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DynaFlex®10403 International Plaza Dr. St. Ann, MO 630741-800-489-4020www.dynaflex.com

Ortho

Volume Four

Dynamics®

N E W S L E T T E RODV O L U M E F O U R 2 0 1 4

Leading the way and challenging ourselves to be better every day... Whether you are in a thriving practice or you are running a business we are all trying to lead the way in our markets. How do we accomplish this and grow our respective businesses in a challenging environment? At DynaFlex we are continually growing through training, innovation and value add services. However, you can only “lead the way”, if you are willing to take risks, move in different directions, and think outside the box. Even the best laid plans can sometimes go awry so you must remain flexible and be willing to modify your current strategy quickly and effectively. Change will always be difficult but it can lead to increased revenues, reduced costs and increased moral among employees. At DynaFlex we like to add value to our clients through multiple different channels, such as practice management courses and continuing education courses with interesting topics. There are many ways to grow your practice and lead the way in your market but you will never know unless you make the commitment.

All the best,

Darren Buddemeyer, CEO

PAGE FOURDynaFlex VP, John Pietroburgo, gives a laboratory perspective on the versatility anduse of the Twin Block.

PAGE TWODr. William Clark provides an article on the benefits of using the Twin Block Appliance.

PAGE ONEDr. Jeff Haskins sits down with Gary Johnson and discusses going Alginate Free.

PAGE SIXDynaFlex VP of sales, Gary Johnson, discusses opportunities your practice may be missing.

How To Go Alginate FreeDr. Jeff Haskins is a prominent orthodontist with three locations in the greater Denver area. Dr. Haskins owns one of the most progressive practices in digital technology and currently owns (3) scanners and has recently gone impressionless. He was recently interviewed by our Gary Johnson regarding the use of his three iTero scanners for the fabrication of appliances. They discuss the benefits of using an iTero unit to go Alginate Free. Below is an excerpt from that interview.

An interview of Dr. Jeff Haskins by DynaFlex Vice President Gary Johnson

Gary Johnson: Dr. Haskins, you have three locations within the greater Denver area, when did you decide to go digital?

Dr. Haskins: We originally began looking at scanning technology for use with Invisalign

about two years ago. It didn’t take long to realize this technology would be a way to improve our accuracy with Invisalign. So in 2011, we bought our first iTero scanner.

Interview continues on page 5

PAGE 2

Twin Block appliances are simple bite blocks that are designed for full-time wear. They achieve rapid functional correction of malocclusion by the transmission of favourable occlusal forces to occlusal inclined planes that cover the posterior teeth. The forces of occlusion are used as the functional mechanism to correct the malocclusion.

The goal in developing the Twin Block approach to treatment was to produce a technique that could maximize the growth response to functional mandibular protrusion by using an appliance system that is simple, comfortable and aesthetically acceptable to the patient (Figure 1).

Twin Blocks are constructed to a protrusive bite that effectively modifies the occlusal inclined plane by means of acrylic inclined planes on occlusal bite blocks. The purpose is to promote protrusive mandibular function for correction of the skeletal Class II malocclusion.

The occlusal inclined plane acts as a guiding mechanism causing the mandible to be displaced downward and forward.

Bite RegistrationThe correct bite registration in Class II Division I malocclusion with deep overbite is typically edge-to-edge with a 2 mm inter-incisal space. The resulting blocks are 5 to 6 mm thick in the first premolar region and 1 to 2 mm thick in the molar region. The important factor is to open the bite beyond the freeway space, so that the patient cannot retrude the mandible when in rest position, but to avoid making the blocks too thick so that the patient can eat and speak comfortably with the appliances in the mouth.

The maximum sagittal activation is 10 mm and larger overjets may be corrected by an initial activation, followed by reactivation of the inclined planes after the initial correction has been achieved. In the treatment of large overjets and patients with anterior open bite it is important to relate the degree of activation to the freedom of movement of the mandible by measuring the

protrusive path of the mandible. The overjet is measured with the mandible retruded and in the position of maximum protrusion. The activation must not exceed 70 percent of the total protrusive path in order to remain within physiological limits of movement of the mandible.

Appliance DesignTwin Block appliances can be designed with many variations depending on the nature of the malocclusion to be corrected. The unique design allows for more patient comfort and increased cooperation. Twin Blocks are separate upper and lower appliances that fit in the maxilla and mandible. This allows for independent development of the upper and lower arches with the addition of transverse and or sagittal screws.

