Welcome to The Golden Age of Orthodontics, the podcast that keeps orthodontists ahead of the curve in innovation and patient care. Join hosts Dr. Leon Klempner and Amy Epstein as they explore groundbreaking advancements shaping the future of orthodontics. In today’s episode, they welcome Dr. Neil Warshawsky, founder of Get It Straight Orthodontics, to discuss the transformative impact of direct 3D printing and digital workflows. Together, they delve into the revolutionary changes brought by this technology, from producing pre-polished clear aligners and nightguards to the role of teledentistry in enhancing patient care. The discussion highlights the environmental necessity of reducing waste through direct printing and recycling practices. There has never been a better time to be an orthodontist.
IN THIS EPISODE:
(5:20) Dr. Neil shares his background and contributions to orthodontics
(7:11) Exploring the new wave of direct printing technology
(17:06) Predictions for the future of aligners and direct printing versus thermoforming
(24:33) The benefits of Ortho FX nighttime aligners
(31:14) The role of teledentistry and the importance of patient comfort
KEY TAKEAWAYS:
Revolutionary 3D printing has transformed orthodontics by producing clear aligners and nightguards with pre-polished surfaces, streamlining the process and reducing waste compared to traditional thermoforming methods.
The daily production of millions of non-recyclable aligner models highlights the need for sustainable practices, such as direct printing and recycling initiatives, to minimize environmental impact.
Customization and patient-centered approaches in orthodontics are essential for achieving better outcomes. Leveraging innovative technology like teledentistry and custom-made appliances addresses diverse patient needs, including those with special requirements. Consistency and comfort are key factors for success with aligner therapy.
EPISODE TRANSCRIPT
What follows is an AI-generated transcript. The transcript may contain errors and is not a substitute for watching the video.
Dr. Leon Klempner: (00:00:00) Unless you've had your head buried in the sand, you've noticed that we've had a lot of technological innovations in our industry. Some of the most interesting to me are 3d printing. properties, but it gets very confusing. So today we're going to break it down. Our golden age of orthodontics podcast sponsors make it possible for us to bring you new episodes.
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Narrator: The future of orthodontics is evolving and changing every day. But although the way to achieve practice growth has changed, there's never been a better time to be an orthodontist. Let's get into the minds of industry leaders, forward thinking orthodontists. and technology insiders to learn how they see the future of the orthodontic specialty.
How will digital orthodontics, artificial intelligence, (00:02:00) clear aligner therapy, remote monitoring, in house printing, and other innovations change the way you practice? Join your host Dr. Leon Klempner and Amy Epstein each month. As they bring you insights, tips, and guest interviews focused on helping you capitalize on the opportunities for practice growth.
And now, welcome to the Golden Age of Orthodontics with the co founders of People and Practice, Dr. Leon Klempner and Amy Epstein.
Dr. Leon Klempner: Welcome to the Golden Age of Orthodontics. My name is Leon Klempner. Uh, if you don't know me, I've been around the industry for a while. Uh, after retiring from clinical practice, I began my next chapter helping orthodontists grow their practices.
I co founded People in Practice, a marketing and consulting agency, and also continued teaching, uh, residents. I'm currently the director and the craniofacial orthodontist at Mount Sinai Hospitals here in New York and part time (00:03:00) faculty at Harvard Orthodontics. And today I am joined by my co founder and more importantly, my daughter, Amy Epstein.
How you doing, Amy?
Amy Epstein: I'm doing really well. Good to see you today. Happy New Year.
Dr. Leon Klempner: Happy new year.
Amy Epstein: Um, well, if you don't, if you, if you don't know my dad, you, um, probably have heard of him or you've seen him cause he's hard to miss if you're walking around. For example, the AIO, he's like about six foot four, um, silver haired guy.
You can find him in a crowd. Salt and pepper. Salt and pepper. There's not a lot of pepper there, dad. I'm sorry. Um, I mean, we absolutely love him. I have an MBA in marketing and we were just talking to our guests a little bit earlier that like, maybe when I finished it, I guess it was almost 12 years ago at this point and I finished my MBA and, um, my dad was like, I, I think there's something here in the orthodontic industry, uh, you know, I'm getting these questions about how I'm marketing my (00:04:00) practice and how I'm attracting new patients and going through all these different transitions, opening up locations, bringing on partners, this type of thing.
