#4 – Manages specialists: Orthodontist


Many practices have dental specialists working part time and for groups, the specialists may rotate between locations. This section will provide training for an office manager to coordinate for an Orthodontist.

What we will cover:

1)     Get to know your Orthodontist

2)     Responsibilities of:      a. Secondary Person (Backup)    b. Coordinator

3)     Ortho Day Breakdown:     a)  Prep   b)  Checklist   c)  Huddle

4)     Ortho Scheduling:   a)  Guidelines    b)     NP / re-eval   c)      Records   d)     Banding   e)      Ortho Visit – Adjustments           f)    Removal    g)     Retainer Check   h)     Retainer replacement   i)     Scheduling Treatment   j)       Paperwork  k)     Ortho Abbreviations/terms

5)     Ortho Insurance

6)     Monthly reporting:   a) Ortho Aging  b) Recall   c) Patient referral / thank you   d) Checklist for ortho patients referring ortho patients   e)  End of Month

7)     Consults:    a)  Prepping   b)     FA’s   c) Consents / Contracts

8)  Misc: a) Checklist   b) Prep day sample   c)  Examples of Letters  d) Classification Models



Now it is time for you to be the office manager for a specialist. You may want to work with each specialist for a short period of time to get a better feel and understanding of the operations of their practice. When you are done you will be assigned a specialist to manage or co-manage. Good luck! In a group practice with multiple specialists, we call each office manager for specialists a “Specialist Coordinator” so we may have an “Ortho Coordinator” and a “Pediatric Coordinator”, etc. This just helps make each person’s role clear.

Checklist for starting a new Specialist Coordinator

  1. Select the Specialist Coordinator with the specialist’s consent.
  2. Set the training schedule
  3. Review the training schedule with the specialist
  4. Administrator meet with the coordinator after 2 weeks to review the level and answer questions.

Steps to train a Specialist Coordinator:

  1. Read through the section for that specialist in detail
  2. The past coordinator to discuss this section page by page with the new coordinator if available
  3. The new coordinator to observe the past coordinator for one day
  4. The new coordinator to work for the Specialist with the past coordinator observing for one day
  5. The new coordinator is now responsible for the Specialist!

Being a Specialist Administrator

Our specialists are highly trained, creative people who are used to working in solo practices.  The challenge for you is to facilitate them to effectively use these talents within the framework of our group to promote the best business results.

As a specialist administrator you have 7 tasks

Task #1: Coordinating the specialist’s energies to fit within our group’s needs

  • Expect your specialist to have a strong personality with definite personal objectives.
  • Spend time observing and learning his/her:   Background, Motivations/Goals, Strengths, How to channel their strengths to promote their and our needs
  • Expect conflicts now and then and learn to handle it to create positive outcomes
  • Expect periodic personality clashes and tension with a push to have their own way at the expense of others.
  • Recognize that pushing for conformity will only antagonize and lead to withdrawal into their shell and disengagement from the group – and taking their good ideas with them.
  • Your success requires you to know how your specialist will react under stress, what personal needs drive their decisions, and how they are comfortable fitting in with their team and the other dentists

Wow! This is not easy! You’ll need the courage to stand up for yourself, the belief that you are okay, doing the right thing, the flexibility to adjust your approach quickly as needs change, and the tact to help them feel they did it.

Ideas to help you succeed:

  • Don’t make unnecessary compromises
  • Develop a staff culture of commitment, trust, respect, and accountability
  • Being able to keep your temp when others lose theirs
  • Manage each person as an individual who has their own strengths, weaknesses, and reasons for working here

Task #2: Understand why your specialist acts the way they do:

  • What are their credentials – where from, how long
  • What were childhood experiences that helped develop personality
  • Type of friends, where live, what do for fun, proudest accomplishments, hobbies
  • Develop a relationship by listening carefully working to develop mutual trust and understanding

Task #3: How can you help them to fit their creative energies and clinical skills into our value system:

  • Develop an environment for your specialist of respect and freedom
  • Avoid  “rules” that limit creativity and freedom to “do their own thing.”  They need to feel they run their own show – some more than others
  • Help them implement new ideas quickly and smoothly.  If they conflict with the group, get with the administrator and owner to discuss confidentially and plan a strategy.  The focus needs to be “how” not get “permission.”
  • Promote a light, fun, environment
  • Stress interdependence with everyone
  • Build trusting, open communications with few secrets and minimal reasons to gossip
  • Stay focused on activities that produce measurable results and then share these statistics with your specialist.

Task #4: Insist on Excellence and Results:

  • Mirror what you expect from your doc and team: Clearly show the visible, measurable results you expect; Be consistent; Provide consistent support; Support growth through the levels
  • Allow conflict, dissenting opinion: Must be for some constructive purpose; Based on fact, not feelings; In a reasonable tone of voice
  • Insist on taking accountability for idea and outcome
  • Set personal standards at least as high for you as others
  • Strong focus on staff career development
  • Develop staff/doc meetings focused on practice improvement

Task #5: Support your specialist to manage staff, build the practice and innovate new concepts

  • Build a strong culture based on our vision, goals, personnel, structure, and actions: Lots of collaborative thinking/dialogue; Rapid sharing of knowledge; Informal, respectful environment
  • Regular meetings promoting all to participate
  • Minimize blame for mistakes: “what did we learn to avoid this outcome when we try again?”
  • Recognize and reward positive results – great and small
  • Use administrator to support your efforts

Task #6: Communicate your organizational structure in such a way that the specialist doesn’t feel controlled by you or our group

  • Clearly define how specialist fits their practice into the group
  • Emphasize how working with our group creates major advantages for your specialist: Increased income; Turnkey clinical care; Solid referrals; Cooperative marketing, etc.

Task #7: Manage effectively while balancing the needs of the specialist and our group

  • Make sure you feel a “can do” attitude – that you are “ok”
  • Work hard to really understand who you are: your strengths, weaknesses and goals
  • Don’t judge good/bad.  Accept the present and plan for the future

Tips on Managing your First Specialist

Reasons docs don’t act when they should:

  • Complex situation causes confusion
  • Tendency to over analyze details delaying decisions
  • So much information from so many sources can’t chose relevant information to make decisions

Practice crises are not caused by:

  • Poor performance
  • Wrong things being done

Instead, they are caused by the old way that led to success no longer works

Administrator’s task to avoid crisis is to have a clear vision of the future that inspires her team to new actions leading to success

  • Narrow the massive information complexity to key, necessary information
  • Have a strategic plan
  • Develop visible measurable goals
  • Focus on most important goals
  • Steer doc clear of intuitive jumps into action that aren’t supported by fact.  Results must be visible and measurable.

