Invisalign moves to ensure quality providers

[DrJasonKTam]

This is some breaking news that may interest you.

There are two major reasons for negativity about Invisalign: 1) poor patient compliance and 2) poor treatment planning by inexperienced doctors.

Only the latter is something doctors can control. As you can see from the forums, there are far too many inexperienced doctors who are treating unknowing patients with Invisalign. To reiterate, the dentist or orthodontist is responsible for the treatment planning, not a technician in Costa Rica.

Align Technologies knows they have a problem with providers, primarily general dentists, who rely on techs to plan their treatment, without an understanding of tooth movement. To this end, they made a move today, applauded by the American Association of Orthodontists, to decertify doctors if they do not maintain a certain level of minimal annual experience and continuing education with Invisalign.

It is a fantastic policy that will help protect the public from entering treatment with non-experienced providers, which, unfortunately, is the majority. Hopefully, this will boost the quality of experience for Invisalign patients in the future!

Here are excerpts from Invisalign's email to doctors today:

Ultimately, success is in the hands of the doctor. As awareness and acceptance of Invisalign has grown, so has consumer demand and the size of our trained doctor base. Which leads us to ask, how can we be confident that every Invisalign® provider actually has enough product knowledge and experience to help give patients a great outcome? Align wants every Invisalign provider to be one we can comfortably direct a prospective patient to with an expectation of knowledgeable treatment and a great outcome.

Effective June 1, 2009, Align is implementing Invisalign product proficiency requirements to help ensure good clinical outcomes and a more consistent standard of treatment for Invisalign patients. This proficiency initiative requires every Invisalign provider to start a minimum number of Invisalign cases and complete Invisalign-specific CE credits each calendar year to maintain active account status.

Doctors who choose not to meet the annual case and CE requirements by December 31, 2009 will be able to continue treating any in-progress cases, but will not be eligible to submit new Invisalign cases or to represent themselves as Invisalign providers.

Attaching proficiency requirements to using Invisalign helps Align preserve the integrity of the Invisalign brand for prospective patients and for the doctors who use our products. Being an Invisalign provider should mean something. Going forward, being an Invisalign provider will represent a baseline of Invisalign knowledge and expertise, and will convey a doctor’s commitment to maintaining proficiency with the Invisalign products and treatment.

[Wobblydeb]

It doesn't seem to suggest that they are limiting this to the USA. I wonder if they are going to apply the same principles worldwide?

If they do apply it worldwide, I cannot see how they can grow their market. Dentists only build up their level of regular referrals gradually - it takes time for word of mouth to increase the potential customer base, and for the dentist to gain the experience to deal with cases they might turn away in the first year or two.

Of course, Invisalign have stopped short of naming the number of cases required. It might be 30 in Boston and 3 in Edinburgh.....

[Wireless]

I think the new requirements are a good move. In the US, it looks like a substantial number of general dentists are handling Invisalign. To me, this would create a problem beyond just Invisalign proficiency in the event fixed braces are required for any final adjustments or problems.

Also, as Invisalign becomes more developed, there are areas where this type of treatment is better than fixed braces. In my case, I have a resorbed tooth root in my upper arch that was enough of a concern that my ortho didn't want to use fixed braces even though I have a severe deep bite. His approach is to do as much with Invisalign as possible then use fixed braces to do final alignment if needed. I'm not really sure how he got Invisalign to accept my case as I'm probably not a good candidate. I've signed up for Invisalign as a part of my treatment plan but not necessarily all of it. I'm ok with this as I didn't personally request an "Invisalign only" plan. I was actually very surprised when it was proposed to me.

I've also seen seeing posts where patients start out in fixed braces and move to Invisalign after they have made enough progress. It looks like there is a trend towards "hybrid" treatments using both methods for parts of a treatment plan where they are most effective.

[DrJasonKTam]

Of course, Invisalign have stopped short of naming the number of cases required. It might be 30 in Boston and 3 in Edinburgh..... :wink:

Actually there is a specific number for new graduates/newly certified, and one for established certified doctors. They have made it slightly easier for those who are just getting started out. The number itself isn't important, but the annual requirement is higher than most doctors have treated in their entire career.

It's a fantastic move by Invisalign to not only protect their name, but the people such as us, who are being treated/have been treated with it also.

[Wireless]

I wonder if Invisalign is also reviewing the complexity of cases with their client orthos and directing more complex cases to those with more experience if necessary?

This is something I am particularly interested in knowing, since I'm aware that my ortho has spent a lot of time reviewing with Invisalign before proceeding. I also did some digging and found out my Invisalign treatment plan is a procedure that is very new - probably less than a year old.

So far, my ortho seems comfortable with what he's doing and my regular dentist has noted major improvements. The only problem so far - an attachment not lining up with a bubble - was easily handled by filing the old one off and using my last aligner to replace it.

