Do you know that patients are doing their own orthodontics using aligners? Do you see this as a threat to your practice? Would your practice’s bottom line improve if you could purchase your aligners individually? Well, maybe this pearl can help you put this changing face of orthodontic aligners into prospective.
Over the 50 years that I’ve been organizing orthodontic practices there has been many changes; some pros and some cons—nothing comes without a price tag. In Part-II of this three-part series we will discus the changing face of your competition. I’m not talking about local orthodontists or about pediatric or general dentists; I’m talking about patients doing their own aligner treatment. We will also discuss in this part how plastic aligner lab fees can be less expensive. In Part-III of this series we will discuss the pros and cons of the changing face of your Orthodontic Records and TC Procedures.
A major change in orthodontic treatment was the use of plastic aligners. At first, plastic aligners needed brackets to finish the cases, but they eventually worked on their own for those who learned how to use them well, but only after starting hundreds of cases. Much of this change came with a Tx quality, Marketing and Bottom Line price tag.
The Pros & Cons of Plastic Aligners:
The major pros of plastic aligners are: 1) esthetics: i.e. the absence of metal brackets and archwires on the teeth; 2) plastic aligners need much less chair time (it takes about 55% of braces chairtime per full case); and 3) Aligners are a good adult marketing technique. The major cons are: 1) plastic aligners require much patient cooperation; 2) the lab costs are upwards of $2,000 per full case; 3) the hefty lab fee just about ate up most of the dollar gain it saved in chairtime; 4) it takes many cases to learn how to effectively use plastic aligners; and 5) non-orthodontists could use the aligners, creating competition for the orthodontists. Orthodontists who do less than 20 cases per year may not be satisfied with the treatment result quality, which is why they only do the easy cases. Orthodontists who do more than 100 cases per year became satisfied with the treatment quality—refer to my management pearl: “Can Plastic Aligners Increase Net”. Invisalign was the first commercial plastic aligner company, but now there are numerous plastic aligner companies, each with their own pros and cons (quality, cost, etc.). And now, plastic aligners can be made in your own lab, saving you up to half the lab cost and thus, increasing your net. Refer to my management pearl: “Do It Yourself Plastic Aligners”. The newest aligner lab service is that you can order your plastic aligners individually instead of in sets.
Aligner History:
In 1998, Invisalign started making plastic aligners, but they weren’t the first to use plastic aligners. Dr. Keith Hilliard of Lakeland, FL had been creating and teaching his own version of plastic aligners years before. But instead of using Dr. Hilliard’s vacuum system to create the aligners, Invisalign printed them with 3-D printers. For years, Invisalign encouraged and used orthodontists to improve their aligners by telling them that the general dentist is not their intended market. But after the thousands of orthodontically treated cases, Invisalign was ready to sell aligners to general and pediatric dentists. This created major competition for orthodontists even though many of the non-orthodontist treated cases failed, requiring an orthodontist to correct them. Nowadays Invisalign has had its comeuppance with other companies providing aligner lab services at less cost although, orthodontists that do hundreds of cases per year seem to prefer Invisalign. The newest comeuppance is that there are new companies that bypass the orthodontist use of Invisalign by selling directly to the patient. This seems to create even more competition for the orthodontist…or does it?
The Newest Competition; Patients doing their own orthodontics:
Patients now have the option to by-pass orthodontic office visits—I’m not talking about Teledentistry (see the management pearl “Is Hybrid Orthodontics for You?”). I’m talking about bypassing the orthodontic practice altogether. Unfortunately, to sound more professional, the companies that provide patient do-it-yourself aligners are incorrectly calling their service “teledentistry” (see attached PDF “At Home Teledentistry”). They use a misleading definition of teledentistry to make their product sound more professional/legal. It infers that the do-it-yourself customer is working directly with an orthodontic doctor of record who is personally responsible for competently completing their case—this is not true, but then again, what is truth nowadays.
What you and your new patients (who bring it up) should know about do-it-yourself aligners:
Usually Do-it-Yourself Aligner companies don’t treat the entire arch, just the anteriors and sometimes the bicuspids for about $2,000. Do-it-yourself-aligner companies also seem to imply that the customer is getting the same high quality of treatment as they would get at an orthodontic practice. Go to this link to see what they are advertising/claiming.
Here are some of the facts about the leading do-it-yourself-aligner companies:
- “Byte” is the most popular service, with about 125 complaints/year
- “Smile Direct” has the most complaints with over 1,000/year
- “Candid” has fewer complaints with about 40/year
- “Alignerco” has fewer complaints with about 27/year
The usual complaints after using do-it-yourself-aligners include:
- They advertise/infer that treatment will last for 3-6 months (adding up to about $400 to $600), but the usual case takes about 18 to 24 months at an average cost of about $2,000.
- Some tooth movements are so strong that they kill the tooth roots, requiring thousands of dollars in root canals and prosthetics to resolve.
- Some people complain of chipped teeth from the aligners, requiring prosthetics to resolve.
- Many complain about numerous problems caused by faulty treatment planning and ineffective aligners.
- Many end up with bite problems from misaligned U&L teeth after treatment, probably because they don’t treat the bicuspids or molars.
If a patient complains, the company just redoes the aligners and charges for more months of treatment, which is probably why the treatment costs thousands of dollars and takes many months.
Unbeknownst to me, my daughter tried “Byte”, paid $2,000 up front and got nowhere with her tooth movement. She told Byte that she wanted her $2,000 back and they sent her a new, more accurate set of aligners, which eventually worked, but the results were mediocre and took many more months to treat.
Do-it-Yourself Orthodontics, Conclusions:
As terrifying as this may all seam, do these companies really create competition for you? The answer is NO! They actually provide you with a service. They reduce/eliminate: 1) your wasted time with curious new patients who definitely can’t afford your treatment; and 2) patients that start but default on their payments. When new patients bring up whether they should be treated by you or treat themselves, just quote the facts and the complaints noted above.
New: Individual Aligner Services:
The other side of this revolution in plastic aligners is a new service by Ulab Systems that lets you purchase one or more aligners at your discretion. This is advantageous when you just need a few aligners for a limited treatment. With this single-aligner-purchase approach you don’t have to purchase large sets of U&L aligners up front; just design and order what you need and add new aligners as treatment progresses. Depending on how good a customer you are, they charge you between $19 (good customer) and $21 (casual customer) per aligner (not per U&L set), with a guaranteed maximum full treatment cost of between $950 (good customer) and $1,600 (casual customer). They claim their service provides an average overall savings of 40% over Invisalign. For the casual customer it is not that great a savings ($400 or 25%) over the casual Invisalign customers $2,000 full case lab fee. But it’s the partial treatments that save you in lab fees because you don’t have to purchase many sets of U&L aligners—many of which you don’t need—you just pay for the U and/or L aligners that you need. But Ulab Systems will need hundreds of orthodontists doing many thousands of cases before the quality of their service/product can be determined although, they claim that 98% of their customers would recommend them.
I hope that this plastic aligner discussion has relieved some of the fears that you may have about do-it-yourself-aligner companies and has provided you with a possibly less expensive source for your plastic aligners and more accurate Tx Fees.
Part-III of this series will deal with how the changing face of orthodontics has changed Initial Records and TC procedures that get the patient started sooner.