Checklist to Implement Inter-Dentist Referrals

All dentists in the building want to refer back and forth between each other – both for GPs & Specialists. Each specialist coordinator is responsible for running the following checklist with their specialist. The instructions are written from an Ortho coordinator example. The same applies for all specialist coordinators.

  1. Secretary/Greeter to check ortho patients for “Do you have a regular dentist?”
  2. Print ortho schedule and highlight all patients scheduled that day that do not have a regular dentist
  3. Assistant Ortho Secretary to mail packet – practice Brochure and Welcome Letter and care to share card
  4. 3 days later –  call pt. to F/U and try to schedule for Comp Exam, CMX ( for adults)


Get to know your specialist

Fill in the blanks:

Dr. ____________ –  Attended ______________ for his education. Special clinical interest of ____________________________. Dr. is a member of ______________ and he practices in our office on _______________.

  • Review a copy of your specialists CV to learn his/her professional background
  • Ask about his/her family – understand their personal experiences
  • Learn more about orthodontics – Watch the Caesy smile channel, Visit the ADA’s website to learn more at and ask your specialist what other materials you could review to understand more about their specialty


Since Orthodontists have 4-6 columns of patients, we staff two administrative team members at the front desk to support the Orthodontist. The Primary person is the Ortho Coordinator and the secondary person is the Ortho backup.

Responsibilities of the Ortho Coordinator (Primary)

  • Keep schedule full.
  • Oversee schedule prep as well as NP/re-eval forms.
  • Take care of secondary person’s role when that person is out
  • Maintain Bingo
  • Maintain blocks in schedule: 8am & 10am – 2 hour blocks for bandings/removals, 11:30am – 2u block for emergency patient (Best for someone who calls & says that their bracket came off & are scheduled in the future for an ortho visit)
  • Lunch – watch that no one schedules all columns
  • Theme Days – make sure patients are aware at upcoming appointment, Take pictures of patients who participate in theme day and explain we will be posting pics on Facebook – the patient with the most likes will win a gift certificate (or whatever Dr decides for prize)
  • Columns (block 3rd & 4th to avoid all afternoon appointments filled then  open as needed)
  • Emergencies space out throughout day (take out of schedule 1 day prior to actual day)
  • Consults and FA’s for Treatment – Once Dr has seated patient and discussed recommendations with them, he will let you know this information so you can prepare documentation.  Prepare excel sheet and contract in system.Using blue folder, meet with patient and discuss. After following steps on checklist – make clinical notes in system noting who you spoke with, what treatment was recommended and results (ie:  need to talk woth spouse, waiting on ins …etc). If treatment accepted, get appropriate documents signed and scanned. Charge out any steps that are performed that day – sometimes they choose to get the “records” appointment done during this visit if possible and set up future appointments as needed

Follow up steps from treatment:

  • Document  on checklist what treatment was recommended and what fee Dr assigned – noting any discounts or notes you need to explain fee.
  • Make sure charged out correctly according to insurance chart and noting any discounts given (ie: sibling discount 10%).
  •  Make appropriate notes in appointment(s) coding the appointment with “NA” to make appointment color red.  This may change as appointments get confirmed, so may have to go back in periodically to “make red”.  (Sample notes:  Need to sign FA’s/contract;  HH scanned/system updated)
  • All new patient’s health history has been entered, signed by Dr. and scanned.
  • Confirm all new patients have either recall set, conference scheduled or clinical note.
  • Make sure all referring letters, completion letters and start treatment letters are completed and mailed to GP docs.
  • Consent forms/contracts signed and scanned.
  • Coupons printed/ amortization schedule scanned.
  • Retention contract signed/scanned – Testimonial – FB permission.

More Ortho Coordinator Responsibilities:

  • GP side patient file needs updated with ortho flags or notes.
  • Follow up recall sent out by _______  make calls to schedule – update excel sheet.
  • Coordinate with Dr /staff info needed for day.
  • Email copy of schedule to Dr with any reminder notes you may have ( bingo winners – problems – updates)
  • Huddle
  • Get color coordinated sheet to ________ at end of day with canc/no show, payment  and scheduling notes updated.
  • Maintain cash drawer/log.
  • Monthly reporting
  • Specialist meetings

Responsibilities of the Secondary Person (backup)

Initial Visit

  • Make sure each new patient/re-eval has Initial Visit section of checklist completed.
  • Verify ortho insurance benefits and document in G-notes.
  • Call patient if no insurance is listed on ortho account.
  • For GP side patients – Copy GP health history for initial exams and attach ortho only dental history page and note on appt line if health history is needed.
  • Make sure each new patient has a “referred by”.
  • First visit date verified and noted by Initial exam date of checklist.
  • Update ortho treatment flag with last prophy date (or flag as Not our GP side patient).
  • Make sure there are enough blue consult folders prepared.

Print schedule and document/ highlight as follows

  • Ortho $ due in green
  • GPside $ due in yellow
  • Due for Prophy as our GP patient in orange – noting actual due date beside it – including 6-8 weeks out to coordinate next visit with due dates
  • Non-GP side patients in purple
  • Starting treatment in pink
  • Past 27 months in treatment in blue (off to left side of appt) – we highlight these to bring Dr.’s attention to these patients so he can discuss treatment with each one and make a plan for when the braces will be removed
  • Update ortho treatment alert with last prophy date (or flag as Non-GP side patient).
  • Color copy this appt schedule for ortho coordinator.

Other Tasks for Ortho

  • Responsible for majority of checkouts.
  • Responsible for scheduling next visit(s)
  • Collects monies at check in and noting on “prepped schedule”.
  • Communication with Orthodontist and assistants to make sure patients are seen in timely manor – keeping track of wait time.
  • Update cancels/no shows from day onto broken list – could create a separate ortho broken appointment list
  • Make calls from Broken and Recall lists to schedule.


For each initial exam, re-eval, start and removal appointment you should have a checklist that shows the steps for that day.  Each one can be color coded to match the prep for that day. ie:  Initial = orange, Starts = pink, removals = blue


Print 2 copies of the day’s schedule.  Put one copy on Dr.’s desk.  Click on the note box on that days schedule and review any FYI “notes”.

