presentation of orthodontic cases

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Patient Case Presentations

Guidelines for Practice Success | Managing Patients | Treatment Recommendations

The success of any dental practice is directly related to patients’ acceptance of the dentists’ treatment recommendations. A “choreographed” case presentation that blends spoken words with non-verbal cues and visual aids can increase patients’ acceptance of your recommendations. In some cases, it can be helpful to support your case presentation with photographic images so the patient can see the condition being treated; make sure to have a signed photography release before taking, using or otherwise sharing those images.

• Be sure that the patient is involved in the treatment decisions and that patient autonomy is respected.
• Discuss the reason treatment is recommended, what to expect during and after treatment, and the risks associated with accepting-and not accepting-the recommended care.
• Speak calmly, reassure patients that they’ll be taken care of throughout the process, and encourage them to ask questions.
• Explain what you are going to do and why. Step by step, say what will be done and why it needs to be done. Remind the patient throughout the discussion of the treatment benefits.
• Present information in bite-sized pieces, perhaps breaking the treatment down by quadrant. Remember, you are communicating highly technical information to an anxious layperson.
• Use as little technical language as possible. Rather than admit they don’t understand what you’re suggesting, many patients will conjure a simplified-and often distorted-translation that could scare them away from a procedure.
• Speak in short sentences. One idea per sentence is easier to understand than a barrage of complex ideas coming at a patient in sentences a mile long.
• Whenever possible, support your recommendations with visual aids, such as pictures, diagrams or ADA brochures that add clarity and more detail.
• Deliver the case presentation in the context of a natural conversation, not a sales pitch.
• Some patients may be nervous about treatment or worried about whether they can afford it. Let them know your practice has plans in place to help finance care and that your staff person (e.g., financial coordinator, office manager) will discuss those options with them.
• Case presentations for minor restorative treatment usually take place in the operatory. Use a private consultation room or your office to discuss major restorative work. The latter also applies to sensitive patients or those needing multiple appointments that will involve higher than average treatment costs.

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The 9 Essential Steps of Every Orthodontic Case

Planning and treating your first orthodontic case can be a daunting task. With so many stages and procedures involved, it can be hard to know where to begin. But don't fret, we break down the process, step by step.

When you summarize the essence of orthodontics, you’ll find that there are just 3 parts: pre-treatment, treatment, and post-treatment. When you break that down, there are 9 essential steps you will see in every orthodontic case.

Providing quality orthodontic care can be easy for dentists. With the right knowledge, support and tools, any dentist can start helping their orthodontic patients. Check out this 9-part guide to kick-start your first orthodontic case.

Diagnosis (pre-treatment)

Starting your case with a solid diagnosis is vital to having an efficient and stress-free orthodontic process. Putting in the time up front to properly evaluate and communicate with patients sets you up for success. While some dentists and orthodontists do a quick, 10 minute diagnosis, we’ve seen this create issues that could have been easily avoided. We recommend a full orthodontic diagnosis to be completely prepared.

Screening with 1 st Consultation

This is when you first seriously discuss orthodontics with your patient to evaluate their needs and desires. You and your assistant can evaluate various factors like previous history, how the patient is classified, and what they may want to improve about their smiles. Read more about this stage and view the Orthodontic Screening Checklist.

After evaluation, address any patient questions and discuss possible treatment approaches. Want to prepare for these questions? Read article: How to Answer the 4 Most Common Patient Questions About Orthodontics

At the end of the consultation, let the patient know that you will need to take records to move on to the next step.

Take Records

We say this a lot, but since it’s important we will say it again and again: take good records. By properly documenting your ortho cases, you protect yourself and get the most accurate information to help you and your patients make the best treatment decisions.

Before you start treatment, you should always have intraoral and extraoral photos, white stone models (or a digital version), and panoramic and lateral cephalometric x-rays. Be sure that your records are always high quality and focused properly. Learn how to take great photo records in this video .

Process Records

Analyze your records. Oftentimes this process confirms your initial screening. But it can also uncover unexpected details like skeletal asymmetry, impacted teeth, bone loss, or short roots. Identifying these aspects can help you keep your treatment on schedule as you can address any issues early on.

Do a cephalometric analysis to see what skeletal and dental features you’re working with. You also need to do a facial analysis, and maybe even a mixed dentition analysis (depending on the patient’s age). While you can do your tracings and calculations by hand, most doctors now use computer software to speed up the process and have prediction visuals.

