Why is the average orthodontic case over 20 months? Why does the average mature practice have such a high percentage of patients overtime? I know you want to point to those outlier, difficult cases but they only account for a small percentage of what I’m talking about. Most of the problem lies between the ears of orthodontists. We are our own worst enemy more often than not. Here are a few ideas to help you shorten your treatment time which will increase your capacity, decrease your work load, increase your efficiency, increase your profitability and enhance your quality of life.

1. Make your initial estimate of treatment time shorter – If you say you’ll get done quicker then odds are you will figure out how to do just that.
2. Become great at bracket position – Bracket position is the most important thing we do in 99 percent of cases. I know you were told that treatment planning is the most important (we all were) but that’s just not the case. Excellent bracket position will solve the vast majority of what ails you and your practice. No, you don’t need to do indirect bonding to get great bracket position. Get yourself some loupes and pay attention to how you place brackets and examine what you see after initial leveling and aligning and you can’t help but get better. Look for things you consistently do wrong. For me it was a failure to place lower canine brackets mesial enough to avoid having to do a step out bend on the mesial of said canines. Once I figured that out and moved my bracket placement mesial, there was much less need for step out bends.
3. Stop banding teeth – It takes two appointments and patients hate it and it’s bad for them. Yes there are times that you MUST band but stop using those few cases to justify your laziness in banding all the rest.
4. Don’t be afraid to debond and rebond a case after initial leveling and aligning or space closure – A braces vacation is a great way to handle any number of problems from compliance to hygiene to motivation to bracket position to a case that just isn’t going well. Take the braces off and let the patient go with no retainers for a couple months then put the braces back on again. You’ll be shocked how much better it looks when you go to rebond and how much you can take care of with improved bracket position. Take off ALL the brackets and bands when you do this or you’ll just rebond relative to the ones you left on and defeat the whole purpose.
5. Advance the case maximally at every single visit – It’s just like football. You want to gain as much yardage as possible every single time you have possession. Simple stuff makes all the difference. If a patient comes in for a repair then see what else you can do. Bond both arches instead of just one at a time. Bond those 7s if they are out of line (or leave the alone if they are aligned) TODAY. It all adds up.
6. Become great at psychology and patient/parent motivation – This is where I excel. I don’t claim to be a clinical guru but I’m excellent at getting patients to want to do what I want them to do. A great deal of this comes from understanding that they all want to be given choices. The same techniques I use on patients work on parents, team members and my kids! It’s not manipulation it’s the ability to help others see that you’re trying to help them and giving them some form of control over what is happening to them.
7. Learn to talk to momma – Getting mom on your side instead of having her defend little Johnny’s antics is critical to success.
8. Learn to bend wire – Learning to bend wire is a matter of practice, trial and error and stubbornness. We orthodontists are so afraid of failure that we often won’t even try. If that is the case then do some free cases and practice your wire bending on them. I like a 19×25 TMA to bend but rarely I’ll use a 17×25 TMA or an 018 steel depending on the situation.  Here are a few videos of wire bending I did a while back. I’m no teacher and don’t claim to be and it’s tough to teach this remotely but what the hell… I don’t mind looking like a fool while attempting to help you.
9. Debond when patients tell you they are happy – You must understand that 98 percent of patients don’t think about “ideal” the same way you do and they aren’t willing to do what you think is necessary to get there. Don’t put your hang-ups on your patients. They are in charge. We are the hired help. When they tell you they are happy then TAKE THE BRACES OFF!!! To do otherwise is crazy, upsets patients and damages your reputation because patients will complain about what you’re doing. To them it’s like going to a hairstylist and asking for a trim and then having the hairstylist tell them, “no, I’m going to do your hair the way I think it should be done”. Stop the insanity that we orthodontists accept as acceptable. Do no harm but do what you’re told!
10. Do more Invisalign – Anyone who has done a fair number of Invisalign cases will tell you that most Invisalign cases finish in a year or less… and that was before the 1 week wear protocol. Nuf said.