In Class II division 2 malocclusion the bite is registered in edge to edge incisor occlusion. Vertical control is important in correcting this malocclusion and the upper block is trimmed progressively to encourage eruption of the lower molars to reduce the overbite. Appliance design is modified by the addition of sagittal screws to advance the upper anterior teeth

The Delta ClaspThe author designed the Delta clasp in 1985 to improve the retention of the Twin Blocks appliance (Figure 2). It is similar to the Adams clasp in principle, but incorporates new features to improve retention, minimize adjustment and reduce metal fatigue, thereby reducing the incidence of breakage.

Clinical ManagementTwin Blocks are designed to be worn 24 hours per day to take full advantage of all functional forces applied to the dentition, including the forces of mastication.

For many years the author has taught that Twin Blocks may be fixed in the mouth for the first two

weeks of treatment. This enables the patient to adapt to full time use without any interruption in appliance wear. After two weeks the patient is eating and speaking with the appliances and is wearing the Twin Blocks full time. This approach overcomes any problems of cooperation during the crucial period of initial adaptation to the new appliances. This simple step eliminates most problems of cooperation.

An edge to edge bite with a small inter-incisal space encourages lip closure within 2 or 3 months of commencing treatment. A labial bow is seldom required as the lips retract the upper incisors. The patient’s profile after 8 weeks treatment provides a preview of the end result (Figure 3).

If designed correctly the Twin Block is the most ‘patient friendly’ of all the functional appliances and has proved to be the most popular functional appliance worldwide as a result of these features. In the treatment of deep overbite the lower appliance does not cover the lower molars and no clasps are placed on these teeth. The lingual flange of the lower appliance extends to the molar region, but does not prevent eruption of the molars.(Figure 4)

This is an essential element to achieve vertical control during the Twin Block stage.

Control of the vertical dimension is achieved by sequentially adjusting the thickness of the occlusal blocks over the upper molars to control eruption of the lower molars.

Dr. William J. Clark | B.D.S., D.D.O., D.D.Sc., F.D.S.R.C.S. (Eng)

continued on page 3

Figure 1

Figure 3

Figure 4

(Figure 2)

Why the Twin Block Makes Sense

PAGE 3

Twin Blocks Increase the AirwayBefore treatment this patient has the typical listless appearance, of many severe Class II division 1 malocclusions, evident in the dull appearance of the eyes and poor skin tone. After only 3 months treatment the patient undergoes a dramatic change in facial appearance. She appears more alert and there is a marked improvement in the eyes and the complexion. (Figure 5)

A large overjet with a distal occlusion is frequently associated with a backward tongue position, and a restricted airway. These patients cannot breathe properly and, as a result, are subject to allergies, and upper respiratory problems due to inefficient respiratory function. Advancing the mandible by functional therapy increases the airway. This is a fundamental physiological change, extending beyond the limited objective of correcting a malocclusion.

Twin Blocks can be easily integrated with fixed appliances to achieve the advantages of combined orthodontic and orthopedic correction of severe malocclusion.

continued from page 2

William J. Clark B.D.S.,D.D.O.,D.D.Sc.,F.D.S.R.C.S.Eng | Inventor of Twin Blocks & TransForce AppliancesDr. Clark is the first recipient of an award of distinction from the British Orthodontic Society for an outstanding contribution to the specialty of orthodontics. In 2008 he received the first award from IFUNA for personal outstanding international service to functionalism and orthodontics. Dr Clark developed the Twin Block Technique in 1977 in his orthodontic practice in Scotland. In 2004 Dr Clark developed invisible TransForce Appliances to correct arch form and align the anterior teeth.

Figure 5

A simple solution, with efficient results•����Efficient�treatment�for�skeletal� Class�II�malocclusion

•��Easy�to�use�and�maintain

•��Greater�patient�comfort

•����Variety�of�tranverse�and/or� sagittal�movement

“ Since I began doing functional orthodontic treatment in 1993, I have tried a myriad of fixed and removable orthopedic appliances for Class II correction. After 25 years, I still prefer the Twin Block appliance to any other. ” Dr. Michael S. Bubon, DDS

“ I’ve been routinely using the “Twin Block” as part of my overall Phase 1 growth modification protocol for retrognathic mandibles for the past 15 years. I understand that I may not be able to grow mandibles, but I always obtain a solid Class I occlusion.” Dr. Leon Klempner, DDS

www.dynaflex.com 800-489-4020

To request a prescription or for more information, please contact us today!

