25% Faster, 40% Fewer Aligners: The Clinical Data Behind FXClear

Alison Werner (00:06)
Hello and welcome to the Orthodontic Products Podcast. I’m your host, Alison Werner.

What if you could reduce your clear aligner treatment times by 25% and use 40% fewer aligners per case? According to preliminary results from a recent independent retrospective study out of the University of Illinois Chicago, those numbers are very real. The study compared the OrthoFX FXClear aligner system head to head with Invisalign and found that the FXClear system not only required significantly fewer aligners and shorter treatment times, but also delivered highly predictable clinical outcomes, specifically when it comes to avoiding

posterior open bites. In this episode sponsored by OrthoFX, we’re looking at the real world impact of that data with the orthodontist whose clinical cases actually fueled the study, Dr. Terry Sellke Dr. Sellke brings over 50 years of experience spanning private practice and academia. In this episode, we discuss his transition to this new generation of clear aligner of polymers and why the material science behind it has allowed him to stop building heavy overcorrections into his digital treatment plants. We also explore the practice

management side of the equation. Dr. Sellke breaks down how marrying highly predictable aligners with remote monitoring safely reduces in-office visits and how that can effectively double your return on investment per patient. So with that, here’s our conversation.

Alison Werner (01:24)
Dr. Sellke thank you so much for joining me. I really appreciate it.

Terry Sellke (01:28)
No problem, happy to be here.

Alison Werner (01:30)
Great. Well, just to get started, ⁓ can you tell me a little bit about your practice and just ⁓ your career?

Terry Sellke (01:39)
Okay, well my career, I’m a dinosaur in orthodontics as they would say. My career began actually in orthodontics when I graduated from orthodontic school in 1972. So it’s been a while and my career has been ⁓

Alison Werner (01:40)
Yeah.

You

Terry Sellke (01:57)
A combination of private practice and an academic. was a co-director of clinics, University of Illinois for 36 years. And I’ve been actively involved in research, University of Illinois for years still to this date. I lecture worldwide on the business of orthodontics. And one of the things I learned in school is that they don’t teach business in dental school or an ortho school.

I went out and got a master’s degree in business so that I could understand how to run this business we call orthodontics. And from there, you know, transitioned into lecturing on productivity, quality of care without, and thus here we are, we’re talking about some of the things that I think are so important to a well-run orthodontic practice.

Alison Werner (02:52)
Yeah, okay, so we’re going to specifically talk about clear aligners today. how do clear aligners currently fit into your treatment offerings and what percentage of your caseload do they represent compared to traditional fixed appliances?

Terry Sellke (03:09)
Well, today in our world, the practice was probably 70 % aligners and the other 30 % is fixed braces, whether it be metal or

ceramic.

Alison Werner (03:23)
So we’re gonna talk about, you your transition to the OrthoFX aligner system. So I’m kind of curious, what kind of clinical and operational factors, because you talked about your experience with, you know, practice management lecturing and the business side lecturing, what operational factors led you to change aligner systems and integrate the OrthoFX system into your practice?

Terry Sellke (03:45)
Okay, the answer is very simple. OrthoFX is a totally different polymer than what was available in orthodontic world when I began with them in 2019, 2020. There was no practice that had that kind of material. And I give the credit to Loc Phan, who is the genius behind the development of their polymer.

Alison Werner (04:11)
I understand that the recent UIC ⁓ retrospective study was based on cases and data provided by your practice, ⁓ though you weren’t involved in this final analysis. So what motivated you to submit your clinical data for this independent review?

Terry Sellke (04:28)
Well, as I indicated, I’m still actively involved with different research projects at Illinois. And one of the things I offered to them as a study, and my office has been the basis for dozens of studies at Illinois master’s thesis and so forth. My practice is an open book for anything that anybody wants to do research on. And it’s been that way for 40 years. So on the issue of aligners, I actually went to Illinois

Alison Werner (04:53)
Okay.

Terry Sellke (04:58)
and said, you know, what would be a great study? And we’ve got a database that’s significant enough that the outcomes can be clinically significant is, you know, I’ve got probably 5,000 patients I’ve treated with Invisalign’s plastic, the SmartTrack material. And I now have got under my belt, you know, probably 500 cases that have been treated with

the OrthoFX plastic, which is FXClear. And I am seeing a materially different outcome between the two of them in terms of quality, treatment time, et cetera. And it could be a good study for Illinois to do. I mean, that’s kind of how it began.

Alison Werner (05:31)
Right.

Okay, so when the team completed their analysis of your cases, they reported a 25 % reduction in treatment duration and a 40 % decrease in aligner usage for the FXClear compared to Invisalign. Were those independent findings a surprise or were they consistent with what you were already sensing chair side?

Terry Sellke (06:04)
Absolutely, it was what I knew to be true for my practice after treating hundreds of cases.

Alison Werner (06:08)
Okay.

Okay, so the study indicated that the reduction in total appointments was primarily driven by fewer virtual monitoring and troubleshooting visits. So looking at back at how you manage specific patients in that data set, how did that drop in mid-course corrections impact your daily workflow?

