The Benefits of Spark Clear Aligners to a Growing Orthodontic Practice

Welcome to the Orthodontic Products Podcast on the MEDQOR Podcast Network. I’m Alison Werner, chief editor of Orthodontic Products, and today, I’m talking with Dr. Alyssa Emory-Carter. She is an orthodontist in private practice in Texas, and most recently, the subject of our March cover profile. For this episode, which is sponsored by Ormco, I wanted to talk to her about her experience as a solo practitioner, building a three office practice, and take a deep dive into how she’s using Spark Clear Aligners to achieve better outcomes and more efficient systems in her practice. Dr. Carter, thank you for joining me today.

Thank you for having me. I appreciate the opportunity and look forward to educating and learning.

Great. Well, so let’s get started. Now, when our freelancer, Greg Thompson, submitted the profile he wrote about you, I found it interesting that you actually joined the practice of the orthodontist who once treated you. How did that come about and what did it mean to have that relationship as you were starting your career?

I was born and raised in a smaller town in north Texas, and the original orthodontist that treated me also treated my father and then full circle came back to end up partnering into the future owner of that practice, and then now I’m the current owner and it’s really interesting to do it that way, but I love it because there’s so many connections and so many ties and some of the parents of the kids I’m treating now were probably next door to me getting braces at the same time I was in the same office. It’s really cool and I knew I wanted to move back home and so my dream is becoming a reality.

Well, great. So how many years have you now been practicing?

Almost six years.

Okay. How has that been making the leap into owning your own practice within that first six years?

I had the opportunity to begin ownership a couple of years after moving back home and then knew that I wanted to be invested in this community and had a recent opportunity to also buy another practice not far from our community, just one community over in another small town. The retiring doctor is super sweet and super amazing and I went over there and visited and the opportunity seemed right and the team has been wonderful and it’s been really fun just intermingling everything and growing together.

How do you judge when the time is right? What conditions need to be there to know that the practice you’re buying or opening, that it’s the right move for you?

I think you have to feel that it’s the right move in the first place. You’ll have that feeling, but more importantly, we all have opportunities thrown at us left and right, and those opportunities aren’t always smart opportunities or what needs to happen with those may not be the best decisions to ensure that you can float your time. For me, I really wanted to focus on do I have the time to support both locations and if there’s growth, do I have the time for that and will it make me happy doing that? If there’s a balance of where it takes away from my time or the happiness that I can have, even though it’s an extra office and potential extra income opportunity, it may not be the right time or the right move.

Okay. Well, you talk in the article about the fact that when you took over these practices, they weren’t running at full capacity every day. How did you go about reaching your capacity goals?

The practice that I most recently had the opportunity to acquire was a gentleman who had already ran a very successful practice before out of California that his daughter now owns, and he retired and then moved back to the area… He grew up in Oklahoma… and decided I just want a really small practice to keep myself busy. He ran two chairs and a very small practice, but did pretty well considering. I knew immediately we could increase the number of patients we saw per day just by bringing a few of our assistants from our main location over there and double the capacity overnight per day, which allowed us to decrease the number of days that we needed to be there full-time.

That was one thing. The other thing is just really, really focusing on systems and efficiency, and that includes Spark and other products that we use such as OrthoFi and dental monitoring and making sure that everything’s buttoned up, so when you are there, that you’re taking care of what needs to be done and that’s taking care of the patients. If you minimize the waste that happens to your side, then not only is that more respectful for our patients, but it also maximizes what you can get done for each patient when you’re there.

You talk in the article about the fact that you have had a relationship with Ormco since residency and in fact, you’re now a paid consultant, but what does that relationship mean to you as a clinician and as a business owner?

This is something that I value a lot in our industry and I feel like orthodontics is so blessed as a profession as a whole because it is a tight-knit community overall where you have relationships built all over, not only the country but the world. That same relationship, to me, is just as important with a colleague as it is with the reps in our industry because they do help service our practices. To have a relationship with someone who doesn’t seem pushy or has an agenda, just wants what’s best for you, products that work with the way you want your practice, knowing every practitioner is different and the way I do things, someone else should take and tweak and make them their own, but most importantly, a higher quality product that has benefits in other ways that I didn’t feel from other products, and then the team backed up behind it that helped our practice run more effectively and more smoothly.

It may not seem like a big deal, but when you’re running low on something or we missed ordering something, and all of a sudden, our practice can be in a bind. When you have a company or a group of reps behind you, you can text or ask for help. “We ran out of this,” or they tell you, “We’re back ordered on this, but this is what I would recommend to replace.” Just having that coaching, that guidance, helps your team a lot and a lot more than I probably appreciated until I sit with the person that does a lot of our ordering in our practice and I hear all the things she has to do, and those reps definitely make her life easier.

So you do use Ormco Spark Clear Aligners in your practice and you’ve done so since the early days of the company rolling out the product. What is it about Spark Clear Aligners that made them the right fit for the way you practice?

