‘As a clinician when I go to a lecture and see someone presenting cases, I want to see the literature behind their decision-making process – it’s how I learn’

I worked in a practice that used the SureSmile Aligner system and had to finish cases the previous orthodontist had started. That meant I had to quickly learn the platform, the science behind it and the way it worked. It is a system that has a number of layers and for the beginner can be daunting given the complexities, which meant I had a lot of questions – and some doubts. To calm these doubts and answer these questions, I approached the team in the US to find out more – I sent them cases, worked through their intricacies and tried to approach my work in a different way while ensuring the best outcome for the patient.

Throughout this process, I was contacted by a member of the Dentsply Sirona team in Spain to deliver a lecture, asking me to share my clinical experience. I remember it well because they said they didn’t want me to sell the system, they wanted me to be honest about my experience and knowledge. Given I had some doubts about the system, it meant I knew where the weak points were, things that could be improved and areas where other systems were better. I was adamant that if someone asked me about these weaknesses, there was no way I could not talk about them, and so it was reassuring to know I could do this. Our goal is to improve the oral health of our patients, and part of that means being honest.

As a KoL, I believe it’s important to also reflect on other systems within the field and work with those too. Again, I’m encouraged to do this – it is the only way we as practitioners will improve the service we offer our patients.

Yes, absolutely. It’s very important not to forget we are the clinicians, and that commercial teams and brands take advice from us, not the other way around. One brand I used to work with, for example, gave me a feeling of being obligated to work with them and them only, which made me feel uncomfortable and should make any clinician and KoL feel uncomfortable. The more cases we did with them, the better the reward for the clinician, which again made me feel uncomfortable. Treating patients isn’t a race and isn’t about getting higher rewards – I want to give my patient all the necessary information to make the best, most informed decision about their treatment. That could be choosing fixed appliances rather aligners because they’re not able to or willing to meet the oral health demands their treatment entails – it does not mean selling a brand because I have financial incentives to do so.

It’s hugely important. Good science is good science, and that is separate and independent of me being a KoL and working with a brand. As a clinician when I go to a lecture and see someone presenting cases, I want to see the literature behind their decision-making process – it’s how I learn and it’s how our profession reflects and improves. When I am delivering a lecture, I always try to search for and include references for the audience so they can see why I took the decisions I did. In orthodontics research is evolving at such a pace that a presentation from four or five years ago could have references that are out of date already!

We also face the scenario where a significant proportion of literature in orthodontics on aligners is based on Invisalign, and these aligners are unique – SureSmile, for example, uses a different material to that of Invisalign, so we have to be very careful of using literature within presentations and references that confuses the two. This will obviously come – and we’re carrying out some research at the moment to gather some of these data, but as you know this takes an incredible amount of time.

You’ve just opened up a big wound of mine! In the last two years in Spain, there’s a boom in the number of orthodontic clinics promising patients fast results at below-market prices that don’t have orthodontists on site – they only have a dental hygienist or dental therapist who give the aligners to the patient. They’re branching out into shopping malls where you can see an orthodontist, too. What it means is patients are looking at orthodontic as if it is whitening – a total optional extra – and they don’t want to fix their underlying problems. They look at it purely from an aesthetic point of view.

There are still too many patients who are undergoing unsafe treatment, and so it will take time for patients to realise they’re not getting the attention their oral health needs with no oversight from an orthodontist.

In Barcelona where in practice, last year there were 10 new clinics popping up whose prices are low and have aggressive marketing campaign. During this time, while I had a healthy flow of patients, I would refuse to treat them the way these clinics had promised – which often involved the removal of healthy teeth or the filing down of natural healthy teeth – which meant my prices were higher, personalised care plans were longer and required a higher level of compliance. I would say maybe one in five patients understood these, but unfortunately the rest did not. I prefer not to treat these patients – they come to the practice with unrealistic expectations about their treatment, and often give the impression they know more than we do!

I think there are signs of improvement. I have patients who last year come in for a first visit and consultation, went through their treatment elsewhere, and have now come back to undergo treatment with me to correct the issues we identified at the consultation, plus to fix problems caused by the alternative treatment they chose. There are still too many patients who are undergoing unsafe treatment, and so it will take time for patients to realise they’re not getting the attention their oral health needs with no oversight from an orthodontist. Unfortunately, these patients are experiencing problems, realising there’s no-one available to address them, so are having to find alternative orthodontists to solve their problems.

I really hope patients will see through the differences between quick fix treatment and between treatment that is thorough, longer but to their benefit. As clinicians, it is also on us to educate patients as much as possible about the pitfalls.

The first thing I would say is that AI is not going to replace us – that’s what everyone is talking about right now! I believe it will be more assisted intelligence, assisting us clinicians in what we do, not replacing what we do.

If you’re looking for a career in orthodontics, it sounds simple, but I would say study, and study hard. The aligner world might seem easy and provide an easy source of income, but it’s way more complicated than fixed appliances, and they are the future of orthodontics, so if you want to control the treatment, you need to understand the science.

Finally, don’t let commercial brands – whether you go on to become a KoL or not – dominate the conversation and direction our profession goes in. We trained clinicians have the knowledge, and we treat the patients. Share your clinician experience without selling the product – if you’re a good clinician and you do excellent dentistry, the products you use will sell themselves. Remember, patients are not customers – they will always be patients who defer to our knowledge, not customers who want to be sold to. It’s a small difference, but it will really change the way you view your job.