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
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
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
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
What is the hardest part of becoming an
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