Marc Ackerman & Ben Burris

What event will totally disrupt the landscape of orthodontics more than any other we can imagine? That’s easy and we have mentioned it before:

When someone is able to directly print clinically effective clear aligners at speed and in the volume necessary to make them commercially viable the orthodontic world will shift on its axis.

In case you thought this was already a reality based on Align’s clever videos showing the aligners emerging from a vat of liquid and giving the impression they are directly printing aligners without the use of models, don’t feel bad. Many orthodontists and dentists assume Align can direct print without the need for the extra steps of printing models and all that goes with it – and that is by design from what we can tell. No, at this point in time no one we know of can print aligners without first printing models. There have been rumors over the last year or so that there are companies that are close but it turns out they are about as close as i-Cat is to making it possible to do Invisalign off of one of their scans (they have been promising that was “going to happen soon” since about the time Ben graduated in 2004). But someone will figure it out sooner or later and given the untold billions that are out there waiting to spend their money on straighter teeth, we are sure there are more than a few working on the problem (or they should be).

Anyway the point of this article is not to state the obvious but to consider the implications of this technology coming to pass and try to predict its impact on the orthodontic profession. Here are a few predictions/considerations presented as food for thought.

1. If this technology is developed by a single company and is patentable then this will be a virtual death blow to the rest of the aligner companies – no matter how dominant they are now. As we often reference the book, The Innovator’s Dilemma, we see no reason to stray from that now. The book explains what happens to dominant tech when a new tech emerges and moves up market so we won’t rehash that. In the book, everyone has access to the new technology and the dominant players still lose. Imagine what will happen if someone gets a patent on the process.
2. If this technology emerges in several places so that most aligner companies have access to it, it is still unlikely that one of the long-established players will come out on top. Again, see The Innovator’s Dilemma for explanation.
3. If either of the above scenarios happen, odds are there will be a significant cost reduction when it comes to producing aligners for several reasons:
   • Less steps to produce aligners means less machinery, less labor and more accuracy due to automation.
   • The lower cost per aligner can either go towards the company’s profit margin (or marketing) or be passed on to the customer or both. Both is the most likely in scenario 1 and lower prices for customers is more likely in scenario 2 but it depends on a lot of things of course.
   • A lower cost, more accurate, shorter turnaround time aligner created by this innovation will dominate the traditional market because us dentists love nothing more than to reduce our overhead.
   • A lower cost, more accurate, shorter turnaround time aligner created by this innovation will dominate the emerging direct to consumer aligner market for obvious reasons.
4. Lower pricing, more marketing and broader appeal of the inexpensive, accurate aligners offered by those who have this technology will drive consumer desire to unimaginable heights. This will have broad implications for both aligner consumers and those who want braces if:
   • Orthodontists/Dentists realize that the fees we charge for the easiest cases are ridiculously high and have no basis in reality other than what we have always done.
   • Most cases in the general population are easy cases – we only see the hard cases because they are the only ones willing to pay the ridiculous prices we have asked in the past.
   • The vast majority of consumers want Straighter and they want it in a short amount of time from a friendly doctor and a friendly team. The idea of keeping patients in braces for years is just plain stupid.
5. If, by chance, a DTC company is the one to develop/acquire this technology and manage to patent it, things could change in ways that we cannot predict. A few things to consider in this scenario:
   • DTC, doctor directed aligner therapy takes far fewer doctors per 10,000 patients treated than traditional practices. Like an order of magnitude fewer. This means if a DTC company becomes dominant in the aligner space there will be far less need for the traditional dentist or orthodontist. For the foreseeable future there will be a need for traditional practices to handle “difficult cases” but these cases are a small portion of the general population and given the mindset of the consumer who is after “straighter” rather than “ideal”, it’s questionable as to how much demand there will be for these services long term.
   • Those who do braces as opposed to aligners may continue to enjoy success and their business may even be bolstered by the increased consumer desire for straighter teeth assuming they understand the marketplace, pricing, customer service and consumer desires. Braces seem to be surging in popularity these days in many segments of the American populous but this can change any time as consumers are fickle.
   • If a DTC company has a 20 year jump on other aligner companies due to their patents on direct printing aligners, the consequences for traditional aligner companies and traditional orthodontics at large would be dire and too large in scope to accurately predict.
6. An increasing number of dentists/orthodontists graduating along with increasing school debt and the years it takes to become a provider may combine with the emergence of this technology to significantly alter the appeal of being a dentist.
   • We are certain that there will always be money to be made and customers to serve in dentistry but being successful in the dental space will require a wholly different mindset should this technology come to pass.
   • Dentistry will likely follow the path that medicine has but the transition will be rapid once this technology emerges. Probably the most likely model for dentists who maintain an antiquated mindset to consider will be what happened to pharmacists.
   • It will be interesting to see if dental schools will be able to continue to charge outrageous prices while not preparing dentists for running any form of business and if dental students will be able to borrow outrageous amounts of money to spend on their “education” as well as the lifestyle most dental students and ortho residents believe they are entitled to.

As with any thought experiment or attempt to predict the future this is fun to do, highly speculative and unlikely to encompass the wild ass things that will actually happen. We know all this and own it but believe this topic is important to discuss for many, many reasons. Also, please remember that it makes no sense to get mad at the meteorologist for their predictions on what’s coming…