Terry Sellke (06:30)
Well, I guess the language-ing that was used, that it was a drop in virtual visit and so forth, really doesn’t in my mind, I had nothing to do with the study other than providing the patients for the sample. So how the study was conducted, the outcome of the study was totally done independently by Illinois. But the long answer to your short question is this.

Alison Werner (06:52)
Yeah.

Terry Sellke (06:57)
I saw that there was a significant reduction in the number of refinements with the OrthoFX material. The reason being that

Alison Werner (07:04)
Mm-hmm.

Terry Sellke (07:10)
We didn’t get unseats like we did with SmartTrack. Significantly fewer cases being redone or having to do another refinement because we’ve lost track of teeth, like upper lateral incisors and so forth. It just wasn’t happening with the OrthoFX plastic. Therefore, fewer refinements, fewer visits, therefore finishing cases in far fewer alignments.

Alison Werner (07:26)
Mm-hmm.

Terry Sellke (07:39)
and frankly to what I knew in my heart to be a far superior clinical result as well.

Alison Werner (07:49)
Okay, so one of the points the researchers highlighted was that posterior open bites, are a common challenge, and they noted that tighter posterior agreement in the FXClear dataset. So clinically, how did you experience the difference in posterior tracking while treating patients involved in this study?

Terry Sellke (08:11)
Okay. Good question. What I observed from the very beginning is having worked with Invisalign and SmartTrak material for years and having done so many cases, it was always a problem finishing details, trying to get good occlusion of posterior teeth. And I think part of the reason, you know, and again, I’m giving you a long answer to a short question was my view.

Alison Werner (08:38)
No, it’s fine.

Terry Sellke (08:41)
was that with the SmartTrack material and I think probably the software to some degree too, we had to build in so much overcorrection in order to get the teeth where we wanted them to be that when we finally, let’s say, reached the tip and the torque and everything else that we wanted on teeth that invariably posterior teeth are out of occlusion, invariably. And so what then that led to is another refinement

to kind of undo what we’d over corrected and more aligners and more work and I think that clearly explains the difference in the number of months. It clearly explains the difference in the number of aligners to treat a case. We did not have to do that with the FXClear material.

Alison Werner (09:33)
Okay, so you spoke about it a little bit there, but the authors suggested just the level of predictability that they found with the digital setup allowed it to be more like a true blueprint. knowing this conclusion was drawn directly from your clinical outcomes, does it change in any way how you approach digital treatment planning or how it’s evolved? Okay.

Terry Sellke (09:55)
For sure. Absolutely

for sure. We don’t build the overcorrection into our digital treatment plan that we used to. We just don’t do it. We don’t need to do it to get to the end of the rainbow.

Alison Werner (10:09)
Okay. So the UIC analysis was limited to mild to moderate non-extraction cases that you provided. So based on your ongoing clinical use, how are you evaluating the system’s performance to look at in more complex scenarios?

Terry Sellke (10:25)
Okay, we…

Like anything new, when you’re trying something new in your practice, you start out with easy cases. Going back to the days when we first started with SmartTrack, we used it on only easy cases because in those days back in 2006, 7, 8, that’s all you could use on. That’s all it work on is easy cases. to their credit, they improved their technology where I could do more complex cases. Well, my fear was with the FXClear, it would be the same story.

Alison Werner (10:52)
Mm-hmm.

Terry Sellke (10:57)
used on easy cases. you know our first let’s say 100 cases with FXClear were easier, okay, by choice, okay, and when we got confidence in the material and the results that we were getting now we use the FXClear on any case, extraction cases, you borderline surgical cases, we used on all cases and we’re getting

very nice results and I’m happy to say the posterior occlusion, there is no comparison in the fit of the teeth at the end of treatment between the two products.

Alison Werner (11:38)
Yeah. And then, you know, we talked about that. Your planning becomes a true blueprint for a case. Do you find that to also be the case with these more complex cases where you can trust that digital treatment plan? OK. You know, looking more broadly at the industry, how do you expect emerging advancements in aligner material science to impact clinical workflows and practice management in the coming years?

Terry Sellke (11:50)
Yes, absolutely.

Well, I would like to hope that, you know, with the emergence of the new polymers and not only FXClear is there, which is what I’m absolutely in love with, but to his credit, Loc Phan come up with the next generation, which is called Air aligners.

I have little experience in that, so I can’t give any feedback on that. If Loc Phan came up with it, I’m sure it works. But right now, with FXClear, I can say that the profession needs to understand that there is a difference in the polymer.

Alison Werner (12:30)
you

Yeah.

Mm-hmm.

Terry Sellke (12:46)
and

the polymer is the magic potent. what, it gets the tooth from where it was to where it needs to go with all of the tip, torque, and angulation and everything else that you need. And the polymer is the secret and the key to everything. And I will tell you with the polymer what doctors have to learn. And I’m giving again a long answer to your short question. What doctors have to learn is

Alison Werner (13:14)
Or it’s fine.

