Expand podcast: TPS and collective intelligence

This transcript has been reviewed by AI and may contain inaccuracies.

Daniel Ramos: Welcome to Episode 6 of the Expand Podcast. In this show, I interview Matthias Peper, owner of TP Solution and founder of the TPAO Congress. To date, Matthias has treatment planned over 125,000 cases for aligners, so he's a true authority and brings a very pragmatic perspective to this topic of TPS and collective intelligence. Enjoy it!

Daniel Ramos: Welcome to the Expand Podcast. Today, the topic for this episode is going to be, in my opinion, a trendy topic—something that I'm very familiar with: TPS and collective intelligence. But I invited someone that I believe has more experience, even more than me—Matthias Peper—because this guy here, besides being a great friend, is behind more than 100,000 cases planned in partnership with dentists and orthodontists from all over the world. Is that correct, Matthias? A hundred thousand cases? Maybe a little more. You can correct me. But first of all, welcome, and thank you so much for being here with us to discuss this topic, which I know you are as passionate about as I am.

Matthias Peper: Wow, thank you so much, and thank you for the invitation and the kind words. It's a big, big pleasure for me to be here with you. And yes, you're right, up until today, it’s been more than 125,000 digital treatment plans that my team and I have worked on over the past 10 years.

Daniel Ramos: That's right. So this is exactly the topic we’re going to brainstorm today, right? This collaboration between TPS, which means Treatment Planning Service, and the dentist who is there with the patient. More and more, I’m seeing this concept being applied in several clinics. This is the basis for my daily routine here at the Planning Center in DSD, and I believe you’ve been on this road for some years now, right?

I need to mention also that you are one of the founders of the TPAO Congress, which, in my opinion, is the best congress about aligners that we have nowadays. I had the privilege of being with you last year in Hamburg, your hometown, right? It was really amazing. For sure, for those who are listening to us, they can check the notes and see some links so they can go to the next one—you won’t regret it!

Daniel Ramos: So, Matthias, I like to say that what we do—dentists and orthodontists—used to be in the past like an individual sport. But, do we have space nowadays, with all the technologies available, to continue this way? Or can you say that orthodontics now is more like a team sport, a collective effort? What’s your opinion about it, and how do you connect TPS with this idea of collective intelligence that more and more of our colleagues are discussing?

Matthias Peper: I personally believe that orthodontics has become more and more a collective sport because we have specialists, we have orthodontists who know where they want to go. But, these days, we also have very complex software—software that lets us try out different scenarios, where we can find the perfect scenario for the patient with the help of specialists. So, I think today it makes sense to have a specialist who gives you guidance on the software, on digital treatment planning, and maybe even on showing different treatment plans for the orthodontist to discuss with the patient, to find the best strategy. In my opinion, these are the best days for finding the perfect concepts for the patient.

Daniel Ramos: Yeah, I completely agree. Imagine me, as a dentist, working in my clinic alone. Actually, this was me some years ago when I started. I had to plan cases, and when you just graduate and start practicing, it’s tough because you don’t have enough experience, and it’s normal to make mistakes, right? So, my decision was to work with a professor of mine for several years. It was like a postgrad course for me so I could gain confidence and start doing the cases by myself. It took me 10 years, this process, making a lot of mistakes along the way.

So nowadays, having a TPS is like having a group of specialists working in your clinic with you. For those of you listening, having this support from people who are doing this every day, and who are completely connected to the latest advances and technologies in our systems, is an amazing leap forward in terms of quality and speeding up this process. Matthias, how many dentists are currently working with you in your TPS?

Matthias Peper: Yeah, it’s exactly as you said. So, today we work with more than 500 orthodontists and dentists from all over the world. Ten years ago, I started my treatment planning service, TP Solution, and we’re really focused on complex aligner treatments to support orthodontists and dentists in getting the maximum out of the software. That’s also why, as you already mentioned, we started our own congress. Last year was the third time we held the TPAO Congress, which stands for Treatment Planning in Aligner Orthodontics.

