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What is DTC and why you should care about it.

Patients increasingly demand a nice white smile produced by a minimally invasive treatment (it is debatable whether orthodontics is minimally invasive). At least 90% of all dentists do not feel clinically comfortable treating their patients with clear aligners and therefore refrain from offering this type of treatment.


As a consequence of this gap between supply and demand, a plethora of "direct to consumer" (DTC) offerings has emerged throughout the Western world.


This post is about how DTC operate and what you, as a dentist, can do to take on the competition.

Clear aligner med en lige trimline uden attachments eller engagers

Enterprise Construction

"Direct to consumer" (DTC) businesses are typically characterized by several factors, including:

  1. These are companies that deal in nothing but clear aligner treatments (and most recently porcelain veneers to correct the fact that they can't straighten teeth properly with the limitations they have in their clear aligner treatment protocols!....).

  2. DTC has an extreme focus on keeping costs as low as possible (From start to finish, for example, there is virtually no dentist involved in the treatment of the patient)

  3. They work with a set of standard parameters for how their setups should be designed by the technicians. I have written a blog post about some of the dangers of using restrictions in treatment with clear aligners. The more restrictions, the more problems.

  4. Time consuming elements of treatments (Attachments and IPR - (Interproximal Reduction)) are reduced to a minimum (read: nothing), to keep costs as low as possible. Which makes orthodontic treatment that meets the "standard of care" impossible.

  5. DTC is adept at marketing and selling clear aligner treatments.

  6. Some DTC businesses operate as independent shops, typically located in pedestrianised or high-traffic areas. The independent shops are always beautiful and inviting to look at. Just as they are stripped of anything that might indicate the presence of a dental practice.

  7. Other DTC outlets offer dental clinics a free IO scanner, free online marketing and a minimal fee per treatment started up. This in exchange for the practice scanning patients, dispensing aligners and letting the DTC company operate under the dentist's authorization!...


75% off written on a transparent box

Treatment outcomes

It is possible to achieve reasonable treatment outcomes, with the limitations of the classic DTC business model. There are just not many patients who are suitable candidates for the treatments. Unfortunately, this is not reflected in the DTC businesses.


Since most DTC companies are founded and owned by financial people outside the dental community, there seems to be a tendency for financial interests to be given higher priority than patient health. Therefore, several DTC companies could potentially be a threat to patient safety.


A better alternative

Unlike DTC companies, dentists treat their patients in a comprehensive manner. This means that the dentist doesn't just lay out a plan for how the smile can be made prettier with clear aligners. But also includes the possible need for a restorative treatment in combination with occlusion and function after the end of orthodontic treatment.


Therefore, treatment with clear aligners will, as a starting point, always be better when performed by a dentist where the case selection, treatment plan, modification of the digital plan and follow-up treatment are performed by a dentist or specialist. This can be done by the dentist him/herself or be delegated to an aligner specialist in-house or online.


Since there doesn't seem to be the political will to restrict the actions of DTC companies, the obvious thing to do is to start acting yourself.


Innovative Smart Start

Over the past 2 years I have worked intensively with both users of clear aligners, the largest aligner manufacturers in the world, as well as a team of orthodontists and highly experienced clinicians, with the aim of enabling general dentists to apply the methods of DTC in their own dental practices. Not by copying the DTC model, but by learning from their work processes. In this way, we have developed an accountable workflow where the dentist is in control of the entire process from start to finish, with the ability to delegate much of the work of clear aligners internally and externally.


The team at AlignerService.com and I have shown how mainstream dental practices can easily implement clear aligner treatments while ensuring their patients biologically safe, realistic and predictable results. Without the practice owner having to be an orthodontic expert but in control of the treatment from start to finish.


Using modern technology, the practice can work interdisciplinarily with their entire team combined with dentists who have the necessary professional and clinical expertise. This enables them to achieve excellent treatment results without the clinician experiencing the frustrations associated with the usual induction or certification in the use of clear aligner systems.


Requirements for quality

It is important to use aligners produced professionally. As long as one of the 4 largest manufacturers on the world market is used, it ensures that the material we use on our patients works predictably and is of a consistently high quality. (There are far too many uncertainties associated with in-house production or manufacturing in small laboratories. In addition, the software used for smaller productions is generally very deficient)

A lot of small stones stacked on top of each other balancing and thereby creating a sculpture

Clear aligners are not just clear aligners. Make sure you get competent advice before choosing the system you want to work with in your dental practice. Optimally, you should seek advice from a few colleagues, all of whom, based on many cases, have extensive experience in using 2-3 different aligner systems.


There should be clinical specialists involved in each patient's treatment planning, the modification of the digital setup/ClinCheck and the advice to the dentist/treatment team. It is not enough to rely on a technician or a service employee from an aligner company. It must be an orthodontist or a dentist with extensive clinical experience (1000+ cases)


No treatment should be started without the responsible dentist having an overview of how the patient will be treated after completion of the orthodontic treatment. Often a combination of orthodontic and restorative treatment will be needed. This should be clarified BEFORE the aligner treatment is started up.


Dental marketing

Patients receive better care and the practice achieves a significant financial gain with minimal labour once the team has been through a Smart Start programme with AlignerService and the principles are implemented in the practice.


With the workflow in place, it can be combined with ethical marketing in collaboration with a local expert or with one of our partners. This raises awareness of the expertise of the practice and the benefits of having a dentist carry out the alignment treatment.


Doctor: you need to start now!

There's a reason it takes 5 years to become a dentist.

Likewise, there is a reason it takes 3-4 years to become an orthodontist.

The reason DTC companies are growing at an explosive rate across Europe and the US is that dentists have generally been poor at meeting patient demand.


There are major challenges associated with the way DTC businesses are run. Too few are aware of the complexities associated with orthodontic treatment. Through many years of experience working with the industry, I have learned that there is a general perception that artificial intelligence and a bunch of algorithms should be enough to design a sound orthodontic treatment plan. Many believe that the computer should be able to do it much better than the dentists!


Sorry if I spoil the good mood. But even after loading a supercomputer with data before, during and after 15 million clear aligner treatments, artificial intelligence has failed to devise treatment plans that are anywhere near defensible.


When neither the dental industry nor politicians are able to see through the complexity of orthodontic treatment. Changes to the current ways that orthodontic DTC business is run have very long prospects.


Doctor, will you allow this development to continue undisturbed?

Will you accept your patients being treated this way?

If not, you need to act now!


How do you want to develop your practice?

You are always welcome to contact me if you have any questions.

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Dentist Jesper Hatt DDS

I hope to see you in the next posting.


Many kind regards

Jesper Hatt DDS



Tlf: +41 78 268 00 78





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