Sorry, you're not a candidate for aligners…

If you listened to the 3rd episode of my Orthopreneurs podcast, you heard Emily, a 30 year old Uber driver/cocktail waitress talk about her reasons for seeing a GP for Invisalign and how, in retrospect, she would pay far more if he had realized what an orthodontist could have done to make the process smoother and faster. It was an AMAZING insight into what we can learn to do better in terms of marketing ourselves as specialists.
Bit did you catch what she said about her two friends?
To me, the most important part was when she said that two of her friends went to see orthodontists for Invisalign and were told they weren’t candidates, so they went to GPs who ended up treating them. Moreover, Emily said that she didn’t even realize that Orthodontists were comfortable doing Invisalign because of her friends’ experiences. She thought that most Invisalign was done by GPs because her friends were turned away by specialists but treated by GPs. We don’t know what their cases looked like beforehand,  but it sounded like they were refused treatment with anything other than traditional orthodontics. We don’t know what the outcomes looked like after the GPs were finished, but she didn’t remark that her friends were unhappy.
We live in interesting times. We see patients getting ortho done through the mail, in malls and with GPs. This is NOT the orthodontic profession of the 80’s, 90’s or even the first decade of the millennium.  As Bob Dylon wrote: “The times, they are a changing” and the question is :”Are you changing with them?” We don’t have to like the changes and akin to the digital camera movement of the 90’s, when film companies refused to believe they needed to change their model, many in our profession refuse to accept that the billions of dollars behind the clear movement is shaping what consumers want and how they expect to get it.
And, at the same time I hear many of my peers complaining that their practices are too slow and they’d love to have more patients. But…
Every single day I have at least one adult patient who comes into my office telling me that they saw another orthodontist who told them that they “aren’t a candidate” for clear aligner therapy. However,  I generally look at their case and figure out a solution with clear aligners. Sometimes it includes some appliance to help with A/P correction. Sometimes it’s understanding attachment protocols. But there’s generally a solution to give them a good outcome based on their limitations.
However, I didn’t get here overnight.
I was an Invisalign provider as a GP, starting in 2003 but stopping two years later. I was that rare GP who realized that I couldn’t do it as well as my Orthodontist and I sent every spec of ortho to them starting in 2005. When I graduated ortho residency 4 years ago, I was so firmly anti-aligner (from my previous experiences and many faculty who espoused that belief) that I tried to talk every patient who wanted plastic into brackets, and I did so very successfully. But there were some who simply didn’t want aligners and they went elsewhere.
I started taking every aligner CE course and fellowship I could get my hands on and analyzed the results of my cases so I could get much better with plastic. Little by little, that improved and as my skill got better, patients started seeking me out for aligner therapy. Now, I have a 62.9% aligner share of chair (SOC) for all new patients coming into my office. I’m not saying that’s what you should do or that it’s for everyone, but my point is that I rarely see a case that I can’t successfully treat with aligners. For me, it was about getting more comfortable with the “tool” and figuring out a financial model that worked for me. I just didn’t like talking people into something they didn’t want. They came in looking for plastic and they deserved that.
This isn’t a clinical discussion, but rather a customer service one. There are many, many peers out there who are far more experienced with plastic than I am and the point of this article isn’t to tell you HOW to treat cases. Rather, I want you to remember the story of Emily’s friends who showed up at two ortho offices to get Invisalign and were turned away. Two patients who could have become raving fans.
Two patients who didn’t realize the remarkable difference between getting teeth straightened with an orthodontic specialist who only moves teeth and a GP who does it as a small part of their practice.
Two patients who might have shown up to my (or your neighbor’s) office saying that their previous orthodontist told them that they weren’t a candidate for Invisalign.
Two patients -whom I (or your neighbor) may have started- who could have started in your office.
Just some food for thought…
All the best,
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  1. Glenn, you bring up a very important point. It takes time and effort to learn to use plastic. We have invested 2-3 years learning to correct malocclusions and straighten teeth with wires. It’s unrealistic to expect to achieve the same result with plastic without learning a new system. We have so many more tools in our tool chest than GP’s. I grew my practice, like you, by studying from colleagues who had way more experience with aligners than I did. I learned what worked and what didn’t and how to use hybrid treatment when aligners couldn’t achieve the result alone. There may be some cases that braces are the best choice, but not as many as most of us think. Like it or not, the future of orthodontics will not be braces. We have the best possible training and education to safely, effectively treat the public. We just need to make the adjustment. Disclosure: I’m the CEO of People & Practice, a digital marking company.