Have you ever had a negative review from a patient? I admit – I’ve had a few in my career. All seasoned dentists get them, even if, in your mind, you didn’t deserve it. I had a doozy on Yelp that shook me to the core and haunted me for a good 10 years! It had nothing to do with my skill as an orthodontist but was simply a misunderstanding about retention. This is something that was so avoidable if my whole team had a better orthodontic aftercare program. I was hoping to post it for you, but Yelp has FINALLY archived it! Hooray!
Orthodontic retention is the most underestimated phase of treatment; practices typically have a protocol for retention that involves a single set of retainers and a finite number of retention visits. In residency, we were taught to see the patient at 1, 3 and 6-month intervals and then discontinue treatment. All additional visits were at cost. When things go wrong with the retention phase after all that investment, they go really wrong and feelings can be hurt if they aren’t addressed properly. If you take a few moments to read negative YELP and Google reviews about orthodontists, most do have to do with retention! What an easily preventable problem!
Orthodontists expect that patients will do their part to wear the retainers as directed to allow the teeth to stabilize, but teeth aren’t static; the periodontal fibers are dynamic and things can settle and shift. Patients expect that their teeth will stay in the final positions forever, but that is unlikely.
Retention patients deserve attention and transparency from the practice in terms of fees and replacement options. I think it is important to start addressing this at the beginning of treatment, not at the end. Start the conversation about expectations. Some patients come in with a preference for a certain type of retention, but this doesn’t always coincide with the orthodontist’s practice philosophy.
Let’s talk about the bonded retainer. There is a time and a place for them, but for me, a bonded retainer is a marriage, and unless I feel it is the best retainer for the patient. I’ll usually recommend an upgrade fee and/or require the patient to invest in an in-house insurance policy for breakage and/or relapse.
Retention is also a great opportunity for revenue, through insurance and subscription programs. The lowest cost retainer, the clear essix, isn’t meant to last a lifetime. A child may run through 6-10 essix retainers PER ARCH in a lifetime, so you should clearly set-up a replacement program so that they can be replaced before they warp, crack or break. Be direct about what is included in the cost of orthodontic treatment and what is additional.
Retention Options
It’s important for offices to consider each of these plans in terms of what makes the most sense for each office. Give the patient a copy of the retention menu at the start of orthodontic treatment, and, if possible, build the additional cost into the whole treatment on the front end so that fees aren’t accessed at the end of treatment when they should be celebrating the outcome and posting their praise about you and your team on social media!
Here are a few retention options that I recommend:
1. Replace if needed: This is the cheapest option for the patient but not the best option. If a retainer is lost or broken, they are replaced, as needed, by the office. This is the traditional plan and the most basic. I don’t recommend this for new patients, only for trusted patients who understand retention. Give your fee on the front end and honor the fee. It can be a sliding scale that increases over time. Initially, it shouldn’t be a revenue opportunity. It is an opportunity to service the patient. If it is within the first year, you may want to include one freebie. I remember my mom being so angry with my brother’s orthodontist because he lost his retainer at college out of state. She had to fly him back home AND pay $500 for new retainers. Granted, this was back in the 90’s. That is crazy expensive!
2. Retainer insurance: This program is uniquely designed by each office with the goal of lessening the cost of lost or broken retainers. I like the idea of a small monthly or annual fee for this insurance. Think Amazon Prime. $5 a month or $50 a year to lock the retainers in at an affordable rate of $50-$100. This is best if you can store the STL of the finished outcome in the cloud so it can easily be duplicated and mailed without an impression or scan.
3. Lifetime retainers: Programs like this acknowledge that retainers are a lifetime commitment and that they should be replaced periodically over time. In general, this program is presented as an additional service at the initial treatment consultation. Fees range between $500 and $1000 added to the treatment fee, but they are often spread out over the financing term for the treatment fee as a whole. I don’t like this option because I think it devalues your practice if you ever need to sell because there only risk for the new buyer and no production.

A clear, convenient and easily understood long-term retention plan is an important part of a professional orthodontic practice. It is only a matter of time before venture capitalists see the opportunity in retention for DIY, so it is critical that you get a jump on the opportunity to launch it in your office.

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