Pacific Coast Society of Orthodontists Bulletin Summer 2020 - 70

Practice Management

Staff Report

Analyzing, Tracking, and Preventing
Repairs

Ms. Lori Garland Parker
Camarillo, CA

Repairs are stripping your practice of profit,
amplifying stress for you and your team, and
frustrating your patients and parents! Once
they begin accurately tracking all repairs, many
practices find they have more rebonds than they
realized because of a combination of repair visits
and loose brackets found at the chair, and they
are ready to do something about it. This article
provides a framework to analyze why repairs are
occurring so practice teams can develop protocols
and effective language for prevention.
Analyzing Repairs
The following questions are geared toward
increasing awareness of possible causes of
repairs and comfort visits, along with thoughts
to promote dialogue and spur action to make a
difference in reducing repairs. It is critical to know
the cause of these issues so that improvement
can be implemented. Here are some thoughts to
get you started.
Loose Bracket
▫▫ Is the break at the tooth-adhesive interface or
at the bracket-adhesive interface? When all
of the adhesive is on the bracket and none
on the tooth, this is typically a bonding issue
resulting from contamination or technique.
▫▫ Is each patient's bite checked after bonding to
ensure that the patient is not occluding on any
brackets? It is important that patients are not
occluding on brackets, especially immediately
after bonding. Some patients clench and can
pop newly bonded brackets off. Bite turbos
or buildups can be used to protect against
contact with brackets.
▫▫ Is a new adhesive being used or have there
been any technique changes? At times, manufacturers will modify their instructions. Each
time a routinely used product is received,
double-check the instructions to ensure no
technique changes are required.
▫▫ Is every clinician following a detailed bonding
protocol? I commonly see various bonding
techniques used among clinicians, resulting
in a higher number of loose brackets. The

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orthodontist typically assumes all procedures
are performed the same way and is surprised
when they see a variance. Many times, clinicians also assume they are all doing things
the same way when in fact techniques vary
significantly.
Is the light-cure unit working properly? Is the
unit checked frequently? Proper light-cure
technique is imperative for a successful
bond. Confirming light-cure health is an
important part of the bonding protocol.
Experts say the best time to check is after
a bonding to confirm the same strength is
consistent. (Check instructions by brand.)
Also, the further the distance from the
bracket, the more cure time is required.
Routinely reviewing the light-cure protocol
is recommended.
Is the bonding adhesive being stored and handled properly? Always store adhesives properly
according to the manufacturer's instructions; check the expiration date, and avoid
cross-contamination.
Did the patient admit to biting something
hard? If so, what? Help patients understand
how they can safely eat many of their favorite
foods. Working together with the patient/
parent instead of telling them what they can
or can't eat or reprimanding them can go a
long way in increasing patient cooperation.
Consider spending time at each team meeting
to advance individual and collective communication talent.
Do you have a new team member who may
not understand the procedure protocol? Effective new employee training is critical. Ensure
all clinicians understand the "why" in addition
to the "how" to encourage consistent proper
technique.
Does the clinician tug on each bracket after
bonding to confirm the bond is strong? This is
a great way to show patients and parents that
the brackets are on tightly and that you will
be giving instructions on how to keep them in
good working order until the doctor removes
the appliances.

PCSO Bulletin    Summer 2020



Pacific Coast Society of Orthodontists Bulletin Summer 2020

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