“Unlimited refinements” have a hidden cost - dentists & patients are footing the bill

Professor Ama Johal

Posted on

January 4, 2023

Refinements, refiners, additional aligners - all of these terms refer to the need to ‘course correct’ during clear aligner treatment. Refinements can be a normal part of treatment, but traditional aligner manufacturers have taught dentists to believe that unlimited refinements are a good thing, when in fact it indicates an industry-wide treatment planning problem.

We're passionate about this because refinement rates are increasing. We've spoken to hundreds of capable dentists who have had to disappoint a compliant patient who wanted a new smile for a special occasion. On average, refinement rates of traditional brands are now more than double the initial number of planned aligners; with 32Co, fewer than half of our cases require refinements.

The truth is, when traditional aligner brands offer you unlimited refinements, it’s not because they’re on your side. Unlimited packages aren’t solving the problem of unexpected refinements - it’s actually part of the problem.

Think of it this way: if you used the same architect to build new houses, and they repeatedly ran into unforeseen issues, would you blame the builders, or the architect’s ability to plan? What if I told you that this architect was working with thousands of different builders, and running into issues every time? Your aligner brand is acting as the dodgy architect of your treatment - and without the proper level of support in planning your cases, both you and your patient potentially suffer unwanted delays.

What does the data show?

In a recent survey of over 400 clear aligner providers, over 53% said they average at least 2 refinements in every case [source: National Aligner Network]. If you’re reading this thinking, “I probably average about 2!”, you’re not alone.

One recent study [Kravtiz et al., 2022] published in the American Journal of Orthodontics reported only 6% of cases completed treatment without refinement, with an average of 2.5 refinement scans per case and 41% requiring 3 or more refinements. This translated to a staggering average of 64 aligners required, and a treatment time of 22.8 months

Why do unexpected refinements occur?

Unexpected refinements can often be attributed to:

  1. Insufficient interproximal reduction (IPR)
  2. Patient factors
  3. Unrealistic treatment planning

The hardest factor to control is obviously patient compliance, but vs. DIY alternatives, in-person treatment is well-placed to nip this in the bud. IPR requires skill and confidence, and at 32Co, we work 1:1 with dentists to support them with this.

However, we’ve seen that treatment planning is by far the most significant factor. 32Co providers have access to 1:1 specialist orthodontist mentorship whenever they need it, and this is proving the difference.

Why do traditional options leave dentists and patients vulnerable to disappointment?

  1. Treatment planning is an orthodontic skill - The order, type and degree of tooth movement per aligner is different in every case. What works in one situation won’t necessarily transfer to another.
  2. Traditional aligner manufacturers don’t set dentists up for success - Despite how easy it is made to look and feel to the prescribing dentist, AI cannot treatment plan for you. Dentists regularly send us simulations from traditional manufacturers which have our Specialist Orthodontist team worried! They are playing fast and loose with clinical rigour and realism, which by definition means far too many treatments don’t go to plan.

So, why do traditional aligner manufacturers offer unlimited refinements?

Manufacturers have two options to combat poor treatment planning:

  1. Lead with clinical rigour to upskill and support clinicians and create a more predictable case journey
  2. Print more aligners

Traditional manufacturers go for option 2 - printing more aligners.

Option 1 is difficult for them to pursue. They are not educators, nor are they clinically-led; they have shareholders to manage and Option 1 is more costly, which adversely affects their margins.

Honestly, it's more profitable to print more aligners. It's not the manufacturer’s chair time that's being wasted, and they don't have to answer to the patient when expectations aren't met - you’re paying that hidden cost.

Why we’ve built a different approach to refinements

We looked at all of the issues feeding into increased refinement rates and built a platform capable of fixing them. We provide high-quality, innovative training (for free). We identify when clear aligners aren’t suitable to meet the patient’s non-negotiable objectives. We offer best-in-class, fast UK-based support - and provide 1:1 Specialist Orthodontist mentorship when dentists need it.

This means that we have detailed understanding of all our providers’ skill levels, and can focus on developing specific areas. This revolutionary approach means dentists are able to consent appropriately on achievable outcomes, and aren’t betrayed by unrealistic treatment plans.

Of course, we offer packages with refinements - but we advise dentists on the likelihood of needing them for each case. That’s why every package we offer is bespoke to each plan. This has the dual benefit of more reliable outcomes for patients, and better prices for most cases. Ultimately, our goal is to reduce the number of refinements as much as possible, for as many dentists and patients as we can.

Why do we care so much about reducing refinements? Because it means:

  1. Your patients’ smiles arriving on time
  2. Less time in the chair (so less time wasted for both you and your patient)
  3. Higher-quality care - and increased trust in your workflow

Additionally, lower refinement rates means earning money more smartly, in less time - regular 32Co Providers are saving up to £400 on extra chair time and refinements per case, and some are passing that saving onto the patient.

Join the Clear Aligner revolution

With better training, more transparency, and in-depth mentorship throughout the treatment planning process, 32Co just gets more reliable results than traditional alternatives.

That’s why dentists love 32Co. You can work with a top Specialist Orthodontist whenever you need it, and our bespoke pricing means cheaper lab bills for the vast majority of cases.

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support@32co.com