Uh, I think that we can help. Together. And, um, turns out he was right. Um, so we've been working together since, and we have a dozen people that we work with across the U S to help orthodontists through all the different types of changes and phases and opportunities that, uh, are being presented in this ever changing industry.
And we're going to talk about one of those changes today, as my dad hinted at. Um, and that's why. We're really happy to have on our podcast today, Dr. Neil Warshawski and Neil. I'm going to call you Neil. Um, Neil is a, and I'm sure you know him because like my dad, uh, Neil is has been around. He's an excellent orthodontist, but he's also very involved in the industry.
So he's a board certified orthodontist with over 30 years of experience, and he's a leader in integrating (00:05:00) advanced orthodontics. Technologies into orthodontic care. This is what makes him very interesting to us. Um, and interesting in general. If you, if you talk to him, he's the founder of get it straight orthodontics, which is a multi location practice in the Chicago area.
Um, he's also runs the ortho department as the associate professor as an associate professor at the University of Illinois. focusing on craniofacial orthodontics. He is an active lecturer, a published author, um, and he's an advocate for direct 3d printing and digital workflows in modern orthodontics.
He's also a speaker for a lot of the companies that we see at the AIO and that we are learning about to see if they're a good fit. For our practices, um, Luxcreo, OrthoFX, ULA, Bria, Brias, Kail, Owen, Lightforce, you name it, he knows a lot. So, Neil, thank you so much for being with us today. We appreciate your time very much.
Dr. Neil Warshawsky: Thank you for having me. And just for a correction, I run orthodontics in the craniofacial center. We're side by (00:06:00) side with orthodontics.
Amy Epstein: Oh, okay. Thank you.
Dr. Neil Warshawsky: But that's my alma mater. I went to school
Dr. Leon Klempner: there.
Amy Epstein: Okay, very good.
Dr. Leon Klempner: Well, I'm glad you're here, Neil. I've been trying to get you on the podcast for a while.
So it's finally come to fruition. So I do appreciate it. So as you know, as Amy mentioned before, um, at the AO meetings, you'll find me walking around and I'm, I'm always looking for what's new, what's, what's developing, you know, how I could leverage it with our, uh, Practices that we do all our marketing for.
So I'm always looking at, you know, ways that, uh, you know, innovations that, that are going to impact the industry. And lo and behold, I see Neil doing some demo somewhere in, uh, you know, in the middle of the thing with a big crowd around them. So I, you know, I weasel my way up to the front and lo and behold, I see this machine that is spitting out aligners and I don't see the (00:07:00) cast and I said, up.
This is going to be a game changer. So I remember this,
Amy Epstein: by the way, he came back to our booth and said, I found a game changer. And so I'm not making this up for your benefit, Neil, but, um, he did say that and we, um, you know, started doing some research.
Dr. Leon Klempner: Yeah. I mean, so, so, you know, tell us a little bit about how you got involved and just give us a, like a, a brief overview of, of.
How you use it and, and, and what your connection was.
Dr. Neil Warshawsky: Okay. So, uh, my background was I, one of the many KOL positions I've had over the last 30 years was I was the dense ply key opinion leader for a rain tree Essex. So I, um, spoke a lot about thermal forming. I mean, I could, I could spit out. Stats on plastic, uh, velocities of tooth movement, stuff like that.
You know, I helped build the M. T. M. System for them back in the day. That was their first clear liner system. You know, (00:08:00) then I went over to, um, I was already a speaker at three M. Built, uh, helped build. I was one of two guys behind clarity, you know, so built the clarity aligner system. So, so I'm a thermal forming guy at heart, right?
And I'm, there's a key guy at Invisalign 1999. We were right at the beginning, we were using Invisalign, but you know, Anyone who uses clear aligners knows there's limits, right? And there's a lot of orthodontists out there that says they can do everything with a clear aligner. And I'm just suspicious of people when they say everything and always because there's always exceptions to a rule.
You know, and I believe in custom care, so I think using the same appliance to do something for everyone just doesn't make sense. So the problem now is the largest company in the world that makes clear liners by far is aligned technology that make a million aligners a day roughly. And they, in my mind, are a marketing company, right?
They are really fast to be the, as I (00:09:00) say, the Kleenex Right. Which is tissue paper. They are the Kleenex to the clear aligner world. Everyone knows the name Invisalign, uh, you know, I left them probably I, I, I'm, I'm still a user of it. I don't really order too many cases anymore. But, um, you know, but if someone says, you know, this is what I want, you know, I'll give them what they want.
