It’s no secret that turf wars between dentists and orthodontists can occasionally lead to bruised egos and even accusations of professional trespassing. Timothy Charles Bandeen, DDS, MS, knows the sentiment exists, but chooses to embrace a general dentist’s expertise and apply it to Bandeen Orthodontics, a 4,100-square-foot practice in Battle Creek, Mich.

The dentist on-site happens to be his wife, Emily Pala Bandeen, DDS, who does all orthodontics all the time. “A lot of orthodontists get nervous about general dentists doing orthodontics,” muses the 39-year-old Timothy Bandeen. “The truth is that there are always going to be general dentists doing orthodontics.”

bandeen_3Since Emily Bandeen eschews general restorative dentistry, there is no awkward referral dynamic at work with other colleagues. She partners on all cases and works with Timothy to treat every patient.

To those who question the care model, Timothy counters: “Look at our results. If people focus only on titles, they are going to miss out on a lot of cool ideas and a lot of good care. Folks who get really upset about it are the ones maintaining, rather than improving, their standard of care and expecting nobody else to catch up.”

The Bandeens’ dentist/orthodontist pairing works much like other medical endeavors that combine specialties from a variety of disciplines. Timothy points to the example of dermatology practices that employ plastic surgeons and general physicians, in addition to dermatologists. “Not everybody is a dermatologist, but it’s still a dermatology practice,” he says. “We borrowed that model.”

After more than a decade of marriage, and 6 years as a business/clinical partnership, harmony still reigns at the practice and in the household. There are clinical (and personal) disagreements, but both Bandeens share the same basic treatment philosophy. “Not everybody is good with talking about work all the time, but we talk work all the time,” says Timothy, who met his wife in an anatomy class at the University of Tennessee. “We both really enjoy it. I can’t imagine practicing without her. Not only is she my wife, but she’s a really good doctor. We complement each other quite well.”

Emily may not have had a formal orthodontic residency, but her practical experience is extensive. Far from her yielding to the orthodontist, Timothy points out that “Emily has really challenged a lot of my concepts. I’d say, ‘Hey, that’s not the way I would have done it,’ and she’d say, ‘Well, that’s the way I did it, so let’s see how it works.’ I had to learn to live with that, and a lot of those ideas worked really well and they were not ways I would have done them. We have molded our treatment philosophies to get a unified vision.”

All patients are shared equally, with Timothy usually taking the initial treatment planning at the exam appointment. Emily reviews the plan, meets again with the patient, and describes the plan. There is no general dentistry performed at the practice, and Emily claims she does not miss it.

Branching Into Sleep Medicine

The Bandeens recently hired a registered sleep technologist and added “Center for Dental Sleep Medicine” to the official name of the practice. It’s only been a few months, but Timothy is actively pursuing sleep apnea treatments in the orthodontic setting.

The idea had been in the works for a long time, but Timothy had concerns about sleep testing and measuring efficacy after treatment. “From an ethical perspective, I would not just give someone an appliance and say, ‘Here, hope it works,’” he explains. “So Chris, our registered sleep technologist, provided a larger framework and a care model when he joined the practice.”

Most oral appliance candidates who visit the Bandeens’ office have already had sleep tests, and some are looking for an alternative to continuous positive airway pressure (CPAP) treatment. Those who have not been officially diagnosed, but are suspected of having sleep apnea, are tested to confirm an official diagnosis of sleep apnea.

Timothy acknowledges that CPAP is still considered the “gold standard” for treating sleep apnea, but he also says that compliance problems are still prevalent among CPAP users, and oral appliances are considerably better than nothing.

“We’re members of the American Academy of Dental Sleep Medicine,” says Timothy. “We’re working right now toward getting our practice accredited with that group. Emily and I are also training up to take the test for diplomate status with that group. It’s a lot of work. Meanwhile, we’re offering custom appliances to our patients—primarily some DynaFlex models that we like.”

bandeen_4Rendering the Smile

Jumping on new technology is not necessarily part of the business plan, but Timothy admits that he usually ends up with some of the latest and greatest orthodontic equipment. The litmus test is practical effectiveness, because “if it’s not effective, it’s just a cool toy,” he says, “and that’s not what we’re about.”

With a technology such as Insignia from Orange, Calif-based Ormco Corp, the Bandeens jumped on fairly quickly, have followed the product’s evolution, and used it to great effect on patients. Timothy favors the Damon System of braces, primarily due to its low force technology that allows for expansion without requiring a palatal expander.

