Increasing Practice Efficiency and Profitability Using In-Ovation “R” Self-Ligating Brackets

A White Paper Report

By: Jerry R. Clark, DDS, MS and Jack Gebbie, BS

Many unsubstantiated claims have been made concerning self-ligating bracket systems as to their efficiency in moving teeth, the time savings that can be realized by using these appliances, and the “magic” that is somehow stored up in these brackets to more effectively align teeth.  This study was done in an effort to draw some scientifically based conclusions to more accurately differentiate between what is “hype” and what is actually true regarding the purported increased efficiency and time savings of one such self-ligating bracket system – In-Ovation “R”® – manufactured by GAC International.  The study was performed to determine if cases treated with In-Ovation “R”brackets were actually treated faster, with fewer and shorter appointments with less clinical chair time needed to complete treatment, and if they truly increase practice efficiency and profitability compared to similar cases treated with traditional edgewise brackets.

Are there other scientific studies available?

Recently, there has been a cry from the scientific community regarding evidence based studies that will differentiate between opinion and fact. 1-4  It is important for our profession, if we are to remain rooted in scientific principles, to honestly research, study and report on the claims made by our fellow professionals and the orthodontic supply companies.   At the present time there actually have been a surprising number of scientific studies performed that have reported the increased efficiency of self-ligating brackets. 5-13  Most of these reports, however, have studied other bracket systems such as Damon and Speed.  To date no scientific study has been applied exclusively to the In-Ovation “R” bracket system to measure the treatment and chair time savings resulting from using this appliance.  That is the reason for this research study.

How was this study performed?

 Treated orthodontic cases were randomly selected from the practice of Dr. Jerry Clark a board certified orthodontist.  No attempt was made, in this study, to quantify the quality of the final treatment results.  It was assumed that Dr. Clark utilized all his technical skills and abilities to achieve the best treatment results possible for each individual patient.  114 cases treated with In-Ovation “R” were studied and compared to 241 cases treated with traditional pre-torqued and pre-angulated  brackets. This produced a confidence level for this sample of 95% +/-8%.   Certain types of cases were eliminated from the study.  Those excluded were: cases with an unusual number of missed or broken appointments, cases with an unusual number of loose or broken brackets, cases that required two- phase treatment, cases with significant skeletal discrepancies (Class III, skeletal open bites), cases with impacted canines, cases with extremely poor cooperation, and cases where some other circumstance significantly impacted Dr. Clark’s ability to complete treatment in a reasonable length of time.

This research project was managed by Jack Gebbie, President  DATATEX, Inc., an independent research and consulting firm specializing in market research.  The data files were carefully reviewed and marketing research standards were applied to the sampling to insure comparisons would be valid across the two alternatives being studied.  DATATEX is member of CASRO (Council of American Survey Research Organizations) and maintains research integrity and standards consistent with this organization.

What was specifically studied?

The study was fairly simple in its design.  Patents treated with traditional edgewise brackets and Roth and Tweed type mechanics with the goal of attaining the Andrews 6 Keys to Occlusion 14 were compared to cases treated with In-Ovation “R” brackets and the light wire mechanics typically used with self-ligating brackets with the objective of achieving similar treatment objectives.  The time required to place brackets at the beginning of treatment and the time necessary to remove appliances at the end of treatment was not included since it is realistic to assume that it takes approximately the same amount of time to place and remove brackets regardless of the type of brackets being used.  What was studied was the actual treatment time from the day treatment was begun to the day appliances were removed.  Also, the total number of patient visits needed to complete treatment was measured as was the total number of minutes of patient chair time necessary to complete treatment.

Are self-ligating brackets really faster?  More efficient?  Better?

The answer is YES!

What were the findings of the study?

Fig1MONTHS IN TREATMENT

The average number of months required to treat cases utilizing In-Ovation “R” was 4.14 months LESS than comparable cases being treated using traditional edgewise brackets.

Fig2NUMBER OF APPOINTMENTS

The average number of patient appointments needed to complete treatment was REDUCED by 6.66 appointments which meant 40% FEWER appointments were required to complete treatment using In-Ovation “R” compared to traditional edgewise appliances.

Fig3CHAIR TIME REQUIRED TO TREAT CASES

The number of minutes of clinical chair time that patients required in order to complete treatment was REDUCED by an average of 174.21 minutes per patient, or put another way, approximately 3 hours of chair time was saved on each treated patient.

That means the average case being treated with In-Ovation “R” took approximately 5 hours of chair time to treat while the average case being treated with traditional appliances took almost 8 hours to treat, a time savings of approximately 36%.

How does the reduced chair time impact practice profitability?

