The Future of Ortho vs Future of Aligners

[4thgen]

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.

FYI Dental students in 2019 still learn how to take x rays, take alginate impression, pour impressions, Pindexing, final impressions, dentures, master casts, wax teeth, crowns, bridges, prep PFM crowns, all gold crowns, ceramic crowns AND prep for CAD/CAM restorations. I don't think adding an additional tool to their arsenal is a bad idea and it will allow them to work in an office with Cerec directly following graduation. If anything, using cad/cam can improve teaching dentistry because they can see their preps, margins, undercuts, occlusal reductions on the computer and measure/analyze it through the software while sending their work to faculty.

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[charlestweed]

FYI Dental students in 2019 still learn how to take x rays, take alginate impression, pour impressions, Pindexing, final impressions, dentures, master casts, wax teeth, crowns, bridges, prep PFM crowns, all gold crowns, ceramic crowns AND prep for CAD/CAM restorations. I don't think adding an additional tool to their arsenal is a bad idea and it will allow them to work in an office with Cerec directly following graduation. If anything, using cad/cam can improve teaching dentistry because they can see their preps, margins, undercuts, occlusal reductions on the computer and measure/analyze it through the software while sending their work to faculty.

That’s great your school teaches you guys all the traditional dental techniques and still has time to introduce the latest technology to the curriculum. That’s a great bonus for you guys. The point I tried to make was one can still have a very profitable dental practice and offer high quality care to the patients without all these gadgets. Low overhead is key. The smaller the operating expense, the larger your take home income will be.

Like I said before, it’s not hard to learn new stuff when you already learned how to do things the hard way at your school. If you don’t know anything about the Cerec and want to buy it, the company will send their sale reps to your office to teach you everything you need to know free of charge. Tech companies like Dentsply are desperate….they’ll do anything to persuade you to buy their products.

 

[Daurang]

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.

I built my 3-ops office with new equipments from scratch for less than $100k in the year 2000; it shouldn't cost more than $150k today. I purchased billing software on ebay for $69 (with no annual support fee) which still works today. I finally dump my 19yo xray developer only because the chemical storage licensing fee plus cost of shipping used fixer is now $1000 annually; updating to phosphate plates bring that cost down to zero. A general practice, at least mine, simply don't need all those latest expensive gadgets to function and treat patients well. It's cool to have a CEREC to show off, and then what? more expensive cost outlay and training and time and maintenance fee and breakdown and update? It's A LOT easier and cheaper to send the case out.

 

[TanMan]

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.


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.

Digital sensors don't need to be expensive. Either find one that has good warranty or buy used. The ROI on used digital sensors is huge for a GP. We are taking BW's, PA's, and pano's all day long. That's at least 40USD per patient per periodic exam (and a lot more for comprehensive exam - FMX + pano) just in xrays.. Worst case scenario @ 40USD, if you're seeing 40 exams per day, that's 1600 already in radiographs alone, with panos and FMX's, it's way more than 40USD. With digital xrays, it's superfast, superquick turnaround. With film... you'll be there all day.

I built my 3-ops office with new equipments from scratch for less than $100k in the year 2000; it shouldn't cost more than $150k today. I purchased billing software on ebay for $69 (with no annual support fee) which still works today. I finally dump my 19yo xray developer only because the chemical storage licensing fee plus cost of shipping used fixer is now $1000 annually; updating to phosphate plates bring that cost down to zero. A general practice, at least mine, simply don't need all those latest expensive gadgets to function and treat patients well. It's cool to have a CEREC to show off, and then what? more expensive cost outlay and training and time and maintenance fee and breakdown and update? It's A LOT easier and cheaper to send the case out.

A CEREC isn't just for showing off, if a dentist buys it to show off, that's a really bad reason to purchase one. A CEREC is a great tool for higher volume offices, since it gets rid of the second cementation visit, you can literally prep all day long and pop back in to cement the final crown. I don't see it as a savings in material costs, but in time. In a busy workflow, prep for a few minutes, come back to a final crown, while you're waiting, you are doing other things such as exams/other procedures (crowns, rct's, fills, etc...) and it's a profitable gap filler. I'll admit, it's not for every office, but if a dentist were looking for a CEREC, I'd recommend getting a used omnicam. They are very cheap right now, relative to a brand new unit.

