The Future of Teeth, 3D printed and by mail

How the profession of orthodontists is responding to new technology companies

New technology is disrupting the orthodontics profession

Until recently, braces could only be obtained very expensively from dentists or orthodontists. However, new market entrants such as SmileDirectClub, Plusdental or DrSmile are leveraging telemedicine and 3D technology to propagate teeth correction treatment with braces for 1/3 of the price compared to an ordinary dentist or orthodontic practice. Who would not take such an offer? What are the consequences for the market? In this regard, can the profession of dentists or orthodontists really be overthrown?

One major advantage these companies have over ordinary dentists or orthodontists is that they use telemedicine and 3D printing technologies to gain a competitive advantage. Telemedicine allows patients to be treated remotely rather than at the doctor’s practice. This is for example of great benefit for patients from rural areas or for whom who have difficulties reaching a medical practice.

A substantial part of the work of these companies do is carried out digitally: from booking appointments to conducting medical check-ups. This saves costs compared to normal visits at a physical dentists’ or orthodontists’ practice. This is a major cost driver for the dentist or orthodontist and consequently for the patient. In addition, manufacturing braces with 3D printers, lowers the costs for these companies compared to dentists or orthodontists which have to buy their braces expensively via manufacturers. So, state-of-the-art technologies make it for these new entrants technically feasible to perform dental corrections faster, cheaper and with less effort in contrast to ordinary dentists’ or orthodontist’s treatment (Jain et al., 2013).

How it works

These companies operate in one of two ways. In the first case, patients can request home-kits to make a mold of their teeth at home. Patients also take photos with their smartphone which are sent digitally to the company. On the basis of this documentation, an orthodontist who works for the company plans the treatment for the patient. If the treatment is feasible, the braces are produced in the laboratory of the company and sent directly to the patient’s home by post. The patient treats himself/herself and progress is monitored via an app. This saves costs for these companies, since patients do not have to come to their practice and be advised and treated as with normal dentists or orthodontists. As a result, these companies are able to offer their treatment at a lower price than dentists or orthodontists.

In the second case, these companies cooperate with dentists or orthodontists and patients book an appointment at a nearby dental practice or company branch. At the physical practice or shop, an intraoral scan is taken to make a 3D model of the patient’s teeth. If the case is suitable for correction, the braces are manufactured and the process continues exactly as described above. Although this model is no longer as cheap as the home kit model, the advantage lies in the more accurate documentation of the teeth of the patient which allows a higher probability of successful treatment of the patient.

Three strategies of response by the profession

I studied orthodontists, who are specialized in aligning teeth with different types of braces and examined how they react to these challenger, commercial companies attempting to penetrate their market. Three strategies emerged from my study:

Strategy 1: Defend against competitors

At the beginning of my investigations, I found that orthodontists defend themselves pointing out that these companies do not provide quality medical treatment because they do not have proper medical education. As a consequence, they conclude that these treatments are dangerous for patients.

“So, if you’re lucky and you’re dealing with a lot of simple cases and you can look in the mirror every evening with a clear conscience and say: “I know what I’m doing”, then ok. But I don’t believe that everyone who does and offers this can do it. You have to make sure that at the end of the day you are a doctor who is carrying out a therapy, a medical intervention in fact.”

Orthodontists highlight the fact that these companies are more interested in profit and that the patient is not the main focus because they are business driven and they have to satisfy their investors. Finally, they also initiate legal proceedings to restrict the scope of action of these companies in the orthodontic market. These corroborated my expected findings from the literature on professionals (Anderson et al., 1999 and Willcox, 1959; Ferlie et al., 2005).

Strategy 2: Switch sides

However, something extraordinary is happening in this market. Although orthodontists are fighting these companies tooth and nail, some of them are changing sides. As described, these companies provide a business model where patients can visit cooperating orthodontists’ practices. As a consequence, orthodontists also have to work for these companies so that their business model works. Orthodontists on the one hand reject these companies which is described in strategy 1 but on the other hand there are orthodontists who are willing to work for these companies.

Strategy 3: Counterattack by copying the business models of competitors

A third finding is that since the lawsuits against these companies had little or no effects, some orthodontists counterattacked. They founded an association to defend themselves against these companies and started to use a similar business model. The orthodontists from the association make their own practice available and combine the concept of these companies with the traditional orthodontics concept. For example, they announce that treatment costs the same price as the braces provided by these companies, with the difference that the patient is treated by a highly qualified orthodontist and with high quality braces from their braces manufacturer. This is in turn, criticized by other orthodontists:

“… and then I say, “Why should I do that? I’ll make 15,000 enemies (orthodontists who are not part of the association) at once, I’m not that desperate.”

The future of orthodontics?

These strategies show that these companies are taken seriously by orthodontists. Currently, these new companies can only treat a sub-section of patients, namely those with a simple to moderate teeth malposition. The further development of technologies will also show whether it will be possible for these companies to treat severe malposition in future. In this context, AI could also play a role to potentially further reduce the human factor (orthodontist) in the entire value chain and to reduce further costs. Therefore, it will be exciting to see in which direction the orthodontic market will change in future.

Fabian Hable

Fabian has worked in orthodontics for over three years. He was responsible for the strategy development and process optimization in his practice. His interest in business development is also directly related to the business model of these companies using telemedicine as a technology. With his know-how in new technologies and digitalization due to the Master “Digital Business and Innovation”, he wants to dive deeper into new business models of different medical fields. If you have any interesting possibilities in this respect, do not hesitate to contact him via https://www.linkedin.com/in/fabian-hable/ .

Sources

Anderson, M. B., Cohen, J. J., Hallock, J. A., Kassebaum, D. G., Turnbull, J., & Whitcomb, M. E. (1999). Learning objectives for medical student education-Guidelines for medical schools: re-port I of the Medical School Objectives Project. Academic Medicine, 74(1), 13–18.

Ferlie, E., Fitzgerald, L., Wood, M., & Hawkins, C. (2005). The nonspread of innovations: the me-diating role of professionals. Academy of management journal, 48(1), 117–134.

Jain, A., Bhaskar, D. J., Gupta, D., Agali, C., Gupta, V., & Karim, B. (2013). Teledentistry: upcoming trend in Dentistry. J Adv Med Dent Scie, 1(2), 112–5.

Willcox, A. W. (1959). Hospitals and the corporate practice of medicine. Cornell LQ, 45, 432.