Efficiency by Design:
The Data Gets Better with Custom Metal SL

KLOwen | News

When Capacity Halved, Efficiency Had to Rise

In 2022, Dr. Paul Trotter faced a challenge familiar to many orthodontists: his father, a longtime partner, retired and cut the practice's doctor capacity in half. Demand wasn't slowing down. Efficiency had to.

Patients were waiting 35 days to get braces on after signing a contract. New patient exams were fully booked 90 days out. Adding staff wasn't the answer. Finding a smarter system was.

His guiding metric became revenue per appointment, the single number that captures true practice efficiency. The goal: see more patients without adding time or staff. Custom braces was the lever that made it possible.

Number of appointments per case

Conventional

17.4

KLOwen Twin

14.1

-19%

KLOwen MSL

9.7

-44%

Conventional

KLOwen Custom Twin

KLOwen Custom Metal SL

$4.65

Every $1 increase in revenue per appointment translates to $4.65 in added profitability, based on analysis of 150,000+ completed cases by Gaidge.

Fewer appointments means higher revenue per visit and an outsized impact on the bottom line.

The Custom Metal SL breakthrough: from skeptic to believer

Dr. Trotter describes himself as a longtime SL skeptic; he once called them "slippery brackets." What changed his mind was simple: counting appointments.

With twin brackets, variability crept in. Assistants had to judge whether wires were fully engaged. Broken figure-eights and poking pigtails generated unplanned comfort visits. With custom SL, the door is binary. Open or closed. Engaged or not.

"In a 0.195 bracket slot, you put that 19x25 in and finishing becomes not an issue. And I know that wire is fully engaged."
Dr. Paul Trotter

The result: 12-week appointment intervals, a simplified three-wire sequence, and average case appointments that dropped below 10. The TC conversation sells itself:

"Would you like to come 9 or 10 appointments, or would you like to come 22? The national average is 22."
Dr. Paul Trotter, describing the treatment coordinator conversation

The bottom line: it is custom, not just digital bonding

Digital indirect bonding alone saves some appointments. Custom braces with digital IDB saves dramatically more, and those are the doctor-intensive appointments: detailing, repos, and broken brackets.
The tipping point is approximately 67% custom case volume, per Chris Bentson. Below that threshold, ROI is limited. Above it, the lab fee pays for itself and then some.
KLOwen's lab fee includes brackets, meaning the gap between custom and digital-IDB-only is narrower than most doctors assume when they run the numbers.
IRB-approved auditing of Dr. Trotter's data is underway with residents at the Dental College of Georgia. Another data update is coming.

"Custom is the secret sauce. It's not about digital indirect bonding. KLOwen is not a bonding system. It is a custom system, and you just have to digitally indirect bond the brackets to get the benefit."
Dr. Paul Trotter

What the capacity gains looked like in practice

+16%

net production, year 1 with custom

+11%

case starts, year 1 with custom

+80

new starts added after switching to Metal SL

Production and starts plateaued with custom twin, not because twin underperformed, but because Dr. Trotter had reached the ceiling of what twin could unlock. Custom Metal SL opened the next wave. He is up another 15% year-to-date in 2026 and actively evaluating whether it is time to bring in an associate.

Watch the recording and earn 1 CE credit

Dr. Trotter walks through his full dataset, case studies, and SL protocol live. CE certificate included.

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For healthcare professional use only. Individual treatment outcomes and treatment times may vary. Clinical examples shown are illustrative only and do not guarantee specific results.

Watch the Full Video: The Data Behind Practice Efficiency

Explore real-world comparisons of Digital IDB, Custom Twin, and Custom Metal SL—and discover how customization can help you see more patients with fewer appointments.

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