Download Session 1: Expectations for this seminar

Seminar 1: Expectations for this seminar
New Patient IPsoft file and picture tab
1. How to start a new file in IPsoft for a new ortho patient.
Click “file-new” or the far left icon, input information with a “*” as mandatory,
other fields are optional and intended for the cases within the practice. POS
cases should be given a case number starting with “pos” and the case number.
Last names and even cities can be titled with descriptions to sort the cases with a
particular problem. Case numbers for the practice should correspond with what
is used on the study model filing system and for practice management. Suggested:
2011.2 = 2nd case started in 2011, OR simply 1-100 to indicate to the student how
many ortho cases they have started.
2. How to search and open an existing patient file
Click on “file-open” or the 2nd icon from the left.
.
Search by case number assigned by the
computer (starts about 2400), last name, first name, doctor assigned case number
(eg. pos 1000), etc. and then “ok”.
3. How to load pictures into the ‘pictures’ tab
Right click on the space you want to insert a picture and select ‘add/edit picture’.
then select from the CD, memory stick, digital
camera memory stick or file folder on the computer hard drive for that patient.
Some will be able to ‘drag and drop’, but this is considered for those with
better computer skills. Keep it simple in class.
4. How to make another pictures page for additional photos
This is very important to be able to do this as the records are now more than ever. Click
on ‘add’, then type in custom label for the new page.
5. How to change the ‘caption’, ‘swap’ picture locations, and rotate a picture
Changing the caption is to change the title above the
picture. Right click on the picture location you want to change, select change caption,
then type in new label. (eg. Frontal ceph, resting lip, wrist x-ray). Swap is when you wish
to move a picture from one space to another (you added a picture to the wrong location).
Right click, then Click swap, and then click the location you want to move the picture to.
Rotate a picture is important when you are importing directly from the digital camera or
for the occlusal views taken in a mirror. Right click and select rotate 90 degrees or flip
horizontal until the picture is oriented as you want.
6. How to generate the ‘lateral ceph’, ‘panoramic x-ray’ and study model views for
the picture tab
It is suggested for the student to make a file folder for each patient on your hard
drive for their records, IPsoft file copies, etc. If using a digital ceph/pano
machine, these records can be ‘imported’ or “added” to the picture tab as
described in #3 above. If using an x-ray film type machine, then the lateral ceph
and panoramic x-ray can be scanned directly into dentalcad (‘acquire’) or saved
into the patient file folder.
Study models need to be scanned by everyone on the double occlusal view for
use in dentalcad using a flat bed scanner, black and white, 96dpi, for measuring.
If scanning directly into dentalcad, a screenshot can be made for the purpose of
the pictures tab. For the lateral study model views, either scan and save or take a
photo and import.
**NOTE: NO photos of the double occlusal study model since this needs to be
measured and photos will not be 1:1 for that purpose. This is the first shortcut
that students want to take to save having to buy a scanner.
1st Consultation (clinical examination)
7. What the difference is between thin, moderate, and thick tissue thickness and how
this influences the extraction vs. non extraction decision
Lower incisor tissue thickness is the amount of attached gingiva ‘in front of’ the
lower incisors. If this is ‘thin’, then there is risk of gingival recession during ortho
treatment if the lower incisors are advanced. If moderate (medium) or thick,
determined by visual estimation, then some incisor advancement can be tolerated.
This can be used at the initial consultation to ’estimate’ if extraction may be
needed or not.
8. What class I is in the permanent dentition and how that is different in the mixed
dentition
The dental school definition of a class I molar is the mesial-buccal cusp of the
upper first molar (6) is occluding with the buccal groove of the lower molar. In
practice, to get a solid class I cuspid, the upper molar is often positioned in a
slightly class III position RELATIVE to the lower molar. The cuspid should be
made class I since this influences the anterior overjet, and the molar positioned in
the ‘best fit’.
In the mixed dentition, the Es or 6s are in ‘terminal plane’ position with the
distal of the upper and lower in the same plane.
9. How to classify the ‘millimeters’ of class II or III
A full tooth bicuspid or cuspid is ‘estimated’ to be 8mm. End-to-end class II is
therefore 4mm, between class I and 4mm class II is 2mm class II. Upper cuspid
fits distal to the lower cuspid in the class I occlusion.
