Thursday, June 4, 2009

What is Invisalign Thinking?

In the past couple of days, the aligner company Invisalign has been sending both written and e-mail communications to doctors that are certified in using their products. It seems the company is now forcing treating doctors to do a minimum of 10 cases per year to maintain the right to use the service. This is coupled with a second requirement of 10 Invisalign specific CE programs.

I've already heard from several doctors who are now "done" with the company based on the above and many more are giving serious consideration to no longer providing or recommending the treatment to patients. These individuals are quality doctors who enjoy providing the treatment but simply do not have a high volume of cases.

It seems interesting to me that a company that charges for certification, charges for CE programs, and then charges for the doctor to use the service is suddenly now forcing the doctors that have paid all of this money to do a "minimum" number of cases... for even more money.

While I certainly applaud the need for CE to keep up on the latest innovations in all aspects of my profession, I can't help but think there is more to this story than what we know so far.

If you are a provider and haven't gotten this info, you will. The e-mail letter was submitted to me and can be read below:

Dear Doctor:

Align Technology has always been committed to great treatment outcomes for Invisalign doctors and patients. This commitment is at the heart of everything we do, and is evident in the investments we make in clinical research, product development, and industry-leading clinical education.

But ultimately, success is in the hands of the doctor. As awareness and acceptance of Invisalign has grown, so has consumer demand and the size of our trained doctor base. Which leads us to ask, how can we be confident that every Invisalign® provider actually has enough product knowledge and experience to help give patients a great outcome? Align wants every Invisalign provider to be one we can comfortably direct a prospective patient to with an expectation of knowledgeable treatment and a great outcome.

Effective June 1, 2009, Align is implementing Invisalign product proficiency requirements to help ensure good clinical outcomes and a more consistent standard of treatment for Invisalign patients. This proficiency initiative requires every Invisalign provider to start a minimum of 10 Invisalign cases and complete at least 10 Invisalign-specific CE credits each calendar year to maintain active account status. Details on all aspects of the proficiency requirements are available at

Align wants to make sure that every doctor who wants to be successful with Invisalign can be successful with Invisalign. As part of this proficiency initiative, we have defined a Proficiency Pathway of Invisalign educational opportunities at to help doctors achieve confidence with key aspects of treatment. And starting today, your VIP page will show a dashboard of your patient starts (based on cases shipped to you) and CE credits for the year to help you stay on top of the proficiency requirements.

Doctors who choose not to meet the annual case and CE requirements by December 31, 2009 will be able to continue treating any in-progress cases, but will not be eligible to submit new Invisalign cases or to represent themselves as Invisalign providers.

Attaching proficiency requirements to using Invisalign helps Align preserve the integrity of the Invisalign brand for prospective patients and for the doctors who use our products. Being an Invisalign provider should mean something. Going forward, being an Invisalign provider will represent a baseline of Invisalign knowledge and expertise, and will convey a doctor’s commitment to maintaining proficiency with the Invisalign products and treatment.

As always, the men and women who work for me in North America are there to assist you in achieving your goals, whether that means meeting this year's proficiency requirements, or going beyond that to truly make the most of Invisalign in your practice.


Dan S. Ellis
Vice President, North American Sales


  1. I stumbled across this blog while looking for an email address for Dan Ellis, a VP at Invisalign. I was hoping to let him know that this new policy is ludicrous, and I will continue to try to reach him.

    I am a Fellow in the Academy of General Dentistry, with plans to recieve my MAGD in the next year. I provide excellent high quality care to my patients. I have taken many hours of ortho CE, with the Invisalign course under my belt about 4 months ago. I start about 6-7 traditional ortho cases each year, and would love to develop Invisalign as a part of my practice. The fact is, there just is not enough demand for it in my town. To now tell me that if I don't start 10 new cases each year, I will no longer be allowed to provide this service is maddening. Maybe Dan will refund the money I spent on his course... not likely.

    I hope Invisalign reverses this policy... let our voices be heard!

    W Ross, DMD, FAGD

  2. Found it! Email Dan Ellis at to let him know how we feel about this issue.

  3. I believe what we have here is a case of redirecting Align's business model based on the recent legal resolution with ClearCorrect. Align's IP seems open to challenge and they now have a definite window of opportunity to "lock in" their market share. They need to profit from their market leadership quickly, as it will surely continue to evaporate.