The huddle for Orthodontics is different from the huddles for other Dentists.  To prepare for the huddle: At the huddle: review number of new patients, look at future week schedules for banding times, give referral letters, discuss any scheduling problems

The On Track Huddle- Orthodontist

  1. Good news for the day­­­­­­­­­­_____________________________________________
  2. Is all staff present- anyone out _______________
  3. Did everyone clock in this morning?
  4. Last day’s schedule
    1. Consults scheduled____________sched for conf_____________________
    2. Conferences scheduled_________sched for tx______________________
    3. NP/Referral letters__________________________________________
    4. Completion letters__________________________________________
    5. # due for pro_________   # scheduled_________
  5. Today’s schedule-let’s review:
  6. # due for pro________ has flag- please discuss importance
  7. Removals/Retainers_______________________________________________
  8. Testimonials for:_________________________________________________
  9. Money problems (client with large balance or WW balance)____________________
  10. Client problems (upset, frightened, appt. problems, premeds, medical alerts?)______
  11. Next week schedule: _______________
    1. Check clinical notes for add’l tx
    2. Check long appts for correct tx (start phases, seps/bands)
    3. FA’s
    4. Retainer pick-up

Ortho Scheduling – Dentrix

Ortho scheduling guidelines

  • We reserve after school hours (3pm and later) for periodic ortho visits that last 2u or less.
  • There are 4 openings for bandings or removals each day – 2 appts at 8am & 2 appts at 10am
  • No appointments over 2u are to be scheduled after 3pm. To explain to clients why all 3u & longer appointments are before 3pm, say “We reserve our after school hours for regular ortho visits – this allows us to take care of more families at a convenient time. This will allow YOU to come after school for your child’s ortho visit.”NEVER shorten appointments
  • When a client calls to schedule an ortho visit, you must check the ledger to see if they have had a banding appointment and if they have come in before for ortho visits. If so, then you will schedule a 2u ortho visit. If not, then you must read Dr.’s clinical notes to figure out what needs scheduled.
  • If a visit is more than 2u, type on appt description line 3u, 4u, etc.

What goes in each column:

  • DRKN – Ortho visits or retainer checks only and after 2pm only 1u or 2u ortho visits and retainer     checks
  • EXAM – Ortho visits or retainer checks only and after 2pm only 1u or 2u ortho visits and retainer checks
  • RCK1 – 8am-12pm banding/removals only and after 1pm only 1u or 2u ortho visits and retainer checks
  • RCRD – 8am-12pm banding/removals only and after 1pm only 1u or 2u ortho visits and retainer checks
  • RECD – 8am-12pm banding/removals or Initial Exams and Conferences and after 3pm only 1u or 2u ortho visits and retainer checks
  • XTRA – FA’s for conferences only 8:15am-11am and 1pm-3pm

Orthodontic patients are handled in a different manner than any other specialist area.  The patient names all have:

  • Account type 7
  • (zz space) in front of their last names (ex:    zz Smith, Charles)
  • One patient in treatment to one guarantor name
  • Almost every patient is on a contract with coupons
  • Chartless – everything scanned to doc center

Every Orthodontic patient follows these appointment steps:

  • New patient initial exam appointment – no charge (1 hr in RECD column)
  • Re-evaluation appointment – no charge – (1 hr appt in RECD column)
  • Records appointment – 1 hour ($147) – am apt
  • Banding appointment – 1 ½  hour ($472) – am appt
  • Adjustments “ortho visit” appointments (30 min appt)
  • Seps (15 min appt) one week before bands
  • Bands (30-45 min appt) one week after seps
  • Removal appointment (1 hr appt) must no later than 2:00pm
  • Retainer replacement appointment (30 min appt) must no later than 2:00pm
  • Retainer check appointments (15 min appt)

There are exceptions to the above appointments – some records/banding appointments are combined; some patients receive retainers only; etc.

New Patient Initial Exam Appointment – 4U 

Before the appointment

Fill out checklist (sample on page)performing all steps listed under Initial Visit

     After the appointment

Check the family file to update any patient information, especially the referring name and who their general dentist is. Then create a thank you for referring letter.

Create the Ortho thank you for referring letter

  • Go to Patient’s Family Screen
  • Click on Quick Letter
  • Highlight – ortho referring DDS final letter (or which ever letter you need)
  • Click on Build/View
  • The letter will pop up on the screen
  • Delete zz between first and last name of patient
  • Type in today’s date (treatment date) and delete excess spacing
  • Type in Dr’s words and delete excess spacing
  • Create a second page with patient name, date of birth, info and pictures from patient gallery
  • Print letter, give to Dr. to make any necessary changes
  • Once final letter is ready, have him sign or stamp his name and mail to the referring Dentist or if one of our Dentists place in red folder on west wing for documenting and filing.
  • File save as: F:sharedSecretariesSecretarial administrationSpecialistsOrthoReferral Thank you then type patient’s name

If the patient scheduled tx, note the amount due, and request signature on contracts, if necessary.

If not ready for treatment yet, make sure the ortho recall is correct in the computer

If patient doesn’t schedule tx, make note in planner to call and follow up 1week later- make clinical note why they did not schedule.

Update ortho checklist and scan to doc center


Schedule Initial Exam

  1. 4u appt in RECD column
  2. Dr.  will evaluate whether or not patient needs treatment
  3. If treatment is necessary, follow up with consult
  4. Prep consult folder to include: (on the left side of the folder) Dr. profile, braces brochure, Speciality brochure, and business card; (on the right side of the folder) FA contract, consent form, and care to share card.
  5. Prepare FA’s – see Consults section

Records Appointment – 4U

This step is sometimes performed at initial exam if patient accepts treatment that day.  This is the appointment where they take Pano, Ceph, Models and Photos.