10. What is a functional shift of the mandible and how can you identify this in the
records
There are two types of functional shift. The most common one is a shift of the
mandible to the right or left due to an occlusal interference, and often times
maxillary constriction versus the lower. You may see a unilateral crossbite, but
you may not. You may see more class II on one side than the other but when you
study model measuring, the dental arches are symmetrical.
The 2nd kind of functional shift is the mandible being positioned forward into
anterior crossbite in a class III case. The incisors hit edge-to-edge and to get the
teeth to bite together, the patient shifts the mandible forward.
11. What is deep bite
When the upper incisor covers the lower incisor more than 1/3 of the clinical
crown. If the upper incisor covers the full lower incisor, this is 100% deep bite.
12. what is a ‘tapered’ incisor and why this is important in orthodontic bracket
placement
The contact point is wider than the incisal edge, giving the impression of spaces
between the incisors. For an improved appearance, brackets are positioned
referencing the mesial line angle, adding more distal root tip, closing the spaces.
13. What is the ‘irregularity index’ and how do we use this to give an estimate of the
need for extraction vs. non extraction at the first clinical exam
Looking in the patients mouth at the initial exam, you add millimeters of crowding
for every ‘broken’ contact point from molar to molar in the upper and lower arch.
Estimate 1/2mm, 1mm, 2mm or more overlap of the contacts to make that tooth
straight on both mesial and distal. The sum is the irregularity index. At the first
consultation, divide this total by ½ (2mm crowding = 1mm incisor advancement)
to determine how much the incisors may advance if that arch is aligned. Then
look at the protrusion of the starting teeth, tightness of the lips, and lower incisor
tissue thickness to make an estimate if the diagnosis may include extractions.
14. How to use the tooth diagram in classification I tab to indicate rotations and teeth
to be banded
At the initial examination of the patient for possible orthodontic treatment, call
out verbally to the assistant (or have the assistant fill out this diagram) the
obvious tooth rotations (mesial or distal rotation). The patient is hearing this
language, adding to their confidence in you and that they are in need of
treatment. Doctors may also want to call out the teeth to be banded, one step that
needs to be done in the diagnosis of the appliance.
15. Why it is important to establish the periodontal and TM joint conditions before
starting ortho.
To avoid being blamed (and attacked) for causing periodontal breakdown or TM
joint problems from the orthodontics you provide, you need to establish the
starting conditions of these issues. If there are joint problems at the start, this
needs to be indicated and considered in the diagnosis. If bone loss has already
been a problem for a patient, this needs to be considered in the diagnosis and
documented that you did not cause this.
16. The difference between facial types ‘dolicofacial’, mesiofacial, and brachyfacial,
and how this may influence your treatment decision.
Dolicofacial patients have long-thin faces, and typically have skeletal open bite
when reviewing the lateral cephalometic numbers. In these types of cases,
extraction is often done to prevent bite opening during treatment, and when this is
done, the extraction spaces close quickly, many times spontaneously with the
molars drifting forward. Steps need to be taken to control this tendency.
Brachyfacial patients have short, square facial features with thin lips and tight
muscles. In these patients, the bite does not open when treated non-extraction,
and if extracted, the spaces close slower. So in these cases, we ‘tend’ (as in not
always, but leaning that way) to treat these types non-extraction.
Mesiofacial patients have ovoid facial structures, not short, not long, the middle.
In these cases, if you treat non extraction, the bite will likely not open, unless you
of course advance the incisors too much. If you treat extraction, the spaces will
not spontaneously close so you will need to apply forces to close the spaces,
needing about 6-10 months to close the bicuspid extraction space.
17. How to determine the upper midline to the face and why this is important
Sit the patient upright in the chair and ask them to smile, looking at how the
upper midline is positioned in the face. This is one key feature of a well treated
orthodontic case and any deviations should be noted and documented before
starting the diagnosis process.
18. How to accurately record with photos the high smile and resting upper lip to the
upper incisor
On separate photographs, added to the picture tab as extra photos, it is a good
habit to include the resting upper lip relative to the upper incisor, especially in
cases that show excess gingival display and deep bite cases. The resting lower lip
to the lower incisal edge can be important information when making the diagnosis
in a deep bite case. The high smile photo should be the TRUE highest smile, NOT
the ‘comfortable’ smile. This is an important feature when making diagnosis that
includes the vertical.
