10 Pearls and Hacks for Better Invisalign and ClearCorrect Outcomes

As an orthodontist, a dental space pundit and the “mama” of the DTC aligner movement, I am often asked for tricks and tips for better aligner outcomes. I have to admit, I am blessed with a bit of a photographic memory. This came in handy on the D.A.T. perceptual ability section, but it also is gift in the prediction of orthodontic outcomes.

Long before A.I., us orthodontists used our own grey matter to predict outcomes. I’ve been in the field of orthodontics going on 18 years now, and I can honestly say that I’ve probably seen tens of thousands of orthodontic cases: my own patients, SmileDirectClub patients and my own StraightSmile Solutions’ client’s patients.

The following is a list of the ten best tips, tricks and pearls for ideal aligner outcomes:

1. Attachments aren’t required. There’s a billion-dollar DTC industry that has proven this concept. For most efficient outcomes and more complex cases, attachments are recommended, though.

2. IPR is very useful in cases of tooth-size discrepancies and perio patients. For me, any perio patient gets IPR. I don’t want to add to their attachment loss by pushing a tooth through the buccal plate. That is a lawsuit waiting to happen.

3. Trim is a personal preference. Don’t stress about it. Higher trim means better retention and less attachments needed but more fit issues.

4. Never, ever do single arch treatment. You’ll regret it. Just say “no”. Never, ever discount single arch treatment either if you do. It just takes once to learn why!

5. Always capture your terminal molar fully on your impression or scan. If it is erupted, you need to capture it. Trust me on this!

6. Your cases will track better and get done faster with a scan vs an impression. Stop stalling, just buy a scanner. It is worth the investment! We know companies that are financing for just $500 a month. If you are doing 1 case per month it is worth it and that is just aligners! Patient experience also has a value as well as shipping time, PVS costs and accuracy.

7. The most overlooked key to success is tracking. You can’t believe how many docs just give a handful of aligners to the patient and just roll the dice that the patients will track. I recommend www.GPorthotracking.com for an affordable, HIPAA-compliant tracking option. Have the patients save all their old aligners. Invest $5 in a cheap, tackle box with compartments and label it for the patient and have the patients bring it to every appointment with their archived aligners sorted in their numbered spots. I have pictures of this hack on my YouTube site: https://www.youtube.com/watch?v=dMQCYOv7mXM&t=116s

8. Less is more. Invisalign moves by default 0.25mm per aligner. ClearCorrect moves 0.3mm per aligner, but did you know that you can change that default if you do Invisalign Comprehensive or ClearCorrect Unlimited? One of the easiest hacks is to take their treatment plan, once optimized, and double it, thus making your increments smaller and more likely to track. If all goes well you can speed up the treatment plan with 4 day aligner changes for Invis and 7 day aligner changes for CC. You’ll look like a hero and you are still done at the same time! If your patient gets off track just go back to the archived aligners and with smaller incremental changes and less forces, you should never need a refinement! This hack is not at all popular with Align Technology or ClearCorrect Corporate, but my patients also get done quicker and use LESS aligners overall because they don’t often need revisions/refinements or MCCs!

9. IPR= more likelihood of refinements. Anytime you do IPR it isn’t an exact science so anticipate a MCC or refinement. Let the patient know. Check out our IPR webinar at www.GPwebinar.com to learn to do IPR more accurately.

10. Be on the lookout for masseters and low angle cases. I love intra-oral botox for aligner cases because those clenchers and low angle cases tend to get posterior openbites from all the intrusion. Be prepared: Use Invisalign only for these cases and add bite turbos preventively. It only takes one of these cases to learn your lesson! No, Align Technology won’t know your patient is a clencher so they won’t add them unless you ask for them. If you get a posterior openbite, don’t stress! One of the quickest way to eliminate them is an old-school positioner. Check out our webinar on closing iatrogenic, aligner openbites at www.GPwebinar.com

Orthodontic sleep, airway, tele-medicine and aligner companies are the hottest tech startups and StraightSmile Solutions® has the experience to to help you scale! We offer anyone currently in the dental industry a 20 minute complimentary consultation. Visit www.straightsmilesolutions.com to schedule your phone call by clicking in the top, right corner.

As an orthodontist, a dental space pundit and blogger, and the “mama” of the DTC aligner movement, I am often asked to predict future trends. Given my unprecedented experience within this space, I am uniquely qualified to answer these key questions:

Would I invest in SmileDirectClub?
Yes, I did, but I was smart and bought my shares at $9 and change. I still think SDC has some key changes to make in order to succeed. If I don’t see things changing soon, I’ll sell. They are an incredibly innovative team, so I am sure they will make smart decisions soon.

2. Would I invest in Invisalign?

Maybe, I’ve given their exec team directly last month a few key tips. If I start to see implementation and a change in market strategy, I will.

