by Greg Thompson

Michael C. Alpern, DDS, MS, is always learning (and teaching) how to treat patients better

Most orthodontists purchase new equipment with an eye toward better business, greater efficiency, and improved results. Michael C. Alpern, DDS, MS, views new technology as a starting point. With an infectious curiosity and a compulsion to find that elusive “better way,” Alpern can’t help but look for ways to improve upon what manufacturers so diligently roll out to the masses. For the past 33 years, this mind-set has allowed the Port Charlotte, Fla-based orthodontist to go beyond the confines of his profession and reach out to colleagues in other disciplines.

As someone who has literally written the book (The Ortho-Evolution – The Science and Principles Behind Fixed/Functional/Splint Orthodontics), Alpern has seen nothing short of a technology revolution since he began his dentistry career in 1967 (he soon afterward moved on to orthodontics). Working with dentists, neurologists, orthopedic surgeons, and even psychologists, Alpern has sought to break down traditional barriers and professional biases.

Occlusal Harmony

If manufacturers don’t have what he is looking for, Alpern may call a colleague and hunker down in the tool-and-die shop until he is satisfied. In this manner, he developed a bracket system, a bonded palatal expansion system, and five different appliances and retainers. Working with an orthopedic surgeon and a dentist, he designed an articulator, essentially a patient replicator that accurately reproduces all the patient’s chewing strokes in the laboratory. Thanks to the articulator, orthodontic appliances, bridges, or dentures can be inserted in the mouth with little or no adjustment.


Name: Michael C. Alpern, DDS, MS

Location: Port Charlotte, Fla (Pop: 135,000)

Specialty: Pediatric and adult orthodontics

Years in practice: 33

Patients per day: 40

Starts per year: 130

Days worked per week: 4

Office square footage: 2,800

Education: Ohio State University

Web site:

Alpern calls it the Poly, short for poly centric hinge joint articulator. The device is programmed using three cephalometric x-rays and represents a new way to reproduce human chewing. “It reproduces all those chewing strokes in the lab,” Alpern explains. “So when we orthodontically correct teeth in what we think is the proper position—it’s not only aesthetically and cosmetically in the correct position—the teeth are in occlusal harmony with each patient’s individualized TMJs, specifically the intercondylar angles and distances.”

As a result, Alpern says, chairside adjustments are significantly reduced, as is the tap-and-grind routine that patients must typically endure. The only problem, Alpern laments, is that it was invented too soon. “It was developed with the help of an orthopedic surgeon and an orthodontist, which was not acceptable to prosthodontists and reconstructive dentists,” Alpern says. “We first built it out of wood and then in a tool-and-die shop—that was about 15 years ago—and it’s been out since them. Because I’m an orthodontist, I primarily used it for building bite splints. But now I’m using it to position teeth, so when I put the braces on, the braces will move the teeth not only into the best appearance, but the occlusion will be in harmony with the patient’s jaw joints. That has never been done before.”

Alpern also uses the device when he treats jaw surgery patients and to do TMJ splints to get patients comfortable prior to orthodontics. The latest iteration of the device is a computerized version that allows for a digital virtual occlusion.

The Poly is now used by about 30 dentists nationwide and perhaps a dozen orthodontists. Why so few? Again, part of the reason is the inherent difficulty associated with orthodontists introducing something different to dentists. “It is difficult for me to lecture about dentures, bridges, and crowns when I don’t do them,” Alpern says with a chuckle. “You wouldn’t have a root canal specialist lecture a dentist about occlusion. We’ve never been permitted to present this effective enhancement to patient treatment. Anything that’s new is considered controversial. Have we proven that it’s accurate? Yes. Hundreds of times.”

Swarming to the Task

If a new gadget does not do the trick, better use of existing team members could provide the best solution. Too many cooks may indeed spoil a broth, but Alpern has used several pairs of skilled hands to completely band, bond brackets, and insert wires in 20 minutes per patient, using what he calls the AccuBond Indirect Bonding System. “Assistants are alerted 2 minutes before the indirect bracket bonding trays are placed and, when ready, all assistants available ‘swarm’ to the patient,” Alpern says. “One loads the indirect trays, while the orthodontist seats the trays and two assistants hold the tray—and simultaneously use two 3-second pac lights to cure the brackets in place.”

Using this basic framework, Alpern eventually found his way to what he calls six- to eight-handed orthodontics. He uses the word “swarm,” but admits the term is inelegant, since the procedure is actually quite low-key. “The orthodontist preparing the patient for Accubond Indirect Bonding will say, in a low tone, ‘I am 2 minutes,’ so all the other assistants judge where they are at,” Alpern says. “When the tray containing all the orthodontic brackets is ready to be placed on the patient’s teeth, we all stop what we are doing, wash hands, change gloves, and in a controlled manner come to the patient. I have one assistant on the opposite side of the patient, another one right behind me, and another one loading the brackets.

“One assistant puts the final, small amount of flowable cement on each bracket’s custom base, she hands me the tray, and I insert the tray while the other two assistants make sure the teeth are dry, holding the cheek and lips back,” Alpern continues. “Once I get the full arch tray seated on the teeth, then we use pac lights with a 3-second cure instead of a 10-second cure. I hold the tray down on one side. One assistant holds it down on the other side, while two assistants are going along lighting each tooth.”