19. What lip competency and incompetency is and how this may influence your
treatment decision
Lip competency is normal and refers to lips that are together when at rest. Lip
“incompetency” refers to lips that are open when at rest and must be forcibly
pushed together (mentalis muscle pushing the lower lip ‘up’. If the lip
incompetency is due to protrusive teeth, then extraction is the most likely
diagnosis. If lip incompetency is due to excess vertical dimension, then
orthognathic surgery or intrusion mechanics (skeletal anchorage) may be
indicated. If the lip incompetency is due to a short upper lip, then soft tissue
surgery (oral or plastic surgeon) may be indicated.
20. How to record what you told the patient when they made the decision to take
records. Possibility of extraction, length of treatment, estimated cost of treatment
In the ‘yellow’ tab of IPsoft, you indicate what YOU told the patient at the first
consultation, and what the patients complaints and feelings about protrusion are.
This information is often critical when making the diagnosis, but especially when
giving a 2nd consultation, you will increase acceptance if you can say “the
diagnosis is exactly as I told you [at the first consultation]”,when they accepted
what you said, requesting to take records.
21. The importance in recording the chief complaint and how that will be used at the
next consultation.
What the patient sees and what they are interested in correcting for the money
they pay, is critical information when making a diagnosis. You need to include
these issues and be certain that the problems THEY see will be corrected. At the
2nd consultation, the FIRST thing you establish is what the patient wants to
correct and that you have a plan to correct that (or not).
22. Why it is important to record what the patient thinks about the protrusion (or lack
of it).
When making your diagnosis, non extraction alignment of crowded teeth will
result in the incisors becoming more protrusive. If the patient already feels their
teeth are protrusive or they do not want any more protrusion, then these cases
will need extraction to reach a treatment goal that is satisfactory to yourself and
the patient.
23. How a staff member can reduce your doctor time at the 1st consultation
Similar to a Nurse in a medical office, the dental assistant can record the features
of the malocclusion, to be confirmed by the Doctor. The assistant can also more
freely talk to the patient about their perceptions of their mouth and what they may
want to correct, recording this in the ‘notes’ section of the yellow tab.
Goals, Limitation, Treatment options considered
24. Why it is important to record your goals of treatment and even make priorities
There is a contract being made between the patient and Doctor of what will be
corrected and what will not be corrected for the agreed fee. The doctor should be
correcting what is ‘valuable’ to the patient, and not simply what their perception
of an ideal occlusion is from dental school. Priorities may be set in the list of
things to be corrected, with the first priority being the most important. If you do
not succeed in correcting the first priority, then you have failed in the case. This
is a measure of success or failure.
25. What is a ‘limitation’ of treatment, why this is important, and list at least 5
If there are no limitations, then the Doctor is obligated to obtain a PERFECT
result from the treatment. The limitations are the ‘excuses’ for a perfect result
NOT being possible, stated in advance is a diagnosis, stated after there is a
complaint is a cover-up.
26. Why it is important to record ‘what you will NOT correct”
This has to do with the patient’s expectations. If they expect you to correct
gingival display, for example, and you do not, then they are angry and feel that
the you did not perform for the fee charged. It is important to go through the list
of what you will NOT correct, maybe even more important of what you plan to
correct, to avoid future conflicts.
27. How to make a list of possible treatment options and why this is important to
make a complete list
If ANY practitioner in your immediate area MIGHT consider another treatment
alternative than you feel is the obvious choice, it is important for you to list that
you considered this option to avoid criticism from that orthodontist in the future.
NOT considering a treatment option, especially orthognathic surgery, is
negligence in orthodontics. A bad result may not be negligence after considering
the circumstances (lack of patient cooperation) that caused the less than desired
result.
If you do NOT consider a possible treatment option, you cannot choose it as
your treatment decision! Consider everything, and then make the best choice for
that individual patient.
28. How to determine which treatment plans are available to the section 1 student and
why this is important to limit yourself at this time of your training to these
There is a list of treatment plans in your section 1 book that have the ones you are
qualified to accept in red and the ones that you need further training in Blue.
There are plenty of cases available in every practice of this “easy” type, so while
you are gaining experience and more education, trust me to tell you which ones
you should feel acceptable to accept. If you get into cases that are above your
abilities, you may lose confidence and not accept any!
29. How to record the first consultation in the treatment history tab
To make the treatment history active, you must first have a time for treatment in
the ‘yellow’ patient expectations tab. Click the ‘begin treatment’ button and
select the type of appointment
What to say (or NOT say) at the initial consultation
30. Why is it important to discuss the possibility of extraction
So the patient will not be surprised and shocked at the 2nd consultation when you
present an extraction diagnosis, potentially not accepting treatment because of
this surprise.
