Seminar 1: Study Guide

Use this guide to help you understand important principles of this

seminar. To see the answers, please click on the collapse buttons next
to the paragraph numbers.

1st Consultation (Clinical Examination)

1. What is the difference between thin, moderate, and thick

tissue thickness and how does this influences the
extraction versus non extraction decision?

Show 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.

2. What is Class I in the permanent dentition and how is

that 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.

3. How do you 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.
4. 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 oftentimes 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.

5. 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.

6. 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.

7. What is the irregularity index and how do we use this to

give an estimate of the need for extraction versus 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 (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.

8. How do you use the tooth diagram in the 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.

9. Why is it 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.

10. What is the difference between facial types:

dolicofacial, mesiofacial, and brachyfacial, and how may
this 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.

11. How do you 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.

12. How do you 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.

13. What is lip competency and incompetency 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.

14. How do you record what you tell the patient when
they decide to take records (e.g. the possibility of
extraction, length of treatment, estimated cost of
treatment)?

This information is often critical when making the diagnosis, but

especially when giving a 2nd consultation. If they accept what you
say and want to take records, you will increase acceptance at
the second consultation if you can say the diagnosis is exactly
as I told you [at the first consultation]. In Seminar 2, youll learn
how to input this into the SmileStream software In the Clinical:
Patient Expectation tab, you indicate what YOU told the patient
at the first consultation, and what the patients complaints and
feelings about protrusion etc. are.

15. What is 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).

16. 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.
 17. How can 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. Assistants 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 in your software (to
learn at Seminar 2).

Goals, Limitation, Treatment Options

Considered

18. 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.

19. What is a limitation of treatment? Why this is

important? 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.

20. Why it is important to record what you will NOT

correct?

This has to do with the patients expectations. If they expect you

to correct gingival display, for example, and you do not, then
 they are angry and feel that 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.

21. How do you 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.

What to Say (or NOT Say) at the Initial

Consultation

22. 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.

23. 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.
24. 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 instructor 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!!

25. Where is the patient going to get his or her 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.

26. What records do 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.

You do not need to send ceph tracings, patient report from

SmileStream, and treatment plans, unless you want to impress
the next person. If you send any SmileStream files, you can
export your patient report and select what you want to provide
or exclude. If you have made an unusual extraction decision (e.g.
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.

27. 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.

28. 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

29. 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

30. 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 degreenot 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 specialistwhich 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.

31. How long of treatment time will you estimate and

why is this important?

A big part of the patients 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
of 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

32. Why is it important to have high quality study

models (white, trimmed, soaped, proper angles, or good
digital models)

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
affected 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!

33. 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

View how to take good photo via this video

34. What photo retractors do you need for lateral intra-

oral photos? What photo retractors do you need for
occlusal photos?
 Retractors that are clear, can be sterilized, and most importantly
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 retractionand are sold through PDS.

View Lateral Cheek Retractors

View Occlusal Photo Retractor

35. 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)

36. 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.

37. 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
38. 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

39. 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.

40. 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.

41. 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.

42. Where are you going to send the study model

impressions and how will you package them?

If you prefer to hold the models in hand (and let the patient do
the same at consultation) to feel that the bite is correct, find an
orthodontic laboratory (Google search?) that provides quality
orthodontic stone 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 labs 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: digital models are also possible and can be more

convenient for you. Make sure that you get double occlusal
views, views of the right and left sides and the optional front
view. Make sure they give you the models in a 1 to 1 ratio to get
the most accurate diagnosis. There are several labs out there,
like OrthoSelect that provide good digital models.

43. Can you use an intra-oral scanner for your records?

Yes you may use your intra-oral scanner images for your model
records, as long as you have all the required views (listed in
previous question). You may need to convert your intra-oral files
into a jpeg or tiff format, or adjust to get a double occlusal view
to use within the SmileStream software.

44. Do you need a scanner to do the diagnosis system of

POS? What type of scanner would you want to get?
 No, you do not need a scanner if you have fully digitalized
records (photos, pan/ceph and models). However, if you do not
have these records digitalized, then you may need a scanner to
accurately digitalize them so you can use them within the
SmileStream software.

