Introduction
Dentists do not feel clinically confident about treating patients with clear aligners. Many may have attempted to treat a patient or two in the past where the treatment did not go as expected. Others have just never gotten started. As a consequence, the majority of practising dentists refrain from treating their patients with clear aligners.
This paper is aimed at dentists who want a clinically safe route to implementing clear aligners in their dental practice.
In the following, I review why it is so difficult to get started using clear aligners. As well as providing a number of suggestions that can lead to a clinically safe, successful and profitable way to implement clear aligners in any dental practice.
Why is it so difficult?
In the past, the implementation of clear aligners in dental practices has typically followed a course similar to the implementation of any other type of treatment in a regular dental office.
This means the dentist learns the theoretical and clinical skills required to perform the treatment in a fairly short course. The acquired skills and systems are then implemented in the practice over a limited period of time.
The same approach cannot be applied as easily when it comes to orthodontics. Orthodontics involves a great deal of theoretical knowledge. This is knowledge that, with a classical approach, must be mastered in order to achieve clinical confidence.
Much of this knowledge takes a long time to acquire - there is a reason it takes several years to become an orthodontist.
In addition to the theoretical knowledge, it requires a lot of clinical experience as well. Add to this a wide range of other challenges associated with the application of clear aligners in the clinic - including: leadership, management, systems, communication and finance.
How and where to start?
Below you will find a list of frequent challenges that typically stands in the way of a successful implementation of clear aligners in a general dental practice:
The practice lacks a vision that includes clear aligners.
The practice owner does not communicate the vision clearly and continuously to the staff and the patients.
Orthodontics requires extensive knowledge of aesthetics, functional occlusion, bone structure, muscles, soft tissues, joints, airways, biodynamics, biophysics and the dynamic relationships, etc. Which makes orthodontics one of the most complex forms of treatment dentists can perform.
- There is a reason why it takes 3-4 years to become an orthodontist.
It takes time to devise and incorporate completely new workflows
It takes good communication skills, a belief in clinical outcomes and your own abilities to get patients to accept treatment.
Without extensive delegation, it is more profitable to do other types of restorative dentistry.
Delegation requires a great deal of resources for the continuing education of the dental team.
Lack of time in the appointment book for treatment, training and incorporating new workflows.
It takes a long time to achieve the desired clinical outcomes.
Uncertainty about handling clinical challenges when the treatment does not proceed as planned on the computer.
To make it easier for you to successfully implement clear aligners in your practice, here's an overview of how others are getting started.
The good start
Define the following:
How many treatments do you want to perform per year, starting with the next 12 months?
Who will carry out the various tasks related to the treatment? (Photos, X-ray, IO scan/image, data upload, communication with: aligner manufacturer, external partner and patient, case selection, treatment plan, modification of the digital plan, support of team, IPR, patient control, attachment bonding, retention, instruction, which aligner system will you use and why, etc, etc. The more elements you can include in your vision, the better. It makes it easier to plan for and therefore achieve success)
You can find relevant starter courses here.
Your plan
Create a step-by-step action plan that breaks down your vision into small elements that are easy to implement in your practice. The action plan should spell out exactly what you want to achieve, who is responsible and when it will be achieved.
Be aware that you will need to adjust the action plan as you gain more insight into what you need to know and do, as you gain experience with the different elements of your action plan.
Share your vision and action plan with your team.
Let the team help you adapt the action plan to your practice. They will help you make it as realistic as possible.
Allocate resources to follow the action plan.
Make the action plan visible to all members of the team and follow up regularly on the plan in a way that supports your team's progress towards the goals set out in the plan.
Where are the limits?
First of all, it is important to realise that you cannot acquire all the necessary theoretical and clinical skills in a weekend course.
There is simply too much to learn!
Just as it is completely unrealistic to learn everything about clear aligner treatments by reading a pile of literature.
Instead, it's a good idea to tackle the elements that are within your normal comfort zone. That is:
Make a treatment plan that describes your desired end result - how do you want your teeth to look after orthodontics so you can perform the final restorative treatment?
Managing the clinical aspects of a typical clear aligner treatment.
Get external help
While you're building systems and workflows, training your team and finding ways to make everything work in your practice, you should ally yourself with an external partner who can help with:
Case selection
Treatment planning
Modification of the digital plan
Support for you and your team throughout the treatment
Clinical confidence right from the beginning
Case selection, treatment planning, digital modifications and team support are the most demanding elements to master. They take a lot of time and training to get right. Just as they are outside our normal comfort zone. That's why it is a great delegating these tasks to an external partner, working as an in-house clear aligner expert online. This approach reduces the pressure on you and your team, as well as creates flexibility in terms of when you need to be able to handle everything related to orthodontics in the office yourself.
It is important that your partners are either orthodontists with an understanding of your comprehensive restorative treatment philosophy or dentists with extensive clinical and theoretical experience with clear aligners.
In the following I write about AlignerService, as a possible partner. On the one hand it reduces confusion, on the other hand it is easier for me to illustrate my points and furthermore it is, at present, the only company that offers a comprehensive support of your aligner treatments from start to finish. If you have another company or partner that you trust, you may probably be able to use them as well.
If you don't have the right partner, or if you try to do everything yourself in the beginning, you risk paying some really expensive lessons that you could have avoided.
