In this episode, sponsored by ClearCorrect, Orthodontic Products Chief Editor Alison Werner talks to Mark Lowe, DDS, an orthodontist in private practice in Fresno, Calif. A frequent lecturer on aligner therapy, he joins the podcast to talk about aligner treatment, why he’s opted to use ClearCorrect aligners in his practice, and the features the brand brings to the table.
In practice since 1991, Lowe is an early adopter of clear aligners, and has watched the treatment modality evolve over the last 25 years. Digital technology has been a key driver of the evolution in aligner treatment, he says, even more so in the last 5 years. But it’s not just intraoral scanning, treatment planning, remote monitoring, and AI technology that have moved the treatment modality forward; the thermal plastics have increased the range and predictability of movement. As Lowe puts it, there has been “tremendous change” in the last 5 years.
Lowe has been a ClearCorrect user for much of his career. He shares how he initially came to the brand with the intention of treating mild malocclusions with aligners, but after using it for some time, he saw how the ClearCorrect aligners could be effective with moderate and then more complex malocclusions. What’s more, he talks about patient response to the aligners. At times, Lowe has used other aligner brands in his practice—and has even used multiple aligner brands with the same patient, which allowed him to receive some unique patient feedback. One point they made, they preferred ClearCorrect’s high trimline over the scalloped trimline found on other brands. That increased comfort translates into better retention and more predictable movement, according to Lowe.
As Lowe talks about the more predictable movement that comes with better retention, he makes the point that more predictable movement allows him to avoid using a lot of attachments. Lowe believes much of aligner therapy today is over engineered, with an over reliance on attachments. From a clinical standpoint, for him, ClearCorrect’s high trimline allows him to treat the way he wants to treat.
In this episode, Lowe also talks about ClearPilot 6.0, ClearCorrect’s latest treatment planning platform and its global footprint. ClearCorrect accepts scans from multiple intraoral scanners when planning aligner treatment. In addition, the company has the ClearCorrect Clinic app which the team can use to communicate with and educate patients. He also shares how he appreciates his relationship to ClearCorrect and the fact that they listen to experienced clinicians as they seek to improve the product. As he says, “They understand that the orthodontist is truly their customer.”
Lowe also shares his experience growing his solo orthodontic practice and working with a pediatric dentistry group practice. He talks about the benefits and challenges of each, balancing his clinical and business owner roles, and the dynamics of the two practices. In addition, he talks about how he has embraced remote monitoring to make treating patients who are on the go easier and more efficient. OP
Alison Werner: Hello, this is the Orthodontic Products Podcast on the MEDQOR Podcast Network. I am Alison Werner, chief editor of Orthodontic Products. In today’s podcast sponsored by ClearCorrect, I’m talking with Dr. Mark Lowe, an orthodontist in private practice in Fresno, California. Dr. Lowe is a frequent lecturer on aligner therapy, and he’s here today to talk about aligner treatment in his practice, why he’s opted to use Clearcorrect aligners in that practice and the features the brand brings to the table. Dr. Lowe, thank you for joining me.
Dr. Mark Lowe: Thanks for having me.
Alison Werner: Now you have both an orthodontic practice and a pediatric group practice in Fresno. Tell me about those practices and what each brings to the table as a business owner and a practitioner.
Dr. Mark Lowe: Yeah, they are two different experiences. So I started my private practice probably around 1991, and it was a small practice, a startup, and it’s grown and it’s been very, very rewarding. You have a clinician side and then you also have the business owner’s side, so you’re wearing two hats so sometimes that’s very, very rewarding, but then sometimes there’s a lot of headaches that come with that. We do see adults and we do see teens and adolescents at that practice. In the pediatric group practice, I started at about four years after I had started my private practice and the multi-doc practice, it’s great because you do get to collaborate with different colleagues and treatment plan, and again, we only see teens and adolescents in that practice.
I’m not the managing partner there, so again, I don’t have to worry about the small business aspects of it, but I do a lot of the clinical work and in charge of the orthodontics there. So that’s rewarding in and of itself, and maybe because I don’t have to worry about the small business aspects, maybe it’s a little more fun atmosphere because we’re dealing with more mild malocclusions and the kids love to have braces and/or clear aligners. They’re two totally different experiences, but I enjoy both of them.
Alison Werner: Great. Well, okay, so you lecture regularly on the use of aligner therapy. What stands out to you about how aligner therapy has evolved overall?
