LAUSR

The Invisalign concept was conceived by two Stanford MBA students Zia Chishti and Kelsey Wirth, and Align Technology Inc was founded over 25 years ago. Neither had any direct experience of orthodontics other than as patients – with degrees in economics and computer science and literature and American history, respectively. Their moment of realisation came from the knowledge that minor relapse in tooth position could seemingly be resolved with optimal vacuum-formed retainer wear; and combined with the potential for three-dimensional printing (stereolithography) on an industrial scale – this has meant >10 million patients around the globe have started aligner treatment with Invisalign (Align Technology, 2021), making it the leading brand of orthodontic aligners. An extraordinary success story for our time you would think, and one that has continued to benefit from rapid advances in digital technology, software engineering and manufacturing techniques. Indeed, many more people have now benefited from orthodontic treatment than might otherwise have done so. So where is the problem? Why does some scepticism remain amongst orthodontists with regard to aligners (and the companies behind them) (The Ortho Cosmos, 2017)? Perhaps the answer is related to a further principle upon which Invisalign was conceived and its subsequent rapid growth realised summarised neatly by founder Zia Chishti: “Some people don’t care about their appearance, and others do, but can’t tolerate the burdens of correcting it. . . . . . We are going to attack both groups with marketing, and it will be a huge market-expansion opportunity for everyone.” (New York Times, 2000). This mission statement is illuminating because it gets to the very essence of the Invisalign success story and more pointedly, why aligner treatments may (25+ years later) still feel like an uneasy fit for some orthodontists. Notably, when viewed in a generic context, this is a statement of intent taken from every successful disruptor’s playbook. That is, the business is built not on the widgets, gadgets and technology that allow removable aligners to be designed and manufactured at scale, but the identification of a failure within the established model of delivery and designed to meet consumer need and demand. All coupled with a relentlessly effective strategy to develop a solution to meet this unmet need without the burden of legacy, entrenchment or confirmation bias, which weighs down (all) established professions. Jumping forward 25 years, the recent shipping surcharge applied by Align Technologies to their European customers has prompted some online debate amongst orthodontic providers about the role of aligners in their clinical practice. Although this was the first price increase for some years, the reaction does perhaps reflect an element of grudging acceptance that seems to exist amongst many orthodontists regarding aligners. Why this might be so and what the relative benefits of embracing aligner technology may be for the specialist are worthy of some discussion.