The Future of Ortho vs Future of Aligners

[Cold Front]

There are now at least 12 aligner companies that are very active in the “At-Home Dentistry” space, and many more are on the way. SDC, Byte, Candid, OrthoFx, EasySmile, SnapCorrect and SmileLove are some of the big names today. These unicorns are part of the big wave of Direct to Consumer businesses that are changing the service industry. Some of the founders of these aligner companies have become instant billionaires. They are changing (and will continue to change) the public’s perception of orthodontics in a big way, and all of this was made possible by the revolution of the 3-D printing technology, the final frontier. General Dentists are already offering Invisalign and ClearCorrect products at their offices. Soon, General Dentists will mill their own Ortho Aligners within an hour, just like a Cerec or E4D crown with the help of the 3-D technology. The future of ortho will mean less referrals, less easy cases, and more competition among orthodontists. Corporate offices will also want a share of the ortho market by hiring more younger and heavily in debt with student loans orthodontists.

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[FutureDent020]

Our profession needs and will always need orthodontists. What are you suggesting to those aspiring to be orthodontists? Don’t go into it? Or just be aware things are changing and be wise about career choices?

 

[2TH MVR]

🙂 Mr. Cold Front. I love your thought provoking threads. But come on. Lots of doom and gloom in your threads. How about a happy thread? 🙂

 

[Cold Front]

Mr. Cold Front. I love your thought provoking threads. But come on. Lots of doom and gloom in your threads. How about a happy thread? 🙂

Lol I’m just passing on the trends that I come across/people don’t have time to read about. I never said ortho is dying, but simple class I ortho is changing through 3D technology. I’m sure that’s not the right approach to all orthodontics services, but it certainly has an impact. Same reason corporations had an impact on general dentistry services and new grads with big student loans.

We dentists love the status quo.

 

[Cold Front]

Our profession needs and will always need orthodontists. What are you suggesting to those aspiring to be orthodontists? Don’t go into it? Or just be aware things are changing and be wise about career choices?

I’m just sharing a basic real world observation. Something few people in the profession care to understand.

Aspiring dentists will be fine, other than big debt/student loans and other trends that they have no control of.

 

[2TH MVR]

Here's my $0.02.
The big players here are Align and SDC. Everyone else is looking to cash out hoping that the big players will buy them out. It happened with Align years ago. Align bought 1 or 2 competitors. Clear Correct was left out in the cold.
In the end ... there will only be Align and SDC. Again .... if the smaller players have a unique product or delivery system .... then they are hoping for a buyout. If no buyout ..... no future for them.
I also predict massive class action lawsuits re: SDC. It will happen. At least Align does R&D, uses attachments, IPR, torquing ridges, etc. etc. SDC ..... nada. Lets just flare and spread teeth outside of the boney support. Hello future labial recession. Hello treatment instability. Hello WORSE malocclusions, but hey ... the front teeth are straight. Give the people what they want at the expense of evidence based treatment. Sounds like a cool research thesis for a perio or ortho resident.

As for Orthodontic specialists? Everyone (mostly GPs) under-estimate the full scope of what an Orthodontist does. Class 1 malocclusions makes up a small amount of those patients we treat. Yes .... we no longer get to treat 100% of all malocclusions. The GPs (aligners, fastbraces, 6 months smiles, etc) have already taken most of the easy stuff with the hard stuff being referred. So .... who is really going to be hurt with SDC? I would opine that GPs who use aligners will be hurt more than orthodontists. We already lost all the easy stuff. Can't lose it twice lol. When a patient is not satisfied with their SDC aligner tx .... are they really going to see their GP for more aligners? Or will they see an orthodontic specialist?

Some here would have you believe that straightening teeth is EASY. Some are easy. Most are difficult. You need to know all the variables. What is the etiology of the malocclusion? What is the specific growth pattern of the patient? Any adverse myofunctional concerns? Ortho is not just straightening teeth. Its about examining EVERY aspect of that unique patient and designing a unique treatment plan for that individual patient. It always amazed me that Align never required any cephalometric data in their Dx and TP. Now with SDC .... we're down to just a picture. Wonderful.

Btw. The true success of ortho tx is in the retention phase. How does the treatment hold up over time?

So maybe Orthodontists will be like Prosthodontists. We'll just treat hard cases which would be just fine for me. The easy cases bore me. I like the dramatic, difficult cases.

I can't complain. I still love my profession.

 

[Cold Front]

Here's my $0.02.
The big players here are Align and SDC. Everyone else is looking to cash out hoping that the big players will buy them out. It happened with Align years ago. Align bought 1 or 2 competitors. Clear Correct was left out in the cold.
In the end ... there will only be Align and SDC. Again .... if the smaller players have a unique product or delivery system .... then they are hoping for a buyout. If no buyout ..... no future for them.
I also predict massive class action lawsuits re: SDC. It will happen. At least Align does R&D, uses attachments, IPR, torquing ridges, etc. etc. SDC ..... nada. Lets just flare and spread teeth outside of the boney support. Hello future labial recession. Hello treatment instability. Hello WORSE malocclusions, but hey ... the front teeth are straight. Give the people what they want at the expense of evidence based treatment. Sounds like a cool research thesis for a perio or ortho resident.

As for Orthodontic specialists? Everyone (mostly GPs) under-estimate the full scope of what an Orthodontist does. Class 1 malocclusions makes up a small amount of those patients we treat. Yes .... we no longer get to treat 100% of all malocclusions. The GPs (aligners, fastbraces, 6 months smiles, etc) have already taken most of the easy stuff with the hard stuff being referred. So .... who is really going to be hurt with SDC? I would opine that GPs who use aligners will be hurt more than orthodontists. We already lost all the easy stuff. Can't lose it twice lol. When a patient is not satisfied with their SDC aligner tx .... are they really going to see their GP for more aligners? Or will they see an orthodontic specialist?

Some here would have you believe that straightening teeth is EASY. Some are easy. Most are difficult. You need to know all the variables. What is the etiology of the malocclusion? What is the specific growth pattern of the patient? Any adverse myofunctional concerns? Ortho is not just straightening teeth. Its about examining EVERY aspect of that unique patient and designing a unique treatment plan for that individual patient. It always amazed me that Align never required any cephalometric data in their Dx and TP. Now with SDC .... we're down to just a picture. Wonderful.

Btw. The true success of ortho tx is in the retention phase. How does the treatment hold up over time?

So maybe Orthodontists will be like Prosthodontists. We'll just treat hard cases which would be just fine for me. The easy cases bore me. I like the dramatic, difficult cases.

I can't complain. I still love my profession.

Clinically speaking, you are 100% correct. You spoke from a clinician stand point.

What about the patient and market stand point? You have millions of patients that want the Aligners, and each one of them choose those products over their orthodontists recommendations (for cost and/or convenient reasons). Why are orthodontists not seeing the big picture... that - yes, traditional braces is the best option for ortho treatment, but patients would like to see a spectrum of options in orthodontic treatments that are not offered in a traditional office.

Yes, Aligner companies are going way beyond their scope of service with incomplete diagnosis and risks, but they are enabled by willing patients who consented for the service and have autonomy over their teeth. Also, these Aligner companies have a group of orthodontists that will stand behind the aligner treatments - and these are licensed orthodontists who are legally involved in the treatment. So this is actually orthodontists vs orthodontists issue in ortho treatment. For everything you disagree about Aligners, there are orthodontists like you who work for Aligner companies that will refute you. Just show the ortho specialty doesn’t have a central coalition and a strong association that stands in unity against everything that would undermine the standard of care in orthodontics.

Do you think SDC Et Al would be where they are today if it wasn’t for the orthodontists who sold their specialty out and choose $$$ over their profession and joined these companies? If anything SDC proved to the public, is that orthodontics can be done by anyone. Just hire an orthodontist and pay him enough to support your version of ortho.

 

[ab117]

Clinically speaking, you are 100% correct. You spoke from a clinician stand point.

What about the patient and market stand point? You have millions of patients that want the Aligners, and each one of them choose those products over their orthodontists recommendations (for cost and/or convenient reasons). Why are orthodontists not seeing the big picture... that - yes, traditional braces is the best option for ortho treatment, but patients would like to see a spectrum of options in orthodontic treatments that are not offered in a traditional office.

Yes, Aligner companies are going way beyond their scope of service with incomplete diagnosis and risks, but they are enabled by willing patients who consented for the service and have autonomy over their teeth. Also, these Aligner companies have a group of orthodontists that will stand behind the aligner treatments - and these are licensed orthodontists who are legally involved in the treatment. So this is actually orthodontists vs orthodontists issue in ortho treatment. For everything you disagree about Aligners, there are orthodontists like you who work for Aligner companies that will refute you. Just show the ortho specialty doesn’t have a central coalition and a strong association that stands in unity against everything that would undermine the standard of care in orthodontics.

Do you think SDC Et Al would be where they are today if it wasn’t for the orthodontists who sold their specialty out and choose $$$ over their profession and joined these companies? If anything SDC proved to the public, is that orthodontics can be done by anyone. Just hire an orthodontist and pay him enough to support your version of ortho.

I wouldn’t be surprised if a good chunk of those orthos who jumped ship to join the aligner companies expect the companies to essentially shield them legally (“oh, they convinced us their research showed it was safe, effective, etc., we see now it wasn’t as effective as they made it sound, we see now it’s caused problems, but hindsight is 20/20...”) and will start retiring with their haul right around when the class-actions start picking up, which I fully expect like 2TH MVR said. I’m probably pretty ignorant to the full reality of the situation or if that could really hold up in court when the treatment is still on their license or however it works, it just wouldn’t surprise me.

