The Bracket Comeback: Why Braces Are Gaining Ground Over Aligners

Alison Werner (00:06)
Hello and welcome to the Orthodontic Products podcast. I’m your host, Alison Werner. In today’s episode sponsored by DynaFlex, we’re taking a closer look at what’s happening in the bracket space. While clear aligners have dominated the conversation in recent years, new data and what many orthodontists are seeing in their practices suggests a shift with braces gaining ground again. So what’s driving that renewed interest and how is the bracket category evolving in response? Joining me to discuss this is Darren Buddemeyer, CEO of DynaFlex.

Darren has led the company for more than 30 years, growing it from a small lab into a major manufacturer of orthodontic products, appliances, and dental sleep medicine devices. In this conversation, we talk about where brackets fit in today’s orthodontic landscape, how innovations in areas like self-ligation and bracket design are impacting efficiency and outcomes, and what orthodontists who may not have revisited brackets in a while might be missing. So let’s get into it.

Alison Werner (01:01)
Darren, thanks for joining me today.

Darren Buddemeyer (01:05)
Hi Alison, thank you for having me.

Alison Werner (01:08)
Okay, so last summer the AAO released its economics of orthodontics survey, which showed that braces were gaining ground over aligners. So I wanted to find out what you’re seeing from your vantage point. And also just talk about the bracket industry today and what those orthodontists who think brackets haven’t, who have to think that brackets haven’t changed much, what they might be missing. So to get us started, when you look at both the data and what doctors are seeing in practice, what do you think is really driving

driving this shift back towards braces.

Darren Buddemeyer (01:43)
is a great question and I think ⁓ seeing the history behind aligners and the success that they’ve had over many years, ⁓ I enjoy seeing this statistic and showing that braces might be back at a higher level of demand than aligners are. And I think several factors are ⁓

are part of that.

I ⁓ think one of the reasons is frankly that brackets just have more control and doctors have

more, ⁓

predetermined outcome, I would say, that they’re confident in. And aligners, look, they have come a long way. The software’s phenomenal. ⁓ The amount and the types of attachments used ⁓ really assist. The doctor’s acceptance of IPR. ⁓

wasn’t there and you know I’ve been in orthodontics for a long time love this field love this profession dearly ⁓ but the acceptance of IPR now has changed over the many years and ⁓

So I think, certainly just my humble opinion, that aligners got close to what brackets and wires can do. And, you know, back in the days when doctors were actively bending wires and putting third order beauty bends into wires and really, you know, nitpicking their cases and wanting perfection, which, you know, I completely understand. ⁓ They were trying to achieve that with plastic that we all

Alison Werner (03:14)
Mm-hmm.

Yeah.

Mm-hmm.

Darren Buddemeyer (03:36)
that was just holding on to the teeth and maybe not doing as much for ⁓ root control as ⁓ brackets and wires do. And I think now, ⁓ you know, that the bracket systems have come so far, you know,

Alison Werner (03:43)
Mm.

Darren Buddemeyer (03:56)
all the self-legation brackets that have been introduced ⁓ into the market, whether you’re passive or active ⁓ practitioner, the brackets just do a better job of moving teeth and adding to the efficiencies of a practice. So it’s not surprising to me to see this trend, and we

Alison Werner (03:59)
Mm-hmm.

Mm-hmm.

Darren Buddemeyer (04:23)
compete in both spaces a

Alison Werner (04:26)
Yeah.

Darren Buddemeyer (04:26)
are a big part of what we do at DynaFlex, but also, know, brackets are a big part of what we do and what we try to, ⁓ you know, hone in and create the most efficient systems possible.

Alison Werner (04:41)
So from a clinical standpoint, when you talk to orthodontists, what are you seeing in terms of the

What cases are they more heavily leaning back towards brackets when you talk to them?

Darren Buddemeyer (04:56)
Yeah, Alison, that’s a great question. And I think you look at the types of cases ⁓ that are more challenging for aligners with less predictable outcomes.

And also aligners come with, you know, the refinement rate is still very high in aligners because of the forces you’re placing on the teeth.

Maybe it’s the material used from multiple different aligner companies. Everybody has their own types of materials. But those materials, you know, actively put a force on the teeth and the forces aren’t always equal and the outcomes aren’t always equal or predictable.

So when doctors look at these more difficult, challenging cases, I think in their mind, ⁓ to gain the control, the efficiency, the predictability, I think ⁓ those tougher cases are definitely better. ⁓

doctors feel like they might have more control using braces.

