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Clear aligner treatment models jostle for acceptance in the pandemic


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Digital workflows have already proven to be an advantage of clear aligner therapy during the SARS-CoV-2 pandemic, but consumers also have the option of forgoing visits to the dental clinic completely. (Image: edwardolive/Shutterstock)
Jeremy Booth, Dental Tribune International

By Jeremy Booth, Dental Tribune International

Fri. 21. August 2020


NEW YORK, U.S.: The benefits of aligner therapy for patients are clear, but the different treatment models that manufacturers offer have already shown various advantages and disadvantages during the SARS-CoV-2 pandemic. Orthodontists around the world have embraced digital workflows since March, but one of the largest manufacturers has experienced significant growth in new case starts that begin with at-home impression kits and not with digital scans undertaken in dental clinics.

Align Technology’s business model relies on dentists and orthodontists seeing patients in dental settings. The company’s CEO, Joseph M. Hogan, told analysts in July: “One of the biggest lessons we have all learned over the last few months is about the critical importance of digital technology.” He made the comments in a webcast conference call, during which he explained that the company had shipped around 41% fewer cases of Invisalign during the second quarter of this year. The company shipped just under 222,000 Invisalign cases between April and June, as the pandemic had forced dental practices in the company’s key markets to close.

Hogan said that the advantages of digital treatment planning and monitoring were magnified when dental practices were forced to close. He added: “Over and over we heard [dentists say] ‘I’ve been able to help my Invisalign patients progress in treatment, but I had to just try to keep my patients in a holding pattern with wires and brackets.’ ”

As the CEO of a company whose business model is based on digital dentistry, Hogan said that his comments were not intended to come across as self-serving, but stated: “This pandemic has emphasized the benefits of digital technology across many facets of our lives and businesses.”

During the same three-month period, SmileDirectClub (SCD) saw unique orders for its clear aligners decrease by 53.45%, compared with the first quarter of this year. It met 57,136 unique orders in the second quarter, compared with 122,751 in the previous quarter. SDC has its own stores where consumers can begin their treatment with an oral scan, but it also offers kits for at-home impression taking and has begun partnering with dentists. According to SDC, its strength lies in offering a number of options for consumers, including remote therapy where treatment planning is carried out without the need for a visit to the dentist.

“We continue to see more states passing teledentistry-friendly laws and refusing to pass laws that put barriers to access to care”
– David Katzman, CEO, SmileDirectClub

Our performance in [the second quarter] and more importantly, since the quarter, reflects the strength of our teledentistry platform along with the flexibility and agility of our business model,” CEO of SDC David Katzman told analysts in August. The company’s chief financial officer, Kyle Wailes, pointed out that many of SDC’s new customers had opted to stay home during the pandemic and were able to begin their clear aligner treatment nonetheless. He said: “[We see that] 50% to 60% of the business today [is] coming from kits, and the remainder is coming from scans. If you look at that, pre-COVID, that was 85% to 90% that was coming from scans. And if you look at that during COVID, it was over 90% that was coming from kits.”

Katzman hinted that the pandemic may result in an even greater acceptance of the remote orthodontic treatment model. He stated: “We continue to see more states passing teledentistry-friendly laws and refusing to pass laws that put barriers to access to care. In addition, we continue to see growth in the adoption and use of teledentistry by the dental and orthodontic industries. COVID-19 has made our lawmakers in the medical communities, including the dental and orthodontic communities, acutely aware of the need for telehealth and teledentistry to be proactively permitted.”

Both Align Technology and SDC posted sharp sales declines, but these were not as steep as those reported for other product categories in dentistry, such as dental equipment and brackets.

Digital is trending in orthodontia

Perhaps the strongest signal of the pandemic effecting a change in orthodontics came from Dentsply Sirona. The company announced in August that it would exit the traditional brackets business in order to focus on its SureSmile clear aligner system, which relies on dentists and orthodontists seeing patients in their clinics.

Dentsply Sirona CEO Don Casey stated: “In the area of orthodontics, we believe that the clear aligner space is an attractive opportunity […] SureSmile now offers a comprehensive digital treatment plan that positions the company well in this rapidly growing market. Going forward, we will focus all our efforts in the ortho space on the clear aligner area. We believe this offers the opportunity to grow, innovate and take advantage of many of Dentsply Sirona’s unique strategic advantages, including our large CEREC user community.”

Dentsply Sirona will exit the traditional orthodontics business, including the manufacture and sale of brackets, bands, tubes and wires, which earned the company around $132 million (€111 million) last year. Casey explained: “We haven’t broken out the total orthodontia business, and we don’t give the clear aligner number, specifically. What I would tell you is that what we’ve seen over the last year is accelerating growth behind SureSmile. And we’ve seen actually very positive trends even coming out of the pandemic. So that’s one of the reasons we feel very comfortable about that decision.”

Trends in the acceptance of clear aligner treatment models during the pandemic will be further defined in coming financial quarters. Hogan pointed out that the companies that have thrived the most during the health crisis are “companies that are digital at their core: Amazon, Apple, Zoom, DocuSign, Netflix, Instacart, just to name a few.”

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