 

[Cold Front]

I wouldn’t be surprised if a good chunk of those orthos who jumped ship to join the aligner companies expect the companies to essentially shield them legally (“oh, they convinced us their research showed it was safe, effective, etc., we see now it wasn’t as effective as they made it sound, we see now it’s caused problems, but hindsight is 20/20...”) and will start retiring with their haul right around when the class-actions start picking up, which I fully expect like 2TH MVR said. I’m probably pretty ignorant to the full reality of the situation or if that could really hold up in court when the treatment is still on their license or however it works, it just wouldn’t surprise me.

I agree. The AAO and their 20,000 orthodontist members had plenty of time to preemptively warn the risks of aligners to the public, but instead the “let’s wait and see when the shoe drops” approach was taken. Do you think if any lawsuit happens against these aligner companies, the inaction of the AAO (and by extension the ADA) would play part in failing their fiduciary duty to their members and the public in general?

For instance, Physicians and the AMA aggressively urged the public to quit vaping and flavored cigarettes, which worked - and now there is an imminent ban against those products. What’s stopping orthodontists and their association to do the same for Aligners (that come with no standard of care diagnosis)?

 

[LFA20]

After seeing all these threads I’m starting to think about doing a not so popular specialty like operative dentistry/oral pathology. I can then go into academia and possibly become an assistant dean or professor and making good money ($200k+) with little to no stress....

 

[2TH MVR]

Clinically speaking, you are 100% correct. You spoke from a clinician stand point.

What about the patient and market stand point? You have millions of patients that want the Aligners, and each one of them choose those products over their orthodontists recommendations (for cost and/or convenient reasons). Why are orthodontists not seeing the big picture... that - yes, traditional braces is the best option for ortho treatment, but patients would like to see a spectrum of options in orthodontic treatments that are not offered in a traditional office.
Align has come a long way. I was in the 1st certifying course in Phx when aligners 1st came out. I was actually excited about this different appliance. As with most new tech .... the aligner cases I had failed miserably. Most of the early cases .... I had to go back and treat with braces. Aligners in the right hands can produce outcomes close to that of conventional braces. But NEVER to the quality of a bracketed patient. With aligners .... there a too many variables that an orthodontist cannot control (relying on a tech or some other dentist/orthodontist to design the aligners, patient compliance, aligners not tracking properly, improper tx sequence, etc. etc.). In the modern ortho practice .... aligners are offered as an option. As for cost. Well .... aligners are a lab expense. Early on .... Align Tech mentioned that aligners would decrease the costs associated with bracketing and time. Common sense will tell you that Align Tech is a middle person looking to be paid. Ortho fees if anything have been decreasing in most saturated areas. Originally .... I offered aligners at a GOOD fee. A fee that would allow me to treat that patient with aligners and follow up with any necessary bracketing if needed. It also allowed me to profit the same even with Align wanting their aligner lab fee. Hard to get that GOOD fee any longer.

Yes, Aligner companies are going way beyond their scope of service with incomplete diagnosis and risks, but they are enabled by willing patients who consented for the service and have autonomy over their teeth. Also, these Aligner companies have a group of orthodontists that will stand behind the aligner treatments - and these are licensed orthodontists who are legally involved in the treatment. So this is actually orthodontists vs orthodontists issue in ortho treatment. For everything you disagree about Aligners, there are orthodontists like you who work for Aligner companies that will refute you. Just show the ortho specialty doesn’t have a central coalition and a strong association that stands in unity against everything that would undermine the standard of care in orthodontics.

As with any industry with their paid experts ..... the stuff coming out of their mouths can be pretty predictable. I'm sure you realize this. These orthodontists have a financial interest in what they say. Are you seriously going to compare these "commercial spokes people" with tenured board certified orthodontists in the educational arena who are involved in evidence based research. Aligners are here to stay. Orthodontists and General dentist simply want their use to not harm the unknowing general public.

Do you think SDC Et Al would be where they are today if it wasn’t for the orthodontists who sold their specialty out and choose $$$ over their profession and joined these companies? If anything SDC proved to the public, is that orthodontics can be done by anyone. Just hire an orthodontist and pay him enough to support your version of ortho.

Again, can't compare those who "sold" their specialty out and those who are trying to make sure that the general public is not harmed with SDC. Look. Here's an example. You place a nice new crown on #3. The crown is too high. This can lead to TMJ issues, clenching issues, patient discomfort, eatting issues, sensitivity in that area, soft and hard tissue issues resulting from excessive contact with ONE TOOTH. Now imagine treating a "simple" class 1 malocclusion with an anterior deep OB and upper/lower crowding or upper spacing. Sounds simple enough with the aligners. Lets just move the front teeth around. Not just a single tooth. ALL OF THE FRONT TEETH. Hows that going to affect the patient? What I see many times (unfortunately even with conventional braces) is that the deep OB is not corrected prior to upper space closure or lower incisor aligning. When this happens ..... upper anterior space closure with an existing deep OB .... the mandible will be FORCED posteriorly. Align the crowded lower incisors without IPR or understanding of their incisal angle to the MP ..... will also cause the lower mandible to be FORCED posteriorly. Last time I checked ..... our goals were to provide tx that is stable and supportive of the soft and hard tissue including the TMJ. SDC without attachments, IPR, proper diagnostic records, and actual Dr. control is a disservice to our patients.

SDC is nothing more than a money grab for the principals (owners). They will become or already have become rich with their idea on the backs of unknowing patients and all those who decide to invest in their product. Moving teeth is a process that requires real time adjustments to the ever changing variables of teeth movement. This isn't like 1-800-contacts where some cheap contacts can be made to a simple eye prescription. This isn't Rocket Mortgage. This a complex treatment where incorrect anterior movement can cause many other issues. Mostly TMD.

Well ... as always .... I do enjoy your banter and all of my comments are of a single opinion. Mine.

 

[ab117]

I agree. The AAO and their 20,000 orthodontist members had plenty of time to preemptively warn the risks of aligners to the public, but instead the “let’s wait and see when the shoe drops” approach was taken. Do you think if any lawsuit happens against these aligner companies, the inaction of the AAO (and by extension the ADA) would play part in failing their fiduciary duty to their members and the public in general?

For instance, Physicians and the AMA aggressively urged the public to quit vaping and flavored cigarettes, which worked - and now there is an imminent ban against those products. What’s stopping orthodontists and their association to do the same for Aligners (that come with no standard of care diagnosis)?

I mean, I'm just a D2 haha, I've just been interested in the situation. I know very little about the legal side or about the responsibility and liability of the organizations. It does all seem pretty weird to me though. I guess I probably would expect litigation to include them though. If you're thinking that their inaction played a role in unscrupulous providers being able to cash in on giving subpar treatment (and complications) to unsuspecting patients, and 2TH MVR also thinks it played a role, and I think it played a role... then I bet lots of other orthos and dentists and lawyers also think the same thing, or will come to think it in the next handful of years.

What I really don't understand is I've only heard concern and disapproval from faculty at school, here on SDN, from dentists I know, along with the assumption that the doctors involved with these companies are unscrupulous. If the whole thing really is that shady, why weren't AAO/ADA motivated to fight harder from the beginning? How did they get FDA approval and all that? It's surprising to me that the situation even got to the point that it's at when every professional opinion I've ever heard agrees that it's bad.

 

[Cold Front]

We all agree that aligner companies are bad for dental profession and patients.

Like Uber, many question the legality of SDC’s business practices. After doing little research, I learnt that couple of months ago, the AAO did file complaints in 36 states with state dental boards and attorneys general alleging that SDC’s service is “illegal and creates medical risks.”

SDC was founded 5 years ago, and the AAO waited all these years and after 300,000+ cases by SDC and before the company became public company to file complaints? Where are the complaints for the other dozen or so align companies? Does the AAO wait until they go public as well? Just shows the AAO is well behind the curve.

A side note, Invisalign is currently available at ortho and general dentist offices today. Something all orthodontists have lived to accept/no complaints filed with dental boards. In couple of years (2022), Invisalign will open retail stores in malls and other retail stores near you. What will the dialogue be then - when that business and revenue shifts from ortho/dental offices to middlemen on the streets?

SDC’s customers finance their aligners through a SDC owned finance company called SmilePay. SDC aligners typically cost $1,895 – for a $250 down payment and 17% APR over two years. Roughly 65% of customers use SmilePay to finance their aligners. Another example why the SDC success is about cost and finance options. In my opinion, the race to the bottom will continue.

It’s the same frustration grocery stores have with Dollar Stores. A Dollar Store opens every 3 hours in this country, because cost is far more important to majority of consumers than quality of service.

 

[charlestweed]

Clear aligners are a good alternative treatment option for the patients who don't want to wear braces. I don't have any issue with the orthodontists who use invisalign and advertise themselves as the "invisalign expert" or "elite invisalign provider" because they have shown cases were treated with clear aligners and got great clinical results. They are licensed orthodontists so they know what they are doing. There are different ways to move teeth. Some orthodontists use clear aligners to move teeth by instructing the invisalign technicians to make the aligners for them. And there are orthodontists like T2thMvr and myself, who prefer using brackets/wires to move teeth by instructing the assistants to change the elastics and wires for them. Good ortho results depend on the orthodontist's abitily to diagnose and tx plan.....it doesn't matter which material (clear aligners or brackets) he/she uses. It's good that these top Invisalign orthodontists' patients can afford to pay for the clear aligners. These high income earners would never walk into my offices anyway. I target the "Walmart" type of patients and most of them can't afford the high intial down payment (due to high invisalign lab fee). It's much easier for me to sell cases when I only ask them to put down $200-300.

Another reason I don't use invisalign in my practice is I hate to be dependent on outside companies (ie Invisalign, 3D printing company, management software company, an outside lab etc)....and have to wait for them. I want to have full control of all my patient treatments. If a tooth is still slightly rotated, I can just spend 10 seconds to correct it by bending the wire....and not have to re-scan the entire mouth and wait for the Invisalign company to send me a new set of aligners....too many steps, too much time, too much hassle, too costly.