If that's really what they want, uh, there are just better products out there and I'm not saying bad or good. I'm not disparaging the product, but you know, they're, they're using a platform and technology that isn't really necessarily evolving, right? They're using thermal form technology. They're still using stereo lithography.
They're still, you know, still printing models and blowing stuff down. So one of the things that I learned along the way was, um, so I'm really into, Because of my craniofacial background, trying to functionally grow people. And I've been working on a project for about eight and a half years to. Build a class to corrector.
That's just better than herpster, (00:10:00) headgear, Mara, carry a, you know, name it. It's a skeletal corrector, right? And, um, you know, I want to print it, right? Ultimately, the holy grail is to print it as a part of an aligner. And, um, when I started doing my homework, I realized that no printers could do it. So I started looking at graphy, which was the The direct print material that I knew of because they advertised.
And I was talking to keep on Kim, who does a lot of the research at ST Louis University, and he runs a department there, and he really grounded me and kind of explained to me what it does and doesn't do well. And, you know, I learned the process of how it cures in a nitrogen environment and this and that.
And I started digging a little bit about looking for their patents. And what I realized is they, they weren't on the patents for direct print technology. It was a company called Lux Creo. I'm like, who are these guys? Right? So, so I did a little homework and, um, learned who they were. And I, so I called the head of sales.
I'm like, Hey, you know, I'd (00:11:00) like to have a key opinion. You know, I want to, I want to talk to your key opinion leader. Cause I, I have a lot of questions here and I'm trying to do something. I just don't understand this. And, you know, and he's like, he's like, well, You know, and the sales guy, his name is Kevin.
Dylan was incredibly knowledgeable about this industry. Like he, more than anyone I'd ever met. So it was really, we had a fascinating talk and, and at the end of the day, he says, you know, we have a technology office in Chicago. If you ever want to go to Chicago. And I started laughing because, you know, it's like the technology office is two blocks from my daughter's apartment.
And I'm like, yeah, I actually know the building like, you know, so, so anyways, it was just a quick love story. I walked in. Um, it was like, you know, uh, yeah. A fat kid in a candy store. I just went berserk on these guys asking a million questions. And, and they just fed my passion and just let me learn. And it's been a fascinating love affair ever since.
So I really, I'm, you know, just one of a couple of people that help them, but I really love these guys because they (00:12:00) don't believe that there are limits to what they can do. And, uh, it's at brash. Um, stubbornness that really is kind of what we all share in common because I don't know a single person that made it through orthodontics school without being some type of a thoroughbred.
Right? You have to be like, just ridiculous. It's something to get through school because it's such a long process. And, um, really a bunch of talented people. Very, very, very, very humble and just Uh, I was blown, blown away when I realized that they didn't create resin. They actually created an ecosystem and wrote all the patents and, and that's kind of where the direct print stuff for me really kind of started to change my practice.
And let me tell you, this is all new. It's all roughly about a year ago.
Dr. Leon Klempner: So, so let me, let me ask you something, I don't want to interrupt you, but just cause just for my own clarification and maybe some of our listeners, uh, might, might have this question as well. (00:13:00) Is Lux Creo, is it, is it, uh, a, a material, is it like a liquid or is it a machine?
What, what exactly is it? It's, it's an ecosystem.
Dr. Neil Warshawsky: So, so this is a group of people. From all different backgrounds. And I mean like all different backgrounds. One guy is a material science guy from that. Design the skin on the 787 airplane. Um, they, um, created a system. So they built a printer. They created resins for different purposes, not just for orthodontics.
You know, they created, uh, resins. You know, they've, they've They've learned what's needed in dentistry and they've built their system to solve solutions. So they do make three resins that I use every single day. One is, uh, a Night guard resin. One is, uh, what we call DCA, which is direct clear aligner resin.
And the third one is a model resin. So those are theirs. Um, they (00:14:00) have, uh, the ability to do other things. Like all I'm for dentistry, you know, when you're sitting on implants and stuff, they, they can print, uh, the denture, the teeth. Um, pretty much anything that can be printed, they can build as a role. So it's software as well as the hardware as well as the resin.
