Innovation is a mainstay in orthodontics—and INBRACE® from Irvine, Calif-based Swift Health Systems is the latest aesthetic innovation to come to the industry. INBRACE is the result of a collaboration between orthodontic and engineering teams at the University of Southern California (USC) who set out to create a non-sliding friction free orthodontic treatment option—that happens to be lingual. Featuring an interdental loop design, INBRACE Smartwires® are programmed to level and align teeth, open and close space, express torque, and correct rotations with no powerchains or coil springs. According to the developers, the smartwire works with INBRACE Brackets to begin moving teeth in all three dimensions on day 1 of treatment.
To learn more about INBRACE and how it is an alternative to traditional lingual orthodontics and even aligners, Orthodontic Products spoke to Ronald Redmond, DDS, MS, FACD, CEO of the Schulman Study Group. Redmond serves as an advisor and mentor to the development team.
Orthodontic Products: What is INBRACE?
Ronald Redmond: INBRACE is patient centered orthodontics created for orthodontists by orthodontists. The technology sprung from my alma mater, USC, through a cross collaboration between digital imaging and craniofacial experts at USC’s Ostrow School of Dentistry and computer science and advanced manufacturing experts at USC’s Viterbi School of Engineering. They worked together to reexamine orthodontic fundamentals under the light of advanced manufacturing technologies and data analytics, and reimagined orthodontic mechanics in an evolutionary way. Moreover, they reimagined the patient experience as well as the impact on practice development in a revolutionary way.
INBRACE is a new type of treatment mechanics that delivers light continuous forces to move teeth in all dimensions starting from day one. No more staging, no more sequencing, it is as close to “set it and forget it” that I’ve seen in my career.
OP: How does it compare to traditional lingual appliances?
Redmond: First, we have to let go of the stigmas of other lingual appliances. I was on the original lingual task force for Ormco, and what we were trying to do was to take the edgewise appliance which was conceived around the ideal smile arc labially and make it work lingually—but it just doesn’t work that way. Forget what a friend of a friend told you about lingual. Forget what your orthodontic advisor told you about lingual. INBRACE is a completely new category of tooth movement mechanics, that happens to be lingual.
In orthodontics, like the rest of life, we are all asked to do more with less. INBRACE allows any practice, from a startup to practices of my friends in the Schulman Study Group, to realize benefits by delivering a 100% aesthetic solution that you can delegate to staff while minimizing chairtime—and all at a price point that is within reach of the majority of patients.
Many colleagues say their patients don’t want lingual, but our data shows that customers want lingual; they just want it at a price point comparable to braces/aligners. And they want it when the office is enthusiastic about it. Patients are smarter than we give them credit for; they can tell when we are behind a product and when we aren’t. I recall a conversation with a friend, I asked him how much he charged for lingual. He said, “Enough so I don’t have to do it.” Finally we can offer a 100% aesthetic option that is easy for the practice to use, and at a price point that patients can afford.
OP: What need does INBRACE fulfill in the orthodontic landscape?
Redmond: We are living in a patient centered world. Our patients are making decisions about our practices before they even walk in the door. The success of aligners shows all of us how powerful a voice consumers have. When patients are asking for Invisalign®, if we really listened, what they are asking for is invisible, and they only know one word for it. More importantly, it is the first viable aesthetic option for cases that many of my colleagues are uncomfortable treating with aligners. INBRACE is also a practice differentiator that is only available from orthodontists, which is another way we can communicate to the public that we are the best providers of orthodontic care, not the GPs or direct-to-consumer companies. I am really excited about that.
OP: How long from conception to production for INBRACE?
Redmond: INBRACE spent over a half decade in development before being released to a wider group of early adopters. As ABO certified orthodontists themselves, the founders—Hongsheng Tong, DDS, PhD, a bone biologist and orthodontist, and Dr John Pham, DDS, MS BSEE, an orthodontist and aerospace engineer—have been very conservative in what promises they make, as a lot of companies in the past have made claims that couldn’t be backed up. These guys are humble, their DNA is to under promise and over deliver. I can tell you that I’ve been blown away by the results, and the response from early adopters has been phenomenal. We all know wires are more effective at moving teeth than plastic. In the coming years, as their algorithms improve, you are going to see some pretty mind-blowing things from this company.