Banding Appointment – 4U – 6U

Before the appointment

  • Fill out the Start Appt section on checklist
  • Make sure that the correct banding ortho code is scheduled with the correct dollar amount

During the appointment

  • Collect the down payment amount
  • Follow any notes made in appt

After the appointment

  • Make sure the correct fee was charged out DO NOT SUBMIT TO INS- give color coded schedule printout to the collections/insurance staff person to process and print the insurance form if applicable

Prepare the Coupons for the Banding Appointment:

  • Click on patient’s Ledger
  • Click on Handshake icon
  • Type in dollars for coupons in Bal. For PA box (about middle of the screen).  The dollars are from the contract, page 6, “Deferred payment price”
  • Type date in First payment due box.  This is always the 15th of  the next month following the banding appointment
  • Type in dollar due each time in Payment Amt. box.  The dollars are from the F.A. sheet, “Monthly installment payments”
  • Set the Contract/Coupons:  click on Terms, click on Select Type, Click on OK,  Click on OK,  Click on Print,         Click off Truth in Lending Disclosure and Click on Coupon Book,  Click on Print, Click on OK, The coupons will print three (3) on a page.
  • Give coupon booklet to patient
  • Scan payment amortization to document center

Adjustments “ortho visit” Appointments – 2U – 4U

These appointments will occur every 4 to 8 weeks depending on the length of time the patient has been scheduled for treatment.  The charge for these ortho visits is included in the fee for the total treatment which was charged out at the banding appt.  Most of the appointments will be for 15 to 30 minutes; some of the appointments will be longer – adding brackets, bands, etc.  Dr. or assistants will let you know if an appointment needs to be longer and how many units

Removal Appointment  – 3U

Before the appointment

  • Complete Removal Appt on checklist
  • Check the patient ledger for any outstanding dollars on the account.
  • Clip together retainer consent form, wear and care instructions, testimonial form and care to share card to have ready when patient checks in.

During the appointment

  • Collect the outstanding balance, if any
  • Have parent or adult patient fill out and sign testimonial form and retainer consent form. Give them the wear and care instrustions for the retainter for the assistants to go over with the patient.
  • Scan to doc center

After the appointment

  • Make sure the removal codes (removal, ortho retainer and seat retainer) were used and no retainer has no fee charged
  • Dr. will fill out “Ortho-Completed Tx” letter-handwritten
  • Build/view the quick letter “Ortho-Completed Tx” letter, give to Dr. to handwrite info.  Give the letter to Dr.  to make any changes, if necessary.  Once the letter is typed and the final is ready, mail to the patient’s Dentist or if it was an in office General dentist, place in the file bin to be recorded in the patient’s chart.
  • Save this letter in F:sharedSecretariesSecretarial administrationSpecialistsOrthoRemoval Letters (then patient’s name)

Retainer Check Appointments   – 1U

There is no fee for retainer checks for the first year or two.  After the patient has been out of braces and has been wearing the retainers for a year, there could be a charge for additional retainer checks.  Dr. will advise.

Retainer Placement Appointment – 4U

There is no charge for the retainer placement appointment – usually occurs the day the braces have been removed.  Make sure this code is charged out when retainer is placed.  There is a charge for any replacement (lost or broken).  This $150 fee PER retainer will usually not be covered by insurance. 

Scheduling Treatment

To treatment plan for ortho in Dentrix – There are multi-codes set up in the tooth chart that have all the codes needed to treatment plan specific recommended treatment.

  • Full braces – also used for Invisalign
  • Child full braces
  • Child partial braces (also known as Phase I or Early treatment)
  • Records- this includes pano, ceph, diagnostic casts, diagnostic pics
  • Go to the tooth chart for the patient, select multi codes and look for the 2 ortho multi codes (tx and recs)
  • Partial records are done at the initial exam but not charged until accepts treatment and records are scheduled

