This post is about getting started with clear aligners.
The content may also inspire colleagues who do not want to work with orthodontics. The content is written with a focus on keeping a cool head and focusing on elements that add value to the dental practice.
Once we have decided to implement clear aligners as part of our treatment offer to our patients, we face 5 hurdles. Of these, 2 are relatively manageable and 3 are very challenging.
In this post I describe the 5 obstacles and ways you can overcome them. There is not just one path, but several. After reading the post here, you will be able to choose from several different ways to get past the 5 obstacles.
The guide is based on observations from over 1500 dental clinics in 15 different countries.
Prerequisites
There are a number of challenges related to treating with clear aligners.
First of all, it is important to realise that there is no difference in principle between the aligners you use. As long as you are able to make the correct diagnoses, know what you want to achieve so that you can draw up an ideal treatment plan and have a grasp of the orthodontic principles, as well as knowing the challenges associated with using the orthodontic appliance you have chosen to work with.
When I describe clear aligners as a type of orthodontic appliance, it's because the industry has generally wanted to make it seem like aligners are a safer choice than fixed appliances. It isn't!
Respect for material selection
Clear aligners can in principle do the same as brackets and wires and should be treated with the same respect as fixed appliances. Therefore, I think it is important to realise that some of the patients we see who CAN be treated with clear aligners should not be treated in general practice, but referred to an orthodontist. Of course, it can be difficult to assess which patients should be referred and which can be treated on one's own. I have described part of the solution in this post on clear aligners in a general dental practice.
Although clear aligners should be seen as a tool on a par with fixed braces, there are ways to make it easier and safer to treat patients with clear aligners in general practice. I have written about how to do this here.
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The 5 biggest obstacles
When you're about to start working with clear aligners, it's good to have an overview of the challenges you'll face BEFORE you get started.
Below, I've listed the 5 biggest challenges.
Visualization of the desired end result
Patient communication & treatment acceptance
The orthodontic treatment plan
Modification of the digital setup
The clinical handling
Below is a description of each obstacle and how you can deal with them.
Visualization of the desired end result
This is within most dentists' comfort zone.
In reality, it's a matter of developing a comprehensive treatment plan. When we send a patient to an orthodontist, it's usually with an idea of how we want to finish treating the patient after ortho. We "just" have to do the same exercise when we treat patients ourselves orthodontically. So here it is relatively easy, to implement clear aligners.
Most patients who have their teeth straightened have a need for some form of restorative treatment after their orthodontic procedure. In addition, this is a good time to introduce patients to anything else that may need to be done in order for the patient to achieve optimal oral health.
Example:
I prefer to straighten the anterior teeth so that the gingival margin is lined up optimally. I find it a lot easier to change the incisal edges and/or the shape of the teeth to achieve optimal function and aesthetics. Than obtaining ideal function and aesthetics aligning everything after the incisal edges and then change the contour of the soft tissue.
In addition, I will always present any need for fixed prosthodontics in conjunction with an aligner treatment. But that belongs to the next challenge.
Patient communication & treatment acceptance
When it comes to both simple and complex treatments, most dentists have challenges presenting treatments in a way that makes patients want to invest in optimal oral health.
On the one hand, patient communication is not part of the curriculum in dental schools, on the other hand, patient communication is a taboo subject among dentists in general.
If it were super easy to get patients to accept complex treatment, everyone would already be doing it. This is where further education is needed if clear aligners are to be successfully implemented. There are very few continuing education offerings that can actually be used directly in practice. At AlignerService you will find useful continuing education in patient communication.
The orthodontic treatment plan
This is where it starts to get challenging for most.
As I've written in the last 2 blog posts, there's a reason it takes 3-4 years on top of our basic training to become an orthodontist. It is naive to think that in a weekend course or 2 you can acquire the knowledge to perform advanced orthodontic treatments.
Choice of patients
Most dentists who want to start treating patients with clear aligners ask for guidelines on case selection so that they can select the simple treatments. The challenge is that no such guideline can be provided. You can get very broad guidelines, but there will always be deviations. Just as biology can make a treatment that looks simple difficult.
It takes experience from somewhere between 200-500 clear aligned treatments that you have done yourself to have a good overview. It takes time and costs a lot (planning time and extra chair time)
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The treatment plan
Most general dentists do not have a problem laying out a comprehensive treatment plan. It's like the cornerstone of our training and one of the few disciplines we'll never be able to delegate.
