Top tips for the ortho-dentist

Figure 1
Figure 1

Thomas Sealey offers his top tips for GDPs building an ortho-dentist practice with complete and invisible tooth alignment solutions.

The evolution of invisible, short-term, cosmetic orthodontic systems has created a new generation of dentist – the ortho-dentist. They are cosmetically-focused and able to provide patients with simple orthodontic correction of anterior teeth, and when combined with composite-bonding techniques, can produce a straight smile that meets the expectations of patients with minimally-invasive options at a reasonable cost and within a reasonable timeframe. If you are just beginning to develop your ortho-dentist practices – or are already streamlining this exciting area of dentistry into your daily life – I hope these following 12 tips will give you some ideas on how to increase uptake and profits.

1. Know your stuff

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Figure 2

As with all dentistry, we must always practice within our sphere of competence and with the support of adequate training and supervision. I would encourage attending as many courses on cosmetic tooth alignment as possible, as each one provides additional information that reinforces (and supplements) prior knowledge while developing this aspect of practice.

Most courses will provide the information and techniques needed to start treatment on simpler cases, with the best courses offering an online portal for continued support as you progress. A simple smile makeover case can be completed in as little as six weeks (Figures 1-6 that show a simple smile makeover case) to six months with most cosmetic tooth alignment systems. Both fixed and removable systems can be used and offer different advantages, depending on the clinical situation and patient priorities. Many situations require a combination of both to achieve the best aesthetic results.

2. First impressions (figuratively)

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Figure 3

Always offer a free consultation to entice the patient to your practice; this is your opportunity to get to know them, make them feel welcome and cared for, and to give them some information. Don’t push the ‘hard sell’ at this appointment as it can scare them off.

Provide the patients with information about the different systems and estimated timeframe. Providing information leaflets on some of your favoured systems will help the patients with their decision-making, too. Costs should always be discussed at this first appointment; this is the primary concern to most patients so you might as well get it out of the way immediately, as it’s always what they want to hear first.

3. Offer something free

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Figure 4

An excellent sales technique is to offer something free to the patient. This will encourage them to feel as if they are getting a ‘deal’ and also shows you will go above and beyond your competitors. I will often provide teeth whitening and a spare removable retainer without charge, but casually mention that these two items usually cost about £500.

The fact is that the better orthodontic systems will actually give you whitening gel included as part of their normal product pack, and so it isn’t costing you any extra anyway.

4. Photography is your best friend

Figure 5
Figure 5

I implore you to photograph every case you complete following the British Academy of Cosmetic Dentistry guidelines. After a while, you will start to see repetition in the types of malocclusions with which you are presented and you can show new patients the completed end results of other similar cases to which they can relate.

Photography is my favourite treatment communication tool and gives patients the confidence in your clinical ability to correct their smile and address their aesthetic concerns. Ensure you have consent to show their photos using a photo release form that they can sign should you plan to use their photographs on your website, on social media, in the dental press or to show to other patients.

5. Invisible is the key

Figure 6
Figure 6

Patients are coming to you specifically for a short-term and invisible solution for their tooth-straightening needs, so it seems completely counter-intuitive to offer them solutions that are not invisible. However, by beginning your sales pitch by showing them metal-only options, such as a regular metal fixed brace and a wire retainer, means that the invisible options that follow seem even more appealing to the patient and justify the increased price.

The brace is only temporary, whereas retention is for life. In my opinion, the retention system should be a priority. There are a multitude of options for getting a patient’s teeth straight, but the wrong choice of retention may cause it to all unfold again. Offering an all-in-one invisible retention system such as SOLID by Cfast will ensure absolute fixture of the teeth in their final position (Firugre 6), with the smooth feel and invisible aesthetics patients now expect.

6. Follow-up

Follow every free consultation with a letter to the patient. Thank them and summarise your discussions. This often-omitted communication tool will make the patient feel very special and cared for before any clinical procedure has begun. It demonstrates that you are thinking about their needs and you have the time to contact them personally and that they are important to you.

Don’t mention costs again in this letter, but do invite them back for continued discussions about their smile makeover journey.

7. It’s all about consent

When the patient returns for their second consultation, it is time to begin the consent process, even before they have agreed a treatment plan. This is paramount before beginning treatment. Even at this early stage, you must document all conversations and information provided to the patient. Always give the patient the opportunity for a specialist referral as they may decide they would prefer a more traditional approach to ensure a skeletal and occlusal class I final result. Specialist orthodontists are fantastic allies to have when you are developing this area of your practice, as they will offer advice and will kindly accept patients who require more advanced orthodontic care.