Plan Treatment

After seeing your analysis, compare treatment options, make your treatment decision, detail your treatment plan, and design your appliance. While some dentists and orthodontists skip this step, we encourage you to plan your case before treatment so that you are proactive, not reactive in front of the patient. You should decide if you need to extract teeth before bracketing the patient, as this makes it easier for you and gives your patient confidence if you tell them up front.

Luckily, orthodontic diagnostic software now makes treatment planning much easier. Read about how SmileStream can help you navigate the orthodontic treatment process.

Recommend Treatment in 2 nd Consultation

Present your treatment recommendation (including the alternatives considered, the orthodontic fee and estimated time of treatment). It can be helpful to print out a patient report to help you convey the reason that you’ve decided on that treatment and why you’re the best doctor to treat them. When they confirm, have your patient sign the contract and informed consent and collect your down payment or first installment.

Your orthodontic treatment will be the bulk of time that your patient is in your office. Your staff can help you tremendously with this phase of orthodontics. If you set yourself up well in the diagnosis phase, the treatment phase should go smoothly, where you follow your treatment plan and make adjustments as needed.

Level and Alignment

At this stage, you are looking to level the arches and align the teeth. First you align, then you level.

You will place separators, cement bands, and bond your brackets. You will be using light, round wires like a .012 NiTi wire. The goal of this phase is to make all teeth straight, eliminating all rotations and correcting root angulations.

When the teeth are aligned and all rotations are fully corrected, you’ll start leveling and going through wire progression. You’re likely to replace your round wire with rectangular wires of increasing width (like an 18x25 NiTi wire) to establish torque and level the curve of spee.

When the teeth are aligned and leveled, you enter the mechanics phase, moving the teeth to the correct and final position. As you continue wire progression you are likely to replace your 18x25 NiTi rectangular wire with a stiffer stainless steel wire (like a 19x25 size) to be able to move teeth with little or no tipping.

Make minor adjustments to fix bracket positioning errors. Many times this can include wire bending or repositioning brackets. Ensure the case has settled before you deband.

Retention (post-treatment)

After debonding, make sure patients retain their beautiful occlusion and alignment with acrylic retainers, clear retainers, bonded retainers, or a combination. Retainers should be worn as long as your patient wants their teeth in this position. This often means lifetime retention. But they do not have to wear their retainers 24/7. After a few months they can often wear their retainer a few times a week or month.

When you have good diagnosis and treatment, you’ll often see better retention. This is because teeth that are in the final position for a longer period, retain better. You also would have checked that the teeth, roots and jaws are in the right areas before debanding as this helps the long term success of retention. There are some tricks you can do to prevent relapse. Read Dr. Shockley Wier’s 5 Pro Tips to Prevent Diastema Relapse.

Orthodontics is a very organized and straight-forward specialty. It’s been around for centuries and its basic process is tried-and-proven into a predictable science. Although there are many different tools that you can use, orthodontics at its essence is simple: help patients by moving teeth and jaws into proper alignment.

By breaking down the orthodontic case into 9 essential steps, we hope that you better understand how the process works. With practice and guidance, providing quality orthodontic care can be easy and rewarding for any dentist.

Interested to start providing high-level orthodontic care in your practice? Progressive Orthodontic Seminars runs a Comprehensive Orthodontic Training program where you get the essentials of providing a successful orthodontic business. This extensive postgraduate program teaches you how to set up your diagnosis, treatment, and retention effectively and profitably. With software to guide you, instructor support, and lifetime access to your training, you have all the tools to add this rewarding specialty to your practice.

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Complex Dental Treatments: 8 Effective Strategies for Case Presentation

About 15 years ago, I was one of the surgical assistants in our oral surgery practice. I had been cross-trained in the front office and was presented with the opportunity to become a treatment coordinator.

I thought to myself, “Easy enough, I come from an assistant background; I have the knowledge of procedures and it comes down to simply presenting the treatment plan.”

My first few cases went great! Straight forward wisdom teeth, a few single implant cases. I thought, “Wow I am golden.”

Then came the eye-opener: a large complex case. Upper and lower All-on-4 surgical treatment with a projected surgical fee of 27k, which did not include the restorative fee.

I began to sweat. My hands got clammy, I was instantly nervous and I began questioning how the patient was going to afford their treatment. I went in to see the patient and stumbled on my words. I wasn’t confident and the patient left the office with the decision to “think about it” and get back to us.

