Changing Trays, Changing Futures
Pictured: Dr. Pfister attends a Fall 2022 Invisalign® summit in Vegas.
Hope all of you are having a wonderful holiday season! While I’ve been enjoying time with family, I’ve also been hard-at-work with continuing education. In fact, the week before Thanksgiving, I attended my first in-person convention in 2 years…
It felt great! It was the first invitation-only summit that Invisalign® has hosted in 4 years… and they pulled out all the stops. It was held at the Aria Motel and Convention Center in Las Vegas. The last time I was in Vegas was 5 years ago for another ortho meeting; and I must tell you, it felt great to be back in a vibrant city with incredible culinary experiences. Yes, gone are the five dollar lobsters and ten dollar steaks; but no masks and open buffets… now that was a real sight for sore eyes!
With Bellagio fountains dancing to Celine Dion and street performers of all shapes and sizes looking like a mass tryout for America’s Got Talent, the setting could have been anytime in the last 20 years, prior to Covid. America is trying to transform back to her old self, pre-Covid, and it gives me faith that we are making headway, slowly but surely.
One of the interesting parts of the Invisalign summit this year was hinted at in the title of the summit itself, Transformation. Let’s take a closer look at how this word defines and frames not only the summit, but the entire process of orthodontics (and especially Invisalign).
Doing anything for 35 years doesn’t necessarily make you an expert, but it gives you a lot of experience on things that work (and many that don’t). In my opinion, it also gives you some credibility in your comments and opinions on the subject.
Through the years, I have always felt a nice smile was important and have tried to instill that importance in my patients, in order that they continue proper oral hygiene and the wearing of their retainers once we have finished their treatment.
But after tuning in to many of the Invisalign experts and psychologist at the summit, listening to stories from my social working psychologist brother’s experience with meth addicts, and hearing personal testimonies from this Fall’s completed Invisalign adult cases in my practice, I have totally low-balled my promotion and importance of a good smile in one’s outlook on life!
As I have written in prior blogs, the bands-and-bracket orthodontic world has had some changes and advancements over the past several decades, but nothing earth-shattering.
This goes for techniques, equipment, and philosophies. It has been a pretty steady-as-she-goes philosophy, with a “don’t fix it if it isn’t broke” attitude.
We considered smiles important with braces but, in most cases, patient cooperation was minimal and the orthodontist did all the work (and thus determined the outcome for the patient). Little did we, as orthodontists, realize the importance of a non-dictator, patient-driven system that allowed the patient to be in charge of their smile and their treatment outcomes.
Enter Invisalign 1999. With the advent of a new millennium, the turn of the century also turned the corner on a totally new paradigm shift in orthodontic treatment.
The team approach was born. Yes, the orthodontist must diagnose and set up the program and construct the treatment plan for the creation of the patient’s new smile (from which the Invisalign aligners are constructed). But now, the orthodontist and patient can go over a preconstruction-of-aligner video to get the patient’s input on certain tooth placements, and thus the patient becomes an integral part of the successful development of their new smile.
Taking this one step further, at the summit I traded in our 2G scanner for Invisalign’s 2023 5G scanner that will actually show pre- and post-Invisalign treatment results of the patient’s actual teeth scanned into the patient’s face from an iPhone photo taken 10 minutes before and displayed on our scanner’s screen at the initial exam! This is a far cry from my first thirty years of orthodontic consultations, where I showed a set of their teeth on a plaster model and I told them, “Don’t worry, we can fix them!”
As orthodontists, we always considered the smile important and, at the risk of over-blowing our own horn, we didn’t focus on it but kept talking about how important good molar occlusion was. And let me tell you this, molars have never generated much enthusiasm in orthodontic treatment!
The Invisalign summit brought speakers together who really have a pulse on today’s youth and adults, what’s important in their worlds, and what motivates them to successfully complete a self-enhancement program. Let’s take a closer look…
According to many experts today, our youth feel lost, unable to positively affect the world around them. Many have feelings of hopelessness, evident in the rise of youth suicides and a real feeling of inability to change the future. They care greatly about their looks, hence a rise in adolescent make-up usage, hair coloring, and styling driven by social media outlets. And thanks to the collateral effects of the quarantine and Covid, this generation has a significant lack of confidence and self-esteem.
Put on top of this a less-than-desirable smile (or as some teens have told me, “I have jacked teeth”), and experts say this is a formula for non-social engagement, isolation, and the list gets more serious with time.
I have worked with youth all my life and the discussions held at the summit were real eye-openers…
The need to fit in by looking normal and having a nice smile is deemed far more important today than any other time in our existence! Success at work, interactions with others, and building a personally positive future is integrally tied into one’s smile.
Researchers have taken this one step further — those with autism, down syndrome, and other people with disabilities equally have insisted on getting orthodontic treatment to look more “normal” or to “fit” in. I personally have found this to be true in my own practice and was glad to see experts promoting treatment to these sometimes-forgotten sectors of our population.