 

[charlestweed]

SDC’s customers finance their aligners through a SDC owned finance company called SmilePay. SDC aligners typically cost $1,895 – for a $250 down payment and 17% APR over two years. Roughly 65% of customers use SmilePay to finance their aligners. Another example why the SDC success is about cost and finance options. In my opinion, the race to the bottom will continue..

Most of the cases that are treated by SDC are easy cases. I can easily treat these cases for under 12 months with brackets and easily beat their price.... and my patients get to see the real orthdontist for treatment and for retainer check afterward.

 

[charlestweed]

For instance, Physicians and the AMA aggressively urged the public to quit vaping and flavored cigarettes, which worked - and now there is an imminent ban against those products. What’s stopping orthodontists and their association to do the same for Aligners (that come with no standard of care diagnosis)?

No need for us, orthodontists, to urge the public not to use these DIY clear aligners. Most people don't realize that teeth will move back to their original positions when retainers are not worn for the rest of their life. I don't think SDC monitor if their patients wear retainers or not. And when people see their teeth get crooked again a few months later, they will go see the real orthodontists. The good thing is they only waste $1800 on these cheap DYI clear aligner treatments. They can afford to pay another $1800 at an orthodontic office like mine to get better and long lasting clincal results.

When I was in dental school, I attempted to cut my own hair to save money and I messed it up real bad. I learned my lesson not to do that again. The good thing is hairs grow back. The good thing is crooked teeth can be re-treated several times. Many of my patients have ortho tx more than once.

 

[Cold Front]

No need for us, orthodontists, to urge the public not to use these DIY clear aligners. Most people don't realize that teeth will move back to their original positions when retainers are not worn for the rest of their life. I don't think SDC monitor if their patients wear retainers or not. And when people see their teeth get crooked again a few months later, they will go see the real orthodontists. The good thing is they only waste $1800 on these cheap DYI clear aligner treatments. They can afford to pay another $1800 at an orthodontic office like mine to get better and long lasting clincal results.

When I was in dental school, I attempted to cut my own hair to save money and I messed it up real bad. I learned my lesson not to do that again. The good thing is hairs grow back. The good thing is crooked teeth can be re-treated several times. Many of my patients have ortho tx more than once.

I agree. All I was saying was that we are living in an interesting time where a lot of industries are disrupted... Uber v Taxis, Netflix/Disney+/Hulu v Cable TV, Electric Cars v Combustion Cars, Amazon v Retail Businesses, AirBNB v Hotels, and so on. It’s now dentistry’s turn.

I’m a dentist, I do not support the profession changing through the hands of corporate America. But we Dentists must first acknowledge that corporations and dental insurances have an intent to “change” dentistry. We often dismiss the unconventional changes those groups bring into the field until they become a very wide spread problem. Most dentists do not follow trends in dentistry and are in a time capsule/live in complete solitary state of mind. I fear the lack of organized dentistry will be the ultimate demise of the profession. The insurance companies and corporations, even dental schools are more organized in their missions to use dentistry to their advantage. To me, Dentists, the associations (ADA, AAO, AAE, etc) and dental boards are too decentralized to safeguard the profession and the public against those who see “oral health” as a commodity that can be bought and sold by anyone.

 

[2TH MVR]

I agree. All I was saying was that we are living in an interesting time where a lot of industries are disrupted... Uber v Taxis, Netflix/Disney+/Hulu v Cable TV, Electric Cars v Combustion Cars, Amazon v Retail Businesses, AirBNB v Hotels, and so on. It’s now dentistry’s turn.

I’m a dentist, I do not support the profession changing through the hands of corporate America. But we Dentists must first acknowledge that corporations and dental insurances have an intent to “change” dentistry. We often dismiss the unconventional changes those groups bring into the field until they become a very wide spread problem. Most dentists do not follow trends in dentistry and are in a time capsule/live in complete solitary state of mind. I fear the lack of organized dentistry will be the ultimate demise of the profession. The insurance companies and corporations, even dental schools are more organized in their missions to use dentistry to their advantage. To me, Dentists, the associations (ADA, AAO, AAE, etc) and dental boards are too decentralized to safeguard the profession and the public against those who see “oral health” as a commodity that can be bought and sold by anyone.

Totally agree. These are interesting times. I'm shocked at how fast things have changed in such a short amount of time. Most of these changes have been very positive for the general public. Of course the reverse can be said for those industries, service sectors, medical/dental, etc. etc. that were happy with the past status quo. I also agree that affected organizations should be more involved. If not .... they will be bullied into a direction dictated by the Corps and special interest groups. But no matter of organization/involvement will help certain industries like coal. Not sure what the answer is. Technology always marches forward and as a result .... the old ways of doing things become obsolete. As more and more workers lose their jobs to technology .... what will the masses do for employment in the future?

 

[Cold Front]

what will the masses do for employment in the future?

Yes. We are definitely in a technology trap era. Automation has been replacing jobs for decades now.

Do you remember when you needed to look a business up about 20 years ago, you would call 411 on your phone and ask an operator to help you? What happened to the yellow pages that arrived on your front door once a year? What about the folded street maps? What about the post card business? Google alone killed hundreds of thousands of those jobs.

Automation probably killed jobs in the millions around the world. Corporations are investing in machines than people, and it comes with a great cost. Look at the transportation industry, airplanes are relying less on pilots - and we all know how that worked out with the Boeing 737 Max incidents that killed hundreds of people, due to computers blocking pilots/humans from doing their job. People are driving every day in an autopilot mode in their Tesla cars and are either sleeping or eating food with both hands - and they get themselves into accidents. Google is testing their Wamu service that will be the driverless Uber service, and we will be sharing roads with those cars in the near future.

There are many examples in other industries that computers have replaced humans, from trading stocks to grocery store services. The future jobs will be humans helping humans in a limited scope, as demand for humans related jobs will decline due to cost.

Corporations with the most automation will offer cheapest products and services in the future (and pay the least taxes). Humans will become more of a liability for companies. Just today, General Motors announced that it’s facing strikes against union workers over contract talks. Automation is a major factor of the dispute. GM is investing heavily in automated cars, and to do so - it had to cut back on investment in their workers, with only two raises in the past 10 years.

 

[charlestweed]

This is why I've always encouraged my kids, nieces, and nephews to pursue either dentistry or medicine. Dentists and doctors will always be needed. Only a small percentage of the population floss their teeth and therefore, dental caries and bone losses continue to be the major dental health problems that require people to see their dentists regularly. People avoid exercising and continue to eat bad food and therefore, doctors will always be needed to treat heart diseases, diabetes, cancers etc. Robots cannot diagnose and tx plan.

I am all for corps’ expansions and their investments on new technology to help make our lives better. Capitalism and new innovations are what make America the best country on earth. Now with Uber, I no longer need to wait in line to check out a rental car and wait in line again to return it. A few days ago, the corp manager asked me if I could cover for the sick orthodontist, who works at an office that is about 80 miles away from my house. I said yes to her without any hesitation because of the Tesla’s autopilot….it was an easy 1.5 hour drive each way….the car essentially drove me to work and back home. So instead of taking a day off, I chose to work and got myself a new Galaxy Note 10 phone….and not feeling guilty about it.

Technology enables dentists and doctors see higher patient volume with less effort. Some of my colleagues claimed that by doing Invisalign tx, they have saved money for not having to hire a lot of chairside assistants to change the wires for them. That’s good for these orthodontists. For me, I save money for not having to hire full time assistants. My part time assistants only come to work for me 11 days/month…and not 22 days/month….that’s easily $5-6k/month in saving right there.

 

[2TH MVR]

I am all for corps’ expansions and their investments on new technology to help make our lives better. Capitalism and new innovations are what make America the best country on earth. Now with Uber, I no longer need to wait in line to check out a rental car and wait in line again to return it. A few days ago, the corp manager asked me if I could cover for the sick orthodontist, who works at an office that is about 80 miles away from my house. I said yes to her without any hesitation because of the Tesla’s autopilot….it was an easy 1.5 hour drive each way….the car essentially drove me to work and back home. So instead of taking a day off, I chose to work and got myself a new Galaxy Note 10 phone….and not feeling guilty about it.

Technology enables dentists and doctors see higher patient volume with less effort. Some of my colleagues claimed that by doing Invisalign tx, they have saved money for not having to hire a lot of chairside assistants to change the wires for them. That’s good for these orthodontists. For me, I save money for not having to hire full time assistants. My part time assistants only come to work for me 11 days/month…and not 22 days/month….that’s easily $5-6k/month in saving right there.

We have different opinions on this subject.

I agree that tech is great for the mundane tasks in our lives. i.e commuting long distances. I do not agree that tech is ALWAYS better than the task that it replaced. I purpously bought a sportscar (Alfa 4C) that was intended for the track. It has NO creature comforts. Rough suspension. No power steering. Little to no nannies. No nav. Crappy stereo. Weighs less than a ton. No door handles. No storage. It is loud. Obnoxious. Rough gears. Mechanical sounds. I absolutely love this car. Why? Because it has NO TECH. In order to track this car well ..... you, the driver .... have to DRIVE. A 911 is a fat, GT sportscar now. It has all the tech. You could drive a track circuit with your eyes closed. Computer doing all the work. What fun is that?
What about braces and aligners? With braces ... the orthodontist is a skilled, creative craftsman. With aligners ..... the orthodontist is just handing out some cad cam trays and hoping for the best
It's like asking legendary famous painters (Rembrandt, Michelangelo, Picasso, Da Vinci, etc, etc) to use Apple PaintBrush app to paint with.
Seriously .... tech is not the answer to everything. Tech is good for mundate tasks. Not creative tasks. Straightening teeth is a creative process.

