This regular column is compiled by JCO Contributing Editor John W. Graham, DDS, MD. Selected participants are asked for brief replies to a series of questions on a single topic. Your suggestions for future Hot Seat topics or participants are welcome.
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- THE HOT SEAT Clear Aligners February 2015
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What is the primary modality for delivering accelerated orthodontics (AO) in your practice?
Todd Dickerson, DDS, MS
Phoenix, AZ
OrthoPulse and AcceleDent.
Jasmine Gorton, DMD, MS
Larkspur, CA
AcceleDent is our “go to” for AO. We also use OrthoPulse when AO is restricted to one arch and microperforation with an electric driver for space closure when the extraction site is not fresh.
Marc S. Lemchen, DMD
New York, NY
*Investor in Biolux Research.
We have been beta testing OrthoPulse for more than two years with very promising results. We also use AcceleDent, Propel, and accelerated osteogenic orthodontics in selected cases. Each modality has its place.
Mazyar Moshiri, DMD, MS
St. Louis, MO
Our primary modality is AcceleDent, but we use Propel treatments as well for our patients.
Tito Norris, DDS
San Antonio, TX
We have been beta testing OrthoPulse a few years and have seen impressive results. We also offer microperforations, AcceleDent, and surgically facilitated orthodontic therapy to our patients. OrthoPulse has been the most widely accepted.
Sharon Orton-Gibbs, BDS, FDS, DOrth, MOrth, MSc
Thames Ditton, Surrey, U.K.
*Adviser to and shareholder of AcceleDent.
AcceleDent—it’s easy for patients and can save clinic time.
Sonia Palleck, DDS, MCID
Woodstock, Ontario
Insignia custom appliances with AcceleDent.
Timothy G. Shaughnessy, DDS, MS
Suwanee, GA
1. Well-positioned brackets at
the initial bonding!
2. Appropriate diagnosis and
treatment planning!
AO device used: OrthoPulse.
Commentary by Dr. Graham: I’m pickin’ up good vibrations.
Do you offer AO as an option, or is it simply built into your treatment plans?
Todd Dickerson, DDS, MS
Phoenix, AZ
It’s offered to everyone, but mandatory for difficult cases and patients with high-strung parents.
Jasmine Gorton, DMD, MS
Larkspur, CA
For adults and longer cases, it is only “technically optional”—like brushing your teeth!
Marc S. Lemchen, DMD
New York, NY
*Investor in Biolux Research.
We offer AO as an option for patients who we think might see the value.
Mazyar Moshiri, DMD, MS
St. Louis, MO
Currently, the modality is optional for my patients and offered as a premium service.
Tito Norris, DDS
San Antonio, TX
It’s an option.
Sharon Orton-Gibbs, BDS, FDS, DOrth, MOrth, MSc
Thames Ditton, Surrey, U.K.
*Adviser to and shareholder of AcceleDent.
An option. What’s paid for is valued and more likely used.
Sonia Palleck, DDS, MCID
Woodstock, Ontario
It’s the standard of care.
Timothy G. Shaughnessy, DDS, MS
Suwanee, GA
Photobiomodulation with OrthoPulse is a must with aligner treatment.
Commentary by Dr. Graham: Jasmine and Sonia for the win.
Are the patients who take advantage of AO in your practice primarily fixed-appliance patients, clear-aligner patients, or both?
Todd Dickerson, DDS, MS
Phoenix, AZ
Both.
Jasmine Gorton, DMD, MS
Larkspur, CA
Almost 100% of our clear-aligner patients and 15% of our fixed-appliance patients (cases requiring more than 18 months).
Marc S. Lemchen, DMD
New York, NY
*Investor in Biolux Research.
AO is used by about an equal number of fixed and aligner patients.
Mazyar Moshiri, DMD, MS
St. Louis, MO
Clear-aligner patients make up about 80% of our patients using AO.
Tito Norris, DDS
San Antonio, TX
Both, although we prefer to pair this technology with clear aligners.
Sharon Orton-Gibbs, BDS, FDS, DOrth, MOrth, MSc
Thames Ditton, Surrey, U.K.
*Adviser to and shareholder of AcceleDent.
In my published sample of 117: 45% ceramic fixed, 16% lingual, 16% classic fixed, 14% Invisalign, and 9% first phase. Of these patients, 76% were adults.
Sonia Palleck, DDS, MCID
Woodstock, Ontario
Both, but I treat more fixed than aligner cases (about 4:1).
