Having attended their seminar presentation, here are my impressions of this potentially game changing technology: -Using digital recreations of the teeth with the braces placed and transmitting it over the Internet to their lab, robots shape the wires to be placed in the braces in such a way as to achieve the doctors prescription for the position of each tooth. This methodology is said to produce extremely accurate results, expedite and thereby shorten the duration of treatment and potentially decrease discomfort and root resorption sometimes associated with conventional braces. Only internal company data is available to date analyzing patient outcomes which purport to support these claims. We heard two practitioners with a great deal of clinical experience support these claims. It is important to note that to the best of my knowledge, controlled studies in an academic environment have not been published to support their claims. Further, the data has not been segregated by case type and therefore on an individual basis, may not be predictive of the outcome with reference to the claims made about this technique.
Some potential issues we will consider before adopting this technique:
- Cost is significantly higher than conventional braces in the range of $800-$1000 per case.
- A 5-7 day delay between scanning the teeth and braces for the wire prescription and taking delivery of the wire to be placed in the patient's mouth.
- Certain case types will undoubtedly treat mroe quickly with this technique but others may not. As with any new technology, universal application may not be appropriate or necessary. Also, the advanced wire alloys used are already available to us with conventional braces and have many useful properties, which can expedite conventional treatments as well. Whether outcomes between these techniques using these wires are significantly different remains to be seen.
- Technological progress is almost always incremental whereas this technique is in part promoted as the future of orthodontics. That's a big claim...we'll see.
- The company, Orametrix, had revenue last year of about $10 million with a combined total of research, development, and sales costs since its founding approaching $120 million. Whether or not this company remains viable will ultimately be determined by profitability in the marketplace. They seem very confident of success. Again, time will tell.
- Their technology is impressive, as is their marketing effort. If and when we become an adopter, we would consider its use on a case by case basis.
- In our world where so many of our adult cases are re-treatments, meaning that a previous orthodontic treatment proved to be unstable, the "holy grail" as we see it is to achieve long-term retention rather than being preoccupied with how fast the treatment progressed which this technology purports to address. A widely accepted viewpoint in orthodontics is that the faster the teeth are moved and the less time they're held in position, the greater the chance of root damage and/or post-treatment instability. To date, I am unaware of a published retention study involving Suresmile probably because they haven't been in use long enough. In our practice, we routinely demonstrate 10-20 year post-treatment follow-ups the stability of our cases over these time frames using bonded retainers individually attached to the back sides of the upper and lower six front teeth. See our website for examples of our work. In the final analysis, our patients value long-term stability and are generally not focused on saving a few months in treatment. It may be possible however to achieve both and we remain open to that if it makes sense.
- Technology as an end in itself is problematic in an age of rapidly escalating health costs. Manufacturers intend to profit in the push to integrate advanced technologies which sometimes precede a demonstrated need which may or may not be of meaningful benefit to the patient. And even if there is some benefit, a cost/benefit analysis is lost among the hype for the new technology. We probably can't afford to keep adopting technology in this way.