Special Section: Startup Showcase

Research shows three in four people need orthodontic treatment, yet in the United States alone, less than 2.5% of those indicated follow through. Why?

Many consumers are not starting treatment because orthodontists are not offering a treatment option that fits their lifestyle—they’re either too visible with metal/clear braces or require too much compliance with plastic aligners. New categories of orthodontic treatment in the past grew our profession by challenging the status quo and introducing stepwise innovation leading to stepwise growth in our market.

InBrace, a new category of behind-the-teeth orthodontic treatment, developed a way of moving teeth using programmed nonsliding mechanics (PNM) which enables autonomous tooth movement in all six degrees of freedom, including opening and closing spaces, simultaneously and automatically from day one. PNM is made possible by a programmed Smartwire that is fully customized for each patient’s unique smile.

The InBrace appliance design, combined with the benefits of PNM, enables orthodontists to leverage all the efficiency upsides of customized orthodontic treatment with the added benefit of offering a differentiated behind-the-teeth option that is delegable to assistants.

During the past several decades, orthodontic practices have increasingly recognized the inherent efficiencies of the digital workflow for aligners. As a result, orthodontists have made
significant investments in digital equipment such as scanners and 3D printers, in digital workflow education for the doctor and staff, and in aligner lab fees. These investments have increased practice efficiencies and patient experience, but data shows that fixed braces are still the appliance of choice for up to 70% of patients in orthodontic offices.

“If you put the braces in the right place, the case treats itself,” a mantra I’ve heard myriad times, is false. For 10 years, I explored digital solutions to perfect bracket positioning and unlock the benefits of true straight-wire mechanics. After trying 16 unique digital braces systems that allowed for measurement down to 0.01 millimeter, I discovered that digital indirect bonding (IDB) and perfect bracket positioning does not allow straight-wire treatment. While ideal bracket positioning did allow me to get the second order where it needed to be, this technology alone lacks control in first and third order. Also, I still needed to make second-order adjustments to align marginal ridges when the real issue was inadequate third-order control.

Digital on its own is not enough; it gets us to only 33%, even with perfect with bracket positioning. A straight-wire solution must be digital and custom.

Imagine if aligners gave us only a single prescription (MBT, Damon, Andrews, etc.) for every case: Teeth would inevitably end up in an incorrect position because a one-size-fits-all system
does not truly fit anyone perfectly. With aligners, the optimal tooth position for the individual patient dictates the prescription as recognized through digital technology. Because of these
experiences, we know it is digital bracket placement with the custom prescription that contributes to success.

The digital custom braces that I tried during my first years in practice taught me much about where to look for optimal solutions. On the surface, it seems like those modalities should have already replaced conventional analog bracket systems. However, there were critical roadblocks with early custom digital solutions:

• The capital and labor intensity to manufacture these appliances created a prohibitively expensive price tag (typically $700+ more than conventional twin brackets).
• The workflow required a considerable time to fabricate and deliver to offices (often four to eight weeks).
• Many systems did not adequately support slot-filling mechanics and required significant wire bending or repositioning to achieve optimal clinical results.

• We need to fill the slot with a custom prescription for excellent, efficient results.
• The IDB trays must be accurate.
• Less-expensive solutions with faster turnaround are imperative for scale in our practice.

LightForce Orthodontics' business has doubled in size every quarter for the past three quarters. The company’s top users include Drs. David Sarver, Maz Moshiri, Brian Lockhart and Alexander Waldman.

The momentum is centered around LightForce’s 3D-printed, fully custom and fully digital tooth-moving platform. 3D printing enables an extreme level of customization and predictability, and the company also offers custom indirect bonding trays, custom bite turbos, custom hook placements, an iPhone-based face scanning software to construct smile arc and, most recently, the launch of the translucent 3D-printed bracket pictured at right. (Its first 3D-printed bracket offering is white.)