Technology — the past, the present, and your future

Editor’s intro: Dr. Terry Sellke’s three principles of delegation, technology, and systems can help orthodontists to continually evolve in this complex and competitive market. Read his perspective, and have a great career!

Dr. Terry Sellke discusses methods to help orthodontists go beyond surviving and get back to thriving


I have been in practice for a long time. My initial orthodontic training involved treatment with stainless steel bands and wires. There were no brackets, no superelastic wires, and no computers. In my early years, our time at orthodontic meetings involved discussions of whose mechanics to follow, and what would produce stable treatment. They were simpler times. Then technology began to play a part in orthodontics. Technology brought us brackets, better brackets, better wires, and computers. We used computers to improve our business skills, to speed our communication, to aid diagnosis, and to visualize treatment outcomes. Our times at orthodontic meetings were then spent debating bracket systems, learning about the next generation of computer programs to make us more effective and efficient as practitioners. By the 1980s we began to talk about third parties that were attempting to affect our domain and our practices. How dare dentists do orthodontics, and how dare entrepreneurs and corporations infringe on the profession of orthodontics.

So here we are today. We are blessed with innovations that make our treatment easier, faster, more predictable, and more profitable. But we are faced with third parties that plan not only to profit from our great profession, but also to own the delivery system. Orthodontics is experiencing paradigm shift it has never known in its 100-plus years of its proud existence. How can we meet the challenges presented by third parties?

The answer is to embrace change and to embrace new technology. Technology is, and will continue to be, rapidly adopted by those who would turn the profession of orthodontic care into the business of orthodontic delivery. Our patients’ chief complaints are emotional and difficult to “upload” direct from consumer. Our advanced training on the biology and mechanics of tooth movement offer improved diagnosis and treatment plans compared to nonspecialists. Adjunctive technologies in our experienced hands will always deliver more when coupled with individualized treatment and superior biomechanics. This offers us the opportunity to stand out as providing “different and better” care than dated, or “cookie-cutter,” alternatives.

Three principles

I have lectured internationally on the business aspects of orthodontics for decades. Our profession’s future lies in applying business principles to the clinical cottage industry we call orthodontics. We must continue to improve every day. There are three principles, that if applied consistently to everyday challenges, will allow as to go beyond surviving and get back to thriving as a specialty. They are delegation, technology, and systems.

  1. Delegation: We need to delegate to others (including computers) things that we currently do but that others can do equally, legally, and maybe even technically better.
  2. Technology: We need to embrace technology that makes us not only better but also more efficient and can be used to enhance the experience of our patients while in our practices.
  3. Systems: We need to develop systems that allow us to incorporate delegation and technology to the maximum possible without losing quality while enhancing the experience of patients we have the privilege to serve. Simple principles — but powerful!

Given the state of orthodontics today, we need to look for things that “give us an edge.” Those that would replace us cannot compete with our diagnostic skills as true specialists. However, that is not nearly enough. Today, to compete, we must offer consumers a level of service they cannot and will not find in the corporate models. This is the key to our future. Technology can save the day and our profession.

In recent years, I have had the honor and great fortune to be invited to speak internationally on breakthrough technologies that accomplish the goals outlined previously. In my busy practice, these breakthroughs have allowed us to differentiate even as we provided improved care with less inconvenience to our patients. Here is what we have done.

The future

In our practice with three locations, we have cone beam (CBCT), lasers, the latest computer innovations, and we use Sure-Smile® and Invisalign®. I believe in all of these technologies. But there are two technologies that have given us an unprecedented level of convenience, comfort, and clinical control. They are remote monitoring and accelerated orthodontics. If anything can differentiate a practice, it is convenience. Patients and parents want what can get them to “the promised land” in the fewest number of months, the fewest number of office visits, and with the least inconvenience.

The office that can provide these consumer conveniences is the winner in the competition for patients. The practice that offers this can charge a premium fee for its services, as consumers will pay more for what they perceive as superior. Convenience is the number one differentiator for consumers — our patients.