As the Invisalign summit continued, this became a meeting different than any other orthodontic meeting I have ever attended! Rather than a bunch of experts talking on “how” to do treatment, it became a discussion on “why” to do treatment.
This sounds very trite and insignificant on the surface but, when fully analyzed, it reflected the very changes I have seen in my own patient population. This current adolescent population cannot be told what to do, or they clam up and refuse to play ball. Rather, they need to feel part of the treatment — that treatment is being done with them and not so much on them. They appreciate being fully informed and knowing that caregivers have the patient’s best interest at heart.
As the summit went on, the difference in treatment acceptance of conventional braces versus Invisalign in the adolescent population became glaringly evident, with the difference in delivery of both modalities being the sticking point.
Conventional braces are glued on the teeth by the orthodontist, the wire to be tied in is selected by the orthodontist, and the rubber bands are selected by the orthodontist. The patient chooses the color of ties to tie in the wire.
Compare this to the Invisalign treatment process, where “trays” (or “aligners”) are designed by the orthodontist, treatment goals are discussed before tray construction with the patient, and the patient changes the trays in their mouth every 7-14 days, depending on what the patient is feeling and how the teeth are moving.
One can begin to see that the success of Invisalign treatment is wholly dependent on the patient’s cooperation. The patient has the power to make or break the system. The decision-making ability and involvement of the patient on the outcome of their new smile is extremely exciting for many of today’s teens. “Finally, someone cares enough about me to listen to me and trust me to get the job done. Wow, I have control over my own future!”
I’ll go one step further and tell you that a lot of adults have chosen Invisalign for the same reason.
Before my readers think I drank too much cool-aid in Vegas, I’ll suggest that which makes Invisalign a democratic system of tooth movement can also be its downfall.
Some patients work better under dictatorships (i.e. conventional braces). We have seen what too much freedom can do to an individual — lack of cooperation, poor results, and disappointment with the final outcome. As one expert at the summit so intuitively pointed out, when considering a patient for Invisalign, spend twice as much time looking in their head than in their mouth!
Research from the summit shows that even in the most Invisalign-aggressive offices, only 70% of the patients seeking a better smile will accept the challenge and choose Invisalign.
There will always be that population who likes treatment done on them, with no cooperation or input from the patient.
My feelings on Invisalign strengthen each year as Invisalign research continues to find new applications for aligner therapy.
I must let you in on the newest step in Invisalign for 2023. My reason for trading in both my 3-D x-ray machine and 2-G scanner is that, at the summit, Invisalign Research and Development announced software in Windows 10 that will merge both the “total” root and bone view of the 3-D x-ray image and the 5G scanner. Finally, diagnosis and the development of aligners for a patient’s treatment can be based on the total tooth and not just what is above the gums! This will be a first for the aligner industry. Treatment involving the entire tooth can be done more efficiently, reducing the time in treatment (with less discomfort and less expense). Again, I say we have come a long way from plaster study models showing only the crowns and speculations on treatment.
I’d like to end with a couple of thoughts on the importance of smiles…
Over Thanksgiving, my brother (a social psychologist in a southern hospital) was up to see me and, during our discussions, I told him how the summit truly emphasized the value of the smile. What he told me really shocked me! As he works with meth addicts and tries to straighten out their lives (these are individuals who have lost their jobs, their spouses, and their children), he stated their refusal to smile and tendency to talk with their head hung low was due to losing their teeth! They hated how they looked; and the loss of their smile devastated them and broke down their self-esteem like nothing else on earth. This truly set me back in my seat. “So you mean those six-to-eight upper pearly whites, when aligned into a symmetric arc, can actually determine one’s self-confidence and be the barometer of the individual’s future?”
“Yep,” said my brother, “see how important your job is.”
Lastly, just last week I had a very unusual 28-year-old female exam. She stared at her arm the whole time I asked her questions about what she was looking for as outcome goals for her orthodontic treatment. She hated her teeth so badly that she booked a flight to California, got a motel, and stayed for a week, only to find out the dental center for dentures on implants would not pull out all her teeth because she was too young and her teeth and bones were too healthy. There is hope for California yet! She was an articulate RN, who had been passed over on job promotions and had a hard time making friends and staying in a relationship. Truly, this was more Dr. Phil stuff than Dr. Chuck stuff; but after a lengthy discussion, she agreed dentures were too radical and a natural approach with cooperation would serve her better. She starts her Invisalign journey second week of January!
So there you have it! This Fall has been very interesting and intellectually stimulating, as my orthodontic world is morphing into the modern age of technology with all the newest and best widgets…
These widgets are designed to produce amazing bites with incredible tooth positioning techniques.
But as perplexing as Mona Lisa’s (and as endearing as your spouse’s or grandchild’s), the value of one’s smile should never be taken for granted! Make sure you brush and floss to protect your smile and, when you have a great one, be thankful and share it with others during this Season of Joy.
Here’s to better smiles,
Dr. Pfister
P.S. Are you interested in seeing if Invisalign therapy is right for you? Learn more about Invisalign treatment at Pfister Orthodontics. Then, contact us today to schedule an exam!