Yeah. And because they built the entire system together, right? And, you know, direct clear aligners are using, um, some called shape memory resin, which if you don't know your materials in this space is super weird compared to thermoforming plastic, because in thermoforming plastic, We heat the plastic to somewhere around 414 degrees for a set period of time, and then you blow it down using a positive pressure machine.
If, if you're, if you're a real doctor, some people still use the old vacuum formers, but they're just not that good for this type of stuff. And then, uh, after you blow it down, you cut it out, you polish it, you know, but it, (00:15:00) but it's a polished sheet of plastic that you're blowing down because it's soft in the direct print world.
One of the issues is How do you polish it? Right? So it has to. So they pioneered digital printing, digital polishing while it's printing. So pieces come off the printer, polished. It's, it's like insane. Your night guards are already clear. When it comes off the printer, so, so their ability to reduce the amount of time to process something at the end is actually huge.
But, you know, more so with direct printing, there is no model. So I'm a, I'm on the, on the ecology side of this. I think if you realize that a line technology produces a million models a day, you have to ask yourself, where did the million models a day go? Because they are not recycling them. They don't recycle their plastic.
It's too expensive. So, they are going in the garbage somewhere, or into a fish hatchery, or somewhere in the ocean, but, you know, maybe (00:16:00) they're getting chipped, I have no idea, but they're not, they're not using a recyclable material. A company like U Lab, for instance, right? U Lab is our in office system.
Okay, they recycle 80 percent of their materials in their Memphis facility. So, and we'll, we'll talk about that.
Amy Epstein: You know, just a quick follow up on that question is, you know, before the show, we were talking a little bit about how you, you know, found Lux Crio, but you said it was out of necessity. Um, and so I want to ask you about that.
Dr. Neil Warshawsky: Okay. So, so if you ever hear, if you ever had the opportunity to meet like someone like Dwight Damon or someone who's like. Big in the industry, I think we all have one thing in common, which is we're all passionate about something, right? Some people, it's about golf. Some people, it's about working out. I love listening to orthopreneurs and ortho pearls because when they do their podcasts and you meet these guys or you listen to them.
I (00:17:00) feel like I'm not the only idiot in the room, right? Like we all, we're all so intense about stuff. So in my case, I came out of school. I've wanted to be an orthodontist since I was five. Okay. Like I got dragged along when my sister was getting her phase one at eight years old and the orthodontist who happened to be my cousin would let me sit in the back with him and hand him instruments.
And I'd wash my hands with Neutrogena soap. And to this day, when I smell Neutrogena soap, the hair on the back of my neck stands up because it's such a visceral effect for You know, I was very passionate, like going through school, like high school, college. I'm like, I'm gonna be an orthodontist. I never said I'm gonna be a dentist because I didn't really understand that.
Right. And, um, it all worked out right. But, um, but I entered orthodontics with one point One purpose in life other than, you know, to make a living, which was, I want to leave it better than how I found it. And because of my role in craniofacial for 30 plus years, mostly at U of I and (00:18:00) University of Chicago, I really like Want to see, you know, certain things evolve and my biggest topic has been class two.
And, uh, so I wrote a patent about eight years ago with a friend of mine who a lot of, you know, his name is Adam Schulhoff, who has created grin. I'm an advisor for grin as well. But, um, you know, so, uh, Adam and I, and another friend of ours, we wrote a class two patents and then, you know, Adam's. Project that grin took off.
So, you know, he's doing that. And our other buddy, he has a sleep apnea company. So he's in his, so I was left holding the bag on the class to think, but that was mostly my idea. And it's, it's been a project of mine that like, there's gotta be something better out there, right? Better than headgear that can grow people.
And, uh, so. When I realized I want to do it on an aligner, that's how I found Lux Creo because they're the only printer who can actually print what I'm trying to make. Okay,
Amy Epstein: great. Um, okay. So, um, it seems like I watched some of your (00:19:00) presentations in the past, so I know a little bit about the Lux Creo, uh, process and there are obviously.
Doctor benefits, time, cost efficiency. Um, but at the same time, there are companies that offer us the opportunity to shop out manufacturing of aligners as well. So how do you see the industry taking shape? Or is it like everyone's going to be buying ecosystem? Are we shopping it out? It was a hybrid.
What's uh,
Dr. Neil Warshawsky: no, I don't think everyone's going to buy it. So I think, you know, the first thing you have to be honest to yourself and you have to say is like. Do you want to do lab work? You know, I like doing lab work. You know, if it's not patient forward and I'm making stuff in the lab, you know, I, I, I find that kind of relaxing in a weird way.