While everything has been clearly explained including alternate plans if needed and nothing has happened out of plan, I still have that "guiniea pig" feeling because the procedure is so new. I would assume in this case Invisalign will be more supportive than on a more normal case? It is good to know there are concerns about quality control and patient care!!

[DrJasonKTam]

I wonder if Invisalign is also reviewing the complexity of cases with their client orthos and directing more complex cases to those with more experience if necessary?

Align Technology doesn't have any direct way of referring patients to doctors based upon the complexity. The only thing they can do is provide a list of doctors, and show who has more experience. It is up to the individual provider to understand what can and cannot be treated with Invisalign.

Invisalign encourages doctors to push the boundaries of what can be treated with aligners, but it is important that patients, such as yourself, understand that they are doing just that, since there is a possibility fixed braces are required. With the proficiencies, they are more concerned with "bread and butter" treatments being unsuccessful or doctors attempting treatment on patients with complexities beyond their abilities, due to a lack of experience.

[DrJasonKTam]

I've received requests to share the proficiencies with the board. Here it is... enjoy!

http://markhamortho.blogspot.com/2009/0 ... tails.html

[Second Time Around]

I'm very glad to see that Align Technology has finally acted upon the issue of inexperienced providers. It is unfortunate it comes too late for those of us that experienced terrible results at the hands of cosmetic dentists with no expertise in regards to moving teeth. I myself submitted a letter of complaint in mid-May after suffering disastrous results.

I started Invisalign in May 2008 with a Premier Provider cosmetic dentist to improve an overjet that had become more pronounced as I had aged (what I considered to be a minor cosmetic concern). I was told that I was an extremely simple case and I was given 16 aligners. I was completely ignored by the dentist once treatment started as I only saw assistants at the checkups. I did not realize that my bite was gradually experiencing damage, and by tray 11, my minor concern had turned into a serious openbite problem. I demanded to see the dentist, who was shocked at the unexpected results and could not explain how treatment had gone so wrong. He ordered a mid-course correction of 7 aligners; however, these did not improve the damage whatsoever.

I have since switched over to an Elite Provider orthodontist for a whole new course of treatment to correct the problems caused by the previous dentist (currently on aligner 3 of 21 U/L) and I cannot believe the difference in how I am treated as a patient and how much smoother the treatment is going. Unfortunately, the financial cost has been high and overall I will be spending two years in Invisalign.

For anyone who is considering Invisalign before these requirements take effect, I cannot stress enough the importance of selecting a doctor with orthodontic expertise.

Dr. Tam I am so glad you posted this press release as I have been very upset by the blatant injustice of Align allowing inexperienced professionals to deliver this product.

[Wireless]

Dr. Tam,

Thanks for your insights on Invisalign and pushing the boundaries of what can be treated. My case seems to fit this category since I have a deep overbite where my lower teeth are contacting my upper gums. What makes my case really different my doctor proposed Invisalign instead of me requesting. My original assessment and initial X-rays indicated a problem with lower jaw curvature and I was told it would be difficult to correct. My treatment plan was regular braces for 18 months with a removable bite plate. Invisalign was never mentioned.

However, my doctor found a resorbed tooth root and this is probably what initiated the change in treatment plans. When I went in for my records consultation, I was told about the tooth root problem, the complications that could result from fixed braces and the precautions that would be need to be taken. He then told me Invisalign was an option with the understanding I would need to finish with fixed braces if he didn’t get the needed results. This recommendation was a total surprise as I had read info on Invisalign indicating it wasn’t suitable for my case. I did research his comments about the resorbed tooth root afterwards and found his comments were accurate. I have also read posts on this board where treatment was stopped because of this problem.

So far, my treatment has gone well with successes already, including my upper arch with the resorbed tooth root nearly fully corrected without any major problems. I’m on tray 13 of 14U / 21L, so I’ll know in three weeks how the uppers turn out – it looks like I’m very close. In addition, all of the gum inflammation from my impinging deep overbite is gone without any need for periodontic follow-up. Even better, I can sleep now without waking up from my lower teeth hitting inflamed gums.

I’m very happy so far that my doctor was creative enough to come up with a better approach and that Invisalign was willing to accept my case even though it is unusual. This was really important as my dentist had told me my ortho work is required to stop gum inflamation. My biggest concern is that I don’t see much vertical correction happening for the deep overbite after 13 trays. I would rather go ahead with fixed braces if this will work better now that my upper arch is finished instead of having refinements that don’t do as well or taking longer. My next appointment is at the end of tray 14, so it will be a great time to discuss my treatment plan going forward.