 

[2TH MVR]

The office tech essentially should mirror the type of patients you will attract and treat. @charlestweed practice philosophy is straightforward and direct. He treats low income patients with extremely low fees. He does not need expensive tech nor would his patients expect that tech. His patients come to his office to obtain good treatment at a very low fee. That's his niche and it works extremely well for his location. His approach may not work as well in a tech savvy, San Jose, Silicon valley, San Francisco, Beverly Hills, N. Scottsdale, etc. etc. area. Charlestweed is very direct with his opinions on low tech, inexpensive, low overhead practices because quite frankly .... with low fees .... that's the only way it could work financially.

Now personally .... I could not live without a digital xray machine and a simple computer network, but that's me. In practices that are less than low fee and more referral driven ... the exchange of digital records, communication with GPs is more important. But lets be real. The more tech in your office .... the more headaches you will have. That's irrefutable. If someone asked me what was the most irritating part of running a practice .... without hesitation ... I would mention the upkeep on tech. Trust me. I have some extreme examples. i.e. I had two locations with 2 servors linked with an internet connection. Someone hacked one of my servors and turned it into a ZOMBIE servor. i.e they used my servor to send out malicious spam without me knowing about it. I only found out when my internet provider (Qwest???) told me to fix it or they would shut my connection down. I had to have my IT guys back up the info, erase the hard drive and start over. All of this while trying to run a practice. What do you do when your tech is down and your practice relies on tech. Appts. Accts receivable. Ins billings. Etc. ETc. ETc. Major headache. Yes ..... this was before cloud based software was available.

I also agree that a new grad does not need all the fancy, EXPENSIVE tech until his/her practice has achieved a financial position that the tech will have a positive ROI.

 

[charlestweed]

A general practice, at least mine, simply don't need all those latest expensive gadgets to function and treat patients well. It's cool to have a CEREC to show off, and then what? more expensive cost outlay and training and time and maintenance fee and breakdown and update? It's A LOT easier and cheaper to send the case out.

It's the same for ortho. A set of 20 50-cent brackets, a couple of 5-cent wires, a pano film, a ceph film, and my brain are pretty much all I neeed to create a beautiful smile for every patient of mine. The total material cost for a full 2-year ortho case is easily under $50.

I don't think the predent and dental students will listen to us. They probably think what we are doing right now are obsolete stuff.....just like how we used to think about the way the dentists, who were 20+ years older than us, practiced dentistry. Most young orthodontist on the orthotown forum said they spent at least $4-500k to build their new offices. This means that for the next 10 years, they have to set aside at least $5k every month to pay back such ridiculous amount of business loans. No wonder why they keep saying it's not worth pursuing ortho anymore. Technology is the main culprit for driving up the cost of running an ortho office.

 

[charlestweed]

Digital sensors don't need to be expensive. Either find one that has good warranty or buy used. The ROI on used digital sensors is huge for a GP. We are taking BW's, PA's, and pano's all day long. That's at least 40USD per patient per periodic exam (and a lot more for comprehensive exam - FMX + pano) just in xrays.. Worst case scenario @ 40USD, if you're seeing 40 exams per day, that's 1600 already in radiographs alone, with panos and FMX's, it's way more than 40USD. With digital xrays, it's superfast, superquick turnaround. With film... you'll be there all day.

You are right. Most dentists use digital x rays (except for the doc, whom I rent an office space from) because the digital sensors are getting cheaper. But I don't think the PA films cost $40 for each patient....it's more like $6-7 for a FMX series. I don't use PA films. I only use pano and ceph xray films for ortho and they are much cheaper...only 50 cents each. The time it takes to develop the films is never an issue for me. I usually laughed when the sale reps used this reason to convince to buy their digital x ray units. I don't just sit there and wait for the films to be developed. I treat my other patients (I have 7 chairs) while the films being developed.

Cost is not the only reason why I stick to film xrays. Durability and reliability are another reason....zero repair, zero maintenance in 13+ years of ownership. And the third reason is film xrays work well with paper chart system. One thing I hate about working at the corp office, which has paper chart but uses digital x rays, is it takes forever for their computers to load the xray images. When their computer system was down, the xrays could not be taken and the corp office had to reschedule the start patients.....and I lost my $75 bonus for each start patient.