For further information visit Dr. Clark’s website: www.twinblocks.com

In today’s orthodontic practice there is seemingly unlimited options when it comes to choosing the proper mandibular advancement appliance that best fits your patients individual needs. Fixed options include many variations of the Herbst® appliance, the Mara appliance, CS-2000® springs, Rick-a-nators, as well as many other custom laboratory fabricated and pre-manufactured appliances. Removable options can include bionators, activators, Frankel appliances, incline planes, as well as many other functional appliances. Some of the fixed and removable options are terrific at addressing Class II correction, but may suffer when it comes to controlling vertical demension issues. Others may come up short when arch form improvements are required as mandibular advancement is achieved. In my experience, the appliance that has the most verstality when it comes to addressing a wide variety of needs is the Twin Block appliance. In many years of discussions involving appliance selection for skeletal class II correction, the versatility of the Twin Block Appliance is why the appliance continues to be the most popular functional appliance manufactured at DynaFlex. The doctors ability to utilize a wide variety of arch development options as they are simultaneously translating the mandible from a skeletal class II to class I is invaluable. Traditionally, we see a midline expansion component in the maxillary arch (Fig. A).

This maxillary expansion component allows us to guarantee that the upper jaw is wide enough to accept the lower jaw in the down and forward position, as well as helping to create needed space to alleviate any crowding that may exist. A common but less frequently used arch improvement technique is to use arch lengthening screws in the maxillary appliance (Fig. B).

These screws can be used independently or combined with an expansion component. Generally this will be used in a constricted class II division II case with a recessive mandible. A separate but significant advantage to the Twin Block is its ability to combine mandibular advancement with the

versatility of controlling vertical deminsion. The Twin Block can be used to address both skeletal open and skeletal deep bites. The skeletal deep bite patients appliance will be adjusted by removing acrylic off of the upper block allowing for eruption of the lower molars. This eruption of lower molars results in an increase in lower face height. (Fig. C)

On patients who exhibit a skeletal and dental open bite the inter occulasal acrylic blocks allow for intrusion of posterior teeth and simultaneously allow for maxillary anterior teeth to erupt. (Fig. D)

If you have questions concerning this appliance or any appliance at DynaFlex, please email johnp@dynaflex.com

PAGE 4

Twin Block Therapy VersatilityThe most versatile orthopedic appliance

John has provided his expertise and knowledge in appliance design and manufacturing to DynaFlex® clients for more than 30 years. John is extremely committed to solving difficult problems in regards to orthodontic appliance selection and custom manufacturing. John has direct contact with all laboratory technicians to ensure that DynaFlex® consistently produces quality appliances that fit the first time.

Executive Vice President discusses the versatility of the Twin Block Appliance

By John Pietroburgo, CDT

(Fig. C)

(Fig. D)

(Fig. B)

(Fig. A)

PAGE 5

DYNAFLEX�IS�THE�LEADING�PROVIDER�OF�DIGITAL�APPLIANCES�FROM�SCANNED�FILES�If you would like to learn more about how to use your scanner for appliances, please contact garyj@dynaflex.com

Interview continues from page 1

Gary Johnson: Were you doing digital model storage prior to investing in a scanner?

Dr. Haskins: No, we were not storing digital models.

Gary Johnson: At what point did you decide you should consider using the scanning technology for orthodontic appliances?

Dr. Haskins: Patients were excited about the accuracy of the Invisalign aligners and the “gag free” practice. So when you put together accuracy along with the patient convenience it only made sense to put a scanner in each location and use it for orthodontic appliances…

Gary Johnson: A question that comes up all the time relates to scheduling. How were you able to go from multiple people being able to take an impression, to one machine that dictates the impression?

Dr. Haskins: We started out with the scanner in a private room with one or two assistants scanning. Because of the increased number of patients being eligible for scanning, we moved the scanner to the clinic and all of our assistants have the ability and opportunity to scan. We average over 10 scans per day. Mom’s and other patients are impressed and enjoy watching patients being scanned.

Gary Johnson: So it is just wheeled from chair to chair?

