Question:   “ Do you really want to do this?”

                                                                                Orthodontist;Toledo,Ohio

 

This was a posted comment from an Orthodontist regarding our recently fee reduction for Invisalign treatment.  I have no way of knowing for sure the intent of this short question but my guess is…have I considered the consequences to my dental colleagues who are commanding fees upwards of $6,000.+ for Invisalign care.

I decided to post my reply for all to consider even though it is directed toward and written to the orthodontic community.  In this age of consumer driven business decisions, if you happen to be a consumer reading this, you may find this point of view and my rational for this extreme price reduction on Invisalign treatment interesting.

I would like to preface that the following statements are based solely my personal opinions and conclusions.  They do not represent any information provided by Align Technology nor are they directed at anyone or any dental care provider in particular.

 

Dear Doctor:

Yes…I am absolutely certain I want to offer Invisalign treatment for $3,995.  The decision to significantly reduce my Invisalign fee was done with a lot of thought and perhaps contrary to what one may think, not a decision out of business desperation.  In fact, you may see that it is much more altruistic than you might imagine.

1.         Invisalign Generation 3.0 (2010) and 4.0 (2011) now actually works to my satisfaction as a fully trained orthodontic specialist.  Invisalign has and is aggressively addressing the mechanics and proper force applications of tooth movement.  They certainly have not addressed all the orthodontic force system challenges we face daily. But, certainly have shown their commitment to continue improvement of Invisalign through significant ongoing research and development of their product.  I believe Invisalign is now as effective a tool in our orthodontic toolbox as fixed braces for most orthodontic treatments (note: I did not say all).

2.         Let’s look back: If you recall, Invisalign was first introduced in 1998/99 to only us, the Orthodontists.  No General Dentists were initially certified or allowed to order Invisalign from Align Technology as a treatment.  I jumped on board, as I believe most of us did.  After doing many Invisalign cases in those early years, I quickly found Invisalign Generation 1.0 did not work very well.  Almost every case required some braces to finish it.  I spent a lot more chair time with my patients in Invisalign than those in braces and simply was not getting the results I expected of myself and my treatments.  I got so frustrated; I virtually stopped using Invisalign from 2002 to 2010.

3.    I believe, many orthodontists felt the same frustration and either quit using Invisalign (like I did) or limited its use to the very simple cases.  On top of that, we were charging upwards of $6000, in my opinion, as a “nuisance” fee and because we simply could get it.

4.     The fact was, the Public was becoming more and more aware of Invisalign and wanted a no-braces braces alternative.  Therefore, many of us Orthodontists began using Invisalign primarily as a marketing tool to get patients “in the door”.  Once in our offices, we would professionally guide these patients seeking Invisalign to fixed braces.  We passively did this with those extremely high premium fees for Invisalign or diagnosing the malocclusion to be conveniently “beyond the scope” of Invisalign. Which at that time was for the most part was true.

5.     The long term result of us marketing the use of Invisalign and enticing the public into our offices with perhaps little or no intent to use it, inadvertently was in fact  helping to create the Invisalign Brand and consumer demand.

6.    The Orthodontists were solely responsible for initially establishing the market fee for Invisalign treatment.  We apparently determined the market would or needed to pay a premium for the luxury of hiding ones braces.  As well as to properly compensate us for the nuisance of using a mode of treatment that did not work as effectively let alone the fact we also incurred a high manufacturing laboratory expense.  Quite frankly, I believe we all set such high fees for Invisalign because we could by charging what the market would bear.  Folks simply are willing to pay dearly for the privilege of getting that beautiful smile without fixed metal.

7.   During all this time, Align Technology, the manufacturer of Invisalign, also continued to market and Brand their product.  Then, much to the criticisms of the orthodontic community, Align Technology began certifying the Family General Dentist on how to order Invisalign.  As we all know, Invisalign Provider Certification by Align Technology does not mean the dental provider understands or is trained in the treatment of dental malocclusions.  Rather, simply how to order it.  Align Technology’s only real responsibility is to limit the sales of their product to legally licensed dentists, nothing more.   Only the governmental licensing boards are responsible for qualifying healthcare providers for the legal practice of their profession.  Invisalign is a legally available mode of treatment to anyone licensed to practice dentistry.

6.     The demand and consumer awareness of Invisalign is and has been growing.  Orthodontist were limiting if not eliminating the use of Invisalign.  Most of us, I believe, were doing everything possible to talk or price our patients into braces and away from Invisalign, perhaps for the right reason…Invisalign did not work very well in those early days.

  SO WHAT HAS HAPPENED?

Look who was happy to step up to offer Invisalign…the General Dentist!  Why not…Orthodontists had already established a nuisance value, high premium fee for them to apparently simply take some impressions and get back an instant orthodontic treatment…right?  What a business opportunity!   

7.     Moving a tooth it easy…just continuously push on it.  The trick is getting it to go in the direction and stop where you want it.  I am still trying to prefect that after two years extra orthodontic specialty training and 30+ years of practice of doing nothing but orthodontics.  The vast majority of General Dentists who offer the world Invisalign have very little if no really understanding of biomechanics and orthodontic force systems.  Invisalign has somewhat freed them of that requirement…they just know Invisalign moves teeth without braces and that fact alone sells.  Ignorance is bliss and blame free.  The General Dentist was not saddled with the knowledge that Invisalign results and tooth movement was extremely inconsistent in the early days for a reason.  It had biomechanical design flaws that we as orthodontists, if nothing else, intuitively seemed to know.