 

[TanMan]

You are right. Most dentists use digital x rays (except for the doc, whom I rent an office space from) because the digital sensors are getting cheaper. But I don't think the PA films cost $40 for each patient....it's more like $6-7 for a FMX series. I don't use PA films. I only use pano and ceph xray films for ortho and they are much cheaper...only 50 cents each. The time it takes to develop the films is never an issue for me. I usually laughed when the sale reps used this reason to convince to buy their digital x ray units. I don't just sit there and wait for the films to be developed. I treat my other patients (I have 7 chairs) while the films being developed.

Cost is not the only reason why I stick to film xrays. Durability and reliability are another reason....zero repair, zero maintenance in 13+ years of ownership. And the third reason is film xrays work well with paper chart system. One thing I hate about working at the corp office, which has paper chart but uses digital x rays, is it takes forever for their computers to load the xray images. When their computer system was down, the xrays could not be taken and the corp office had to reschedule the start patients.....and I lost my $75 bonus for each start patient.

I'm talking about insurance reimbursement of 40-100+ per FMX.

 

[2TH MVR]

Charlestweed's overhead is probably 5-10%. He's laughing all the way to the bank. Good for him.

 

[charlestweed]

I'm talking about insurance reimbursement of 40-100+ per FMX.

I forgot that general dentists can bill the insurances for xrays. I can’t do that because if I do, the GPs would be very mad at me for taking away a portion of the xray fee that they can collect from the patients’ insurances….and I’d lose the referrals.

 

[charlestweed]

Charlestweed's overhead is probably 5-10%. He's laughing all the way to the bank. Good for him.

My overall overhead is around 35-37%. More than 40% of this 35-37% overhead amount are for the staff salaries. Office rents are about 30% of this overhead amount. Ortho supplies are not much….probably less than 5%. And the rest are for things like property insurance, property taxes, worker comp, business licenses, malpractice insurance, utility bills etc.

 

[Cold Front]

To get back to the topic...

Smiles Direct Club stock fell 45% since their IPO 2 weeks ago. I think that’s due to investors getting spooked by other IPO’s that are over promising their services and products.

The U.S. orthodontics market alone represents an opportunity of more than $230 billion annually. By comparison, Align's total revenue in 2018 was less than $2 billion while SmileDirectClub's revenue last year was less than $400 million. So it’s safe to say that these align companies are where DSO’s were 15-20 years ago in the dental office market space. However, the pace SDC is growing could mean they could eventually have 5-10% of the ortho market if they keep hitting their targets in about 5 years - just by themselves. They are still unknown to those who are shopping for ortho services.

 

[charlestweed]

is ur os still win xp

Yes and it's because the ortho photo software, that I purchased in 2006, is only compatible with windows xp. I can easily replace it with a newer photo software for only $500 + another $1000 for a windows 10 laptop but why? If it ain't broke don't fix it.

There is no internet in my office because my staff do everything manually... $10 appointment book, paper insurance billings, paper charts etc. Why do I need to pay for the managment software (and all the maintenance headaches) when I only have 100-300 active patients in each office (800 active patients total for all 4 offices)? What's so hard about managing such low number of active patients? General dentists probably need the management software more than us, orthodontists, because their patients come back every 6-months for periodic exams. For ortho, when the patients are done with their treatments, I put their charts in separate file cabinets.

I have unlimited data plan on my phone and I use it as a mobile hotspot for my personal laptop... it's for personal use. All my PCs at home have windows 10 OS.

 

[CGtoDentistry]

Yes and it's because the ortho photo software, that I purchased in 2006, is only compatible with windows xp. I can easily replace it with a newer photo software for only $500 + another $1000 for a windows 10 laptop but why? If it ain't broke don't fix it.

There is no internet in my office because my staff do everything manually... $10 appointment book, paper insurance billings, paper charts etc. Why do I need to pay for the managment software (and all the maintenance headaches) when I only have 100-300 active patients in each office (800 active patients total for all 4 offices)? What's so hard about managing such low number of active patients? General dentists probably need the management software more than us, orthodontists, because their patients come back every 6-months for periodic exams. For ortho, when the patients are done with their treatments, I put their charts in separate file cabinets.