Ortho Paperwork

All Orthodontic handouts are kept physically in the Ortho Forms Binder

  • Highlighted prep page – Used to make sure all payments are collected and prophies are scheduled. Make notes of payments and scheduling on this page.  Give to the billing/collections person at end of day
  • Dr. Khan’s profile – Put into every consult folder and Mail to all patients you schedule for initial exam
  • Brochure for referring dentists –  Used to market HP specialists and Mail with thank you for referring and completion letter to patient GP’s
  • Braces trifold brochure – Mail to all patients you schedule for intial exam and Put in every consult folder
  • Braces Handout – “More than one way to straighten teeth” – Put in every consult folder and At consult – review the four systems available and determine what the patient wants.
  • Frequently asked questions – Give to any person inquiring about orthodontics and Flyer to put in every consult folder
  • Medical/Dental History – Separate health histories for adults and children,  Mail to all patients you schedule for initial exam,  After appt, make sure Dr. has signed Heatlh History then scan to doc center
  • Weekly checklist – Used to prep and follow up
  • Consult checklist – Used to prepare for initial exams and schedule tx
  • Consult cover sheet – Glued to consult folder as cover page
  • Sign in sheet – Put on front check-in window ledge for patients to sign in at arrival
  • Patients Here –  Lets back staff now a patient is here and Attach this page to a clipboard and hang on wall in hallway, Write patient name as they check in, highlight their name in blue if 27+ months in tx
  • Lab Slip – Assistants use to label lab cases
  • Huddle –   8:15am huddle with Dr., assistants and secretaries – used to review day
  • Excel payment calculation form –  Secretary uses info from new patient checklist to complete the cells,  This form merges to create Treatment Plan Fa’s,  Copy to doc center
  • Early Treatment plan – Used to explain tx plan and Fa’s during conference,  Informed Consent is included toward the end of the document, the parent must sign and date this before starting braces,   Financial contract is at the end of the document, the parent must sign and date to agree to payment arrangements before starting tx, Secretary is to make sure this form is signed, a copy is given to the patient, our copy scanned to doc center
  • Financial Arrangement Contract (several versions 1) expander & full tx, 2) Express Smile, 3) Full Treatment, 4) Invisalign) –  Used to review financial arrangements during conference,  Secretary creates this word document by merging from the excel sheet,   Parent must sign and date agreeing to financial arrangements  before starting tx,  Save signed copy in document center, original to patient
  • Consent form –  Used to explain limitations and risks of tx,  The parent and child must sign and date this before starting tx, Secretary is to make sure this form is signed, a copy is given to the patient, our copy scanned to doc center
  • Invisalign consent form – Used to explain limitations and risks of Invisalign tx, The parent must initial each page before starting tx, Secretary is to make sure this form is initialed, a copy is given to the patient, our copy scanned to doc center
  • Pay as you go form –  Useful to patients that want to auto withdraw pmts, Make sure ALL info is completely filled out and signed, scan to doc center and make GNote that patient is using this form,  Give form to insurance/billing person
  • Orthodontic referral form –  Used internally when HP refers to Dr. for ortho tx – GP fills out & secretary scans to ortho doc center,   Dr. fills out “comment” section and returns to GP side after initial exam
  • Ortho refer out –  Has separate form for child and adult,  Used when Orthodontist refers a patient to their GP for treatment,  Give to patient after we scan copy to doc center
  • Ortho Handout – “User’s Guide” – Back staff reviews at banding appointment & gives to patient
  • Thank you for referring letter – Sent to patient GP to thank them for the referral and let them know what tx plan is, Sec print ortho ref-blanks quick letter, give to Ortho to fill out. Dr. will return to secretary to type and give back to Dr. for approval and signature.  Save to: F:SecretariesSecretarial administrationSpecialistsOrthoReferral Thank you(Patient Name).doc.  Make second page to letter of patient pics   Print and mail to GP
  • School excuse form – Original to patient, no need to keep/scan a copy
  • Discontinuation of treatment –  Must be signed and dated when braces come off early, Scan to doc center,  Mail letter to DDS
  • Retention contract –  Given to parent or adult patient to sign and date when getting braces removed,  Scan to doc center
  • Retainer Wear and Care Instructions –  Given to the patient with Retention contract,  Attach a care to share card,    Back staff reviews w/patient
  • Completion of Treatment –  Sent to patient GP to let them know patient has completed ortho tx, Sec print ortho completed tx quick letter, give to Ortho to fill out. Dr. will return to secretary to type and give back to Dr. for approval and signature.  Save to: F:SecretariesSecretarial administrationSpecialistsOrthoRemoval letters(Patient Name).doc    Print and mail to GP
  • Case completion – note to patient/parent, Mailed to parent when not present with patient when braces were removed, Gives retainer recommendations and GP follow up
  • Testimonial Consent Form –  For clients who are a good testimonial after removal, Must have parent/guardian signature if under age 18,  Prepare testimonial with pics from patient gallery, save to T:MarketingInternalTestimonials(Patient Name).doc    Post picture & comment on FB
  • Braces Bingo – Used to encourage patients to care for their braces and hygiene,  See F/secretaries/sec admin/specialists/ortho/ortho bingo/bingo rules for more details
  • Post Tx Conf Postcard – A gift used to thank patients for allowing Orthodontist  to complete their tx,
  •  Put in removal basket and give at deband appt,  To order more postcards, contact Photographer
  • Collection Letter – first –  Insurance Coordinator, sends when patient missed payments
  • Collection Letter – final –   Insurance Coordinator, sends when patient far behind on payments and offering to remove braces
  • Overdue for prophy letter #1 – Mailed to patients 8 months overdue for prophy, Scan copy to doc center, Document in clinical notes and GP Gnote that letter was mailed
  • Overdue for prophy letter #2 –  Mailed to patients 9 months overdue for prophy,  Scan copy to doc center,   Document in clinical notes and GP Gnote that letter was mailed
  • Ortho checkout-  Back staff fills out for each patient for what was done today and what is next visit, Patient carries to front staff to schedule next visit appropriately and check out correctly
  • Orthodontic Alert –  Assistant and/or HP hygienist to fill out and secretary to mail to parents due to lack of cooperation for tx and/or hygiene, Scan copy to doc center, Document in clinical notes and GP Gnote that letter was mailed
  • Express Smile –   Used at consult to show what limited treatment can do
  • Consult Flyer –  Put in every consult flyer,  Shows what ortho has to offer
  • Theme day appt cards –  Used when scheduling on theme days, $250 discount card,  Encourages patients to schedule all a.m. appts – our difficult times to fill,  Just an idea – on hold

Orthodontic Abbreviations / Terms

Orthodontics is a separate “language” from dentistry.  When clients have completed their ortho appointment here is a list of abbreviations you may see .

N/V = Next visit

Deband = Remove braces

Seat Retainers = Place Retainers

EDCBA / ABCDE         ABCDE / FGHIF = Dentist’s Terminology of

EDCBA / ABCDE         TSRQP / ONMLK Primary teeth

AW = Archwire

Arrow up = Upper or Maxillary

Arrow down = Lower or Mandibular

P.O.H = Poor Oral Hygiene

O.H.I. = Oral Hygiene Instruction

Co-op = cooperation

Seps. = Separators = Little rubber rings placed between the teeth

Twist = twistoflex = type of archwire

H.G. = Headgear

Records = Cephalmetric X-ray, Panorex, Intra- oral photographs, extra – oral photographs, maxillary and mandibular arch impressions for study models

Recall = See at later date for continued evaluation

Recement = Cement loose or band

Hyrax = Maxillary Expansion Appliance

Ortho Insurance

Find out which insurance plans the orthodontist has joined.

Find out how to handle Medicaid patients – does he have a referral for these patients?

Monthly Reporting

Ortho Aging


Ortho Recall Follow up – if never scheduled from recall card,  Call twice to schedule them, If still not scheduled, personalize and mail “ortho follow up” letter- from quick letters (retainer checks only get the 2 calls, no ltr necessary),   Insert any promo flyers, Document on excel sheet and clinical notes,   List to be worked weekly


One week or so after the telephone calls have been placed for ortho recall we send a follow up letter.  This letter is similar to general dentists recall letter.  It is in the quick letters as “orthofollowup” letter.

  • Click on family file
  • Pull up patient (remember zz)
  • Make sure does not have a future appointment
  • Click on first person listed on the account (usually a parent)
  • Click on the envelope icon (quick letters)
  • Scroll down to the “orthofollowup” letter
  • Click on “Build/View” (takes a while to merge)
  • The letter will appear –
  • delete “for _______zz” from the address
  • delete “for _______” in salutation
  • add child’s name to first line (delete extra spaces)
  • Print the letter, copy to document center
  • Close the window and say “NO” to question do you want to save changes
  • Close the letter
  • Change the patient status to inactive and delete and CC dates
  • Note “sent ortho follow up letter” in clinical notes
  • Stamp Dr’s signature at bottom of letter
  • Mail letter (fold under the salutation and it will fit in a window envelope)

Ortho no show or cancelled appointments

We call to reschedule them or send them a “missed ortho appt” letter- from quick letters.

We do not believe in charging ortho patients a fee for their first missed visit- we know that most physicians do this, but we want to maintain a friendly relationship with our clients and feel that charging them for missed appointments would cause bad publicity.

