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Teleorthodontics’ Democratization of Clear Aligner Treatment

Clear Aligner Chronology

Invisalign was launched in 1997 and was only available to orthodontic specialists and not general practitioners. Align Technology’s orthodontic advisors recommended this tactic in order to avoid the wrath of their trade organization and its members. In 2001, Dr. Jon Richter a general dentist, filed an anti-trust suit against Align [1]. As a result of this lawsuit, Align was forced to make Invisalign available to all general practitioners.

The SmileDirectClub teleorthodontic platform launched in 2014 a platform which enabled dentists and orthodontists access to treat their patients remotely and at a substantially lower cost using today’s technology.

In February 2017, a Journal of Clinical Orthodontics Interview with Joe Hogan, CEO of Align [2] was published. He stated that the SDC model was about convenience and price point, and predicted that competition would be in the general practice aligner segment. The cost of SDC treatment is 60% less than its competitors.  In December 2017 the biennial Journal of Clinical Orthodontics orthodontic practice study for was published [3]. It reported that the mean cost of orthodontic treatment was $6200, the mean net income of an orthodontist was $547,712, and 36% of orthodontists reported not being “busy” enough. The expectations of orthodontists for 2017 practice growth based on 2016 numbers revealed that 81% of orthodontists expected gross income to stay the same, 48% of orthodontists cited general dentists doing Invisalign as a key factor in lack of practice growth, and 42% of orthodontists cited general dentists doing traditional orthodontics as a key factor in lack of practice growth.

At the start of 2018, clear aligners accounted for only 15% of the existing orthodontic appliances market. In April 2018, Align expanded its Invisalign product portfolio, more than likely in response to the exponential growth of SDC [4]. At about the same time. Forbes reported that Align should “brace for competition from less expensive market alternatives” such as SDC and others [5]. In their 3rd quarter earnings report, Align stated that the lower average selling price of their products resulted from promotional discounts, a shift in product mix, and unfavorable foreign exchange [6].

A Synthesis

Many orthodontists who offer in-office teeth straightening seem to be arguing with great vigor that teleorthodontic treatment with clear aligners is bad for consumers, bad for their business, and in general bad for the status of orthodontics as a branch of “healthcare” [7,8]. While organized dentistry used its bully pulpit to disavow teleorthodontic treatment and issued complaints with state dental boards and other regulatory bodies in an attempt to restrict trade [9,10], more than half a million consumers have gained access to orthodontic treatment because of this teleorthodontic model, improving their oral health and quality of life. It is unfortunate that the traditional orthodontic community did not realize that their busyness problem and growth stagnation are the result of their own unwillingness to offer limited clear aligner treatment at a reasonable fee.  Rather than adjust to the needs of the consumer and respond to market demand, orthodontists and dentists decided to act in a protectionist and anticompetitive manner. No matter how much consumer traffic Align may initially drive into orthodontic offices and how many different products are offered, treatment acceptance will always be determined by price and convenience. Unfortunately, these parameters are set by the orthodontist and not Align.

So, for the large segment of the population seeking limited alignment of their teeth who cannot afford high priced and inconvenient treatment in the bricks and mortar orthodontic office, SDC has filled the vacuum and given them an alternative. Clear aligner treatment would never have been democratized if it wasn’t for teleorthodontics.

  1. Billion-Dollar Battle. Dentaltown.com June 2018
  2. Mr. Joseph Hogan on Align Technology. J Clin Orthod. 2017 Feb;51(2):95-102
  3. 2017 JCO Orthodontic Practice Study. J Clin Orthod. 2017 Oct;51(10):639-656.
  4. Align Technology press release. https://www.globenewswire.com/news-release/2018/04/04/1460346/0/en/Align-Technology-Expands-Invisalign-Product-Portfolio-With-New-Options-and-Greater-Flexibility-to-Treat-a-Broader-Range-of-Patients.html
  5. Forbes. Bracing For Competition? Cheaper Challengers Enter Invisalign’s $1.5 Billion Market. https://www.forbes.com/sites/michelatindera/2018/05/02/bracing-for- competition-cheaper-challengers-enter-invisaligns-1-5-billion-market/#6c7ea0532392
  6. The Motley Fool. https://www.fool.com/investing/2018/10/25/lower-invisalign-prices-slow-align-technology-incs.aspx
  7. Kravitz ND, Burris B, Butler D, Dabney CW. Teledentistry, Do-It-Yourself Orthodontics, and Remote Treatment Monitoring. J Clin Orthod. 2016 Dec;50(12):718-726.
  8. New York Post. At-home invisible teeth aligners could come back to bite you. https://nypost.com/2019/04/29/at-home-invisible-teeth-aligners-could-come-back-to-bite-you/
  9. American Association of Orthodontists Consumer Alert. https://www.aaoinfo.org/_/online-orthodontic-companies/
  10. American Dental Association discourages DIY orthodontics through resolution https://www.ada.org/en/publications/ada-news/2017-archive/november/ada-discourages-diy-orthodontics-through-resolution
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