31. How can a complaint of protrusion help the discussion of extraction
To correct protrusion, you need to make space to move the front teeth back into. If
the patient wants to correct that complaint, they must accept extraction.
32. How much are you going to charge for “records” and what does this include
This is an individual question, of course, asking you to set your fee and policy
before being faced with a patient that wants orthodontic treatment. Consider if
you will be submitting this case for diagnosis consultation (you should on at least
the first 10 cases, the danger area if you have a bad experience), and if you will
credit the patient for the records if they accept treatment with you (otherwise they
must pay for the records if they want a second opinion). The records includes
your time spent in diagnosis and treatment planning, the real cost!!
33. Where is the patient going to get their records taken
Determine which records you can provide in your own practice, on site, and
which ones you may need orthodontic lab or radiologist support to obtain (TM
joint views, 3D scans, frontal ceph, lateral ceph, wrist x-ray, etc). Determine the
locations that these extra records can be obtained in your area and obtain
referral cards and prices. It is often suggested to have the lab bill your practice,
making one less excuse for the patient to not go.
34. What records to you give the patient who asks for a second opinion
If you have not started treatment, and the patient has paid for the records in full,
then the full set of records should belong to the patient. Do NOT send ceph
tracings, patient reports, IPsoft files (can only open if you have IPsoft), and
treatment plans unless you want to impress the next person. If you have made an
unusual extraction decision (eg. Extraction of upper 6s or 7s), then you may want
to include an explanation of why this treatment decision was made and that you
first considered the other, more standard choices.
35. When do you want to schedule the “records” appointment and for how much time
The best time to take records is IMMEDIATELY after the patient has made the
decision to invest in that next step, their objective is to get the final diagnosis and
more precise numbers for time and cost of treatment. If you reschedule the
patient, and/or send them to an x-ray lab/radiologist for some of the records,
expect a significant number to ‘forget’ about it, losing the enthusiasm that you
instilled in them at the first consultation. My suggestion is to agree with the staff
to even stay at lunch, if necessary, to get the records taken.
How much time? NO DOCTOR TIME. Should take about 30 min with an
experienced assistant, 1 hour with inexperienced.
36. Why is it important to ‘call out’ to an assistant what you see when doing a clinical
evaluation?
So the patient can hear how smart you are and build confidence in your abilities
37. Why should you quote a range of fees and stay within that range?
Since you do not have full information (x-rays needed), you cannot be expected to
know all the details of the treatment, and thus cannot be expected to quote an
exact fee. The ‘estimate’ is a range of what you expect as a “high and low” end
to the case as you see it without full information. You will provide an exact fee
after reviewing the records and making a formal diagnosis.
The patient accepted to take records based on the range of fees quoted, so this
must have been acceptable to them. If you exceed the quoted estimate, expect
some patients to NOT start treatment, having to get a new approval from a spouse
or maybe get a second opinion as they go” shopping”.
At the 2nd consultation, try to say the words at the very beginning…”it is exactly
as I told you at our last meeting”. Now there should be little reason not to start
38. Should your fees be the same, higher, or lower than those of a specialist? Why?
Specialists would like to compete with you based on their additional training (and
degree…not all have MS), NOT on price. By undercutting the specialist fee, the
specialist will get frustrated with you for ruining the marketplace for
orthodontics. My recommendation is to charge at least the same fee. Let the
patient decide to have you treat them based on the confidence and trust they have
in you. Patients in your GP practice already trust you and therefore will prefer to
have you do their treatment than a specialist…which implies a higher fee.
If there is a patient “shopping” for cheaper price, I suggest you quote a higher
fee than the specialist, avoiding accusations that you ‘stole’ their case! You tell
them that you tried to send the patient back to them, quoting a higher fee, but the
patient stayed for treatment anyway. One case is NOT worth having bad feelings
with your specialist.
39. How long of treatment time will you estimate and why is this important?
A big part of the patient’s decision to start treatment is the time of treatment. How
long will it take to get the great smile that they have in their mind as the end
result?
As a general rule, do NOT treat cases in less than 1 year or you will find them
to be unstable in retention. Class I cases take less time since you do not need to
use inter-arch mechanics (elastics or ??), although with POS non-cooperative
mechanics, and extraction class II case can be easily finished in 18 months.