I have unlimited data plan on my phone and I use it as a mobile hotspot for my personal laptop... it's for personal use. All my PCs at home have windows 10 OS.

That's good that there's no internet in your office if you're using a windows xp machine. Currently work in cybersecurity and that's something easy to take over if it's not blocked/protected as a previous poster mentioned.

Unfortunately, lots of hackers tend to see small dental and medical clinics as easy prey due to dentists and physicians being not as technically savvy

 

[charlestweed]

Wow ur cheap. That’s a compliment btw

It's not that I am too cheap to spend $1000-1500 on the new photo software and new computer. I already have a very efficient system in place and I don't want to disrupt this smooth workflow that I currently enjoy by making my staff learn new things. If things has worked well and my assistants are very efficient at performing the same repetitive tasks every day, why make changes? Why waste money on new technology to make an already efficient system more efficient? And new technology doesn't necessarily make things better and more efficient.

Another reason to keep everything low tech is I want to have things for my 3 F/T staff to do during the non-patient days...the days that I work for the corp offices. These are my 3 very good loyal reliable employees and to make them happy, I have to give them F/T work hours. Two of them assist my wife 4 days/month at her office.

 

[charlestweed]

Another reason to keep everything low tech is I want to have things for my 3 F/T staff to do during the non-patient days...the days that I work for the corp offices. These are my 3 very good loyal reliable employees and to make them happy, I have to give them F/T work hours. Two of them assist my wife 4 days/month at her office.

One of these 3 F/T employees has just given me his notice today and his last day of employment will be this coming Saturday. He recently passed the commercial driver license test and will work as a truck driver. He’s the reason I stopped sending cases to the lab and started making all the ortho appliances in-house. He already had the ortho chairside assisting experience when I hired him. I trained him how to make all the ortho appliances so he could make them during the non-patient days. I was very surprised about this short notice but the same time I am happy for him. I thanked him, we shook hands, and I told him that I would add 8 more hours to his last paycheck....a small going away gift from me. I am not going to find another person to replace him because a couple of my P/T employees have asked me to give them more work days. For the next few days/months, instead of coming to work at 2pm, I’ll have to come in 1-2 hours early to make the ortho appliances myself. I plan to give each of the 2 F/T employees a raise of $1 more an hour and ask them to do more work in the office.

 

[CGtoDentistry]

One of these 3 F/T employees has just given me his notice today and his last day of employment will be this coming Saturday. He recently passed the commercial driver license test and will work as a truck driver. He’s the reason I stopped sending cases to the lab and started making all the ortho appliances in-house. He already had the ortho chairside assisting experience when I hired him. I trained him how to make all the ortho appliances so he could make them during the non-patient days. I was very surprised about this short notice but the same time I am happy for him. I thanked him, we shook hands, and I told him that I would add 8 more hours to his last paycheck....a small going away gift from me. I am not going to find another person to replace him because a couple of my P/T employees have asked me to give them more work days. For the next few days/months, instead of coming to work at 2pm, I’ll have to come in 1-2 hours early to make the ortho appliances myself. I plan to give each of the 2 F/T employees a raise of $1 more an hour and ask them to do more work in the office.

This is fantastic. Really shows your care for your team and fantastic leadership skills, something that I think is oftentimes missing in todays working world. I'm way younger than you, but this is how I'd want to run my own dental practice if I end up getting into dental school within a few years. I think there's a way of treating team members that I've seen lacking in the military.

Very generous of you, and that only increases employee loyalty. It's not all just about the bottom line right?

 

[Cold Front]

2018: CVS carries and offers Smiles Direct Club ortho aligners.

2019: Walmart opens dental offices.

2020: Walmart will carry and offer Smiles Direct Club ortho Aligners.

SmileDirectClub signs exclusive deal to sell dental care at Walmart

SmileDirectClub was one of the worst-performing IPOs of 2019. But the stock surged Monday after the company announced an exclusive deal with Walmart.

www.cnn.com

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[2TH MVR]

2018: CVS carries and offers Smiles Direct Club ortho aligners.

2019: Walmart opens dental offices.

2020: Walmart will carry and offer Smiles Direct Club ortho Aligners.

