chance – make
sure you have the right person
doing the job.

No. 2: Make sure your team
is prepared

Trust that advertising does work but

know there is a cost associated with
each call generated. Ask yourself if
your team is prepared to sell your
services and convert those calls into
new patient appointments.
Typically, a referral call from a
general dentist is a smoother sell,
while a call derived from an advertising campaign initiative needs
more convincing. While your conversion rate is much lower on direct
marketing, as an average, that does
not have to be the case if you know
in advance what you are trying to
achieve.
Make sure your entire team
understands the difference between
these two call types and adjusts
accordingly. You have to be prepared to close all of your leads.

Advertising is a great way to generate new leads that your practice
can turn into new patients. But it is
imperative to make sure that you
are tracking which key area of your
advertising is driving the new leads.
This will help you measure your
return on investment as well as
tailor your advertising budget to the
most successful media to reach your
target audience.
Marketing your practice is one of
the most costly, and potentially most
successful, things your practice can
do. I hope these steps help you to
better develop your targeted marketing campaign.
Welcome to the world of advertising! It can be tremendously rewarding when it is executed properly.
For a limited time, OrthoSynetics
would like to offer you the opportunity to have your marketing questions answered by one of our industry experts. Call Angela Weber today
at (888) 622-7645, or join the “No
More Spaghetti Marketing” club at
www.nospaghettimarketing.com,
and we will send the “Planning
Guide to Successful Marketing”
directly to your e-mail address. OT

OT About the author

No. 3: Are you talking to me?
Make sure you know the demographics of your audience or target
market.
Not sure how to define your
target market? Take a good look
around your office. How old are your
patients? How old are their parents?
Do they both work or do they have
a stay-at-home parent? Scan your
parking lot to see what types of cars
they drive.
Your target market data exists
right before your eyes. Once you
know who you are talking to, consider where and how you can reach
them.
Advertising that is too general
and speaks to no one in particular
does not carry the same impact as
a targeted, audience-specific message.

No. 4: Tell them what you want
When developing your advertising
campaign, make sure you have a
specific call-to-action that motivates
your potential patients and has an
easy follow-up. You need to tell your
future patients what benefits they
will receive by starting treatment at
your practice.
Your message needs to be simple,
clear and easy to follow. Be aware
of your medium when you develop
your call-to-action; for example,
a message online will be structured differently than a message

Angela Weber is the director of
marketing for OrthoSynetics (OSI),
a business service company in the
orthodontic and dental industries.
She has more than 10 years experience in healthcare marketing working with practices throughout the
United States. She knows her way
around a P&L statement; the focus of
her marketing strategies is to make
a positive impact on the practice’s
profitability. OSI has helped numerous practices achieve marketing success through strategy, creativity and
implementation. Expertise includes
generating new patient revenue
through Internet, mass media and
traditional marketing efforts.

OT Contact
E-mail: aweber@orthosynetics.com
www.orthosynetics.com
www.orthosyneticsblog.com

[17] =>

Industry 17

Ortho Tribune | June/July 2009

Taking charge of oral hygiene
Procter & Gamble’s
new Ortho Essentials
program puts control
in patients’ hands
By Kristine Colker, Managing Editor

