Trends in Dentistry: The Expansion of Orthodontics
By Jason Mazda
The world of orthodontics is rapidly transitioning from traditional wire retainers and appliances to clear aligners fabricated with the use of CAD/CAM technologies. Revolutionary new products and increasing demand from adults seeking orthodontic care have coincided with an increasing trend of general practitioners keeping work in-house that they previously referred to specialists. Large players in the industry have staked claims to the lion's share of this rapidly growing segment, while new business models have evolved to disrupt the dentist/patient relationship by marketing orthodontic services directly to consumers. These and other drivers have made orthodontics an area of potential growth for dental laboratories, with analysts forecasting that the global invisible orthodontics market will grow at a CAGR of nearly 13% from 2018 to 2022, according to Technavio.
Manal Ibrahim, DDS, PC, and Donal P. Inman, CDT, have had a front-row seat for all of these changes. Ibrahim is a Diplomate of the American Board of Orthodontics and an international lecturer on orthodontic aligners, in addition to owning Innovative Orthodontic Centers, with two locations in Illinois. She also holds a certificate in Advanced Combined Prosthodontics and has practiced restorative, prosthetic, and implant dentistry. Inman is the President of 40-year-old Inman Orthodontic Laboratories Inc. and inventor of the Inman Aligner and several other orthodontic products. Both Ibrahim and Inman spoke to Inside Dental Technology about the state of orthodontics and the impact on laboratories.
IDT: What factors have played into the increased popularity of orthodontics to the point that it has become such a rising and competitive market?
Manal Ibrahim, DDS, PC: Increased marketing by clear aligner manufacturers has raised the awareness level of the public regarding the option of orthodontic treatment that does not involve braces. Additionally, the technology that has been incorporated into everything we do has made orthodontic procedures so much faster, simpler, and more efficient, with better outcomes. Patients are fascinated by how different today's processes are from the braces, wires, color ties, and head gear that orthodontics previously required, and they are more willing to seek out orthodontic treatment.
Donal P. Inman, CDT: Clear aligners have exploded in popularity, and any orthodontic or dental laboratory can enter this market with a moderate investment. The demand has been driven in large part by direct marketing to patients, such as television commercials. We see some practices that specialize exclusively in clear aligners, and we also see significantly more general practitioners offering orthodontic treatment than in the past, to the point that approximately 50% of our work comes from general practitioners.
IDT: How has digitization opened the door for more practitioners to offer orthodontic treatment to their patients in order to enhance the standard of care?
Ibrahim: When you are able to scan a patient and assess the teeth in three dimensions on a screen, you have a better ability to truly diagnose, treatment plan, and execute that plan with extreme precision. Conversely, the technological developments have been so impactful that I fear for practitioners who have not kept pace, because a time will come when those people are so far behind that they will never be able to catch up, and their patients will seek out technology from other dentists. For those who are incorporating the latest technology into their practice, however, the fun is just beginning. As more technology is introduced and improved, the possibilities are just endless.
IDT: Is orthodontic treatment utilized as often as it should be as part of complex restorative treatment plans?
Inman: No, I don't think so. Too many "instant ortho" procedures are being performed with too much healthy enamel being destroyed for the sake of avoiding true orthodontic treatment. This trend is changing, however, and I see conservative options that involve orthodontic treatment becoming much more common. We are seeing more of an emphasis on function, so many dentists are pre-aligning the teeth before they perform cosmetic work. There is a lot of education available now regarding pre-alignment and more conservative dentistry. Lecturers show cases in which patients requested veneers but were able to receive a smile makeover simply through alignment of the teeth along with some etch bonding and tooth whitening.
Ibrahim: I first pursued orthodontics because when I practiced as a prosthodontist, my work required a significant amount of pre-prosthetic orthodontics to set up cases for proper restoration. That was extremely critical in achieving a great esthetic result without overly invasive treatment, so I pursued the ability to perform my own orthodontic treatment. Restorative work can be so much more conservative if the teeth are first properly aligned. Orthodontics can change a full-mouth rehabilitation into a four-veneer case. With that being said, dental professionals often do not have the opportunity to adequately educate patients about that, so the direct-to-consumer marketing that aligner manufacturers have invested in has been important. Many orthodontists may not like Invisalign or Smile Direct Club, but they raise the awareness level of the consumer, which is great for our profession.
IDT: How would you suggest laboratories position themselves to capitalize on this growing business market?
Ibrahim: From an orthodontist's perspective, personally, I had to leave a laboratory that I had worked with for approximately 8 years because they were not ready to interface with my scanners. It was heartbreaking, because they did great work and we had a great relationship, but they were not set up to instantly integrate with my scanners and turn cases around quickly. Laboratories that do not make it easy for a practitioner to scan and upload files so that they can create great work and send it back expeditiously are losing out on business. Staying ahead of the curve is important in anything. Laboratories need to continue to anticipate what will come in the future and set themselves up for it.
Inman: It is very important to be well educated. You must 3D print and you must have good orthodontic software and know how to use it. Laboratories need to help guide their dentists. For example, we help clients implement digital workflows weekly, if not daily. They seem to really appreciate our experience and willingness to help. The digital workflow for orthodontics eliminates one patient visit, which does require some adjustments to the process, so it is important to consider these changes carefully.
IDT: What do you envision being the future for orthodontics in dental practices and laboratories?
Inman: Even more dental laboratories will become involved with clear aligners. While I believe the price pressure for clear aligners will continue, I am optimistic about the future of the orthodontics market overall. With the speed and lower materials costs that new 3D printers offer, we now have the ability to serve dentists who previously could not afford our price points. My laboratory recently purchased another 2,000-square-foot bay to expand, and I am certain that my 24-year-old son and partner, Jesse, will have a solid long-term future. I had stopped trying to grow the business, but it began growing again despite my resistance.
Ibrahim: It is a really exciting time in dentistry, and it will only get better as technology continues to evolve. Brackets will be a thing of the past. Orthodontics have been synonymous with braces, but the future is clear aligner therapy. We need to embrace that technology and engage in the learning process regarding the mechanics of this treatment and how to achieve successful results. In-office fabrication will be one option, but laboratories will play a significant role in creating not just the models but also the treatment plans and aligners. There will also be more players on the manufacturer side as time goes on. There will be more opportunities for both dentists and laboratories.