You think that braces are the future? Everyone's laughing.

If you’re a regular reader of my blog, then you know how much I stress the importance of clinicians understanding that while the clinical outcome is important (and is what lets us sleep at night), the public generally could care less. Nonetheless, every single day I see orthodontists trying to convince peers (and themselves) that if we just do a great job, and educate the public (about what, I’m not sure) that everything will be OK. We’re orthodontists, they say, and braces are a better alternative. If the public could only understand the difference between braces and Invisalign….
Enter Joe Hogan, stage left…
CNBC bills their show, Squawk Box, as “the ultimate ‘pre-market’ morning news and talk program, where the biggest names in business and politics tell their most important stories.” In short, the biggest business influencers go there to discuss the biggest news stories. On June 1st, Joe Hogan, Invisalign’s CEO, was asked to discuss Invisalign, its future and its impact on the global orthodontic community. If you’re an orthodontist who’s hanging on to the idea that braces are still the future, please listen to the exchanges on that show. (The link is at the bottom of the page and you should watch it after reading this post.)
“We see this as an analog to digital movement” Hogan explained to the hosts. “It replaces an old analog system where metal is glued to your teeth.”
Ok, so you’re not convinced yet. I get it. You were taught metal, you like metal and you think that it still gives the finest clinical outcome. Listen on…
Andrew Ross Sorkin, one of the hosts and a very typical example of your potential patients said: “It’s effectively opened up the kind of people who are selling the system. It used to be just an orthodontist would give you Invisalign and now dentists do it and I believe others will do it too.” Hogan agreed and explained that even Smile Direct Club can do it and he explained how Invisalign has a 17% share in SDC.
Then Sorkin asked the biggie:”Does this take over the traditional orthodontistry [sic] business?”Without hesitating and mid way through Sorkin’s sentence, Hogan said “Absolutely. It’s just a matter of time.”
Invisalign, love it or hate it, is growing by over 20%/year in the US, it’s posting 100% growth/year in China, 50%/year in Spain, and 40% in other areas around the world, yet Hogan explained that it still has only a 10% penetration rate in the US and less overseas. Hogan even acknowledged that Unitek and Ormco are developing their own systems and are expected to be big players which should only “legitimize the space” and help it grow even further.
We can agree to disagree that the future is plastic. But remember, those who know it well will tell you that Invisalign doesn’t change the way teeth move, but is simply a different way to move them. The same concepts of tooth movement still apply and the outcome relies on the know how of the clinician. I’ve seen clinicians get exceptional results in difficult cases using Invisalign. It’s not the method, but rather the clinician overseeing the outcome that makes the difference. Obsess on the clinical outcome and you can get it with Invisalign, and that’s what distinguishes us from general dentists and SDC. Our expertise allows plastic to be another tool in our toolbox.
Sure there are limitations for certain cases, but if there are truly 3,000,000 orthodontic case starts/year in the US and Invisalign accounts for less than 10%, I see that as a HUGE opportunity for orthodontists to accept it and be a part of a movement that certainly isn’t new, but is growing.
So, you can push your chest out and explain proudly to the world that you’re an orthodontist and shun plastic and Invisalign (and other aligner companies and options) and continue only doing brackets and you have every right to do that. However, don’t sit there and try to convince me, yourself and others that if you just educate the public about how braces give a better outcome they’ll all flock to you and shun plastic. Not only do I believe that statement to be misleading, but the market share numbers for plastic aligner starts per year would also disagree. The public wants plastic and they’re not going to put up with you if you push braces on them.
If you’re not knowledgable on how to get remarkable outcomes using plastic and genuinely believe that you can get a better result with brackets, for the sake of your business and your professional AND technical growth, you must make an investment in your education and learn how to be a better plastic orthodontist. I started with invisalign as a GP in 2004 and yes, back then, it was tough and I got very frustrated with the system.  I walked away from aligners as a viable alternative. Today, it’s an altogether different ballgame and I’ve happily embraced (or un-braced) it. (Sorry, but that pun was just too easy.)
Oh, and please don’t say how sad you are for the profession. Not only does it make you sound bitter, and it helps nobody, but you’re showing your pessimistic side. Stop and take a look round at the rest of the world and then look at what we do. We are blessed in every single sense of the word. We get to decide what we want to do and if we market ourselves well and take care of those in our charge, we have an amazingly bright future.
Remember, speaking about outcomes and educating the public is your technical side venting out loud. If you want to be successful, you better let the entrepreneur have a say every now and then.
All the best,
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Click Here the link for the Squawk Box episode with Joe Hogan, CEO of Invisalign.


  1. “Our expertise allow plastic to be another tool in our tool box.” Very well said! A competent and knowledgeable orthodontist who keeps mind open and is always willing to learn does not need to worry. Enjoyed reading this article very much. Thank you!