Do NOT quote too short a treatment time. If you exceed the quoted time, the
patient may be angry with you, lose confidence, and even change to an
orthodontist! Get them to agree to a longer treatment time at the start, make your
financial agreements for a shorter time to be assured that the patient is paid when
you are finished. NO one will complain if they finish early, unless they have a big
payment to get the brackets removed.
24 months will be enough to get most patients finished, many will be early
DEPENDING on what you call a finish. The definition if ‘finished’ is highly
variable between dentists and specialists. It can be anything from “when the
patient is satisfied” to “the perfect occlusion”.
Generating Orthodontic Records
40. Why is it important to have high quality study models (white, trimmed, soaped,
proper angles)
This is a “sales” tool. You will start more cases with beautiful models than with
visually poor quality models. The quality of YOUR work is most often judged by
the quality of the study models (which you had nothing to do with except write the
check). Your reputation and the reputation of POS is directly effected by the
quality of your models.
If a patient goes to a specialist for a 2nd opinion, the patient will likely hear that
the models are of such poor quality that they need to be taken again, at an
additional fee! The patient then has a bad feeling about you. Never let this
happen. Your records should be at least the quality of the specialist if not higher.
Besides, the patient is paying for these records!
41. What photos do you want as your standard set of records?
3 face: front, profile, high smile
6 intra-oral of teeth:
 front teeth in occlusion,
 right and left lateral teeth in occlusion,
 front with teeth open so you can see the lower incisors,
 upper and lower occlusal photos (taken in mirror)
Additional for the best job:
 profile with high smile showing the upper incisor inclination to the face
 upper resting lip to the upper incisor
42. What photo retractors do you need for lateral intra-oral photos?
Occlusal
photos?
Retractors that are clear, can be sterilized, and most important allow for the
patient to bite in their natural bite without pain (or you get bad bites!). The
occlusal photos, taken in a mirror, should hold back the lips from the teeth.
McGann made retractors from impressions taken of patients lips and cheeks
under retraction…and are sold through PDS.
43. Why might it be important to record the resting upper lip to the upper incisor?
Some patients have too much vertical, giving a ‘toothy’ appearance. The
diagnosis of the various treatments of “vertical maxillary excess”, using skeletal
anchorage intrusion or orthognathic surgery, is completely based on the resting
upper lip to the upper incisor (similar to what you did with denture teeth)
44. Why might it be important to take a photo of the full profile with high smile?
If you change inclination of the incisors, either by advancement (procline) or
retraction (retrocline), the starting inclination is important to document what you
did, to consider in the diagnosis, and to make your records ‘best in town’.
45. What additional records will you obtain for a growing girl and boy?
 Height measurement and any information you can get about their past height
history
 Boys: hair growth, change in voice
 Girls: start menarche, breast development
 Family information. Are their parents and brothers/sisters tall? What do they
look like (profile?)
 Shoe size and has that changed recently.
 Wrist x-ray to better determine the stage of growth
46. At what ages for girls ________ and boys__________ will you add a hand-wrist
x-ray?
Girls age 10-13
Boys age 12-15
** remember one, add or subtract 2 years for the other gender
47. When will you ask for a frontal (PA) ceph to be added to the records?
In all patients with asymmetry, which can include midline deviations, occlusal
plane cants, shifts of the mandible to one side.
** it is recommended that you include this record as standard on ALL patients, to
avoid needing the x-ray to make your diagnosis on an asymmetry case, and as a
screening for “bad bites” on everyone else.
48. Who will take the photos?
Study models?
Panoramic?
Lateral+frontal ceph?
Wrist x-ray?
This is a personal question of how you will manage getting these records in your
practice, helping you setup the systems to start ortho cases. If you have a
pan/ceph machine ‘in house’, then you should be able to generate all these
records when the patient decides to take them. If not, then you will have to search
for dental x-ray labs or radiologists around you that can fill in the missing
records.
49. Why is it important to send a bite with the study model impressions? What
material will you use to record the bite?
CR or CO?
The lab will put the bite between upper and lower models when trimming the
“heal” of the models on the model trimmer. You then set the models down on the
table at the ‘heal’ to show the correct bite.
I use pink base-plate wax to take the bite, in centric occlusion, taken by the
assistant, for ALL cases EXCEPT those with anterior open bite. For those few
cases, I use an injected impression material and the bite is retained with the
models.