8.     So, in my humble opinion…our actions as orthodontists to passively direct our patients to fixed braces rather than the Invisalign care that we likely were heavily internal and externally marketing, basically handed Invisalign orthodontics on a silver (maybe gold) platter to the General Dentist.

9.    What have we inadvertently created?  The “gate-keepers” of many orthodontic referrals have now established themselves as the Invisalign orthodontists in the eyes of the public.  And worse yet, I believe that we trained Orthodontic Specialists are now viewed by many as Fixed Braces orthodontists.  You want fixed braces…see an Orthodontist.  You want Invisalign…any Dentist can do it.

  Here’s the bad news for us, the “Fixed Braces” orthodontists…

Align Technology is rapidly fixing their product and is absolutely committed to supplant fixed braces as the primary appliance of choice for routine orthodontic care in the future…I believe they are likely to succeed.

10.     I recognized with the release of Invisalign Generation 3.0 that Align Technology was finally addressing their biomechanical design flaws and I began tip-toeing back into using Invisalign.  The improved results and the ease of use were immediately apparent.  Now with the very recent release of Generation 4.0 right on the heals of 3.0, further demonstrates to me, Align Technology’s commitment to creating an orthodontic appliance system that now biomechanically works on an expanding range of malocclusions as a true alternative to braces in a continually growing group of orthodontic patients.

11.    What has most impressed me with new and improved Invisalign is the efficiency of time management within the daily practice of orthodontics over fixed braces.  Briefly, the primary reasons Invisalign is more time efficient to use are:

a) The new software enhancements have made manufacturing instructions very easy.  Very seldom do I revise the online treatment plan more than once.  In the early days, I would spend hours trying to create an acceptable treatment plan with, at times, up to 4 or 5 separate revision requests before the Aligners were even produced.

b)  Patient check-ups and aligner delivery appoints are typically shorter and less frequent than fixed braces.

c)  There are virtually no emergency repairs or appliance breakages throughout Invisalign treatment compared to fixed braces.

There are many other areas to compare the pros and cons of appliance types but in general, I believe, time efficiency is the great balancer for the high manufacturing cost.

12.  I believe, what the Invisalign General Dentist is seeing, is the significant treatment result improvements rather than the time efficiency.  Being held to a different standard of care requirement due to their limited education in orthodontics, results and expectations have always been allowably different.  Whatever they achieved with Invisalign was simply and acceptably “the best we can get”.  Now…this best we can get is getting better whether they are aware or not that the all those funny looking attachments are the “Sorcerers’ Key” to success.  They have to be “giddy” with joy seeing a continuing higher profitability with the extremely high fees that have been established. As well as a growing confidence to expand the range of malocclusions they are choosing to accept for treatment, solely due to Align Technology’s continued improvements of the biomechanics of Invisalign.

SO…What has ALL this to do with my advertised $3,995 Invisalign fee?

13.   I want to state…I believe that only a trained orthodontist should be doing orthodontics.  I do not believe there are ANY “simple” orthodontic cases that can be definitively diagnosed in advance.  After over 30 years of exclusive orthodontic practice, I am still surprised daily with the simple cases that become nightmares and the pretreatment malocclusion disasters that seemingly fix themselves to perfection almost magically.  I also believe there should not be a different standard of care allowed any provider that voluntarily chooses to treat a dental malocclusion.  Since neither of these statements is ever going to be mandated, I conclude that it is our own personal mission to do what we each individually can to serve and guide the Public ethically.

14.    As I look at the alternatives to getting the Public out of the Invisalign General Dentist office and into an Invisalign Orthodontist office…the most preferable method is through public awareness education.  The problem is, that will certainly involve ethics issues and an undermining of the public’s confidence of our profession and that serves no purpose.

15.   The most reasonable alternative that became apparent to me which can be directed at the Public because remember the “gate-keepers” are Invisalign providers too, is PRICE.

16.    I can do orthodontics including Invisalign more efficiently that the General Dentist.  I believe the vast majority of Orthodontists can too.  Our offices, business systems and support staff are all designed and trained to see a greater number of orthodontics patients per day.  The time efficiencies of Invisalign fall right into our business design. We can provide orthodontics, including Invisalign and its high laboratory bill, cheaper than the Invisalign General Dentist.

17.   I have decided to significantly reduce my profit margin on Invisalign to a point that maybe the Invisalign General Dentist can not justify the significant profitably loss especially considering the nuisance of blending orthodontics with all the other facets of dentistry to competing with me at this price.

18.   We, orthodontists sent the Invisalign public away years ago, it’s our responsibility to considering lowering our expected big profits to get the Invisalign business back in the orthodontic offices like it should be….provided by specialists that are properly trained to use all the tools in the toolbox because not every one works every time no matter how well designed it is.

Where will your Orthodontic Specialty practice be in 10 years if Align Technology supplants fixed braces as the primary appliance of choice with the Public for routine orthodontic care?… 

And it actually works!