Braces and DentalMonitoring: Expanding the Platform to All Your Cases

Alison Werner 0:10
Hello and welcome to the Orthodontic Products podcast. I’m your host, Alison Werner. And today I have with me Dr. Andrew Grillo, an orthodontist in private practice at Great Lakes Bay Orthodontics in Michigan. In this episode sponsored by DentalMonitoring, we’re going to talk about how to expand your use of remote monitoring to manage your braces cases. I know in talking to many of you that you have definitely embraced the technology to monitor your aligner cases. And you’ve seen the benefits when it comes to more efficiently tracking cases and improving your workflow. So we’re going to get firsthand insight into how the technology has evolved from a doctor working in a practice that was an early adopter, and has now made the transition to using it with braces cases as well as those aligner cases. Here’s my conversation with Dr. Grillo. Dr. Grillo. Thank you for joining me today.

Dr Andrew Grillo 0:53
Yeah, thank you so much for having me out. And I’m excited to talk about something I’m really passionate about today.

Alison Werner 0:58
Excellent. Well, let’s get started. So, as I said, You were an early adopter of dental monitoring 2015, correct.

Dr Andrew Grillo 1:06
Correct. Yep. That’s when my senior doctors first gave it a try.

Alison Werner 1:11
Okay, so what what was the motivation? As you know it for incorporating remote monitoring into the workflow then? And what was the problem that the practice thought it could solve?

Dr Andrew Grillo 1:23
For sure. And so yeah, get back to 2015, we put ourselves in that pre COVID mindset. So I think all of us are in the hustle and bustle and shake up of what’s happened since COVID. And obviously, things are a little bit different. So going back to 2015, I was not with the practice yet. So yeah, I came out of residency in 2018. The senior doctors that I took the practice over from, they were always early adopters of technology. So of what I remember is, they heard a little bit about DentalMonitoring, and some of the advantages of being able to monitor your patients, and where they were mainly trialing it out, and they only really had a couple patients at that time, was patients that lived out of town. So some of our college students. And also some patients that proved in the past to struggle with compliance wearing aligners. So it was just a small subset of patients that they were using at that time. And they didn’t have that great of experience for it for a couple of different reasons that I can get into. But yeah, just to get back into 2015, our office was doing a good amount of aligners, you know, so at that time, we were about 40% aligners practice. And our senior doctors at the time saw some benefits of out of town patients, or non compliant patients to give this a try to see if it would, you know, improve treatment and give us better control of our care.

Alison Werner 2:44
Okay, so talk to me about when you joined. Okay, what year did you join the practice? Then?

Dr Andrew Grillo 2:49
I joined in the summer of 2018. So it’s been about five years now.

Alison Werner 2:53
Okay, so where were things when you joined? And, you know, talk to me about what your thoughts were when you kind of walked into using DentalMonitoring.

Dr Andrew Grillo 3:03
So yeah, with 2018, that’s where we started to kind of dabble back into it. So, throughout 2015 to 18, it fizzled out, you know, it wasn’t working for our team for a variety of reasons. I think it’s come so far. But we’ll talk a little bit more throughout this discussion of how great the implementation process is with the DM team. But yeah, so we fell off board 2015 to 18. When I came on board, it was something that intrigued me. I heard a little bit about it just from hearsay, from other orthodontists or ortho Facebook groups. And so I was like, yeah, let’s give this a try. So I learned about it myself. And at the time, we had a rep that got us kind of reacquainted with it a little bit. And we started to dabble back into it. And we were used to using it at that time with our aligner patients and starting to see some good advantages, but really was come 2020 come May, you know, so during the COVID time, that’s really when we actually truly dove into it. So 2018 we just kind of dabbed our foot back in the water. But 2020 is really really started to fully implemented, I would say so not a whole lot from 2018 to 2020, to be honest with you.

Alison Werner 4:05
Okay, so Okay, let’s get to 2020. We’re, and you guys have been using it with the aligner cases before to some extent. So come 2020, how did you expand that usage? Or what did you realize that it could do?