Centric occlusion (maximum intercuspation, bite back on your teeth) is
standard in orthodontics. On certain cases, such as those with TM joint
problems, you may want to take a centric relation bite and mount the models on
an articulator.
50. Where are you going to send the study model impressions and how will you
package them?
Find an orthodontic laboratory (google search?)that provides quality orthodontic
models at a fair price. The lab does NOT need to be near your practice as the
impressions and finished models are transferred by mail.
Packaging (box and mailing label) is usually provided by the orthodontic lab.
Wrap the wet alginate impressions in wet paper towels, put into zip lock bag, and
into the provided shipping box.
** note: some take 2 impressions, pouring one in their practice lab to start the
diagnosis process (model measuring), sending the second to the lab for the
official set. (do NOT pour one impression twice)
** note: e-models are also possible, but most prefer to hold the models in hand
(and let the patient do the same at consultation), and ‘feel’ that the bite is correct.
Growth
51. How do you classify stage 2 growth by CVM (cervical vertebra maturation)?
There is a curve on the inferior of C2+C3, but flat on the inferior of C4
52. What are the “C” numbers that we look at when determining CVM growth stage?
C2, C3, C4
53. How do you determine stage 3 growth by CVM and what does this represent?
There are curves on the inferior of C2+C3+C4, AND the shape of C3 and C4 is
“rectangular horizontal”. The vertebrae and wider than they are tall.
54. How do you determine stage 4 vs. 3 by CVM standards?
By the shape of C3 and C4. In stage 3, the shape is “rectangular horizontal”. In
stage 4, the shape changes to “square” although one (usually C4) remains
rectangular horizontal. Square is when the shape is the same size in width as
height.
55. What changes in the growth at stage 4 in girls?
Their growth generally becomes more vertical, with very little differential
horizontal growth (that can correct class II dental) remaining.
56. What happens to the differential horizontal growth in girls after they reach
menarche?
There is less differential horizontal growth (that can correct class II dental or
make class III dental worse).
*note: full eruption of the 2nd molars is also a sign that differential horizontal
growth is not expected.
57. What growth stage(s) has the most differential horizontal growth?
Stage 2-4, with stage 3-4 being the most active time. The face of boys and girls
changes to young men and women.
58. How can differential horizontal growth help you correct class II dental?
If managed correctly, correction of the class II can be entirely by growth in a
good growing patient. Differential horizontal growth can ‘only help you’ when
working on class II cases.
59. What features does a wrist x-ray have at stage 3 growth in a boy?
Presence of a sesamoid on the medial aspect of the thumb.
60. What features does a wrist x-ray have at stage 2 growth in a girl?
Presence of pisiform in the wrist bones. The presence of a sesamoid in girls
indicates a period of time between stage 2-3, the ‘sweet spot’ for class II
correction in girls.
Setting up your practice for ortho
61. Why is it important to have a meeting with your staff before accepting patients for
orthodontic treatment?
So your practice looks coordinated to a patient (and mother) and runs efficiently.
You need the staff to understand that you are now offering orthodontic services,
what is expected of the assistants, the receptionist, appointment scheduling,
billing, insurance issues, financial policies, contracts, patient reports.
It is also most important that they know YOU will be offering these services in
the highest quality, possible through the supervision of an instructor (expert).
62. What topics should you discuss with the staff before accepting ortho patients?
Process of starting a case
Appointment scheduling intervals and times
Presenting a positive and exciting attitude to the patient/parent
What you want the assistants to do (and how they will be trained)
What you want the receptionists to say when discussing ortho
Fees, including down payment and payment schedule
Individual patient appliance
Diagnosis and treatment support from POS
How much emphasis you want to put on this service in your practice.
63. Are you going to include the cost of records in the total orthodontic fee?
Some do, some don’t. Make the decision now. If a patient does not start, then of
course you should be due the fee for the records and diagnosis of those records. A
policy that the records fee will be included in the total orthodontic fee IF THEY
START treatment, can often lead to more patients accepting to take records.
64. How much is the minimum down payment for a starting orthodontic case?
The standard is 25-33% of the total fee. The lower this is, the more cases you can
start, but sometimes the down payment can be TOO LOW, resulting in some
patients getting their appliances with you, then transferring to another that
quoted cheaper monthly! I would suggest go NO lower than $600 down to cover
your costs and time.