This “controlled gathering” has the effect of lavishing attention on the patient and provides a chance for a bit of levity. “When we are doing this, we always kid the patient and keep things humorous,” Alpern adds. “We say, ‘This is a test to see how many hands we can get in your mouth.’ It shows we really care and that we are giving them the maximum amount of attention.”

Alpern stresses that the AccuBond system does not require this many assistants. In fact, AccuBond can be placed with one assistant. “Many hands,” he says, “just makes it quicker.”

Since the best form of advertising is word of mouth, team members are sure to casually mention to patients and parents that the multihanded technique saves lots of time and stress on the patient. Getting all the braces on the teeth in 20 to 25 minutes is no small achievement. “My team explains to the patient that they are lucky to not have to experience sitting in a chair for an hour and a half as each bracket is hand-placed on each tooth,” Alpern says. “Many patients also don’t realize that orthodontics is a form of cosmetic dentistry. If a tooth is undersized or chipped, I let patients know that I can bond artificial enamel on there and help them feel better about themselves.”

Alpern and team members (left to right) Sally Pope, Ada Hinda Alpern, Denise Lee, and Aileen S. Buschner.

Smiles Are Serious Business

Despite his intense focus on the hardware innovations that drive so many practices, Alpern takes pains to never lose sight of the human element. He personally knows the misery of severe jaw problems because he experienced them all too frequently as a child growing up in 1950s Ohio. As one of the first humans given palatal expansion, the young Alpern later required a bilateral mandibular osteotomy. The experience ultimately forged a desire to help children overcome similar problems. “With the bullying that goes on today, there is a continual barrage directed at these poor young kids who don’t feel good about themselves,” Alpern says. “Above all, we spend time building a patient’s self-esteem. If someone asks me what I do, it’s not orthodontics. It is building a patient’s self-image.”

Building better smiles is serious business for Alpern, so when some patients mistake his concern for anger, it’s time for his wife, Ada Hinda Alpern, to step in and smooth the waters. Ada Hinda has been with Alpern for every one of his 33 years as an orthodontist. She has served as hygienist, chief radiographer, office manager, patient relations coordinator, chief marketing person, and an invaluable motivator and coach for patients. If the doc just needs a hug at the end of a tough day, she is also the one for the job.

If Ada Hinda must switch from producing submento-vertex cephalometric images to soothing the feelings of patients, it is all in a day’s work. After all, she admits that her husband can cut an intimidating figure decked out in mask, microscopic loops, and head light. “Sometimes it is hard to be warm and fuzzy, and if I am worried about a patient’s brushing and gum disease, patients may think I yelled at them, although I haven’t raised my voice in 30 years,” Alpern says. “Ada senses that, and she will take parents and patients aside and explain that I treat patients as if they were my own children. Do you want a doc who is worried and cares about you? Or do you want someone who won’t say something when you really need help?”

At left: Alpern’s team uses their “swarm to the patient” bonding technique. At right: Alpern’s poly centric hinge articulator.

Always Learning

With his extensive academic background, it’s no surprise that many of Alpern’s 130 or so yearly starts are filled with tough cases who need the most help. With the office set up as a teaching and research center for other orthodontists and dentists, it’s the perfect space to discuss tough cases and apply ABO and Angle society standards. For more formal teaching sessions, the waiting room (which features a 300-gallon fish tank that acts as a buffer to the kids’ game section) quickly converts into a lecture hall.

When he isn’t doing in-office teaching, Alpern travels to Charleston, SC, on his own dime, to teach at the Medical College of Charleston. Why does he do it? He loves it. “Young minds always challenge you and make you better,” Alpern says. “There are always going to be bright young people that take my ideas and improve on them.”

As the son of a dentist, Alpern readily accepts that knowledge-seeking with a penchant for invention is literally in his blood. A legal pad sits on the bedside in case ideas occur at midnight. If he stews on a problem and finds no answer, Alpern does not hesitate to go outside the orthodontic profession by seeking knowledge from board-certified orthopedic arthroscopic surgeons, neurologists, clinical psychologists, and even sleep apnea specialists. Factoring in medical expertise across a broad spectrum allows Alpern to view the big picture when caring for his patients.

He uses much of this same attention to detail to capture wildlife images with his digital camera, a passion that he can indulge in his rural backyard, which sits next to a river not far from Florida’s Everglades National Park. With life revolving around work and three successful children, capturing images is a chance to experience nature and explore photography, a hobby that has inevitably helped his orthodontic profession.

Alpern does all the photography in his office, which includes the professional photos that adorn the office. Experience in radio and television—he has made four training tapes for orthodontics and one for dentistry—has helped him stay on the cutting edge of accurate facial pictures. As for wildlife photography, he enjoys filming the family of eagles that has taken up residence on his boat cover. Asked if would ever want to take up photography full time and leave his practice, Alpern quickly dismisses the notion. “As long as I can physically get to the chair,” the healthy Alpern says, “I plan to practice and teach.”

Greg Thompson is a contributing writer for Orthodontic Products. Please send questions and comments to