Dr Andrew Grillo 4:19
Yeah, so when everybody was shut down, including ourselves. It was difficult really, to be in touch with our patients. You know, so we were trying to get text pictures and different things. And for patients on DentalMonitoring when we started that up during the COVID, it was really what we found out as kind of the only option for us to really effectively monitor and stay connected with our patients. It was so much easier of a process to get good quality photos and images. And it was a great way to see where people were at without physically trying to bring them in at that time. As you guys remember it was somewhat of oh no unknown patients didn’t want to come in. We were unsure whether we could kind of bring peace pull back and right away. So at that time, it was the kind of the only way we saw it at that point in our practice where we could effectively get good images, and assess where treatment was at and make decisions as to what’s next. So that was definitely the tipping point with COVID. And we really got the staff all on board with it. And it really forced our staff and our team to really embrace it, learn it and figure out our systems from, you know, front desk to TC to clinic, the doctor, what’s everybody’s role. So we worked really hard at that time to implement it, and it pays huge dividends in my practice today. But yeah, May 2020 was really our aha moment with DentalMonitoring.

Alison Werner 5:38
And then at that point, were you still focused in on the aligner cases? Or had you expanded out at that point to some of the braces cases just because of kind of the emergency of situation it all?

Dr Andrew Grillo 5:48
Yeah, at the time was just the aligners. So yeah, for the first really, a year and a half or two years since 2020 there, we just focused on aligner patients. And obviously, it was something that we were seeing great advantages for with the aligners, I think it’s pretty easy to see the benefits of DentalMonitoring with aligner cases, you know, I think it is kind of peanut butter and jelly, they go together really well. It allowed us to hand out all the aligners to the patients and really have good control of what we’re doing with really spreading out visits. So that’s obvious, we don’t need to talk too much about that. Hindsight, looking back, it’s something that I really wish we would have dove into in with our brackets patients at that time. So I’ve been all in with our brackets, our comprehensive cases, these last several months. And I’m absolutely loving what I’m seeing with our clinic efficiencies from our point of view and the patient’s point of view.

Alison Werner 6:35
Okay, so talk to me about that trend, or that jump to braces cases. What, what did you realize needed? Okay, well, actually, first, what told you that the DentalMonitoring platform would be able to meet the needs of managing those braces cases? What about the technology? Or what about the platform gave you the trust to go in that direction?

Dr Andrew Grillo 6:57
For sure. So yeah, just to talk a little bit about the AI, it’s, it’s amazing. It can pick up things that if I took a quick look at photos, they’re hard to see, you know, to see that a tie is off, or steel ties off, or a brackets broken or whatnot, it’s some of those things are really hard to see. So I just want to give the AI props that it it does work out extremely well. And I was seeing these things, obviously with aligners, we’re seeing things in such detail. And and obviously, it’s something that being able to have great control of your care and your treatment is huge. So seeing this repeatedly with the aligners and then seeing where we’re at with our braces patients, our braces treatments, were taking longer to finish than our aligner cases. So they were taking about four months longer than our aligner cases to finish. So that’s numbers we were tracking. So looking at our aligner or braces patients, I was like I want to make our treatment more efficient. I felt that patients were coming in and that visit was a little bit unknown or unpredictable, we might have had a plan to do X, but after the patient came in there with this bracket off, and this while you’re not engaged, or this wire out, it’s something that was really leading to very inefficient treatment on our end. So just repeatedly, I was seeing these appointments that I wasn’t happy with the progress that we had those previous couple months. And I thought we could, you know, really dial in our care and bring patients in kind of on demand. And so that’s where the aligners it’s, it’s seamless. And it’s easy. It makes sense. It’s bringing the aligner patient in when they’re ready to bring it brought in, whether that’s on the last set or partway through or you needed to be doing IPR. I really wanted our practice to have that mentality with braces is we don’t have a set interval anymore. It’s we bring in our braces patients when they’re ready to be seen. So it’s it used to be eight weeks, everybody’s coming back every eight weeks, which is pretty far out interval for a bracket cases. But now it’s just on demand man. It’s like if it’s six weeks, it’s six weeks, some people we go out as far as 12 to 14 weeks. So I really felt like our treatments been so much more efficient with our braces treatments since they’ve been in monitoring.

Alison Werner 8:57
Talk to me a little bit about the tools within DentalMonitoring that help you track these braces cases, because I know there’s the treatment goals functionality that is now available. There’s what is it standard 2D full monitoring option? How have those different protocols within the system helped you? What tools are you using there?