I do see benefits in having a treatment plan where Invisalign is used for where this method is best followed by fixed braces, or the opposite depending on the patient plan. In my case, I’m glad I didn’t have to deal with the extra procedures for the treating the damaged tooth root with fixed braces or risk a failed treatment plan and resulting problems if my ortho hadn’t modified my plan.

Thanks again for your insights and contributions to this board. I definitely feel more comfortable with having a better understanding of Invisalign’s handling of unusual cases.

[Wobblydeb]

I've received requests to share the proficiencies with the board. Here it is... enjoy!

http://markhamortho.blogspot.com/2009/0 ... tails.html

Ahhhhh ....... as suspected, this applies to North America only. It makes sense - no other market is mature or large enough yet to impose those kind of restrictions on.

Something to remember for people reading this board who are not in the USA! Invisalign is a relatively new technology in many parts of the world and the resulting inexperience of dentists should be taken into account if you decide to pursue this route....

[thornhilldental]

I agree that this move by Invisalign will ensure better treatment for patients, however this is a big risk for them as they will lose a lot of revenue. This is particularly true with newly certified providers. Since new providers will be only be gradually getting new cases and will be more selective in their initial cases, it will be very difficult to reach the minimum requirement. Thus, I believe Invislign will see a huge drop off in the number of new Invisalign providers.

[Wireless]

From my experience being an "advanced" Invisalign case, it appears they are promoting themselves as having capability to treat more complex cases that traditionally require fixed braces. This will expand their market beyond simple ortho cases. However, to do this, they need to ensure their doctors have the ability to treat the new cases they are targeting.

In my case, fixed braces may be required at the end. I would assume similar cases would be limited to an orthodontic practice rather than a general dentist?

[Second Time Around]

I notice a few posts expressing concern regarding potential drop in revenues for Invisalign. In my opinion revenue cannot be the first consideration when dealing with a medical treatment!

People are willing to pay very large fees for this product and the treatment involves tremendous inconvenience with respect to eating, lifestyle etc. It is completely unreasonable to place unsuspecting individuals at risk of serious bite problems at the hands of inexperienced providers in the name of revenue. At the consultation stage, one takes comfort in the Premier Provider status of a dentist. It takes some time to figure out whether or not your doctor is relying solely on the computer and can't address problems. There is a lot of information on these types of forums; however, I discovered the forums after starting the process, which I suspect is the case with most people.

As I described in a previous post, I followed every single Invisalign rule and ended up with severe problems. My current orthodontist was able to explain to me several key mistakes with respect to my previous treatment plan. I have no choice but to start over (at additional cost) with 10 more months of treatment and a tremendous amount of attachments. No company should be deriving revenue from providing this type of service. The new rules will not eliminate the problem completely; however I think its a step in the right direction.

[Second Time Around]

I notice a few posts expressing concern regarding potential drop in revenues for Invisalign. In my opinion revenue cannot be the first consideration when dealing with a medical treatment!

People are willing to pay very large fees for this product and the treatment involves tremendous inconvenience with respect to eating, lifestyle etc. It is completely unreasonable to place unsuspecting individuals at risk of serious bite problems at the hands of inexperienced providers in the name of revenue. At the consultation stage, one takes comfort in the Premier Provider status of a dentist. It takes some time to figure out whether or not your doctor is relying solely on the computer and can't address problems. There is a lot of information on these types of forums; however, I discovered the forums after starting the process, which I suspect is the case with most people.

As I described in a previous post, I followed every single Invisalign rule and ended up with severe problems. My current orthodontist was able to explain to me several key mistakes with respect to my previous treatment plan. I have no choice but to start over (at additional cost) with 10 more months of treatment and a tremendous amount of attachments. No company should be deriving revenue from providing this type of service. The new rules will not eliminate the problem completely; however I think its a step in the right direction.

[24braceface]

I notice a few posts expressing concern regarding potential drop in revenues for Invisalign. In my opinion revenue cannot be the first consideration when dealing with a medical treatment!

People are willing to pay very large fees for this product and the treatment involves tremendous inconvenience with respect to eating, lifestyle etc. It is completely unreasonable to place unsuspecting individuals at risk of serious bite problems at the hands of inexperienced providers in the name of revenue. At the consultation stage, one takes comfort in the Premier Provider status of a dentist. It takes some time to figure out whether or not your doctor is relying solely on the computer and can't address problems. There is a lot of information on these types of forums; however, I discovered the forums after starting the process, which I suspect is the case with most people.

As I described in a previous post, I followed every single Invisalign rule and ended up with severe problems. My current orthodontist was able to explain to me several key mistakes with respect to my previous treatment plan. I have no choice but to start over (at additional cost) with 10 more months of treatment and a tremendous amount of attachments. No company should be deriving revenue from providing this type of service. The new rules will not eliminate the problem completely; however I think its a step in the right direction.

Where did you post it? I'm curious to see what went wrong with your braces.