What’s so special about this congress is that, on one hand, we have specialists—the orthodontists—who share their clinical knowledge, showing what they did previously to plan cases. At the same time, we reveal all the secrets of digital treatment planning because the software today is getting more and more advanced, which is a big opportunity, but on the other hand, you need to spend a lot of time in front of your computer to really understand it in detail. This synergy of all experts coming together is the future, and maybe that’s why TPS and the TPAO Congress have become such big things. We had more than 1,200 doctors from all over the world, and the idea is all about learning, learning about digital aligner orthodontics.

Daniel Ramos: Yeah, this is a great example of collective effort. I was at the last congress, and for every lecture we saw, the orthodontist presented their experience and cases, and then afterward, Matthias, with his expertise, explained what was happening in the software. So, everyone could see both sides—the clinical outcome and the behind-the-scenes of the software. This is very rare in most congresses, where we only see beautiful smiles after everything is done, and it’s hard to capture all that is happening. This was a great example of combining technician and orthodontist expertise to present better outcomes.

Matthias Peper: Exactly, exactly. And sometimes it can be frustrating for an orthodontist sitting in a congress, reviewing amazing cases with complex movements—medialization, crossbite correction—and they’re thinking, "Okay, I see that it's possible to do this with aligners, but I don’t know how to program it or how to discuss it with the technician. Which tools do I use, and how do I use them?" They want to go out and understand the details or see if someone can help them with that.

Daniel Ramos: One time, I heard from a colleague orthodontist that he was kind of afraid that a TPS might try to take over his job. In an interdisciplinary clinic like the DSD Planning Center, orthodontics is just one piece of the puzzle, and the orthodontist was worried, saying, "Why would I refer my cases to you? You’re going to do my job." But I don't think this is a fair way to think, at least not from the patient's perspective. Because if there's an opportunity to have more people working together—without substituting, but adding value—it’s better. We're adding filters to avoid mistakes, to prevent unnecessary treatments. This is something that I believe a treatment planning service can add—having one, two, or three more orthodontists, dentists, and technicians working for me, as the orthodontist, so I have more time to study, go to congresses, read papers, and have more quality time with my patients. Not like I did in the past, where I had to stay on Saturdays and Sundays doing clean checks because I didn’t have the proper time during the week, which delayed everything for the patient. Matthias, do you agree? Have you heard similar concerns from orthodontists?

Matthias Peper: Yes, I’ve heard that. But I think at the end, there’s only one question: What can we all do together to find the perfect solution for the patient—the best solution possible? This is only achievable if we work collectively. We are specialists in software—that’s what we do every day. We have experience with more than 125,000 cases, so that doesn't mean we do things better than an orthodontist, but it means we do things better in a technical way. We are the quality managers—we know exactly about staging, velocity protocols, and how to position attachments perfectly. But, as you said, it’s collective—we need to get the best outcome for the patient, and if it takes two or three more people from outside, then let’s do it. Let’s put the patient at the top.

Daniel Ramos: Yes, exactly. That’s a powerful message. The question of whether orthodontics is an individual or collective effort—it’s clear that now it’s a collective sport. Even for those who are not using a TPS, they are using the technicians from aligner companies to help in the process. Few doctors are doing everything by themselves. For those using a company, they are already using collective intelligence.

Matthias Peper: Exactly, and also, sorry to interrupt, but it was the same before. There was always an orthodontist and, on the other hand, a technician who was creating some appliances. It’s just a little more digital now.

Daniel Ramos: Yes, for sure. And this collaboration needs to exist because I believe that we cannot do everything by ourselves. It's crazy to think we can, right? First, we don't have enough time, unfortunately. We need to balance our personal life and work, and trying to do everything... I’ve been in that situation—it’s complex and difficult to maintain for a long period of time. Even being behind a TPS here in Madrid, when I was practicing and seeing patients in Brazil in my clinic, I still used a TPS service. People asked me, “Daniel, you are the one coordinating TPS, why are you using the same service?” And I said, “Because there, I have more colleagues helping me.” Then what I do is a final review. As you mentioned, the orthodontist in the end needs to understand what’s happening, and if he agrees, he personalizes it. I believe over time, TPS and the orthodontist get to know each other and start combining their efforts. This synergy needs to exist if the orthodontist or dentist wants to have a better balance between work and personal life, right?