Dr Andrew Grillo 9:20
Yeah, so that’s the beauty of the DentalMonitoring is you can cater it to your practice. So the goals are awesome. They’re there to use if you want to, I think that’s a great opportunity for my practice is to use those goals more, you know, to rely on the AI. Early in the process, I think it’s been great those first year or two is to learn it and see it with you know, not just the artificial intelligence but with our human intellect too, and learn from the AI. So yeah, there’s so many goals that you can set up for is the wire passive yet or not, you know, or is it still active? And so that’s a huge one with brackets cases. But then there’s other triggers that you can look at is the patient Class I, Class 2, Class 3, where our midlines you can set up certain goals of let you know, when the midlines are shifted a certain amount or when the midlines are on with each other, or if the deep bites open a certain amount. And then there’s so many different factors that you can put into your DentalMonitoring if you want. So you can really customize each protocol to be exactly that fits your practice. And I really encourage the goals to implement to use those. And that’s where I challenged my practice to do that more. So that’s a big part. And then let alone just the pictures and images, that’s huge. So with our braces patients is our physical, I said it at some point, whether it’s a very trained team member, or myself, is we now have a protocol that we’re setting a very detailed plan of action for that next visit. And I can confident be confident that we can do that at that next visit at that right interval that we decide. And it’s accurate. It’s what I would be making that decision if I saw them with my own eyes in person. So it allows a lot of flexibility in our internal systems, that assistants aren’t waiting on me as much, you know, what does doctor want to do that day. We already have that plan in place. And so that’s really freed up our doctor time, and really lead to less wait, wait times for our patients. So that the AI’s super powerful depend upon. You can use goals if you want to. You can custom add to your practice. And then from there, your human eye can hit it and make decisions to as you see fit.

Alison Werner 11:21
Well, extending out from the goals component there. They also there’s also DM Insights, which is kind of the data that’s collected around all your cases to help you get insight into what’s working, what’s not, your you know, your your patterns? How has DM Insights informed how you are managing your brackets cases? Are there any changes you’ve made, or anything you’ve noticed about the way you treat because of that?

Dr Andrew Grillo 11:47
Yeah, that’s a that’s a great question. And just to kind of step back, when you look at DentalMonitoring, I think somebody who’s new to it sees it as a monitoring company, you know, just gathering images, you know. But really what DentalMonitoring how they view it, and how people who have used it quite a bit is it’s actually a data company. And really, the data is much more vast with brackets cases compared to aligners and the insights for those that don’t know what it is, it’s essentially a very organized subset of the data of all the different parameters that the artificial intelligence looks at. And so with that data, you can analyze it and make good decisions with your practices. And I’ll give you guys a couple examples. But yeah, with our brackets, patients, one thing that we were seeing is that we were getting a loss of o-ties, so we still use a normal bracket, not a self-ligating bracket. And so you can tell if an o-tie comes off. So what does that mean? So yeah, we were seeing that our lower fives, the o-ties were by far the most frequently common tooth that the o-ties were coming off. And therefore we are also seeing that we had a lot of wires that were coming out of the sixes, because the patient’s biting and they’re flexing out the wire. So we had an uptick in these emergencies. So we were seeing this trend, looked at the insights saw that these lower fives were really having some issues. And so we changed our protocol. That especially right off the bat when you’re in a round wire is we want to get steel ties on those lower fives to keep them fully engaged, to keep that wire from sliding out of the molars, and to ultimately keep emergencies from happening. So that’s a really good example from the braces perspective. An aligner one and it just jumped to aligners a little bit. One huge one that I found out I love telling this to doctors is ensuring that the attachments are in the proper position is is huge. And so with that template tray when you’re bonding, the initial attachment day one is that template needs to fit like a glove, it needs to be pushed all the way up, so the incisal edge is flush. So that way the attachments are in the right spot. And with insights, what we’re finding is that at week one, or aligner one or two even, we’re getting these air gaps, you know. So we’re scratching our head of how can we already have an air gap this early in treatment is the patient non compliant. But after we looked at this trend over and over again, we’re able to see that our attachments we were bonding and properly, all the attachments were too far incisal. Therefore the aligner right off the bat was too far incisal. And we’re not giving us our ourselves a chance right off the bat. So we have a new protocol in our office because of that insight is to section the template aligners, so we do it in quadrants and sometimes even section of even further so that we can perfectly adapt that template aligners so that the attachments are in the perfect position. So those are a couple of great examples. I could go on and on with the insights but there’s so much data out there and DentalMonitoring is a data company and the more you use it, the more you can really see those benefits.

Alison Werner 14:52
Okay, though, those are great examples of you know, really how you’ve changed, you know, a clinical protocol within your practice and you know, it’s practical knowledge that you can use, which is really interesting. I’m curious, okay, how has your practice’s workflow changed on a typical day? How? How are you guys going about checking in on all the data that is coming in from the patients? And then just also, you know, from insights, etc? How does How is your day flow changed with this?