Remember, we are ortho-dentists, not orthodontists, and shouldn’t portray ourselves as such. When discussing costs with your patients, try to include everything into the treatment plan and break it down with an expected timeframe. This will help the patient plan their finances and understand how the treatment will progress. Often you can arrange a finance plan for you patient too and this can make payment options easier for them. By the end of this second appointment you should have agreed a particular orthodontic system with the patient and you can begin the first stages of treatment planning.

8. First impressions (literally)

Most orthodontic systems offer a digital representation of the patient’s teeth before and after treatment, so the patient can see the expected outcome. I feel this is an essential step to demonstrate what can realistically be achieved with these shorter-term systems and allows us to highlight and explain any limitations and observations with the patients’ treatment.

Once you have taken the first impressions, you can send them for this digital set-up, and continue to complete the full orthodontic examination, including all normal special tests and observations. Invite the patient to return to view the digital set-up and confirm the final stages of consent. It is imperative to inform the patient about:

  • Occlusal and incisal changes of the anterior and posterior segments
  • Any increase or decrease in overjet or overbite
  • Any rotations or spacing
  • The fact that the skeletal relationship cannot be changed.

Discuss again the expected timeframe, appointment schedules, any composite buttons or bite-stops that will be placed and, finally, payment planning.

9. Retention, retention, retention

Orthodontic relapse is the nemesis of the ortho-dentist. Without retention, your hard-earned tooth alignment will fail. If you fail to discuss retention before treatment, you are dentolegally vulnerable if complications or failure occurs. The key to success is to fully discuss the retention regime prior to beginning treatment and plan and cost the ongoing maintenance into the treatment plan right from the word go, so that there are no ‘surprise extras’ to shock the patient after tooth-straightening is completed. I have seen many cases relapse when only a fixed wire retainer is placed, and similarly when only a removable retainer is given; where possible, it is recommended to provide both fixed and removable retention such as SOLID by Cfast.

10. Cash in with composite

In almost every case of simple anterior orthodontic correction you will find that the teeth still don’t look ‘veneer perfect’. This is usually due to facial asymmetries, incorrect tooth size proportions and uneven incisal outlines due to historic tooth wear. All these can spoil the final end result. Right from the beginning of treatment planning (Figures 1 and 2) you should be thinking about the end – result of the patient’s journey; will it be perfect or could more be done? I will always discuss composite-bonding at the treatment planning stages and advise the patient that after straightening and tooth whitening (Figure 3), we will reassess and make further decisions on any more improvements that can be made. 

As part of your consent process you would have already discussed ceramic veneers, and it is likely that your patient has chosen a cosmetic tooth alignment option due to the low risk and minimally-invasive approach, therefore composite-bonding can offer the patient a reasonable solution in keeping with the minimally-invasive ethos. By planting this seed at the beginning of treatment, once orthodontic correction is completed, you can re-visit this suggestion and more often than not you will have patient acceptance.

In many cases, a far superior end aesthetic result can be achieved with simple, no-prep, composite bonding techniques (Figures 4 and 5). Please understand that the usual consent process is mandatory. Advantages, disadvantages, risks and alternatives, as well as the ongoing maintenance and costs, must all be discussed. If your patient is willing, then you can achieve a substantial improvement in the anterior smile aesthetics by edge-bonding usually just the front four incisors; this can therefore increase your profit by at least £500 on every single patient.

11. Don’t be afraid to ask

Once you have finished your treatment and the patient is delighted with the final result, don’t be afraid to ask them to recommend you. Ask them to post their experience on social media and link it to your website. It is a nice gesture to offer 10% discounts if they refer their friends and family also.

If you spend that little bit of extra time and attention to get the patient’s smile as perfect as you can, they will be so thrilled with the end-result that they will have no reservations to tell anyone who will listen. If your patients leave smiling, then the rewards to you and your practice will be immeasurable. If they leave feeling disappointed, underwhelmed or financially cheated, then your reputation will very quickly suffer.

12. Go the extra mile

Going above and beyond your competitor is the only way to separate yourself from the pack. For example, if you remove fixed braces and there is one tooth that’s not quite right, then don’t even hesitate – correct it with one or two clear positioners and do not charge the patient. They will tell their friends ‘this dentist is such a perfectionist that they made 100% sure that my teeth were exactly as I was hoping, I’m over the moon’. 

This simple gesture will be worth so much more in the long-run than the extra £50 you may spend to get things perfect. If you aim to exceed patient expectations during every stage of their treatment then the rewards through their recommendations and word of mouth referrals will, in time, transform your workflow and re-energise your staff as your practice evolves into the exciting realm of the ortho-dentist.

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