Dr. Mark Lowe: Well, I started practicing orthodontics in 1991, and then I was an early adopter of clear aligners. So we’re looking at coming on to the 25th year of clear aligners. So it has evolved tremendously in the last 25 years. But the digital revolution of clear aligners, which is leading the way in all of dentistry really, probably started in about 2007, and then it’s just kind of gained more and more speed. And the last five years has really been tremendous in terms of a digital transformation in clear aligners, and it’s going to lead through all of orthodontics and dentistry as well. And the technology is just amazing in terms of the introduction of intraoral scanners, which are becoming more and more commonplace, and the software that has changed in terms of outcome simulation and virtual treatment planning.
The revolution or innovation in the polymers or thermoplastics has really led to an increased range in predictability of movement. And from the pandemic side, we now have utilized remote monitoring more so there’s a lot of AI and software with that, and I don’t think that’s going to go away. Even though might say the pandemic’s over, we’re still utilizing that to increase clinical efficiency and even patient satisfaction because they don’t want to come to the office quite as much as they used to. So tremendous change in the last five years.
Alison Werner: Yeah, no, definitely. So in your practice, what’s the percentage of aligners and what’s the breakdown, adults versus adolescents?
Dr. Mark Lowe: So in my private practice, we’re probably about say 55, 60% adults and the rest adolescents. So a little heavier on the adults. In the pediatric practice, obviously it’s all adolescents and teens. Overall with both offices, we are probably 50% clear aligners and 50% still traditional fixed appliances. So that’s kind of a happy medium, not just because of the demand, but also when we talk about different aligners, we do talk about an increased lab cost. And so from a cash flow point of view, in terms of a small business, that’s something that all orthodontists are concerned with.
Alison Werner: Yeah, absolutely. So you do use ClearCorrect aligners in your practice. Why was this aligner brand right for the way you practice?
Dr. Mark Lowe: Well, when I first got started back in 1999 with clear aligners, there weren’t many clear aligner companies. And after having treated so many cases, there was a time point where we needed to fix our own relapse, if you will, or even more mild malocclusions. And it just wasn’t cost-effective to use the brand we were using. And so we got involved with ClearCorrect, just using simple treatments, a lot of retainers. They had a streamlined system for retainers. And so we kind of started with just some small mild type treatments. And after utilizing the product more and more, we thought, “This could be very effective at more moderate malocclusions.” Because of the different advantages of the system, we started doing more difficult malocclusions as well. It wasn’t something that we just thought, “Hey, why don’t we switch companies?” Or anything like that.
But we were exposed because of the length of treatment we had done with clear aligners. And so one of the things that I’ll talk about is it wasn’t intuitive, but we’re one of the few offices where we have used multiple aligners on patients in terms of the brands, and many of the patients, in fact… I mean there’s no study yet, but people who have used multiple brands often prefer the ClearCorrect brand. And I don’t know if it’s just the three layer quartz material or the high trim line. And again, it wasn’t intuitive when I first started because I would’ve thought that the scallop trim line would’ve been more aesthetic and more comfortable for the patient, but it’s the actual reverse.
Alison Werner: Oh, interesting. Okay. Yeah, that’s definitely probably a very unique experience to have used a number of brands on one patient. So what are some of the features that stand out to you about the ClearCorrect brand?
Dr. Mark Lowe: Well, I think that the number one feature that I’ve really been a proponent on is the high trim line. And even though I didn’t think intuitively that that would be comfortable for the patient, it turns out that they do like the trim line. And again, for me as a practitioner, it allows more retention of the aligner so it grabs onto the clinical crowns a little bit better. And when you have increased retention, not only could you have more predictable movement, but you can decrease the number of attachments or engagers that you use.
Especially as we talk about the advance in the AI and the treatment softwares, we’re now to the point where I believe that there’s a lot of over-engineering going on in using almost too many attachments and engagers. And so I’m really pleased. I mean, I’ve done treatments without using any attachments or engagers because of the increased retentiveness. And so from a clinical standpoint, that’s my favorite aspect is the high trim line, which allows me to decrease engagers and attachments. And I’ll tell you, after doing this almost 25 years, no patient has ever asked me to add more attachments or engagers.
Alison Werner: I would imagine. As you’re treating those more difficult cases, what else stands out to you when you’re working with this product?
Dr. Mark Lowe: Well, I think, again, we talked about transformation in the last five years, last eight years, they’ve really streamlined a lot of their AI in terms of their virtual treatment planning, thermoplastics, the three layer clear quartz is a nice feature, and I just think that they’re really progressive because of their connection with Straumann and their global footprint. When you talk to them, they want to be a leader in the clear aligner industry. They don’t want to just be another… At last AO, there was over 20 clear aligner “companies” and they want to be the leader. And so I’m really pleased to be able to work with them and to improve the product.