Dr Andrew Grillo 15:22
Yeah, so it’s definitely been a progression. So obviously, when you start using DentalMonitoring, you have zero cases, right? Zero patients that are being monitored, and then you start getting people into the mix scanning every week, or whatever interval you set. And so obviously, at first, the first several months, it’s not necessarily a slow process, but it just, you know, it doesn’t take much internal systems or team changes to accommodate the pool of patients you have in there. So the first several months, I recommend, you know, having one good, you know, very detailed team member, usually a clinical assistant, you know, that’s trained up and knowing what to look for. So the role of that person is the DMC, the DentalMonitoring coordinator. So initially, it just a part time process, you know, it could just be even, like 30 minutes, 15 minutes a day. And that, that employee can still do other things throughout the office see chairside patients. So for the first several months, that’s where we were at. Just to talk through where we kind of ramped up to, now we’ve got about 800 patients that are being monitored actively in it. So it’s busier, it’s more work, more notifications to keep up with, I would say 90% of it is handled internally with the AI. So just having the protocol set up properly, having the goal set up properly, then there’s the important 10%. So that’s what’s great as the the AI really does help kind of filter through which are these important 10% of patients that decisions need to be made on. And then from there, it was getting the whole team involved. So it’s not just your DMC making that decision. Sometimes it’s the DMC getting the doctor involved. Early in treatment, say if there’s a patient that you have a hygiene issue or a compliance issue, you can see that and sniff it out very quickly. So that’s where we’ve involved our treatment coordinators, you know, to set up phone calls or send video messages of some concerns we have, and to give active feedback and instruction on on habits that that they need to change and how they can change. And then obviously, you need the front desk to be scripted on you know how to field some Q and A’s coming in of active patients, but also prospective patients. So it’s something that’s it’s known in the community just by word of mouth that we’re doing this and the benefits it has to the patient for convenience. But when it gets to a level where you have your whole team involved, it’s something that it changes your whole entire practice, it changes your scheduling workflow, like we talked about, it’s on demand scheduling right now. So if you look at our schedule for weeks out, it’s pretty wide open. We scheduled all of our appointments within a two week time period when they’re ready to be seen. So therefore, it does involve our front desk team members knowing when to schedule people. So at a certain point, it does get to a system that needs to be the full entire office, everyone needs to understand their role. But there’s so many benefits for every single role. And it’s been definitely a game changer in our practice for a lot of different ways.

Alison Werner 18:10
Well, I was going to ask you next, you know, what has kind of your team’s response been to expanding the use of DM to all the patients? And, you know, you talked a little bit about how their day has changed. But do you have any advice for doctors who are looking to implement this or expand out to braces on what they should talk to their staff about or any training or just any tips or tricks?

Dr Andrew Grillo 18:32
For sure. So yeah, first off, it’s the implementation team with DentalMonitoring is phenomenal. So that’s something going back to when we really were getting our feet wet back in 2018, and even 2020, it obviously improved a lot. But now here in 2023, is they’ve got a field of team of team members on DM that want you to succeed. So early on, they’re very much involved in the process. So I think that’s kind of the number one thing of really getting everybody on board is having good training, just like anything. Of course, when you implement something new into your office, I think it’s a knee jerk reaction for most team members to be a little resistant to change. So that’s something where I think as, as doctors or leaders or office managers in our practices, is you really need to keep on your team members of what’s the vision of DentalMonitoring, you know, what’s the benefits that our patients get, and once the benefits that our practice gets. So there’s kind of that coaching or leadership moment that we need to have as doctors and leaders to kind of know that vision. So between the implementation being phenomenal, and then between having your team buy in, that’s where you’re going to have the most success. And DentalMonitoring is something that if you just do it on a couple patients, or several patients, you know, anybody who uses DentalMonitoring will tell you it just doesn’t work. You know, you really have to be all in on it. And you really have to structure your practice around it a little. So I really encourage new doctors or prospective doctors to really jump in the pool. It’s any new start, get them started and DentalMonitoring. Get all your starts throughout one whole month or two whole months started up and really start to see these trends, figure out the systems that work for your practice. And then from there, it’s just an exponential positive effect that streamlines throughout the whole team.