Like I, I, I can sit down on a Friday night and bend seven hyraxes and watch a movie and not even think about it, you know? Um, so your practice has to have the right clientele to begin with, right? We, we see a (00:20:00) lot of adults and I think, you know, it's not about, you know, knocking, uh, A grand slam out of the park every time you don't have to have a full case in order to make people happy.
And that's kind of one of those tough lessons I've kind of learned to accept that, you know, people don't always want a full correction. People want two teeth moved in their social six and, and they'll, they'll rave about you, you know? So it's like, so I think the concept that I tell people is under promise and over perform.
That's where direct print comes in because direct print oftentimes uses little to no attachments, right? That's a big deal when you have somebody who's like in their middle of their career and their vein and they don't want to be able to have a bunch of crap on their teeth, you know, and I'm sure we've all seen the case that, you know, someone walks in with a, with a removable product, they have 60 attachments on their teeth and I'm like, why didn't you just put braces on?
That would have looked better, you know, so it's, um, It's it's sort of kind of kills two birds with one (00:21:00) stone when you're able to make a decision between thermoforming versus direct printing. Right? Direct printing is a little more accurate. The trade definitely is acutely tighter. It's a better fit and you can make it even tighter through the software settings.
So depending on what your goal is, if you have a tooth that's being uncooperative, you know, oftentimes you'll see me like If I have a thermoforming case and something's not responding, I'll re scan it and I'll specifically put it in direct print at that point to finish whatever's just not happening with a thermoformed aligner.
It's interesting. They have different
Dr. Leon Klempner: qualities, you know. You know, you know, the happiest day in my career. One of the happiest days of my career is when I started sending out all of my retainers and my models and I got rid of the plaster and I got rid of all of that stuff in the lab. I was just so happy to just write a script and then just get it back and not (00:22:00) deal with, you know, covering the lab and, you know, you need trained people and, and it was just messy and you were breathing in all of this junk.
And then we had. methyl methacrylate and all this type of stuff. So I'd be one that would want to farm this stuff out. So how does that work? If you have, who am I farming to? And, and how does that work? So we
Dr. Neil Warshawsky: are a mix of both, right? I, I still believe, you know, like I, like I told you up front at the beginning, I speak for ortho effects.
Um, and, um, it, you know, I, I believe That it's kind of like a kitchen, right? You know, there are some things you can do by heart and there's some things that take a little bit of time. And when I see a very involved, intricate case, I still think and and most importantly, when I when I'm pulling my patient and You know, questioning them, like, you know, what's your goals?
What's your objectives? How much do you want to be a participating factor here when I hear that they don't want to wear stuff full time? I'm (00:23:00) immediately like, okay, we're giving you a premium product. We're going to give you nighttime from ortho effects, which is the only product I use from ortho effects.
Um, because that's the only product out of about 100 companies on the market right now that says it doesn't have to be worn. Um, More than, you know, well, a minimum of 9 to 12 hours a day, you know, every other product is 22 hours a day, which is pretty much the speech we give everybody like, you know, take it off for meals, you know, brush your teeth, you know, if you're going out for an hour, you can leave it off, but otherwise get it back on right with ortho facts.
They're, they're the only animal in the whole industry that builds a tray differently. And it's interesting because they're the guys that started Invisalign, you know, all four of the owners are from Invisalign, you know, one was a finance person who ultimately ran the company. That's the call. Ren was the person who launched all the products.
From 2012 to 2016, um, Locke is the guy who built all the resins, who we'll talk about him in a second, and (00:24:00) Henry's the guy who did ClinCheck and, uh, the, for the iTero, he did the simulator. So, you know when, when you get those four, four people, honestly, like between just between Henry and Locke, honestly, they created the clear aligner industry.
In my mind, no two people have been more influential. Forward facing in my mind than those two people, block built what you call today. Um, the active plastic at Invisalign, which is a smart track. Um, he left Invisalign and what's company called Bay Materials. He created a reversed version of that, which is called F L X, which is by far the most popular plastic in the industry.
Many companies is literally take that plastic and they use it for their liner system. Perfect example is clear correct. Clear correct is owned by Strauman. Strauman bought bay materials. It wasn't the greatest aligner system. I'm sorry if you use it. That's my own personal thoughts. Um, but then they bought FLX and they put FLX into (00:25:00) clear correct and clear crack got better because he's a premium material.