When it comes to the orthodontic treatment plan, however, we don't have a lot of prerequisites to be able to create a treatment plan that is both:
Biologically safe
Realistic
Clinically predictable
When you see the treatment plans visualised in the software of the aligner manufacturers, you are led to believe that everything can be done... It can - but only on the computer screen!
In order to design a treatment plan that meets the 3 prerequisites I have just listed, we need to have a really good grasp of orthodontic principles. If our knowledge of ortho is even a little rusty, we will not be in a very good position to succeed.
(Note. It takes a lot more than knowledge of placing attachments/engagers or timing of IPR to be able to lay out a proper orthodontic treatment plan)
Modifying the digital setup
I have written and said it many times before.
The plan visualized by the aligner manufacturers' software should NEVER be taken seriously. It is a computer VISUALIZATION. Anything can be done on a computer screen... EVERYTHING. But just because something can be done on a screen doesn't mean it can be done in reality.
95% of all digital setups must be modified to provide either biologically defensible-, realistic- or clinically predictable treatment outcomes.
Keep in mind that all digital plans are designed by either artificial intelligence or a technician with no dental background. (I know there are companies that advertise that they have South American orthodontists controlling their setups. We have seen several digital plans from these companies and can state that the quality of their setups is no different from the other companies)
It is rare that general dentists are able to modify their setups to golden standard. There are many orthodontists who also do not have this part of the treatment with clear aligners under control (Because the forces distributed on the teeth with clear aligners behave differently than with fixed appliances, some movements require more or less time with one system compared to the other)
If you do not feel confident in this discipline, it is best to delegate it to a partner who can do it for you. In the end, it will save the dentist several hours of extra time at the dental chair and computer.
Clinical management
Here we are back in our comfort zone.
It's about bonding attachments/engagers to enamel. Delivery of removable appliances and instruction in use and hygiene. Enamelplasty, clinical photos, IO scan/image, etc.
Individual procedures may require explanation, instruction and hands-on training. But they are similar to what we do already and are therefore within the comfort zone of ordinary dentists. This makes it relatively easy to adopt and implement in the practice.
Do you want a clinically safe way to use clear aligners in your practice? Then sign up for the course: smart start with ClearCorrect. You can read more and register here: https://alignerservice.com/workshops
Make it easy for yourself
Rather than trying to become a clear aligner master before starting to work with clear aligners. It is advisable to assess which of the obstacles below you are comfortable with, and which require light or extensive training.
With an overview of the need for additional resources, one can begin to assess what makes sense to work with in each dental practice.
Most dentists will typically find that the obstacles I have highlighted in red are outside their comfort zone and require relatively extensive training and education.
Visualization of the desired end result
Patient communication & treatment acceptance
The orthodontic treatment plan
Modification of the digital setup
The clinical handling
My recommendation is to start by becoming skilled in creating comprehensive restorative treatment plans, defining desires for the ideal positioning of teeth in the dental arch. Next, getting a grip on the clinical workflow of clear aligner treatment. BEFORE starting to become proficient in the red disciplines.
My best advice:
Mankind is fabulously adept at constantly overestimating its own abilities.
We think we can achieve much more in much less time than we actually can. When we fail, we have all sorts of excuses for why it was ok.
Now make it a little easy on yourself.
Lower the bar.
Be less ambitious and accept that it takes much longer to learn and implement new knowledge.
Set written goals.
Share your goals with someone who can hold you accountable.
Make a written plan while you are top motivated and stick to the plan when alternatives to exercise tempt you.
If you follow this advice, you will find that you achieve far more goals and maintain motivation along the way.
If you need a coaching partner along the way, please feel free to contact me (you can find my contact details at the bottom of the page here)
Management considerations
As some resources are needed to obtain all the necessary competences, one should consider, among other things:
How long will it take and how much will it cost to obtain all the necessary competences?
Can the obstacles be overcome more easily by delegating the tasks to someone who knows how to do them? (What options are available and which are suitable for me and my needs?)
What will it cost and what will I gain from delegating tasks to others?
Do I want to be an orthodontist? Or general dentist using clear aligners as a tool to achieve better restorative treatment results?
Should it be a profitable business for me to perform clear aligner treatments? Or will I accept that the treatments make a profit while I have fun performing the treatments myself?
All managers should take the time to consider these issues. When you get an overview of the tasks to be solved and compare the resource consumption and output of the different solution models you come up with. Decisions that benefit patients, employees and the practice owner will be easier to make.
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I hope to see you in the next post
Kind regards
Jesper Hatt DDS
P: +41 78 268 00 78