Daniel Ramos: So, it doesn’t mean, and I’d like to hear from you—even though I think I know your answer—but I want everyone to hear it. Is it possible to say, “Okay, I don’t like orthodontics, my thing is prosthetics or implants, but I want to do orthodontics with aligners.” And now that we have TPS, I’m just going to delegate everything to TPS and they’ll do it for me. Do you think it's possible to offer a good quality treatment without really following the other road, which is studying and learning more about orthodontics? Can you just delegate everything to a TPS?

Matthias Peper: That’s a very good question. And I can tell you that in the past 10 years since my company has existed, we have about 20 technicians and around 500 orthodontists or doctors working with us. And none of our customers are like that. Because, in the end, you need to like what you do, and you need to understand what you’re doing. We provide a digital treatment service, but at the end of the day, even though we deliver the aligners, the doctor needs to understand what they’re doing—how to use auxiliary techniques, how to bond the attachments, and what to do if the aligner isn't fitting perfectly anymore. This is absolutely necessary. We are a treatment planning service; we help deliver a perfect, predictable digital treatment plan, but at the end of the day, the doctor needs to be motivated to do all of the duties involved.

Daniel Ramos: Yeah, I completely agree. I feel that the final destination for everyone is to provide the best possible care for the patient. The patient’s happiness is the goal, the target, right? That’s where we want to get. We have two clear paths in front of us: One is to say, “Okay, I need to become an orthodontist, I’ll do a postgraduate or master’s degree, study, and learn.” Some doctors look at the other road, seeing TPS as a shortcut, which I think is a great way to learn faster. So we have road number one and road number two. But what I like to repeat is that the secret is the third road—the combination of both. If you seek out information, do all the courses, attend the TPAO Congress, and also use a TPS service, you're going to learn much faster with great support from those who are doing this every day.

Daniel Ramos: I believe that’s why, in your platform and company, you combine both. You're not just offering treatment planning—you’re offering education too, right? Tell me more about that.

Matthias Peper: Yes, exactly. On one hand, we have TP Solution, which is our treatment planning service, but on the other hand, we also have the TPAO Congress every two years. We also have the TP Academy, which is an educational platform. We spend a lot of time on this platform, offering education for everything in detail—from the beginner who’s starting to use aligner software to learning how to do prescriptions, clinical references, and individualizing the process for their specific needs in their practice. And, of course, how to do treatment planning and use the 3D tools. But it’s not just that—it’s also about what to do when the patient comes back, in terms of monitoring.

Because digital aligner orthodontics doesn’t just mean ordering some aligners—it means understanding in detail what to do next. It’s not like you have 40 aligners for the upper and lower arch, give them to the patient, and have them come back in 80 weeks. No, it’s the other way around. We need to understand the monitoring; we need to double-check if the treatment plan is following the clinical situation. What can I do to reach the desired outcome? Do I need to discuss with the patient that they need to wear elastics for a longer time? Can I change the aligner wearing time from 14 days to 10 days, maybe to seven days, or does it make sense to go back to 10 days? So, it’s just about how we spend our time now.

Matthias Peper: I think it’s very similar to what orthodontists used to do in previous years with fixed appliances—it’s just a new method to learn and adapt to.

Daniel Ramos: Yes, I completely agree. I believe we have a lot in common, and I think we’ve identified that since day one. I’m also working in a Planning Center, and we believe that the service we provide is not a product that ends when we deliver the aligners. The relationship with our clients—the dentists—continues. For every case, we provide support and consultancy from the beginning to the end, offering solutions. It’s like a happy marriage, right? It lasts until the end. And I believe this is how a treatment planning service should be.

For those listening to us who have never used a TPS, one of the most important messages here is that it’s better to have more—two heads are better than one, three are better than two. The more the better. So, if you have a partner, a treatment planning service that can help you, it’s always better than working alone and making all the decisions yourself. You have the final call, but sharing decisions with more people is much better.

