Orthotown April 2022 - 50

We are fortunate today
to have choices in our clear aligner
offerings, and with that ability
to choose comes a responsibility
to choose wisely for both our
patients and our practices.
Starting with the big names
When I graduated from residency in
2013, clear aligner options consisted of
either Invisalign or ClearCorrect. While I
gave ClearCorrect an honest effort, I found
it was light years behind Invisalign in terms
of staging and ease of use-it simply wasn't
worth the cost savings, given the results
I was able to obtain. To solve the cost
problem, I was often encouraged to " sell "
Invisalign to boost my status and achieve
lower prices; however, I was unconvinced by
the mathematics of this strategy. It is often
cited that up to one-third of one's Invisalign
lab fee can be attributed to marketing,
the rationale being that Invisalign sends
patients to your door through its doctor
locator. Similar claims are made about
reducing chair time and the billable hours
of an assistant to work it.
The unique economics of a startup
practice, however, render these justifications
rather weak. If my established competitor
pays $1,100 per case, that would put his
" marketing " portion at about $366, leaving
about $734 as his " true " lab fee. Without a
volume discount, my lab fee would be around
$2,000. Subtracting out the same $734
" true " lab fee will leave me with a $1,266
" marketing " allocation per patient. This
portion ultimately pays for marketing that
pushes patients to a doctor locator in which
I am at the bottom of the list. Put another
50 APRIL 2022 // orthotown.com
way, newer offices pay almost twice as much
toward Invisalign's marketing campaigns,
which benefit their largest competitors the
most! Likewise, I am of the strong opinion
that chair time is not expensive until one
has maxed out capacity, a problem only a
select few startup owners face.
Still, Invisalign is a known brand that
patients ask for by name. Align Tech owns
the most data of any aligner company and
uses it to constantly innovate through the use
of its " force-driven algorithm, " which uses
pressure points and voids to induce tooth
movement even as the shape of the aligner
will not conform perfectly to the shape of
the tooth or attachments. (This is a similar
concept to placing a " dimple " in an aligner
or retainer to induce tooth movement.) The
company's ubiquitous marketing also has,
unfortunately, led some to believe they can
trust the algorithm to make up for a paucity
of their own clinical skills, which couldn't
be farther from the truth.
For those able to win at the volume
game, lab fees can be quite justifiable;
however, maintaining their status can
result in pressure to oversell the product.
Ultimately, I came to the conclusion that
Invisalign makes the most sense for two
types of practitioners: those who win at
the volume game and achieve the highest
statuses, and those who have a strong history
with this modality and have mastered its
nuances to the point that changing would
be overly cumbersome. I encourage those
who fall outside of these categories to
consider some other options.
Testing new alternatives
By late 2018, I was becoming increasingly
motivated to explore aligner alternatives
when Invisalign stopped accepting scans
from my Trios scanner. I was fortunate then
to become an early adopter for 3M's new
Clarity aligner. This allowed me to cut my
lab fees by one-third while using a product
that was as effective as Invisalign for the mild
to moderate cases I was treating.
Overall, I had an excellent experience
with Clarity. The approver software was clean
and efficient, but best of all it was web-based,
so I could work from any computer in any
location. (Invisalign has since developed a
web-based " lite " version of ClinCheck as
well.) Clarity uses a displacement-driven
system in which aligners are formed by
digitally sectioning teeth and incrementally
moving them along their intended pathway.
Aligner shape is identical to the shape of
the teeth, a similar concept to " resetting "
teeth on a plaster model and making an
Essix retainer over it.
Clarity lacks optimized attachments and
certain algorithmic functions proprietary to
Invisalign, but this didn't present a problem
to me. I felt confident forgoing much of
the algorithmic tooth movement to rely on
my own knowledge of aligner mechanics
instead. A newer feature of Clarity-and
advantage over Invisalign-is the ability to
use a more flexible plastic ( " Flex " ) initially,
then switch to a more rigid plastic ( " Force " )
for finishing movements.
Overall, my experience with Clarity
was one in which I felt little pressure to
" produce " for 3M as we grew our brands
together. I found that patients weren't as
married to the Invisalign brand as I had
once believed and would easily go along
with my recommendation of this alternative
clear aligner. After years of monopolistic
control by a single aligner product, it was
refreshing to feel control gradually shifting
back into the hands of orthodontists.
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Orthotown April 2022

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