As for your PT assts. I get it. For you ... it is a necessity to survive in your market. But it is this pervasive attitude (save money at all costs by lowering employee costs) that is part of the problem in this society. Look at the wealthiest person in the world (Bezos) cutting out health benefits to his PT workers at Whole Foods. Automation (tech) slowly eroding all jobs. When I was in private practice ...my staff were my 2nd family. They received 3 weeks of paid vacation, trips to Hawaii for the AAO meetings, group health insurance, PTO, well pay, profit sharing plans, etc. etc. When I wasn't making as much money .... I actually lowered MY salary in order to maintain the benefits for my hard working, veteran staff. Some may say I invested too much into my staff. Maybe. But it was the right thing to do. I literally had the same hard working staff with most of them with me for over 20 years.

So tech is making your life easier and more profitable. One person wins. Many others lose. I say all of this and I'm a staunch conservative.

 

[charlestweed]

We have different opinions on this subject.

I agree that tech is great for the mundane tasks in our lives. i.e commuting long distances. I do not agree that tech is ALWAYS better than the task that it replaced. I purpously bought a sportscar (Alfa 4C) that was intended for the track. It has NO creature comforts. Rough suspension. No power steering. Little to no nannies. No nav. Crappy stereo. Weighs less than a ton. No door handles. No storage. It is loud. Obnoxious. Rough gears. Mechanical sounds. I absolutely love this car. Why? Because it has NO TECH. In order to track this car well ..... you, the driver .... have to DRIVE. A 911 is a fat, GT sportscar now. It has all the tech. You could drive a track circuit with your eyes closed. Computer doing all the work. What fun is that?
What about braces and aligners? With braces ... the orthodontist is a skilled, creative craftsman. With aligners ..... the orthodontist is just handing out some cad cam trays and hoping for the best
It's like asking legendary famous painters (Rembrandt, Michelangelo, Picasso, Da Vinci, etc, etc) to use Apple PaintBrush app to paint with.
Seriously .... tech is not the answer to everything. Tech is good for mundate tasks. Not creative tasks. Straightening teeth is a creative process.

You and I are not very different on this subject. We, consumers, get to pick and choose which technology that we think would benefit us. Different consumers want different things. And of course, there are many tasks that can only be best performed by human.

I am totally with you on the clear aligners and that's why I don't use them. I am a very anti-tech person when it comes to running my ortho office and patient treatments. Like I said before, I don't want to be dependent on the outside services. I don't have to wait for the lab because I make RPEs, quads, TPAs and essix retainers in-house. I haven't yet found any new invention in ortho since graduation that is worth purchasing. I still practice ortho the same way that I was taught 15+ years ago.....paper charts, pano/ceph films, Headgear, Facemask, brackets, wires etc. Instead of using the automated text reminder software like many of my colleagues, I make my staff pick up the phone to call each patient a day before. Instead of using the Dolphin software, I make my staff hand-trace the cephs. Instead of using the intra-oral scanner and an outside 3D printing company, I make my assistants take alginate impressions and pour them in stone. This is another reason why I keep everything low tech....and that is to have things for my 3 F/T employees to do so they won't sit around doing nothing during the non-patient days.

As for your PT assts. I get it. For you ... it is a necessity to survive in your market. But it is this pervasive attitude (save money at all costs by lowering employee costs) that is part of the problem in this society. Look at the wealthiest person in the world (Bezos) cutting out health benefits to his PT workers at Whole Foods. Automation (tech) slowly eroding all jobs. When I was in private practice ...my staff were my 2nd family. They received 3 weeks of paid vacation, trips to Hawaii for the AAO meetings, group health insurance, PTO, well pay, profit sharing plans, etc. etc. When I wasn't making as much money .... I actually lowered MY salary in order to maintain the benefits for my hard working, veteran staff. Some may say I invested too much into my staff. Maybe. But it was the right thing to do. I literally had the same hard working staff with most of them with me for over 20 years.

This is where you and I differ. Jeff Bezos did not violate any labor law. He cuts the operating cost so we, the consumers, can enjoy Amazon's low cost products that are delivered to our door steps every day. If the employees at the Whole Food stores feel they are not paid fairly, they can always leave their jobs. If my employees are not happy with me, they can quit. My 3 F/T employees and 4 of my 7 P/T employees have been with me for 10+ years.....none of them has health benefit. Some of the part timers asked me to give them more days but my offices are not busy enough to hire them more days. I can't just pay them for sitting around doing nothing. It's supply and demand. Here in CA, we have oversupply of ortho assistants.

I don't have any problem rewarding my staff for their good work. The problem is most of them want to do minimal work (ie reties) and leave early. Nobody cares about your own office the way you do.

 

[SoftGel]

So tech is making your life easier and more profitable. One person wins. Many others lose. I say all of this and I'm a staunch conservative.

You sound like a pre-conversion YangGang'er

 

[2TH MVR]

You sound like a pre-conversion YangGang'er

Lol. You're right.

 

[bracketbuster68]

Yes. We are definitely in a technology trap era. Automation has been replacing jobs for decades now.

Do you remember when you needed to look a business up about 20 years ago, you would call 411 on your phone and ask an operator to help you? What happened to the yellow pages that arrived on your front door once a year? What about the folded street maps? What about the post card business? Google alone killed hundreds of thousands of those jobs.

Automation probably killed jobs in the millions around the world. Corporations are investing in machines than people, and it comes with a great cost. Look at the transportation industry, airplanes are relying less on pilots - and we all know how that worked out with the Boeing 737 Max incidents that killed hundreds of people, due to computers blocking pilots/humans from doing their job. People are driving every day in an autopilot mode in their Tesla cars and are either sleeping or eating food with both hands - and they get themselves into accidents. Google is testing their Wamu service that will be the driverless Uber service, and we will be sharing roads with those cars in the near future.

There are many examples in other industries that computers have replaced humans, from trading stocks to grocery store services. The future jobs will be humans helping humans in a limited scope, as demand for humans related jobs will decline due to cost.

Corporations with the most automation will offer cheapest products and services in the future (and pay the least taxes). Humans will become more of a liability for companies. Just today, General Motors announced that it’s facing strikes against union workers over contract talks. Automation is a major factor of the dispute. GM is investing heavily in automated cars, and to do so - it had to cut back on investment in their workers, with only two raises in the past 10 years.

Here's an interesting perspective on automation. Perhaps automation isn't what it's been said to be.

 

[Cold Front]

Here's an interesting perspective on automation. Perhaps automation isn't what it's been said to be.

The guy in the video is selectively explaining automation as something that will never replace people from doing jobs. Automation is replacing lowest skilled jobs and the transition of that happening is much quicker than it happened in the past decades/centuries. Yes, humans moved on to more skilled jobs, but the gap between people moving to more skilled jobs and automation is getting smaller and smaller.

Also, the demand for automation has never been higher than any other time in history, because of demographic challenges today are much different than before. With fewer working labor force in aging societies like the west will have no choice but to invest in automation to keep up with society’s demands.

The guy in the video also doesn’t take into account that many countries have become more anti-immigrant nations over the past decade or so. The US asylum and immigration arrivals are at record low - even illegal entry to this country has slowed down. Immigrants have historically been the low income earners and were cheaper to have them than investing in expensive automation technologies. So now, the tables have turned, and automation will be the next cheapest option for corporations to grow domestically. There is a rise in trade wars and tariffs, to curb companies from going overseas for cheap labor, and to invest back in the US... but that is not profitable either, that’s another reason why automation get a chance to grow. Apple would make all their iPhones in the US if they had a machine that built the phones without a human component.

Finally, automation is getting cheaper over time, particularly in the economics of scale sense. You can have an endless supply of automation, but you can’t have an endless supply of humans in the future - specially when you already have a shrinking population. People are marrying robots as companions in Japan already. Humans are engaging more with their devices/technology over time, so that relationship will naturally breed an automation links between people, far more than human skills between people.

One more thing, I read today that there is a police officer shortage in this country - and that about 5% are already in retirement phase today, and another 15% will retire in 5 years. Also, applications for police jobs are down - partly because the job is highly criticized in the media and in the public opinion. This means fewer officers in the future, and no automation can replace those jobs - unless we allow more drones, speeding cameras (or even Judge Dredd style officers on the roads) to keep society in check. I can really see that happening... maybe not in our lifetime. There are hundreds of other examples like this out there... But ignore that guy in the video!

 

[SoftGel]

Here's an interesting perspective on automation. Perhaps automation isn't what it's been said to be.

Very interesting. To nitpick something I feel this guest completely misses:
The "unemployment rate" has fluid interpretations that allow it to be manipulated for political aims. The party in power uses the number to frame their own narrative in the press. Obama did it. Trump does it constantly. But until you take into account "labor force participation" (counting people who gave up looking for work), your not seeing the larger picture. When you apply a less political definition of "unemployed" it's hard to come to any conclusion other than "oh ****!"

The Unemployment Lie: Why the Unemployment Rate is Inaccurate and Paints an...

This is why the unemployment rate is inaccurate.

www.tremr.com

 

[2TH MVR]

Getting this back to the aligner companies. Seems to me that the general public is just so enamored with the hi-tech associated with these products. If you have fancy commercials and marketing, fancy packaging and a home delivery system .... your product has already become successful. People seem to equate high tech with a high degree of treatment success. Hi tech does not equate to high quality. Look at the early aligners. They performed poorly until they started to sequence them properly, attachments, power ridges, torquing ridges, IPR, unlimited trays, etc. etc. Look at the early cad cam crowns. I remember early on that these cad cam crowns looked like temporaries. I realize as the tech matures ... it gets better with each version. Maybe. 😉

 

[DrJeff]

Getting this back to the aligner companies. Seems to me that the general public is just so enamored with the hi-tech associated with these products. If you have fancy commercials and marketing, fancy packaging and a home delivery system .... your product has already become successful. People seem to equate high tech with a high degree of treatment success. Hi tech does not equate to high quality. Look at the early aligners. They performed poorly until they started to sequence them properly, attachments, power ridges, torquing ridges, IPR, unlimited trays, etc. etc. Look at the early cad cam crowns. I remember early on that these cad cam crowns looked like temporaries. I realize as the tech matures ... it gets better with each version. Maybe. 😉

The interesting thing that I'm seeing is that with a product like SDC and how it's marketed, you're seeing a number of folks, willingly paying for the service, and in the now couple of patients in my own practice that are in the middle of SDC treatment (one of whom is a perio patient with generalized 5-8mm pocketing and refuses to go to the periodontist because it "costs to much" ) is that they also tend to complain about any co-pays they may have with my restorative treatment.... Granted my sample size in my own observations is n=3, but I have found that interesting, as well as somewhat troubling in that in the case of the perio patient who is in SDC treatment now, my local orthodontist whom I send most of my referrals to, refused to treat this same patient about 2 years ago when the patient inquired about ortho treatment for themselves duringone of the visits for their child's ortho treatment that my local orthodontist was doing....

