Embracing new technology helps
facilitate practice growth
The credo in my orthodontic practice is “exceptional lives through remarkable smiles.” I think this speaks to the power that orthodontists have to transform lives, whether the focus of our treatment is a patient’s smile, oral health or facial profile. The benefits of treatment are especially powerful for young patients in their formative years, when their self-image is continually being measured online and their smiles are on display in social media. Thanks to advances in diagnostic and treatment options enabled by digital technology, orthodontists today can affect the health and well-being of these patients more than ever before.
Digital technology can also benefit the bottom line for orthodontists by increasing practice growth and improving overall efficiency. The advent of digital scanning and advancements in clear aligner technology have enabled me to expand my base of teen and younger patients without sacrificing quality of care. Today I feel optimistic about both the future of my practice and of orthodontics as a profession.
Clear aligner technology accelerates growth
in patient-driven practice
After graduating from my orthodontic residency program, I entered orthodontic practice in Santa Barbara, California, and joined my mentor and business partner, Dr.?Raymond Kubisch. At the time, he was the only orthodontist in the community with a significant number of Invisalign clear aligner cases and most of his patients were adults. While my prior experience with Invisalign treatment had been minimal, I was excited about the opportunity to learn new techniques and quickly became proficient.
As I progressed from being a practice employee to a partner to a solo practice owner, I saw the potential to expand clear aligner treatment beyond adult patients to children and teens, but I recognized that education would be key to realizing that potential. Early on, I encountered resistance from patients and parents as well as from the referring dental community. Teen patients consistently opted for braces over clear aligners because it was what their friends had and because braces were the treatment option familiar to their parents. This preference was reinforced by dentists in the community, who cautioned that only the simplest cases were appropriate for treatment with clear aligners. When a dentist referred a teen for orthodontic treatment, he or she typically would say, “Oh, you’re not an aligner case; that treatment wouldn’t work for you.” Changing this mindset required re-educating professionals [See sidebar: Professional Outreach Drives a Team Approach] and conducting outreach to teens and parents.
For me, reshaping the attitude of teens and younger patients toward clear aligner treatment has meant staying in step with dramatic changes in the social media landscape and identifying teen leaders who could become influencers. Teenagers today look beyond what their closest friends are doing to what the leaders among them are modeling, particularly online. It could be a star athlete at school or even someone they follow on Instagram, such as singer Billie Eilish, who sings about her Invisalign treatment. In a relatively short period of time, as the number of influencers grew, I saw teens go from resisting Invisalign treatment to asking for it by name. They now view it as a modern way to receive orthodontic treatment with lifestyle benefits that far outweigh those of traditional braces.
Despite being progressive and digitally savvy, it’s interesting to note that these teen patients have actually lagged behind their parents in their treatment preferences. At a point when teens were still insisting on braces, their parents began to recognize the benefits of clear aligner therapy that extend beyond aesthetics. These include fewer office visits (in my practice, an average of nine visits versus 18), shorter visits, shorter treatment times (an average of 13 months for aligners, compared with 18 for braces), fewer emergencies, greater patient comfort, and better dental hygiene due to ease of tooth brushing and flossing.
Of course, some parents have concerns about their children’s compliance with aligner wear, especially if they have a 7- or 8-year-old child who requires Phase 1 treatment. Currently 50% of my Phase 1 patients use Invisalign First clear aligners after rapid palatal expansion. I assure parents that young patients actually do a better job with compliance than my adult patients, thanks to the scheduled nature of their lives and their experience with following rules at school. However, I always stress to parents that both aligners and braces carry significant responsibilities and that with both modalities, children need to understand what is expected of them.
Today, after seven years in practice, and my third year as a solo practice owner, nearly 70% of my patients are in clear aligner treatment. While I believe that there are very few cases that can’t be treated with clear aligners, I don’t insist on this modality across the board. We are a patient-driven practice, and it is important to me to respect my patients’ wishes. I also charge the same for clear aligners and braces, so price isn’t a factor for patients in their decision.
drive patient satisfaction
As technology today has moved from analog to digital, so has treatment planning within the practice of orthodontics. Over the years, new technologies such as digital intraoral scanning have emerged, offering a significant upgrade from impressions. Other key benefits include improved restorative and orthodontic workflow, visualization tools, chair-side milling integration, and Invisalign connectivity. While an initial capital investment was required, having an intraoral scanner—I have an iTero Element—has paid significant dividends in my practice. Not only has it made the aligner submission process easier and faster, but scanning is also much more comfortable for patients than taking impressions.