Dr. Haskins: Yes, we move it from chair to chair. We scan 100% of our patients that need an appliance, retainers or start Invisalign treatment. Scanning is now the first step in our process. For appliance patients, we scan then place brackets and separators. The lab fits the bands. The patient is scheduled back in two weeks to deliver the appliance. Scanning for appliances has reduced the number of appointments from 3 to 2.

Gary Johnson: So you have been able to eliminate a band fitting appointment?

Dr. Haskins: Yes

Gary Johnson: I have been told by doctors that there are pros and cons to this approach…

Dr. Haskins: Yes, one of the challenges is that the bands may not always be perfectly snug. In our practice, we are only using the initial bands for the treatment associated with the appliance (distalization and expansion). Once the appliances have done

their work, we remove the bands along with the appliance and replace them with long term bands. Gary Johnson: I speak with practices all over the country about this very point about band fits. As a practice management consultant, my feeling is that if 7 or 8 of the 10 bands fit well and the office has to “fuss” with a couple, the benefit of eliminating the appointments for 80% of your patients is much more efficient and patient friendly than doing things the “old” way. Do you agree?

Dr. Haskins: Yes I agree, scanning technology has allowed us to eliminate 3 appointments per patient throughout the course of treatment. We eliminate the initial band fitting appointment and two appointments at the end of treatment. For debands, we scan for retainers with the braces on, submit to DynaFlex for virtual removal of the braces, and manufacture two sets of clear retainers. This saves the patient another appointment. We then deliver the retainers at the braces off appointment.

Gary Johnson: Did your staff embrace this technology or resist it?

Dr. Haskins: The staff was very positive about going “alginate free” because they were already using the technology for Invisalign. Their lab work has been significantly reduced as well.

Gary Johnson: How have your patients responded to the technology?

Dr. Haskins: They absolutely love it, going digital has increased our initial starts.

Gary Johnson: So based on your experience, I know you feel the scanner has been great for Invisalign but do you feel it has been a benefit overall for appliance treatment as well?

Dr. Haskins: Without a doubt, being completely digital has been a great practice builder.

Gary Johnson: Not that we are trying to reduce positions in the practice as our main goal, but technology has allowed for efficiencies dating all the way back to Henry Ford. As business owners, we would be foolish not to look at the savings that can be realized by using the scanner and the lab to make the appliances.

Dr. Haskins: We have eliminated one full time lab technician and we have also eliminated three appointments per patient. These cost savings along with the convenience of scanning, have made going digital a winner for us.

PAGE 6

In our inaugural Wowed! section of the DynaFlex Newsletter, the feature article will be focused on the initial phone call. I have had the opportunity to observe and secret shop many practices throughout the country. Find out if your staff is as good at the initial call as you think they are or you think they should be.

My name is Gary Johnson vice president of DynaFlex, one of the world’s most progressive orthodontic companies and a nationally recognized lecturer on everything practice management. My new book, Wowed! Using the Principles of Wow to Forge the Ultimate Customer Experience, hit the bookstores February 4th, 2014. I will be speaking on some of the ideas from the book at the upcoming AAO in New Orleans, Monday, April 28th.

Are You Missing Opportunities?

“Winning is a great deodorant, it hides a lot of things that could be bad in your organization...”

John�Madden,�NFL�Hall�of�Famer�and�NFL�Analyst

Winning is a Great DeodorantAs I decided what topic I should cover in this volume of this newsletter, I was listening to the NFL Network on satellite radio. One of my all-time favorite football coaches, John Madden was being asked to describe what has turned out to be a very controversial decision to “bench” the star quarterback and last year’s Rookie of the Year. Whether you have followed this particular story or not is irrelevant to the point John made in his assessment. He said, “Winning is a great deodorant”. You see in the previous year, the football team had won their division and went to the playoffs. This year, they were in last place. His point is a great one. When things are going well it is easy to ignore problems in your organization that could be an issue. When these problems go unfixed, they can be the difference between making or losing money in softer economies.So how does John Madden’s comment relate to your practice? I think it relates very well. You see, I have had the opportunity to analyze some of the best practices in the country. Practices that are successful by even the highest measure, yet those successful practices are still missing opportunities every month. In my opinion, as many as three to five starts or new patients per month.

