News Archives - The Ortho Cosmos

Unmasking Pathological Skepticism

September 6, 2017 by Scott Frey Leave a Comment

Forging Doubt

Manufacturing doubt is not difficult, because in science all conclusions are provisional, and skepticism is intrinsic to the process. However, just because we don’t know everything, that does not mean that we know nothing. In fact we know quite a lot, but it is about what we do know, and what we can begin to uncover, that merchants of doubt want to conceal.

The term pseudo-skeptic refers to those who declare themselves “skeptical” of a concept when in reality they would not be convinced by any evidence. By redefining their own credulity and bias as “skepticism” they attempt to claim the moral high ground in any discussion to exempt themselves a logical critique of their argument. This practice of faith-based disbelief is not scientific in the least and is deeply unhelpful to the specialty. Forging doubt, especially in the teeth of scientific evidence, in order to protect the status quo only erodes the potential for meaningful progress and serves to lowers the bar for care.

A goal of proper skepticism is also to reveal the deception of dubious doubters so that the magic behind their tricks disappears. Thus it is important that we unmask common characteristics of pathological skeptics, so that we are not fooled by cheap card tricks. The differences between pseudo-skepticism and skepticism appear in the conduct of an individual’s actions and statements. The following are common characteristics of pseudo-skeptics in orthodontics:

Does not question anything from established scientific institutions, but takes whatever they say on faith and demands that others do the same. Views the scientific establishment as a religion and authority to be taken on faith and never questioned or challenged. Fails to understand the difference between the scientific process/methodology and the scientific establishment.
Assumes that the scientific establishment is objective and unbiased, and free of politics, corruption, control, censorship and suppression for no other reason than blind faith in authority. Science is a tool and methodology, not an authority to be obeyed. It is important to be able to understand the difference between the scientific process and the scientific establishment.
Resorts to various logical fallacies. Most often appeals to authority, appeals to ignorance, appeals to tradition, and moving the goal posts to institute hurdles against new concepts.
Assuming their criticisms require no burden of proof.
Double standards in the application of criticism. Only applying “critical thinking” to concepts or treatments that oppose tradition, but never to the status quo itself.
Immediately judges as false and debunks any scientific data that contradicts their paradigm. Especially if the source of the preliminary data is outside the “scientific” establishment.
Automatically dismisses and denies all data that contradicts tradition or orthodoxy.

iTero Element 1 min Scans

June 30, 2017 by Scott Frey Leave a Comment

As the version 1.5 software update was pushed out for the iTero Element, they added features like TimeLapse and multi-bite scanning, but they also revamped the software codebase allow you to capture scans faster without changing the rate or quality of the data capture. These improved scan times close the gap with the Trios intra-oral scanner and the machines should now be fairly comparable in terms of quickness (as has been our experience with both scanners in our office).

The improvement in scan times has been dramatic enough that Invisalign is even going so far to call this a “1 minute scan.” Their claim that patient scans can be completed in as little as 60 seconds, with the same accuracy and reliability as before, is based on a small pilot study on scanning times performed with the new software. Align technology was able to provide us details regarding the pilot study.

Data analysis was based on 40 iRecord scanning sessions with average scan time of 58 seconds by 2 experienced persons scanning. Each scanning session consisted of an iRecord intra-oral scan protocol (scanning both upper and lower jaw along with bite), one patient (Align Employee – an intra-oral scanner model), and two different scanner operators (Align Employees). Every variable was carefully measured to reliably imitate the workflow of a dental patient, a dental professional, and a dental practice. Each operator was timed from the start of the scan (where the scanner was placed on the initial lower back molar tooth) and ended after the scanning of the bite. The scanning of both jaws with the bites is enough data for an entire dental digital impression, which is what professionals consider a full scan. Both operators were asked to conduct scans as effectively as possible while capturing all accurate dental data.

The conditions of the scanning sessions are meant to replicate how many dental professionals perform their scans and in what conditions that these scans are performed. From the data, the average scan time of 58 seconds leads the iTero team to believe that a 58 second scan will be a time goal other dental professionals and practices can obtain once gained an experience.

