We live in a very interesting time. The advent of SmileDirectClub has changed the game forever, but this is just the beginning and there will be a resulting chain reaction that is perpetuated for years to come. For example, by originally using Clear Correct for some of their aligner production and then moving on to work with Invisalign, SmileDirectClub has created a source of aligners and technology for others who want to imitate SmileDirectClub. Clear Correct certainly won’t sit on their hands! There are rumors that 3M will release a clear aligner product at the 2017 AAO Annual Session. There were rumors that Ormco would release one at the Annual Session as well – but I have it on good authority that Ormco will not… yet. A SmileDirectClub imitator, Orthly, has recently come on the market and I’m sure it is just the first of many, many startups trying to capture the market that SmileDirectClub’s success has unveiled. There is also an orthodontist created/owned company with hopes of playing at a high level in this space called Simply Fast Smiles. Even the “old man” of clear aligners, Invisalign, is changing things up massively by taking a substantial stake in SmileDirectClub, changing the way they do the Doctor Locator and offering special partnering opportunities and increased rebates for ultra-users of their product. Exciting times to say the least! So, who will win this battle to dominate the clear aligner marketplace?

Everyone. Wins. (or at least everyone has the opportunity to win)

  1. Customers/consumers/patients will win because orthodontic care – at least some version of straightening if not comprehensive care (yet) – will become available to the masses, most of whom are locked out of orthodontic treatment by the traditional model.
  2. Companies producing aligners will win because there is a demand that needs to be filled and that is good for their business. There is plenty of business for everyone. A rising tide raises all ships – and the amount of the market reaped by each company will probably be directly proportionate to their current brand recognition. In this way the rich (Invisalign and SmileDirectClub) will get richer but the other, lesser known brands will do just fine as well. Oh, and competition is a good thing!
  3. Orthodontists who understand what is going on, what patients want, how to give it to them and how to reduce overhead and increase volume to harness the lower price point will win massively. Orthodontists who understand how to Modulate Service to Fit Price will find this exciting time very fulfilling and extremely rewarding.

So who has the potential to lose?

  • Orthodontists who don’t understand what is going on or who insist that “you can’t do that” because anything outside of their experience is bad. Unfortunately this is a very large percentage of our peers since Orthodontists Are Like Taxi Drivers for the most part and they are Mad at Invisalign for taking a stake in SmileDirectClub and for the other, recent changes.
  • Orthodontists who think that they can compete with SmileDirectClub while still providing what they consider “quality orthodontics”. I’ve had many, many orthodontists say that they think we should compete with SmileDirectClub by doing “better work” and doing attachments and IPR because “that is what patients want”. Nothing could be further from the truth from where I’m sitting. This is confirmation bias in action and it’s dangerous.
  • Orthodontists who are more interested in control or “doing things the right way” than in success. Things like white labeling Invisalign aligners to sell under a new brand will be problematic because one is paying full fare for the Invisalign brand and doubling up costs by trying to create a new brand. Or companies who think that they will win by touting “quality” orthodontists, “quality” treatment or “quality” outcomes to the consumers who are interested in SmileDirectClub. I’m not saying that providers or companies shouldn’t do their best for each and every patient/consumer, I’m saying that upping the ante on customer expectations in this realm, with this demographic, with this delivery system is a very bad move. I’d be willing to bet that I’ve done as much or more doctor directed, remote orthodontic treatment as anyone on the planet so I am not speculating here. I’m speaking from experience.
  • Orthodontists who don’t understand that competition and lowering prices in orthodontics is a good thing for 99.9999999 percent of the population and those who refuse to up their production to make up for the loss of revenue/profit on any given case.
  • Orthodontists who forget that some fishing lures are made to catch fish and others are made to catch fishermen… Just because a product or a business model is attractive to orthodontists doesn’t mean it will be attractive to patients/customers.

So what does all this mean? What will the marketplace look like in 2, 5 or 10 years?

Who knows? Bill Gates famously said that,

“We always overestimate the change that will occur in the next two years and underestimate the change that will occur in the next ten. Don’t let yourself be lulled into inaction.”