We want our patients to appreciate the value of our time and realize that there are consequences of missing an appointment. How to handle a client calling to cancel:

  • Oh Mrs. _____, I’m sorry you won’t be able to make your appointment.  I know Dr. ____ was hoping to see you for this visit so your orthodontic treatment is not delayed.  If we reschedule your appointment, it will probably be 2-3 weeks.  Will you be okay until we can arrange that visit?
  • However, if a patient needs to cancel, reschedule their appointment immediately, no problem. If a patient missed 2 or more appointments in a 12 month period, then they are considered a chronic no show.
  • To log a no show or cancellation with less than 24 hr notice (not for new patients):
  • Record event in ledger by changing the treatment to cancel or no show, then setting appointment complete (no need to break appointment)
  • Make sure the patient’s name makes it to your ortho broken appointment list
  • Attempt to call the patient to give them the no show speech and mail quick letter
  • Script when calling: “Hi, this is Bobbe calling from HealthPark Dentistry to schedule your orthodontic visit. Please call me at 937/667-2417 so we can get this scheduled for you.”
  • Flag account “Chronic No Show” then write note “Cannot schedule until speaks w/Bobbe for the chronic no show speech”
  • Mail quick letter “ortho missed appt”, copy to doc center
  • Script when they call back: “Thanks for calling me back.  It looks like you need to get scheduled for your orthodontic visit, right? I see you missed your last appointment (or 2 or 3) with us. (pause and let patient speak) I understand that things come up and schedules change. The tough part is that we waste that time that we could have given to another patient for their treatment. I’d be glad to get this appointment scheduled, however, if you miss this appointment you will be charged $25.”
  • Document instance in clinical notes & flag
  • After the speech is given flag the account to read “charge if missed, no show speech given- date and initial.”
  • If a patient misses another appointment and already has a flag that shows they have had the chronic speech, then charge the patient for missing this visit, mail letter “GP missed appt charge”. Scan to doc center & document in clinical notes.

Patient referral / thank you

To run a patient referral report & send thank you letters for ortho:

  • Open Dentrix, Office Manager
  • Reports, Management, Referred by Patient Report
  • Provider – all to all
  • Referral & Production Dates – select for the month (or whatever range you need)
  • Referring patient – Select ZZ a to ZZ z to search all ortho patients
  • Click okay – this puts this report into the office manager print list
  • Select this report & click print
  • Once this report has been run, review it to find any outside the family referrals (do not just look at last names, there are many families with multiple last names).
  • For all outside family referrals, build/view the Ortho Patient Referral quick letter. You will need to make sure the names print correctly (remove all ZZs) and add in the correct monthly payment amount and the month they have earned credit.
  • Coordinator to make the adjustment to their ortho account.
  • Have Orthodontist sign this letter.
  • Make a flag and G note in both patients accounts of the referral.
  • Give the patient another care to share card at their next visit with a reminder to Dr. to thank them for the referral.
  • Checklist for ortho patients referring ortho patients

Run the Referred by patient report and look for any ortho patient referrals.

  • Go to office manager, Reports, Management, Referred by Patient report
  • Change the dates for referral & production to the month you are looking at.
  • Change the patient lookup from ZZ A to ZZ Z to include all ortho patients.
  • Click okay and then print the report.
  • If you see any ortho referrals, then look into the new patient’s ortho ledger to see if they started braces.
  •  Check to make sure these referrals are OUTSIDE the family, ifso then they get credit.
  • If they did, then build/view the Ortho – Referred patient quick letter and add in both the monthly payment (for the referring patient) and the month this credit will be given (use the next month). Then, print this letter, have Ortho sign, include an ortho care card & mail to the patient.

End of Month

At the end of each month, the ortho coordinator is responsible for filling out an end of month report. Found in F:sharedSecretariesSecretarial administrationSpecialistsOrthoEnd of Month (excel).  The purpose of this report is to provide some results to the Orthodontist and to make sure you have a strong follow up system for major cases.

You need to run reports in Dentrix to find :

  • New patients
  • Case acceptance
  • Start by creating new excel worksheet :
  • Open Excel F://shared/secretaries/secretaries administration/specialists/ortho/endo of month/case acceptance 2013
  • Create a new worksheet for the month
  • right click on the last month created
  • select insert
  • make sure Worksheet is highlighted, click ok. Wwill automatically be named Sheet1. click down and drag to after last month created right click on Sheet1 and click rename
  • Now, type current month
  • Go to previous month and copy format to new month, deleting patient info from previous month
  • Click save button

To find new patients, run the following report for code D8000-8002 (ortho new patient exam) :

  • Office manager, letters, Misc tab – highlight the letter that says “Completed procedures report” and click Edit
  • Select Edit – the defaults are all correct, they are:
  • Patient name: ZZ a – ZZ z (the ZZ patients are the ortho patients)
  • All providers
  • Checkmark the patient box
  • Uncheck all gender, position & balance aging boxes
  • Do not check the “Guarantors only” box
  • Billing type 7
  • Clear all the fields (starting with appointments and ending with zip codes)
  • Click the button next to Procedures – this brings up a window “Select procedure range”
  • Checkmark the Completed box
  • Enter D8000 in the Beginning and D8002 in the Ending box
  • Enter the month in the Beginning and Ending date boxes (for example 1/1/11 – 1/31/11)
  • Select Data fields: first and last name, first and last visit date, appointment date and reason
  • Click okay to close the window
  • Now click OK again to close this window also.
  • Click on Create/Merge – Select “Create data file Only” – click OK
  • Now it counts – you can watch the numbers as it looks for the patients who have a continuing care appointment in that month. This takes a few minutes since it has to look at each patient in the system.
  • Once the report is finished (the window showing the counting will disappear), then click View List – this will bring up your results in a window.
  • In the window, choose Edit – Select all and then Edit – Copy
  • Now, go back to Excel and click Edit – Paste (under Ortho Consults)

**Now, repeat for codes D0340 (Ceph x-ray), D8700 (Removals), D0130 (Emergencies seeing Dr. Mason), D9310.2 (Looksee)

To find ortho new patients: Search for Code D8000-8002 (initial exam and conferences)

To find ortho recalls: Check Family File in Dentrix for an ortho continuing care

To find ortho cases accepted: Search for Codes D0340 (ceph done w/ records) from your new patient list

Create extra columns to track:

  1. Letters sent to non-GP side patients
  2. Ortho collection goal
  3. Ortho collection %
  4. Phase 1, Full Cases, Invisalign, Limited tx, or retainer only (how many cases presented, now many accepted)
  5. Bonus per case
  6. Consults

Using “prepped” checklist Orthodontist will let you know what treatment he is recommending and go over what cost will be assigned (usually dictated by insurance chart) noting any additional discounts for siblings – match previous quote etc. Then prepare appropriate forms.