So, you know, uh, um, Spark from and Vista uses F L X. It's private labeled, you know, Great Lakes sells it as a private label. There's a lot of companies to use that material. And the reason being is it's really that good. You know, as as plastic goes, it's worth four bucks a sheet because it actually performs.
You know, there are a couple couple companies now that make their own stuff. You know, one of the newest ones to the market who's really been incredibly aggressive is angel liners, right? That's the one. Yeah. That's the number two company in the world right now behind Invisalign, but they're number one in China.
And, um, you know, it's, you'll have mixed feelings from different people about that, but, uh, they make a really good product. I have to say, I can't, I can't beat them up because I've tried a couple of cases and. Their customer service was great. They were very responsive. A couple of my friends are the (00:26:00) key opinion leaders over there.
Uh, one of the sales guys is a good friend of mine who I know from 3M when we were doing clarity and it's just, they're growing like gangbusters because they're cheaper. And they are very focused on the consumer, meaning our, as the orthodontist, our experience. So, and they are just 100 percent automated.
If you see how they make stuff in their factories, it's insanely cool to watch. I mean, it's
Dr. Leon Klempner: crazy. I've heard a lot of positive things about their software. They're using a lot of AI. You know, they'll give you like, uh, CVM, you know, uh, a lot of, of interesting, uh, Uh, areas, uh, you know, landmarks on SF, you know, they'll deliver all of that.
So I've heard a lot of, they have a class two correcting system as well. Yeah. Yeah. So let me take it back to the nighttime aspect of ortho FX, because to me that that's a significant benefit to the, to the end user, to the patients, right. Very, if (00:27:00) you could offer that. Yeah. So, so I don't understand what, what is so special.
That you could get the same result in half the time with this particular plastic. Okay, I don't get
Dr. Neil Warshawsky: that. So, um, if you're, if you're a numbers person and you know. You just want to know just in general how products perform, you know, the only benchmark article that I know about Invisalign is Neil Kravitz's article in 2022, which shows that Invisalign takes about two years and three refinements to complete.
And, um, you know, so it's, it's an honest study. It was retrospective. It's studied several hundred cases though. So, and that was a much bigger study versus his master's thesis. So he did the same thing 10 years earlier. And we all love Neil because he's just today. He's super humble. He's very positive and complimentary to (00:28:00) everybody in the industry.
And we need more people like him. I'm a big fan. So he's got a good name, too. So, uh, but, uh, You know, when you look at the first 10, 000 cases that came out of ortho effects, which were not nighttime, they were just their tetra material, which is their 22 hour where in their first 10, 000 cases that they finished documented 79 percent of the time the cases were completed with the original trays and a refinement.
I believe of less than 10 trays. So those are really good numbers, right? So they, the group that ran that company walked into my office in 2018 and asked me if I would look at Tetra. I don't know why they were interested in me, but we all kind of knew each other. And I said, You know what, look guys, I'm under contract at 3am because of clarity.
I'm, I'm, I can't even talk to you. And I basically threw them out. Uh, I finished my project during COVID in 2022 and January 7th in 2023, they walked in my office and they're like, can you (00:29:00) talk to us now? And I'm like, I'll give you five minutes, which turned into an hour. They showed me what was going to become the nighttime material.
And I was very intrigued by the fact that the FDA actually certified this. That it could be warped for 9 to 12 hours, and they actually got the FDA certification. 100%. No material had ever done that. Now, the reason that it's so special is for three reasons. Okay. So the first, um, and Locke fan, the creator of the material is just a genius at resins.
Okay. He's got a. Bunch of patents, maybe like close to 500, not all in the ortho space. But if you look in the ortho space, he's the most accomplished. So Locke created something called an air shell. So the way their trays are built just in general, all he has four different resins, four different materials are all built the same way.
It's an outside and inside tray. It's sealed on the edge and there's an air gap in between. If you look at every other material like FLX, Smart Track, um, even (00:30:00) 3M. So only three companies really make their own, well, maybe five now, but most, most companies don't make their own materials, but they all make the same concept, which is a laminated material.
