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Second Opinion: Clear Aligners: Building Practices of GPs and Orthodontists by Dr. Rene Sterental

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Clear Aligners: Building Practices of GPs and Orthodontists
A hypothetical town hall meeting to discuss the considerations prior to adding clear aligners to a general dental practice.
by Dr. Rene Sterental
Technology has changed tools, processes and relationships in every industry, and dentistry is no exception. In general and orthodontic practices, the advent of clear aligner technology represents a disruptive technology with opinions differing widely on how and where it can and cannot be used most effectively. If we held a town hall meeting to answer questions about introducing orthodontics with clear aligners into a practice, the following topics are common concerns.

1. “I want to learn to use clear aligners, but how am I protected from failing?”
No doctor wants a case to fail. With varying degrees of comfort with orthodontic skills, many GPs are understandably cautious about extending their treatment offerings into unfamiliar territory.

Case Selection is Critical
When starting out with clear aligners, it is best to start with cases that are appropriate to your skill and experience level. These are often simpler cases, involving crowding, spacing or basic aesthetic concerns that do not require a change to the occlusion and typically have a projected treatment length of six to 12 months.

A Helping Hand Along the Way
For GPs new to clear aligner technology, manufacturers might provide training and assistance. For example, Align Technology provides GPs with trai-ning that covers case selection to improve treatment predictability; helps reduce time and effort required by the doctor and minimizes the amount and depth of specialized training required to use the system. Assistance includes such things as basic clinical and operational training needed to begin treating a broad range of patients with Invisalign; a comprehensive getting started kit; online connection to information and resources and an Invisalign Assist treatment option.

The Invisalign Assist treatment option provides procedural and technical support throughout the treatment process to help GPs achieve desired patient results. It includes a progress-tracking tool, detailed appointment plans for each patient, compliance indicators and ClinCheck setups created for each case by Invisalign technicians. As the GP becomes more comfortable with Invisalign, he or she can upgrade to Invisalign full treatment option, and extend capabilities to encompass more challenging cases.

Digital Treatment Delivers Visibility and Reassurance
Digital treatment plans for clear aligners enable doctors to see how teeth will move from diagnosis to completion – before and during the process. This high level of visibility allows doctors to see and plan tooth movements at every stage before treatment begins. Minor adjustments can be made at the end of treatment to reach the desired outcome. Digital treatment plans require thorough planning at the beginning of each case. If the patient is compliant and the treatment plan is correct, doctors gain enhanced predictability and minimize the risk of failure.

Establish A Relationship with A Local Orthodontist

Having an established relationship with a local orthodontist enables GPs to refer cases that exceed their comfort level. Ideally, the orthodontist would also offer clear aligner solutions, enabling both doctors to collaborate on case referral.

Additional Training
Additional training for doctors and staff is often available from aligner manufacturers. Continuing education (CE) credits often can be earned from live training courses, helping GPs and their staff to continue learning. Align Technology also provides information on a wide range of clinical topics online at www.aligntechinstitute.com.

2. “What is the role of clear aligner treatment versus brackets and wires in a GP office?”
Clear aligners and brackets and wires each have its place, and that place depends largely on the doctor’s skills, comfort with technology and the patient’s requirements. Brackets and wires are a proven orthodontic treatment approach and the preferred technique for many orthodontists.

Patients Who Won’t Seek Orthodontic Treatment
Brackets and wires are obviously not for patients who are not likely to seek orthodontic treatment. They might be adults whose teeth have just “always been this way.” They are not concerned about aesthetics. Or they might believe that they don’t have problems that need correction. However, many can benefit from clear aligner treatment from their GPs to improve their oral health. As the first point of contact for patients, the GP is the care provider most likely to identify issues and associated complications of crowding or spacing. Many patients do not realize that spacing, crowding and other malocclusions can lead to periodontal disease and create abnormal amounts of stress on teeth and jaws. Research has indicated that 74 percent of the U.S. population could benefit from straighter teeth.1 When teeth are crowded, plaque with harmful bacteria can attach to the tooth surface down to the bottom of the pocket2 and be difficult to remove. Bacteria can cause gum tissue surrounding the tooth to degrade, and if not treated, result in bone loss.3 Poorly aligned teeth can also develop abfractions at the gum line. Premature wear can lead to poor root support, loose teeth and eventually, tooth loss. Clear aligners can be used effectively in these cases, especially when doctors educate patients about the consequences of malocclusion and choose cases appropriate for their skill level.