3. What do I think of “all the others” in the doctor-facing channel (eg: Spark/envista, ClearCorrect, 3M Unitek..etc)

I don’t think about them. Negligible. Many will be gone soon. Nothing special there. No innovation.

4. What do I think about the copy-cat DTC companies (eg: Candid, Byte)?

Same answer as above, unless their strategy changes. Given some of the new legislation, there’s a better way to scale and they are doing it wrong.

What are SmileDirectClub and Direct-to-Consumer (DTC) Aligners?
SmileDirectClub is disrupting the orthodontics industry by providing a generic version of the Invisalign teeth aligned that’s direct-to-consumer. In 2018, the first round of Invisalign® patents expired. SmileDirectClub uses the same clear aligners, but it cuts out the in-person, orthodontist middleman by selling straight to customers. The company relies on teledentistry, which means a dentist looks at your teeth via cyberspace. This makes the process a lot cheaper but also, at times, less reliable and ideal. SmileDirectClub charges $1,895 for its service, versus $5,000 to $8,000 for existing alternatives. SmileDirectClub also has incredible financing that is really unmatched in an orthodontist’s office. You just make a down payment of $250 and monthly payments of $85.

What are Invisalign and Doctor-Directed Aligners (DDA)?
These are braces made of plastic which is fabricated by 3D printed models which are generated from a digital treatment plan. Nothing has to be glued on your teeth or “tightened” which saves time at a doctor’s office. Keep in mind that the average Invisalign case (ASP), according to the most recent Invisalign Q3 report, is $1260. Orthodontists and dentists have to raise that price to cover their own overhead and expenses beyond that lab fee. Most doctors I know are selling Invisalign for $4000-$5500. That is significantly higher than SDC for very similar technology.

Orthodontic sleep, airway, tele-medicine and aligner companies are the hottest tech startups and StraightSmile Solutions® has the experience to to help you scale! We offer anyone currently in the dental industry a 20 minute complimentary consultation. Visit www.straightsmilesolutions.com to schedule your phone call by clicking in the top, right corner. Venture Capitalists, our rates start at $600 an hour for a phone call up to 50 minutes long. Email us to schedule at [email protected] .

There is nothing I like better than an underdog story and boy do I have one for you today!

I previously posted an article about measuring orthodontic efficiency in your practice. If you haven’t taken my challenge, please click here before you read the rest of this blog. If your margin isn’t at least enough on each case, you aren’t doing it efficiently. You should be profiting at least $1500-$2000 on each case. If you aren’t, read on. I’ll be talking about ways to take back control of the profitability of your orthodontic cases by leveraging technology to reduce chair time and lab fees.

I’ve been preaching remote consults and remote aligner check-ins for years with my StraightSmile Solutions® clients. This is not at all DIY or DTC dentistry. It’s actually quite the opposite. It’s just reducing unnecessary chair time and increasing efficiency in your practice.

In response to the frustration of many of my clients pertaining to the high start-up costs to join Dental Monitoring® (DM), my friend Dr. Doug Moorehead of Moorehead Dentistry in Ohio is launching a myriad of programs through GP Ortho Tracking™ to increase the ROI in your aligner, braces and functional appliance patients. With UNLIMITED patients and check-ins and start-up costs as low as $199 for each practice, it is the perfect solution for every general dentist, orthodontist or pediatric dentist who doesn’t have enough volume to sustain the high costs of Dental Monitoring System.

Just to compare apples to apples, let’s say you have twenty (20) active orthodontic patients. Your cost for all your patients for the set-up and support for first year of GP Ortho Tracking is just as low as less than $1400. In comparison, DM would be more like $4000-$6000 depending on which plan and services you choose.

To learn more about GP Ortho Tracking, visit: https://gporthotracking.com/

Looking to scale ortho? You can click here here to schedule a call.

Check out some of the new services we’ve launched in 2019, too! www.straightsmilesolutions.com/services/

Our YouTube site has a ton of great information on all kinds of orthodontics and tip to save money on lab fees, click here to check it out and subscribe!

It is the wild, wild west in the land of clear aligners. StraightSmile Solutions® is the ultimate aligner matchmaker. We help doctors select ideal cases for white labeling aligners to save on average 50-75% on lab fees and still obtain ideal outcomes.

With price points as low as $15 per aligner, now is the time to lower your lab fees!

Give us a buzz to learn more or to be connected to one of these excellent aligner design companies: [email protected] or schedule a phone call by clicking on the link on www.straightsmilesolutions.com

We help doctors and DSO’s through all steps in the white-label aligner process.

Aligner white-labeling is here. StraightSmile Solutions® is the ultimate aligner matchmaker. We help doctors select ideal cases for white labeling aligners to save on average 50-75% on lab fees and still obtain ideal outcomes.

