Taking Control of Aligners
McInnis, a graduate of the Medical University of South Carolina, who completed his orthodontic residency at the University of Missouri, Kansas City in 1998, was part of that first wave of orthodontists working with Invisalign when it launched. Initially, cases weren’t as successful as he would have liked. The combination of PVS impressions, materials, and inadequate attachments kept McInnis turning to fixed appliances. But about 5 years ago, his opinion changed as he saw how other orthodontists were pushing the modality’s limits beyond what he considered possible. What’s more, he saw a treatment modality that could help eliminate the decalcification and other hygiene issues that come with fixed appliances. From there, he dug into the biomechanics and realized he could get the results he craved with aligners.
Aligners, and a digital orthodontic workflow overall, allow McInnis to significantly reduce the number of follow-up appointments necessary. This translates into higher revenue for the practice even though the material cost of treating a fixed appliance patient is lower.
“Braces themselves are cheaper than say aligners, but you end up seeing the patient almost twice as much. [With aligners,] you can treat a patient with a more expensive lab bill and still come out ahead because you’re going to see them fewer times in your office,” he points out.
Today, the practice is evenly split between aligner and fixed appliance cases when it comes to new starts.
McInnis started offering in-office aligners over a year ago, giving patients a more affordable option and reducing his lab costs. Most labs have a fixed fee, regardless of the number of aligners printed, and they often require the full lab fee upfront. As patient down payments are typically lower than the lab fee, it’s often months before the practice breaks even and sees any profit—a concept McInnis never loved.
“With in-office aligners, my initial cost is solely related to the aligners that I fabricate. My costs for producing those aligners are spread out over a longer period of time,” says McInnis, who offers patients the choice between braces and aligners, and then between in-office aligners or Invisalign. The patient chooses, but McInnis is able to offer a lower down payment with in-office aligners because of the pricing structure as it relates to the lab bill. McInnis opts to print smaller aligner orders in house, leaving the larger orders to outside labs.
Now in terms of costs, McInnis is quick to dispel the idea that the cost of the 3D printer should be the barrier to printing in-office aligners. Often, he hears colleagues cite the $8,000-$15,000 cost of a printer as the reason they can’t possibly get into in-office aligners, while at the same time they didn’t bat an eye at a $150,000 x-ray machine or a $30,000 intraoral scanner. “You obviously make choices based on a number of factors, but don’t look at the cost as the big deterrence because where there are more expensive things that you use in your practice on a daily basis. This particular one will allow you to generate a different revenue stream,” he points out. For McInnis, labor is the largest expense, not his 3D printer. Currently, he has two-full time lab techs.
For those who do decide to make the plunge, McInnis cautions against the budget printers. Yes, the upfront costs and resin costs may be less, but there’s a trade off in terms of accuracy, reliability, and staff time. “Having consistency of workflow and dependability of a commercial machine was the direction that I went,” says McInnis, who next plans to expand into printing indirect bonding trays. “Ultimately, I was trying to have something that would cut down on staff time because labor amounts to one-third the cost of the aligner,” while the printer cost averages about 50 cents per aligner in his practice. His in-office lab fabricates on average 110 aligners per day.