Adult Patient Preferences
Even patients who understand the benefits of straight teeth might object to wires and brackets or a two-to-three-year treatment plan. Adults in particular consider clear aligners more attractive and a short treatment easier to comply with. As long as the GP and patient understand and agree to the scope and deliverable outcome for a treatment regimen, then clear aligner treatment will be appropriate.

Continuity of Patient Relationship
Providing orthodontics with clear aligners in a GP office helps maintain patient relationships. Frequently, patients do not want to start a relationship with another care provider. If the GP can provide treatment with clear aligners for cases in which they feel comfortable, patients usually choose to remain with their familiar provider. Of course, complex cases will continue to be referred to local orthodontists.

Control over Comprehensive Treatment Plans
GPs can also use clear aligners to complement restorations. Restorative dentistry has frequently required teeth to be prepped prior to restorations. Clear aligners can help conserve patients’ teeth by moving the teeth to the best position for occlusal forces to work, before restoration. By maintaining the patient relationship throughout a comprehensive treatment plan, GPs can reinforce the patient’s decision and reassure him or her of progress toward the desired results. GPs can maintain control of the end-to-end treatment plan with the restorative results in mind.

Growing the Practice
Incorporating orthodontics with clear aligners into a GP office is another way to grow the business. Patients are likely to refer friends and family, growing the patient base as well as offering new treatment options to existing patients.

Enhancing Skills
As GPs gain experience with clear aligners, they can take advantage of advanced technology and techniques to achieve even greater treatment precision and predictability. For example, advanced virtual modeling led to the introduction of Invisalign G4 SmartForce features. Based on biomechanical principles, Smart- Force features are customized to address straight and rotational movement, as well as the path that a tooth must take to reach its final position. When combined with adjunct techniques, such as attachments or elastics, aligners can greatly enhance the scope of a doctor’s capabilities and address more complex cases if he or she chooses.

3. “My local orthodontist provides clear aligner solutions, and I do not want to step on any toes. What will he or she think?”
GPs can use clear aligners very effectively to build their practices working with simpler cases while referring complex cases to the orthodontist. GPs and orthodontists have built synergistic relationships where both use clear aligner treatment, and both practices benefit from building new patient relationships. In fact, orthodontists can actually receive more referrals from GPs with the ability to offer their patients an attractive, more predictable treatment alternative to brackets and wires.

New Opportunity for New Business
Clear aligners offer an effective treatment option and assistance to both GPs and orthodontists. For GPs, clear aligners provide a way to improve overall oral health and address the needs of patients who would otherwise not seek to have their teeth straightened. For orthodontists, clear aligners offer a treatment alternative to brackets and wires to meet patients’ preferences and improve treatment predictability. For GPs and orthodontists alike, clear aligner solutions can help build their practices, expand treatment options for patients and generate more referrals.

References
  1. Brunelle, et. al. in Journal of Dental Research (2/96)
  2. Chun-Hsi Chung, DMD, MS/Robert L. Vanarsdall, DDS/Elisabetta Ada Cavalcanti, DMD/Jill S. Baldinger, DMD/Chern-Hsiung Lai, DMD, PhD; International Journal of Adult Orthodontics and Orthognathic Surgery, 2000
  3. Kirsten Staufer, Helga Landmesser; Journal of Orofacial Orthopedics, 2004




Author Bio
Dr. Rene Sterental is the clinical director of New Product Development at Align Technology. He has been a staff orthodontist at Align Technology since 2003 and is also a member of the Align Speaker Bureau. Dr. Sterental received his orthodontic and dental degrees from Universidad Central de Venezuela, Caracas. Additionally, Dr. Sterental is an adjunct clinical assistant professor in the Invisalign undergraduate clinic at the University of the Pacific, San Francisco. Dr. Sterental is an international member of the AAO, the World Federation of Orthodontics and the Venezuelan Society of Orthodontics.
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