Two Front enters the clear aligner market with a business model that allows orthodontists to avoid the financial burden of a brick-and-mortar practice.  

By Greg Thompson

By the time Ingrid Murra, DDS, completed her orthodontic residency in 2018, new possibilities in the realm of clear aligners were emerging for savvy practitioners. Dozens of Invisalign patents had expired and several venture-backed direct-to-consumer aligner companies had come onto the scene, offering clear aligners in the mail. 

While many orthodontists contend that these companies were and are not able to offer patients high quality care, their large marketing budgets further raised the profile of orthodontic treatment—creating an opportunity for recent grads like Murra. With some new orthodontists carrying an average of $400,000+ in student loan debt, a brick-and-mortar, solo practice can be out of reach. Murra saw an opportunity as these market forces came together. 

A newly minted orthodontist with credentials from NYU Dental School and Harvard for orthodontics, Murra went to New York venture capitalists with an idea: an orthodontist-led clear aligner company on a mission to modernize the orthodontic patient’s experience and empower the experts, the orthodontists. Murra got seed funding for her venture, dubbed Two Front, which put orthodontists squarely in the clinical mix, in contrast to some of the more “consumerized” models. 

In-Home Aligner Treatment 

The Two Front model provides in-home aligner treatment from an orthodontist. It works like this: Over the course of two in-home visits, an orthodontist—and, when needed, an orthodontic assistant—will visit the home to capture a 3D scan using a portable intraoral scanner. A van comes equipped with the equipment to take panoramic or cephalometric radiographs. During these visits the orthodontist places any necessary buttons and patients receive their first 6 months of aligners. “From there,” explains Murra, “the experience is remote through Two Front’s telehealth platform. All visits are digital, and licensed orthodontists are available around the clock to make sure patients stay on track.” 

The Two Front model is a natural progression that builds on the past two decades, which by all accounts has seen nothing less than a revolution in the field of orthodontics. The legal maneuvers surrounding patents have opened up possibilities, particularly for young practitioners finishing up their extensive educational process. 

In the Orthodontist’s Hands

“When I was in residency, I realized, ‘Wow, we can actually do almost everything with clear aligners that we can with braces,” Murra says. “However, there are so many companies out there claiming they can give you a beautiful smile who are not orthodontists. There’s a huge gap in consumer education around how clear aligners are an orthodontic appliance just like braces, which still require an orthodontist to give patients results and not cause any bite or TMJ problems.” 

The American Association of Orthodontists (AAO) had similar concerns back in 2018, issuing a statement which warned people about direct-to-patient orthodontic companies, saying consumers should think twice before opting for a procedure “without an in-person, pre-treatment evaluation or ongoing in-person supervision from a medical professional.” 

“Half of my passion is bringing orthodontics back into the hands of orthodontists,” Murra says. “I’m looking to empower them through an asset-less, concierge practice model, and give them back their patients with Two Front as the operating system.”

Competing with the so-called “tech companies” that have come into the field of orthodontics is no small undertaking, but Murra points out that these companies have undeniably expanded demand. “Something like 48% of the United States wants clear aligners,” Murra enthuses. “When they say they want clear aligners, it means they want orthodontics.”  

Taking on the Non-Clinical Work

The Two Front operating system hopes to capitalize on that demand, particularly for orthodontists looking to start a practice but who are carrying almost a half million dollars in debt, and who aren’t looking to take on additional debt to build or buy a practice. 

Another segment of the industry that might find this model appealing, according to Murra, are those savvy practice owners who primarily do braces and want to slowly transition to seeing aligner patients under Two Front’s system. Murra says the system gives orthodontists a higher margin per patient than the average national overhead, while Two Front does all non-clinical work, and finds orthodontists their patients. 

“There’s nothing scarier than your third-year residency when you’re learning how to perfect your cases, but you don’t have a job,” Murra laments. “Orthodontic practices are not necessarily hiring right now at the same speed, especially given COVID-19. What we’re trying to do with Two Front is empower orthodontists. My whole mission here is to educate patients on why they need an orthodontist, even with clear aligners, and pair patients with orthodontists through a brand that moms and families can trust.” 

A Orthodontist Brand

Two Front launched its in-home orthodontic services on August 3 in Los Angeles, where Murra lives. The young venture represents a new beginning for Murra, who traces her love of orthodontics to experiences as a 10-year-old with “a mouthful of teeth who was insecure about my smile.” Armed with a beautiful smile, she eventually took on leadership positions that matched her high level academic skills.

“Two Front should not be confused with a direct-to-consumer clear aligner company,” Murra clarifies. “While we are a brand, we are a brand of orthodontists. Our business model is that we are an operating system for orthodontists. 

“We are modernizing the experience of orthodontics through house calls and telehealth,” she continues. “I’m on a mission to build this trusted brand so orthodontists can get back into the clear aligner industry, because no one should be moving your teeth besides an orthodontist.” 

No Need for Brick-and Mortar

At least at first, Murra envisioned a brick-and-mortar base of operations for Two Front in the heart of Manhattan. In the process of building the software, the customer experience, the EMR system, and HIPAA-compliant patient/doctor chat, it became clear that such an edifice was unnecessary, and she is able to help more orthodontists at a faster rate through an in-home model. The COVID pandemic only cemented that decision. 

The “house-call” model of Two Front has allowed Murra to onboard orthodontists onto the platform and scale up quickly. From a patient perspective, educating the world about the value of orthodontists is part of the mission, “even if you’re pursuing orthodontics through clear aligners.” She calls it a “truth in education” movement and plans to continue advocating for the profession. 

On the fabrication side, there are approximately 28 FDA-accredited manufacturing facilities in the United States making clear aligners. Murra looked into starting her own facility, but realized that these highly regulated operations were essentially living up to a consistent set of standards. From there, she says, “I basically chose a manufacturing facility that lived up to my standards, such as using the best materials and having machinery that is able to scallop at the gingival margins.”  

With so many crucial pieces in place and a willingness to learn and evolve, Murra is confident about the future. “We hope to have hundreds of orthodontists on our platform, empowering them to see patients on their own schedule through this new practice model,” she says. “Best of all, this does not require you to take out a $475K loan to open up a brick and mortar space. We are serving as the operating system for orthodontists, and helping them with all of these different components. We are providing the lead generation, software and EHR, scheduling, orthodontic assistants, and all the physical necessities to actually run this business as a trusted brand.”  OP

Greg Thompson is a freelance writer for Orthodontic Products.