The relatively different approach of using Insignia with the Damon System allows the Bandeens to put the braces on in a “good spot” right off the bat. “We can treatment plan exactly where the braces should go to begin with by using Insignia, and we can get custom-built wires that will minimize the number of adjustments we have to make,” Timothy explains. “We’re going for a low force system, and we should not be bending as much. Bending typically introduces high force circumstances.”

Timothy explains that a CAD/CAM rendering of the smile and the bite starts the process before any braces go on. They take a Lythos scan (instead of an impression), then electronically send the data to Ormco, ultimately getting a computer rendering that can be manipulated.

bandeen_6The process allows the Bandeens to demonstrate what they want the smile to look like, and easily show patients/parents. “We look at that together before the patient has started and we set goals,” says Timothy. “Emily and I can look at the computer screen together and customize our initial planning. We get custom wires, custom braces, and custom placement of braces with the Insignia process. It all adds up to a unified treatment plan.”

The Bandeens’ treatment plans have yielded excellent results and positive word-of-mouth in the 50,000-plus population city of Battle Creek, Mich. There is a lot of competition in the community, but Timothy makes a point of not keeping track of his competitors. He explains: “We manage the competition by ignoring what everyone is doing. I learned this lesson after my wife joined the practice. She said to me, ‘You’re getting stressed out about what everyone else is doing. Why are you worrying?’ She explained that what we were doing was so different that we simply needed to focus on ourselves. We try to keep our focus on what we do well.”

On the Road with Ormco

In 2010, Bandeen settled on Insignia as the practice’s standard of care. About a year later, he got a call from the folks at Ormco who calculated that Bandeen Orthodontics was one of the top five Insignia users in the world. Battle Creek is not a large town, but the numbers added up, and Ormco officials wanted to know the secret of the Bandeens’ success.

A number of other doctors were curious about how it was going using Insignia as a standard of care from a business and clinical standpoint. Bandeen was willing to share his thoughts with colleagues, and was soon on a plane, on his way to a seminar where he merely explained his daily routine. “I’m not trying to sell anything,” says Bandeen, who will also be speaking at Ormco’s upcoming Forum 2016 event, taking place February 10 to 13, 2016, in Rancho Palos Verdes, Calif. “I’m just describing the process. It’s fun, it’s cool, and people have been interested. I’m talking about the clinical and business concepts of Insignia.

bandee_5“Structurally, it’s different from the business side because it’s a little bit more expensive than just a regular set of braces,” he continues. “However, if you are effective and efficient with your treatment, it will save appointments later, and you take less time clinically, and the costs wash out. That’s what we’ve seen on our end.”

In addition to the Insignia process and the Damon System, the Bandeens have been getting a chance to use the i-CAT FLX, which is helpful for the burgeoning sleep medicine side of the practice. Their i-CAT FLX analyzes the airway in three dimensions—giving a radiation dose of only 11 microsieverts for a quick scan. That’s a little less than half the radiation dose of a nice digital panoramic image, and Timothy reports that the information yield is a lot more than other more traditional imaging systems.

“We also have a really big interest right now in inexpensive and effective in-office 3D printing,” he enthuses. “I don’t think $10,000 or $20,000 is inexpensive, so I’m talking about printers that are $500. We want to use them to eliminate impressions. It’s fun, and through Ormco, we had a chance to talk to other people around the country, and world, about those types of things.”

Being on the road for Ormco occasionally means a family trip for Timothy, Emily, and their four children, ages 8, 6, 3, and 1. “If we can, we’ll take one of the grandmothers along,” says Bandeen with a chuckle. “Sometimes Emily’s sister will even come along and will hang out with the kids while we’re at a meeting.”

It’s an incredibly busy life for the Bandeens, but the work/family dynamic is made a little easier because Timothy and Emily genuinely love what they do. The recent case of a young man named Matt illustrates why the two enjoy the profession so much.

Matt experienced about 9 mm of palatal expansion, without a palatal expander, through use of the Damon System with Insignia—a change that markedly improved his smile and his attitude. “The change also seemed to help his sleep apnea, but we didn’t have our formal methods to check that in place at the time he went through treatment,” says Timothy. “We’re looking to the future and seeing how orthodontic treatment affects the airway, and we’re actively in the process of measuring those changes.

“Matt looked great,” remembers Timothy. “We set out to change his smile, and there was so much more to it. I’m always discovering more and more layers of what we can do with orthodontics. The profession constantly provides more challenges. The bottom line is that we focus on quality patient care, we delegate effectively, train effectively, and trust in our amazing team to provide the best patient care. It takes a good team to do this well.” OP

Greg Thompson is a freelance writer for Orthodontic Products. He can be reached at awerner@allied360.com.