Timothy G. Shaughnessy, DDS, MS
Suwanee, GA
Both, but my experience with fixed appliances is limited to clinical-trial testing of OrthoPulse.
Commentary by Dr. Graham: Both. Nearly all of my adults use AO, and the majority of my patients are adults.
Do you charge a premium for AO, or is the cost built into the overall treatment price?
Todd Dickerson, DDS, MS
Phoenix, AZ
Patients do not value it unless there is an associated fee.
Jasmine Gorton, DMD, MS
Larkspur, CA
We charge a premium based on a “pass-through” model.
Marc S. Lemchen, DMD
New York, NY
*Investor in Biolux Research.
We have an extra charge for AO.
Mazyar Moshiri, DMD, MS
St. Louis, MO
We charge $700 for AcceleDent
and $400 per Propel treatment.
Tito Norris, DDS
San Antonio, TX
We charge a premium.
Sharon Orton-Gibbs, BDS, FDS, DOrth, MOrth, MSc
Thames Ditton, Surrey, U.K.
*Adviser to and shareholder of AcceleDent.
AO costs are additional. Patients decide if the cost and commitment are worth faster treatment.
Sonia Palleck, DDS, MCID
Woodstock, Ontario
It’s built in.
Timothy G. Shaughnessy, DDS, MS
Suwanee, GA
OrthoPulse is provided and built into my aligner treatment fee.
Commentary by Dr. Graham: It depends on the patients and how my treatment coordinator reads their financial situation.
Do you feel that the cost of AO is justifiable?
Todd Dickerson, DDS, MS
Phoenix, AZ
Yes, especially for patients who ask, “How much longer?”
Jasmine Gorton, DMD, MS
Larkspur, CA
Yes, but I would like to see it be less so and for it to become a “why not?” response from the patient instead of a “what?!?!” response.
Marc S. Lemchen, DMD
New York, NY
*Investor in Biolux Research.
It depends on the patient’s priorities. If the quickest possible treatment is the goal, then AO should be included in the treatment plan.
Mazyar Moshiri, DMD, MS
St. Louis, MO
AO is a premium service that people want—so, yes. Additionally, practices come out ahead on the costs with reduced chairtime.
Tito Norris, DDS
San Antonio, TX
Absolutely. I’d do it if I were treating myself or my children.
Sharon Orton-Gibbs, BDS, FDS, DOrth, MOrth, MSc
Thames Ditton, Surrey, U.K.
*Adviser to and shareholder of AcceleDent.
It depends. It is offered to all patients with any of the following: a deadline, ≥ 18 months of projected treatment, concerns about treatment duration or cosmetics, medical/dental reasons for AO, or a long distance from the office.
Sonia Palleck, DDS, MCID
Woodstock, Ontario
Every cost in orthodontic treatment is justifiable.
Timothy G. Shaughnessy, DDS, MS
Suwanee, GA
Yes, because the clear-aligner patients save measurable treatment time and the doctor saves chairtime.
Commentary by Dr. Graham: Almost everyone agrees with a resounding “yes”! Orthodontists need to stop stepping over dollars to pick up pennies.
What do you see as the primary benefit of AO?
Todd Dickerson, DDS, MS
Phoenix, AZ
Invisalign cases finish better and faster, with fewer refinements and fewer appointments.
Jasmine Gorton, DMD, MS
Larkspur, CA
Adults: (1) acceleration and (2) improved comfort. Teens: (1) improved comfort and (2) acceleration.
Marc S. Lemchen, DMD
New York, NY
*Investor in Biolux Research.
The primary benefits include accelerated treatment and, in the case of OrthoPulse and AcceleDent, increased patient comfort. It is likely that it improves aligner compliance, but compliance with the device itself is another story.
Mazyar Moshiri, DMD, MS
St. Louis, MO
Reduced treatment times mean increased cooperation, fewer hygiene issues, and an overall improved treatment experience for the doctor and patient.
Tito Norris, DDS
San Antonio, TX
We can treat patients in fewer visits.
Sharon Orton-Gibbs, BDS, FDS, DOrth, MOrth, MSc
Thames Ditton, Surrey, U.K.
*Adviser to and shareholder of AcceleDent.
Faster treatment for all modalities, great tracking with Invisalign, and seven- to 10-day changes of aligners. For fixed-appliance patients, pain is reduced.
Sonia Palleck, DDS, MCID
Woodstock, Ontario
Quicker to the finish line.