Many choose to use credit companies to be paid in full for the entire treatment
in advance, giving up the % charged by the service to collect from the patient.
This has been a very popular way of removing the financial issues from the
treatment, allowing you to focus on doing the best job.
65. How will you structure the payments of an orthodontic fee over the expected time
of treatment?
Remove the concept that the patient is paying for the service rendered that day.
This is a financial arrangement, having nothing to do with the 1-5 minute
adjustment visit that is done very 8 weeks. My suggestion would be 10 equal
payments, charged very other month?
66. What are the appointments to start an orthodontic case, who provides the service,
and how much time do you want scheduled for each appointment?
1ST consultation: usually not scheduled in the beginning until you start getting
referrals from your patients for orthodontic treatment. Consider it part of your
comprehensive exam and 3 minutes as you update current patients charts with an
orthodontic screening. An interested patient with lots of questions can take 20
minutes and set you behind schedule.
Records: Staff does this, with “non doctor” chair time needed for 30-60 min.
2nd consultation: Doctor should spend NO more than 10 minutes, or your case
acceptance will go down as you confuse the patient. Keep it simple, leave out the
technical talk as they already think you are intelligent. Business staff time may be
scheduled for the contract and informed consent (20 minutes?)
Decide if this consultation can be done in a separate consultation area where
money can be openly discussed, or if these will be done in the treatment chair.
Separators or even “quick start” can be done at this visit in the treatment chair.
Separators 5 min, quick start bonding upper 3-3 plus archwire= 1 hour, mostly
staff time after you get experience, all doctor time at the beginning.
Band sizing: Staff time eventually, 20 min.
Band sizing and bond upper 3-3 or 4-4: 1 hour
67. How often and how much time do you want scheduled for an orthodontic
adjustment visit?
Set your sights at 20 minutes, 3 per hour at the start. If you are spending more
than 20 minutes, then you are doing too much. Doctor time can be 1 minute once
the staff is trained and proficient.
68. Why do you need a scanner to do the diagnosis system of POS? Do you need a
scanner with flat bed capability only or do you also need a scanner with 8x10”
transparency lid?
The study models and lateral ceph are MEASURED, and the measurements need
to be accurate. Photographs are not 1:1 and cannot be measured. If you have a
digital pan/ceph, then you only need to scan the study models, which can be done
with any scanner (flat bed). If you have ‘film’ panoramic and ceph, then you need
a scanner with a ‘transparency lid’, large enough to scan the 8x10” ceph.
** note: if you have digital ceph/pan and use ‘e-model’ service, then you do not
need a scanner. BUT you must ask for the double occlusal study model view of
McGann.
69. What records must be scanned at 96dpi (1:1), black and white? Why must they
be scanned?
Lateral ceph, frontal ceph, double occlusal model view. These records are
measured (traced) in dentalcad program and create the basis for your diagnosis.
The study models and lateral ceph are merged for each patient to make dental vto
(visual treatment objective) ‘pictures” of the expected treatment result.
70. What is a PDS “education kit” and when do I need to have these materials ready
to use in the seminar?
This is a group of instruments and materials that have been assembled for you to
do the hands-on exercises in sections 1+2. You must have them ready by the 3rd
session.
71. What is a PDS practice kit and how is this used to start treating patients?
This is a group of instruments and materials that have been recommended by
McGann and assembled by PDS to make a ‘turn-key’ startup of your orthodontic
department. Buying decisions have been made for you, materials have been
approved and used by McGann, and PDS has purchased inventory to service your
needs to allow for a quick start-up. (without this, it would take at least 3 months
to get the needed materials from all suppliers!)
72. What is wrong (or right) with putting orthodontic pliers and cutters in cold
sterilization solution? steam autoclaves? Chemical autoclaves? Dry Heat
sterilizers?
Cutters will dull in anything that is moist. Dry heat is the only way to get the full
life from a cutter. All orthodontic pliers may ‘rust’ and become unsightly to a
patient when placed in cold sterilization and steam/chemical autoclaves, reducing
the useful life of the plier.
** note: surgical ‘milk’ can be used to protect pliers in steam and chemical
autoclaves, but this process reduces the turn around time by about 20 minutes.
73. What is the turn around time for instruments to see the next orthodontic patient?
If the staff is waiting for the instruments from the last patient and getting them
sterilized for the next, doing nothing else, then 20 minutes is an approximate time.
