Proactive treatment with Propel

Dr. Thomas Shipley discusses how he has increased efficiency and productivity in his practice

It’s Wednesday afternoon, and I am at my desk. It’s time for the after-school rush, so I head out into the six-operatory orthodontic bay of my private practice. “Wait a moment,” I think. “Where is everyone?” There are only two patients in chairs, with four chairs empty. This concerns me, and I quickly return to my desk to run statistical reports.

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Then it dawns on me that I have time to run statistical reports on a Wednesday afternoon! Even better, I find that I am on track to have my best January in the history of my practice — this is all due to a simple technology I’ve added to my practice known as Propel.
Since introducing Propel into my practice 2 years ago, I’ve noticed a trend — there are sporadic moments in the afternoons when I have more time to breathe and stretch. More so, I notice that I now have more time to converse with my patients. There are more giggles returning to the air, or at least I have more time to notice them. When I walk into the new patient exam room, I am more relaxed, and my patients notice it too.

I started proactively using Propel in 2013, and last year I completed over 50 proactive Propel cases. Proactively means that I do the Propel procedure early on in an orthodontic case to speed up the overall time of treatment. For fixed appliance cases, that means that the patients will typically finish in less than a year. For Invisalign® patients, they will typically finish in half the time with fewer refinements.

If I have completed over 50 cases at least twice as fast, that means that I see 50 fewer patients every month — or that is about 12 fewer adjustments per week or three fewer every afternoon. That totals at least 1 hour of chair time every afternoon! Now, my toughest decision is what to do with the extra time. Given the new free time Propel has provided, I am able to keep the practice running on time. I have reached my production goals, which has given me new opportunities to further market my practice. I have also decided I can wait a little longer to hire an associate. All of this was possible for an investment of about $6,000, which is enough devices for more than 50 patients.

In my office, almost every patient whom I select as a candidate for Propel accepts the treatment. Propel is a procedure where I use a surgical-grade stainless-steel driver to make “dimples” into the cortical plate directly through the gingiva or mucosa. This is typically done with very little discomfort or recovery for the patient. The result is a cellular cascade of events, which results in an increased rate of bone turnover and, therefore, an increased rate of tooth movement.

I place a strong topical compound anesthetic over the soft tissue and leave it there for 4 minutes. If preferred, but usually not necessary, an injectable local anesthetic such as Septocaine® may be used. I rinse the topical off and wait 10 minutes. During this time, the patient rinses with chlorhexidine twice for 1 minute. As the topical begins to take full effect, the orthodontic technicians complete the scheduled orthodontic adjustment for the day. I then begin Propel, making 1 to 3 micro-osteoperforations (“dimples”) mesial and distal to each tooth I want to activate. The patients are instructed to take Tylenol®, if they experience any discomfort after treatment, but not ibuprofen as patients should avoid any NSAIDs as they can hinder orthodontic movement. Most patients report feeling some pressure for a few hours but complete resolution of any discomfort by the following day.

Case No. 1 presents with a Class I dental deep bite with generalized upper and lower anterior spacing (Figure 1). Upper and lower fixed orthodontic appliances were placed. This case would typically be diagnosed as requiring 9 to 12 months in my office. We decided to speed the process, by using Propel. The day that the appliances were bonded, micro-osteoperforations were placed upper and lower anteriorly to create a cellular response, which speeds the rate of bone turnover in the area, thus speeding the rate of tooth movement (Figure 2). The deep bite was improved to 50%, and all spacing was closed in 9½ weeks (Figure 3).

Case No. 2 presents with 90% deep bite, moderate upper crowding, and severe lower crowding (Figure 4). The patient was referred by a colleague who had received Propel at our office. Invisalign was chosen as the treatment choice, and Propel was initiated on the day attachments were placed for aligner No. 3 (Figure 5). The patient wore each of the remaining 32 aligners at just 3 days per aligner. Typically, without Propel, the patient would have switched the 34 aligners at 2 weeks per aligner for a total of 68 weeks. In our office, one to two sets of refinement aligners would have been ordered to complete the case in a total of 18 to 24 months. In this case with Propel, no refinement was needed, and treatment was completed in exactly 18 weeks (about 4 months). The deep bite and crowding were fully resolved (Figure 6).

In conclusion, I can offer Propel to release challenging movements, or I can offer Propel in my office for decreasing the overall treatment times of my patients, which has greatly increased efficiency and productivity. Propel can be implemented into the orthodontic office easily with little disruption to patient flow — other than creating more room for flow!
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