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Out of Alignment: Why Dentist-led Care is Essential to Successful Aligner Treatment


 By: Dr. Michael Grossman
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What happens when a big dental company that services practicing dentists purchases a company that directly competes with those same medical professionals?

As a practicing general dentist committed to providing exceptional orthodontic care to my patients, I am concerned for my fellow GPs!

Several big dental practices are buying direct-to-consumer dental companies, enabling patients to bypass visits to a dental professional—and that should worry anyone in the field. However, despite this business model’s growing popularity, you can still protect and grow your practice without falling victim to the commoditization of dentistry. 

The Value of Doctor-Directed Care

I am a small-town dentist and, frankly, I’m not sure the ADA is paying much attention to the future of professionals like myself. If they were, I don’t believe companies that sell aligners direct to patients would be gaining market share at such a steady pace.

I would argue any orthodontic tooth movement should be monitored by a licensed dentist—and in person. As we navigate the COVID-19 pandemic, patient safety remains paramount. Streamlining patient visits is of the essence, but there’s still no substitute for the direct, face-to-face care of a dental professional.

DIY Ortho Risks

As a GP, 50% of my practice revenue comes from orthodontics, including myofunctional treatment, early interceptive treatment, traditional braces, cosmetically-focused braces, and of course, aligner therapy. 

I have seen enough DIY ortho cases failing to know how much frustration this causes patients.

There is also a long list of potential complications this type of “treatment” can lead to, such as:

  • Undiagnosed caries getting much worse during treatment

  • Undiagnosed periodontal disease 

  • TMJ related issues caused by occlusal instability

  • Poor treatment outcomes due to lack of anchorage/proper tooth movement mechanics

  • And the list goes on..

Am I angry with Align Technology? Absolutely not! I appreciate Invisalign and use it extensively. I also am pleased to see the changes they’ve made to support doctor-led treatment. By closely monitoring treatment, we can optimize results for our patients and make sound clinical judgements. Aligner systems used under the care of a dental professional will always give better results than DIY options.  

Become an Ortho Guru

So, what can dental professionals do when patients think they can bypass expert treatment? To ensure patients receive the best care, it is extremely important to position yourself as an authority in orthodontics. It is fairly easy to start this journey by taking on some straightforward cases and learning a system that is doctor-directed. The system itself is less important than developing the confidence necessary to start treating cases.

Learning orthodontics in any capacity is not accomplished by taking a weekend course alone. In dental school, we learn very little about orthodontics and are led to believe it is a mystery that can only be solved by a 2–3-year residency. In reality, like most specialty procedures—root canals, extractions, treating periodontal disease, crown/bridge/dentures, implants—there are times to refer (in the case of an impacted wisdom tooth wrapped around the nerve, for example) and times to treat in your office.

By pursuing further education that not only teaches an alignment system but also teaches diagnosis, tooth movement mechanics, implementation and staff training, and benefits/limitations of all types of treatments including brackets, you can equip yourself to confidently treat patients who present to you with malocclusion, cosmetic issues or everyday crowding.  

Dr. Michael Grossman graduated from the University of Massachusetts with his Bachelor of Science degree in biology, then earned his Doctor of Dental Surgery degree from the State University of New York (SUNY) at Buffalo in 2004.

Dr. Grossman is a member of the American Academy of Sleep Dentistry and is a SomnoMed certified dentist. He has taken numerous courses on the treatment of Sleep Apnea. Dr Grossman believes that by treating Sleep Disordered Breathing he is truly helping his patients’ overall health. Hundreds of his patients no longer suffer from the detrimental effects of Obstructive Sleep Apnea due to Dr Grossman’s oral appliance therapy. They no longer snore loudly causing bed partners to leave the room... he’s saving lives and marriages!! They no longer have to wear cumbersome CPAP machines.

In his personal life, Dr. Grossman’s greatest joys are his wife, Meagan, and their children, Andrew, Lilah, Noah and Owen. Dr. Grossman’s other interests include playing the guitar, skiing and golfing.

Berman Instruments

At Berman Instruments, we fully believe in the importance of dentists helping dentists. We carry this motto through everything we do. It’s reflected in our pricing and mission as a company. Meet my friend Dr. William Nudera, a fellow endodontist who also believes in helping our dental community.

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