Alison Werner 20:18
I’m curious, have you I would assume at this point, you have some cases that have completed that were completely on DentalMonitoring the whole course of treatment. I’m curious, did you, was there something you were, you found interesting about doing your first those first couple of cases and getting to you know, the final stage about how DentalMonitoring affected how you treated or the outcomes or you know, the patient experience?

Dr Andrew Grillo 20:45
Yeah, remember kind of an aha moment for me kind of to kind of explain that answer a question there. Dan Bills, he’s on the East Coast. And I don’t know Dan personally, but he’s obviously been known as a little bit of guru of adapting new technology, and some systems in your office. I was at a presentation a couple years back, and Dan’s practice, they take intraoral photos, pretty much at on every single appointment that walks in the door, you know, of their active patients. And it was something that when I heard that I was like, holy cow, how do they have the time to do that, the systems to do that. But the reason why Dan did that is he said, so they can really learn, you know, and, and really help improve their treatment outcomes, they can really plan what their next visit is really well and ultimately get more efficient results, get to that finish line faster, and get a better result overall. So that was his reasoning behind it. But in my head, I was like, how can we logistically make that happen. But then it hit me, it’s with DentalMonitoring, we’re getting weekly photos, and it’s not our team gathering these photos, it’s the patient, you know, doing the work for us. And so that’s where it was really an aha moment that having these internal systems and having the patient, you know, have this app and doing this for us, it’s a great benefit for the patient. But it’s huge for us, we’re learning so much that throughout treatment, I’m making decisions kind of on the fly, and adjusting the next visit now to be as accurate as possible, or getting the most out of every single visit. So our treatments are going super fast. And our results, in my opinion, are just so much more spot on. And so it’s amazing to see how quick treatment can go when every single visit is really getting a lot out of it. And and we’re not taking steps backward. We’re always just taking steps forward.

Alison Werner 22:28
Well, I guess my last question to you is, what’s your overall message to your peers about remote monitoring technology?

Dr Andrew Grillo 22:35
Yeah, I would say it’s, it’s, it’s not just the future, but it’s now. It’s something that’s really when you look at it, just starting to scratch the surface. I believe just four to 5% of orthodontists have implemented it or trying it. And Chris Bentson is somebody that I know a lot of our orthodontic community really values his opinion and looks up to. And Chris really has been talking about this lately that this is this is the future. This is the way that we’re going to be treating. Remote monitoring has really changed how we’re going to practice. And it’s something that sooner you implemented, I think the sooner that you can really start to see the benefits. And one thing I haven’t quite talked to on yet is kind of big picture looking at your practice and the benefits you have. And so obviously, you can, you can cut down appointments a lot. And so it can really make your clinic day go more smooth, you know, seeing 80 patients or 60 patients compared to 100 or 120. So you can cut out so many visits. And then from there, you can also look at the idea of cutting down days. So I’ve got a pretty large practice in Midland, Michigan, used to be open four full days, and we were busy seeing about 60 to 70 patients a day felt busy to us. But now we’re only open two and a half days. And our practice is double the size, and we’re seeing the same amount of patients. So it’s something that it can make a huge difference, not only in the day to day at the office, but when you look at the big scheme of cutting down so many workdays, it really allows you flexibility and your work life balance that really allows you to work less if that’s what you choose, or it really allows you to be able to have extra days to say open another location. So I think it’s something that for doctors, whether you’re earlier in your career, like myself, or if you’re a senior doctor, I think it’s a great way to to find what you want and to really build your practice the way you want. And so yeah, remote monitoring is something that if you’re not doing I’d highly encourage trying it out or just having a conversation with the DM team or with a DM KOL member. But it’s been life changing, you know, for me, and I’m not just saying that it’s something that I think it’s worth the discussion if you haven’t tried it yet.

Alison Werner 24:36
Great. Well, Dr. Grillo, thank you so much for sharing your insight and getting down into the weeds on this topic. I really appreciate and I think our listeners will too. So thank you,

Dr Andrew Grillo 24:45
for sure. Yeah, and I’m passionate about and I’m here for any follow up questions do so Yeah, feel free Allison to pass along my information.

Alison Werner 24:52
If you would like to get in touch with Dr. Grillo. You can reach him at Dr Grillo at GLB ortho.com. That’s Dr G R I L L O at G L B ortho.com. And if you would like to learn more about the DentalMonitoring platform, visit dentalmonitoring.com. As always, thank you for joining us. Be sure to subscribe to the Orthodontic Products podcast to keep up with the latest episodes. And be sure to check out orthodonticproductsonline.com to keep up with the latest industry news. Until next time, take care.