Editorials Orthodontic Science and Practice – Edition 53

Prof. Dr. Alexandre Moro
Scientific Director

How do you measure the success of your practice in the age of Instagram?

With the massive use of social media, the marketing of orthodontic practices has changed a lot. Some practitioners seem to spend more time taking selfies and posing with patients than sitting at the owl performing treatment. For the younger generation this seems normal, because they grew up with a cell phone in their hand, and all this technology is very natural to them. However, for the generation that is in their 40s and above, this is very strange. Taking pictures of a bunch of boxes of aligners does not seem, to the older generation, to be a way to show success in an orthodontic clinic. However, it does seem to be fashionable.

But how then can we measure this success? We have already had the opportunity to address this topic in two other articles in this column. In 2011, we wrote about the seven characteristics of successful orthodontists¹, and in 2018 we wrote the editorial entitled “What are your practice metrics? “². Due to the rapid changes that technology has imposed on us, it is worth returning to this subject.

In 2019, Roger Levin, an American consultant who has worked with the management of thousands of practices, wrote an article³ in which he describes four ways to measure your orthodontic success:

1. Production: production is the most important number to know in terms of understanding your practice. Not just the number, but more importantly, the direction. If the production is high, you need to know exactly why. Likewise if it is low. Production here refers to everything you do in the office, i.e. initial consultations, clinical appointments, appliance removals, talking to family members, etc.

2. Indications: The lifeblood of any orthodontic practice is referrals. It really doesn’t matter what else you do. You can have the best clinical treatment in the world, but if you don’t have enough referrals, you won’t have enough starters. If you don’t have enough patients starting, you don’t have enough production. If you don’t have enough production, you won’t have enough profit, and if you don’t have enough profit, you won’t have enough income. Do you get the idea? Track all your referrals. In this case, the more data, the better. Levin emphasizes 5 areas for searching for referrals: your own patients, the patient’s family, the social networks/internet, the community, and nearby dentists.

3. Patients initiating treatment: Above all, all three questions fall into this category. Measure how many patients are initiating every day. Your treatment coordinator (CT, administrative secretary) needs to have a target number that you need to track. CTs are like athletes. They play a sport every day called “close cases and start treatment”. They will not win every time, but with the right training, they can win most of the time. Following their performance will only make them better.

4. Patients late to finish treatment: As surprising as it may seem, this is a critical data point. Simply put, a treatment that is late to finish is pure overhead. Every time that patient is seen, treated, or any administrative function occurs, the practice is literally losing money. A clarification is in order here, as the American orthodontist works with a fixed price for the treatment. For example, if he charges $5,000 for a treatment that should last 24 months, if the patient remains in treatment after the 24th month, he is losing money at each visit. This is what we have seen recently here in Brazil with the aligner treatments. Many people are charging a locked-in price, and not finishing in the proper time, or worse, not doing refinements so as not to extend the treatment time. In other words, they are undertreating the patient for financial reasons.

The orthodontic office is quite complex, with many parts and pieces. Most of them will work well as long as the key performance indicators are aligned. The only way to know is to track your numbers. So, in addition to photos on Instagram, we must also take our own measurements to be successful in our practice.

1. moro A. The seven characteristics of successful orthodontists. Orthod Sci Pract. 2011: 4(15):607- 8.
2. Moro A. What are the metrics of your practice? Orthod Sci Pract. 2018; 11(41):4-5.
3. Levin R. Four Ways to Measure Your Orthodontic Success. Orthodontic Products. https://orthodonticproductsonline.com/practice-management/business-development/four-ways-to-measure-your-orthodontic-practice-success/.

Prof. Dr. Alexandre Moro
Scientific Director

Prof. Dr. Ricardo Moresca
Scientific assistant editor

Thank you very much, Dr. Hugo Trevisi!

With an easy smile, soft spoken and simple manner. This was Dr. Hugo Trevisi, whether on the great stages around the world, where he delighted everyone with his innovative ideas and impeccable clinical cases, or chatting away (but not too far from orthodontics) and enjoying a good wine.

As an orthodontist, he will always be remembered as an exceptional clinician, an out of the ordinary. Intelligent, analytical, methodical, persevering, creative and brilliant. A lover of our profession and of things well done.

He was tireless in his search for excellence. The dissatisfaction with the results and the restlessness about the limitations of the technique were what motivated his inexhaustible search for the technical and scientific improvement of our specialty.

His tenacity to learn new ideas and his unsurpassed dedication to patients led him to be one of the greatest clinicians of our time, as described by Dr. Richard McLaughlin.

Of his vast legacy, he will be forever remembered as the creator of the MBT Orthodontic Treatment Philosophy, along with Richard MacLaughlin of the United States and John Bennett of England. It is currently the most widely used orthodontic technique in the world. Every day, thousands of orthodontists in every corner of the planet employ his ideas, concepts and innovations in the treatment of their patients.