They still are small enough to the point where they will listen to experienced clinicians. And I think that’s important in terms of not just customer service, but who is their customer. And I think they understand that the orthodontist is truly their customer, not the patient. When we talk about direct to consumer or really large companies, sometimes I think they feel as though the patient is their customer, and that’s simply not the case. These clear aligners are tools that we use to correct malocclusions, and so just to have their ear, just to have input is very powerful.
Alison Werner: Yeah. Well, you mentioned the treatment planning platform. What else stands out to you about ClearPilot 6.0, which is that ClearCorrect treatment planning tool?
Dr. Mark Lowe: Yeah, ClearPilot 6.0 is obviously way more advanced than ClearPilot 1.0, and it really has all the features that I’ve utilized previously, like the movements table and the superimposition screens and features. But I also know that we’ve advanced the product to be able to utilize cuts and slits in the actual aligner themselves so we can do Class II elastics and all these other features like bite ramps or if we’re going to do some restorative work on adult patients, the Pontic features. So there’s a lot of new features that 1.0 wouldn’t allow us to do. And so we’re able to do just about any kind of malocclusion with these aligners. Plus, again, you add on my favorite feature of the high trim line and the increased retentiveness, and we can decrease the attachments, which is really what I’ve noticed in a lot of the over-engineering is that I just want to have the movements that I feel are good orthodontic movements that are predictable, and I don’t want to try to overachieve that by adding on a lot of unnecessary movements that are predictable and adding on a lot of attachments that are complicating the case.
In fact, with my residents when I teach, if I see a case that has say 14 attachments on an upper arch, that to me is a fixed appliance brace case. That’s not a clear aligner case. And we’re seeing a lot of other companies come back with multiple attachments that are unnecessary, particularly as we start to go into teen treatment and mixed dentition treatment, which is the largest segment of the market that we’re heading towards.
Alison Werner: Yeah, okay. So ClearCorrect features an open platform. Why is that aspect important to you as you’re working?
Dr. Mark Lowe: Well, I think this touches upon their global footprint that they will accept intraoral scans from multiple different scanners, so they’re not tied to one scanner. And then also they have a clinic app, which allows a easier workflow, particularly for the staff to upload photos and records and also just allow communication with patient education. So I think that’s important, and you can see, with their global footprint, that they’re going to be utilizing different companies and different scanners, and there’s different ways to practice. I mean, we practice orthodontics one way in North America. When I’ve gone to other countries, it is similar, but there’s different nuances. And so having an open platform allows them to be able to work with different orthodontists all over the world.
Alison Werner: Okay. How do you assess a treatment modality like aligners to know what is the right brand for you and the way you want to work?
Dr. Mark Lowe: Well, at first, when I talk to any company, I want to do two things. One, I don’t want to reinvent the wheel. Again, we’re at 25 years, so there have been a lot of great transformations that have already occurred. I just want to take and build upon that. And so I like to be able to have an influence in terms of utilizing my experience to what we need to fix. There’s some things we don’t need to fix, and we just need to improve upon those features. And so with talking with ClearCorrect Straumann, they really do want to make the product the best it can be for orthodontists.
And in fact, one of the features that we didn’t really talk about with ClearPilot 6.0 is the ability to customize your preferences. But not only that, if the communication with the technicians is going awry, you can do your own doctor edits and improve your customization of what you would want to see for that particular patient. And so I think we look at all the features of the actual aligner themselves, we look at the improvements in AI, and we come up with, “Is this the best product for the patient?” And again, with different aligners, there’s going to be different bells and whistles, but I’ve been really, really impressed with the way ClearCorrect Straumann is focused on having the orthodontist as their client, their customer, and being responsive, which is very, very important.
Alison Werner: Yeah. You’ve talked about what it means for you as an orthodontist, but what feedback have you gotten from your team as they’re working with the product and working with patients?
Dr. Mark Lowe: Yeah. Again, if you talk about over-engineering or you talk about making things too complicated, the world is super complicated. And on a day-to-day workflow, we really want it to be as seamless as possible, not only for the patients, but for the staff as well, and for the doctors as well. We want to be able to be time efficient and get these things done without a lot of… With technology sometimes there’s a lot of hassle in terms of trying to get work done. We’re human beings and we’ve got things to do other than playing around with this digital transformation and having a lot of hurdles to jump, so to speak, to get to where we want to go. So streamlining workflows is very, very important, not only for the doctor, but for the staff, and then streamlining it for the patients. And that’s what it’s really all about.
Alison Werner: How are you using remote monitoring with your patients in your workflow?
