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Orthodontic treatment runs over months or years, with regular short adjustment appointments interspersed with longer review visits. The system tracks each appointment and procedure, building a longitudinal record of tooth movement from the initial assessment through to the retainer stage.

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Before You Start

  • Clinical Procedure Templates for orthodontic procedures must be set up.
  • The orthodontist must have a Healthcare Practitioner record.
  • An orthodontic assessment (full clinical examination + OPG + study models) must be completed before treatment begins.
  • You need the Healthcare Practitioner role to document orthodontic procedures.

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Setting Up Orthodontic Procedure Templates

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Step 1: Orthodontic Assessment

The initial orthodontic assessment is documented as a Patient Encounter with appointment type “Orthodontic Consultation”. Record in the Patient Encounter: Dental and Skeletal Assessment:
  • Skeletal pattern: Class I / Class II (retrognathic mandible) / Class III (prognathic mandible)
  • Facial symmetry
  • Soft tissue profile (lip competence, mentolabial fold)
  • Incisor relationship: Class I / II div 1 / II div 2 / III
  • Overbite: reduced / average / increased / complete
  • Overjet: specify in mm
  • Arch form: tapered / square / ovoid
  • Crowding: mild / moderate / severe, specify which teeth are displaced
  • Spacing: generalised / localised, specify
  • Crossbite: anterior / posterior, specify teeth
  • Missing teeth: congenitally missing, extracted (record reason)
  • Impacted teeth (especially canines)
  • Dental midline shift
Records Required Before Treatment:
  1. OPG (panoramic X-ray) - ordered from the encounter (see Dental Radiography)
  2. Lateral cephalogram (if available for cephalometric analysis)
  3. Study models (upper and lower alginate impressions poured in plaster - sent to lab)
  4. Clinical photographs (extraoral and intraoral)
Treatment Plan Recorded in the Encounter:
  • Type of appliance: fixed braces (metal / ceramic) / clear aligners / removable appliance
  • Extractions required: which teeth, timing
  • Estimated treatment duration
  • Proposed outcome
  • Retention plan (type of retainer, duration)
  • Fees and payment plan

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Step 2: Bond-Up (Brace Placement)

When treatment begins, record the bond-up as a Clinical Procedure:
  1. Open the Clinical Procedure record for “Fixed Brace Bond-Up (Full Arch Upper/Lower)”
  2. In the Notes field, record:

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Step 3: Regular Adjustment Appointments

At each adjustment appointment:
  1. Create or open a Patient Encounter (appointment type: “Orthodontic Adjustment”)
  2. Record a brief assessment of current progress in the encounter notes:
    • Which spaces are closing
    • Which teeth are moving as planned
    • Any pain or problems since last visit
    • Oral hygiene status (gum health with brackets)
    • Elastics compliance (if elastics are being worn)
  3. Create a Clinical Procedure record for the adjustment:
Adjustment notes to record:
Clinical Procedure record for an orthodontic adjustment showing notes with current wire, new wire placed, modules changed, and next appointment plan

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Step 4: Clear Aligner Treatment

For patients using clear aligner systems (such as Invisalign or a similar system):
  1. At each aligner issue appointment, create a Clinical Procedure record for “Aligner Issue”
  2. Record in the notes:
For aligner reviews where progress is assessed:
  • Check that teeth are tracking the aligner (no gaps between aligner and tooth indicate tracking issues)
  • Check attachment position and integrity
  • Check oral hygiene under attachments
  • Issue next sets

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Step 5: Brace Removal (Debond)

At the debond appointment, the brackets and bands are removed. Create a Clinical Procedure record:

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Step 6: Retainer Fitting and Review

After the laboratory returns the retainer:
  1. Book the patient for a “Retainer Fit” appointment
  2. Create a Clinical Procedure record for the fit
  3. Record:
At each retainer review:
  • Assess tooth position (has there been any relapse?)
  • Check retainer fit and condition
  • Reinforce wearing instructions

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Monitoring Orthodontic Progress

Use the Clinical Procedure list to track all orthodontic procedures for a patient:
  • Filter by Patient Name to see the full sequence of adjustments
  • Use the patient history timeline to review the chronological record
The diagnosis recorded in each encounter (e.g., “Class II Division 1 malocclusion”) feeds the Diagnoses dashboard chart, allowing you to see what the most common orthodontic presentations are at your clinic.

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Field Guide: Patient Encounter (Orthodontic Visit)

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Best Practices

  • Take clinical photographs at the bond-up and at regular intervals (every 3-6 months) during treatment - these are invaluable for tracking progress, for consent documentation, and for before/after comparisons at the end of treatment
  • Warn patients at each adjustment that they may experience soreness for 1-2 days after the wire is changed - this normalises the experience and reduces unnecessary emergency calls
  • Oral hygiene deteriorates under fixed braces - check gum health at every visit and refer to the hygienist if significant gingivitis develops; proceeding with orthodontics in the presence of active gum disease causes permanent damage
  • Retention is for life - explain this clearly at the start of treatment and again at debond; patients who stop wearing retainers will experience relapse, and relapse disputes are a common source of complaints
  • For any bonded retainer, check the bond at every review - a partially debonded bonded retainer is worse than no retainer (selective relapse of unretained teeth)

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Troubleshooting

A patient has missed multiple adjustment appointments and treatment is prolonged Document each missed appointment in the patient record. If significant time has passed, a re-examination may be needed to see if the braces are still working. Discuss with the patient whether they wish to continue or to debond early. A patient’s teeth are not tracking the aligners Check compliance (not wearing aligners for the required hours). Check for missing attachments. If tracking issues persist, order a refinement scan to get new aligners made to accommodate the current tooth position. A bonded retainer has debonded partially Book the patient urgently. Identify which teeth are no longer retained. Rebond the wire. Check for relapse of the unretained teeth. Document fully.