 

[charlestweed]

The guy in the video is selectively explaining automation as something that will never replace people from doing jobs. Automation is replacing lowest skilled jobs and the transition of that happening is much quicker than it happened in the past decades/centuries. Yes, humans moved on to more skilled jobs, but the gap between people moving to more skilled jobs and automation is getting smaller and smaller.

Also, the demand for automation has never been higher than any other time in history, because of demographic challenges today are much different than before. With fewer working labor force in aging societies like the west will have no choice but to invest in automation to keep up with society’s demands.

The guy in the video also doesn’t take into account that many countries have become more anti-immigrant nations over the past decade or so. The US asylum and immigration arrivals are at record low - even illegal entry to this country has slowed down. Immigrants have historically been the low income earners and were cheaper to have them than investing in expensive automation technologies. So now, the tables have turned, and automation will be the next cheapest option for corporations to grow domestically. There is a rise in trade wars and tariffs, to curb companies from going overseas for cheap labor, and to invest back in the US... but that is not profitable either, that’s another reason why automation get a chance to grow. Apple would make all their iPhones in the US if they had a machine that built the phones without a human component.

Finally, automation is getting cheaper over time, particularly in the economics of scale sense. You can have an endless supply of automation, but you can’t have an endless supply of humans in the future - specially when you already have a shrinking population. People are marrying robots as companions in Japan already. Humans are engaging more with their devices/technology over time, so that relationship will naturally breed an automation links between people, far more than human skills between people.

One more thing, I read today that there is a police officer shortage in this country - and that about 5% are already in retirement phase today, and another 15% will retire in 5 years. Also, applications for police jobs are down - partly because the job is highly criticized in the media and in the public opinion. This means fewer officers in the future, and no automation can replace those jobs - unless we allow more drones, speeding cameras (or even Judge Dredd style officers on the roads) to keep society in check. I can really see that happening... maybe not in our lifetime. There are hundreds of other examples like this out there... But ignore that guy in the video!

Isn’t low immigrant rate a good thing for the US citizens, who don’t have to worry about their jobs being taken away by legal/illegal immigrants? I don’t see this happening here in CA. I guess it’s because CA is an immigrant friendly state. My ortho practices have benefited so much from the high birthrate in the Hispanic population and the increase in number of Asian immigrants in recent years. Many of my young teenage Asian patients still have an accent.

There are many highly developed countries like Japan, S. Korea, Taiwan, the UAE etc that hire migrant workers from poor countries like Vietnam, Cambodia, Laos, Myanmar. And these migrant workers don’t just sign up for these jobs….a large percentage of their paychecks go toward paying the middleman companies that helped them get these jobs. They’d rather be exploited and make some money than staying in their home countries and have no job. And here we are in the US, the richest country in the world, complaining about having no job…. dentistry is bad, medicine is bad, ortho is a dying specialty. Japan, South Korea most lucrative for Vietnamese workers - VnExpress International.

There are plenty of jobs available in the US. The question is are people willing to do these jobs? …or do they think some of these jobs are beneath them? I know some new grad orthos who would rather stay home than getting jobs that require them travel a long distance....that pay them the same as general dentists.

If the illegal immigration is down, then why does this Administration constantly get criticized by the media for over-crowed detention centers and mistreatments of the immigrants? So the caravans of immigrants from central American countries are just make up stories by this Administration?

I think the guy in the video made some good points.

 

[CGtoDentistry]

[/QUOTE]

One more thing, I read today that there is a police officer shortage in this country - and that about 5% are already in retirement phase today, and another 15% will retire in 5 years. Also, applications for police jobs are down - partly because the job is highly criticized in the media and in the public opinion. This means fewer officers in the future, and no automation can replace those jobs - unless we allow more drones, speeding cameras (or even Judge Dredd style officers on the roads) to keep society in check. I can really see that happening... maybe not in our lifetime. There are hundreds of other examples like this out there... But ignore that guy in the video!

You'd be surprised how much retired law enforcement can make when factoring in overtime and pensions. Back when I was active duty with the Coast Guard I'd work with a lot of law enforcement in the New York/New Jersey area. Some of these guys were making $150K a year when you factored in overtime. Their pension system is typically their pay for the last 3 years of work (retirement for NYPD is 20 years if I recall correctly), so lots of these guys would work a crazy amount of over time in their last 3 years. They'd then move to a low cost of living state like Florida and draw their pension from there

Also have met plenty of people who have had time in active duty military, then switch to the reserves and go either federal, state, or local law enforcement. This enables these guys to "double dip" on pensions. So they get a pension from their LE job and when they reach the reserve retirement age get a second pension from the military.

I'm sure there are a lot of dentists in the military forum who do something similar by drilling

 

[2TH MVR]

The interesting thing that I'm seeing is that with a product like SDC and how it's marketed, you're seeing a number of folks, willingly paying for the service, and in the now couple of patients in my own practice that are in the middle of SDC treatment (one of whom is a perio patient with generalized 5-8mm pocketing and refuses to go to the periodontist because it "costs to much" ) is that they also tend to complain about any co-pays they may have with my restorative treatment.... Granted my sample size in my own observations is n=3, but I have found that interesting, as well as somewhat troubling in that in the case of the perio patient who is in SDC treatment now, my local orthodontist whom I send most of my referrals to, refused to treat this same patient about 2 years ago when the patient inquired about ortho treatment for themselves duringone of the visits for their child's ortho treatment that my local orthodontist was doing....

I would have to believe that the SDC patients or should I say .... consumers .... are asked to sign a consent form requiring a complete soft and hard tissue exam by their GP. You know ....

The interesting thing that I'm seeing is that with a product like SDC and how it's marketed, you're seeing a number of folks, willingly paying for the service, and in the now couple of patients in my own practice that are in the middle of SDC treatment (one of whom is a perio patient with generalized 5-8mm pocketing and refuses to go to the periodontist because it "costs to much" ) is that they also tend to complain about any co-pays they may have with my restorative treatment.... Granted my sample size in my own observations is n=3, but I have found that interesting, as well as somewhat troubling in that in the case of the perio patient who is in SDC treatment now, my local orthodontist whom I send most of my referrals to, refused to treat this same patient about 2 years ago when the patient inquired about ortho treatment for themselves duringone of the visits for their child's ortho treatment that my local orthodontist was doing....

It's hard to believe. I'm sure these consumers (can't call them pts since a Dr. is not involved directly) are asked to sign a statement to protect the company. A disclaimer that reads:
You have to see your general dentist prior to starting aligners.

The interesting thing that I'm seeing is that with a product like SDC and how it's marketed, you're seeing a number of folks, willingly paying for the service, and in the now couple of patients in my own practice that are in the middle of SDC treatment (one of whom is a perio patient with generalized 5-8mm pocketing and refuses to go to the periodontist because it "costs to much" ) is that they also tend to complain about any co-pays they may have with my restorative treatment.... Granted my sample size in my own observations is n=3, but I have found that interesting, as well as somewhat troubling in that in the case of the perio patient who is in SDC treatment now, my local orthodontist whom I send most of my referrals to, refused to treat this same patient about 2 years ago when the patient inquired about ortho treatment for themselves duringone of the visits for their child's ortho treatment that my local orthodontist was doing....

The interesting thing that I'm seeing is that with a product like SDC and how it's marketed, you're seeing a number of folks, willingly paying for the service, and in the now couple of patients in my own practice that are in the middle of SDC treatment (one of whom is a perio patient with generalized 5-8mm pocketing and refuses to go to the periodontist ... the case of the perio patient who is in SDC treatment now

I'll bet those periodontally involved teeth are moving really fast. Pt then believes those sdc aligners are a miracle.

 

[Cold Front]

Isn’t low immigrant rate a good thing for the US citizens, who don’t have to worry about their jobs being taken away by legal/illegal immigrants? I don’t see this happening here in CA. I guess it’s because CA is an immigrant friendly state. My ortho practices have benefited so much from the high birthrate in the Hispanic population and the increase in number of Asian immigrants in recent years. Many of my young teenage Asian patients still have an accent.

There are many highly developed countries like Japan, S. Korea, Taiwan, the UAE etc that hire migrant workers from poor countries like Vietnam, Cambodia, Laos, Myanmar. And these migrant workers don’t just sign up for these jobs….a large percentage of their paychecks go toward paying the middleman companies that helped them get these jobs. They’d rather be exploited and make some money than staying in their home countries and have no job. And here we are in the US, the richest country in the world, complaining about having no job…. dentistry is bad, medicine is bad, ortho is a dying specialty. Japan, South Korea most lucrative for Vietnamese workers - VnExpress International.

There are plenty of jobs available in the US. The question is are people willing to do these jobs? …or do they think some of these jobs are beneath them? I know some new grad orthos who would rather stay home than getting jobs that require them travel a long distance....that pay them the same as general dentists.

If the illegal immigration is down, then why does this Administration constantly get criticized by the media for over-crowed detention centers and mistreatments of the immigrants? So the caravans of immigrants from central American countries are just make up stories by this Administration?

I think the guy in the video made some good points.