74. What tray setups do you want to establish for your orthodontic department, if any.
Separator tray
Band and bond tray
Lost bracket tray
Cool and retie trays
 Refer to list of instruments on separate sheet.
Technical (IT)
75. Where do you find the orthodontic contract [draft] document
At the end of the “patient report” document. In the IPsoftware, from menu bar,
click “patient-patient report”
76. where do you find the informed consent [draft] document
At the end of the “patient report” document. In the IPsoftware, from menu bar,
click “patient-patient report”
77. Why do I need Microsoft Office with powerpoint and MS word?
You will be given many presentations in powerpoint form, PLUS you will
determine which bracket (torque) to use with the “all templates” powerpoint file.
Microsoft word is needed for ceph overlays and for patient report and treatment
plans.
78. Why do I need Screenhunter 5.1+ program?
To build treatment plans to be patient specific (treatment decision model
measuring, dental vto, etc). Also used in conjunction with MS word and
powerpoint for ceph overlays and ‘all templates’ powerpoint to determine bracket
torque for each case.
79. How can you tell if a digital ceph is calibrated (1:1) correctly?
The teeth are usually too big on [digital] cephs out of calibration. To check,
place 2 points that are measured (eg. Condylion + a point = maxillary length) on
the calibration ruler on some digital cephs, or if no calibration ruler, then tape a
piece of metal of known length on the next ceph you take and measure that.
80. How do I register for the POS Forum?
Follow the registration procedure on http://forum.posortho.com and then send an
email to [email protected] announcing that you are a [new] POS student and
you need the request approved.
81. Where can I find the cases shown in this session and MORE cases for additional
study?
The IAT (internet assisted training) website. From www.posortho.com, click on
current student, then on the left hand column (green), see under additional
training the IAT link. ** you will need your password authorized for the sessions
you have paid for.
82. How do I get access to the IAT (internet assisted training) website?
Request from POS administration that your password be authorized for the
sessions you have paid for.
83. How do I get access to the videotapes of this session 1?
Request from POS administration that your password be authorized for the
session you attended and paid for. These are viewed by “streaming” video.
84. Where is the website for my patients to view the advantages of individual patient
orthodontics?
www.individualortho.com
85. Where is the website with POS videos of many topics?
These are on your memory stick, organized by session.
POS support systems
86. What is the POS case diagnosis system and how do I submit a case for diagnosis
assistance?
The instructors of POS make themselves available AS THEY HAVE TIME to work
with you on case diagnosis of your personal cases. You submit a case on-line
through www.posortho.com, current student, submit a new case for diagnosis.
Then selecting from the instructors that are available at that moment, agreeing to
the time to return the case that they have listed.
** G6 students, which you are if you have this expectations sheet, need to select
an instructor that offers “g6 diagnosis”, in the notes below their name when you
click on the instructor.
87. How much can an instructor charge to help me with my case diagnosis?
UP TO 1 hour of time, billed at the going rate for each location. If you submit
your case fully prepared, expect a much less fee than if you submit a case with
records only to be fully diagnosed by the instructor (many will not accept such a
case submission). Be sure to tell them what your level of training (POS seminars
taken) is in the notes section and when the patient is scheduled for the 2nd
consultation.
88. When can I start a case?
You can start now with the consultation and diagnosis process, but you cannot
bond and band the case until after session 3.
89. What is the POS Mentor program?
A mentor (POS instructor) is assigned to you to not only check your initial
diagnosis, but also to follow your case until completion. There is a flat fee per
case in the mentor program.
90. Must I send all cases to a mentor to be a part of that program?
NO, some choose to send only those cases they would otherwise refer, keeping the
income in their practice as they are directed by the mentor, learning along the
way.
91. How much does it cost me to retake a session? When does this policy end?
Retakes are free for your entire career, lifetime learning.
Administrative
92. Can a friend who missed this session 1 join my class to take the seminar series?
Yes, he/she can review the video of the session they missed, and is not so far
behind that they cannot catch up. After session 3, it would be difficult to catch up
by that method, although they can start in the IAT (internet assisted training)
program and then start live the next time the live seminar series starts.
93. When is the last time a friend can join my class?
Start of session 3
94. When is the deadline for the ‘pay in advance’ discount?
End of session 2
95. How can I get credit towards my education by starting cases?
Mentor program, credit is issued for cases started up to graduation towards their
education. Cases started after graduation can receive credit towards section 4
training. See Administration for details.