What we should take away from this data is that, with practice, your staff is going to develop the muscle memory to knock out intra-oral scans on relatively mild malocclusions in about a minute, which is fantastic. More challenging bites to scan will naturally still require a little more time, but they will certainly be much much quicker as well.

Fifth Circuit Ruling On Specialty Advertising

June 26, 2017 by Scott Frey Leave a Comment

As many of you are aware, the Fifth Circuit Appellate Court last year ruled in favor of Texas dentists from the American Academy of Implant Dentistry, the American Society of Dentist Anesthesiologists, the American Academy of Oral Medicine, and the American Academy of Orofacial Pain being able to advertise as “specialists” in Texas. Following this ruling, various false authorities online have been moonlighting as attorneys, offering up their interpretation of this resolution, and spreading fear that this opens the door to any dentist being able to call themselves a ‘specialist’ in whatever they choose, such as clear aligner specialists. It seems that they fail to see the irony of someone without any legal training offering a legal opinion on this ruling in particular.

In order to receive proper guidance from a qualified legal specialist, we consulted with Sean Murphy, associate general council at the AAO, for clarification. Naturally, there were substantial differences between the online rumors and what the Fifth Circuit held. First, the 5^th Circuit’s decision only concerns Texas’ specialty advertising regulation (Section 108.54), and there was no ruling made about the constitutionality of any other state’s advertising laws or regulations. In addition, and as the Court made clear, “Section 108.54 is held to be unconstitutional only as applied to these plaintiffs.” Opinion, p. 6. Given the Court’s as-applied finding, the only dentists who can now advertise as specialists in Texas are those doctors from the nine ADA specialty fields (who were already able to advertise as “specialists” under Section 108.54) and those members of the American Academy of Implant Dentistry, the American Society of Dentist Anesthesiologists, the American Academy of Oral Medicine, and the American Academy of Orofacial Pain. So, does the 5^th Circuit’s narrow ruling allow anyone to call themselves an orthodontist or an aligner specialist after taking a weekend course? No. Overall, the idea that this ruling grants permission to any and all general dentists to declare themselves a specialist in whatever they please, especially one of the established ADA specialties, is complete and utter nonsense.

The take home here is that nothing has really changed other than Texas dentists who practice implant dentistry, anesthesia, oral medicine, and orofacial pain tired of the slow pace of specialty recognition by our parent body, the ADA, so they reached out to the courts for help and got it. The sky is not falling, it is not a new world order and when you wake up tomorrow, most general dentists in Texas should still not be advertising as specialists.

iTero TimeLapse Technology

June 14, 2017 by Scott Frey Leave a Comment

TimeLapse Technology

As part of the recent iTero 1.5 software release, orthodontists now have access to Invisalign’s TimeLapse Technology on our Element machines. This feature takes historical scan data and compares it to the current scan in a visual manner, allowing patients see changes in their tooth wear, tooth movement, and changes in gingiva over time. You can see how this TimeLapse feature works in the videos below.

Tooth Movement TimeLapse

Tooth Wear TimeLapse

Gingiva TimeLapse

The TimeLapse feature is mainly targeted at increasing utilization of this technology with general dentists who would be tracking these types of changes at routine cleanings, but orthodontists may find some applications beneficial such as assess the extent and nature of orthodontic relapse after treatment and generating examples of treatment changes to demonstrate to patients.

I will say there is huge potential in the future for this technology because it will help facilitate better collaboration and more effective referrals between family dentists and orthodontists once Invisalign is able to generate a more integrative cloud based infrastructure. I looking forward to it!