here is no question that oral
hygiene habits can be a source
of much concern for both orthodontists and their patients. Good
oral hygiene can be hard to come
by in any patient, let alone in teenagers or adults who have mouths
full of wires and brackets. And no
matter how many times you might
tell them that bad hygiene can lead
to poor results and longer treatment
times, there is only so much you can
do. Right?
Wrong.
Thanks to Procter & Gamble,
there is now a way of ensuring that
not only are your patients brushing
and rinsing as desired, but that they
are engaged and having fun with
the process as well.
Ortho Essentials is a three-step
oral hygiene program designed to
help orthodontists streamline and
strengthen their oral hygiene control procedures by standardizing
their check ups, consistently reporting their results and making sure
patients improve their oral hygiene
at home.
“I saw patients in my practice
not ending up the way we wanted
them to in regards to hygiene,” said
Dr. Duncan Brown, the orthodontist
behind the Ortho Essentials program. “I became enormously frustrated.”
Brown shared his concerns with
other orthodontists, and together,
they decided to come up with a
common grading scale for quality
control. That, coupled with a 2007
study done by Procter & Gamble
scientists that showed that patients
who used a regimen consisting of
a oscillating/rotating power toothbrush and Crest Pro-Health paste
and rinse had up to 40 percent less
plaque than those who used a manual toothbrush and a regular anticavity toothpaste, paved the way for
the Ortho Essentials program.
“What’s unique about the program is that it combines the products with the process,” Brown said.
“The approach has never been done
like this before.”
The way the program works is
simple. Each practice receives a kit
that contains a five-level rating system ranging from poor to excellent.
This rating system is supported by
visuals on a Healthy Mouth Assessment Card, which helps illustrate
each level so staff members and
patients have a standard to compare. Every visit, orthodontists and
their patients can go over results to
see where the patient falls on the
chart and see which areas of the
mouth need some improvement.

“Hygiene needs to be individualized,” Brown said. “This way you
can work on problem areas.”
Each practice also receives a contract for both the orthodontist and
the patient to sign as well as all the
tools a staff needs to track a patient’s
progress.
Finally, patients are either given
or are encouraged to purchase an
Oral-B Triumph with SmartGuide
Ortho Unit and Crest Pro-Health
toothpaste and rinse for home use.
To further personalize the program, Brown suggests using a
reward system. In his own practice,
he said, good hygiene earns patients
tokens, which they can then use to

buy items. In addition, those patients
who receive all fours and fives on
their rating system chart are entered
into a drawing for an iPod touch.
Dr. Leslie Winston, director of
professional and scientific relations

for Procter & Gamble, said the best
thing about the Ortho Essentials
program is that it doesn’t let orthodontists just react to poor care but
instead empowers patients to take
control of their oral hygiene.
“One of the most important things
about the program is that we put so
much control in patients’ hands and
made them part of the process, which
is so different than talking down to
them and telling them what they
should be doing.” Winston said. “The
fact is we’re teaching them skills they
can use for the rest of their lives.”
For more information about Ortho
Essentials, including how to get started, visit www.dentalcare/ortho. OT
AD

[18] =>

[19] =>

Industry 19

Ortho Tribune | June/July 2009

TMJ disorder and orthodontics
By Chris Farrell, BDS

“Doctor, I was fine until I had my
braces on, but now I think I have
TMJ.”
In every orthodontic practice,
this situation arises consistently
and with alarming regularity. TMJ
disorder is one of the most common problems affecting millions of
people each year. Yet almost every
case is not properly diagnosed or
treated, causing continuous pain for
the patient. This is apparent even in
the orthodontic office.
Studies show that “the prevalence
of TMJ signs and symptoms has
been noted in several reports and
ranges between 35 percent to 72
percent.”1
If we refer to the American Journal of Orthodontics and Dentofacial
Orthopedics, the majority of our
orthodontic patients have signs and
symptoms of TMJ disorder.1 What is
the management strategy for these
patients to avoid unjustified blame
being placed on orthodontic treatment?
Patients and parents are more
knowledgeable than ever, with
Google being the new university
for the general public. It becomes
difficult to say TMJ disorder has
nothing to do with the orthodontic
treatment.
The literature is certainly inconclusive for now about the impact
of diverse orthodontic techniques,
with or without extractions, on the
causation and treatment of TMJ disorder. We know it is out there, but
what changes need to be made to
our treatment techniques to avoid
the focus of attention on TMJ?
In the future, the widely used cop
out of, “It’s not my problem,” will be
unsuccessful against a class action.
Causes and treatments are heavily debatable. There have been
prominent legal cases claiming
extractions were the sole cause of
TMD.
For years, professionals have
been treating patients with functional appliances to prevent TMJ/D.
However, there are no evidencebased techniques that confirm what
you do clinically every day.
Do your techniques make TMD
better or potentially worse? We must
find the appropriate professionals to
give the clinician a better guide than
at present.
This short article is in contrast to
the volumes written about TMJ/craniomandibular/myofacial pain disorders, with most of them being far
removed from the day-to-day issues
of orthodontic practice.
If the author has one suggestion, it is that orthodontists need
to be aware that full evaluation of
every orthodontic patient for TMJ
disorder is mandatory. Every new
patient should be evaluated for his
or her TMJ status and should be
questioned on the presence of key
symptoms, such as headaches and

