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Practice Management: A Second Chance Wm. Randol Womack, DDS, Editorial Director, Orthotown Magazine

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A Second Chance
What could Align Technology's new Teen product mean for the future of orthodontics?
by Wm. Randol Womack, DDS, Board Certified Orthodontist
Editorial Director, Orthotown Magazine

After reading a recent article in an orthodontic trade journal
by Brett Blake, an independent marketing expert and financial
analyst, I was impressed with his take on ortho/GP issues.
So, I contacted Brett to further explore his views on the impact
that technology has on the future of orthodontic practice. He
graciously agreed to expand his thoughts on some issues that,
in his opinion, are critical to our practices. I think you will find
our dialogue very thought provoking.

Brett, you have gone on record calling Invisalign Teen the orthodontic profession's second chance. What do you mean by that?
My message is not about a specific product, per se; but a general call to arms to the profession. If the Piper Jaffrey analysis is to be trusted, the total number of orthodontic cases performed by general dentists in 2005 exceeded the total number of cases started by orthodontists. In addition, GPs continue to see more rapid growth in ortho cases than orthodontic specialists do.

Those numbers are staggering to me, and provide evidence that Time Magazine might have been correct when its May 22, 2000 story predicted that the orthodontic profession would disappear. That story also predicted that Invisalign would be the technology that would eliminate the need for the specialty and would allow all dentists to perform orthodontics. That prediction seems to be coming true, not entirely because of Invisalign, but the trends have certainly been fueled by Align's decision to offer Invisalign to general dentists.

Do you think Align Technology always planned on selling through dentists?
No. I don't have access to the early thoughts and plans of the company, but, in my opinion and from a purely economic point of view, it would have been much more profitable for the company to remain focused on orthodontists.

Then why was there a shift? Why would Align sell to dentists?
I understand that Align started out with an "orthodontics-only strategy" (much like Orametrix's current strategy), but the orthodontists were (and probably still are) awkward when it came to adopting and adapting to innovation, which Invisalign required. In addition, as a result of the legal action brought by the Academy of General Dentistry [in February 2001], Align was forced to train general dentists who would offer the product to their patients. Interestingly enough, this actually resulted in a survival strategy that seems to be working.

What did you mean when you stated that the orthodontic profession is "awkward when it comes to adopting and adapting to innovation?"
America has become an innovation nation. Today's orthodontic consumers have grown up in an era of rapid advancement in technology. They have come to value and seek after the cutting edge of innovation. Most industries have adapted in significant ways to create systems and operations that can quickly identify, validate, refine and commercialize new products, services and technologies. However, the orthodontic profession is a notable exception.

It seems clear that two things keep many consumers from entering treatment: 1) the unsightly visual appearance of metal braces, and 2) the amount of time it takes to complete an orthodontic treatment. The technologies that seem to offer a solution for each of those consumer concerns (Invisalign, SureSmile) have faced stiff headwinds among orthodontists. This is to be expected, but think of the consequences – could it be that the day will come when consumers will be forced to go to their GP to find the two treatments they consider to be on the cutting edge of orthodontic treatment?

Sounds like you question the profession's business sense.
While I've heard several doctors complain about the lack of business training in their graduate programs, most doctors I've met are smart and are making reasonable business decisions. In fact, it took some specialized education to convince business leaders to see that logical business decisions led to financial ruin. The issues faced by orthodontists were very common among high-tech companies prior to Harvard Business School Professor Clayton Christensen's research and writing about what he calls the "Innovator's Dilemma." He asserted that most innovations are not given consideration by the most educated persons in an industry because the smart people can recognize the inherent flaws in the new technology.

In other words, orthodontists see both the clinical and financial flaws in new technologies and they reject them as inferior to what they are currently doing. In most cases they are right and the most profitable thing to do and the best thing for their patient, is to stay with the tried and true methods. Their mind is focused on providing the best standard of care in their practice; they haven't yet felt the full impact of innovation on their industry or in their personal practice (though many are starting to feel the edge of the coming storm).

Are you suggesting that orthodontists lower their standards?
No. This is not a zero sum game. I'm suggesting that orthodontists begin to ask what treatment modalities are most desired by their patients? Then find those companies that are investing in solutions their patients want.

They'll often find these technologies need improvement. Orthodontists should provide the standard of care and work closely with those companies to help them improve their technologies until they meet the higher standards.

According to Professor Christensen, smart people have to be trained to recognize innovation as a messy process – most new products must be introduced before they are as good as those already on the market. Innovation is messy, just like birth is messy, but it's a process that must be engaged in if the industry is to perpetuate itself.

So what do you suggest orthodontists do?
I think Invisalign Teen represents a "second chance" for the industry. The company has publicly stated that this product is for orthodontists only. Given Align's success in going around orthodontists in the past, this should be music to orthodontists' ears – especially when the American Association of Orthodontists (AAO) estimates that more than 50 percent of all cases are teens.¹
¹ 2006 AAO Member Survey

If I were a practicing orthodontist I would embrace this opportunity to use Invisalign Teen. I would use this product and/or others like SureSmile to help me learn to add innovation to my office. Some questions that need answers might be: How do you price an innovative product and get paid a premium for the product? How do you learn to use the product effectively and, additionally, help the company continue to improve the technology until it is as good as other treatment options? Whom should you offer the technology to and how do you resolve any conflict between your standards and your patient's standards for treatment?

What else should orthodontists know about innovation?
There are several issues that I see as important. Pricing is one of them. Consumers expect to pay more for better technology, but most of the doctors I've spoken with are afraid to charge more for the technologies they think are superior. Orthodontists must learn to get paid for advanced technology. The additional revenue created allows them to overcome the initial higher costs and to put up with some of the early productivity losses the practice experiences while they learn to get up to speed on the new procedures associated with a new technology.

As an aside, price is an important consideration even for those practices that are not adopting innovative new treatments. Most doctors do not understand that price is a method of communicating quality. In my home town, the highest price for orthodontics is being charged by a pediatric dentist – consequently he does more cases each year than any orthodontist in town. I find it amazing that some GPs are getting more per case than orthodontists are getting.

Is there anything else?
Learning to adopt and then adapt innovation is a great start, and it helps the orthodontists to earn more of the new case starts and to slow the number of GPs performing orthodontics. I believe innovation can be the best way for orthodontists to maintain their life-style and to combat all other issues. If they can own new technologies, they will be able to demonstrate a significant consumer advantage over their GP colleagues and they will more easily be able to control and maintain the high margins that their additional education and training warrants.

Brett, I really appreciate your point of view from outside the profession. Thank you so much!
Interviewee's Bio
Brett Blake is CEO of Acceptx Financial Solutions, Inc., and is a highly rated lecturer among orthodontic study groups. He is a Scholar Member of the Gerson Lehrman Group Council where he advises Wall Street analysts and investment bankers, and was selected a Top 100 Venture Entrepreneur in Utah. He earned an MBA from the Harvard Business School and graduated cum laude from Brigham Young University. Mr. Blake invites dialogue on this and other issues via his blog at www.smartmoneydocs.com or via e-mail brett.blake@acceptx.com.
Orthotown Magazine
November 2025
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