The other part of that is if there’s any class two or class three showing at all, that’s very difficult to achieve with aligners. So ⁓ that may be another reason why, again, for predictability of outcome, that doctors would lean towards using ⁓ braces or fixed brackets instead of

Alison Werner (06:11)
Mm.

Darren Buddemeyer (06:26)
aligners.

Alison Werner (06:28)
You know, there is a perception among some doctors that, you know, brackets haven’t changed much. What do you think they might be missing about how this category has evolved to treat those cases?

Darren Buddemeyer (06:41)
That’s another really good question and when you look at the studies, it’s amazing to me how many doctors are still using a standard twin bracket and getting good results from that bracket. Been around for a long time, it’s typically pre-torque, pre-angulated. It’s got everything built in that you would want. ⁓ As you use elastics, there’s some friction involved that you have to be aware of.

But also now you have ⁓ self-ligation that’s become extremely popular over the years. You know, we’ve all ⁓ heard and seen lectures by Dr. Dwight Damon and he’s done a fantastic job in his bracket system. ⁓ And so you’ve got companies now that are building different types of ⁓ brackets that have

Alison Werner (07:15)
Mm-hmm.

Darren Buddemeyer (07:36)
various features that allow you to ⁓ have more efficiency and ⁓ gain some ⁓ control where, you know, that might have been lacking in earlier brackets. So I really believe self-ligating brackets, you know, have a huge advantage for clinicians that are working with them and understand those mechanics.

Alison Werner (08:03)
Yeah.

Okay. So you talked about the self-legating brackets there.

So talk to me a little bit more about how today’s bracket systems kind of are addressing that efficiency in the practice, whether that’s the chair time, the wire progression, or just reducing the need for adjustments.

Darren Buddemeyer (08:19)
Yeah, I think with the new bracket systems that are available to orthodontists today, I think that they do gain a lot of efficiencies, whether you’re using a passive self-legation bracket or you’re using an active self-ligation bracket, ⁓ know, whatever you’re comfortable with and whatever you choose.

I think that both of those are better than previous brackets that were on the market. And there’s certainly a lot of twin users you can see.

that in the data, ⁓ the JCO studies. ⁓

The way that we look at it is that we’re trying to help doctors through innovation by using the most up-to-date ⁓ newest technology in ⁓ the bracket and the bracket prescription. So again, this bracket prescription and technology that we’re talking about for us is the Norris system. ⁓

⁓ developed a new system that we really fell in love with. There’s a lot of reasons why, speed, efficiency, ⁓ treatment time, appointment times, ⁓ but using a different slot size has been one of the key factors in… ⁓

it’s become such a great option. And the slot size being an 020 by 026 falling right in between 018 and 022, we feel like is a better system. And we’re seeing that in the numbers, we’re seeing that in the data, and not just through certain clinicians, but through a lot of doctors who are now involved in utilizing that bracket system.

Alison Werner (10:02)
Okay, so I kind of want to get your thoughts on aesthetic systems because aesthetics remain a big driver for patients. So how has innovation and bracket design changed the conversation with patients when it comes to aesthetics?

Darren Buddemeyer (10:18)
Yeah, and that’s that aligner versus brackets because aligners are extremely aesthetic. And that’s why, you know, a lot of patients walk into their orthodontist office today and,

Alison Werner (10:21)
Right.

Darren Buddemeyer (10:31)
you know, lot of my friends and family members and, they just want to fix this, you know, and so ⁓ without showing that they’re doing anything.

So. ⁓

What we’ve done is in conjunction with Dr. Norris has created the Norris Clear Bracket. And this was quite a challenge. And I don’t want to get into all of the engineering and the mechanics that went behind this, but it was extremely challenging because you’re taking a material, you know, 99.9 % aluminum oxide.

that is a very good material, but ceramics will never be the same as metal. And you can’t expect the same type of performance ⁓ in a ceramic setup as you do in a metal setup. However, ⁓ after four long years of development and a lot of work with our engineers, we feel like we came up with the aesthetic bracket system that will set a new standard in the market.

Alison Werner (11:13)
Okay.

Okay, so

from a practice management perspective, how should orthodontists be thinking about balancing aligners and brackets in their case mix right

now? What do you hear when you talk to the orthodontist you’re working with?