Trouble with Transparency Under the Sunshine Act

June 7, 2017 by Scott Frey Leave a Comment

Time for Transparency

In order for fellow orthodontists, as well as the general public, to adequately assess for conflicts of interest and general bias, all monetary contributions from companies and organizations made either directly or indirectly to doctors must be publicly disclosed in some fashion. The Physician Payments Sunshine Act, passed in 2010, was an attempt to provide greater transparency; however, the law doesn’t adequately cover all streams of income that can flow from manufacturers and distributors. This means that many doctors are on the honor system to provide this information and it allows for some to keep the origins of their income concealed.

Each year, the previous year’s data for Open Payments is submitted from manufacturers by March 31st, and they allow a 45 day process for dispute and review before the information is published to the Open Payments Database on June 30th. If you are interested, these payments made directly to doctors can be looked up for anyone you are curious about using the Open Payments Data Search Engine. Our concern however are the payments that are going unreported and do not appear on the site.

While the Sunshine Act requires medical product manufacturers to disclose to the Centers for Medicare and Medicaid Services (CMS) any payments or other transfers of value made to physicians or teaching hospitals, transfers of value that are made to a third party that isn’t a doctor or teaching hospital do not need to be disclosed creating the potential for abuse.

Clever individuals and groups are able to essentially ‘launder’ money provided by companies through educational organizations, industry magazines, educational grants for meetings or forums, vendor fees at the same meetings, internet groups, etc. because these entities do not have reporting requirements under Sunshine regardless of whether or not the entities are owned by a doctor or a group of doctors. In the instances where these entities are doctor-controlled, once the money goes in they are able to reroute the funds to themselves, pay it out to affiliated doctors or speakers, or pass the funds between other organizations and groups that are aligned with their interests and working towards the same end. Furthermore, preferred pricing on products extended to key accounts are not adequately disclosed.

Naturally, we are beginning to see more and more organizations like this popping up with affiliated doctors organizing themselves into what can only be described as “mutual admiration societies” to help establish credibility and coordinate promotional efforts. Since the industry money is being ‘cleaned’ by passing it through or amongst these entities first, these doctors can also technically deny that they receive compensation from these companies, and without them opening their books completely it essentially impossible to distinguish funds that are provided by manufacturers from those that are earned by other means (ticket sales, membership fees, etc.). They are basically on the honor system to disclose any potential conflicts of interest.

There are plenty of other forms of bias out there that can cloud research and recommendations, but financial conflicts are an extremely important disclosure to make. The dilemma we now face as a specialty is that we simply may not be able to get straight answers from the types of entities we have outlined here on the sources and extent industry financing the receive. Therefore, we must consider the information flowing from these organizations, and their affiliated doctors, with increased skepticism and challenge.

In the interests of greater transparency, we list all disclosures of any financial relationships our doctors have either directly or indirectly with companies or any of the entities in question on our Speakers page under the About tab.

Invisalign Releasing Extended Payment Terms

May 23, 2017 by Scott Frey Leave a Comment

Extended Payment Terms

It is important for orthodontists to offer flexible financing arrangements to help make great orthodontic care more accessible to patients. Unfortunately, due to the lab fee, many doctors have felt that they can be as flexible with in-house financing terms when using products like Invisalign. We have already shown that orthodontists don’t need to charge more for Invisalign or be less flexible with financing, but the upfront costs of the lab fee are about to become even less of a concern because Invisalign will begin rolling out extended payment terms on their lab fees to doctors.

This will allow doctors to provide even greater flexibility in their financial arrangements with patients, and will help to make treatment more affordable for families. Initially, this program will only be available to Invisalign’s Top 1% and Elite level providers so if you aren’t a Top1% or Elite doctor and you feel excluded, time to treat more patients with Invisalign….

The rest of this post, including details on the extended payment terms, is available only to orthodontists and orthodontic residents registered with the Ortho Cosmos…..

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What to Look for at the AAO 2017

April 21, 2017 by Scott Frey 1 Comment

With the AAO kicking off today, we thought it would be worthwhile to give a quick run down of some of the things that caught our eye at the annual session this year. We don’t have any formal posts planned over the weekend, but I’ll be checking in throughout the session on Facebook to share interesting finds and updates. Hope to see you there!

