Incorporating Invisalign Chelsea Knorr, staff writer, Dentaltown Magazine

What is the implementation of Invisalign like from day one? Dr. Austin Reed was his own first Invisalign subject. After taking the needed continuing education, trying the treatment on himself and integrating the service into his practice, he tells Dentaltown readers about his positive experience, his reasons for taking on orthodontics in the first place and the process of implementing Invisalign, from start to finish.

What factors did you consider in making your decision to add orthodontics to your practice?
Reed: I decided to add orthodontics to my practice for several reasons. First, I practice in a young community with many young families with children. I was referring a lot of orthodontics out and I decided I wanted provide some basic services to my patients. My practice is about 15 minutes outside of a larger town and my patients appreciate that they can stay in my office and receive a variety of services. Secondly, I had a lot of patients asking me how they could improve their smile. As I said, most of my patients are younger and I didn't necessarily want to see them doing veneers when ortho would be a much better option. Many were reluctant to do traditional orthodontics, so I looked for another option for them. We try to emphasize the many benefits of having properly aligned teeth in addition to just the cosmetic benefits – like decreasing the risk of periodontal disease (and all of the general health effects that it has), reducing premature wear and chipping of teeth, reducing abfraction forces, reducing TMJ pain and improving the overall prognosis for all the teeth to be maintained for a lifetime.

After incorporating Invisalign, would you consider any traditional orthodontic methods?
Reed: I am not currently doing any traditional orthodontics. At this point, we have chosen to keep things simple. Getting started with Invisalign does not require a lot of extra instruments or equipment. There is an orthodontist in the larger town next to us who does Invisalign. If there is a complicated case we feel uncomfortable treating, we know we can still refer it out. Also, Invisalign is constantly updating its product and making it better. There really aren't a lot of things that Invisalign can't do at this point. So if we find one of those things, it is probably best to refer anyway.

How do you decide what types of cases you want to treat? How about what products or brands to work with?
Reed: Clear Essentials I, Invisalign's first course, does a good job teaching which cases are easily treated with Invisalign and which cases are more difficult. When I came back to my office after the course, I had a concept of where I wanted to start (Class I occlusion, mild crowding or spacing). After I gained some experience, and took some more continuing education, I was able to increase the difficulty level of the cases I treat. As far as what products I work with, Invisalign is flexible, so doctors can use the products they feel most comfortable using. We use a basic putty and a light body PVS material for our impressions and get great results.

What were key factors in getting started?
Reed: The first step in getting started is obtaining the proper education. I had a base knowledge of orthodontics from dental school and I combined that with Invisalign's Clear Essentials I and II. Following those two courses, I have taken online seminars and classes available free of charge on Aligntech Institute's Web site. Once I was comfortable with the process, it was important I start talking to patients about the new service. I was amazed how many patients had heard about Invisalign and had actually thought about getting Invisalign. Most patients don't bring up these topics, but when I start the conversation it is easier for them to ask questions. Commitment to talking to all of your patients about Invisalign is the biggest key to getting a great start.

As far as training, what did you and your staff need to feel confident about the process?
Reed: The first thing the staff need to know about Invisalign is what type of cases it can treat. The easy answer is that it can treat just about everything. Over the years Invisalign has continually improved, and now with Invisalign G4, there are very few cases it can't treat. With that said, each doctor needs to decide what his or her own personal comfort level is and what types of cases he or she wants to treat. If the staff understands the type of cases the doctor is comfortable treating, they can start the conversation with patients and gauge their interest level. Invisalign's Clear Essentials I class also covers how Invisalign works and what the benefits are for having Invisalign treatment. Most people are concerned about cosmetics but it is our job to inform them about the other, more important, reasons to have Invisalign.

How did you ensure your team was prepared and motivated to support the new offering?
Reed: Once the team was properly educated, it was very easy for them to buy into the concept of Invisalign. It is a great service we can offer to our patients that will not only make them feel better about their teeth and smile, but also benefits their long-term oral health. Both myself and another staff member decided to have Invisalign treatment, so it didn't take us long to become experts for our patients about what to expect.

How did you set production goals?
Reed: We initially started out with a goal of one case every other week, or 24 for the year. Quickly, we realized we were setting the bar too low.

Figure this: If a practice with two hygienists should see at least 64 hygiene patients a week, and half of those people have teeth that have some sort of crowding or spacing issue, then you will see 32 people per week who could benefit from Invisalign. If you and your staff are committed to talking to these people about Invisalign, one patient, out of 32 per week is not a very hard goal to meet.

