The business of dentistry can be summed up in a simple formula: profit = revenue – cost. If you want to increase your profit, you either need to increase your revenue or decrease your cost; bonus if you can do both. Increasing revenue can occur by things such as expanding providers, expanding hours, or expanding services. Costs are somewhat fixed, meaning I am not going to rush to move my practice if my rent is higher than the average dental office or fire employees if my payroll costs are too high. I can work on cutting down my supply costs, but this only affects a percentage or two if I am lucky, and with costs rising during the COVID-19 pandemic, even that would be a stretch. After practicing for almost 15 years, I don’t want to work harder; I want to work smarter.
In the last 10 years, I transitioned to a restorative-based practice and was happy to refer out procedures such as surgery, implants, endodontics, and tough orthodontic cases. With all of the turmoil and uncertainty over the past year, however, it became very apparent that keeping services in-house was a benefit not only to our practice, but for our patients as well. Patients were scared to travel and be exposed to different people and providers. There were and continue to be shortages in personal protective equipment (PPE), and we can do better as an industry to conserve it by keeping our patients in our practices. Same-day dentistry has allowed our practice not only to sustain but thrive.
The other phenomenon we have seen is our patients’ commitment to taking care of themselves. Patients are home more, seeing themselves on Zoom calls day in and day out, and have the time and flexibility to get treatment like orthodontics. In our practice, we went from doing a couple of ortho starts a month to a couple of ortho starts a week, and this growth keeps trending up.
I started offering orthodontics with clear teeth aligners in 2006 in my practice, and I’ve seen some amazing changes. Back then, there were not many options available for aligners, and my team hated taking the impressions for them even though we knew it was a profitable service. We went through so much polyvinyl siloxane (PVS) to get that perfect impression. Have you recently checked the cost of PVS? It is so expensive! As a new business owner, it felt like money was swirling down the drain every time we had to redo a traditional impression.
I was thrilled when we could finally scan the patient with our CEREC and send a digital impression directly to the aligner company. When this was first available, however, scanning was no small feat. Although the material cost was less, the scanning software was not as user-friendly as it is today. We’ve discovered tips and tricks along the way, like using OptraGate, moving the camera in certain patterns, and even turning off the overhead lights in the operatories so the camera can pick up the teeth better. When the CEREC Primescan was launched in 2019, the scanning capabilities were a game changer; we reduced chair time significantly from one hour to 30 minutes for the initial appointment. The catch was that the new Primescan did not “talk” to the aligner company we were currently using, so it was time to discover other options.
As a digitally driven office, my patients are pretty horrified if we come at them with a traditional tray and goop. When we started using the Primescan, we decided to try the SureSmile aligner system. With this system, I was pleasantly surprised at how well the teeth tracked according to the treatment plans and how responsive the SureSmile team was to modifications in treatment plans. I have even had a patient comment about how these aligners were more comfortable than one of the other systems when we chose to do refinements with SureSmile. As a practitioner, I love the flexibility. I can choose a more traditional method like I am used to, where SureSmile sets up the case and sends me all of the aligners, or I also have the capability to print the models and fabricate my own aligners in-office, which can result in an incredible cost savings.
As our volume of scanning has risen, availability of Primescan became a problem for our office. We didn’t want to turn away or reschedule patients if we could just scan them while in the chair, so we researched other possibilities for scanning ortho, night guards, bleaching trays, and surgical guides. We implemented the Heron 3Disc Scanner into our practice in addition to our Primescans. The Heron 3Disc is the only scanner manufactured in the United States, and it is light, efficient, and perfect for these auxiliary scans when we are not delivering same-day restorations. Not only was I shocked at how quickly it scans, but it is also more affordable than other scanners on the market. What I love about using SureSmile is that it will accept scans from any scanner that can produce an .stl file. Having these options has truly increased our production by utilizing our assistants’ time to the fullest for their own productive procedures.
What does this actually look like for a potential ortho patient?
At the initial appointment, we make sure there is a current CBCT, digital scan, and photos (taken by my assistant) pulled up in the room. If the patient is interested in ortho at a hygiene appointment, we have flexibility in our rooms for the hygienist to move to another operatory, or we can move the patient to an overflow chair. I have tried talking to patients about orthodontic treatment prior to taking records, but we’ve had a significant increase in patient acceptance when the records are done prior to the consult.
If the patient accepts treatment, it is as simple as submitting the records. If a patient is not ready for treatment, we keep the records and follow up in two weeks to see if they have any questions. Sometimes, patients just need to figure out how to pay for the treatment. Track your acceptance rates and find out what works best for you and your team. You can make financing easy by looking into third-party options, such as Proceed Finance or CareCredit. Build those fees for the third-party financing into your treatment fees. Pay attention to what they are; 10% can be a lot!
At initial delivery, my assistants go over instructions and add necessary attachments. When I come in for the official check, I do any interproximal reduction that is necessary, and then the patients are ready to rock. This is a 20- to 30-minute appointment of assistant time depending on how many attachments are necessary. We give three to four sets of trays and have the patients reschedule for a check every four to six weeks. The benefit of adding this service to your practice is that it tends to be high assistant time and low doctor time, which adds great profitability.
When the patients are finished with treatment, we celebrate with our entire team and do something fun like give balloons or flowers to the patient. We want other patients to ask what is going on and get that momentum rolling for the discovery for their own needs and wants for ortho.
If you are ready to increase revenue in your own practice, check out SureSmile.com and start your journey with clear aligners today.
KRISTINE AADLAND, DMD, graduated from Oregon Health & Science University School of Dentistry in 2006 with clinical honors. In her dream practice, she is constantly pushing the limits of CEREC technology with bridges, implants, orthodontics, and her same-day smile makeovers. Dr. Aadland is visiting faculty for CDOCS in the forum and at their Scottsdale facility, and she travels for CEREC trainings, ACCEPT courses, and other speaking engagements.
