Orthotown March 2018 - 35

4.5
H

uman beings are creatures of
habit; we tend to park in the
same spot each day, sit in the
same seats in meetings or classrooms, have
our typical morning and evening routines,
etc. For orthodontists operating a thriving
practice, it is critical to have systems in place
to establish standard operating procedures to
assure quality finishes within a predictable
time frame. These protocols become habitual
with repetition; eventually, a change in
protocol or procedure requires some form
of painful stimulus-either economically or
professionally-to initiate the need for such
change. Along with the disruption caused
by changing a major system in our practices,
we second-guess ourselves, wondering if we
made the correct decision.
This project was initiated by the lead
author after he heard what appeared to be
impressive claims of increased efficiency by
Dr. Luis Carrière, who repeatedly presented
case histories in which patients were in active
fixed appliances for approximately 10 months.
Having a healthy degree of skepticism, the
lead author returned to his own office and
harvested data on 12 consecutive debonds
using the Carriere SLX bracket system and
found similar results. Were these patients
outliers? Was this an expected outcome on
a routine basis? The fundamental questions
then arose: Why is there such a difference?
To what should these patients be compared?
And how exactly is a legitimate comparison
arrived at?

Developing meaningful metrics
Having searched the literature for a
reasonable standard method for determining
profitability, what was instead found was
a mountain of references to presentations
and lectures. Yet almost no published
articles referenced a way to actually measure
efficiency and effectiveness in our own
offices. The available references were more

vs

2.2

about the cost of treatment for the patient or
a summary comparison of bracket designs.
The authors then set out to develop
what we believe is a simple set of meaningful
metrics that can be easily calculated with
data provided by most practice management
systems, to determine if we have indeed
improved efficiency after a given change
in some aspect of our clinical practice. To
illustrate these metrics, we have gathered
data from three individual practices that
had recently switched from another passive
self-ligating bracket system (which we'll refer
to as "OSL"), where treatment included following the recommended archwire sequences
and appointment intervals, to Henry Schein
Orthodontics' Carriere SLX system ("SLX"),
along with a revised archwire sequence and
appointment interval recommendation.
These metrics can easily be used for any
similar comparison, providing valuable
information for practice owners upon
which to make decisions about product or
procedure changes.
In two of the three practices, the following metrics are routinely collected and
reviewed each month on all patients who
have completed treatment that given month.
In the other practice, the data was collected
on request.
* Number of repositioned brackets.
* Number of repaired brackets.
* Total number of rebonded brackets.
* Number of detailing appointments.
* Total number of appointments.
* Number of minutes of chair time.
To avoid as much bias as possible, a
staff member in each office was requested
to independently gather records on the most
recent 12 sequential debonds using each
system, OSL and SLX. After collecting
data on the dozen debonds of each system,
we discovered that the data from the first
two practices was very similar. To validate
our findings, we recruited the third practice

7.1
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19.9
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orthotown.com \\ MARCH 2018

35
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Table of Contents for the Digital Edition of Orthotown March 2018