Financial Arrangement forms

  • To prepare the payment arrangement document:
  • Open Excel
  • Open the file: F:SecAdminSpecialistsOrthoFinancial ArrangmentsPayment calculation Dr Khan.xls
  • Fill in all gray cells: Lifetime ortho maximum and Deductible
  • Percentage the payments are made at
  • The dollar amount of ortho benefits used previously
  • Number of months of treatment
  • Total charge for entire treatment
  • If no insurance, write NO ORTHO INS  in Insurance Co field
  • Complete the remainder of the financial sheet (with or without insurance).   some info from calling the insurance, some info from the treatment plan Dr. Khan creates (number months in tx, total fee for treatment, etc.). DO NOT save this excel worksheet- copy to document center.

Next, open the Word Treatment plan – This automatically inserts the patient’s name, date and all the financial calculations from the Excel sheet.  Make sure that all the blanks have been automatically filled in correctly.

  • Print this contract to review with the patient & have them sign.
  • Give a copy to the parent in the consult folder to keep and color scan the original to the document center.
  • To save the financial arrangement contract to the patient’s family file document center:
  • With the FA contract open, click edit, select all- then right click, copy
  • Now, go to patient family file
  • Select document center
  • Click aquire, paste from clipboard
  • Select document type as “patient treatment”
  • Type Document type as “Ortho FA contract”
  • Click ok

Financial Arrangements for Ortho

Using blue consult folder go over cost, insurance benefits, and payment options with patient and whoever is in charge of that account.

  • Informed Consent form –  Write the patient’s name at the top and then the patient signs on page 2- for prophy notice and the last page for consent of tx.
  • Make a copy of this for consult folder and color scan original to the doc center.
  • Now, Sec. does consult with patient’s parent or adult patient.
  • Review the contract with the patient’s parents (or patient, if adult) –It would be wise to have read through the contract before you begin handling conferences to be able to briefly discuss topics.
  • Patient will either schedule tx, set continuing care for re-evaluation or WCU
  • After the appointment Check the family file to update any patient information, especially the referring name and who their general dentist is.

After the appointment

  • Check the family file to update any patient information, especially the referring name and who their general dentist is.
  • Create Ortho referring letter
  • Go to Patient’s Family Screen
  • Click on Quick Letter
  • Highlight – ortho referring DDS final letter (or which ever letter you need)
  • Click on Build/View
  • The letter will pop up on the screen
  • Delete zz between first and last name of patient
  • Type in today’s date (treatment date) and delete excess spacing
  • Type in Dr’s words and delete excess spacing
  • Create a second page with patient name, date of birth,  info and pictures from patient gallery
  • Print letter, give to Dr. to make any necessary changes
  • Once final letter is ready, have him sign or stamp his name and mail to the referring Dentist or if one of our Dentists place in red folder on west wing for documenting and filing.
  • File save as Referral Thank you then type patient’s name
  • If the patient scheduled tx, note the amount due, and request signature on contracts, if necessary.
  • If not ready for treatment yet, make sure the ortho recall is correct in the computer
  • If patient doesn’t schedule tx, make note in planner to call and follow up 1week later- make clinical note why they did not schedule.
  • Update ortho checklist and scan to doc center

Check off list for Orthodontic Patients  

Patient name: _______________________________ DOB:______________

Ortho  Tax ID #____________   NPI number: ____________


Initial Visit:

Initial exam Date: _______________                            Ins Co Name: __________________________________

□   Set up zz acct                                                  PhoneNumber: _________________________________

□   Billing type 7                                                   Contact Name: _________________________________

□   Fee schedule set for Managed Care                   Parent Name / SS#: _____________________________

□   Referred By                                                     Lifetime Max: _________________________________

□   First visit date                                                  Deductable: ___________________________________

□   Call ins. for ortho benefits                                Paid at What %: ________________________________

(delete ins. from their acct if no ortho coverage)     Pay automatically or Statements?: __________________

  1. Make G notes                                                   Any Ortho used?: _______________________________
  2. If no ins.listed, check GP acct.                                      For Adults, ask if ortho coverage for adults?: _________

If dual ins. ask secondary if they have a non-duplication clause _____________________________________


Recommended Treatment:      ____________________________________________

□   Edit the FA’s (word and excel document) to match tx fee and tx plan from Dr. Khan, print

□   Introduce yourself see if anyone has questions

□   Discuss insurance and make financial arrangements

□   Tx accepted:  Yes ___         No___              □ Clinical note made

□   Treatment plan contract signed- copy to patient (original in chart)

□   Financial Arrangement form signed- copy to patient (original in chart)

□   Tell patient about Care to Share _____ cards given

□   HH and Ins card scanned                                         □  Verify HH and insurance info entered correctly into system

□   Document on GP pink sheet if patient doesn’t accept Tx    □   Confirm all NP’s either recall reset – clinical note


Start Appt: ________________________________________

□   Make appt status “NA” (red) with insert dateline notes: 1) signing contracts  2) payments … etc

□   Confirm all new starts have both their consent & FA form signed and scanned

□   Confirm all new starts have coupons, amortization page scanned to doc center

□   Confirm all starts have referral thank you letter (unless GP side pt)

□   Flag prophy units for GP Acct in pt (extra units)

□   Update ortho Tx flag (Start date, GP side /not)

□   Confirm all starts were 1) Tx planned & charged correctly 2) any discounts given 3) managed care fees

□   Enter tx into dentrix

□   Insert payment arrangement note in start tx appt – how much to collect


Removal Appt:___________________________________________

□   Make appt status “NA” (red) with insert dateline notes 1) Testimonial – paper for FB or video 2) sign consent form – attach Dr.’s care to share card

□   Deband basket given (code 8002 in ledger) and deband note on pink sheet

□   Pictures downloaded and placed on FB

□   Confirm all removals have retention contract / testimonial form signed and scanned

□   All removals have completion letter to GP & document on GP pink sheet

□   Manually change retainer fee to $0

□   Update ortho Tx flag and Flag – no longer ortho



This is a fun way to help ortho patients to take care of their braces and be rewarded.