Daniel Ramos: So, it’s clear that orthodontics is not an individual sport—it’s a collective effort. And it’s also clear that TPS is not a substitution, but an addition. We’re adding more brains, more knowledge. And I believe you also learn from some of the dentists you plan with, as they learn from you. We’re improving the protocols, increasing the amount of data we’re collecting. I’m fascinated by the number—125,000 cases with different brains involved. This is a massive amount of data that you’re collecting and seeing outcomes from. My next question is: Do you have the chance to monitor the outcomes? Are they sharing the results with you, or do you use a monitoring system? How are they sharing their outcomes with you, and for those listening, how does this work?

Matthias Peper: Very good question. It’s very interesting because 10 years ago, when I started the company, I was working with the first orthodontists. At that time, I only had the chance to see the refinement and discuss outcomes with the doctors. Sometimes they sent me pictures, and we would try to qualify that. So, for the doctors we work with, we educated them to always take records at the beginning, the middle, and the end, whether or not they do a refinement. This way, we can prove our quality. We live off the feedback from our doctors. I can say that 95% of the doctors who started using our service still work with us, which is, for us, the biggest proof of concept that it makes sense to work together.

We see a lot of results because we also work with many key opinion leaders in orthodontics who present these cases on stage—not just at the TPAO Congress, but at aligner congresses all over the world. And for many of these results, we were the ones working on the digital treatment plans. So yes, we see a lot of outcomes, and we can also say we can prove our quality in terms of reducing refinement rates. We did an internal survey and found that we were able to reduce the refinement rates of the doctors we work with by an average of 22 to 28%.

Daniel Ramos: That’s amazing data. It’s a great way to, not necessarily convince, but to help doctors see with their own eyes the importance of adding this kind of service. In the same way, we at DSD use the digital—it facilitates everything we are discussing. It would’ve been very difficult in the past to have a treatment planning service for braces. But with digital and software advancements, we can do this—we can connect, share data, and plan cases together.

Here at the DSD Planning Center, we’re doing what we call the quality control protocol, or the P-QM. We start out by planning the ideal—the most comprehensive solution. As you mentioned, the software lets us test different scenarios: Plan A doesn’t work, so we try Plan B. If that’s still not good, we move to Plan C. After orthodontic treatment or a set of aligners, we can export the STL file or take a new scan and compare the results. This is something we never did in the past because we didn’t have that reference.

Daniel Ramos: We would plan a case, ask the patient to do all the documentation and everything needed to evaluate properly, but most of the time we were imagining the outcome. We were explaining to the patient, “Oh, it’s going to look like this other case, it’s going to be a class one, it’s going to be good.” But we couldn’t really compare because we didn’t have a reference.

By using the GTO (Goal Treatment Outcome), and by using these quality controls, we can now compare what we planned and what we achieved. This way, we are testing and proving that certain protocols work better for certain types of cases. We now have the data to say, “Okay, it's better to use this new protocol instead of the old one because we’ve seen in X number of cases that it works better.”

There’s never been a better possibility for really checking the quality of our work. I 100% agree with you on that.

Matthias Peper: Exactly. And when GTO entered the orthodontic world, at first doctors questioned whether it would be more work. They wondered if they would have to collect more data. But, little by little, they became convinced that there’s no other way nowadays.

I believe one of the greatest benefits of GTO is this possibility of connecting and simulating different outcomes. You can make mistakes on the computer instead of in the patient’s mouth. This goes back to what you said earlier—the most important thing is the patient.

We can’t test things directly in our patient’s mouth, but now we can do these simulations in the computer.

Daniel Ramos: Yes, exactly. And sorry to interrupt, but this is a great point. How easy is it for the orthodontist to check if they’re ending up with a perfect intercuspidation or a good mesial area, for example? In a digital treatment planning process, this is much easier.

You can view the treatment from so many different perspectives. You can zoom in as closely as you want, and you can be much more specific. Sometimes, we see cases where the orthodontist wants to end up with a perfect class one, but they're thinking of a class one in a theoretical sense, from the book’s point of view—focused on the molars and canines. So, we distalize a bit, and from a buccal point of view, it looks perfect. But when we look at the intercuspidation from a different view, we see that the molar’s position is actually a bit off. Maybe it needs a bit of mesial-out rotation, or maybe we’ve distalized too much.

In a situation like that, we need to adjust things slightly to ensure better intercuspidation and avoid a TMJ problem for the patient in the next 5 or 10 years. With digital tools, we can be much more precise.

