The dental sector is in rude health but the ortho category is probably rudest of all, with its global market forecast to see a compound annual growth rate of 8.2% between 2017 and 2023 (Allied Market Research).
It’s easy for GDPs to enter this market. You can take the Invisalign route, pay top whack for lab work and not get too involved in treatment planning. Or you can take a more in-depth approach.
We asked Sue Bessant, technical director at Wired Orthodontics, the orthodontic business solution that trains dentists and supplies lab work, to give you the lay of the land.
Sue, can you explain the dilemma?
Often people might be considering certain types of training for the wrong reasons. For instance, I talked one of our delegates out of doing an MSc which he was considering because he thought it would give him more protection from the GDC.
Obviously you have to be sure on consent, but spending £30k on an MSc won’t necessarily help with that. You are safe if you have a good clinical mentor and you learn how to document everything properly, develop your in-house processes and your treatment planning skills. Then you can practise in any area safely, even children’s ortho.
Why not just do a clear aligner course?
That suits some dentists because some brands have an international presence which customers recognise and you don’t need to learn many new skills. One downside is the bigger lab bills, for instance lab fees might be £1,800 in a £3,000 treatment plan, versus £440 in our lab. If you are in a flooded clear aligner market like London and you can’t get enough volume for a discount, those lower margins can be hard.
You can’t comply with GDC guidelines if you just do clear aligners because you’re a one-trick pony and can’t offer options. In fact GDPs have a lot to bring to the table and even though they might lack confidence in ortho initially, they often turn out to be better placed to treat complex cases because of their broader experience. When you learn to do your own treatment planning you can take on higher value cases and mix the ortho work with your restorative and implant work.
And then, of course, you might actually enjoy doing more technically advanced, creative work — many of our delegates rediscover a passion for dentistry and enjoy their work again for the first time in years.
How much can GDPs earn in ortho?
If you start one new case a month you will turn over an extra £42k in your first year, but we have delegates who are seeing up to 15 new cases a month. It’s a relatively easy category to build — the market demand is out there — but there is always an ebb and flow. Some years you may not start any cases because you are busy servicing the cases you started the previous year.
How is digital technology helping GDPs enter the ortho market?
Digital technology enables us to monitor our delegate’s cases and make sure they are operating within their range of competency. It can be a useful consent tool too. Sometimes a client will have reservations as to whether the clear aligner treatment plan they’ve received from the manufacturer is achievable and will ask us to do a digital set up to what we consider a realistic evaluation of what is possible for the patient.
There can be valuable learning even if a dentist doesn’t proceed with a case — they still have to understand the mechanical principles and use software to plan a case even if we advise them that it’s too complex for them to take on in-house. They can then refer it on, sharing the digital files, so a lot of the legwork is done.
More and more clients are ringing up saying, “I’ve just bought this scanner, can you accept the files?” Now the answer is usually yes, we are moving to open format so we can work with pretty much any file type. We accept STL files and scans from Itero, 3Shape, Carestream, Cerec and Emerald.
Are there more technical revolutions in the pipeline?
A lot of labs are making noise about how they are all digital, but I think ortho labs and digital workflows are still in their infancy. Some labs are saying they are positioning brackets digitally but they are using the default setting and still placing the brackets manually and making manual transfer jigs.
We can now move teeth easily within the software and make comparisons on tooth position and the amount of movement, but there are some major developments to come. Soon we will be able to accept intra-oral scans and design aligners and retainers virtually and send them straight to print. Cutting out the impression stage and the physical lab stages can only increase the accuracy of fit and reduce remake times for both the lab and practices.
The software we use allows us to place the brackets according to measurements calculated by tooth size. We can view an outcome simulation based on that bracket position on the same screen, and we are then able to alter the bracket position and see the effect on the outcome in real time. This advance will allow us to be more precise in our bracket positioning, meaning that the dentist will need to spend less time in finishing, bending wires and repositioning brackets. It could also make treatment time quicker.
The material I need is available for this but we are trialling different 3D printers. Factors to consider are size of build platform, number of prints in one go, print and post-processing time, amount of resin used and capital outlay. It doesn’t need to be cheaper than doing it manually, and I doubt it will be, but the outcome has to be better. Less wire bending and bracket positioning will save dentists effort and surgery time — that’s the real cost saving.
How has digital technology affected workflow in ortho?
It’s a cleaner, quicker workflow, with no impressions. You can instantly see on screen if the scan is OK, whereas it may be several days until a lab pours impressions so you can assess them and see whether you need to get the patient back in. So there’s less wasted time in surgery and you’re keeping the book free for fee earning rather than redoing impressions.
Digital models are now acceptable in place of the old plaster ones —I’ve just been to a practice and picked up 200 ortho cases, and they have regained their store room. If retainers are lost you can instantly get the lab to remake them from the scan without needing to bring the patient back in. That saves clinic time, but we forget about our patients’ time, it’s a real pain to get time off work to go in for a new impression.
There’s a bit of wow factor for patients if they ring with a problem like a lost retainer and you can solve it with no hassle to them. Patients love being scanned rather than having impressions taken, it’s becoming the norm and patients now expect this sort of tech. They have it everywhere else in their lives and expect it from dentistry too.
Are there any challenges with the digital technology?
Scanners are a big outlay which can put practices off. Some thought is required on how to make them earn their keep, and they certainly can. Don’t expect to just do things the same way, workflows need to be changed.
I hear that some multi-surgery practices dedicate a room as a scanning suite and patients are routed through, but trying to share a scanner between surgeries doesn’t work, it’s quicker to take an impression.