Suppose your practice produces a profit of $350 per hour (an average figure for an active well managed practice), and you are able to save 3 hours on each case you treat, then the profit for each case treated is INCREASED by approximately $1050.  However, In-Ovation “R” brackets do cost more than traditional edgewise brackets by approximately $5 per bracket.  That means if you bond 5 to 5 you use approximately 20 brackets on each case for an additional expense of about $100 per case.  So the actual estimated additional profit for each case using this scenario is about $950.  That is a pretty good return on an additional investment of $100 for In-Ovation “R” brackets.  However, this is just an average.  If your practice profit per hour is less than $350 per hour then your savings will be somewhat less.  But, if your practice profit is more than $350 per hour then your profit will increase even more.

So, what’s the bottom line?

Granted, a competent and conscientious orthodontist can most likely obtain excellent treatment results regardless of the type of appliances they choose to utilize.  I am often questioned by my colleagues,  “Why should I change?  Why should I pay more for In-Ovation “R” brackets when I am already achieving excellent results with my present bracket system?”  The critical and more important question is, “What is best for our patients?”

If we as orthodontists are committed to providing the very finest treatment for our patients I personally feel it is important that we look at the findings of this study and draw the obvious conclusions concerning the treatment of our patients.  If we want to provide the very finest orthodontic care, in the most cost effective manner, with the least amount of discomfort to our patients, with the fewest number of visits required, provide shorter appointment times, and complete treatment as quickly as possible – I feel it now requires us to avail ourselves of the advanced technology of self-ligation.  Anything less would not be providing the finest available treatment for our patients.

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Editor’s note: Dr. Jerry Clark and Jack Gebbie would like to sincerely thank Debbie Terrell, Kyle Bechtel and Dr. John Oubre for their efforts and invaluable assistance in accumulating data for this study. The complete study is available upon request by contacting DENTSPLY GAC.

Bibliography

1.  Turpin DL. Evidence based orthodontics. Am J Orthod Dentofacial Orthop. 2000 Dec; 118(6):591.

2.  Huang GJ. Making the case for evidednce-based orthodontics. Am J Orthod Dentofacial Orthop. 2004 Apr;125(4):405-06.

3.  Turpin DL. Changing times challenge members…then and now. Am J Orthod Dentofacial Ortho. 2004 Jul;126(1):1-2.

4.  Turpin DL. Putting the evidence first. Am J Orthod Dentofacial Orthop. 2005 Oct;128(4): 415.

5.  Harradine NWT. Self-ligating brackets and treatment efficiency. Clin Orthod Res 2001; 4: 220 – 227.

6.  Eberting JJ, Straja SR, Tuncay OC. Treatment time, outcome and patient satisfaction comparisons of Damon and conventional brackets. Clin Orthod Res 2001; 4: 228 – 234.

7.  Shivapuja PK, Berger J. A comparative study of conventional ligation and self-ligation bracket systems. Am J Orthod Dentofac Orthop 1994; 106: 472 – 480.

8.  Thomas S; Sherruff M; Birnie D. “A Comparative In Vitro Study of the Frictional Characteristics of Two Types of Self-Ligating Brackets and Two Types of Pre-Adjusted Edgewise Brackets Tied with Elastomeric Ligatures.” Eur. J. Orthod. 283-91; June, 1998

9.  Pizzoni L; Ravnholt G; Melsen B. “Frictional Forces Related to Self-Ligating Brackets.”  Eur. J. Orthod. 283-291; June 1998

10. Henao SP, Kusy RP. “Evaluation of the frictional resistance of conventional and self-ligating bracket designs using standardized archwires and dental typodonts.” Angle Orthod. 2004 Apr; 74(2):202-11.

11. Damon DH. “The rationale, evolution and clinical application of the self-ligating bracket.” Clin Ortho Res. 1998 Aug;1(1);52-61.

12. Parkin N. “Clinical pearl: clinical tips with System-R”. J Orthod. 2005 Dec;32(4):244-6.

13. Harradine NW. “Self-ligating brackets: where are we now?” J Orthod.2003 Sep;30(3)262-73.

14. Andrews LA. “The six keys to normal occlusion.) Am. J. Ortho.1972 Sept. 62(3):296-309.

Biographies

Jerry R. Clark, DDS, MS
Dr. Jerry Clark is a board certified orthodontist who maintains a full-time practice in Greensboro, NC.  He received his BS and DDS from the University of North Carolina and his MS in orthodontics from St. Louis University.  He is also Chairman of the Board of Bentson Clark, a company that specializes in the sale and transition of orthodontic practices.

Jack Gebbie
Mr. Jack Gebbie is president of Datatex, Inc. and handles research projects for both national and regional companies for over 11 years with particular experience and expertise in the fields of healthcare and financial services.  He is a graduate of Wake Forest University and is a member of CASRO (Council of American Survey Research Organizations) and conforms to the research integrity and standards established by this national organization.

This article was published in 2014 OrthoCE.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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