He has authored four books, numerous published articles, and countless courses, conferences, and lectures given around the globe. One of his most important works, the book that introduced the MBT Philosophy to the world, has sold over 85,000 copies in 14 languages.

In Brazil he was always recognized as a brilliant orthodontist, one of the forerunners of the continuous arch technique, and as a visionary who was always ahead of his time when it came to innovations in orthodontics. However, it was abroad, especially in South America, Europe, and Asia that his greatness was fully appreciated, and he was recognized as a myth. I had the opportunity to witness real crowds in endless lines to secure a photo next to one of the most important orthodontists of our time. Dr. Trevisi is certainly one of the best known and most recognized Brazilian orthodontists in the world.

However, despite his unsurpassed technical quality, it was as a person that Dr. Hugo Trevisi captivated everyone. His humility reflected the greatness of his soul. He took pleasure in sharing all his knowledge and experience. His generosity was embarrassing. His thought was always to share ideas to multiply and spread knowledge. A simple, affable and funny man, always with a friendly and caring word at the right time.

Like many of us, my professional life has been deeply influenced by his ideas. In the last 20 years I had the privilege of learning directly from the master and maturing as a person by enjoying his friendship. But, paradoxically, it was in 2020, in the middle of the new coronavirus pandemic that we were closest, even at a distance, when we worked together in the preparation of the book describing the last inspiration of his creative genius, the TDWire mechanics – Trevisi Double Wire, an innovative double archwire mechanic with self-ligating brackets.

The longing will never be assuaged and the void will never be filled, but his legacy, as an orthodontist and as a man, will live on. His memories will always be in our hearts. You will always be an example of strength, dedication, and leadership.

Thank you so much, Dr. Hugo. You have made a difference in our lives.

Prof. Dr. Ricardo Moresca
Scientific assistant editor


Dr. Hugo José Trevisi died on 11/01/21, victim of complications from Covid-19.

Editorial – Digital Notebook Dentistry in Science

Prof. Dr. Mauricio Accorsi

Scientific Director DDS-BR

DDS-BR is going digital!!!

We are completing two years of Digital Dentistry in Science. DDS-BR, as we like to call it, was another good bet from Editora Plena, from which we got all the support and encouragement to make it a reality. With the collaboration of several colleagues and beautiful articles, we are taking knowledge and information to innovative professionals all over the country. Therefore, it is with deep pride and satisfaction that we communicate that DDS-BR is going digital!

Soon, within the Editora Plena internet portal, we will see an exclusive site for our DDS-BR, which comes to life in an environment for which it was created and that will certainly be more comfortable with new features, such as a video channel, commercial news, interesting links, courses, and unpublished interviews! In addition, DDS-BR is also going international!!! All articles published in the physical magazine will receive a translated version, initially into English, which in addition to increasing the visibility of Editora Plena worldwide, will also bring a great benefit to the authors, who will have their articles published in English and fully open for consultation.

And what to expect in 2021? – Science, politics, technology, and fake news…

As it could not be otherwise, we take advantage of this space to talk about issues of interest to our profession, with this focus on the digital and technology world.

As we all witnessed, 2020 was absolutely different from what we expected. It was supposed to be a milestone with the Tokyo Olympics and futuristic thematic fairs around the world, and Brazil recovering from a political and social trauma that delayed the country’s development by decades, due to the biggest corruption scandal in human history. On the contrary, we saw the world turned upside down, plans undone, trips and congresses canceled, projects postponed, companies broken, families separated, and, unfortunately, thousands of lives lost, many of which could have been saved.

However, whenever we lose something, someone, or our self¹, we must not also lose the lesson.

As health professionals, and having gone through college level courses, which are often followed by graduate programs, we learn from an early age the importance of science in our lives. We study hard to try to understand the origin of things, the meaning of method, and the importance of discipline in the process we do daily to diagnose and treat our clients, always trying to make the best therapeutic decision for each particular case and for this we rely on the best scientific evidence available. We have also commented extensively on how new technologies can help the whole process, from diagnosis to personalization of treatments.

Artificial intelligence, cybernetics, nanotechnology, bioengineering, genetics, augmented reality and virtual reality are just some of the disciplines that we will see increasingly present in our clinical practice and also greatly assisting research, teaching and telehealth. The colleagues who follow our notebook and realize the value of technology are also aware that this same technology means nothing if it does not come allied to science and good clinical practice, which must be based on knowledge, experience, and ethics, because what really matters is our ability to deliver increasingly appropriate results in order to improve the quality of life of our customers.

So, if we can perfectly understand the value of all this in our profession, why have so many of us become denialists² in this pandemic and absolutely dramatic year of 2020? Unfortunately we saw in Brazil actions deliberately contrary to the determinations of the health authorities, which, in a consensual manner throughout the world, were based on science to guide us on how best to minimize the effects of the Covid-19 pandemic. Thus, it was absolutely clear that we should avoid crowds, wear masks, and do constant hand hygiene, among other measures, such as the use of tests and social distancing. It seems that, in order to follow a “great leader”, many preferred to give up their most cherished beliefs, such as the value of science, quality information, and, ultimately and even more seriously, the truth of the facts by deliberately “believing” in “fake news” to live in a parallel reality full of conspiracy theories that defy the logic of those who remain firm in the purpose of contributing to a collective effort to save as many lives as possible.