I suspect that the market will be flooded by a litany of new aligner brands, all backed by big bucks and all screaming for the attention of this massive, newly discovered client/patient pool. The overall impact will be a fantastic explosion in access to care and desire creation on the consumer end. In the short term (and probably in the long term as well) the two best-known clear aligner names (Invisalign and SmileDirectClub) will dominate because of their head start, brand awareness, logistics, capacity and finances, but there will be plenty of business for the others as well.

In traditional offices, we will see a significant decrease in the fees for traditional orthodontic treatment – especially in the more metropolitan areas at first – and this is a good thing despite what we orthodontists think about it. We orthodontists want lower pricing in all other areas of the American economy but we want the prices we charge for what we are selling to remain artificially high? This is totally illogical but all orthodontists agree that this is how it should be – however, democracy has no dominion over truth! It’s time to wake up and realize that things are changing. Also, please realize that it could be much worse! There is such a massive, untapped pool of customers/patients out there who want orthodontics that we can easily make up for price/profit reduction on any given case by increasing our workload. What if that weren’t the case?

What’s that? You don’t like the idea of having to work for your money? Well then, my orthodontic brothers and sisters, you have a long road ahead of you…


4 thoughts on “The Future of Clear Aligners

  1. Ben, you are always provocative, sometimes ornery and a self proclaimed contrarian who likes a good and honest debate. I’m posting on top of your article to express to the readers of this essay that there is nothing provocative, ornery, or contrarian in the content in my opinion; in fact – I wish I would have thought to write it myself as I think it concisely summarizes what’s happening with the aligner market. Read it twice or maybe go old school and print it out to refer to down the road – I think it’s spot on.

  2. Thanks Chris. It means a great deal to have someone of your stature and knowledge say so.

  3. I don’t feel threatened by “take home” options since I am fortunate enough to cater to a sector that values the theoretical expert supervision and can pay for it. I also admit that a high percentage of adult invisalign, once you learn the basics of clincheck design and how to monitor/finish, is really not that hard. I’m also surprised by some of the SDC results I saw on Facebook. What disturbs me though is that Invisalign naturally wants their cake and to eat it too. Looking at the SDC Page, I think there is validity to the cynicism that there will be many cases that don’t qualify or that the pie chart Align keeps showing is close to accurate (1% overlap in…something…). Align has made many of us tons of $ and incomparably raised awareness to our profession. Had they proclaimed this, modestly, and said that now they have to do what is right for them, and own that statement and ask for continued loyalty, I would have more respect. Nevertheless, I remain loyal and I’m blowing away my previous YTD cases starts.

  4. Thanks for your comment. You bring up several interesting points I’d like to address.
    1) You obviously feel you’re the top of the profession and your patients recognize your value no matter what. I don’t know about your pracrice but I do know orthodontists who command fees in excess of 15k a case and serve what they consider “price insensitive” clientele. Perhaps you are truly a member of this most elite group of orthodontic practitioners (I don’t know) but I’ll also tell you that almost every orthodontist believes that they are the top of the top and the odds don’t favor that – it’s 99:1 against!!
    2) Dillard’s, Macy’s and other outlets believed, as you do, that their customers valued them over cut rate, half-ass suppliers like Amazon. They were wrong.
    3) Orthodontists love to point at what they consider examples of “bad treatment” and the “scores of unhappy SDC patients” they discover on Facebook. They hold this up as proof that they are right and SDC is bad… however orthodontists forget that SDC has treated almost 50,000 patients now and has very, very few detractors. As a percentage I can tell you that the average orthodontic practice has many times the number of complaints and bad reviews and lawsuits per 100 patients treated than SDC. What orthodontists don’t seem to grasp still is that Better is Better and access to some form of orthodontic care is better than none. I’m not sure you and others ever will get that. You need to understand that this is not an emotional issue. This is just a matter of SDC filling a need that we orthodontists have long ignored and the fact that people are thrilled about it and flocking to SDC despite what we orthodontists believe.
    4) As to your point of expecting Align to operate in the way you think they should – I think it’s obvious that we orthodontists act in our self interest and expect others to act in our interests as well no matter how illogical that is. I do commend you for admitting that we’ve done well using Align. That’s a fresh and honest perspective!
    Finally, I’m sure that you’ll do well now and in the future as you’re obviously more aware and more progressive than the vast majority of orthodontists. Here’s to your continued success! Thanks so much for taking the time to discuss this issue.

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