Remember, there are four main steps to the alternative aligner workflow and the Design is just step #2. For ideal outcomes, all four steps must be executed ideally and your SOP and workflow must be optimized.

Give us a buzz to learn more or to be connected to one of these excellent aligner design companies: [email protected] or schedule a phone call by clicking on the link on www.straightsmilesolutions.com

We help doctors and DSO’s through all steps in the white-label aligner process.

My eighty-seven-year-old mother-in-law now knows what a clear aligner is. That is because SmileDirectClub has done in the last three years what Invisalign failed to do over the past twenty years – create global brand awareness of their product.

With this in mind, I have a hard time understanding the victim mentality displayed by the dental profession towards SmileDirectClub. The consumer’s ability to recognize or recall a brand is central to his or her process of making a purchase decision. Purchasing cannot proceed unless a consumer is first aware of a product category and a brand within that category. Thank you, SmileDirectClub, for creating this awareness on your dime. It’s our turn now – let’s capitalize on this instead of playing the victim!

This is where OrthoFx comes in. I’ve had my eye on OrthoFx for a number of months. I wanted to share what I learned in a blog post for my readers. When my incessant requests for interviews with their exec team went unanswered, I even went so far as to visit their headquarters in Fremont last summer – but nobody answered!

Finally, after 6 months of trying, I was invited to meet with the team. We met today, and once I understood the business model and opportunity, I was really blown away.

Many doctors enroll in the Invisalign Clear Fundamentals course. Unfortunately (for them), very few successfully integrate aligners into their practice. I attribute this to the fact that the quality of Invisalign’s onboarding experience greatly deteriorated as they scaled. OrthoFx is looking to change this.

OrthoFx understands that not all patients are interested in a referral to a traditional orthodontist. It is inconvenient and unfamiliar. For this reason, many patient’s oral health needs are unaddressed if their general dentist doesn’t offer orthodontic services. However, general dentists are uniquely qualified to provide limited orthodontic treatment because they truly understand the oral health of their patients and they follow their patients for life. As we all know, malocclusion causes more than just cosmetic concerns: the collapse of arch width, loss of guidance, tooth wear, deepening bites, fremitus and bone loss all come as a result of continued tooth movement. Malocclusion is a progressive disease.

OrthoFx believes in the “hub and spoke” model of interdisciplinary care. Few general practitioners can carry out a proper facial, skeletal and dental orthodontic assessment and diagnosis. In order to provide true quality of care, we need to collaborate with local specialists. OrthoFx hopes to both educate dentists correctly and provide a platform for mentorship from specialists.

This is not at all a “ship and forget” model. The team at OrthoFx allows the doctor to just be the clinician, without the stress of marketing, billing, case presentation and collections. They partner with the doctor to create a happy patient journey through and beyond treatment.

Many doctors are also unaware of the importance of orthodontic aftercare, both from a care perspective and from the standpoint of an additional revenue center. OrthoFx will also be providing this resource to their providers.

In conclusion, I have my eye on this tech start-up. They are a progressive company looking to level the playing field and support interdisciplinary care all while providing an excellent patient experience and high-quality orthodontic products.

Orthodontic sleep, airway, tele-medicine and aligner companies are the hottest tech startups and StraightSmile Solutions® has the experience to help you scale! We offer anyone currently in the dental industry a 20 minute complimentary consultation. Visit www.straightsmilesolutions.com to schedule your phone call by clicking in the top, right corner. Venture Capitalists, our rates start at $600 an hour for a phone call up to 50 minutes long. Email us to schedule at [email protected] .

Orthodontic sleep, airway, tele-medicine and aligner companies are the hottest tech startups and StraightSmile Solutions® has the experience to to help you scale! Check out some of our domains that are for sale to get you started. We offer anyone currently in the dental industry a 20 minute complimentary consultation. Visit www.straightsmilesolutions.com to schedule your phone call by clicking in the top, right corner. Venture Capitalists, our rates start at $500 an hour for a phone call up to 50 minutes long. Email us to schedule at [email protected] .

You asked and we listened, gone are the days of ugly, metal bonded retainers! The Peek® Retainer is here from Retain3r!

What is bonded lingual retention? This retention help with the prevention of relapse of crowding, rotations or spacing in the maxillary and mandibular anterior segments following orthodontic treatment.

Main Types:

1. Lab Custom Cast or 3D Printed

2. In-Office Fabrication

For this review, we’ll be discussing creating your bonded retainer in-office. This saves on time and lab fees.

3 Major wires used:

Stainless steel braid wire.

Titanium Single strand.

Titanium braid wire.

SS Braid wire

Permanent retention is greatly enhanced using a flattened, dead soft 8-braided wire. Intra-arch splinting with this thin ribbon arch prevents torque control problems that can occur using a round braided wire of these procedures.

