JCO Journal of Clinical Orthodontics
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VOLUME 39 : NUMBER 04 : PAGES (259-263) 2005



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Over the past five years, Dr. Brewka and his staff have become increasingly proficient in using Invisalign appliances; as an Invisalign Premier Provider, he has started more than 700 patients in Invisalign treatment. His main practice is divided between two offices in south suburban Denver: one in Littleton (3,700 square feet, with eight chairs, operating three days per week) and a satellite seven miles to the west (2,000 square feet, with six chairs, operating one day per week). In July 2004, after 33 years in practice, Dr. Brewka brought in Dr. Shon J. Peterson as an associate for these two thriving practices.

In 2003, the practice launched an Invisalign media campaign, developed and managed by VisionTrust Communications, that triggered new-patient phone calls from all over the Denver metropolitan area. This suggested that a new, more centrally located office might have a marketing advantage. The decision was made to take a chance on an Invisalign-only office in an upscale shopping area called Cherry Creek North, near downtown Denver (Fig. 1).

The only ground-level space available in the retail district was a 630-square-foot former beauty salon (Fig. 2). This location is surrounded by beauty and nail salons, as well as some of Denver's most exclusive boutiques, spas, and restaurants.

Bacon Design and VisionTrust created an interior concept with "feng shui" energy, contemporary style, and class. Feng shui is the ancient art of balancing and harmonizing the flow of natural energies in one's surroundings; more simply stated, it is the Chinese art of placement as applied to interior design.1

A handpicked staff of four contributes to the positive patient experience. The office opens twice a week at 7 a.m.--a popular appointment time for working executives--and has slots available through midday. Appliance delivery appointments, involving the exchange of the next three aligners in the series, are scheduled every 15 minutes, and patients are reappointed at six-week intervals. As long as the aligners are tracking well, the staff stays on schedule. The open clinic concept lends itself well to patient interaction, often leading to conversations that continue outside after appointments.

Now, after two years in operation, this little spa-style office has proven to be a positive concept. It is an untraditional orthodontic office for an untraditional orthodontic treatment: Invisalign. No braces are on hand--not even a distal end cutter!

Floor Plan

The economics of establishing an office in a high-rent business district made it prudent to lease only the space required. When developing a floor plan for small offices, however, there is always a temptation to break up the space into small rooms or unfriendly, confining cubicles.2 Dr. Brewka wanted a design that would promote a friendly atmosphere and a sense of openness, clear of clutter. The final design provides a smooth traffic flow throughout the space, yet still includes functional areas of semiprivacy or complete privacy where needed (Fig. 3).

Reception Room

The space allotted to the reception room is generous, considering the total square footage of the office. Features contributing to a pleasant first impression and a comfortable ambiance include a beautiful saltwater aquarium, a television monitor for educational videos, a decorative ceiling fan, and warm, indirect sconce lighting (Fig. 4). The coffee-and-juice bar is a popular extra for the target age group (Fig. 5). Starbucks coffee and fresh-cut flowers are delivered every day the office is open.

In the window facing the street, a video monitor continuously plays a customized videotape, created by VisionTrust, that includes text captions about the practice and how Invisalign treatment works. This new-patient introductory tape is visible to couples strolling by or people walking their dogs at any hour of the day or night. In addition, the practice's famous "Invisalign Bush", with aligners festively painted for every season from St. Patrick's Day to Christmas, twinkles 24 hours a day in the corner.

A wall panel and a mini-appointment desk separate the reception room from the open-bay operatory (Fig. 6). The divider not only provides visual privacy, but enhances a continuous-ceiling effect that affords a more expansive feeling to both the operatory and the reception room. High-quality, comfortable thin-line reception chairs were selected over upholstered furniture to make the room feel less crowded--an important consideration when dealing with smaller offices.2

Treatment Coordinator/Exam Room

The amount of space available for the treatment coordinator/exam room was less than is usually dedicated to this dual function. Fortunately, the area had a large exterior window, and a full glass wall with a sliding glass door was installed facing the reception room (Fig. 7). When the door is closed for an exam/consultation, the voices cannot be heard outside the room. Visual privacy was not important to Dr. Brewka, and the design contributes to his philosophy of openness throughout the office. It also gives the treatment coordinator a full view of the reception room, appointment desk, and operatory (Fig. 3). The room is large enough to accommodate an exam chair, extra seating, and a spacious desk for the coordinator. Because the staff is cross-trained and the appointment secretary is often used as a chairside assistant, the treatment coordinator, who has a good view of the appointment desk, can answer the phone and help elsewhere when needed.

Open-Bay Operatory

In the operatory, two unique, electric patient exam/treatment chairs from the Better Back Store are used mainly for impressions, insertion of aligners, and progress checks (Fig. 8). Although they are extremely comfortable, they had to be elevated an additional 6" with custom-made Formica platforms to put the patients at a better working height for doctors and staff. Their stylish appearance diminishes the stereotypical feeling of a dental office, making the busy open bay more relaxed and casual (Fig. 9). Fiberoptic mirrors, cordless curing lights, cordless electric handpieces, and cosmetic wall mirrors all contribute to the unconventional atmosphere. A full-service treatment bay is used for reproximation, recontouring, impressions, facebow transfers, and equilibration procedures (Fig. 10). Reproximation can be an important stage in Invisalign treatment; in some cases, it is almost back to general dentistry. This operatory alcove has a traditional dental chair with support systems, such as high- and low-speed handpieces, water supply, and evacuation. A rear-delivery system has definite advantages for doing four-handed work with an assistant, as in cases requiring extensive reproximation.

All unmounted models are stored via computer, using OrthoCAD, to save precious space. Radiographs are referred out to independent commercial laboratories, thus eliminating the space requirements for x-ray equipment, darkroom, and chemical storage.

Laboratory and Storage

Because the Invisalign technique requires an exacting impression procedure, a sizable pour-up area is needed in the laboratory. In addition, more storage space than usual is required to accommodate patients' unused aligners (Fig. 11).


Although Invisalign is only one tool in Dr. Brewka's orthodontic armamentarium, he and his staff are committed to the Invisalign system. It may still be in its infancy, but they believe its treatment goals should be the same as those used in conventional cases. Only through perseverance in finishing--refining occlusal functional details with overcorrection, performing fiberotomies when needed, prescribing gnathological positioners, and equilibrating on centric-mounted final casts--will the Invisalign system pass muster.

The dedicated Invisalign center shown in this article allows the practice to focus on a whole new, untraditional patient base, develop innovative Invisalign treatment approaches, and have fun at the same time. 

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