It's usually got polyethyl chloride on the outside, which is plastic. So it, um, Resist stain. And it's got like, uh, something flexible on the inside, like polyurethane. Okay, that's, that's how FLX is built. If you look at smart track, the polyurethane is on the outside, which is why it stains easier. Okay. So when, when you look at the, the technology with an air shell, first of all, the outside layer and the inside layer are incredibly thin.
So that inside layer is always going to fit well when you change from tray to tray to tray. It's the outside layers where the magic is. So with nighttime, the materials is incredibly flexible. It really fits almost over more than one stage. And it's because of its flexibility and the fact that the layers aren't bonded together.
They've, they've (00:31:00) reduced this stress strain relationship. What hook, Hooke's law. And in Hooke's law, it says as this. As the stress goes up on the plastic, so does the strain on the tooth. In this case, if the tooth is out of whack because the two layers aren't bonded together, the inside layer still fits very well, and the outside layer is separated, so it just twists.
So, if you look at the amount of force being applied to the teeth, Whether it's day one or day seven, it's aimed to be around 150 grams. Now, if you look at a typical aligner coming from a manufacturer, let's say Angel, Spark, Align, any of these big companies, Claire, you know, whoever, I don't care where you use it from, you can see forces up to 7, 800 grams.
Right. And, you know, we call it a cliff dive because, you know, you put the tray on, it's very tight. And then over a few days, it dies. Right. And as it dies, it's going to force the tooth to move for the wrong reason sometimes. So you (00:32:00) get undermining resorption versus frontal, you know, uh, resorption and bone apposition on the back end of a tooth.
And as a result of that, what you're seeing is. Teeth are moving, but they're really in my mind, more susceptible to relapse, right? Because all of a sudden you take this force off and then they're running for the fences, right? The teeth are all over the place. Cause you know, you took this heavy force off when you have this light force, it's kind of really not that heavy.
What you find out is when you take the tray off and you put the tray back on, there's not a lot of difference to the tooth, right? We're not, we're not overstressing the tooth. So that's my. Belief of why nighttime is working for me, right? But nighttime is their only material where they say if you don't wear full time, um, it'll still work and I have to say, you know, 150 or more cases in.
I can honestly tell you it does work now. It doesn't work on everybody the same. And I definitely have people wearing it for nine hours a day. And I tell them if you were for nine hours a day, we're going to build you in a sprint, (00:33:00) meaning I'll build you 20 trays or more. Okay. I don't care when I get to 20, I'm just rescanning you.
You know, I don't want to do refinement. I just don't believe in it. I believe in being forward facing on the patient. And when things don't look good, then I want to, I want to get you. And whether it's a smart STL or a real scan, I want to, I want to refine it, rebuild it. If you will build forward, as I say on the fly, right?
So, so one of the things I will say, so I believe what makes the most sense. Today is I think teledentistry should be used with all clear aligner systems. Okay, because you know, when people tell me, well, patients come and I can see what's going on, you know, I'm going to call bunk on that. Okay, your eye is not as good of a scanner as a scanner, right?
You know, and like, I think like. I can see pretty good things, but you know, it's like I'm wearing glasses. I have loops, you know, on any given moment. If someone upsets me, you know, my judgment is going to be off a little bit. You know, when you looking in it, you know, on a video on a phone, (00:34:00) you know, especially like an iPhone or something.
The camera is phenomenal, right? You can see really well. I just need to see if you're in the ballpark or not, right? And depending on how far you're off, that determines whether I want to scan you and build you forward or not. So I think it's really just clever, right? When, you know, and my entire practice is custom made products.
So, like, I have to say, like, my biggest problem today is I don't have enough employees. I can't find them, let alone hire them. So, you know, using custom made appliances and teledentistry has really helped me manage, especially clear aligners, right? And a lot of times, I just tell patients, like, wear it an extra week.
You should be better. And a lot of times, that's all it is. Because not everybody is the same. So the same thing with this nighttime material. They say 9 to 12 hours. I don't tell people that. I tell people nine to 12 contiguous hours is the minimum of what you need, right? And I want you to wear it more than that.
And I think if you're in between probably 15 to 18 hours, you're going to be (00:35:00) great. You know, most people are willing to do that because that means you can have it off at work or school and still pretty much. Do what you want, you know, and for me, that's been a, uh, just an absolute game changer. Because when I tell people that they're like, well, how come all my friends have to wear it all the time?
