The Science of Invisible Orthodontics



Orthodontics has always been a very active area in dentistry; it may be almost as old as fillings and extractions which go back to ancient Egypt, but that doesn't mean it has stagnated. In the last 20 years, the development and continued adoption of clear aligners has really changed how people see orthodontics and the kind of patients engaging in care.  Clear aligners have thrown up challenges which the dental industry has never really faced before. Dental care usually falls into two categories, acute care, like fillings and crowns which are carried out during a session and maintained over the regular dental check-ups every six months. Next, ongoing care, all the dentistry that requires regular visits to the clinic every few weeks (usually 6) to have the equipment adjusted and progress monitored, over the course of treatment. Invisalign Clapham does things differently: the entire course of treatment is carried out in a simulation at the beginning of the treatment and then each of the aligners in the sequence contain all of the necessary adjustments. The necessary scan before the aligners can be designed can be carried out by a technician or hygienist. So, in theory, the entire treatment could be carried out without ever meeting a dental professional. What does this really mean for dentistry? And orthodontics in particular? 

Clinic based treatment which is monitored 
Although referred to as clinic based treatment compared to many other forms of treatment, contact with the local clinic might be minimal, the patient would have to attend an initial assessment and health check-up, followed by a scan and would then need to collect the aligners from the local clinic. After which, check-ups can be performed over video conferences online. This allows unnecessary travelling to be reduced and only if issues are noticed patients are called into the surgery. 

Home treatment, unmonitored 
Unmonitored home treatment relies on the use of solely online manufacturers who may conduct an interview at the beginning of care, but not necessarily so, and are unlikely to check up on their patients throughout treatment. Their business model sees aligners as a product and their patients as customers. 

Effectiveness 
An article published in the American Society of Orthodontists explored the outcomes of these two quite different implementations of the same technology. They concluded that patients attempting to carry out unsupervised clear aligner care had longer treatment times than those monitored by the local clinic. The British Society of Orthodontists considers clear aligners to be a safe and effective treatment, but only under the direct supervision of a professional and has questioned the business model of online-only manufacturers refusing to endorse it as a treatment option for its patients. 

Conclusions
There are definitely opportunities for online consultations to be incorporated into the repertoire of local dental clinics, allowing many issues to be resolved at home and a degree of triaging to thin out the necessary attendance to their clinics. But providing aligners with no further oversight may result in short-changing a patient, even if it seems like a cheaper or more convenient option.

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