The Critical Role of the Supervising Doctor

What Direct-to-Consumer Aligners Neglect

Clear aligner orthodontic treatments are more popular than ever. Who wouldn’t want to wear removable orthodontics that blend in with your smile, as opposed to cumbersome metal brackets and wires? Who wouldn’t want to check in with the dentist less frequently? However, all that convenience and self-guided use still involves a precise orthodontic process that is as equally dependent on careful treatment planning and monitoring as traditional bracket-and-wire braces.

More than five million patients have purchased a course of Invisalign (the most well-known name in clear aligner treatment) and more dentists and orthodontists now provide it as a treatment option. At Orthosnap, we provide a similar treatment that tends to work faster and more effectively, due to impression-moulding and closer attention to detail. Despite our differences in process and results, there is one thing we agree on: the role of the supervising doctor is critical to safe, successful treatment.

Do a quick internet search of “Invisalign without a dentist” and you’ll find a number of businesses willing to customize a series of aligners, sight unseen. They send out a home impression kit, which is then assessed by one of their remote dentists. The consumer gets their bargain-price aligners and is left to complete the treatment to their own best ability. There are several things wrong with this scenario! Direct-to-consumer models may make people feel empowered, and they may work if circumstances are just right, but there is much they are neglecting. The risks to one’s oral health are too great to ignore.

Assessing Candidacy

The first benefit of having a dentist or orthodontist supervising your treatment is assessing your candidacy for aligners. This always involves an oral health exam to check for signs of decay and periodontitis. If a patient begins a course of aligners with untreated issues, he or she may be putting the teeth at risk of rapidly advancing decay or gum disease. The damage that could be done in as little as six months is staggering. Considering that most people don’t keep a DiagnoDent in their medicine cabinet or know how to measure their periodontal pockets, having a dental provider clear you for treatment is a critical prerequisite.

Orthodontic Treatment Planning

Beyond basic oral health, most laypersons are not skilled at assessing the severity and nature of their malocclusion and bite issues. You need a doctor who understands the underlying anatomy and how the product works to determine whether it will be capable of successfully realigning the teeth. Neither alignment issues nor overall oral health can be assessed properly by a remote dentist who only sees a model built from a home-administered impression kit.

Radiography an important part of the oral health check and treatment planning, and a growing number of providers go beyond x-rays to include CBCT scans, as well. Three-dimensional imaging is superior to 2D radiography when you are trying to assess the position of the roots and supporting structures.

Dr. Jeffrey Miller’s 2016 presentation “10 Things You Will Not Hear from Invisalign” raises an important point regarding better screening and treatment planning. Call it housing, boundaries, or orthodontic walls—but, in some cases, there simply isn’t enough bone to support the movement of individual teeth. Poorly planned aligner treatments can result in a situation that ultimately ends in root dehiscence or fenestration. Two-dimensional imaging does not always give us the ability to screen these patients properly. You need to be able to see each individual tooth’s root-bone relationship to assess the limits of the buccal and lingual cortical plates.

Long-term oral health can be compromised by aligner treatments that don’t screen and plan treatment accordingly. As far as we can tell, the direct-to-consumer models don’t even require x-rays to begin treatment. That is scary, to say the least.

Check-Ups and Mid-Course Corrections

If you read patient reviews of direct-to consumer models, you’ll start to see a pattern of patients noticing their teeth moving improperly and requesting corrections. Sometimes it takes them months of customer service nightmares to have the treatment plan corrected, and they may have to pay additional fees for this.

With a supervising dentist or orthodontist, these problems can be corrected before they escalate to the point that a patient notices a problem. Trying to do it alone can result in a three-steps forward/two-steps-back scenario that can drag on for years. This can add up to stress on the teeth and bone, prolonged treatments timelines, and a general sense that you are wasting your money! Having a professional to monitor a patient’s progress, face-to-face, cannot be undervalued.

The Bottom Line

Ultimately, there are two things that patients and consumers need to be reminded of: no two mouths are the same, and a dental impression is never the full picture. There may be cases in which the role of the doctor is minimal—but an unvetted, unmonitored course of orthodontics carries terrifying potential risks. Orthodontists and dentists are trained to see the whole picture and use their specialized knowledge to make sure treatment is appropriate and effective. Taking him or her out of the picture is like playing Russian roulette with your smile.

Give Your Patients an Affordable Alternative, with Orthosnap

A great way to discourage your patients from seeking out direct-to-consumer aligners is to offer them a more affordable option. Orthosnap provides a clear aligner system of straightening the teeth that uses dynamic modeling and moulding, rather than 3D printing. This gives patients a faster-working, better fitting treatment. (You can hear it in the snap of a perfect fit.) Our system also happens to be less expensive.

To learn about Orthosnap’s dynamic physical modeling system, visit our webpage How Orthosnap Works, or email Orthosnap inventor Yan Pogorelsky at

Leave a Comment