I'm like, well, different products. That's all, you know, and, and the, the thing about it is, is this is the only company out of the hundred companies making aligners that does it this way. So they're very disruptive. Again, they have a deep, deep knowledge set of. Of what's, you know, what's the industry about?
And, you know, and even if it like is close, but not perfect, you know, I can always then say, okay, come on in. I can scan you and I can, I can build you to retainers and deliver them in the same day because I've got both the Lux Creo system and thermal for me at my fingertips. And we're, I'm a huge you lab user.
So it's like, That's just my thought
Amy Epstein: and you know, I want to touch on it just we have like just a minute or so (00:36:00) left But it it does seem like there are some obviously there are doctor benefits here patient benefits You mean that I think nighttime is Of everything we've talked about a huge, uh, I would say marketing hook.
Uh, do you, do you use that in a way that you know,
Dr. Neil Warshawsky: it's, it's interesting. I don't like, I don't like to back myself in the corner and tell people like you can wear for 12 hours a day. I wait till I talk to them and I, I. Uh, I say, tell me your handcuffs, tell me what I can't do. And when time is a factor, that's when I pull that out of my bag and surprise them.
Right. Cause it's always, it's always nicer to. Offer them more than they expect in return, right? Other than promise, you know, for the stars and then fall short and then look like, you know, you're just not that good. You're like everybody else. You just promise, promise, promise, and you fall short. So, but I, I make, I make people own it a little bit.
Like, I'm like, you know, you have, you have to be consistent, right? The name of (00:37:00) the game is being consistent. Um, the biggest, the biggest. I will say this unquestionably, the biggest comment I've heard repeatedly with this material is it doesn't hurt just over and over and over about how comfortable it is.
So, especially when someone is sensitive or I have someone with sensory integration issues, like I see a lot of special needs things. Adults and kids, and it does very well for that.
Amy Epstein: So listen, it sounds like we need to have you back and dive into some of the topics we talked about today to go even deeper.
But in the meantime, if we have questions for you, if our audience has questions for you, how might they best reach you?
Dr. Neil Warshawsky: Oh, that's easy. Um, you can always email me. It's my email. Super easy. It's dr neil. D. R. N. E. I. L. Just like, just like my scrub at get it straight dot com. Um, you can always come and see me like I'm, I'm, uh, in the near future.
I'll be the orthodontist lecturing at the midwinter meeting (00:38:00) in february in Chicago. Uh, I'm, I'm sure I'll be on the floor at the A. O. Um, I, you know, I get thrown out for various events throughout the year always, and, um, no, I'm, I'm, I love, I love being a part of solutions and helping people. It's kind of what I enjoy, so it's never a stretch, and I don't mind calling people back at the end of the day.
So,
Dr. Leon Klempner: you know,
Dr. Neil Warshawsky: and you can reach out to me through any number of the social media options out there. It's like I'm on all that as well.
Amy Epstein: Well, appreciate that. Well, thank you again for joining us today. We appreciate it. We'll see you at the AIO. I'm sure. Um, and in the meantime, happy and healthy new year to you and your family.
Dr. Neil Warshawsky: Thank you. You as well. Neil.
Amy Epstein: You can subscribe or download other episodes of the golden age of orthodontics on Apple, Spotify, SoundCloud, YouTube, or wherever you get your podcasts. And if you enjoyed it, we'd appreciate you telling a colleague (00:39:00) for more information about people in practice. You can visit our website at pplpractice.
com.
Dr. Leon Klempner: I want to thank everybody for watching and listening. And, uh, if you have any marketing questions, uh, you can shoot me an email at Leon at. PPLpractice. com. I want to take this opportunity also to welcome K. L. Owen and Grin as our new sponsors. Uh, we talked about, uh, customized appliances, um, and some, uh, monitoring, remote monitoring for aligners today.
So, uh, if you're looking for, uh, a special deal, uh, go to our website at, uh, PPLpractice. com and go to our partner page. Um, And I want to leave you with what I've left you with every podcast for the last four years, which is my strong feeling and belief that it's never been a better time to be an orthodontist.
We're in the golden age right now, and you need to take advantage of it. (00:40:00) So until next time. Bye for now.
Narrator: Thank you for tuning in to The Golden Age of Orthodontics. Subscribe now on Apple Podcasts, Spotify, or visit our website at thegoldenageoforthodontics. com for direct links to both the audio and video versions of this episode.
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