2021: @2TH MVR becomes greeter at Walmart.

 

[Cold Front]

2021: @2TH MVR becomes greeter at Walmart.

View attachment 291944

2023: You get promoted to an orthodontist in the Aligners aisle.


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[2TH MVR]

I knew it was coming. The Corp I work for has been working on it's own proprietary ortho aligners. Training starts this month. Aligners will only be offered to patients 18 and older and those with very minimal malocclusions. Not a huge skill set to treat patients with aligners. Right? Probably will make my life that much easier. I guess I'll need to modify my personal standards on what is an acceptable post aligner occlusion.

 

[Cold Front]

I knew it was coming. The Corp I work for has been working on it's own proprietary ortho aligners. Training starts this month. Aligners will only be offered to patients 18 and older and those with very minimal malocclusions. Not a huge skill set to treat patients with aligners. Right? Probably will make my life that much easier. I guess I'll need to modify my personal standards on what is an acceptable post aligner occlusion.

That’s interesting - you/your employer finally joined the bandwagon. Will your office 3D print the Aligners in-house? This move will probably increase the profit margins for the company - not sure if some of those profits get passed down to the doctors who are actually diagnosing the cases?

My state Medicaid started paying $300 for occlusal guards once a year, with no-restrictions/prior authorizations. I see about 5-10 people who have some form of bruxism a day, so I’m considering making the occlusal guards in-house - and looking into a 3D printer that would allow me to bypass the labs. The assistants would do all the work, and all I would have to do is the diagnosis/exams.


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[2TH MVR]

That’s interesting - you/your employer finally joined the bandwagon. Will your office 3D print the Aligners in-house?

Tapatalk

We've always had the option of Invisalign. But the down payment was a roadblock for most low income patients. Think about this. The cost of aligners adds to the cost of the service. Braces are inexpensive. The profit with aligners is less than conventional braces. No 3D printer. I do not have all the details yet. 18 and older. Just for minimal stuff. The way it was intended originally.

 

[Cold Front]

We've always had the option of Invisalign. But the down payment was a roadblock for most low income patients. Think about this. The cost of aligners adds to the cost of the service. Braces are inexpensive. The profit with aligners is less than conventional braces. No 3D printer. I do not have all the details yet. 18 and older. Just for minimal stuff. The way it was intended originally.

SDC announced yesterday that they will go toe-to-toe with Invisalign and offer all their services to dentists and orthodontists. Invisalign stocks dropped 5-10% immediately.

SmileDirectClub to compete with Invisalign by selling aligners to dentists, orthodontists

SmileDirectClub announced Tuesday that it will compete directly with rival Align Technology's Invisalign as the nation's clear-aligner boom continues.

www.usatoday.com

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[SoftGel]

Eli5, so what does this mean to a predent?

 

[Cold Front]

Eli5, so what does this mean to a predent?

This effects dentists and orthodontists in practice now, pre-dents are still a long way from worrying about any of this.


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[SoftGel]

Walked into that one

 

[2TH MVR]

SDC announced yesterday that they will go toe-to-toe with Invisalign and offer all their services to dentists and orthodontists. Invisalign stocks dropped 5-10% immediately.

SmileDirectClub to compete with Invisalign by selling aligners to dentists, orthodontists

SmileDirectClub announced Tuesday that it will compete directly with rival Align Technology's Invisalign as the nation's clear-aligner boom continues.

www.usatoday.com

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Not surprising. Align Tech reminds me of General Electric company. A big, dinosaur that had its way in the 90's, but will struggle going forward.

 

[ElCubanito]

As a GP I only refer cases that I cant finish in 1 Yr. While I don't do aligner therapy because of the ridiculous lab costs I have seen a reduced number of cases in the past years due to aligners. You cant fight the current climate, patients want dentistry done quick, cheap and easy, like an App download. Is it bad for patients and dentistry; yes, but its heading that way anyways. The future of Orthodontics will be concentrated doing really difficult cases, TRAVELING, and MEDICARE. Nothing anyone could do but adapt to the coming change.

 

[ElCubanito]

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.


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.

I did my first start up for 80K construction/including used equipment. 400K What you put inside that? Lamborguini Dental Chairs? LOL