Seminar 1: Expectations for this seminar

New Patient IPsoft file and picture tab1. 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 tabIt 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 decisionLower 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 dentitionThe 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 IIIA 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 recordsThere 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 biteWhen 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 placementThe 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 examLooking 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 bandedAt 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 importantSit 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 incisorOn 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 decisionLip 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 treatmentIn 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 consultationSimilar 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 considered24. 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 5If 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 listIf 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 theseThere 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 tabTo 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 consultation30. 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 extractionTo 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 includeThis 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 opinionIf 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 timeThe 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 Records40. 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 smile6 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 10-13Boys 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.

Growth51. 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 ortho61. 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 caseAppointment scheduling intervals and timesPresenting a positive and exciting attitude to the patient/parentWhat you want the assistants to do (and how they will be trained)What you want the receptionists to say when discussing orthoFees, including down payment and payment scheduleIndividual patient appliance Diagnosis and treatment support from POSHow 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? 1 ST 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. 2 nd 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 trayBand and bond trayLost bracket trayCool 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 derrick@posortho.net 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 systems86. 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.

Administrative92. 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.