OP: What are the components to setting up a case?
Redmond: If you do aligners, you are already familiar with the workflow. You submit an intraoral scan along with your treatment goals to INBRACE. Your setup is made and reviewed by an INBRACE orthodontist here in the United States before being returned to the doctor for approval. After the setup is approved, your INBRACE kit arrives about 6 weeks later. It includes preloaded indirect bonding trays and your patient’s custom designed smartwire. Bonding and wire insertion can be completed in a 1 hour appointment.
OP: How does INBRACE affect patient appointments?
Redmond: Using an average 20- to 24-month case as a baseline, your practice will have significantly fewer appointments spread out over longer intervals. The principle of light continuous forces means that INBRACE Smartwires express themselves over time, and basically eliminate the need for patients to go into the office for activations. Most cases can be treated with as few as two to three wires. The company is careful not to make claims about shorter treatment times at this time, because the goal is clinical success and the fairest answer is that patients think they are finished long before their doctor does.
OP: How does INBRACE impact patient hygiene?
Redmond: This is one of the great benefits of INBRACE. With its unique interdental loop design, patients can brush and floss normally. Aligners, they’re great, but to prevent discoloration or odors, patients have to clean them regularly and we’ve all seen patients stuff them in pockets, napkins, and the like. I was chatting with a patient and we did some back of the envelope math—removing aligners three times a day for meals, four times a day for snacks/coffee/business meetings. That’s two aligners seven times a day for 365 days; over 2 years that means you have your fingers in your mouth over 10,000 times.
OP: On the company website it says, “…we don’t rely on patient compliance to achieve great outcomes on schedule.” What does this statement mean?
Redmond: The beauty about the INBRACE system is that it takes the intelligence of a digitally designed treatment plan and combines it with a fixed appliance system that executes that digital design. INBRACE programs each smartwire with the light continuous forces required to move teeth. With INBRACE, they are your patients, it is your case. With aligners, our work frequently ends with the setup. The actual therapy is the responsibility of the patient. As a profession, our greatest threat with aligners is that patients think that they are doing all the work, and if they don’t wear them, it is still our fault. INBRACE brings that control back to the orthodontist.
OP: Does INBRACE require any special training for the orthodontist or staff to begin use?
Redmond: INBRACE has a great onboarding program for doctors and their staff. As I mentioned, being successful is a team effort, and not being set in your ways. The most successful offices are the ones that embrace a culture of change and know how to follow through and implement within their teams to be successful. The INBRACE team is there to support offices in every way that they can—be it the doctor, the TC, or assistants.
OP: How does INBRACE drive practice development?
Redmond: Along with less chair time, fewer appointments, and a reduction in overhead, we’ve started to observe something novel with INBRACE patients. They are referring new patients much earlier than aligner or traditional braces patients, typically in the first few months of treatment, unlike my braces patients that typically refer at the end of treatment. That is reason alone to bring INBRACE into your practice. This team is also smart and they are going to be mounting a large patient awareness campaign to drive patients to practices. There is a new word for invisible, it’s INBRACE.
OP: How and why did you decide to get involved with INBRACE?
Redmond: I have had a long career in orthodontics, and have been humbled to have seen just about every advance, or purported advance, over the decades. As an active USC alum, I came to know these two remarkable individuals: Dr Tong and Dr Pham. Dr Tong has a doctorate in bone biology; Dr Pham has a master’s in engineering. And people spoke highly of them as people. They saw things not as they are, but how they could be. I have always been a technologist, and they had the DNA of successful teams I’ve known in the past. I wanted to be a part of giving orthodontists a solution that will help the profession fend off competition from GPs and direct-to-consumer companies.
OP: What has your clinical experience with INBRACE been in your practice?
Redmond: INBRACE is the most exciting innovation to my orthodontic practice in 4 decades. Patients are enthusiastic about INBRACE; they frequently comment, “I’m amazed at the speed my teeth are straightening.” Their excitement produces referrals. I was cautious in the beginning about visit intervals of 4 to 6 months; but by asking the patient to take photos of their teeth at 6 week intervals, I was more comfortable, and so were the patients. Patients have busy lifestyles and really appreciate not interrupting their schedules with frequent office visits. OP