ear and eye pain, as well as classic
TMD intracapsular symptoms.
You will be asked at some time if
the patient had the symptoms before
orthodontic treatment; if you have
no records, you have no defense.
You will need to compare this with
the records during and after the
orthodontic treatment. Many orthodontists do this already, but it should
be a universal practice.
By association, the orthodontist
can be drawn in to the TMJ/D issue.

Fig. 1: Severe case of reverse
swallow, contributing to future
TMJ disorder.

There is no proven link between
orthodontic treatment and TMJ disorder; however, the position and
function of the condyles is directly
controlled by the oral structure (see
Figs. 2, 3). Therefore, the orthodontist’s actions can influence the TM
joints. This is a question of anatomy,
not law.
So why do so many of our young
patients have a prevalence of TMJ
disorder?
Are they experiencing an early
degenerative disease, and if this
is the case, why is this problem so
common?
g OT page 20
AD

[20] =>

Industry & Products

Ortho Tribune | June/July 2009

f OT page 19

OT About the author

New theory of TMJ disorder —
the convenient truce
Proposition 1:
• TMJ disorder is caused by trauma
to the TM joints, which causes
pain in the associated craniomandibular muscles.
• Incorrect myofunctional habits —
reverse swallow, tongue thrust
and mouth breathing —cause the
condyles to be distalised and traumatized 2,000 times a day. The
trauma to the TM joints starts
at an early age and explains the
high prevalence of TMD in children and adolescents.
• Incorrect myofunctional habits
cause malocclusion and TMJ disorder; this is the “smoking gun” of
orthodontic treatment.
AD

Fig. 2: Normal uncompressed TM
joint.

Fig. 3: Reverse swallow and tongue
thrust compresses the TM joint.

To avoid unnecessary parent and
patient legal issues on TMD:
• Identify any TMJ disorder signs
and symptoms at the first consultation visit.
• Do a TMJ muscle and joint palpation on every new patient.
• Evaluate the TMJ risk assessment
before commencing your orth-

odontic treatment plan.
• Have adequate TMJ/D disclaimers in your treatment plans.
• Do a soft tissue dysfunction evaluation at the first consultation and
identify the real causes of the
TMD. The patient with the reverse
swallow and tongue thrust will
undergo orthodontic treatment

Dr. Chris Farrell, BDS, (Sydney University), CEO and founder of Myofunctional Research Co. (MRC), has
been a clinician in private practice in
Australia and England since graduating in 1971. His practice in Australia
specializes in myofunctional orthodontics and treatment of TMJ disorder. Farrell will conduct educational
seminars on TMJ, myofunctional
appliances and practice management
this fall. For more information, contact MRC at info@myoresearch.com.

successfully, but without correction of these habits, TMD problems may not be resolved and
symptoms could worsen.
If the malocclusion is blamed
for the cause of the TMJ disorder
and the pain increases during treatment, you have a problem. As we
know, correcting the malocclusion
does not always resolve TMJ issues.