Dr. Mark Lowe: Well, the pandemic really taught us. I started a concept of long distance orthodontics quite a while ago, and I did, it wasn’t a thought, but I realized I had a patient who was… I’m in California, and the patient came all the way from New York. They were working in California, and somehow they ended up in my office. And I kind of realized that college students and traveling business people and military, this was all kind of patients. I don’t have a license to practice in Florida across the country, but could I simplify my treatments, be efficient with my treatment, only see them a few times, and have this concept of long distance orthodontics? And then fast-forward to the pandemic where we really couldn’t see our patients as often. They didn’t want to come to the office or even during a shutdown… In California, we were shut down for a month or two or three.
So what could we do with this concept? And so the concept of remote monitoring, long distance orthodontics kind of merged, and we simplified our treatments. We had to be more efficient because we weren’t going to be able to see them as much to do interproximal reduction or add as many engagers. And so we definitely streamlined our procedures, but we still are providing what I would call supervised teledentistry, meaning that we do take records, we do the same diagnosis that we would for any patient, including fixed appliance patients, but then we customize it according to their needs and when they’re going to be able to come into the office. And so with these new remote monitoring apps and/or software platforms, we’re able to allow the patients to not have to come in as frequently. If our normal schedule was one month, then we could easily go two or three months.
And it just customizes as to when they can come in. I sometimes think I’m a scheduling coordinator as opposed to an orthodontist or a dentist. I have to ask, “Well, when are you going to be back from college?” Or, “When are you going to be back from deployment?” Or, “When are you going to be back for work?” And so it really has made a big difference. We could still be far more efficient at utilizing this, but I think it’s definitely the future because during the pandemic patients even were wary of coming in so frequently. So I think it’s definitely a big innovation in clear aligner treatment. But not only that, again, a lot of this AI is going full circle to fixed appliances and 3D printed appliances, which we’re starting to use as well in fixed. And we want to monitor those patients and they don’t want to come in as frequently as they used to. So could we monitor those patients as well? So remote monitoring is here to stay.
Alison Werner: Yeah. As you mentioned, you teach in a residency program and it’s associated with the University of California at San Francisco. What have you seen in how residents approach working with aligners, but also just what are the issues they’re looking at as they enter the workforce?
Dr. Mark Lowe: Yeah, what’s interesting is to see some inexperienced providers start to enter into the clear aligner world. And so again, if they find a product that is easy to use, I think that’s the number one feature that they’re looking for. And again, with the ideas of seeing the patients less, they’re embracing a streamlined workflow, something that could be remote monitored, and it is kind of neat to see which brand that they utilize. We have over three brands of clear aligners in our residency. And again, there’s bells and whistles and there’s advantages and disadvantages of each brand, but to see someone who’s inexperienced kind of migrate towards one or the other is kind of interesting because they don’t have a bias.
Alison Werner: Yeah. So what excites you about orthodontics and the future?
Dr. Mark Lowe: Oh, I mean, just having witnessed the digital transformation over the last, again, using clear aligners for almost a quarter-century now, I think the future of that digital transformation is going to go full circle to fixed appliances, and especially with 3D printing. We talked about the software and the polymer innovations, thermoplastic innovations, but again, with 3D printing now, we can go full circle and we talked about 3D printed fixed appliances as well. And then the future, maybe even by 2030, we’re talking about digital transformation of all of orthodontics, and could we end up with a hybrid treatment where instead of having attachments, we have 3D printed brackets, which can utilize the advantages, for example, of extrusion?
Fixed appliances have a huge advantage in children’s with tooth movement over clear aligners. Could we combine the two and see a day where there’s not clear aligner treatment patients, fixed appliance patients, there’s just orthodontic patients, and we’re using a hybrid of fixed appliances and clear aligners together? And I think that’s exciting. We’ve been talking about it for a long time, but we didn’t have that technology and we do today. So it’s going to be neat to see where this goes, but I’ve been pretty much spot on a lot of these predictions, and it just has to do with what I’ve wanted to do as a practitioner, and now these companies and the technology is providing it. So it’s pretty exciting to see where we’re going to go.
Alison Werner: Yeah, absolutely. Well, Dr. Lowe, thank you for taking the time to share your experience and your insight today. I really appreciate it.
Dr. Mark Lowe: Yeah, great. I had a great time.
Alison Werner: Great. And to our listeners, thank you for joining us. Be sure to subscribe to the MEDQOR Podcast Network to keep up with the latest Orthodontic Products podcast, and check out orthodonticproductsonline.com for the latest orthodontic industry news. Until next time, take care.