That night, I realized I had a lot to learn. From there, I continued on with confidence and perfecting my treatment plan presentation . This mission resulted in a treatment plan acceptance rate of 98%.

I believe patients need to feel confident that they are in the right office and that their needs are addressed (especially to eliminate their fears.)

Here are my eight effective strategies I have found to be successful for presenting complex treatment cases.

Step 1: Do Your Homework!

As a dental treatment coordinator , you want to be educated on each of the procedures performed in your practice. You need to know pre and post-op care and be able to articulate them to your patient in an easy to understand manner.

A great way to do this is to sit in on your doctor’s consultations, observe surgeries, and train on total patient care. Prior to presenting treatment cases, be sure to read all notes in the patient’s chart.

This starts with the initial phone call all the way through to the doctor’s notes. This homework will help you determine the type of patient you are presenting to (fearful, straight to the point, second opinion, lots of questions.)

All patients are different and you should know how to effectively communicate with each one of them based on their preferences. There needs to be a smooth transition from the first phone call to meeting with the implant treatment coordinator.

As such, documentation in the patient’s chart needs to be as detailed as possible for the doctor and treatment coordinator to know how to tailor the care to their specific needs. Also, make sure their insurance has been verified and that you have verified coverage for the specific codes presented.

Step 2: Simplification

Simplifying the process is vital to case acceptance.

For example, if you give an All-on-4 patient a treatment plan that visually has a long list of teeth to remove, all implant positions, each of the 15 min intervals of sedation, etc., then you are already overwhelming them.

We found that the treatment plan should be itemized in your system, but the patient should be presented with a more simplified version.

Example, all teeth removed with All-on-4 implant placement and sedation included. Now you have an outline of what is being performed and the patient is focused on the next step of their care instead of the fear factor.

Our goal is to always calm, educate and provide solutions.

Step 3: Introduction

Always introduce yourself to the patient and explain the role you play in their care. Let them know you will be the one to communicate with everyone involved in their care to assure a smooth, successful experience.

To many patients, it can be worrisome when dealing with multiple offices. By clearly describing the role you play, you can gain confidence and begin to build trust.

Step 4: Body Language

Always sit with your patient at a safe distance. Preferably next to them if the space allows. Don’t stand and talk down to them. Sitting with your patient allows them to feel comfortable and not rushed through the treatment planning process.

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Step 5: Build Trust

It’s important to have a calm and uninterrupted conversation with the patient to identify any fears or anxiety. Once you understand their concerns, you can take steps to address them in a thoughtful and reassuring manner.

Next, you want to reiterate and confirm the treatment the dentist is recommending and paint a picture for them. Detail the steps in their care and what aftercare will look like. This overview will give the patient an idea of what to expect.

It’s a great opportunity to market your website. Consider showing them pertinent videos of the procedure, before and after photos and reviews of patients who have been through the same treatment.

Step 6: Q & A

Take time to address each of the patient’s questions and concerns and document them. Taking notes and offering to email them a summary can be very helpful and most patient appreciate it.

Step 7: Finances

Present the financial investment to the patient. Discuss ways the patient may want to explore to pay for their procedure. Offer third party financing as an option.

Also, mention ways they may not have considered (such as a loan from their bank, refinancing their home or pulling from their 401k). Finances should always be discussed towards the end of the visit.

Step 8: Conclusion

Summarize the next steps in the patient’s care and provide a packet with detailed information. Share your contact information and ask if it’s okay to follow up.

To summarize, simplifying patient treatment presentation and following these effective strategies will demonstrate and facilitate five key pillars: teamwork, education, documentation, mindset, and care.

Remember, always care for the patient before you take care of them. And most important: when your mindset changes, so does your case acceptance!

About the Author

Elaina wharton, maadom.

Elaina Wharton, MAADOM has been working alongside Dr. Ali Alijanian This link leads to the Dr. Ali Alijanian’s website for the past 18 years. She joined his oral surgery practice in 2005 as a certified surgical assistant.

She quickly found herself cross-trained throughout each role in the office before growing into her position as practice administrator.

In addition to managing the practice, Elaina is the coordinator for the Partnership Study Club in Walnut Creek, CA This link opens a new tab to the Dr. Ali Alijanian’s website .

In 2016, she became a Fellow of AADOM  and has served as the President of the Contra Costa CA local Chapter since 2019.

When not wearing her many dental hats, you can find her on the sidelines cheering on her two children at their baseball and softball games.

October 16, 2023 at 11:56 am

Excellent, Alaina! Thanks for sharing!

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