If you have film panoramic and ceph, then you should get a
scanner with a transparency lid, large enough to scan the
8x10 ceph. (e.g. Epon V800)

If you have white stone models, then you can either scan the
study models (which can be done with any flatbed scanner), or
take a good photo of them. If you take a photo of them, make
sure that your photo is at a set distance and 90 degree angle to
get accurate readings. For photos, we suggest that you use a
model stand or to stand your camera at a set distance flush on a
table for constant measurements. This way you can create auto
resize settings into SmileStream (which youll learn at Seminar
2).

45. What records must be scanned at 96dpi (1:1), black

and white? Why must they be scanned?

If you do not already have the lateral ceph, frontal ceph, double
occlusal model view in digital format, they must be scanned at
96dpi for accurate 1:1 measurements.

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.

46. How can you tell if a digital ceph is calibrated (1:1)

correctly?

The teeth are usually too big on [digital] cephs if they are out of
calibration. To check, you have a few options (some will be
covered in Seminar 2). You may use the ruler tool in SmileStream
to match with the ruler on your ceph. Or, you can assume that
your incisor is 25.5mm and calibrate in SmileStream. Or, place 2
points that are measured (e.g. 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.
Growth

47. 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

48. What are the C numbers that we look at when

determining CVM growth stage?

C2, C3, C4

49. 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.

50. 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.

51. 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.

52. 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.

53. What growth stage(s) has the most differential

horizontal growth?

Stages 2-4, with Stages 3-4 being the most active time. The face
of boys and girls changes to young men and women.

54. 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.

55. 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.

56. 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 Stages 2-3,
the sweet spot for Class II correction in girls.

Setting Up Your Practice for Ortho

57. 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).

58. 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.

59. Are you going to include the cost of records in the

total orthodontic fee?

Some do, some dont. 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.

60. 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.

61. 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 every other month?

62. What are the appointments to start an orthodontic

case? Who provides the service? 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

63. 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.

64. 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 class. You
must have them ready by Seminar 3 in the Live Series or Module
1 in the IAT series. Contact your administrator for more details or
to order.

65. 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!)
 66. 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 turnaround
time by about 20 minutes.

67. 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.

68. 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 in Chapter 3.

POS Support Systems

69. Where can I find the video or cases shown in this

seminar, and MORE cases for additional study?

After youve logged into www.smilestream.com, click on the

Education tab to find the IAT (internet assisted training) and
streaming video content. You will be able to request and view
 content for the seminars that you have paid for. You may request
access on this site or through POS administration.

70. Where is the website for my patients to view the

advantages of Individual Patient orthodontics? Can I use
this info to market my new services?

You may use the content from this site or link here to optimize
your marketing. www.individualortho.com

71. 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 Seminar 3.

72. What is the POS case consulting system and how do

I submit a case for consulting assistance?

The instructors of POS make themselves available AS THEY HAVE

TIME to work with you on consulting of your personal cases. You
submit a case on-line through www.smilestream.com. In the
Clinical tab, youll click the consulting icon (which looks like a
head) and select from the instructors that are available at that
moment, agreeing to the time to return the case that they have
listed.

View video walk through of consulting

73. Whats my free case? Whats included? How do I

redeem this? Is there a deadline?

To help you get started and be successful in orthodontics, we are

giving every student one free mentoring case! You choose a
mentor to do your initial diagnosis and support you throughout
the case. You also receive US$200 credit for your materials. You
must redeem this by Seminar 4 or Module 2. Since the free case
often takes more time for the mentor, some instructor
restrictions apply. View instructions

74. How much can an instructor charge to help me with

my case consulting?
 The website will show you the maximum time or cost the
instructor can bill you for. Instructors may choose to bill a set
amount, or for the amount of time he or she takes. For the latter,
if you submit your case fully prepared, expect a smaller 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 is and how many
POS seminars youve taken in the notes section and important
details.

75. 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.
Some mentors choose to include US$200 of material cost in the
fee, and this will be listed on the site.

76. 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.

77. How much does it cost me to retake a seminar?

When does this policy end?

Retakes (live and online) are FREE for your entire career, lifetime
learning.

Administrative
78. Can a friend who missed this Seminar 1 (or Module
A) join my class to take the seminar series?

Yes, he/she can review the video of the seminar they missed,
and is not so far behind that they cannot catch up. After Seminar
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.

79. When is the last time a friend can join my class?

Start of Seminar 3 (or Module 1)

80. When is the deadline for the pay in advance

discount?

End of Seminar 2

81. What do I do if I miss a seminar?

Contact your local administrator to help you make up the

seminar in another location or online.