Low “legal” immigration is not a good thing for a country that has a low fertility rate and an aging population. Yes, immigrants typically compete for lower paying and unskilled jobs (i.e. Amazon fulfillment centers, grocery stores, restaurants, farms, etc), but with good economy and low unemployment, there is little to no competition. With more than 7 million job openings in today’s economy, employers are still looking to add workers. That causes wage gain, which is good for both immigrants and US citizens.

In the future, there will be less immigrants due to globalization narrowing the gap between developed and developing countries, leading to fewer migrants coming to the US. Also, the number of children born vs the number people entering retirement every year are about even, about 4 million each. That means we have reached a peak demographic workforce, and in a decade or two - the people retiring will outweigh the people entering workforce... and eventually leads to a negative population growth, which is bad for the economy. Japan is a good example of this; anti-immigration, declining fertility and population. They have about 40 million people (1 in 3 Japanese) over the age of 65, and that’s taking a toll on their economy - growing way smaller than the US, China and many other countries.

Illegal immigration to the US is down by about 40% in some estimates at the Mexico border. In fact, it has been going down for many years now. But it has always been a hot button topic in politics - because there is a common belief that illegal immigration leads to more crimes, poor neighborhoods, and using a lot of tax payer services (from roads to healthcare and schools). So administrations have to speak on this issue because the average American is concerned about this, and some of that is xenophobia, and tax payers want to hold the government accountable. The media also puts a spin to this issue, just shy of full blown propaganda to juice what their audience want to hear. Yes, there are detention center abuses and a host of other slippery slope problems that face illegal immigrants when they cross the border, but this is just the nature of the system dealing with the problem. Majority of the immigrants are processed and go through the legal channels; from immigration courts to deportations.

I can’t speak for the Asian countries and the way they manage immigration, but places like the UAE and Qatar are well known for companies to fish very cheap labor from rural rural parts of poor Asian countries, take ownership of them, take their passports, and put them in slum neighborhoods and treat the workers inhumane ways. All international agencies have condemned the Middle East countries for their treatment on immigrants, and that’s how they built the tallest buildings in the world and soccer World Cup stadiums. You could say the same thing about the US 150 years ago, when ethnic Chinese Immigrants were brought to this country to build the Transcontinental Railroads - their rights and working conditions.

 

[Cold Front]

Going back to the Aligner topic...

Many well established 3D printing companies are now entering the aligner ortho market, and are helping the smaller align companies with cheaper supplies cost and faster delivery times (from weeks to days). I think this will push the aligner prices down even further and expand the market in the very near future.

SDC currently works with HP for their 3D printing, but I will not be surprised if HP one day undercuts SDC and offers their technology directly to dentists or even patients - with the way things are going with DIY dentistry.

 

[DrJeff]

Going back to the Aligner topic...

Many well established 3D printing companies are now entering the aligner ortho market, and are helping the smaller align companies with cheaper supplies cost and faster delivery times (from weeks to days). I think this will push the aligner prices down even further and expand the market in the very near future.

SDC currently works with HP for their 3D printing, but I will not be surprised if HP one day undercuts SDC and offers their technology directly to dentists or even patients - with the way things are going with DIY dentistry.

The clinician side of me wonders if the cost of aligners being at a point where it's less expensive than traditional "brackets and wires" orthodontics will ultimately be a good thing for treatment outcomes? Right now, at least before SDC etc started driving the price down, "old school" invisalign was most often marketed at a premium over brackets and wires, and often (or at least what my orthodontist wife has told me time and time again) when it was stressed to patients (or especially the parents of patients) the utmost importance of compliance of wearing the aligners 23 or so hours a day, many parents, where cost isn't the issue, would choose brackets and wires out of compliance concerns.

Are we really getting to a point where if the full paradigm shift to basically plastic aligners for most ortho happens (maybe even pushed by insurance companies if the materials price keeps going down) that ultimately across the orthodontic patient population that this will provide results equivalent and as timely as brackets and wires when the variable of patient compliance is significantly brought into the equation? I'm not so sure of that. And then what happens in that situation? Extended treatment time? Mid treatment switch to traditional braces? Aligners getting a "bad" reputation by the public because they "don't work" (even though it's because of the patient not following the usage guidelines and not the aligners themselves??

 

[Cold Front]

The clinician side of me wonders if the cost of aligners being at a point where it's less expensive than traditional "brackets and wires" orthodontics will ultimately be a good thing for treatment outcomes? Right now, at least before SDC etc started driving the price down, "old school" invisalign was most often marketed at a premium over brackets and wires, and often (or at least what my orthodontist wife has told me time and time again) when it was stressed to patients (or especially the parents of patients) the utmost importance of compliance of wearing the aligners 23 or so hours a day, many parents, where cost isn't the issue, would choose brackets and wires out of compliance concerns.

Are we really getting to a point where if the full paradigm shift to basically plastic aligners for most ortho happens (maybe even pushed by insurance companies if the materials price keeps going down) that ultimately across the orthodontic patient population that this will provide results equivalent and as timely as brackets and wires when the variable of patient compliance is significantly brought into the equation? I'm not so sure of that. And then what happens in that situation? Extended treatment time? Mid treatment switch to traditional braces? Aligners getting a "bad" reputation by the public because they "don't work" (even though it's because of the patient not following the usage guidelines and not the aligners themselves??

I agree. It’s alarming to see the public falling for these gimmicks.

I think it comes down to this for the consumers... Aligners are a bargain, it's convenient, and it makes you look better on Instagram, that's the trifecta!

SDC executives admitted that they think a lot of their success with Aligners is driven by the selfie phenomenon, and it’s a trend that is not going away.

I’m very curious to hear from the orthodontists; how many of their patients utter these words to them as new patients - "I just want to straighten my smile up a little bit”? Majority of those patients will never set a foot inside an ortho office again, because “a little straightening” is now synonymous with Aligners and not orthodontists, for those patients. To me, that’s where I would draw the line.

 

[2TH MVR]

Just read a recent article regarding SDC and Align Tech. I guess SDC did around 400 million vs Align's 2 billion in revenue last year. SDC has been chipping away at Align's business by a factor of 10% and this is rising. Align execs seem to think that the target consumer is different for themselves and SDC. Interestingly Align is curiously sitting on the sidelines watching all the lawsuits (local dental boards, ADA, AAO, etc. etc.) that are being brought against SDC. I'm betting that Align is patiently waiting to see what ...if any fallout occurs with the legal issues and SDC. Align could EASILY put out their OWN direct to consumer aligner product. Is it possible that Align is concerned with alienating their orthodontist/dentists users by doing this? Interesting to watch.

As an aside. I mentioned before that the Corp I work for did not offer aligners. We did technically, but not many low income patients could afford the larger down payment and quite frankly ... aligners weren't being pushed. Well .... that is starting to change. Rumour is that my Corp is experimenting with offering "proprietary" aligners. A less expensive alternative. This should be interesting.

If I was Align tech .... I would be worried. They are essentially a middle person. A lab providing a lab product. As tech improves (3D printing, etc) that product will be easier and cheaper to produce.

 

[DrJeff]

Just read a recent article regarding SDC and Align Tech. I guess SDC did around 400 million vs Align's 2 billion in revenue last year. SDC has been chipping away at Align's business by a factor of 10% and this is rising. Align execs seem to think that the target consumer is different for themselves and SDC. Interestingly Align is curiously sitting on the sidelines watching all the lawsuits (local dental boards, ADA, AAO, etc. etc.) that are being brought against SDC. I'm betting that Align is patiently waiting to see what ...if any fallout occurs with the legal issues and SDC. Align could EASILY put out their OWN direct to consumer aligner product. Is it possible that Align is concerned with alienating their orthodontist/dentists users by doing this? Interesting to watch.

As an aside. I mentioned before that the Corp I work for did not offer aligners. We did technically, but not many low income patients could afford the larger down payment and quite frankly ... aligners weren't being pushed. Well .... that is starting to change. Rumour is that my Corp is experimenting with offering "proprietary" aligners. A less expensive alternative. This should be interesting.

If I was Align tech .... I would be worried. They are essentially a middle person. A lab providing a lab product. As tech improves (3D printing, etc) that product will be easier and cheaper to produce.

Doesn't surprise me that publicly at least, Align is staying out of the direct to consumer model that SDC's primary model is.

That Federal Court Ruling against SDC a few months ago, hit on a key thing that is in the dental practice acts of most states, which basically states that orthodontic impressions have to be taken by either a dental professional directly in some states or a staff member under the DIRECT supervision of a dental professional. To "correct" this and allow legally some of the model for impression taking (even their digital scanning centers that may not have a licensed dentist staffing them) would require each state that has language like that in their dental practice act's to legislatively open them up and pass language allowing that change, and once the decision is made by the legislature to open up their practice acts, then you could see other groups looking to "jump in" and change things for their benefit. For example in my home state of CT, oral surgeons are allowed to administer sedation themselves while also doing procedures on patients. The Anesthesiologists in CT would like to change the dental practice act to prevent oral surgeons from being able to both administer conscious sedation and do oral surgery related procedures and make it so those procedures where conscious sedation are involved are either done in an outpatient surgical center or with a separate, licensed anesthesiologist are part of the oral surgery "team". They can't do this unless the dental practice act is opened, so to just reopen that legislation for 1 specific thing, may very well find that other, unintended things, can end up happening as well.

That ruling against SDC was significant on a wide host of issues, and why I am guessing until some final ruling comes down and/or numerous states change their practice acts, Align may choose to stay in the situation where their at with their products coming directly through a dental professional

 

[CGtoDentistry]

If I was Align tech .... I would be worried. They are essentially a middle person. A lab providing a lab product. As tech improves (3D printing, etc) that product will be easier and cheaper to produce.

Thoughts on the business decision for orthodontists or dentists to acquire aligner 3D printers? From an engineering perspective this is not a difficult thing to accomplish, and as previously mentioned much of the creative process comes from the orthodontist anyway (my ortho designed a unique plan around my dental implant to accomplish a great result/give me space for an implant on the other side of the arch w Invisalign).

