smile solution street smash solutions.com and today we're ramping up for cda 2022
in san francisco and the topic of the lecture that i'm going to be doing at cda is about decreasing
your refinement rate so let's talk about what is a refinement rate and why is it important that you
know your refinement rate how do you find out what your refinement rate is for invisalign i'm sure
you can find it out from other aligner companies too but you can definitely get that those metrics
from definitely from your territory manager they should be able to get those metrics for you
to know what and you can also just manually figure it out i mean you just audit your cases
and the ones that are finished and you see which ones had refinements now i like to always throw
out the ones where the patient moved the patient just said they didn't want to finish i mean those
you didn't finish those cases right so of the ones that were actually quote unquote finished
and idealized what is your refinement rate what percentage had to do at least one refinement
now what's a normal refinement rate for an orthodontist versus a general dentist well
it should be the same and it really should be zero so i mean certainly no orthodontist is
gonna have zero we're gonna probably have 10 20 maybe 30 percent max but most general dentists
that i've checked out have more like 70 80 90 100 and that's way way way way way too high and
this a refinement for invisalign is like a bracket repositioning for braces you shouldn't have them
if you have them you did something wrong and none of us are perfect right but just like you can use
indirect bonding to have a computer digitally place your brackets to decrease the likelihood
of needing bracket repositions you want to get it right the first time and just sail through right
you can do the same thing with aligners you can have first of all you can have an
orthodontist double check your cline check to make sure it's a decent clinch act remember you
never do what the technicians say the technicians are not orthodontists and if they say they are
they're lying they may have one on staff that's trained in another country trust me their goal
is to churn out as many possible approved clinic clint checks as possible they're a public business
right they're a public entity that's how they get their metrics is getting as many approved as
possible they're a business your business your job is to get the best outcome for your patient their
job is to make the most money sorry two different things okay so you need to learn what a good plan
is and how to optimize your own plan that's going to take time unless you are an orthodontist you're
not going to be able to do that and all these classes that are put on by online technology
no i've sat in on most of them i've audited a lot of them it's terrible information why
because it's all about keeping the treatment plan short sweet and messy not well done not optimized
not idealized not good healthy movement it's about keeping things short and sweet so that they
can get the most money not you're doing not that you're doing the best thing for your patient which
is a liability for you you need to know how to do the right thing for your patient there's always
options don't get me wrong there's sometimes when that patient really wants short sweet even if it's
not perfect and that's fine but you can't offer your patient that version unless you can offer
your patient the understanding of what perfect is and show them perfect and if you can't show
them perfect you have no business doing short and sloppy because that is where you can get yourself
in trouble either with your insurance company or with your dental board if the patient wants to
complain it's going to get escalated to someone like me who's going to look at that and say
that's a terrible clinch check okay that wasn't done right did they show the patient ideal if
you did not show the patient ideal and you don't have that documented going back into your portal
and you don't have the verbage documented in your chart and you don't have a signature from your
patient saying that they declined ideal you can be in trouble okay i know i haven't kind of got off
tangent but i really need you guys to understand that so let's go back to refinement rate first
thing you have to do is idealize your treatment plan make sure it's a predictable treatment plan
that can actually happen second thing you need to do is slow down your aligners i always recommend
that you double all your clinch so once you get it right if they tell you it's 25 it's now a 50 okay
bare minimum maybe even 2.5 on clear correct i do three times okay because theirs is so fast and
ridiculous it's just not it's not even healthy for the teeth and gums and bone in my opinion
okay as an orthodontist i know what a movement is healthy stable and what's more likely to damage
bone gums teeth roots and cause tipping instead of translation okay every orthodontist i know
that does invisalign we slow it down i don't know anyone that does it we just look at and we just
laugh and we go that's ridiculous who's gonna do that double it okay the other benefit of making it
longer is it actually doesn't make the plan longer it makes the plan shorter because things are more
likely to track patient is happier and more comfortable patient isn't in as much pain that
it's easier for them to seat them they're more clean they don't have to leave them in for 10 days
two weeks they might leave them in for five days seven days and i'm not even going to get into the
whole wear thing because i have a zillion videos on that if you want to know about refinement where
