Invisalign: Leave it Behind

I graduated Temple dental in 2001 with little clue how to successfully and orthodontically move a tooth. Like most clinicians, I  learned little about orthodontics in dental school. Sure I bent  some wires, took a gazillion alginates, uprighted some molars, and occasionally made an active or passive appliance. Requirements, however, were minimal and Ortho at Temple was always the ‘easy A.’ 

When Invisalign started promoting clear braces without wires and brackets and helped treatment plan with their orthodontists, I was interested. I became an Invisalign provider in 2002 after a two day course in Manhattan. A couple years later I was further certified in advanced Invisalign (Invisalign II).  All one had to do was take good PVS impressions, photos, bite registration and complete a rudimentary script. The aligners would be fabricated in bulk and switched every two weeks. The teeth would move into proper alignment predictably, without trauma, and what was the biggest selling point to adult patients…nearly invisably.

Invisalign approved nearly any case you sent. Even with unpredictable movements like extrusions, intrusions, rotations and difficult cases like open bites and cross-bites, Invisalign provided a successful clincheck. This of course was nonsense and after a few poor results, I quickly learned Invisalign’s limitations. The technology was great for minimal to moderate crowding and if one chose cases that demanded more advanced movement, the doc and patient had to be prepared for mid-course corrections, refinements, and likely fixed ortho at the case’s end for tweaking.  

I complete an average of half a dozen cases per year and get questions daily from interested patients whose main turn off is cost.  However, things have changed. In 2009 Invisalign sent out written and email communications explaining new requirements now placed on certified docs. Clinicians now need 10 active cases per year and 10 Invisalign specific CE credits. Unless these requirements are maintained, dentists no longer will maintain active account status.

I am all for continuing education but 10 active cases for a GP is ludicrous.  Orthodontists can easily meet this quota because ortho is the only discipline of dentistry practiced. However, as a GP, ortho is a small section of mine. My labs do not place requirements on how many crown and bridge or implants units I restore with them. I have paid thousands of dollars to Invisalign for their certification courses, CEs, and cases submitted for treatment. Now Invisalign wants even more.   

I say leave it behind. One of the awesome aspects of our profession is its autonomy. We are not owned by anyone. We practice dentistry with our own ethics, by our own rules, and we stand behind it alone and proud. This bravado is rare in healthcare today, and I am proud to be part of a profession that allows such gifts.

So I have turned to other avenues of ortho. Six month smiles is fixed ortho that does not change angle classification but does align the anteriors. It is also more predictable than aligner therapy. Clear Correct is a company out Houston that has found its niche among providers ousted by Invisalign. It is the same aligner therapy but cheaper and there are no requirements on clinicians. They do not, however, have all the bells and whistles of Align’s website and 3D clincheck system. I am about to start my first Clear Correct case and will blog my thoughts in the months ahead.

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