I'd see this as similar to the CEREC. But then we get into the business acquisition of acquiring the piece of equipment to mill the aligners, as well as any technical updates to the piece of equipment.

Interested to hear your perspective. I think it may be useful for the big corps to do it all in-house but maybe makes sense for a practice owner to outsource at a dental lab (could be profitable for dental labs to train techs on this equipment similar to crowns?)

 

[Cold Front]

Align could EASILY put out their OWN direct to consumer aligner product. Is it possible that Align is concerned with alienating their orthodontist/dentists users by doing this? Interesting to watch.

Align have already alienated dentists/orthodontists and DID have their own direct to consumer stand alone stores since 2017, which they expanded to 12 stores in malls and retail centers until SDC sued them for violating their non-compete agreement. A judge ruled Align to close all their stores, and barred them from opening any new stores and the direct to consumer market until 2022 - when the non-compete provision with SDC ends.

Align will be back in a full blown scale in couple of years - as they try to catch up, compete and take a share of the aligner market (that they feel have been taken from them by SDC).

 

[Cold Front]

Thoughts on the business decision for orthodontists or dentists to acquire aligner 3D printers? From an engineering perspective this is not a difficult thing to accomplish, and as previously mentioned much of the creative process comes from the orthodontist anyway

There are small network of orthodontists who have already started their own aligner and 3D in-office printing. It’s slowly becoming a more ubiquitous technology for orthodontists, I would say in 5 years - every ortho office will have 3D machine and print their own aligners.

Today, 3D printing is proving to be a game-changer not just for dentistry, but also for medicine, manufacturing, aviation and anything you want. 3D technology is being used in orthopedic and oral surgery. We dentists are talking about 3D revolutionizing (some aspects) of ortho, but the 3D technology cost and efficiency have improved a lot over the years.. just like renewable energy technology did for solar panels and electric cars.

 

[2TH MVR]

I'd see this as similar to the CEREC. But then we get into the business acquisition of acquiring the piece of equipment to mill the aligners, as well as any technical updates to the piece of equipment.

Interested to hear your perspective. I think it may be useful for the big corps to do it all in-house but maybe makes sense for a practice owner to outsource at a dental lab (could be profitable for dental labs to train techs on this equipment similar to crowns?)

Aligners have been around a LONG time. Originally orthodontists use to "reset" teeth in a plaster model and then make an Essix ret to help with aligning a single tooth. One of the larger ortho supply companies offered "Red, White and Blue". Anyone remember those? 3 aligners with resets to help with minor tooth movement. Align Tech just took it one step further.
Anyone can make aligners. You cannot compare aligners treating a malocclusion to a CEREC single crown. The success of the aligners is mostly in choosing the right, simple malocclusion to treat. What about sequencing the aligners to move the teeth? This is second nature for an orthodontist that does this EVERY day in their offices. You can't FORCE teeth into alignment. You have to create room sequentially. Leverage off of adjacent teeth. Understand anchorage requirements. Understand the vertical and horozontal components of the desired tooth movements. Understand stability for end of treatment.

My biggest issue with aligners is that those other than orthodontists are HOPING that the "so-called experts" working for Align Tech will magically, predictably and with stability can treat the submitted case. You're essentially putting your patient's treatment in the hands of who? Seriously.

It scares me that the employer Corp I work for is looking to make their own aligners. I will be the treating orthodontist. I'm already thinking about an additional consent form informing patients that aligner treatment is unpredictable and is not as ideal as conventional braces.

Originally .... at that 1st certifying course. It was mentioned that aligners are an additional ADJUNCT to conventional braces. I embraced it at that time. Now .... aligner companies are looking to use aligners for EVERYTHING.

I'll pass. I want to have complete control of the patients I treat.

 

[charlestweed]

There are small network of orthodontists who have already started their own aligner and 3D in-office printing. It’s slowly becoming a more ubiquitous technology for orthodontists, I would say in 5 years - every ortho office will have 3D machine and print their own aligners.

Today, 3D printing is proving to be a game-changer not just for dentistry, but also for medicine, manufacturing, aviation and anything you want. 3D technology is being used in orthopedic and oral surgery. We dentists are talking about 3D revolutionizing (some aspects) of ortho, but the 3D technology cost and efficiency have improved a lot over the years.. just like renewable energy technology did for solar panels and electric cars.

Electric cars just as fast and have almost similar range as the gas cars but it still takes 3-4 times longer to re-fuel them…and there are fewer surpercharging stations in the country than gas stations….therefore, a long road trip, that requires multiple refuelings, will take 1-2 hours longer to get to the destination. I have solar panels but I still rely heavily on the power company for my household needs…..can’t generate electricity during the cloudy days (from Oct-Jan). And due to the high cost of solar panels, it’ll take me at least 10 years to get back the amount that I invested. I would lose money on solar panels if I sell my house in less than 10 years.

Technology is expensive and not necessarily better and faster. It takes way too many steps, too much time and money to produce the clear aligners in-house. Brackets and wires are much cheaper and faster. It takes me 10 seconds to put a simple bend on an archwire. I’d rather hire P/T assistants to perform all the clinical tasks for me than spending my own time on the computer (after the office hours) to design and to make the clear aligners in-house. No need to worry about the machines breaking down on me. Doctor's time = money. It’s much cheaper to hire P/T assistants (because of the surplus of assistants here in CA) than to invest the money on the expensive technology to make the clear aligners in-house. With brackets/wire system, I can see 50-60 patients (weekdays) 80-100 patients (weekends) in 4 hours….and then I just go home….no additional work after the office hours.

With the low overhead of the traditional brackets and wires, I can pass on the low ortho cost treatments to my patients. Most parents don’t care what material (clear aligners vs brackets) I use on their kids. As long as they pay less for their kids to have beautiful smiles, they are happy. The good thing is more than 75% of my patients are under 18 yo….and most of them want colorful braces. I think future generation orthodontists will have to use clear aligners more to attract more adult patients. For me, I’d rather treating kids….they are not as picky as adult patients.

 

[Cold Front]

Electric cars just as fast and have almost similar range as the gas cars but it still takes 3-4 times longer to re-fuel them…and there are fewer surpercharging stations in the country than gas stations….therefore, a long road trip, that requires multiple refuelings, will take 1-2 hours longer to get to the destination. I have solar panels but I still rely heavily on the power company for my household needs…..can’t generate electricity during the cloudy days (from Oct-Jan). And due to the high cost of solar panels, it’ll take me at least 10 years to get back the amount that I invested. I would lose money on solar panels if I sell my house in less than 10 years.

Technology is expensive and not necessarily better and faster. It takes way too many steps, too much time and money to produce the clear aligners in-house. Brackets and wires are much cheaper and faster. It takes me 10 seconds to put a simple bend on an archwire. I’d rather hire P/T assistants to perform all the clinical tasks for me than spending my own time on the computer (after the office hours) to design and to make the clear aligners in-house. No need to worry about the machines breaking down on me. Doctor's time = money. It’s much cheaper to hire P/T assistants (because of the surplus of assistants here in CA) than to invest the money on the expensive technology to make the clear aligners in-house. With brackets/wire system, I can see 50-60 patients (weekdays) 80-100 patients (weekends) in 4 hours….and then I just go home….no additional work after the office hours.

With the low overhead of the traditional brackets and wires, I can pass on the low ortho cost treatments to my patients. Most parents don’t care what material (clear aligners vs brackets) I use on their kids. As long as they pay less for their kids to have beautiful smiles, they are happy. The good thing is more than 75% of my patients are under 18 yo….and most of them want colorful braces. I think future generation orthodontists will have to use clear aligners more to attract more adult patients. For me, I’d rather treating kids….they are not as picky as adult patients.

Electric cars became mainstream the last 10 years or so. Because the cost of lithium battery and the entire auto industry was pushing back against electric cars. The tipping point came when the public and governments started to push for low carbon footprint cars, which was targeting the emission standards of combustion cars - do you remember the “cash for clunkers” program by the government?. Some states like CA had/have carbon emission tax on their cars. That made way for electric cars like Tesla to lobby for subsidies and grants to make Tesla what it is today. The infrastructure is the next phase, as 80% of all cars are driven locally - so home charging is already supporting electric cars to be more practical cars as combustion cars, locally. The range has also improved from 200 miles for premium models when electric cars initially rolled out, and now 300+ miles is pretty common for many base models. Lithium battery prices have dropped about 90% over the last decade. As a result, it paved way for the mainstream manufacturers like VW, Honda and so on will roll out a fleet of electric cars next year for the masses. The chargers have also improved and now the gap between charging an electric car and fueling a combustion car is getting smaller every year. A lot of new apartment and commercial buildings now come with electric chargers as standard, at least in my state. The infrastructure for long road trips is underway because it happens in phases in the US. In Europe, long road trip is not an issue for those smaller countries - plus they have more electric cars than the US. So more electric cars will lead to demand for more infrastructure, just like the rise of cars lead to more roads.

Technology is expensive initially, but with time and demand, it always leads to efficiency and lower cost. A lot of dental labs are utilizing 3D printing technology, from doing denture wax ups to ortho appliances - just think about how much human time will be saved in the thousands of dental labs that will get their hands on 3D printers in the near future. They will not teach dental wax up and setting occlusions for dentures in dental schools in few years - it would serve no value when computers are doing that in the real world. There will come a point your P/T assistants will be trained to use the 3D technology to save time and cost, after all - in the future, the cost of technology will go down and employees will ask for a pay raise every year!