Remote monitoring

Imagine a world where an orthodontist can remotely monitor treatment of any patient. They can be anywhere, and the doctor can be anywhere. The patient need only come to the office for necessary treatment appointments. Imagine the value proposition to patients of full, exceptional treatment in less than 10 appointments with braces and less than six with aligners. Think of the value to the practice! What will this yield in productivity? (What have I taught for decades?) What could this mean to your profitability? Could this be a key to competing on price?

There is a company that offers remote monitoring. That company is Dental Monitoring. This is not a pipe dream. It is real. It is accurate. It works. I have been using this technology in my practice for over 2 years. How does it work? Artificial intelligence!

Accelerated orthodontics

I have studied and used accelerated orthodontics for many years. After accumulating hundreds of cases of hands-on experience using their products, I’ve found a company offering accelerated orthodontic technology that works very effectively for my purposes and my patients’ lifestyles and clinical needs. The company that offers this technology is Propel®. Their products require minimal clinician, staff, or patient training, and they have in-office and at-home treatment options. They can be used independently, or in combination with each other. My main objective with using them isn’t simply to move teeth faster; rather, it is to move them better.

High-frequency vibration (VPro+) operates at a very specific frequency and g-force specifically developed for dental purposes. The patient bites on a wafer that vibrates. It runs for 5 minutes and shuts off. We’ve observed the following benefits in our practice:

  • For aligner cases, the ability to prevent unseats is far superior to “chewies” and other methods we’ve tried. This is verified in our Dental Monitoring reports.
  • For braces and aligner cases, patients are consistently reporting less discomfort with VPro+ use.
  • Accelerated tooth movement. This is very easy to quantify with our remote monitoring service. We are witnessing verifiable aligner tracking and predictably advancing aligners in 4-day intervals without modifying treatment velocity.

Micro-osteoperforations (MOPs) is based on 100-year-old science behind the corticotomy technique. We expand the maxilla in a high percentage of our growing patients. Expansion offers the opportunity for reduced extraction, fuller smiles, better nasal respiration, and even Class II correction. The dilemma is that adults cannot have their “palates popped” without surgery. We have been using MOPs in adults to expand the maxillary dentoalveolar process to create space, improve smile arcs, correct crossbites, torque roots, etc. It works, and it works well!

Looking back at the simpler times of my early career, I’m humbled to have learned from you all, and to realize all that I’ve learned along the way. I look to the future with optimism and excitement. The market will continue to evolve, becoming increasingly complex and competitive. I believe practicing with these three principles as a guide will allow our profession to thrive and our care to improve. By combining specialty tools with specialty care that simplify today’s challenges we can stay ahead. Have a great career!

Dr. Sellke wrote in-depth about one of these three principles in his article, “Remote monitoring of treatment — less time, more control.” Read it here.

Terry A. Sellke, DDS, is a native Illinoisan. His fervor for Illinois extends to his academic background, having enrolled in the University of Illinois undergraduate and dental school. He graduated with his Doctorate of Dental Surgery in 1971. Two years later, he achieved a specialty degree in orthodontics. In 1974, he received a Master’s degree in orthodontics, the same year that he opened the first office of what was to become Drs. Sellke and Reily, Ltd. In 1980, Dr. Sellke became a Diplomate of the American Board of Orthodontics. He still teaches orthodontics at the University of Illinois College of Dentistry, where he earned the titles of professor, master clinician, co-clinic director, and master’s thesis advisor. Dr. Sellke lectures domestically and internationally on clinical orthodontics as well as another of his passions, applying business principles to the practice of orthodontics.

Disclosure: Dr. Sellke discussed his experience using various accelerated tooth movement technologies on a CE webinar hosted by Propel Orthodontics in January 2019. He has lectured previously on behalf of Dental Monitoring and SureSmile.

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