The Initial CallRecently, I was conducting a practice management analysis for a prominent orthodontic practice. The practice does well over 50 case starts a month and has a very successful orthodontist at the helm. Before arriving at the practice, I “secret shopped” the front desk and recorded it. What I found was quite surprising. While the front desk person was very sweet, she let me, the patient, dictate the entire call. She never got my name, contact information or a scheduled appointment. Now keep in mind this is a fantastic orthodontic practice with an outstanding specialist. As successful as this practice is, how many calls like

the one described above happen there every single month? Enough to lose three to five patient starts a month? I say a resounding, “Yes!”While there are many great organizations like the Scheduling Institute, Leann Peniche and others that teach great phone techniques, I have my own 5 keys points that I believe should be asked on every call and I have outlined them below.

How did you hear about us?As a business leader, I always want to know how a potential customer has heard of our business. Did they see an ad? Did they get referred from a friend or dentist? This question is the first one that should be asked. Asking this question right upfront also does another very important thing; it establishes control. When someone calls our business, we should take control of the call so that we can ensure the call goes in the direction we need it to go.

In case we get disconnected, may I get your name and phone number?This may sound basic, but you would be shocked at the number of calls in which this is not done. I have conducted thousands of calls and found far too many that fail to collect this basic yet critical information. Without this key data, we have nothing. No way to follow up. No way to track this potential customer. This information absolutely MUST be collected. Also, by providing a reasonable reason, in case we get disconnected, most if not all people will give your team their contact info.

Have you had your child evaluated before?This question can tell you a great deal. First, in can tell you if you are their first visit or fourteenth. Second, if you are not the first appointment, it can help your treatment coordinator probe (during the initial consult) to determine what they liked and did not like about the offices they have

visited. This will allow your team to concentrate and target in on the benefits most important to your potential patient.

Let me explain what to expect on your initial consultation with our practice.By explaining what to expect on the initial call, we set the expectation and help the potential patient visualize how the appointment will go. By providing this information, we also eliminate many questions that the potential patient may be thinking about. Also, this is a great time to introduce them to your treatment coordinator (if you don’t have one, my question would be…”Why?”). When I say introduce them, this is what I mean. Simply have the front desk person mention the treatment coordinator’s name and let the potential patient know that he or she will be their point of contact throughout the process.

Lastly, and most importantly…Get the Appointment!In my experience, covering these four main points above will make getting the appointment scheduled much easier and will make the appointment much more concrete. I like to have the front desk person say something like, “At this point, it probably makes sense to schedule an initial consultation. I have two openings in the next two weeks (always schedule in two weeks or less if possible).” Also don’t ask when they want to come in because it will almost always be at the most popular time. If your team has done a great job on this call, many of these potential patients will choose one of the two times you recommend. If you have to give up a premium time fine but don’t give it up unless you absolutely have to. We need to fill the slots we want to fill and we can do so if we teach our team to ask people to take those slots.

By Gary Johnson

Wowed!�is�an�easy-to-read�book�designed�for�any�supervisor,�manager,�or�business�leader�that�wants�to�form�a�business�or�business�unit�that�utilizes�platinum-level�service�ideas�to�“Wow”�their�customers.

“We all are leaders of something, from business to family. Leadership principles and customer service books abound the shelves of libraries. What separates this book is that it’s liberally illustrated in an interesting storytelling fashion that bring

the lessons home to us, making it easy to read and eminently understandable.”—David. M. Sarver, DMD,MS

PAGE 6

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P.O. Box 99 • St. Ann, MO 63074-0099314-426-4020 • Fax: 314-429-7575

What to look forward to in the next issue...Would you like you and your practice to be featured in the next issue of OrthoDynamics? Submit your relevant and current article(s) to britneyv@dynaflex.com with subject line “article submission”. We prefer that the submission be between 600 to 1,200 words, submitted as the body of an email rather than an attachment. It is important that articles be copy-edited carefully before submission. If your article is selected to be shown in the next issue, we will contact you as soon as possible.

010314 © 2014 DynaFlex® , St. Louis, MO 63074. Printed in U.S.A. All rights reserved.

New Exciting Informational Articles Inside!

Stacey Gassett, CPA & CFO of DynaFlex discusses how most small businesses utilizes a CPA only to complete tax returns, and why the role of your CPA should be much greater than completing a few IRS forms.

Learn how to use the CS-2000® and the many benefits that it offers by Dr. Michael Williams, DDS, PA

Understanding the role your CPA should take.

Using CS-2000® for correction of Class II and Class III cases.