New Products

Invisalign’s Mandibular Forward Advancement (pending US release) – There will be a heavy Teen focus at the Invisalign booth this year, and for those of us looking forward to their functional aligner appliance there will definitely be additional information to prepare you for when it gets to the US.
Henry Schein’s New Color Class II Motion Appliances – The ‘Colors in Motion’ are very cool and will be a lot fun for patients.
EasyRx – For those of you not familiar with this product, it is a really nice in-house service for coordinating 3D printing within your practice, and worth a look. They are rolling out the ability to do some processing of the models from within the Rx form so you will be able to in a few clicks add a base, hollow out the .stl files, label them, and queue them for printing at any location right from the cloud (no noodling around with MeshMixer).
The Wireless Trios – Probably going to cost waaaaay too much, but will still be cool to look at.
Various 3D Printers & Software across the exhibit hall. Make sure you check our series of posts on 3D printing so you don’t overpay and find the right machine for your practice needs.

In the Lecture Halls

Saturday 9-10AM: LeeAnn Peniche – BYOB: Be Your Own Brand
- I have never used LeeAnn, but I have heard great things. Will be worth getting up early for.
Saturday 10:15AM: Hugo De Clerck – Rotations of the Maxilla and the Occlusal Plane: The Key to Successful Orthopedics
- Will have some great information on what actual orthopedic effects on the maxilla look like, since most people are only familiar with protraction dogma.
Saturday 2:15AM: Rebecca Bockow – Goal Oriented Treatment Planning with Corticotomy Facilitated Orthodontics
- Not familiar with this speaker, but will try to swing by to check out the content. We should always be looking to modify gingival phenotypesto reach our treatment goals rather than treating to the pathology.
Saturday 3:00AM: Antonino Secchi – Leveling the Occlusal Plane to Solve Vertical Problems
- I saw Antonio’s topic and now I know why he was so impressed by my Invisalign lecture that he attended last year. Great guy!
Sunday 9:15 – 10:15AM: Maria Bailey – Millennial Moms: 202 Facts Marketers Need to Know
- Unless you actually happen to be a millennial like myself, this should be a great talk to catch to help guide your understanding of how to connect with this generation of parents/patients.
Sunday 10:30 – 11:30AM: Chris Bentson – State of the Orthodontic Industry
- Chris always has solid information.
Sunday 3:00PM: Mani Alikhani – Vibration and Perforation: What Do They Have in Common?
- Vibratory stimuli are much harder to direct, but still a useful tool for bio-stimulation. If you are prescribing these types of interventions, it is good to examine the physiology behind them to better guide your judgement.
Monday 10:15AM: Branislav Vidovic – The Influence of Orthodontic Treatment on Facial Balance
- This talk sounds like it might cover some similar concepts that I cover in my Soft Tissue Orthodontics courses so might be interesting to check out.
Monday 10:45AM: Chris Chang – Three Major Applications of Extra-radicular Screws
- Chris has a very interesting practice and I always enjoy seeing him present.
Tuesday 9:00AM: Seung-Hak Baek – Surgery-First Approach for Skeletal Class III Patients
- Even if you do very few surgical cases, everyone needs familiarize themselves with surgery first approaches. Much better for insurance approval, speed of treatment, and patient acceptance.
Tuesday 10:25AM: Jianyong Wu – Treatment and Post-Treatment Effects of a New Magnetic Palatal Expansion Appliance
- If you are still hanging around on Tuesday, you might poke your head in and see what the appliance looks like. We definitely need a better range of options for expansion with more precise (and lighter) force levels that we can prescribe.

The Guru is Dead. Long Live the Guru

April 19, 2017 by Scott Frey Leave a Comment

False Arguments from Authority

There are entirely too many business gurus out there claiming to be in possession of “special knowledge” which is evidently denied to everyone else. The more unpredictable the changes within the specialty, the more people appear who claim to have all the answers about how to run a successful practice.

