Bringing smiles to life

Jan. 1, 2009
Making the move to appliance therapy

Making the move to appliance therapy

by Robert A. McCulla, DDS

For more on this topic, go to and search using the following key words: appliance therapy, orthodontics, vision, influences, purpose, deep bite, crossbite, practice profitability, Dr. Robert A. McCulla.

The purpose of my practice is to bring smiles to life. Success is measured in that moment when you hand patients a mirror to view their new smiles and experience with them the joy, newfound confidence, and (for yourself) pride in a job well done. There is nothing like it!

We have taken children from crowded arches, crossbites, deep bites, flared anteriors, thumb-sucking bites, or collapsed posterior bites (prematurely exfoliated primary teeth leading to tipped molars) to beautiful full smiles — usually without extractions — through the application of orthodontic principles and appliances. We have done good things, important things, and profitable things.


In the last 10 years, we have seen a tremendous expansion in the orthodontic side of our practice When we introduce something into our practice, it must fit our VIP. It begins with a Vision — what will it look like? As a team, we then determine the Influences — how will it be done? These have to fit with our practice Purpose — why do we do what we do — why do we bring smiles to life?

My assistants and I began our orthodontic journey in 1999, attending a series of seminars presented by Dr. Brock Rondeau. We learned the basics of diagnosis; cephalometric tracings and measurements, impression-taking, which cases to take on — and more importantly — which cases to pass on.

As a result of this training (an initial outlay of approximately $10,000), my team and I got up to speed and generated a complete “shopping list” of the tools and supplies necessary to expand our orthodontic offerings and capabilities.

“Dr. Ortho”

When we began doing full orthodonics, I presented treatment to what I considered the easy cases — Class I, minor crowding (children and adults). As our experience and confidence grew, we took on more challenging Class II and deep bite cases. Many of the patients with whom my team had built trust were very willing to move ahead with treatment. “Dr. Ortho” was poised for a strong emergence!

In our practice, my production as “Dr. Ortho” is counted as a separate provider to more effectively track production. He accounts for about 20% of our practice, including orthodontics and Invisalign®.

Taking off

Our nonextraction approach with children's cases is gaining converts at a very rapid pace. Parents are actively seeking us out as a preferable alternative to first-bicuspid extractions. We also feel our team provides comprehensive service for our patients in terms of orthodontics, restorative, and hygiene care.

Ancillary product sales have improved significantly. We are now treating entire families. We are benefiting from the willingness of parents, in the midst of these hard economic times, to choose orthodontics for their children over cosmetics for themselves.

Important: The common thread in our treatment style for children is nonextraction. Word gets around that we don't ascribe to the old-school, four-tooth extraction technique, and we get more referrals. It's made a big difference!

With adults, we often present cases in terms of function over esthetics. Many of our adult orthodontic patients come out of hygiene appointments. Because of our verbal training, we can explain the causes, risks, and benefits from a functional standpoint as well as a hygiene-maintenance standpoint, and thus “roll over” a hygiene patient into an ortho patient.

Other typical adult cases include many “precosmetic” procedures, pretreatment with removable appliances prior to full banding or Invisalign, palatal expansion with posterior bite plane for posterior crossbite correction, anterior plane appliance for anterior crossbite, and Invisalign.

Hindsight, regrets, and ROI

In the beginning, I probably pushed too hard, too soon with presenting orthodontics. Mom or Dad would bring in Junior and one or more siblings for the intial new patient examination, and I would present two, three (or more) full cases at once and just blow them out of the water. After all, they had only come in for a checkup, X-rays, and prophy!

After a while (and with some urging from my team to cool my jets), I toned down my approach to “bringing up the subject” during the initial exam, mentally prioritizing the siblings and presenting based on urgency. The difference is that now parents ask me when and if child number two, three (and so on) is ready to start!

Appliance therapy and orthodontics has dramatically challenged, changed, and enhanced our practice for the better. We offer complete one-stop preventative, restorative, and orthodontic care to all our patients. The perception of our office is that “we do more here for our patients.”

By embracing orthodontics fully, we do more. Today, we have a highly productive practice and “Dr. Ortho” contributes $400,000 per year. Orthodontic production and collections are steady, as is income ... and it only promises to get better!

Since incorporating orthodontics and removable appliances into my practice, I have changed smiles and lives. It has expanded the role played by my team in the success of my business. It has also renewed and expanded our sense of purpose and pride in accomplishment, generated unprecedented growth and service diversification, and of course, increased profits.

Believe me, it will do the same for you!

Dr. Robert A. McCulla has a full-time practice in Turlock, Calif. He is a member of the International Association for Orthodontics (IAO), International Congress of Oral Implantologists (ICOI), Dental Organization for Conscious Sedation (DOCS), and the Academy for Sports Dentistry (ASD). He coaches dentists with Kathy Larson of VIP Leadership Systems.You may contact him by e-mail at [email protected].

Success Tips: A Final Prescription

Begin with a vision: Share your vision of incorporating orthodontics into your practice with your team.

Involve your team: Team members should be involved from the very beginning. Involve them in the planning and growth process. Bring them with you to the meetings, the courses, and the seminars.

Obtain knowledge: Choose a course of study to give you the science, theory, and practical knowledge to get started right away. Find your mentors, teachers, and coaches, and learn from them.

Get help: Purchase a pano/ceph unit to produce the necessary radiographs. Every team member should be trained to take excellent impressions for diagnostic models. To this day, I use Appliance Therapy Group's “Second Opinion” Diagnostic Service on every case. I do this to assure that I have the proper records before I proceed with diagnosis and treatment.

Get the word out: Market yourself. Let people know what you are doing. Call it “early orthodontic treatment,” “nonextraction orthodontics,” or “two-phase orthodontics” ... but tell people about it!

Get busy: Expanding into orthodontics means doing orthodontics. Begin with some easy cases: team members, family, and friends. As your experience grows, so will your client base.

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