Dental Asia Jan/Feb 2018

18 DENTAL MANAGEMENT DENTAL ASIA JANUARY / FEBRUARY 2018 I lecture worldwide on the business of orthodontics. We live in an ever more competitive, ever more regulated, and ever more price-controlled world. Importantly, the patients we serve seek convenience as well as quality. The practice that can master both of these aspectswill surely be thewinning orthodontic practice of the future. Dental Monitoring: A smartphone-driven technology I was intrigued to read the AAO Tech Blog by Dr. Domenico Dalessandri of Italy (11 th March 2016) entitled, “Smartphonebased orthodontic monitoring: the big brother in our patient’s mouth.” In it he discussed app-based monitoring systems offered by various vendors. He asked, “Could these systems become important tools allowing us to improve our treatment quality and e ƥ ciency?” Following that blog was another, entitled “eOrthodontics,” by Dr. Anthony Puntillo (20 th July 2016) where the author also explored remote monitoring of patient care. Both authors mention a smartphone driven technology called Dental Monitoring (DM). At the time of these blogs, I too was contemplating the beneƤts and rewards of remote monitoring. If it could work, and if it was accurate, remote monitoring o ơ ered orthodontists the chance to monitor treatment MORE frequently yet with FEWER patient visits. The potential to the practice would be better results in fewer visits and in fewer months. This should translate to more proƤt per case, and in this world of cost control by third parties, that is truly an exciting consideration. Remote monitoring There are also advantages for the patients and parents with remote monitoring. In addition to those outlined previously for the practice, patients and parents want convenience. Parents don’t want to take kids out of school. Even after-school appointments compete with sports and other activities while complicating the lives of busy parents. If there was a way, therefore, for patients to be treated remotely, and at the same time enhance (not compromise) quality, this would be a boon to any practice. It would represent a win-win- win proposition sure to be a practice builder. Following these blogs, my practice began the use of remote monitoring. We wanted to test if quality monitoring was possible, if enhanced patient communication could be achieved, and if this could lead to fewer and shorter visits with treatment in fewer months. I understood that remotemonitoring is not newat all. How long have pacemakers been placed, for example? Inmedicine, there are myriad examples of patient monitoring done remotely that enhance patient care and treatment outcomes. Whywouldwe NOT expect this medical concept to have applications to orthodontics? Case report Our office now has s e v e r a l h u n d r e d patients being remotely monitored using DM. We have developed systems for use of this tool. We have found it works far better than expected, and patients and parents love the beneƤts. I would like to give just one example of how remote monitoring can change your practice. I have included two photographs from DM dated 30 th November 2016 (Fig. 1) and 13 th December 2016 (Fig. 2). We were prompted by DM after the latter set of photos that this Invisalign ® patient was experiencing failure in the Ƥt of her aligners. Please note how much we had lost control of tooth no.7. This was during a period of only two weeks. Our o ƥ ce, like most using Invisalign, tends to see patients every six to eight weeks. We use Propel to help seat aligners, and patients are instructed to change aligners every week. Imagine, in a world where this patient would have gone through possibly four more aligners before she returned to the o ƥ ce, what the status of our treatment would be? It would have required ordering new reƤnement aligners! Instead we were able to remotely intercept a serious problem, react and go back two aligners, recapture tooth no. 7, and Ƥnish this patient without further incident. Taking back control A l i g n T e c h n o l o g y has recently revised its Invisalign change protocol to a one-week aligner change - but with an important provision - the need to monitor the patient closely. With any removable appliance, once the patient has l e f t y o u r p r a c t i c e , t h e n c omp l i a n c e i n wearing it is totally in the patient’s control, and as the orthodontist you do not know how the treatment is tracking. I am sure all my professional colleagues have experienced many instances where patients come back for their next appointment, and Remote Monitoring of Treatment – less time, more control Dr. Terry Sellke discusses a smartphone-driven technology to increase e ƥ ciency Fig. 1 Fig. 2