Are aligners a reliable fast-track treatment plan?

As a general dentist in practice for over 37 years, I have witnessed many fad dental trends come and go in dentistry. The latest greatest “dental whatever” bursts on the scene, always with a ton of hyperbole, then an avalanche of “pop” continuing education (CE) courses would ensue and everyone would hop on board to ride the newest wave, only to find out during clinical application that the hype was just that, hype, and the dentist really didn’t net any clinical gains from it and sometimes sustained significant loss.

I could list probably hundreds of such fads, such as Sargenti root canals, Mastique veneers, Miracle Mix restorative material, the ThermaFil endodontic system, etc. But the latest greatest “pop CE” I see trending these days, aimed at GPs and Pediatric Dentists, is “quick and easy” orthodontics. Companies that pitch fast braces or even more popular and pervasive, the clear aligner companies who promote their fad-ortho to dentists, suggesting doctors can offer teeth straightening to their patients and skip all that traditional orthodontic training.

Many dentists end up in my Comprehensive Straight Wire courses because they have had a “run in” with just such a fad.

They are attracted to the hype (how could they avoid it, aligners are ubiquitous), so they decide to take Invisalign, Clear Correct, or one of the growing number of aligner classes being offered today. They might even take some type of Fast Braces or Six Month Smile braces course or some other course that promotes orthodontics without attention to diagnosis and treatment planning. Then these naive but very inspired and highly motivated dentists run back to their offices, start some cases and find themselves in awkward clinical situations not talked about or covered on “fad-ortho, pop CE day”.

Specifically, the typical scenario I see goes something like this: The dentist takes a one weekend course in Invisalign or some other aligner class, which assures them that they need very little orthodontic knowledge nor do they require what are considered classic “standard of care” records. Simply take some photos and some impressions (or even better, scan the patient’s models to be submitted digitally), submit the case for review and they will be told by the aligner company if the case is suitable. Of course, the case is almost always “treatable”, and the aligners are summarily procured.

The truth is I always shudder “just a little” when the company that reviews and authorizes a case for a dentist subsequently stands to profit from that decision. “Green lighting” the dentist’s case is just one more set of aligners they get to manufacture and sell. When a case is submitted, for example, to Invisalign for approval, that dentist needs to understand that the company profits if the case is approved. This suggests a potential conflict of interest with which I am very uncomfortable. Just a note of interest and caution, Invisalign and their recommended digital scanner, iTero, are both owned by the same parent company Align Technologies. Recently, an aligner company would not accept scans from one of their major competitors, which again has the appearance of a conflict of interest, questionable ethics, profiteering and an attempt to monopolize the aligner market. I only bring this up because I don’t like dentists to depend on these “profit-driven entities” to make their diagnoses, write their treatment plans and produce their appliances. It is a slippery slope. Many cases are approved for aligner therapy that would be better suited for conventional braces or should only be treated by an experienced orthodontically savvy clinician. And no matter how guilty of irresponsible actions the “for-profit entities” may have been, at the end of the day, we, the dentists, are the only ones accountable and stand liable for anything that goes wrong.

So, it is through this “drive thru, fast food, orthodontic CE” I believe that many dentists who have “learned to do aligners” have been misled and encouraged to treat patients orthodontically even though these doctors have come away from those CE courses with virtually no orthodontic knowledge. They subsequently end up with problems with their aligner cases and have no training, no knowledge, no means to correct the issues that arise. Their cases often need some kind of “orthodontic rescue” because the aligners or the “speedy braces” are not working. And it is only at this point that they realize they lack the orthodontic knowledge and skills necessary to deal with the situation. The fact is the “speedy braces or aligner” company representative didn’t teach them anything about diagnosis or treatment planning. In fact, reflecting on the “training” they received, many report they were told not to worry about records or diagnosis, but to trust the company with the design of the aligners and the methodology of moving the teeth.

Consequently, they face patient disappointment and anger, possible legal entanglements or at least the possible refund of patient’s money and the embarrassment of referral to an orthodontist to fix the situation. Not to mention the irrecoverable money paid to the “speedy braces or aligner” company for the bracket set-up or the trays.

Finally, they enroll in my classes to try to find a way to dig out of the mess!

It happens more often than you would think. Thankfully, there are courses out there like mine that can help dentists in these situations get educated and up to speed on good general dental orthodontics.

In closing the first segment of this three-part blog, I would say that good aligner therapy is achievable but not the way that most dentists do it. And nothing is more important than doing the orthodontics correctly, including good records, good diagnosis and thoughtful treatment planning. So, I cannot endorse aligners and fast braces as they are taught and presented in the dental world today. There is no free lunch. Get good orthodontic training first, learn how to treat the cases ideally, and then learn how to do compromise treatment. That way, when the “fast and easy” approach doesn’t work out, you can rescue those cases yourself.

In Part Two of this blog I will look at clear aligners and their advertised claims of superiority over braces, specifically concerning time in treatment.