Darren Buddemeyer (11:54)
Well, I think it’s extremely personal decision.

think doctors, some doctors feel very comfortable in their use of aligners and knowing the nuances and. ⁓

and the challenges with aligners. And I think the doctors that lean more towards brackets, ⁓ you know, understand what they’re going to get out of their system.

And again, at the end of the day, everybody wants the best result for the patient possible, right? And they want to walk out the door on

day and and you know have a beautiful smile feel confident and and all the reasons why we are all in this ⁓ industry and so ⁓ I think the decision comes down to more how you structure things in your practice and what you ⁓ what you understand about ⁓ you know aesthetic orthodontics and how you want ⁓ those patients to be treated.

Alison Werner (12:56)
So looking ahead at your own roadmap for DynaFlex, what’s next for the company in the bracket space and where are you investing or innovating?

Darren Buddemeyer (13:07)
Well, we’ve been investing and innovating into the clear ⁓ aesthetic bracket. And I think for, I can tell you for a couple of reasons. One is we do see that there’s some deficiencies

in using aligners. ⁓ There’s a lot of efficiencies in using a passive self-ligating bracket system. ⁓ And so we did our best to combine that and

And again, this was a challenging ⁓ project that we love to work on and to create these types of super efficient ⁓ brackets. And being able to come out with an aesthetic bracket that really, I think, hits on all levels of what doctors are looking for, what patients are looking for in the performance. ⁓

and with the aesthetic balance ⁓ in this product. So that’s been our main focus for the last four plus years is bringing something ⁓ like this to the market that we’re really proud of. I think… ⁓

you know, as it, we’re launching it at the AAO and we’ve done a ton of clinical testing on it. A lot of doctors involved in the clinical testing and the results have been outstanding. And so we’re really excited to introduce this at the AAO and highlight this as our premier product. ⁓

Alison Werner (14:44)
I wanted to find out like how does DynaFlex, you know, as a full orthodontic lab, how does that feed into, you know, this,

the interest in the increased demand for bracket cases? How does it what does it mean to an orthodontist who is looking at their bracket options to have a company that has that full range of offerings?

Darren Buddemeyer (15:08)
Yeah, I think because we’ve been, and you know, originally we started out as a lab, and I have lot of knowledge and experience from working, you know, as a young person all the way in every single department of the

lab. ⁓ So, ⁓ you know, starting out as a lab, you know, there wasn’t this need that there is today of a lot of upper arch development.

Alison Werner (15:22)
Mm.

Darren Buddemeyer (15:34)
And today what we’re seeing is ⁓ doctors gravitating towards some sort of arch development in the upper arch and maybe some up righting of the lower teeth.

And ⁓ those sort of changes make for… ⁓

tremendous efficiencies not only for the patient but for the practice as well. And so I’m really excited to see that you know I think a lot of the ⁓ residents coming out of school today are very comfortable with doing arch development. ⁓ They’re being taught more about utilizing ⁓ some type of appliance whether it’s to expand or to distilize. ⁓

And so when you get finished with that therapy and some call it phase one, the bracket part of that or the aligner part of that becomes a much simpler process. So for us being able to offer that to our current clients who, you know, utilize their lab services and then move on to either our brackets or our aligners for us, we feel like is a huge advantage. And it really brings a lot of synergy to ⁓

and to our customer base.

Alison Werner (16:56)
Well, just to wrap up more broadly, where do you see the most meaningful innovation happening in the bracket space over the next few years?

Darren Buddemeyer (17:07)
Well, selfishly, would tell you that DynaFlex has the most innovative products for brackets over the next several years. But a lot of companies in this industry do a really good job of bringing out great products. ⁓ I do think this trend towards brackets will continue. And I think there’s a lot of good reasons why. And I think that with the innovations of products like the Norris Clear that we’re

Alison Werner (17:26)
in.

Darren Buddemeyer (17:36)
at the AAO I think is certainly going to help that because you do have the full aesthetic option with a lot of control that you would see in a metal bracket. I mean this thing is as tough and as strong as a metal bracket. We built it that way to withstand the forces. You have to remember when you’re using a ceramic or a clear bracket, know the properties are a little different but

this bracket that we’ve developed, we feel like is really gonna set the standard for the next many years.

Alison Werner (18:13)
Well, Darren, thank you so much for helping me kind of unpack where things stand today. I really appreciate it.

Darren Buddemeyer (18:19)
Yeah, thank you so much. I really enjoyed the podcast and the interview and look forward to seeing you at the AAO.

Alison Werner (18:26)
Yeah, definitely.

All right, take care.