Timothy G. Shaughnessy, DDS, MS
Suwanee, GA
I’m convinced that aligners can be changed more frequently and with less discomfort if OrthoPulse is faithfully worn for five minutes per arch per day.
Commentary by Dr. Graham: Practice differentiation, with reduced treatment times and increased patient comfort.
What has been your overall patient response to AO?
Todd Dickerson, DDS, MS
Phoenix, AZ
Excellent.
Jasmine Gorton, DMD, MS
Larkspur, CA
AcceleDent: mostly great, some neutral. Microperforation: little to no enthusiasm, but most will tolerate it.
Marc S. Lemchen, DMD
New York, NY
*Investor in Biolux Research.
They are impressed that we are pushing the technology barriers to meet their desires for speedier treatment.
Mazyar Moshiri, DMD, MS
St. Louis, MO
Patients want more esthetic and faster treatment; thus, many have been intrigued by the offer, and some pursue it aggressively. Others may not wish to have the additional cost, as can be expected.
Tito Norris, DDS
San Antonio, TX
They’re thrilled.
Sharon Orton-Gibbs, BDS, FDS, DOrth, MOrth, MSc
Thames Ditton, Surrey, U.K.
*Adviser to and shareholder of AcceleDent.
Very positive. Saving treatment time is obvious with Invisalign; fixed-appliance patients need positive feedback during treatment.
Sonia Palleck, DDS, MCID
Woodstock, Ontario
Amazing! Love it!
Timothy G. Shaughnessy, DDS, MS
Suwanee, GA
Generally positive, but my experience with AO is entirely limited to OrthoPulse.
Commentary by Dr. Graham: Positively positive.
How much, in percentage terms, do you feel AO reduces your treatment times?
Todd Dickerson, DDS, MS
Phoenix, AZ
35-60% at the moment.
Jasmine Gorton, DMD, MS
Larkspur, CA
30-50%, depending on the technique and the patient.
Marc S. Lemchen, DMD
New York, NY
*Investor in Biolux Research.
We would estimate about 30%. A good proportion of the time savings is in the initial alignment, and I think there is general agreement on that fact.
Mazyar Moshiri, DMD, MS
St. Louis, MO
30-60%, depending on patient biology and cooperation.
Tito Norris, DDS
San Antonio, TX
50%.
Sharon Orton-Gibbs, BDS, FDS, DOrth, MOrth, MSc
Thames Ditton, Surrey, U.K.
*Adviser to and shareholder of AcceleDent.
My research shows 33.5% faster for fixed appliances and 37% faster for Invisalign. Invisalign is now even quicker, as most patients change aligners weekly.
Sonia Palleck, DDS, MCID
Woodstock, Ontario
25% as an average of fixed and aligner cases.
Timothy G. Shaughnessy, DDS, MS
Suwanee, GA
Aligner treatment time is often reduced by 50% vs. manufacturer recommendations. Fixed-appliance treatment time reduction is much more difficult to measure.
Commentary by Dr. Graham: Tim summed it up well; my fixed-appliance time reduction seems to be around 40%.
Why do you think AO still isn’t utilized in most U.S. orthodontic practices?
Todd Dickerson, DDS, MS
Phoenix, AZ
Fear of higher fees and lack of experience.
Jasmine Gorton, DMD, MS
Larkspur, CA
Good question!
Marc S. Lemchen, DMD
New York, NY
*Investor in Biolux Research.
AO is a new technology, and there is not yet enough hard positive evidence. Cost is a factor as well. I think we will see costs decline as more vendors enter this market, while usage will increase.
Mazyar Moshiri, DMD, MS
St. Louis, MO
I believe it may still be too soon for some doctors, pending the availability of strong studies and data supporting AO.
Tito Norris, DDS
San Antonio, TX
Most doctors don’t realize that by utilizing accelerated treatment (and passing associated fees along to the patients), they can significantly increase profitability per visit.
Sharon Orton-Gibbs, BDS, FDS, DOrth, MOrth, MSc
Thames Ditton, Surrey, U.K.
*Adviser to and shareholder of AcceleDent.
Perhaps they don’t see the win-win situation. It is speedier for the patient, and chairtime is freed up for the clinician.
Sonia Palleck, DDS, MCID
Woodstock, Ontario
There is more AO treatment than there are accelerated orthodontists.
Timothy G. Shaughnessy, DDS, MS
Suwanee, GA
Randomized clinical trials are needed for evidence of treatment time reduction.
Commentary by Dr. Graham: Because they’re orthodontists. #sorrynotsorry
