Guest Editorial January 2019

“The 2nd Wave”

Over the past few years there has been a profound awakening in everyone’s conscience to the benefits of straight teeth.  You would be hard pressed to find a human in the United States that has not been touched by the $100s of millions poured into marketing campaigns championing the use of aligners to straighten your teeth.  

This “Wave” of orthodontic innovation has not skipped over general dentistry.  Digitizing optical scanners are revolutionizing the way in which dentists view their patients.  3D modeling and artificial intelligence greatly assist with the burden of routine data entry and lower the time threshold necessary to create sophisticated restorative appliances in house or with the assistance of a “digital” lab.

There is however, an often overlooked significant difference between computers creating orthodontic aligners and computers creating restorations.  The patient’s orthodontic experience lasts for months (even years) while the restorations can often be completed in the same day or week. The pace of a safe orthodontic movement depends on each patient’s oral health during treatment.  Factors like existing bone loss, teeth that are already loose due to misalignment, and even genetic factors must all be considered before and during treatment.

It is easy for start-up companies and manufacturers flush with cash, to bury or call into question an orthodontist’s motives when they point out that aligner therapy can have severe side effects.  We all love to hear about a new ingenious technology that is benefiting society, especially if it is revolutionizing the way in which we can have access to treatment. But shouldn’t we be aware of the possible downside?

What exactly are some common side effects of receiving orthodontic treatment?  The most common failure in orthodontic treatment is a poorly defined treatment plan that ignores bite stability during and post treatment.  Many practitioners focus on quickly moving the obvious teeth back into alignment within the existing arch form with little or no consideration given to the stability of the teeth or arch post treatment.  Aligner stores staffed with sales associates are even having their customers select from a visual complexity chart to determine how much they want to spend on their treatment.

The patient’s chief complaint is often esthetics.  However, what is often revealed during the doctor’s exam is a more complex cause of the esthetic concern.  This in-office through examination is the key difference between online orthodontic retailers, outlet stores, or the orthodontist or dentist’s office visit.  All of these new alternatives to visiting the doctor’s office are very convenient, and while you’ll never talk to a trained clinical professional directly, they do have doctors, or at least technicians, overseeing the manufacture of the aligners.  You can be sure that most of the online and brick and mortar aligner outlet stores will deliver you a high quality plastic appliance. But who is responsible for the application of the aligner therapy?

Trained dental professionals have already begun to see the 2nd Wave of patients seeking to re-do or undo a poor discount orthodontic experience.  Historically retreatments were often necessary due to the patient’s lack of compliance regarding retainer wear.  This new category of retreatment is clearly the result of poor planning and often a complete misdiagnosis of the patient’s condition.  Many tooth alignment issues often present esthetically, however orthodontics is often not the right discipline for remedy. Whether the case appears to be simple or complex it can require a multi-disciplinary treatment course.  We owe it to our patients to provide them with the most extensive and comprehensive knowledge available. Mail order plastic aligner simply cannot deliver that. We can do better.

By Dr. Randy Kunik