I’m a big believer in leveraging my technology investments with patients, and the ability to show clear aligner outcome simulation impresses both patients and parents. When discussing treatment with them, I like to let the kids interact with the simulation of their future smile. They have fun “moving” their teeth around using the scanner touchscreen, and parents are more engaged. Meanwhile, in those cases where extractions are needed, outcome simulation can allay parent fears about their children having gaps between their teeth and help them understand what a child’s arch will look like.
ClinCheck software also helps me plan restorative cases with general dentists. They can tell me where they need a tooth moved, and I can use the software to show them what I can do and ensure they’re satisfied, which is the essence of interdisciplinary treatment.
Facing the challenges
of change in orthodontics
Adopting new technology requires investments in time and money, as well as modifying established processes.
An orthodontist who is just getting started with clear aligner treatment but wants to charge the same for both modalities is likely to face some challenges with cash flow because he or she has to pay a lab fee for each new clear aligner case, instead of using brackets and wires that are paid for and sitting in inventory. The lab fees per case can put a strain on cash flow in the beginning, but the return on investment is well worth the initial outlay because patient volume increases and the lab fees per case come down. I recommend having a working capital cushion to help get through the first six months or so until volume discounts become feasible.
There’s no question that the digital age and the advent of new technologies is changing the practice of orthodontics. In recent years, we’ve seen do-it-yourself and direct-to-consumer orthodontic companies spending millions of dollars marketing their clear aligners. As a result, many of my orthodontist colleagues are down on the profession and view clear aligners as a threat to their livelihood.
While I sympathize with their concerns, my perspective is different. Why? We know that 60–75% of the general population has malocclusion, but only a fraction of these potential patients actually pursues orthodontic treatment. Thanks to the marketing messaging from consumer companies, however, more people than ever before are now interested in orthodontic treatment. And while they may never have considered braces, they’re open to transforming their smiles with clear aligners. In the end, as consumer awareness increases, I’m confident that many of these individuals will be more comfortable working with an orthodontist than going at it alone.
It’s up to us to reframe our perspective and take advantage of this rising tide, while ensuring the importance of doctor-led care is a key differentiator in our own marketing. We can turn a potential negative into a huge opportunity and a catalyst for continued market expansion and practice growth.
In my own practice, I’ve experienced exponential growth and have transformed my patient base from mostly adults to one that’s 60% children and teens. For me, digital orthodontics using clear aligner treatment is key to this success and growth. With my end-to-end digital workflow, I can treat more patients while still providing the highest quality care. My staff and I look forward to seeing each of the more than 80 patients we see each day, and I can’t help but be excited about the future.
Drives a Team Approach
My relationships with area dentists are integral to the success of my practice, both because of the patient referrals they provide and because we collaborate closely on restorative cases. Approximately 30% of my patients are referrals from area dentists. Conversion rates are higher than average with these patients, and they cost little to acquire.
I am a co-director of the Santa Barbara Dental Study Group, which is an affiliate of the Seattle Study Club. Our chapter includes more than 40 dentists and we meet nine times a year. We cover many topics in this study group, including orthodontics. Because I’ve been able to share advancements in orthodontic treatment with this group and show them what’s possible to correct with clear aligners, dentists in my community have become more willing to tell patients that clear aligner treatment is an option for them. I also work to educate dentists who offer such treatment about which kinds of cases they should and shouldn’t be taking on—and for what reasons. I stress that while my office is designed to be efficient when treating aligner cases, it can be difficult for busy dentists to successfully treat orthodontic cases that are beyond their skill levels and experience.
I truly believe in treating the dentists and other dental professionals in my area as members of an interdisciplinary team. By working together, we can provide patients with the highest quality of care and drive patient satisfaction.