Successful treatment encompasses much more than just aligning teeth and requires the orthodontist to have skills beyond the ability to position brackets accurately or design a Clincheck. These technical skills are important and are the epicenter of our focus, but are only part of the equation and the process begins before the doctor even sees the patient for the first time.

Web Presence 

The setting and meeting of expectations plays a huge role in patient satisfaction and this usually begins when the potential new patient lands on your website. What does your website look and feel like? How easy or difficult is it to find what they are looking for. Does your website stand out from the others the patient has visited? Do you offer live chat conversations 24/7? Can your pricing and financing be found on your website? Does your website recognize mobile and adapt automatically? Is your website content up to date? Do you have a blog with useful and current information? Do you have social media pages that show happy customers to whom this potential customer can relate? If not, you’re behind the curve or you will be soon. All other things being equal, the patient will decide on who they see for treatment without even making a phone call if you do a great job with your web presence. Also, how you present your practice and the terms you extend online are setting expectations that the patient will carry with them through and beyond treatment.

The Initial Visit

The new patient exam is almost a religious experience to the modern orthodontist. We have built this visit up in our minds and our practices to become something it never should have been. We spend a minimum of an hour to do something that should take 15 minutes tops and we believe that every patient wants to “get to know us” and to “spend quality time with the doctor” so we act accordingly with special rooms, special people, special tours, special smiles and special treatment for the new patient. One big problem with this TC driven new patient experience is that we have lost touch with reality. People have stuff to do and places to be. They don’t want to spend more than an hour on something perfunctory like getting orthodontic treatment – or at least most people don’t – despite what we tell ourselves. They don’t care about the doctor’s personal life, they don’t want to chit-chat forever, they are busy, this appointment is just one of many things they need to do and they already believe that you can do the job (that’s why they are in your office) so don’t mess it up by talking so much! The second problem with the accepted method of handling new patients is that we set expectations of hand holding and rear kissing during the new patient visit that plague us throughout treatment. If you treat patients “extremely well” in the initial visit and then they are just one of the gang on the next visit, you can see how issues can arise. Finally, not only do we give a false sense of “we will give you all the time in the world every time you come into our office” during the TC driven new patient appointment, we often fail to “lay down the law” when it comes to important things like after school appointments, nights weekends, holidays and treatment time. We also fail to have the hard discussion with the unrealistic patient about realistic outcome expectations in the new patient consult. Traditionally we tell the patient what they want to hear in the new patient visit but by doing so we are setting ourselves up for massive failure later. Failure that we mistakenly blame on the patient or on treatment outcome when it occurs later in our relationship. We think that “getting the start” is primary in the new patient visit and end up costing ourselves and the patients time and money.


This is the last thing we orthodontists want to talk about but the first thing most patients want to discuss. We leave it for last in the TC driven new patient visit and are typically embarrassed to talk money at all. There is no need for all the drama. Patients know what it costs or close before they show up at your office. We need to do a better job of being up front with pricing, financing and the logistics of monthly autodrafting during the course of the contract. Patients will thank you. Especially if you make this simple to understand and implement. Jump right in and get it over with rather than drawing it out like a sword over an hour!


It’s not hard. Put the brackets in the middle of the teeth, line them up with the long axis of the root, level, align, close gaps, wear elastics, take the braces off and retain. Or, in Invisalign cases, scan, evaluate the Clincheck, modify as necessary, deliver trays, deliver attachments, do a little IPR as needed, wear elastics, remove attachments and retain. Simple. We were taught in school that DX and TX planning are the most important parts of orthodontics. I’m here to say that is not true in 98% of cases. Yes, there are a small percentage of cases that can cause you major headaches if you mess up the DX and TX planning but the VAST MAJORITY of the time, bracket placement and Clincheck design are the primary factors on our end when it comes to clinical success.


Did I say bracket placement and Clincheck design are primary when it comes to great clinical outcomes? Well, that’s not exactly true. Getting patients to want to do what you want them to do is probably even more important. What I mean to say is that without great bracket placement and Clincheck design you won’t get a great result but without the ability to get great compliance, you won’t get a fantastic result no matter how good you are technically. The trick is to get patients to want to do what you need them to do. To do so you must find out what is important to the patient and show them why doing things your way is of benefit to them. Patients don’t care what we want or what we need. Griping at them just makes you sound like their parents and we all know they don’t listen to their parents. So what do you do? Be nice, be understanding, be sympathetic and, above all, be honest. I’ve given you some scripting I use in the past here on OrthoPundit but you are smart people and can figure out what you need in any given situation. Just remember that kids want their braces off and they don’t care about you and you’ll do great.


I love to bend wire to finish cases. Detail bends are what take a good case to a great finish in a short amount of time in my opinion but I know many of you repo and that’s fine too. I don’t claim to be a clinical guru and perfection is not the point of this blog. Great results and happy patients are what is important to me and the point of this article! As I get close to what I think is the end I’ll start asking questions like, “How does your bite feel to you?” or “Do your teeth look better than they did when we started?” or “How do you like how your teeth look?” And then I shut up and actually listen. I want perfection in each case – perfection is unattainable but I want it. That being said, patients want a great result and want their braces off (and not necessarily in that order). We orthodontists should want our customers to enjoy the process, get what they expected or more and finished satisfied. We orthodontists should moderate our want/need to point out every single deviation from “ideal” that we see in a patient for the same reason we moderate what we say when our spouse asks how an outfit makes them look. It’s wise to give critical feedback about things that can be controlled but we often lose sight of realistic expectations in our specialty and we expect our patients to see things the same way we do. That is dumb. We also have to keep in mind that a “good finish” is relative. If you’re in month 28 of a 24-month case then your expectations of how a case “should look” must be adjusted down significantly. At this point in the game it’s about getting to a stopping point! Or it should be. Overtime treatment is death to the modern orthodontic practice for many, many reasons.


We need to be realistic and clear about how retention works and who’s responsible for care after treatment. Retainer wear and personal responsibility are something we orthodontists have allowed to fall on us instead of on the patient. This is a huge mistake. The patient needs to understand that if they don’t do their part then they will have to get braces back on again. There is simple scripting to help with that. Also we offer to our patients so that we have a backup plan should things go wrong.

As you can see, successful orthodontic treatment encompasses far more than just moving teeth but it can be much simpler than we have made it in the traditional orthodontic office. Of late I’ve been working hard at stripping away the layers of fluff that we don’t need and patients don’t want to get to the essence of what is necessary to get the job done and have a successful practice with happy patients who send their friends. For example, we now do chairside new patient consults in a matter of minutes. Our price, financing, paperwork and appointment policies are streamlined and easy to understand and made available to the public so patients know what they are getting into. Most in our organization were terrified that going away from a traditional orthodontic mindset and TC driven new patient visit would be death but we have found that patients really don’t care to talk to the doctor that much, have other things to do and appreciate that we value their time. Going back to offering Invisalign is another change we have made in the last year – because patients want it. Not only do we offer Invisalign but we offer Invisalign on the same pricing and financing terms as braces. The results have spoken for themselves and the practice is booming.

The world has not only changed but will continue to change. We must keep up with the wants and needs of the modern patient even more than we keep up with the latest innovations in orthodontics. I know that sounds strange to most orthodontists but think it through and think about which option will do more for your practice and you’ll see the truth of the matter.