ORTHO BYTES
Clinical implications of digital orthodontics
W. Ronald Redmond, DDS, MS, William J. Redmond, DDS, MS, and M. John Redmond, DDS, MS
Laguna Niguel, Calif
After nearly 30 years of orthodontic practice, I (W.R.R.)
have achieved several goals that allow for a total integration
of computers and treatment efficiency. First, my 2 sons have
elected to join me in the practice of orthodontics, and second,
I have arranged what I believe to be the perfect marriage
between orthodontic and computer technologies.
As our practice grew to multiple locations, we developed
a unique clinical problem, handwritten treatment cards.
Patients would frequently make appointments in offices other
than the location where their treatment card was stored. We
spent a great deal of time faxing copies of treatment cards to
outlying locations and had even more trouble making sure the
fax copy was re-entered onto the original card. This quickly
became a nightmare.
Even though we started using computers for all of the cler-
ical and some of the clinical operations as early as 1985 using
Orthotrac software, we didn’t realize that our computer system
would facilitate our practice growth and ultimately simplify
our clinical activities. Orthotrac solved the problem by pro-
viding us with electronic treatment cards. This “simplifica-
tion,” however, posed its own set of problems. Computer ter-
minals needed to be placed at each chair and networked. In
addition, the satellite offices required high-speed networks to
allow a patient’s treatment information to be viewed at any
location. With the help of Orthotrac and the telephone compa-
ny, the networking was accomplished. Can you imagine the
joy? No longer did we “pull” and “file” patient charts each
day. No longer did we fax copies of treatment charts. Best of
all, patients were impressed with our high-tech offices.
As our practice continued to grow, we found that our sys-
tem was still not entirely complete. Patient folders containing
examination notes, radiographs, and clinical photographs
occasionally were transferred from their original location or
taken home by one of the doctors for diagnostic purposes. We
found ourselves mired in a morass of lost or misplaced
records. When a doctor asked for a panorex or headfilm while
the patient was in the chair, the answer was invariably, “Sorry
doctor, the records are in another office location.”
system and camera that would allow for storage directly on
my hard drive. An automatic back-up system was set up on my
server that continuously updates dual hard-drives of all patient
radiographic and photographic records. I no longer need to
worry about crashes or lost information as a result of the
redundancy of the dual drives. A network of computers allows
for easy viewing of photos and radiographs that have been
transferred quickly and in a cost-effective manner.
Over the last 12 months, we have put in place a new net-
work that incorporates digital photography, digital radiogra-
phy, and Microsoft terminal server technology. Using a new
communications service, Digital Subscriber Line (DSL),
which can transmit and receive information up to 1.5
megabits per second, we have established an intranet for our
orthodontic practices. Because this intranet is accessible from
any Internet connection, we now have the ability to view our
examination notes, radiographs, and clinical photographs
from practically anywhere.
We are delighted to be able to view our diagnostic records
from any practice location and from our homes. No longer are
we told that the records are in another office. And, as you might
expect, our patients are again impressed by our high-tech capa-
bilities. Best of all, our clinical efficiency is improved because
of ready access to pertinent clinical information.
A confluence of opportunities occurred within the past 18
months that made the preceding capabilities possible.
Microsoft Windows NT 4.0 with Terminal Server Client was
released in 1998. This software is a return to a “server-cen-
tered” network. Like the SCO UNIX based system we had
been using for our Orthotrac management program, Terminal
Server facilitated the transfer of graphic data through a local
area network (LAN) or a wide area network (WAN). The pro-
grams and the data remain on the server, and the terminals (or
PCs) simply provide a viewing screen, keyboard, and mouse.
This method of software deployment has been called “thin
slice” utilization. Multiple “licensed-users” can access the
same program simultaneously. The obvious power of this sys-
tem is the decrease in data transferred, with the inherent
increase in transfer speed, and management of programs
through periodic updates only on the server.
Several different options were explored that would allow
for the digitalization of orthodontic records, but each method
presented obstacles that would prove to be cost-ineffective and
make data transfer so slow as to be impossible. Once more, we
looked to the computer industry and the latest in computer
technology to find the answers. I found a digital radiographic
Terminal Server Client functions equally well in an
intranet or Internet environment, however, each program is
accessed by a separate intranet or Internet connection. This
proved to be cumbersome and inefficient.
Citrix Metaframe 1.8, also a thin slice software, provides
a solution to Microsoft’s Terminal Server Client, by transmit-
ting the server desktop to the terminal with all the program
Copyright © 2000 by the American Association of Orthodontists.
0889-5406/2000/$12.00 + 0 8/1/104691
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