When bonded on the lingual of the upper incisors, a very thin rectangular wire can be adapted with little lower incisor interference.

The soft wire is easy to adapt and prevents inadvertent tooth movement associated with active force wires.

It’s excellent for semi-permanent orthodontic splinting of the upper or lower incisors. It can be used to hold diastemas closed, maintain difficult extraction sites and solving various other tooth-splinting dilemmas.

Excellent for splinting periodontally compromised teeth.

Titanium Single Strand

Single strand NICKEL FREE titanium flat metal ribbon with increased interproximal strength is ideal for semi-permanent splinting and maintaining difficult extraction sites.

Titanium wire offers reduced wear rates and is nickel-free, eliminating potential patient allergy issues. The wire can be easily formed, and its flat dimensions are ideal for retaining final torque positions.

Braided Titanium Wire

NICKEL FREE Braid construction enhance strength to avoid snapping and increase surface area.

Unique strand construction allows a slight degree of physiological movement yet retaining the post treatment smile arch.

StraightSmile Solutions® supports doctors with all orthodontic treatments, including but not limited to functional appliances, braces, hybrid treatment, habits, lab selection, airway and of course- aligners! Our goal is to find you the right solution for your case and your treatment philosophy and budget. We support you with everything you need: case selection, treatment planning, team training, staging, compliance, operations, outcomes, and retention. We also help to train doctors and teams with hands-on courses that are both digital and destination. For more information visit www.straightsmilesolutions.com. Disclaimer: StraightSmile Solutions® is unable to support any direct-to-consumer operations or doctors at this time.

Aligner white-labeling is here. StraightSmile Solutions® is the ultimate aligner matchmaker. We help doctors select ideal cases for white labeling aligners to save on average 50-75% on lab fees and still obtain ideal outcomes.

Remember, there are four main steps to the alternative aligner workflow and the Design is just step #2. For ideal outcomes, all four steps must be executed ideally and your SOP and workflow must be optimized.

Give us a buzz to learn more or to be connected to one of these excellent aligner design companies: [email protected] or schedule a phone call by clicking on the link on www.straightsmilesolutions.com

Copyright StraightSmile Solutions® 2019

Hand Wrist Radiograph in Orthodontics

StraightSmile Solutions® uses a variation from the Hand Wrist Radiograph from The Atlas of Greulich and Pyle (1959)

Why is Growth Prediction Important in Orthodontics?

 

*To understand the potential direction of facial development

* To predict growth potential left

* Too stage the onset of treatment timing prior to treatment in a Class II or III Skeletal malocclusion patient

* To select the most effective treatment plan

* To clarify a major discrepancy between dental age and chronological age

* To time Orthognathic surgery

What Data Can be Used for Growth Prediction in Orthodontics?

 

* Growth Charts

* Secondary Characteristics

* Skeletal Development

* Chronological Age

* Dental Development

Anatomy Markers:

 

To keep it simple, we recommend just focusing on 3 bones:

1. The Epiphysis and Diaphysis of the Middle Phalanges in the 3rd Finger.

They are small bones forming the fingers. They are three in number in each finger, except the thumb, which has only two phalanges. They ossify in three stages. The Diaphysis is the middle section of a bone. The Epiphysis refers to the ends of a bone.

2. The Sesamoid Bone

The Sesamoid bone is a “Dot-Shaped” bone in the thumb

3. The Radius

The wrist bone.

Pre-Puberty:

 

The middle finger, middle phalanges has a diaphysis that is smaller than the epiphysis

3 Years Before Peak Puberty:

The epiphysis and diaphysis of the middle finger and middle phalanges are equal

Puberty is Starting:

The sesamoid bone presents in the thumb.

Puberty is Peaking:

The epiphysis of the middle phalanges of the middle finger caps the diaphysis by surrounding like a cap.

Puberty is Almost Complete

Fusion occurs between the epiphysis and diaphysis of the middle phalanges of the middle finger in absence of the fused radius bone.

Puberty is Completed

The complete union of epiphysis and diaphysis of the radius. This is the last bone to ossify.

The ossification of all the hand bones is completed and skeletal growth is finished.

StraightSmile Solutions® supports doctors with all orthodontic treatments, including but not limited to functional appliances, braces, hybrid treatment, habits, lab selection, airway, and of course- aligners! Our goal is to find you the right solution for your case and your treatment philosophy and budget. We support you with everything you need: case selection, treatment planning, team training, staging, compliance, operations, outcomes, and retention. We also help to train doctors and teams with hands-on courses that are both digital and destination. For more information view our services here. Disclaimer: StraightSmile Solutions® is unable to support any direct-to-consumer operations or doctors at this time.