 

[2TH MVR]

Tech is good until you realize all the costs involved to stay current. Hardware that becomes obsolete in a few years. Software that requires infinite software support since that is how those companies make money. IT people to keep the ever aging hardware intact. Internet connections. Cloud. Let's not forget about web security. Buy the best anti virus/spam software and I can assure you there are far brighter people out there that can infect your info. Spyware. Ransomware. Etc .etc.
I like @charlestweed simple practice with no tech. So simple it cannot break down. No paying other people to service non-existent tech issues. He has no tech. I like everything about him .... We'll except for the electric cars. 😉

 

[Cold Front]

Tech is good until you realize all the costs involved to stay current. Hardware that becomes obsolete in a few years. Software that requires infinite software support since that is how those companies make money. IT people to keep the ever aging hardware intact. Internet connections. Cloud. Let's not forget about web security. Buy the best anti virus/spam software and I can assure you there are far brighter people out there that can infect your info. Spyware. Ransomware. Etc .etc.
I like @charlestweed simple practice with no tech. So simple it cannot break down. No paying other people to service non-existent tech issues. He has no tech. I like everything about him .... We'll except for the electric cars. 😉

We have to embrace change, and technology will inevitably change almost all aspects of our lives.

Computers today pretty much don’t need software upgrades and support service that previous generations models did. Do you remember when you had to go a computer store to buy a new software? Now it happens automatically without you even knowing about it. Because that would mean a significant cost for the corporations that made those technologies (more employees, more overhead, etc). Not to go off topic, but the video game chain Game Stop announced couple of weeks ago that they will close all their stores nationwide and let go their 40,000+ employees due to customers now buying and downloading videos games from the internet. The days where a kid would go to a video game store to buy a video game is officially behind us.

The dental world is lagging the technology world about a decade - because the investment in dental technology hasn’t been significant as the real world technology. I bought and still have my office computers and practice management software (Softdent) about 10 years ago, and since then - faster computers and more stable processors came out, even Softdent released 4-5 new versions of the practice management software. I can only recall half a dozen times over 10 years where I had to call Softdent for service support or my local computer guy to look into a glitch in my office computers. That would be unheard of 10-15 years ago.

Like I said, dental technology is lagging. Not only that, dentists over 55 are highly reluctant to spend on new technology for their offices because of cost (I wouldn’t) and the idea of not wanting to do major upgrades in their office during the last decade of their career. I would say that is a big factor of the lag, because corporations who develop new technologies for dental offices understand that less than half of dentists (40-55 yrs old) would consider buying their products.

Amazon released headphones with Amazon Echo yesterday. Soon, a dentist can order all their dental supplies by talking to his/her headphone while at the gym or driving on their home. How many hours of a dental assistants or sitting in front of a computer to place orders will be saved?

 

[2TH MVR]

I had a new patient come in for a new patient exam yesterday. She is from India. Chief complaint? She was treated with Invisalign in India and was not happy. Middle aged women. Treated with 4 bicuspid extractions. A majority of the extraction spaces remained. No attachments. No elastics. SEVERE class 2 malocclusion with 10mm of OJ. Pt told me she had many trays and that her tx was not progressing. I repeat. No attachments were placed and no elastics. It will take me 18-24 months of conventional braces to complete space closure with parallel roots, proper anterior torque, reduce the 10mm of OJ with elastics and pay attention to anchorage requirements to make sure we retract upper anterior segment posteriorly and protract lower molars forward to obtain a class 1 occlusion and obtain an ideal OJ/OB. I'm dumbfounded. Extraction ortho cases are hard enough with braces, but aligners with no attachments, no elastics.

 

[charlestweed]

Technology is expensive initially, but with time and demand, it always leads to efficiency and lower cost. A lot of dental labs are utilizing 3D printing technology, from doing denture wax ups to ortho appliances - just think about how much human time will be saved in the thousands of dental labs that will get their hands on 3D printers in the near future.

Technology that helps reduce cost and increases efficiency is a good thing if the office has an unlimited supply of patients, if the office is fully booked every day, 7 days/week, and if all the staff members are at their maximum capacity. The problem is the supply of patients is limited due to all the things that you mentioned before (low birthrate, oversaturation due to openings of new dental schools and ortho programs, fewer PPO plans, more HMO plans, bad economy etc). The supply of patients is limited even further when the office doesn’t want to see medicaid and “Walmart” type of patients. Here in CA, many dental/ortho offices are struggling to fill their appointment books. I don’t understand why many new grad orthodontists (and some veteran orthodontists as well), who already have a lot of student loan debts, took out more loans to buy expensive high tech equipment for their new offices, and let these machines to do the all the work while their staff are sitting around doing nothing. Why? Why? Why? Why spend $500-600k to build a new office with all the high tech gadgets inside it but don’t have any marketing strategy to bring in the new patients to fill all the chairs? What’s the point of having all the high tech gadgets but have no patient to treat? Why pay for an automated text messaging service when the front desk person has plenty of time to pick up the phone to call the patients to remind them their appointments? I think it’s better to spend as little as possible for a new startup office. As the office grows and the doctor feels his office is near its maximum capacity in handling the current patient volume, he can start investing his money on the new technology to help reduce the workload for his staff so they can perform other important tasks to improve the clinic flow….so he won’t need to hire an associate dentist or an additional assistant.

So far I haven’t yet found any new invention in ortho that helps reduce cost and increase clinical efficiency. I haven’t yet seen any new technology that allows orthodontists to see more patients in a day now than what they could in the past. All I hear are constant complaints from my colleagues on the Orthotown forum about their equipment, that they purchased not too long ago, keep giving them problems, about the amount of time the staff has wasted in learning how to operate these new toys, and how frustrated they are in dealing with the tech companies’ poor customer services. Many of them have also complained about the high cost of operation that keeps rising every year. It’s the reverse for me….brackets and wires are getting much cheaper now than when I set up my first office in 2006. The last big purchase that I made was $17k for the 4 new ortho chairs + side units for one of my offices ….and that was in 2012. I haven’t bought anything new since that time. "If it ain't broke, don't fix it."

Dental labs are facing fierce competition as well. They don’t have unlimited supply of lab cases either. They have lost a lot of cases from orthodontists (like myself), who make their own ortho appliances in-house. Only the busy labs have the money to invest in 3D printing technology. Many smaller lab owners are struggling to get cases from the local dentists. Some of these struggling owners have do the lab work by themselves (because there are not enough cases to hire workers to help) and still use traditional lab techniques and low tech equipment to save money.

They will not teach dental wax up and setting occlusions for dentures in dental schools in few years - it would serve no value when computers are doing that in the real world. There will come a point your P/T assistants will be trained to use the 3D technology to save time and cost, after all - in the future, the cost of technology will go down and employees will ask for a pay raise every year!

That would be sad if dental schools stop teaching their students how to do these lab procedures, which help a lot in dental knowledge and manual dexterity. For me, they were not a waste of time at all. It’s sad to see some new grad dentists, who don’t know how to design the RPD framework and spend a long time to make a temporary crown. I am glad my ortho program director made me make all the ortho appliances. I learned how to bend wires faster. With the lab knowledge, I trained one of my F/T assistants to make ortho appliances in-house so he has something to do and not sitting around on the days that I work for the corp offices. I’ve saved at least $2-3k every month for not having to use an outside lab (except for the Hawley retainers, which I still use for 10% of my patients).

 

[Cold Front]

That would be sad if dental schools stop teaching their students how to do these lab procedures, which help a lot in dental knowledge and manual dexterity.

You and I were taught to develop radiograph films by hand and in dark rooms - do you think it’s sad if dental schools switched to digital xrays and stopped teaching dental students on how xrays films are developed?

What about schools buying Cerec machines for their pre-doc students? Is that bad idea for students to learn crown and bridge?

There are many examples that schools are adopting new technology, mainly to save cost and prepare students for the real world. I will be not be surprised if Aligners and 3D printing eventually make their way to dental school curriculums. I was trained to do Invisalign in dental school. Schools and corporations work together to change the industry... and that leads to more technology and less traditional requirements for students, and that’s sad!

 

[charlestweed]

You and I were taught to develop radiograph films by hand and in dark rooms - do you think it’s sad if dental schools switched to digital xrays and stopped teaching dental students on how xrays films are developed?

What about schools buying Cerec machines for their pre-doc students? Is that bad idea for students to learn crown and bridge?

No, I don't think dental schools should spoil their students with the modern equipment like the Cerec, intraoral scanner, 3D printer etc. The students need to learn to do everything the hard way. The harder the curriculum is, the more they'll learn. There is no reason for any new grad dentist to spend ridiculous amount of money on these expensive equipment when starting a brand new office with no patient.

Some offices, that hire associate dentists, still use film xrays. When a new grad gets a job at one of these low tech offices, he/she shouldn't have any problem. With lower overhead, the owners of these low tech offices can afford to pay their associate dentists higher salary. My wife's boss, who runs a million dollar practice with in-house OS, perio, endo, ortho, and pedo, switched to digital pan/ceph just last month and he's going to donate to me his old film developer. If my film xray units stop working in the future, I will have to either buy the used ones or switch to digital ones because companies don't make film units anymore. Some of my colleagues already had to replace their digital units only after a few years of usage. My 13+ year-old film unit has not had any service and continues to work like a tank.

Schools should teach the students to learn to do the jobs of the assistants and lab technicians ie taking x rays, taking alginate impressions, pouring impressions, pindexing, waxing up crowns, setting denture teeth and flasking them etc. When I waxed my own crowns/brigdes, I was able to see my own mistakes.....my crown preps had irregular margins and didn't have enough occlusal clearance, the 2 abuttment teeth that I preped for a bridge didn't have the same line of draw etc. When the students are taught to do things the hard/traditional ways, it shouldn't be too complicated for them to switch to working with modern equipment. When a person can drive a stick shift transmission, he shouldn't have any problem switching to driving an automatic.

There are many examples that schools are adopting new technology, mainly to save cost and prepare students for the real world. I will be not be surprised if Aligners and 3D printing eventually make their way to dental school curriculums. I was trained to do Invisalign in dental school. Schools and corporations work together to change the industry... and that leads to more technology and less traditional requirements for students, and that’s sad!

It is indeed sad. The sale reps, who work for these tech companies, are really good at brainwashing the dental students. A new office doesn't have to cost $400-500k to set up.