why hasn't this already happened to ortho?

[akog]

Since Invisalign basically tells the dentist what to do for each visit, what has stopped orthodontics from becoming a sort of telecommute business almost entirely... for full braces and more?

I mean, I can imagine a dentist training one of their assistants in some ortho and subscribing to a service where that assistant see the patient and sends pictures, x-rays, and an intraoral scan of the mouth off to a service where an orthodontist writes back a treatment plant.

I'm not saying I want that... in fact I think that would be bad for ortho results in general, but I can see competitive pressure making it a reality. What is stopping this?

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[ncide]

Invisalign does not tell the dentist what to do. There are algorithms and technicians in place that help to guide inexperienced doctors in formulating a treatment plan, but dentists have full control of the outcome. The dentist basically tells Invisalign what to do, not the other way around.

On top of that, plastic aligners are not as good at moving teeth as traditional braces are in the hands of an experienced doctor. If teeth are not tracking, the doctor has to catch it early to anticipate changes in the future aligners. This often means additional refinement trays or the patient gets traditional braces put on for more efficient movement. Interproximal reduction may be required and permanent modifications to dentition may only be made by a dentist. The dentist will have to supervise a patients teeth if they are in elastics to make sure progress is met and there isn't any over or under-correction of their bite.

That isn't to say that your model doesn't exist though. It does. See: www.smiledirectclub.com

 

[gatorfan99]

Don't assume that Invisalign = ortho for dummies, there's lots of pros and cons and it's NOT all encompassing solution

 

[yappy]

The aligner manufacturing companies are to orthodontics as dental labs are to general dentistry.

 

[akog]

I think my question was misinterpreted. I'm not asking about Invisalign itself or aligners. I totally get their limitations. I'm asking about braces and other more complete solutions.

One of benefits of being an orthodontist, as described on this board by orthodontists, is how little time one spends with their hands on the patient--that it's mainly about treatment planning. If that's the case, and if things like Invisalign have proved that general dentists are more than willing to adopt new technology platforms to deliver orthodontic solutions, then what is stopping market forces from abstracting the orthodontis out of his/her orthodontic office almost entirely? That is, the general dentist has one of their dental assistants trained specifically to interact with an orthodontist remotely to provide braces for a broad range of occlusion problems... beyond what Invisalign or weekend CE can handle.

So is there some clinical limitation here (such as the orthodontist absolutely needing to see patients in person), is it a technological limitation (such as the need for cheaper, more widespread 3D imaging to even allow the orthodontist to work remotely in the first place), or is their some business limitation (such as it just not being practical for GPs)... ?

Tl;dr... my imagination is telling me that, in the future, technology and organized care might force orthodontists into a sort of, how should I put this... remote radiologist capacity. What is stopping that?

 

[vk223]

I believe besides treatment planning, there's some kind of fine adjustment orthodontist has to do rather than relying on the assistants. For example, placing the brackets at a specific position, bending the wires, etc. And most importantly, communication with patients. I think patients would raise questions and doubts if they were paying so much for braces but can't even see the doctor in person.

 

[THS]

I used to assume invisalign could replace conventional comprehensive ortho... until I took an ortho course. Invisalign is just another tool dentists/orthodontists can use, but it has limited applications. In fact, it is a mistake to treatment plan every ortho case as an invisalign case, because they often are not good invisalign cases. I believe this is a problem that many general dentists will have if they don't recieve proper training in ortho treatment planning and early recognition of future problems.

Great for adult ortho, MTM, anterior esthetics. In the future, I (as a general dentist) will not try any ortho, much less invisalign, for growth modification, Angle Class correction, occlusal adjustment, etc.

 

[BluntForceTrauma]

I believe besides treatment planning, there's some kind of fine adjustment orthodontist has to do rather than relying on the assistants. For example, placing the brackets at a specific position, bending the wires, etc. And most importantly, communication with patients. I think patients would raise questions and doubts if they were paying so much for braces but can't even see the doctor in person.

Work as an ortho assistant, and I definitely can attest this is true. Every office is different and in the state where I work (TX) the only thing assistants can't legally do is bond the facial surface of teeth or use a handpiece. The orthodontist I work with prefers that he places all the brackets and steps in wires, however.

Basically, there are always things that the orthodontist has to do because he's had the training.