References
1. TMJ/D in children and adolescents: Associations between occlusal
characteristics and signs and symptoms of TMJ dysfunction in children
and young adults. Riolo, Brandt and
TenHave. Am J Orthod Dentofac
Orthop 1987:92:467–77. OT

NeoLucent Ceramic
Bracket System

Ortho Organizers, a leading global
manufacturer of orthodontic products, laboratory services and continuing education programs, announced
the launch of its new, esthetic bracket
line, NeoLucent™ Ceramic Brackets.
The bracket system was carefully
crafted with patient comfort as the
utmost concern. The brackets are
among the lowest profile in the orthodontic market, measuring only 1.98
mm for the upper centrals, and feature a smooth, polished surface with
rounded corners. Designed to blend
with natural tooth tone, these ceramic brackets offer a virtually invisible
appearance.
The brackets are manufactured
in America from 99.9 percent pure
polycrystalline alumina. In addition,
NeoLucent brackets are breakage
resistant and are anti-allergenic as
they do not contain nickel, chromium
or other metals.
Ortho Organizers
Phone: (760) 448-8600
or toll-free (800) 547-2000
E-mail: usasales@OrthoOrganizers.
com
www.OrthoOrganizers.com

[21] =>

Ortho Tribune | June/July 2009

Industry & Products 21

Opal Etch
Opal Etch is a 35 percent phosphoric
acid etchant with a unique, self-limiting
chemistry that minimizes the possibility of over-etching. It combines the top
attributes of etchants including variable
viscosity, the ability to penetrate in the
smallest fissures on occlusal surfaces,
precise placement on vertical surfaces
without migration and self-limiting etching.
The distinct blue gel is dispensed
by a syringe with tips that aid in a controlled flow and precise application. The
thixotropic solution thins and paints on
easily, unlike other gels that are difficult
to spread. The gel is viscous enough to
prevent migration on a vertical surface,
but can still penetrate in the smallest fissures on occlusal surfaces because of its
physical and chemical properties, which

promote capillary action. The viscosity
also allows it to maintain a thick enough
layer to prevent premature drying and
inadequate etching.
Studies and clinical experience
have indicated that 15 to 30 seconds
is adequate for etching most young,
permanent teeth. However, variations
exist when considering enamel solubility between patients and possibly within
the same tooth.
One benefit of conventional acid
etching is that it tends to neutralize
the differences between individuals and
between teeth. Thus, a phosphoric acid

etch of sufficient time can compensate
for those individuals whose enamel is
more acid resistant.
“Attempts to use materials that produce a minimal etch — such as glass
ionomers, hybrid resin glass ionomers,
and the newer self-etching primers —
appear to result in increased clinical
bond failure rates,”1 according to the
book, “Orthodontics, Current Principles
and Techniques.”
The self-limiting properties of Opal
Etch prevent over-etching to create the
ideal bonding surface. Originally touted
as a benefit for etching dentin because

etching too deeply can result in sensitivity, the thixatropic properties in Opal
Etch work equally well on enamel.
The proprietary formulation of Opal
Etch also contains a surfactant for easy
rinsing of the gel, thus simplifying
removal.
Thickening agents such as polymers
and submicron silica additives, which
often leave a residue, are not included
in this formulation.
1. Orthodontics, Current Principles and
Techniques, Fourth Ed; Graber, Vanarsdall, Vig: Chapter 14, page 583:
copyright 2005, Elsevier.

Opal Orthodontics
(888) 863-5883
www.opalorthodontics.com

Dentistry meets its ‘cloud
computing’ match in DentalCollab
Modulus Media launches centralized,
treatment management system
with an online social networking system

