Ever since Align Technology disrupted the orthodontics market with the launch of Invisalign back in 1998, other companies have seen the potential of clear aligners. However, for almost twenty years, Align was in the enviable position of having next-to-no competition due to its watertight network of patents, making it virtually impossible for any other company to succeed.
However, in October of 2018, Invisalign’s tight network of over 400 US-based IPs and 300 foreign-issued patents ran out, opening up the market for others. This led to an abundance of clear aligner companies like Smile Direct Club which changed the way clear aligners were offered to consumers.
Life Before Direct-To-Consumer (DTC) Clear Aligners
Up until 2018, the clear aligner market was dominated by Invisalign’s dentist-led model. To put it simply, treatment was offered to patients via a dentist only but any treatment planning and aligner creation had to be provided by the manufacturer.
This meant that dentists needed to pay a substantial lab fee to Align Technology for the creation and manufacture of each set of aligners.
Because dentists needed to pay a substantial lab fee and factor in their own personal treatment time, the end product didn’t come cheap, costing each patient somewhere between $3000 and $8000. Unfortunately, this price point has made Invisalign treatment inaccessible for some people.
Other companies like Smile Direct Club recognised this and introduced what we know as the direct-to-consumer (DTC) business model.
The model recognised the limitations of the dentist-led model and sought to simplify the process by eliminating dental visits altogether. Using the DTC model, cases were evaluated in the comfort of a customer’s home, either by taking a series of self-instructed impressions or by visiting a designated ‘bricks and mortar’ store. Here, consumers could get impressions made and receive their customised clear aligners within 48 hours.
By cutting out the middle man – in this case, the orthodontist or dentist – DTC aligner companies like Smile Direct Club were able to slash the price of treatment, offering it, in some cases, for under $1000.
Opening up the market like this has seen DTC players in this sector grow massively and indeed, the future was set, or so it seemed, until the collapse of Smile Direct Club in December of 2023 when they made an unsuccessful attempt to file for bankruptcy protection.
What went wrong?
One would argue that ‘consumerising’ orthodontic treatment is a flawed system because, in reality, orthodontics is a complex medical procedure that needs an in-person exam. This was reflected in a 2020 study carried out by Professor Anna Wexler whose research into DTC health companies found that 6% of all consumers needed to return to a traditional doctor for follow-up treatment.
While other companies like Candid Co’s decision to close its 45 stores and revert to an orthodontist-led model was said to be down to rising advertising costs and customer acquisition, you wouldn’t bet against similar customer-based factors playing their part.
So, what's next for clear aligners? Where do we go from here?
The COVID-19 pandemic created the need for alternatives to in-house dental visits and monopolised treatments by clear aligner manufacturers. So, while DTC business models in their raw form may not be the best way forward, the answer may lie in several factors, namely telehealth and in-house aligner manufacture.
Telehealth
Companies like Byte, recently bought out by Dentsply Sirona and Uniform Teeth (now known as Smile2Impress) already offer their customers remote monitoring technology. Here, patients have access to a dentist or orthodontist via an app where they receive professionally monitored treatment without the need for an actual dental visit.
According to the American Dental Association, technological advancements such as machine learning and artificial Intelligence may also mean that in the near future, orthodontic diagnosis and treatment planning can all be done remotely, making this process very easy.
In-house aligner manufacture
In recent years, scanning, planning and printing equipment have also evolved tremendously, opening up the doors for in-house aligner manufacture. Now, just as with CEREC Crowns, the technology is there for dentists to produce their own custom aligners in practice, without the need to go through a centralised manufacturer’s laboratory.
Ultimately, these two factors will play their part in bringing down the costs of clear aligners while providing solid competition for market leaders like Invisalign.
Life After Smile Direct – The key takeaway
The evolution of the clear aligner market and the subsequent collapse of Smile Direct Club shows that professional involvement in the orthodontic process is crucial for successful and long-lasting treatments. However, the future of clear aligners is likely to be one that matches both convenience and price. Get that right and it will be a hard act to follow!