Terry Sellke (13:16)
is to build into the treatment, and by the way, the treatment planning software with OrthoFX is better too, but they build into the treatment instead of building over correction, build little bit of over correction, okay? And they’re gonna find that they don’t have to.

Alison Werner (13:24)
You

Terry Sellke (13:37)
undo things because they didn’t overdo it to begin with. And that’s a learning experience. And for someone who’s worked in aligners, it’s hard to let go of that. It’s hard to believe that you don’t have to do that, but you have to give it a chance. And I’m telling you, it’s amazing how well it works.

Alison Werner (13:49)
We will. OK.

Yeah.

Yeah. What does, know, given your your focus on practice management, kind of the business side of orthodontics, what does it mean to have a system that, you know, you can trust the treatment plan and you’re not having to take those extra steps? What does that mean overall to the business?

Terry Sellke (14:19)
Great question. There is a company called Gaidge in the orthodontic industry in the United States. They represent like 1800 really good orthodontic practices. And they have a metric called value per visit. Value per visit, put simply, would be you take the treatment fee and divide that by the number of in-office visits.

And what you come up with very simply is value per visit. Meaning how much did you generate per visit? Value per visit, frankly, it may be a little too simplistic, but it’s the best we can do in the orthodontic industry with all orthodontists practicing differently. You know, we have to find a common denominator and value per visit is what’s the best that’s out there. With value per visit, using that as a business metric.

Alison Werner (14:52)
Mm-hmm.

Thank

Terry Sellke (15:15)
If you can treat a patient in half as many visits, you have doubled your profit, your return on investment for that patient. Now you can do it consistently in every patient. The outcome is not only, let’s say you’re making more profit per case, but you’re able to treat more patients in fewer days because it’s fewer in office visits and all of those things.

But the key is, it’s not just making more money per case. Importantly, it’s a better result and less time. And remote monitoring is a big factor in that whole thing too, because I can remotely monitor the progress when I’m not seeing unseats

Alison Werner (15:58)
Yeah.

Mm-hmm.

Terry Sellke (16:04)
I just simply tell the patient, don’t need to come in. In fact, our lines in our office now, picture an orthodontic practice. Typically, you finish what you’re gonna do today and you say to the patient, okay, we’ll see you in six weeks for ABCD, okay? In other words, the next appointment is made today. In my office, we don’t do it that way. In my office, we say, we’ll let you know when you need to come in next time.

Alison Werner (16:15)
Mm-hmm.

Mm-hmm.

okay.

Hmm.

Terry Sellke (16:34)
As long as you’re doing your scans and I can remotely monitor your progress, you might go 20 weeks before I see you. As a pair to the mindset of I got to see in four weeks or six weeks or whatever it might be. That’s huge. That’s huge.

Alison Werner (16:42)
Okay.

Right.

Yeah,

yeah. So the material science having a product, an aligner that you know is tracking correctly and then that remote monitoring aspect completely changes the way you’re operating as a business.

Terry Sellke (17:04)
Totally, totally, totally, totally. And everyone wins. Everyone wins. You know, the doctor makes more money per case while producing a better result.

Alison Werner (17:09)
Mm-hmm.

Terry Sellke (17:15)
But the patient wins too. Patients have busy lives. A lot of orthodontists have this mindset of, patients love to come in. We have fun when they come in. No question they have fun. They got better things to do. Mom doesn’t want to take off work to bring them to your office for what is an appointment that says, yep, everything looks okay. Why not do that remotely? So it’s that combination that is a paradigm shift in orthodontics.

Alison Werner (17:36)
Yeah. Yeah. Yeah.

Terry Sellke (17:46)
And it’s, in my mind, is the most exciting thing that’s occurred in my 50-year career.

Alison Werner (17:53)
Hmm. What would you say to orthodontists who you know, you have been in this field for over 50 years. What would you say to orthodontists who because I talked to still a lot of doctors who are wary of remote monitoring or don’t see the value in it. You’ve talked about the value there. But what would you say to those who you know, are mid-career at this point who are hesitating a little bit about making that change to employ this and then to marry it with ⁓

the newer aligner systems.

Terry Sellke (18:28)
I would say to them, maybe a little bit more tactfully than this, you know, the future is there. This is, this is the future. You can choose to join it or be among the dinosaurs. You know, you will become extinct because this is what consumers want. And in a world where third parties are controlling what we can charge.

Alison Werner (18:53)
Mm.

Terry Sellke (18:54)
And so if our fees can’t go up with the cost of inflation and yet everything else is ⁓ staff costs, material costs are going up.

Alison Werner (19:03)
Yeah.

Terry Sellke (19:04)
that

reduces, doctor, your take home. And any business can’t survive that way. So we need to realize we have a business and our job is to increase productivity. That’s what any business on the planet has to do to survive. And this is the answer to increasing productivity and at the same time, improving quality.

Alison Werner (19:07)
That’s right.

Yeah, well, we’re going to leave it there. Thank you, Dr. Sellke so much. I really appreciate you tying those the clinical and the practice management together. Thank you. Definitely, definitely.

Terry Sellke (19:35)
No problem. Happy to work with you.