Four-week appointment intervals are no longer the norm. Longer intervals mean more free chair time. But filling that free chair time doesn’t happen by magic. Here are four strategies to do so.

By Roger P. Levin, DDS

Years ago, there was an absolute standard that orthodontic patients needed to be seen every 4 weeks. I have no desire to debate any orthodontist’s clinical decisions, but I can report that 4-week intervals for orthodontic patients are now the vast minority of orthodontic protocol. Whether it was due to advances in materials, technologies, wire and bracket systems, or aligners, intervals are now longer than ever before. Fortunately, these longer intervals are creating an amazing volume opportunity.

Understanding volume and chair time

Chair time is simple to understand. You have a finite number of hours of available chair time based on the number of chairs in your practice and the number of hours that your office is operational. The more hours you work, the more chair time you have for the same number of chairs. Simple so far, right? What is not so simple is analyzing and mapping out a schedule that maximizes the use of chair time. This has always been one of the goals of orthodontists and will continue to be because chair time optimization has a direct effect on overall orthodontic practice production. And, in the end, orthodontic production is the most important factor for any orthodontic practice.

When patient intervals had a standard of every 4 weeks, this created a mathematical limitation on how the schedule could be built. And with any interval, only so many patients can be seen in so many chairs. It is an easy mathematical calculation to determine how much chair time is available, and how it will be used for patients. When chair time goes from intervals of every 4 weeks to intervals of every 6, 8, or 10 weeks or more, this opens up more available chair time.

Every orthodontist knows this. Where the breakdown occurs: Not taking steps to properly take advantage of the new increased available chair time. We see practices that are still producing at around the same level despite significantly increased available chair time.

We encountered one practice recently producing $1.6 million per year for the last 3 years with slight increases. Over that same period, they increased the interval between patient visits and their available chair time increased by 20%. Clearly, production had not grown along at the same rate as the available chair time. Why? Because no one was focused on doing anything else differently. Appointment intervals were increased and that was it. As we explained to the orthodontist, chair time does not fill by magic. You must put in place strategies to take advantage of the increased chair time.

Strategies for filling free chair time

Take advantage of increased chair time to increase referrals. Many orthodontic practices are simply comfortable. They produce at a certain level and may decline slightly each year. Complacency keeps them from maintaining a fully viable referral marketing program focused in the five key focus areas: patients, parents, social media, referring doctors, and the community. The orthodontist in the practice noted above, in order to fill up the increased chair time, immediately began to emphasize reconnecting and enhancing the office’s relationships with referring doctors.

Upgrade your treatment coordinator system. Most orthodontic treatment coordinators (TCs) have no background, education, or experience in sales. This was fine when the economic law of supply and demand was at the right ratio and orthodontic practices generally had enough starts. However, in the face of new service delivery models, including dental service organizations (DSOs), orthodontic service organizations (OSOs), and general dentists all offering aligners at lower fees, the TC process in the orthodontic practice must be reinvented. The TC should be focusing more on relationship building, branding of the orthodontist, and answering questions about why this orthodontic practice is the right practice. You want a parent or patient to say to themselves at the end of the appointment: “I want to be a patient here.”

Build the most efficient schedule. There are many experts on orthodontic scheduling, as well as countless books and articles. Unfortunately, many of them are now out of date. In today’s environment of increased patient appointment intervals, orthodontic practices have a terrific opportunity to re-analyze and restructure the schedule for increased production. In the example above, the doctor had a $1.6 million annual production that was fairly flat for the last 3 years. After mathematical analysis, we built a schedule to achieve $2.2 million in annual production working the same number of hours with the same number of chairs (remember they had increased their intervals which increased their available chair time).

Retrain the entire orthodontic team. We often find resistance to changes amongst the team and a perception that if the practice grows, they will have to work harder. Fortunately, using the right systems always leads to greater levels of efficiency, which helps the team to have easier and more enjoyable days. This does not mean that you won’t have to put in work. It just means that the days will be so efficient and smooth that you’ll enjoy the work, and you will not think of it as being hard.

There is an amazing opportunity to increase orthodontic practice volume that is taking place right in front of our eyes. The strategies identified in this article will be helpful and we encourage every orthodontist and orthodontic practice to take advantage of this unique and wonderful opportunity.OP

Roger Levin

Roger P. Levin, DDS, is the CEO and founder of Levin Group, a leading practice management consulting firm that has worked with over 30,000 practices to increase production. A recognized expert on orthodontic practice management and marketing, he has written 67 books and over 4,000 articles and regularly presents seminars in the U.S. and around the world. To contact Levin or to join the 40,000 dental professionals who receive his Practice Production Tip of the Day, visit or email [email protected].