A small cost with a big impact
Most colleagues think it is better to pay a relatively small amount, which ensures the practice against embarking on complex treatments that should have been referred to an orthodontist. Rather than starting a treatment that risks costing a lot of money, or in the worst case, the licence.
Helle Hatt DDS founded AlignerService.com, which helps dentists in 15 countries achieve realistic, biologically sound and predictable treatments with clear aligners. Her team consists of both orthodontists and dentists with many years of clinical experience in the use of clear aligners.
Getting started
To get a great start, you need to have a plan to make you or your team will super good at:
Taking full series of high quality clinical photos. At least following the photo protocol of the aligner company.
Taking perfect IO scans/impressions that contain all the necessary data - without compromises.
Taking the necessary X-rays (PAN+necessary intraoral x-rays)
Managing the digital aligner portal.
Focus on getting started.
Teach yourself and your team to become super skilled at taking clinical photos, intraoral scans, panoramic x-rays, registering patients in the online digital system and uploading data.
Choose one area of focus at a time!
For example: You only focus on dental photography. When you do this you don't focus on anything else (If you do. You will typically fail or spend a lot more time implementing new skills in the practice).
Set a target for how many patients you or your team will practice on per day (note typically 1 patient per day is sufficient).
Pursue the goal.
Follow up - does the team pursue the goals on a daily basis?
Submit data on the first patients
While training taking the photos, IO scan, X-ray and using the doctor portal, the doctor identifies patients who might be candidates for treatment with clear aligners.
Set aside ample time to collect data. This will ensure that you have a proper, stress-free experience.
Upload data to the doctor portal.
Contact AlignerService.com and share your desired treatment outcomes, your restorative treatment plan, as well as the patient's wishes.
Once the digital treatment plan meets your requirements, has passed the quality control at AlignerService and is approved for ordering, order the patient's aligners.
Starting treatment
The patient is given the first 2 sets of aligners, which must be worn at least 22 hours a day for 2 weeks each.
After 4 weeks, attachments/engagers are bonded and initial IPR may be performed.
The first patients should be followed relatively closely so that the practice gains an understanding of how the aligners work and at the same time builds a solid protocol for the clinical follow-up appointments.
If the practice encounters challenges with the treatment or has questions about the practical management of the treatment, the doctor or the team contacts AlignerService, who will guide you to resolve the issues and move forward with the treatment properly, until the last aligner is delivered and the patient is ready to start a retention programme.
Costs
Chair time is extremely expensive in any dental practice. Laboratory costs for clear aligners are also at the high end. Therefore, it is important to recognize that the first cases will cost the dental practice money.
As with any implementation of complex new knowledge, this is the investment required to make the systems work and should therefore be considered on an equal footing with educational expenses.
Workflows related to treatment with clear aligners differ significantly from all other types of treatment in the office. Therefore, it is important to realise that implementing clear aligners as part of the treatments offered to patients, initially requires a certain amount of resources.
The products
Laboratory costs will not be the biggest financial challenge. It is the amount of chair time spent on the first cases that is going to cost the practice a lot of money. It is also the number of chair time that needs to be managed if treatment with clear aligners is to become a profitable business in the practice. This is why it is extremely important to get the internal workflows of the practice right.
The workflow must ensure clinical safety, a high quality of treatment and sound finances. If this is not achieved, the practice will automatically stop offering the treatments in the future.
The right pricing of clear aligner treatments
Typically, it is a good idea to start by defining the prices the practice wants to charge for simple and complex treatments. Not now, but once the team masters the internal workflows and feels comfortable with them.
Once prices are defined, it is a good idea to give the first 10 patients about 25% discount on treatment. The discount creates a certain peace of mind for the practitioner, because it should be clearly stated that the discount is given as part of the implementation of the clear aligner workflow in the dental practice.
The discount also provides a minimal increase in the likelihood that patients will accept treatment. However, it is important to remember that it is rarely the price that determines whether or not the patient chooses treatment. Rather, it is the perceived value of the treatment outcome to the patient compared to the investment involved in achieving the desired outcome, the timing og the treatment and other events going on in the life of the patient.
Now what?
This blog post only scratches the surface of what it takes to get off to a successful start.
Take a hands-on course that not only covers the basic clinical aspects, but also gets around how to implement treatment in your practice and get your team involved. It can save you a lot of worries and problems.
Follow a tested protocol that works. There is no need to make the same mistakes that other doctors have made in the past.
You can download a diagram outlining a great start here:
Identify your first 2 patients.
Upload data.
Contact AlignerService and get started.
It is only when you start working with clear aligners in the practice that you get a feel for the treatment. With clear aligners, no theoretical review can compensate for the practical experience you gain through treating your own patients.
Data from all clear aligner companies show it very clearly: Only the clinicians that start right away after an intro course will implement clear aligners in their practices and achieve succes on the long run.
Remember: You are certainly better at treating your patients than the DTC shops.
If you want to know more
In the coming weeks, I'll focus on the areas that often pose challenges to dentists and their teams when they first start performing clear aligner treatments. As well as describing how to easily establish a clear aligner business model in a dental practice that benefits patient health, team job satisfaction and practice finances. With less stress and higher productivity.
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Currently, a post in Danish will be published first and the same post in English the week after. I am not yet able to differentiate between Danish and English users on the technological platform I use - sorry
I hope you will be reading the next blog post.
Many kind regards
Jesper Hatt DDS
P: +41 78 268 00 78