What was the support from Invisalign like?
Reed: Excellent. Invisalign, through its Aligntech Institute, offers everything a practice needs to incorporate and thrive with Invisalign. It offers a full range of marketing materials, both direct and indirect, to help incorporate and build the Invisalign brand in your practice. These products are crucial in letting patients know you offer Invisalign and what benefits they will receive from the treatment. On the technical support side, Aligntech Institute offers continuing education that is available online and free of charge. If there is a specific type of case I am struggling with, I can go online and view a presentation on how to best manage that type of case. Doctors are also well-supported by Invisalign territory representatives to help with any other hiccups along the way.

I understand you were your own first subject. How did you "select" your first case? Can you walk me through how you did this?
Reed: Case selection is explained in detail at Invisalign's first course Clear Essentials I. Obviously some cases are going to be harder than others, so it is best to start with easier cases to improve your chances for success at the beginning. I had ortho as a teen, and as many teens do, I did not wear my retainers for the prescribed amount of time. So my case started with posterior Class I occlusion, with moderate lower anterior crowding. I also had a small black triangle between #8 and #9. In my case, #23 had moved lingually and supra-erupted. Due to my occlusion, tooth #23 and tooth #10 had premature incisal wear. Tooth #23 had even become non-vital and needed to have endodontic treatment. I had previously consulted with an orthodontist to see what I could do to fix my lower anterior crowding. They had suggested full ortho. I really didn't want to do full ortho again at my age, like many adults. So I started with Invisalign and have had great results.

How to do market the service?
Reed: Our marketing approach is two-phased. First is our internal marketing, we have all sorts of signage in the office letting our patients know that we offer Invisalign. We have pamphlets, posters, signs, the works. We even have the Invisalign logo on our scrubs. If you walk through our office and don't know we offer Invisalign, you have had your eyes closed. Second, we have a strong external marketing presence as well. Radio has been incredibly successful in our area. It has really pulled patients into our practice that otherwise probably would not have been. To go along with that, we believe a strong Web presence is essential. People like to get information at their own pace and after they hear our radio ad, or see a brochure in our office, it is important to have more information available to them on the Web. This way they can learn more about Invisalign and be even more excited about it when they get to my office.

How do you approach case selection?
Reed: As I stated earlier, there are very few cases Invisalign can't treat. I only pick cases that I am comfortable with so I know we will get great results. As with anything in dentistry, you should only treat what is within your comfort level. I still refer more complicated cases to an orthodontist. It is nice to have a local orthodontist who will treat more advanced cases with Invisalign so that we can offer the service to everybody.

How much time do you schedule for patients?
Reed: The discussion of Invisalign starts at the hygiene appointments. If the patient needs or wants Invisalign, we set up a 45-minute appointment in our overflow chair. I will stop in during this appointment to answer any questions the patient might have and continue the message about the benefits of Invisalign. I have my staff discuss fees and payment options at this appointment. Once the patient is committed to begin treatment, I have an expanded function assistant take a series of photos, PVS impressions and a bite registration. Roughly three weeks later, we see the patient for a 30-minute appointment for the ClinCheck. At this appointment we review the virtual models, estimated treatment outcomes and estimated treatment time. This is something that could be done by office staff but I prefer to do myself. Our delivery appointment is 30 minutes in the overflow chair. This appointment can be done mostly with auxiliaries depending on your state law.

How do you handle patient compliance?
Reed: Invisalign Assist and Invisalign Teen have compliance indicator tabs on the buccal surface of the second molars. These help parents know if their kids are wearing the aligners for the desired 22 hours a day. We don't have many problems with compliance though. Most patients are excited. They realize Invisalign usually has a shorter treatment time than traditional orthodontics and patients are eager to wear the trays to keep treatment on schedule.

How is the relationship with orthodontists in your area?
Reed: We have an orthodontist locally who also treats with Invisalign. We have a typical GP-specialist-type relationship. It works well to have someone I can call if needed.

How many patients have you treated? Were there any you couldn't finish with Invisalign?
Reed: We've treated 36 total, 33 this year, and none we couldn't finish.

What is the hardest part of becoming an Invisalign provider?
Reed: Becoming an Invisalign provider is easy. The hardest part is committing to making it a point to tell all your patients about it. Providers will be surprised how many of their patients don't know what services are offered. They will also be surprised at how many people are interested in Invisalign treatment.

Can you summarize the integration process?
Reed: Invisalign has been successfully integrated into our practice. We are getting referrals from patients and parents who we have treated with Invisalign. We have a marketing strategy in place that is effective but also continues to evolve. My recommendation for GPs who do offer orthodontics – Invisalign is a great service you can offer to your patients. Properly aligned teeth provide so many benefits. Getting started is easy, and once you have it fully incorporated into your practice it will provide personal and financial rewards. A new service like Invisalign can re-energize your practice because many of your patients are already thinking about and wanting Invisalign.

Thank you for sharing your experience with our readers.


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