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 SUMMARY OF THE  ORTHODONTIC CONSULTATION EXAM

Our goal is caring for you J Our mission is quality care

TED ROTHSTEIN  DDS, PhD

Tel   852 1551     Website    www.drted.com     Email   drted35@aol.com

(Diagnostic, treatment plan and fees may change pending review of diagnostic records)

       Teeth small/Jaw big

 Mild                  Skeletal                                  Teeth big/Jaw small

 Your problem is a:               Moderate              Dental               Problem       Upper jaw narrow

Severe         Dental-Skeletal                          Up/Lo jaw  Short/Long

I advise  A.  that the treatment in progress be completed.

B.  that treatment be initiated in  6  12  18  24 months.

C.  that jaw surgery should be considered in your case.

D.  that you would benefit by beginning orthodontic treatment now.

E.  that you may opt to have no treatment without worry.

                                      baby teeth                                    is required

 Removal of some     ADULT TEETH                          IS NOT REQUIRED

                                    wisdom teeth                             might be required

       Dr. Ted will give you a prescription to have the teeth removed by another doctor.

Your orthodontic treatment can be accomplished with the following kind of braces:

      A.  Standard metal bonded (glued-on) braces.

      B.  Clear-transparent bonded braces (8 upper and 6 lower) and tooth-colored wire.

      C.  Invisalign (removable-invisible) for part or all of the treatment. (Upper  ●  Lower)

      D.  Lingual braces bonded behind-the-teeth:         Upper   ●   Lower

Attention:  In the last 3-4 months of treatment, clear braces may be replaced with metal braces
 and Lingual braces/ Invisalign replaced at no cost with clear braces to finalize minor details.

The treatment requires at least        patient-care visits over       to       months, provided the patient
cooperates in preventing detachment of brackets, keeping appointments, wearing  elastics and power chains as instructed.

  Diagnostic records (molds, x-ray, photos) and Dr. Ted’s analysis-plan:   $385 (included in fee)

 "Diagnostic setup" (Dental molds showing predicted outcome of treatment):  $185-$285.

FEE (metal braces):  (Diagnostic records, placing-removing braces, adjustment visits, retainers):                                                                                                 
$4385                    $4685                      $5185                     $5485               Other: $
 

  FEE (cosmetic braces): 

        Clear/Clear  $5985        Invisalign Invisalign $7685          Lingual/Lingual $9785 

   Invisalign/Clear  $6985   Lingual/Clear  $8885     (Lingual: iBraces +$1685; STb +$685)    

 + $1785 surcharge when non-surgical widening of the upper jaw is required.

 + $1785 if treatment requires removal of 2-4 teeth (adds-12-14  months to treatment.

  Pay fee plans:   1. CitiHealth Card and CareCredit, MC, Visa, Amex, Disc

     2. In-office plan: Initial payment 40%; balance in equal monthly payments

Insur: BCBS,Cigna,DC37,UFT,GHI,Guardian,Hlthplx,Metlife,Aetna,Oxford,CSEA,Prudentl, United
SIDS-CSA,Dentcare,Conn.Gen., Delta Dent, Equitable, Travlrs, Medicaid, J Hancock, HIP-Carington,1199

AVOIDABLE SURCHARGES:
1. Broken appointment: $125 (cancelled appt. with 24hrs. notice no charge)
2. Detached brackets after the 4th one @ $35/bracket: Eat: mushy foods (bananas and spaghetti).

Do not eat: crispy (toast), crunchy (carrots) and crusty (fried chicken) foods and candy

SUPPLEMENTARY INFO:  

1. Need for tooth–colored “attachments" to assist movement of teeth with Invisalign trays.

2. Need to slenderize teeth (sanding between them) instead of removing any of them.

3. Need for "bite turbos" (lingual braces to help correct deep overbite), lab fee: $685.

4. Other outside lab fees when applicable $385-$685.

5. 3 years of retainer replacement insurance for lost, broken or worn retainers: $285.

6. “Bullet Proof” (bonded/fixed supplementary retainers): $265
7.  Temporary teeth to fill in extraction spaces: $265/tooth
8. Orthodontic Jaw Wiring (OJW) for weight loss/control: $2,685

TEETH WHITENING: In-office one-hour: $585; take-home: $285
In-office whitening and take-home maintenance kit with custom fitted trays: $685

 
 REGARDING FEES AND SERVICES:  The active treatment fee includes all diagnostic records needed
during the patient's treatment and all emergency visits. All records are done here in the office..

ORTHODONTIC INSURANCE BENEFITS: You will need to provide us with the necessary forms with
your part filled out. The insurance company takes 3-5 weeks to reply to the forms we send them.  We
will know your benefit when we/you receive written confirmation from your company.  The benefit
is typically paid over a period of 24 months. You are responsible for the balance should the insurance
company fail to pay their part, or your benefits are terminated. If your treatment is completed EARLIER t
han expected you have 2 options:.

Option 1:  Braces will be removed when the remaining balance is paid-in-full including that portion
that remains to paid by the insurance company, because insurance will stop paying. 

Option 2:  You can opt to keep the braces on for the remaining months until the insurance can finish paying your total benefit.

PATIENT-CARE HOURS:

                            Monday                                   8:00-6:00

                            Tuesday                                  7:00-4:00

                            Wednesday                           11:00-6:30

                            Thursday                                 8:00-2:00

                            Friday                          No patient-care hours  

                            Saturday (every 6 weeks) 8:00-12:00 (except June 30-Sept. 22)

TYPICAL COURSE OF TREATMENT: Next visit will take 60 minutes for staff to make molds/x-rays/photos and Dr. Ted to bond clear or metal brackets on the upper teeth.  Then, if planned in advance, Dr. Ted will give you a prescription to have teeth removed.  An arch wire is usually placed on adults at this visit. We wait four weeks to place an arch wire on younger patients. Temporary replacements for removed teeth are ordered from the lab. The braces are adjusted every 4-8 weeks.   After 4-6 months Dr. Ted will bond brackets on the lower teeth and continue adjustments until the teeth are perfectly straight. The braces are then removed and not later than the next day we provide you with clear-transparent, form-fitted teeth covering-retainers.  You must wear them 6 nights/week for three years while the teeth tighten into place.  After that I strongly recommend wearing them one night each week forever to keep them precisely straight. …Lingual braces take 3-4 week to arrive from the lab, and 90 minutes to bond them on and place arch wire. …Invisalign trays take 6-8 weeks. At the first Invisalign appointment Dr. Ted will provide you with the first set of about 20 -25 trays with instructions for use and care.  Attachments are bonded when applicable. Every 6 weeks you will receive three more sets of trays.

DISCOMFORT:  You will experience some tenderness1-2 days after the wires are placed which lasts 2-3 days. Advil/Aspirin/Excedrin/Aleve will help.

SPECIAL NOTES SPECIFIC TO YOUR TREATMENT IF ATYPICAL:
Possible post-orthodontic treatment needs: teeth whitening, teeth cleaning, root scaling, fillings, bonding, laminates, gum trimming, periodontal care,  crowns, bridges, hugger bridges, implants, root canal treatment.