There is just one problem….. In an increasingly uncertain marketplace, existing business models offer little value, regardless of who is ‘selling’ them. Who out there feels that with the flow of venture capital into the dental space, crushing student loans levels among new graduates, and rapidly shifting technology that the practice of orthodontics is becoming more certain?

Building an orthodontic practice that treats patients well takes hard work. If you are looking for a proxy-parent to tell you how to do it, I hate to break it to you, but there is no such thing as an authority. Furthermore, those offering advice must be subjected to greater scrutiny.

The best way to excel in an uncertain market is to learn faster than your competition. By testing your intuitions quickly and inexpensively, you can help minimize risk, and build a model for practice that best suits your patients today.

What Patients are Saying About Smile Direct Club

March 25, 2017 by Scott Frey 1 Comment

Innovation that helps expand access to care is a great thing for healthcare, so when I saw Smile Direct Club entering the market I was very intrigued. In theory, mail order aligners and at-home orthodontic treatment has the potential to be helpful to a number of patients who otherwise would not be able to see an orthodontist. However, as is the case in many areas of healthcare, corporate greed can often taint a promising approach to treatment.

The inherent problem with Smile Direct Club is that it is not a doctor run organization; it is owned by Camelot Venture Group (Sharper Image, Lens Express, etc.). Their model is not about patient care, it is about profit, and they have been very successful at lobbying state legislatures to allow them to operate without the same oversight provided by state dental boards who’s mission is the protection of the public. Prospective buyers should treat this like any other medical decision and get multiple opinions. They may find that the local orthodontist they know and trust already offers comparable pricing for limited treatment as well as convenient at-home treatment.

There are certainly patients with minor tooth alignment problems who would be great candidates for this type of care model. However, it is hard to tell whether you are actually a candidate for their treatment because SDC provides a financial incentive for dental professionals to approve their treatments so they can ship cases. Additionally, it is extremely difficult for patients to track down reviews of Smile Direct Club, and when you find one it is hard to rule out whether or not it is a fake review or patient story sponsored by the company. Difficulty in gathering valid feedback from customers may stem from the company’s Terms of Service that requires customers enter into an Arbitration Agreement that covers “any dispute regarding the products and services.”

I thought it would be helpful if I could compile patient reviews of Smile Direct Club to make them easier to find. It took me a while, but I did my best to gather a representative sample of SDC reviews from people who actually appear to be verifiable patients of Smile Direct Club. I was hoping for better, but this is what I found.

Patient Reviews of Smile Direct Club

Read C S.‘s review of SmileDirectClub on Yelp Read Bradley B.‘s review of SmileDirectClub on Yelp

Read Samuel T.‘s review of SmileDirectClub on Yelp Read R O.‘s review of SmileDirectClub on Yelp

Read E C.‘s review of SmileDirectClub on Yelp Read Corie K.‘s review of SmileDirectClub on Yelp

Read Jen M.‘s review of SmileDirectClub on Yelp Read Karlyn B.‘s review of SmileDirectClub on Yelp

Charting a New Direction

March 21, 2017 by Scott Frey Leave a Comment

It is Time to Rethink Orthodontic Learning & Discussion

The free exchange of ideas is fundamental to both the health of the specialty and the advancement of patient care. Unfortunately, in the world of social media it has become all too easy for many orthodontists to recede into ‘safe spaces’ and intellectual ghettos where ideas are no longer challenged.

We seek to provide an alternative.

Opening the peer-review process for scientific publications in order to make the process more transparent and to invite more substantial challenges to scholarly publications. With the increasingly rapid pace of innovation in orthodontics, we are now finding that reviewers assigned the responsibility of vetting scholarly claims are not always equipped to pose pointed questions to the authors on new topics. Opening up the peer-review process provides for a more robust critique of publications and allow better science to prevail.
Free, uncensored discussion and full transparency. Proxy-parents, tribal knowledge, and corporate interests are not the pathways to advancing the specialty. Meaningful progress can only come from a competition of ideas.

We are very excited about this project and hope you’ll join us in improving the specialty better and educating the public.