sorry invisalign where schedule just go into you can even just go into my channel and um
search in the search bar go to straight smile solutions channel you have to be in my channel
from there there's a little magnifying glass you can put in like seven days or you can put in
alignment delivery instructions and all those things will come up because it's not a standard
thing there's actually a procedure to that it's not as simple as it sounds okay so double it
um optimize it and then lastly you need to create an accountability loop what does that mean well i
mean i've done a liners on i don't know thousands of people directly and maybe hundreds of thousands
of people indirectly helping other doctors do it i mean a ridiculous amount of aligners
and the one thing that i know the doctors that use an accountability loop a virtual accountability
loop are much more successful and they have a much much much much lower refinement rate down to the
level of the orthodontist that doctors that don't there are free ones if you're using invisalign
you can use invisalign virtual it's free it's a little bumpy it's a little clunky you're gonna
have to have an app on your phone the doctor's app the patient's gonna have to have a patient's
app on their phone my suggestion is that you help them download it and learn how to use it because
it's not necessarily self-explanatory you need to give them a set of retractors you need to simulate
it in the office at the delivery appointment make sure they know how to use it i mean in our
office i can tell you what we do and a lot of it depends on the demographics of your patient
our office tends to be a variety of different ages and we have patients that are in their 20s and 30s
and teens we have patients that are in their 60s 70s we like to give our patients an option of
coming more some patients are really in our office is pretty central um so it's pretty convenient for
patients to come and patients like to come there's a mcdonald's there there's a chick-fil-a there i
mean it's not inconvenient at all so we don't really have a problem getting patients to come
back every few outliners to check in in person but if they're busy or if they're on vacation or if
they're like a really busy person that's kind of groaning at the idea of coming in monthly for an
aligner check then i recommend putting them on a virtual check virtual check you can use invisalign
virtual or you can use one of couple different a handful of different other programs some are
affordable some aren't the one i like is called in hand dental very affordable in the 100s per month
for i think up to 30 or 40 patients um so it's only like a couple dollars per patients per month
you're going to have a hipaa compliant portal with an app similar but the nice thing about
that is it's not only for your invisalign patients you can use it for any aligner company
so if you're not only using invisalign you got braces you're using sure smile you're using
global you're using clearcorrect you can use it on anyone it all goes into one dashboard which
is great right so that's the one thing i like about that and it's very very very easy to use so
definitely want to do that you want to make sure that your patients get the thumbs up
or thumbs down and they don't progress onto their next aligner unless there's 100 tracking
i like to double check the tracking slightly open front side side to make sure it's all 100 percent
seated if it's not i'm going to ask them to try it in that previous aligner if that's still not
fitting try the previous liner before that make sure they're saving all their old aligners right
um and then the other things you should be checking is the bite it's even nice if you
give them articulating paper to teach them how to use it of course tap tap tap um and then take
your five interaural photos and this these are going to be biting down you know front side side
top bottom as much much as you can i mean it's not going to be perfect it's not going to be
orthodontic level photos it's just rough photos so we can see what's going on obviously there's any
red flags if things aren't fitting we're going to tell the patient to either go back and try
on the other aligners we're just going to have them bring all their old aligners in remember to
make sure they save all their old aligners and we're going to find out where they are if it's
like way off we're going to do a refinement but most of the time if you do this virtual check-ins
we can you know block we won't have to do a refinement because we're gonna tell them
hey look that's not fitting we're gonna catch the problem before it snowballs
and gets really really bad you know go back to the right aligner maybe now they're going to be
in two upper and three lower you know instead of four upper and lower and have them catch up
because we're not all perfect and sometimes we have a bad week right all right so just creating
some awareness about your refinement rate and how this can make your office way more productive
because patients hate refinements i mean sometimes they're necessary but patients really hate them
they lose trust in you um it's expensive for your office because every time the patient is
coming in when they don't need to it's taking up chair time that could be profitable chair time
so if you can create that accountability loop you will sail through your aligners way faster
get better outcomes patients will be happy they'll leave you good reviews they'll
send you referrals and ortho is going to be really fun for you all right thanks so much