ORONTO, CANADA — Modulus Media, a Toronto-based
technology development and
marketing company, announced
the June 26 launch of DentalCollab, a Web-based software —
available at www.DentalCollab.
com — that finally unites a centralized, treatment management
system with an online social networking system to create the ideal
“Treatment Workspace” for the
field of dentistry.
The “cloud” in cloud computing is a metaphor for the Internet. As an expression, cloud computing entails offering Web-based
software services via the Internet
where the data and software are
stored on servers managed by the
service provider.
Thus, cloud computing users do
not need to spend untold dollars on
hardware, software, upgrades or
ancillary support services, but need
AD

only to pay for the services they use.
Some of the more trusted and
familiar cloud computing services
are online banking, e-mail accounts
such as Gmail™ or Yahoo! Mail®,
social portals such as Facebook and
MySpace and Internet-based photo
albums on sites such as Webshots
or Flikr®.
Similarly, DentalCollab is a
cloud computing service that allows
the dental community to not only
facilitate all aspects of treatment
management, but also to collaborate with specialists, consult with
patients, coordinate with referrals,
mentor or be mentored by peers,
and share cases with labs and suppliers.
Through its creation of a shared
Treatment Workspace, DentalCollab allows practitioners completely secure patient information
management and includes seamless treatment planning, while

also facilitating networking with
experts anywhere on the planet
who have a computer with Internet
access.
The
Treatment
Workspace
is an easily navigated mini-Web
page where all those involved in a
patient’s care can coordinate their
efforts as well as share and manage
vital information.
Additionally, staff members can
schedule appointments, follow-ups
and reminders, consult with patients
and manage multiple schedules for
even the busiest practice.
“Our comprehensive software
allows you to easily interface many
of your other programs such as
charting systems, digital X-rays
and patient financing services, thus
consolidating your information,”
said DentalCollab founder Shane
Powell.
DentalCollab uses the same
hardware and software security
provisions that online banking
providers use — end-to-end
encrypted data infrastructure;
back-ups/data redundancy; 24/7

system monitoring; permissions/
roles-based user management;
and 256-bit bank-grade security
certificates with a $100,000 warranty.
Finally, dentists have a place to
do everything they need, and want,
to provide the utmost in treatment
planning and meet the modern
needs of their techno-savvy patients
by going beyond the traditional
method of contact via telephone
and snail mail.
Using DentalCollab means dentists can avoid costly software
upgrades, hardware upkeep and the
time wasted seeking out technical
support or repairs.
“The DentalCollab software functions like a basic Web page, so it
feels as if it is running on your own
computer. This translates into a
very short and fast learning curve,”
explained Powell.
DentalCollab saves practitioners
time and money.
For more information, please
visit www.DentalCollab.com or
e-mail sales@dentalcollab.com. OT

[22] =>

Events

Ortho Tribune | June/July 2009

Off to Minnesota
GORP brings residents, orthodontists and exhibitors together
for three days of learning and networking

f you are an orthodontic resident,
then Minneapolis — more specifically, the campus of the University of Minnesota — is where you
want to be come July 31.
For three days, residents from
across the United States and Canada
will gather together to attend the
21st Annual Graduate Orthodontic
Residents Program (GORP). There
they will listen to speakers such
as Dr. Brent Larson, Dr. Gerald S.
Samson and Dr. Bjorn U. Zachrisson; visit with exhibitors; and partake in special events, such as a golf
outing or a paddleboat tour.
The idea for GORP began in 1989
as a means of bringing the orthodontists of the future together for
a summer meeting, while at the
same time creating an environment
to foster professional growth and
interpersonal relationships among
colleagues and representatives of
orthodontic manufacturers.
During the past 20 years, the
meeting has grown to an event that
involves more than 400 students.
The meeting is held every other
year at the University of Michigan,
with the alternate years at other
institutions.
Past meetings have been held at
Harvard University, University of
Texas at Houston, University of Illinois at Chicago, Ohio State University, University of Toronto, University of Kentucky, University of North
Carolina, University of Washington,
and Saint Louis University.
The program is unique in that it
is the first meeting to bring together
residents in a dental or medical specialty program.
The meeting is sponsored by
donations from orthodontic exhibitors, and by the American Board
of Orthodontics and its constituent associations and the American
Association of Orthodontists Foundation.

