Self-Ligation or Tried and True Twins.....what to do?

*** Please note that this blog is a reflection of how I choose to practice Orthodontics. I don't use it to cause anyone to feel bad about the treatment decisions they make. One of the best (and we're one of the few remaining professions that can still say this) aspects of running your own practice is making the choices and decisions that YOU fell good about. That's what gets me excited about coming to work every day. Okay, almost every day!

When Damon brackets first came out, I was super excited to try them out. As a matter of fact, Dr. Damon practiced only 90 minutes from my own practice, so another Orthodontist and I contacted him and ended up checking out his practice first hand. Now whatever you think of Dr. Damon via his brackets, marketing, etc., I came away with a great impression of him. I not only learned about his "new" bracket system, but I was impressed with his excitement for Orthodontics, rapport with his patients, and graciousness to allow us to visit his busy practice. He was just a super guy and he made us feel very welcome.

So I purchased and tried several cases, then I tried some other self-ligating, but I always came back to twin brackets. So here's my comparison:

COST- This is a blog about reducing overhead, so the cost of supplies definitely gets first billing. For Damon brackets and other self-ligating brackets, the cost seems to be anywhere from $4-$11/bracket. Seriously is anyone actually paying $11 for a bracket? Yes they are because I've heard it first hand from some young practitioners! Last year between new starts, rebonds, partial treatment and re-treatment I probably put on 9000 brackets. At 11 bucks that's $99,000 in brackets. At a low of $4 that's $36,000 in brackets.

You can get excellent quality twin brackets for 50 cents each, so my cost for brackets last year was 4500 bucks. To me that's a HUGE savings. A savings I can use to treat myself, pay taxes, give more to charity, or completely fund another employee ($14/hr is roughly $28k/year in wages).

EFFICIENCY- the value of clinical efficiency is extremely important. One of the best ways to reduce overhead is to streamline treatment modalities, and FINISH cases on time! (see earlier blog posts). I have seen no difference in the literature or my own self ligating cases of faster treatment times. So in terms of treatment time I see no advantage of one over the other.

Another aspect of clinical efficiency is chair time/appointment time. Here I have to give the nod to self ligating brackets. My normal adjust appointments are 20 minutes and after the learning curve for SL brackets I could probably get normal appointment times down to 10 minutes, thus reducing labor costs. So that is a definite advantage of SL brackets.

But here's the rub. Is it that advantageous to reduce appointments to 10 minutes? If all your adj appts fill your schedule in 10 min increments and patients are even a little bit late there's no wiggle room for unknowns. For instance I like to rebond brackets. If we have a normal 20 minute adjust and I see a bracket off position, we just rebond it. That's one of the ways I feel I can keep my treatment times short. With 10 minute appointments that wouldn't be an option. You could argue maybe I should use SureSmile or something and that would help but then we get into cost/benefit again and for me the added cost isn't worth it.

Also, I do think 10 minutes is kind of a short patient interaction, and if little Johnny is done before mom has parked the car then more often than not you may have some 'esplaining to do.

MARKETING, or SL vs. Colors

I would argue that the biggest reason Orthodontics has become a rite of passage for middle school kids and has exploded in the last 20 years is the introduction of colored O-ties. (With payment plans being a close 2nd). I know we'd like to think it's due to our advancements in technology, decreased pain of adjustments, etc, and to some extent it is. But hands down, the funnest and most important decision kids in my chairs (and many adults, too) make is what Holiday, sports team, dance recital, etc they need to match with their choice of colored o-ties. You get a 12 year old girl in your chair with 2 friends she brought from school and you'll be amazed at the color choice discussions that arise (of course many of you see this every day). Either way, it's a marketing dynamo, because it gets people excited about braces!

So why take that away? Sure you can tell the 12 year old that colors just slow things down but I don't think she's buying it. Or you can add the colors on the SL brackets but once that's done the only advantage I feel you have (time of appointment) has just been lost. I have more than a few SL transfer cases scream with delight when I changed out there appliances with "colored" ones. I'm not lying it just happened last week!

True, there is some Marketing you'll be missing out on as well. You won't be part of the "club" that uses SL appliances, and they've done an excellent job of marketing themselves, to their credit. But with the money you save you could hire a full time practice marketer that I'm sure could overcome that issue, if in fact it is one.

Okay I'm rambling now. As always, comments are welcome. And if you use SL please know I commend you for practicing the way YOU choose! That's what it's all about.

DC