You will find a copies of the prepared bingo cards, rules, and pictures of prizes in: _______________

If a patients bingos, ask them what gift they want from the category they bingoed in, make a note in their next appointment and your planner so you remind Dr.  to bring it by their next appointment time. Let Dr. know what the patient wants so he can purchase it. When you give the prize to the patient, ask if you can take a picture of them with their prize (include a staff member or Dr. ), and post on Facebook. They will need to sign a release form and scan to their document center.

There is a folder located in the ortho drawer labeled “braces bingo”. On this folder, track the winning patient’s name and the prize they received.


This is a fun way to encourage ortho staff and patients to relax and have a fun time together and be rewarded.

October of each year you create a flyer to hang around the EW to advertise theme day. Involve Dr. and the staff – ask what ideas they have for each month’s theme. Google is full of ideas, too. Keep it simple. If staff has to purchase clothing or supplies to participate, your participation rate is going to be low. Examples: Crazy hat, mismatch clothes, sunglasses day, tie die, Christmas sweater, Halloween dress up…etc.

If a patient comes in dressed up, explain to them the directions involved:

  1. They earn an extra bingo spin for their braces bingo
  2. Sign a release, take a picture of them and post on FB (scan release to document center)
  3. Tell them to have all their family & friends go on our FB page & “like” their picture
  4. The patient with the most “likes” wins a gift card (usually about $10 and Dr.  picks where the card comes from)
  5. One week later, you will check FB and see who has the most “likes”, contact that patient and congratulate them
  6. Let Dr. know who the winner was so he can bring the gift card (usually he buys the multi pack to keep here so he doesn’t have to remember to buy them all the time, then you just need to let him know when you are getting low)
  7. Put an note in the winner’s next appointment so you can remember to give them the gift card
  8. Take their picture again and put on FB congratulating them

There is a folder located in the ortho drawer labeled “braces bingo”. On this folder, track the winning patient’s name and the prize they received.

Ortho Follow-up System

This system covers two area of ortho follow up

  1. Patients that did not accept treatment
  2. Patients that were mailed a recall card

Did not accept Treatment

One week after an initial exam of a patient that did not accept treatment, you want to call them – go back and read your clinical notes, follow up on whatever reason they had that made them not schedule the day of the initial exam. The reasons to not schedule are usually “I need to think about my options”, “I need to discuss finances with my spouse”, etc. This is a chance to answer any questions they might have about treatment or finances. Get Dr.  involved if there are questions you cannot answer. Document your calls and conversations in the clinical notes. This information will be helpful to you when you run end of month.

Recall Cards

Once per month we mail recall cards to any orthodontic patient due for either a re-evaluation or retainer check. One week after she has mailed these cards open the excel tracking document and pick the month you need to call and print it.

First, scan the patient names on your list – in parenthesis by the name, type retainer check for those that are out of braces and just need to come back for their 3-6 month retainer check.

Next, check to see who is scheduled. If yes, in the first column (for the first follow up call) type NV and the date of the appointment. Sometimes patients have come in early and the visit has already been completed. Type completed in the column and n/a in the other two columns – no other follow up is necessary. If no, call to schedule. Document the date of the call in this column and make a clinical note. One week later, repeat these steps for the second call attempt to schedule. For those that have a NV make sure the visit was completed – you may need to go back a few months to follow up on these appointments. If you notice they canceled or no showed, called to reschedule.

We make 3 attempts to schedule for those needing re-evaluations and 2 attempts to schedule for those needing retainer checks.  Do not leave a message.  You must talk to the family. Any re-evaluations that have not scheduled after the second call, mail them a letter. The letter is a quick letter “ortho follow up”. The letter will need to be personalized. Mail the letter, then document in clinical notes.

Example of the recall card tracking spreadsheet:


Tracking of Ortho recall cards sent – 2013
Recall Month Date Sent How Many Patient names F/U Call 2nd F/U Call Letter Sent
January 12/18/2012 34 Debra Bateman (ret ck) NV 3/8 cx’d n/a
Christopher Bean NV 2/22 cx’d 3/14 vm
Riley Brady 2/9 vm 2/20 vm 2/22 ltr
Jacob Broerman completed n/a n/a
Beth Brooks completed n/a n/a
Rick Cantrell (ret ck) 2/9 vm 2/20 vm n/a
Makayla Claude (ret ck) 2/9 vm 2/20 vm n/a
Mackenzie Dix 2/9 vm 2/20 vm NV 4/3
Natalie Erdahl 2/9 no n/a n/a


________________________________                                 _______________

Ortho Coordinator                                                                       


Thank you for referring letter:

Dear Dr. Wilson,

Thank you for referring your patient Wyatt Wilson.  I had the pleasure of evaluating Wyatt on _____.


MEDICAL HISTORY FINDINGS:                                                                    Insert Picture



The treatment plan includes:_________________________________________________


Treatment to begin: _______________

I ask that all of our patients maintain a regular schedule of 6 month examinations, cleanings, and fluoride treatment at their family dentist.  If you have any recommendations as to changes in this routine schedule, please do not hesitate to make us aware of your concerns.  Should you have any questions or concerns about Wyatt’s case, please do not hesitate to contact me.

Thank you for your kindness in referring one of your patients to me.

Sincerest regards,



Follow Up Letter

Dear «FName»,

Our records indicate that you have not scheduled an appointment for           since the initial exam.  In order to ensure that we provide a quality service, please check one of the following options regarding your future orthodontic plans:

_______________         I am interested in orthodontic treatment for my child.  Please call me to set up an appointment. My daytime phone number is __________________ and the best time to reach me is ________________.

_______________         I am interested in adult orthodontic treatment for myself.  Please call me to set up an appointment. My daytime phone number is ______________ and the best time to reach me is ________________.

_______________         I am interested in orthodontic treatment for myself or my child.  However, my schedule does not permit at this time. Please call me in the month of ___________ for my appointment.

_______________         I’ve decided not to have orthodontic treatment.

_______________         For financial reasons, we anticipate starting in the month of __________.

_______________         I went to another orthodontist because ____________________________.

Our goal is to provide the best possible orthodontic treatment for our patients to improve your smile and bite.   If you have any questions or concerns, please call us at _______.  Please return this form within 30 days.  Thank you for your time.

Sincerely yours,

Ortho Handout

Classification of Teeth into three major categories

Class I- CROWDING                                           SPACING

Class II- The mandibular molars are posterior to the maxillary molars.

DIVISION 1                                         DIVISION 2

Class III- The mandibular molars are anterior to the maxillary molars.

PSUDO                                    SKELETAL