However, this absolutely does not mean to endorse erratic actions such as what have become known as “lockdowns,” which are often performed at the wrong time, in the wrong places, and in the wrong way in the wrong places and in the wrong way. We all know the importance of preserving economic activity, because the consequences in the medium and long term can also be very serious
be very serious. But there is no other way but to do things the right way, because when we give up our life for the economy, purely and simply, we are automatically giving up our humanity, our empathy, and consequently heading towards an even darker future.

Never in history has there been such a huge collective effort, with so much investment and focus based on knowledge accumulated over decades, to come up with a viable, effective and safe vaccine in record time as now. And, instead of celebrating together, many chose to follow a dark path, following a perverse and lethal ideology, in the opposite direction of the whole world. By supporting a denialist, populist and lying discourse to give vent to the “ego” that cannot live without being right, we are contributing to the death of thousands of innocent people, lives that could be saved every day. In this way, we gradually distance ourselves from each other and make dialogue progressively more difficult and distant, especially in an increasingly polarized and hostile world.

Unfortunately, as the American pediatrician Paul Offit said, trying to bring to the light of reason a fanatic, that is, someone who has been convinced of something that is not based on facts and reasonableness, is a Herculean task. And we would have no major problems if fanatics were few, but in Brazil they are miserably many, thanks to the nefarious effects of social networks, combined with a chronic laziness to be informed and to study, especially the value of the scientific method.

We should not stop betting on life and humanity, and especially on our ability to find solutions to the most complex problems, in the most difficult moments, such as these vaccines that will set us free. Opening our minds and hearts to the good winds, good energies and to the reality of the facts, can be much more revitalizing than betting on “early treatments” and of proven ineffectiveness according to our National Health Surveillance Agency. To our unhappiness and indignation, this institutionalized denialist approach may have contributed to the death by asphyxiation of several Brazilians in the city of Manaus, in the saddest January ever, as Dr. Margareth Dalcolmo, a pulmonologist and researcher at Oswaldo Cruz Foundation and one of the heroes of this pandemic, said.

As health professionals and scientists, we are opinion leaders and have a responsibility to the common good, and we will certainly be held accountable in the future for our actions and examples. If this were not the case, we should not be a priority group for vaccination against Covid-19 in Brazil. It is also expected that our representatives will take a stand in order to support the importance of science and ethical behavior in society.

Finally, here is a mini-manual based on an article from BBC³ to avoid the spread of a virus even more lethal than SarsCov-2, which is the virus of ignorance ignorance, spread shamelessly throughout the country, precisely by those who should set the example: When you receive a “news”, take some precautions and reflect. Do not believe the “news” or share it immediately. If it has caused too great an emotional reaction, be suspicious. “Fake news” are created to cause, in some cases, great surprise or rejection to something or someone. Another fundamental point is to know if the “news” confirms any of our convictions, which tends to reinforce a tendency to propagate.

What we most need today is to develop the habit of suspicion and investigation. So read the whole “news” and not just the headline. Go after the source – it is a comment from a friend on WhatsApp, a video from a YouTube influencer? Always be suspicious of the dark intentions behind each post, each strategy. Always try to look at the “big picture”, that is, try to distance yourself from the “news” and see how it fits into a panoramic context. You must have already received numerous fraudulent news and often they come from where we least expect, precisely from those who should ensure the truth of facts, science and common common sense, so every care is too little.

Use reliable search engines and also platforms that check news and try to have a “personal filter”, because both in the political-ideological spectrum, on the left and on the right, we will see totally biased vehicles, often financed by shady interests. Always check the context and especially the date of publication. Playing true but outdated news is another example of misinformation. Finally, choose carefully reliable and independent vehicles and make abundant use of one of the most important mental faculties we have, which is reasoning. As Andrew Carnegie said: “He who cannot reason is a fool. He who will not, is a fanatic. And he who dare not, is a slave.”

It may sound pretentious, but sometimes small gestures can save lives, especially in times of chaotic leadership, in the midst of the biggest pandemic of the last 100 years, which in Brazil alone has already cost the lives of more than 230,000 people.

¹ Self – masculine noun
1) diffuse feeling of the unity of the personality (its attitudes and behavioral predispositions).
2) individual as he reveals and knows himself, represented in his own consciousness.
² Negationism is the choice to deny reality as a way to escape an uncomfortable truth. In science, negationism is defined as the rejection of basic, unquestioned concepts supported by scientific consensus in favor of ideas, both radical and controversial.
³ https://www.bbc.com/portuguese/brasil-45043716

Dr. Mauricio Accorsi
Scientific Director – DDS Booklet – Digital Dentistry in Science

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