I’m going to take a break from my usual posts related to 3D orthodontics, to express my opinion about the cold war that is dawning in the United States between our profession (specialized orthodontists) and the largest producers of clear aligners. It's a rather long post, but it's worth reading to the end.For those of you, either from Europe or other parts of the world, who do not have Facebook or other means of staying up-to-date with current events (I suggest every orthodontist to subscribe toOrthodontic Pearls, a very active facebook group), I am talking about the agitation caused by the arrival the opening of scanning centers by Aligntech. Centers where, without qualified medical personnel, they have direct contact with the patient/consumer, initially bypassing a visit with the orthodontist, though a visit apparently does play a secondary role (it is useful to read the Invisalign UK manager’s response, as published on Kevin O'Brien's blog whose content is quite contradictory with the official web advertisement of the Invisalign Stores).Another strong element of tension is the spread of SDC (Smile Direct Club) centers, in which Aligntech holds shares (19%). In this case, it is pure DYO (Do it Yourself Orthodontics) with the patient making their own impressions at home and receiving the aligners by mail, bypassing the orthodontist completely (or going into a center to be scanned).We can see one of the first tutorial on how to perfectly manage your Do It Yourself orthodontics. It's called Smile Direct Club | 5 Things I Wish I Knew BEFORE and it already got more than 100'000 views. It's also shown how to perform your own IPR at home, with Amazon providing IPR stripes. It's useful to watch it as it gives a better idea of the process. The youtube vlogger was probably paid as a web microinfluencer or offered the treatment (I know this world as my wife is one of them) and he offers a 50% reduction code to follow his way. Are you tempted?In Switzerland, where I live, a similar business model just opened and scanning centers were opened in Lausanne and Zurich. At least a dentist is declared to be present.Finally, just to fan the flames of an already heated conflict, there are the misleading advertisements coming from Aligntech (which indicate that traditional "metal" orthodontics are a historical relic of the past) and SDC (with their simple, but direct, "Braces suck").

From Invisalign: metallic Era is like Jurassic?

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From Smile DIrect Club: no comments...

[embed]https://www.youtube.com/watch?v=Y1hDP8Gv7P4[/embed]With this premise providing the reader with context about the climate on the American front, I now wish to contribute with my opinion, as a European orthodontist, about how we can react to this flood of orthodontic products that are thought to go straight forward from manufacturers to the patient mouth. In truth, I believe we must stand alongside our American colleagues not just out of professional solidarity, but also because America is the testing ground for what will soon happen in the rest of the world.I wish to contribute a few ideas in particular.

1. David and Goliath

The recent manufacturer media campaign has been interpreted as an insult to our profession, marginalizing the role of the orthodontist. This has caused a strong and justified emotional reaction, and after a few weeks of online discussion and official positions taken by the CAO and AAO, the first concrete media reactions have arrived. These videos are the first official response, with the aim of educating the public.

How Do I Straighten My Teeth? See An Orthodontist

by American Association of Orthodontists

1'100 views

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‍They deserve praise because they have progressed from mere words to taking real action. There is room for improvement, but I must ask myself another question.Are we really capable of competing with Aligntech on the communication front? I can’t help but feel that we’re attempting to cross the Atlantic Ocean in a rowboat, while our competitor is already halfway across with an ocean liner. It appears to be a rather uneven fight, like the biblical one between David and Goliath The pervasiveness of Aligntech's message is enormous compared to ours. It would be hypocritical to deny that this media power has its advantages, creating much more public awareness about how even adults can have their teeth aligned and in more aesthetic ways than the classic method.As long as this was the message, the manufacturer's role was to support our profession. The company enjoys direct returns through the many patients who come to the first visit asking about Invisalign. Now, however, they have crossed the line of what should be a beneficial relationship between health professionals and suppliers of supporting products.So what’s to be done? Has anyone considered our potential influence, either as individual orthodontists or as a group? I don’t think so, and to be honest, the odds aren’t good, even if the more than 1 million views in a few days for the Normals vs Professionals is encouraging. Most of our contacts are friends and/or patients that have presumably already completed treatment or are already part of the circle of people who understand orthodontics. The most we can hope to do is simply reinforce the positive ideas they probably already have. On the other hand, canonical marketing campaigns which aim at reaching the masses, have prohibitive costs that only large companies (with a specific amount of income set aside for promotion) can afford. I truly fear that concentrating our efforts on marketing campaigns is sadly reminiscent of Don Quixote’s battle against the windmills. However, for those who know the biblical story, David does eventually win his battle against Goliath. He doesn’t manage it by fighting on the same level as Goliath (through force), just as we shouldn’t use up all of our energy in a media battle against clear aligner manufacturers. David beats Goliath through cunning, and that’s what we should do too.

2. Politics: the only battle we can win?

I must confess that I don’t understand much about politics, but I do know that certain important decisions, such as authorizing or outlawing certain pseudo-medical practices because they are considered dangerous for the public, belong to the centers of power. I imagine that certain representatives of our profession (if not orthodontists, then at least dentists) sit at discussion tables on health issues. For me, this is where we need to focus our efforts: providing valid scientific and medical arguments that allow legislators to ban dangerous practices like DYO. Fortunately, Aligner lobbies don’t yet exist and can’t elect senators, but it is still good to have colleagues, dentists and physicians who are sensitive to issues of public interest, among our political representatives. As reported by Kevin O'Brien, a dentist who proposed orthodontics without visits in England has already been forced to suspend its commercial services. Why shouldn’t this happen in the United States? Will we be forced to accept the Uber-ization of our market? At least in Uber there’s an actual driver behind the wheel...

3. Legal assistance for dissatisfied patients of DYO

Could we possibly prepare ourselves, at the national level tof orthodontic associations, to assist (and amplify with a media sounding board) the first dissatisfied patients of do-it-yourself orthodontics?It won’t be long before people start to realize what kind of damage such practices can create in patients who have not passed a pre-screening with a professional. The first, unfortunate, patients to suffer the consequences should be facilitated and assisted in preparing a lawsuit against... certain unspecified culprits =)In some ways the companies of DYO will be legally protected, but what will happen when they will be faced with the first lawsuits? A professional health care provider who responds with professional insurance for the damage caused is missing. Who then will be to blame and who will pay when something goes wrong? Being close to these patients and helping them repair the physical, economic, and emotional damage can be a great opportunity.It is time to gather ideas and stimulate discussions that allow our representatives to make concrete decisions that coincide with the spirit of the majority.I hope that this stimulates some fruitful discussion and that you stay tuned for script ideas on a counter-campaign video which I would like to propose in the next post.