I probably have a little bit of bias here, but I was really impressed with when the continued release of advanced products from Ormco as a whole and had the privilege of seeing a little bit of behind the scenes things that go into those processes and then the Spark rolled out and I was already looking into other clear aligner options and was fortunate enough for our regional manager to believe in our practice and give us the opportunity to start using it.

Since then, there’s been multiple things that we as orthodontists love to use with our aligner systems that haven’t been available before, whether it’s features in the software, features in the aligners, et cetera, that when we ask for those, they actively begin working on those requests to make the product better for us. That’s really important to me because if they’re willing to do that, eventually, you’re going to have a product or where they already do that I feel is superior not only in how clear it is and how well it moves teeth and how comfortable it is, but in the ability for me to treat patients to a higher level of care because of the features that they’re now allowing me to use to be a better orthodontist.

So what are some of those key features within the aligners that they’ve rolled out over the years that have really stood out to you and made a difference as you’re treating clinically?

Within the aligners, definitely the integrated hooks that they offer, and then in the software, there’s multiple features, but one is the CBCT integration, the true roots that you can see in your setups, the ability for us to alter occlusal planes and define how we want things to be done without limitations. You may get more in that it’s not the best manufacturing protocol, but if it’s what you want to do, there’s no turn down, and then there’s some other really amazing things in the pipeline coming out that I’m not sure I can talk about yet, but that will be [inaudible 00:08:25] and game changing for me and my team.

Okay. Well, one of the things that is there is the proprietary material which is the TruGEN material and there’s actually two varieties. There’s TruGEN and TruGEN XR. How does having those two material options come into play as you’re progressing through a case?

I love having those options. I usually start my comprehensive cases with TruGEN and it’s really built more like a NiTi wire and a stainless steel wire. The TruGEN has a little bit more flexibility built into it, but it will still rebound 90% of where it began, so I use that for the bulk of the movement, and then when I order a refinement if needed or I’m doing a short small case with just limited movement, I usually start with TruGEN XR, which stands for extra rigid, and I take that as my finishing wire, my stainless still wire and try to re-grass any fine-tuning that I didn’t get full expression of on the first round.

Okay. You actually looked at the analytics when you were comparing Spark to other clear aligner brands in your practice. What were the key takeaways from that analysis?

There’s a few key takeaways for sure. I knew that I had some frustrations. I had no idea what I was going to find when we did that, and I was really surprised actually to find how many less refinements we were doing, but also not only just less refinements, but the quality of the result. Now my expectations are even higher with my aligner outcomes. I didn’t realize more importantly that with each set of trays a patient gets, the amount of time that they’re in that set of trays and not 1 through 30, but they’ve gone through 1 through 30 and now they’re beginning the refinement. I guess each number of refinements a patient gets, they start to slowly get this burnout effect and with more refinement, that effect becomes worse and the [inaudible 00:10:10] really starts dropping off more and more.

Really, if you can keep it below two refinement, you’ll win a lot more and you have a better outcome in a shorter amount of time. If you do have to keep going in refinement, not only are you doing an extra refinement, but that time sometimes can be 10 trays, but take them as long as it took to get through their initial 30 trays because they’ve lost some of their motivation and investment. That was really eye-opening to me because I felt that I would rather give someone more trays at the beginning and make sure my results and my movements are super predictable and a little more effort than promising someone 20 trays with an amazing result and then needing 10 more and then 10 more, et cetera, et cetera. Now, however many trays I think it needs, and if that’s 20, great, if that’s 80, great, that’s what they’re going to get. As soon as I start to see something not tracking or feel that we’re going on the path of refinement instead of just, “Oh, wear it better. Use your your Chewies,” I instantly snap back into Spark and begin a refinement.

So that’s your patient’s experience with refinement. What else about the patient experience have you noticed a change with this aligner?

They are more compliant because our patients do say that they’re more comfortable. They definitely do not turn or stain colors, even if you drink black coffee with them. I’m not saying I know how, but I do. They definitely don’t stain. They’re super comfortable on less of the bulkiness and they look more clear and patients that want aligners just want something that isn’t noticeable, and when they have to wear something that starts to stain or they have a lisp or they feel like people can see, they’re just not going to wear them as much. That means we’re not going to have as much tracking, so think they’ve done a really nice job with how well they adapt to the teeth, the clarity and the fit to help us help our patients wear them more.

Okay. So what about your team? What have they appreciated about the Spark Aligner system?

Team loves them. They love the attachment template because they think it’s easier and more comfortable for the patient. More importantly, they had a lot of confusion before with just different aligner systems and a ton of options. Do we have refinements left? Is this patient about to be charged again? Do they have to be done with treatment by 12 months or 24 months? Now, once we have a case, it’s just so simple for them to go into the dashboard and understand is it Spark 10, 20 or unlimited? They know they’re all five years and it’s just helped our workflows because we’re not trying to understand any of that chair side or figure it out, and then they can open the clin checks, they can open the dashboard and see just by the click of tabs, they’ve done such a nice job organizing this for our team.

