In this episode of Coffee Break with Coachman, Christian Coachman speaks with Dr David Lopes, Director of Global Clinical Product Development at Align Technology, the global medical device company behind Invisalign® and iTero.
Christian and David discussed their experience in ortho-restorative cases, the benefits of orthodontics with Invisalign, and the collaboration between DSD and Invisalign.
Meet Dr David Lopes
David graduated from the University of California in San Francisco in 1997. He credits his passion for continuing education to his former employer, who was innovative and determined to stay at the cutting-edge of clinical dentistry, practice management, and technology.
Through this learning, David developed a passion and enthusiasm for interdisciplinary dentistry and looking at his patients’ oral health as a whole, especially oral health and esthetics as a holistic unit, and how to best serve patients. He describes this as his driving passion through 20+ years of practice.
Though his background is in restorative dentistry, David became Invisalign certified in 2007, as he found that having greater control over tooth positions serves both him and his patients well.
In 2016, he began to work with Align and describes his mission, in part, as to make the learning experience less self-reliant for the dentist and to guide doctors down this path so that they can realize the benefits of moving teeth.
The concept of ‘moving teeth first’ in restorative procedures
Christian: “In ortho-restorative cases, I realized that the first challenge for us, as professionals, was to see the beauty of moving teeth, and why it's good for the patient. Then the second challenge was to convince the dentist to move and then together, convince the patient, right?"
David: “When I talk to dentists about this mind shift you're talking about -- I think you'll appreciate this -- I say: "Go back to when you learnt how to do denture set-ups (and I know you refer to the denture set-up sort of philosophy when you look at smile design). And so, if you were handed a denture set-up where the teeth were out of alignment and one tooth’s here and one tooth’s there, and you're instructed to improve it, and fix it, would we just get our hammer out and start adding composite to the teeth? No – we would get our heating instrument, our waxing instrument and move the teeth.
So, on one hand we're taught to think this way, but in so many other examples, we're taught to just fix it, and 'do what you got to do'.
So I'd like to just remind dentists ‘Hey, you're actually really good at repositioning teeth, you were taught to do it perhaps better than anyone else in this world. You know where the teeth should line up, you know what looks best, with facially-driven esthetics and so forth, so trust that.’
It's the tool that becomes the trick. Now you don't have a heating element or a waxing instrument, you have ClinCheck®, you have Invisalign, you have clear aligners -- so learn how to use them, get on the journey, get better at it, and there you go."
What are the exact advantages of moving teeth? Why should dentists convince patients to do it?
David: “When you're sitting down with a patient and you have to do some sort of either simple restorative or more advanced, and their teeth are misaligned – the contacts are uneven between the teeth, adjacent teeth, the opposing teeth – is the sweat coming down your forehead? Is it more stressful? Does the appointment take longer? Are you stressing that the restorative material properties you're using are over bulking surfaces?
Compare this to when you're sitting down with a patient and the teeth are aligned nicely. We see this as a celebration because now we can really operate, we can do our craft, we can operate at our optimal performance because the teeth are in the right position.
So when I talk about these situations with dentists they're like: ‘Of course it's much easier this way, I get much better results.’
And I say, ‘Why don't we try to do that as much as we can? Why do we want to go the other way?’
For patients, it’s for the health obviously. If the teeth are in the right position, you should ask doctors: are you going to cut less or more of the tooth? If they're in the wrong position, I am either going to have to cut more if it's subtraction or add more material over both the surfaces.
And so they realize, it's much healthier if I get in the right position, do as little damage or trauma to the teeth as possible, use the restorative materials to their optimal advantage, and aesthetics and optical properties.
When you state all of these obvious reasons, the light bulbs just start switching on. And for patients, you are able to show them the difference between not moving the teeth versus moving them – such as in the collaboration that we do with DSD, where the patients can see a visualization of when their teeth have moved versus not moved, and how much tooth might have to be cut off if we don't move the teeth. It's a big deal.”
Simpler, faster orthodontics with Invisalign
Can you explain a little bit about why orthodontics is more simple because of Invisalign's technology?
David: “That's an excellent question and you know I work at Align right, so naturally I represent Align, but what I'm going to share now is quite truthful -- this is a doctor's impression, ok.
Whatever technique is used, we hope our patients have the healthiest outcome with the best results. Align's advantage is that they've been doing this for over 20 years. Over nine million smiles have now been treated with Invisalign -- many of these very, very complex corrections as well.
And so, when you have that sort of experience and database, teams working globally every day to learn as much as possible from what we've encountered there -- the good, the bad, you know all of that –– and you have doctors that can help you develop all this, it's just a natural advantage to be able to tweak and perfect your product.
We have what are called smart technologies. We have SmartTrack, which is our device itself – not all plastic is created equal.
We like to say that, but it's true that the plastic itself can generate forces on the teeth that are unprecedented compared to the evolution of their plastic aligners, and that took a lot of research and development to get to that point.
SmartForce refers to the features we put on the teeth -- the attachments and the way the aligner engages with the teeth to optimize the direction of the movements, the magnitude and the velocity.
Then you get into the treatment planning part and the treatment plan for the doctor is supported by being able to visualize exactly what they want.
Then you can stage it through the course of treatment in a way that delivers an efficient, very predictable path for the patient. So, all this combined means that you can do now offer shorter treatment plans. We have ‘one-week wear’ for example, which evidence-based research has shown that a one-week wear will deliver amazing results very, very quickly.”
Could you give some insights for the people starting their journey? How would you suggest they start their Clincheck journey?
David: “Sure. I think the first thing is to consider ClinCheck as a visual treatment planning tool.
If a general dentist were to think of how they treatment plan their restorative cases -- unless they're doing a diagnostic wax-up –– then they're having to do that treatment planning either in their head (which we all do visually), or maybe using a DPMS system, entering treatment plans on a two-dimensional surface.
ClinCheck is a three-dimensional way to treatment plan and preview the results of a case. Now, the tools -- we learn how to use tools such as the 3D control. What 3D control allows you to do is to change the position of the teeth in real-time, with the face right next to the 3D controls so that you can see the results of the tooth movement with the face next to it.”
Invisalign Go and case selection for short-term orthodontics
What is Invisalign Go®?
David: “Invisalign Go is an example of where we designed a product specifically to guide less-experienced doctors on the journey – to build up some confidence and repetition.
Case selection is really important, so that you don't jump into a really difficult case before you are prepared to do so. Invisalign Go guides doctors in selecting the right case to keep them in a very predictable arena of treatment, with simple, achievable movements that build doctors' confidence.
Within 30 seconds or less, ClinCheck will tell you which movements are simple, which movements are more difficult, and if the overall treatment goals are easy.
It will also tell you whether to go ahead with treatment or whether you ought to consider looking at a different treatment plan before moving forward, so the doctor can make an informed decision.
The way we all get better is when we do more, repeat, and learn from others. And so with case assessment, that's the goal -- allow the doctors to experience success and build successes up so that they can have the confidence to become better and better at it.”
Thank you again to David Lopes for being a guest on Coffee Break with Coachman! You canwatch the whole interview here.
Or why not check out Christian Coachman's full clinical masterclass on how to successfully implement aligner treatment in your practice called Grow Your Aligner Business. You can find it on DSD's premium video content platform, WatchDSD.
This article was created in association with Align Technology.
For more information about how DSD can help you transform your clinical workflows with digital and improve your aligner treatment offering,book your seat at DSD Residency 1 Livestream here.