Matthias Peper: Exactly. And the level of detail we’re able to reach is incredible. You’re analyzing the smallest things, and for one person to do this alone for all their patients is extremely difficult. It’s challenging to go into that level of detail consistently. This is where a treatment planning service comes in. You have a team of people trained to see these small details, and they help prevent you from making a rushed plan because a patient is waiting, and you’re overloaded with other patients.

When I started, I would often have to open up time on my nights or weekends to do treatment planning. Sometimes you miss something simply because of the volume of cases. Even within the TPS, we have internal quality controls to check for these small details before the case goes back to the doctor.

For one or two cases, maybe you can put in the time and effort to create the perfect treatment plan, but if you’re seeing 10, 15, or 20 patients every day, it becomes impossible to maintain that level of detailed planning on your own.

Daniel Ramos: Yes, exactly. I’m glad you brought that up because that’s exactly what we’re doing. We’re focusing on those details, leveraging our experience and the thousands of cases we’ve seen. For example, we might plan a case in one way, but then realize that the class one looks good on the buccal side, but there’s an interference somewhere else. So, for the next case, we know to adjust that angle, change the torque, or remove some contacts. Case after case, we’re improving.

And using a service like TPS adds these insights from day one. It’s like you’re getting all of this experience added to your treatment plan from the start.

Matthias Peper: Exactly. And something else we see is that software sometimes has its own algorithms and artificial intelligence built in. It may have a different idea or view because it’s based on programming. There's always someone or something behind the scenes setting the algorithms and how the software works. I know we’ll go into this more in another episode, but what I want to explain here is that when we get the first digital treatment plan from the software, we need to read it and understand it. We need to identify any problems and figure out how to fix them easily. This is part of our quality management process.

I 100% agree with you—we have a checklist, and it’s an intense checklist. I want all my employees to be talking the same language and have the same signature as I do. For me, it's all about quality management, and this checklist is gold.

Daniel Ramos: Yes, that’s like your secret sauce, your Coca-Cola formula.

Matthias Peper: Exactly.

Daniel Ramos: And we’ve been talking all this time about our human efforts to be better. But now, I want to give a little spoiler to everyone—we also have artificial intelligence that can help us. If used properly, it can be extremely powerful. I know because we have our CEO, Christian Coachman, at DSD, who is one of the world’s leading experts on AI. There are so many possibilities when you combine collective intelligence, a TPS, and AI tools in orthodontics. This combination is a game-changer. It’s the digital, the human, and the AI working together.

But we’ll have to wait for the next episode to go deeper into that. Matias, I’d like to take some time now to wrap everything up and summarize what we’ve discussed about TPS and collective intelligence.

First of all, I think we both agree that there’s no room anymore for the lone orthodontist. It’s not an individual sport anymore—it’s a team effort, a collective effort. Orthodontics shouldn’t be an individual sport like it used to be. GTO, the digital world, has amplified the collective intelligence we have access to.

I believe the digital is the catalyst for this change. It’s enabled us to share and collaborate no matter where we are in the world. You’re on vacation, I’m in Madrid, and we’re still able to have this discussion. The digital allows us to connect the best experts from everywhere and simulate multiple outcomes.

For those listening, don’t be afraid of TPS or collective intelligence. Use it to become better. Use it to add value and offer the best treatment planning and decisions for your patients. Use it as a tool to speed up your learning process and gain more knowledge.

I’d love to hear your thoughts on this, Matias, and your final conclusions.

Matthias Peper: Yes, I 100% agree with you. I’m always open to feedback because it helps us learn and improve. I think the key takeaway from this conversation is that we need to work together, share our knowledge, and continuously improve for the benefit of our patients.

Thank you so much for inviting me to this podcast. It was a pleasure discussing this topic with you.

Daniel Ramos: Thank you, Matias. It was great to have you here. I’m honored to host this episode of the Expand Podcast, and I’m sure our listeners have learned a lot from this discussion. I hope to see everyone back for the next episode, where we’ll dive into the topic of artificial intelligence in orthodontics.

Thank you so much, Matias. Have a great day, everyone!

Matthias Peper: Thank you! Have a great day. Bye!