Am I designing the case? Is it waiting for Spark to send me something back or are they already manufacturing it? Just very easy to read and understand. From an input of even the front desk, if a patient calls and asks about their trays, they can give them direct feedback on exactly where those trays are in the process, and then in the clinic, they can give me direct feedback at the chair without me having to help them figure it out where we are in a case, and it may seem silly, but that does create a lot more simplicity and builds more trust with your patients, with your team when you walk up and your team knows exactly what’s going on and you don’t have to explain anything to them.

Oh, absolutely. No, that doesn’t seem silly at all. Now, your newest office didn’t previously offer aligners, correct?

Correct.

Okay. So now you’re integrating Spark. What has that experience been like to start from ground zero with incorporating a new treatment modality?

Actually, every practice I’ve been a part of, even my main practice, did not use aligners when I started either. Really, I was the main aligner doctor working until I became solo. It’s definitely different. Fortunately, we’ve gone through some hurdles through different systems earlier on and had some systems fine-tuned, so in the new practice… Knew exactly what we needed to train, exactly how we check in aligners, the uploading process. It’s been very, very simple. They’re excited. We have some patients that we’ve started and things are going well, and the girls just… They’re like, “Wow, this is so cool. I want this.” Yes, it is. It’s been amazing.

Well, it’s good to have that kind of buy-in, so that’s great. Now, you also use dental monitoring to track patients through treatment. How has this combination of Spark and remote monitoring technology created efficiencies in your practice?

Do use remote monitoring. There is a side of it, and we’ll get into it by the processes, and to your previous question on how has it been putting it in a new practice, the easier something is for our teams [inaudible 00:14:42], the more likely they are going to use it and buy in and get up to speed on it faster. That’s always my goal, is even though the people in our current practice understand something, how can we make it easier for everyone else? That’s through our systems that we create, but as far as the remote monitoring with Spark, one feature is definitely [inaudible 00:14:59] that you can now use where patients don’t have to present themselves physically in the office for refinement scan when we need one or if we can do them without extra oral pictures.

But more importantly, it’s allowed us to pre-plan in a better way a patient’s treatment from beginning to end and then set alert point to check progress based on what we need to check. By opening AP correction, space closure, if we want IPR, check for refinement, so all of the things that we’re checking with our braces patient, we’re able to pre-program those and exactly at what points by looking at my setup and the staging, set these alerts, and then many times, our Spark patients are seen five times, six times total, and the patients love it. They’d rather do that than see me.

To change gears a little bit, on the clinical side, what technology intrigues you these days?

I like anything that makes things easier for our patient with a higher quality result, something that is flexible for their lifestyles, and I like anything that is digital because I feel that when we see things 360, which we can’t do when we’re just looking with a mirror in someone’s mouth, we get to see them in a different way and probably improve a diagnosis that we have for our patient. Those type of things bring out the nerd in me and really help me do what’s better for our patients and in the long run, if it’s better for our patients, then we need to do it regardless if it’s easier for us. At that point, it’s how can we do it and it be better for us?

Right. Okay. So what excites you about the future of orthodontics?

All of it. First of all, I think we have such an amazing profession. It’s a positive profession. Patients enjoy getting beautiful smiles, but what excites me most is that it’s changing and that what used to be metal bands on every tooth now is small little brackets, and eventually, everything is becoming so customized for each patient that it’s going to be aligners and custom braces and a few times in to see your orthodontists. Other than that, you’ll be texting us through your app about how treatments go. We tell our patients now, this may be… Well, I usually say this when I meet them, “This may be the best or worst news you’ve all day, but you’re going to carry me around in your pocket for the next year or two years. Bad news is you’re going to carry me around and you are going to have to give me some information every week. The good news is if you ever need anything or have a question, I’m in your pocket and you can let me know immediately.”

The parents love that. Busy. I can’t find time to go to the eye doctor one time a year. It just seems inconvenient, which is crazy, yet we expect our families to come see us 12 times a year or 10 times a year, whatever it is. That was so eye-opening to me, and I was determined to challenge the status quo and change that. Braces patients, aligner patients, they’re all on remote monitoring and they will not come into our office unless they demand to. My goal is to not waste their time.

Yeah. Well, excellent. So Dr. Carter, thank you so much for joining me today. It’s been a pleasure.

Thank you for having me. I look forward to our profession, and I really appreciate you guys always doing these for us and letting us learn from other doctors or other consultants, et cetera, in our profession.

Great. Well, thank you. To our listeners, thank you for listening. Be sure to subscribe to the MEDQOR Podcast Network on your favorite podcast platform to keep up with the latest orthodontic products episodes, and in the meantime, visit orthodonticproductsonline.com to keep up with the latest industry news. Until next time, take care.