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The Future of Orthodontics

By Frank Witsil
Detroit Free Press

March 05. 2018 6:56PM
Motor City Lab Works partner Christian Groth describes the use of digital scans that are used to make molds of teeth to be used for retainers and aligners with digital printers on Feb. 1 at the company in Birmingham, Mich. (Ryan Garza/Detroit Free Press/TNS)

For a glimpse of the future of orthodontics, consider a peek inside Motor City Lab Works, a Birmingham, Mich., office filled with 3D printers and other equipment that create custom retainers and clear plastic aligners.

In the laboratory, technicians use digital imaging and printers that spray resins to not just straighten people’s teeth, but also potentially save patients thousands of dollars and the discomfort of metal braces.

“This is like the Terminator coming out of the metal,” lab co-owner Christian Groth said, describing how one of the big printers works. “You know when the Terminator came out of the liquid? This is kind of what this printer is like. You’ve got this liquid resin and the model is rising out of it.”

In the science fiction film, it took seconds for the liquid-like substance to take solid form. In real life, it takes minutes and hours to make orthodontic models.

Still, dentists and orthodontists say it is only a matter of time before even more sophisticated technology makes it possible to make plastic appliances during patients’ appointments and for entrepreneurs, such as those behind SmileDirectClub, to sell more do-it-yourself treatments.

Legal, medical clashes

The advances already are setting off some big legal — and medical — clashes.

The broader question in the medical community — not just among dentists and orthodontists — is what limits, if any, should be put on entrepreneurs as innovations give patients treatment options that eliminate face-to-face visits with licensed professionals.

"One of the struggles that we are having in this field right now is getting both sides of the story," Groth said. "The two sides of the story are the SmileDirectClub side and the other side is the orthodontists and dentists."

The dental industry has been transformed in the past 20 years by computers that can design a sequence of clear aligners — plastic appliances that fit over the teeth and nudge them into place — to replace metal wires and brackets.

Moreover, 3D printer technology, which has helped create the molds for the aligners, has become more sophisticated and affordable, giving rise to companies such as SmileDirectClub — started in Detroit by two entrepreneurs who grew up in Michigan — that sell the aligners directly to patients.

SmileDirectClub says that braces can run $5,000 and more, but with the company's aligners, children 12 and older can have their smiles transformed for $1,850.

With the click of a mouse, SmileDirectClub customers can set up a free, 30-minute appointment to book a scan of their mouth at a shop and order a kit to make their own teeth molds to mail back to get “a digital rendering of how great your new smile will look following treatment.”

But, Kevin Dillard, general counsel for the St.-Louis-based American Association of Orthodontists, argues that orthodontists are essential and that self-treatment, such as that offered by SmileDirectClub, can in the long run, do more harm — and cost more — than good.

“If what they mean by bypassing the middleman is taking the specialist or the professional out of the treatment plan process or follow-up process, that's a bad thing,” Dillard said. “These people are specialists who make sure the teeth and jaw fit together properly.”

Last April, the association, which represents more than 19,000 orthodontists around the world, filed complaints with boards and attorneys general in 36 states, raising concerns about whether SmileDirectClub was improperly providing medical treatment.

The company has only one New England location, in Boston.

SmileDirectClub said in an email to the Detroit Free Press that it works with a network of more than 225 licensed dentists and orthodontists.

“It has been and will continue to be our primary mission to provide customers a more convenient and affordable option for straightening their teeth than what is offered by traditional orthodontics,” the company said. “SmileDirectClub's teledentistry model provides greater access to care for thousands of customers who, without cost-effective invisible aligners and convenient remote care, would not otherwise have access to a viable teeth-straightening option.”

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