The speakers
During the three days, residents
will hear from a variety of speakers. Dr. Gerald Samson will discuss
“Addition, Subtraction and The Full
Monty,” which will focus on a simplified approach to understanding
applied clinical orthodontic physical science.
Dr. Brent Larson will take on
“Playing for Par in the Game of
Orthodontics: The Role of Indirect
Bonding” as he compares orthodontics to the game of golf — efficient
treatment is like playing in the fairway and getting the ball in the cup
with as few strokes as possible.
The presentation will demon-

The group photo taken at the 2008 GORP, held last summer at the University of Michigan.

GORP day-by-day
Friday, July 31
6:30 a.m.: Buses leave for golf
tournament
8 a.m.: Dale B. Wade Memorial
Golf Outing
11:15 a.m.: Buses leave for Minneapolis Queen paddleboat cruise
luncheon
3 p.m.: ABO certification course,
presented by CDABO
5:30 p.m.: Cocktail party
7:30 p.m.: Dinner and program
featuring comedian John DeBoer

10:45 a.m.: Dr. Brent Larson
11:45 a.m.: AAO president
Noon: Box lunch provided, exhibitors
2 p.m.: Council on New and
Younger Members
2:15 p.m.: ABO representative
2:30 p.m.: LeeAnn Peniche
3:30 p.m.: 3M Unitek Picnic
5 p.m.: Group picture.
9 p.m.: Resident party

Sunday Aug. 2

8 a.m.: Continental breakfast,
exhibitors open
8:45 a.m.: Introductory remarks
9 a.m.: Dr. Gerry Samson
10 a.m.: AAOF representative
10:15 a.m.: Exhibitors/coffee
break

8 a.m.: Continental breakfast,
exhibitors open
9 a.m.: Dr. James A. McNamara,
Jr., Honorary Lecturer Dr. Bjorn
Zachrisson
10 a.m.: Exhibitors/coffee break
10:30 a.m.: Dr. Bjorn Zachrisson
11:30 a.m: Raffle
1 p.m.: Check out

strate a simple, predictable and reliable method for placing brackets
that will be beneficial for residents.
LeeAnn Peniche’s topic for the
weekend is “The Right Stuff: Establish a Practice That Has Your Name
All Over It.” Specifically designed
for orthodontic residents, she will
focus on the importance of image in
establishing a practice.
Dr. Bjorn U. Zachrisson will take
on a double dose of presentations.
First up is “Planning Esthetic Treat-

ment After Traumatic Injuries and
Loss of Maxillary Incisors,” which
will detail the advantages and disadvantages of different treatment
options for replacement of missing maxillary central and/or lateral
incisors in young and adult/elderly
patients.
Afterward, he will move on to
“Interproximal Enamel Reduction
of Premolars and Anterior Teeth
— A ‘Must’ in Contemporary Orthodontics,” where he will detail why

Saturday Aug. 1, 2009

OT Get Ortho Tribune!
Kick off your career on a good note
by staying on top of all the industry news, trends and events! For a
complimentary subscription to Ortho
Tribune, simply e-mail your name
and mailing address to database@
dtamerica.com or call our office at
(212) 244-7181.

reshaping anterior and posterior
teeth toward ideal morphology by
grinding is not only a useful technique, but actually a necessary
ingredient in modern orthodontics.

The events
Of course, there is no shortage of
fun to be had during the annual
GORP event, from a program featuring comedian John DeBoer to
raffles and a resident party. Two
special events include the Dale B.
Wade Memorial Golf Tournament
and a narrated sightseeing cruise
on the historic Minneapolis Queen
paddleboat.
Residents can choose to participate in the golf tournament, which
will take place at the Wilds Golf
Club, one of the top courses in the
Twin Cities area, or they can take
a tour down the Mississippi while
having lunch aboard a 100-foot,
modern-day replica of the grand
riverboats that used to sail there.
For more information on GORP,
visit the Web site at www.gorportho.
com. OT

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[cover] => Ortho Tribune U.S.

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