Remote Monitoring of Treatment – Less Time. More Control.

By Dr Terry Sellke, DDS, MS

I lecture worldwide on the business of orthodontics. We live in an ever more competitive, ever more regulated, and ever more price controlled world. Importantly, the patients we serve seek convenience as well as quality. The practice that can master both of these aspects will be the sure winning orthodontic practice of the future.

I was intrigued to read the AAO Tech Blog by Dr Domenico Dalessandri of Italy (March 11, 2016) entitled “Smartphone- based orthodontic monitoring: the big brother in our patient’s mouth.” In it he discussed app-based monitoring systems offered by various vendors. He asked: “Could these systems become important tools allowing us to improve our treatment quality and efficiency?”

Following that blog was another entitled eOrthodontics by Dr Anthony Puntillo (July 20, 2016) where the author also explored remote monitoring of patient care.

Both authors mention a smartphone-driven technology called Dental Monitoring (DM).  At the time of these blogs I too was contemplating the benefits and rewards of remote monitoring. If it could work and if it was accurate, remote monitoring offered orthodontists the chance to monitor treatment MORE frequently yet with FEWER patient visits. The potential to the practice would be better results in fewer visits and in fewer months. This should translate to more profit/case and in this world of cost control by third parties that is truly an exciting consideration.

There are also advantages for the patients and parents with remote monitoring. In addition to those outlined above for the practice, patients and parents want convenience. Parents don’t want to take kids out of school. Even after-school appointments compete with sports and other activities while complicating the lives of busy parents. If there was a way, therefore, for patients to be treated remotely, and at the same time enhance (not compromise) quality, this would be a boon to any practice.  It would represent a win-win-win proposition sure to be a practice builder.

Following on these blogs my practice began the use of remote monitoring. We wanted to test if quality monitoring was possible, if enhanced patent communication could be achieved, and if this could lead to fewer and shorter visits with treatment in fewer months. I understood that remote monitoring is not new at all. How long have pacemakers been placed, for example? In medicine, there are myriad examples of patient monitoring done remotely that enhance patient care andt reatment outcomes. Why would we NOT expect this medical concept to have applications to orthodontics?

Our office now has several hundred patients being remotely monitored using DM. We have developed systems for use of this tool. We have found it to work far better than expected and patients and parents love the benefits to them.

I would like to give just one example of how remote monitoring can change your practice. I have included 2 photographs from DM.

They are dated 11/29/16 and 12/13/16. We were prompted by DM after the latter set of photos that this patient being treated with Invisalign was experiencing failure in the fit of her aligners. Please note how much we had lost control of #7. This was in a period of only 2 weeks of time. Our office, like most using Invisalign will tend to see patient every 6 – 8 weeks. We use Propel to help seat aligners and patients are instructed to change aligners every week. Imagine, in a world where this patient would have gone through possibly 4 more aligners before she returned to the office, what the status of our treatment would be? It would have required ordering new refinement aligners! Instead we were able to remotely intercept a serious problem, react and go back 2 aligners, recapture #7, and finish this patient without further incident.

Align Technology has recently revised its Invisalign change protocol to a one week aligner change – but with an important proviso - the need to monitor the patient closely.  With any removable appliance, once the patient has left your practice then compliance in wearing it is totally in the patient’s control and as the orthodontist you do not know how the treatment is tracking. I am sure all my professional colleagues have experienced many instances where a patient comes back for their next appointment and things are nowhere near where they should be. The patient is disappointed – a longer treatment and the aligners are now highly visible. The orthodontist is disappointed in the appliance -the aligner doesn’t fit and a new scan or impression is needed. And more appointments are necessary and profitability is reduced.

Remote monitoring with DM is the way to address these concerns. If you can’t fix the problem, you can at least reduce its incidence significantly as described in the above-mentioned patient example. You should change the aligner when it has expressed all its force and the teeth have moved into the desired position that warrants moving into the next aligner- not after one week or two weeks. This depends on many variables but patient compliance is the major one.  Think of an aligner simpler to an arch-wire.  With braces, it is the orthodontist who determines when it is appropriate to move to the next wire. With Invisalign and other aligners we have given away control of this decision point to the patient. They change the aligners themselves. Now with DM, the orthodontist can take back control of the clinical decision of changing out of one active appliance into another.

In a challenging world, we need to seek out cost effective methods to improve our care and also differentiate our practices.  Similar to the Invisalign example, DM remote monitoring also delivers similar benefits with fixed appliances. Now you can pick up very quickly when a bracket de-bonds, a wire breaks or oral hygiene needs to be improved. 

In more than 30 years of practicing as an orthodontist, I have seen how technology and systems can improve orthodontics– giving efficiencies and control that lead to better patient outcomes and improved profitability for the orthodontist. Remote monitoring with DM will be the next significant leap in how orthodontics is practiced in the 21st century. Over the next year, I will be conducting a series of one and two day workshops for orthodontists and your staff, to show how to easily integrate remote monitoring into your practice. For more information, go to