    As we see with new distributor sales model, you cannot sell to everyone (and expect to profit).

    I will be interested in following this story.

  4. As an orthodontist who does a very limited number of Invisalign cases each year, I was appalled by this policy. I have to wonder if they are reeling from the effects of the economy and are trying to scare GPs and orthodontists into sending business their way. That might not be the reason, but the motive is there and cannot be discounted.

    If you hear of any other doctors interested in legal action, let me know. I don't think there is much of a shot for that though.

    There is always the possibility of a public relations campaign by orthodontists who would like to inform the public about the strong-arming going on and how the ethical doctors refuse to treat patients with a particular tx modality just to make quota. maybe we could also touch upon the oft needed requirement of fixed appliances to get it just right.

    Salvatore Livreri, DMD

  5. Hello, I just received the letter that Invisalign sent regarding the requirements needed in order to keep the certification. I'm a GP that also practices orthodontics as part of all of my offered services to my patients. I live in a small town were people are striving to keep their jobs. Yes, there are many patients that are interested in Invisalign but cannot afford it (and I have the lowest prices in this area). I don't sell dentistry and not planning on doing it to benefit Align technologies; specially somebody that is not a dentist but makes a big profit out of us dentist through our knowledge and approach to our patients. I believe that Invisalign is a great product for some patients; Invisalign is not for everybody (if you want good results).There are many products out there like bracers, Bioliner, ClearCorrect, make your own aligners from Essex Dentsply, etc. They all move teeth...its not the technology but the dentist who make it work for the patient depending on their patient's needs.
    I don't agree with Invisalign's reasoning behind this requirements...they claim that they don't want patients to be treated by inexperience dentists, as if quantity makes quality. I believe that Invisalign has money interests and issues behind this decision that will only affect them negatively; more and more dentist will stop doing Invisalign; they are promoting only the big practices with many patients and hurting the small private practice. What they don't know is that patients sometimes don't want to go to a different practice to have treatment done, they prefer to stay with the dentist they know (I know this for a fact because I refer all my ortho patients to the orthodontist but they come back and wants me to treat them). The patients are out there, and the different products are out there too; ultimately, the patient does not care that much if it was Invisalign or ClearCorrect or Bioliner as long as their teeth are straight and they saved money.
    I have called the costumer service of Invisalign with my complaint and I will call the ADA.
    Oh, by the way, I do around 3-4 cases of Invisalign per year and not planning on putting requirements with deadlines at this moment in my life!!!

  6. I am glad that I wasn't the only one feeling diasppointed and cheated by the invisalign not so smart decision. I just paid them
    2K and got certified about 6 months ago and got started on my first case. I have a small private office and there's no way i will meet their requirement of 10 new cases within the next 6 months. I am particularly upset that a commercial company is dictating how many cases a Doctor should or need to do every year. I believe that we, the doctor, should decide how many case we feel comfortable doing and I will not alter my treatment plan or hard-sell invisalign to my patientes just because I need to get my quotas. I have no problem with the CE unit but I also wonder their true motive behind their decision. I hope they will come to their senses and reverse their decision. What if ADA requires doctors to do a specific number of crowns or molar RCT every year in order to keep your license? Sounds ridiculous, right?

  7. This is the letter I sent to invisalign:Message: To whom It May Concern: I do not believe a company has a
    right to dictate how many Invisalign cases I produce a year. When I paid
    over $1000 for the Invisalign I course several years ago and then
    followed it up with Invisalign II , I earned an invisalign certified
    provider certificate. I do not believe this can be taken back. I Never
    would have taken the course in the first place if I knew there was a
    "quota" that had to be met. Implementing a 10 credit per year training
    requirement is fine by me, but I think forcing doctors to submit at
    least 10 cases per year will encourage doctors who are close to the 10
    case limit, but not quite there to take on cases that they would
    normally refer to an orthodontist because of their comfort level. Also,
    with the hard economic times we are facing, many people are not opting
    for cosmetic or elective procedures at this time. I have a small home
    office and run a low key practice, But like any other dental procedure I
    should be able to pick and choose which procedures I do in my office. I
    plan to bring this up with both the ADA and AGD and I will speak to Art
    Meisel (legal counsel) for NJDA regarding this matter. Dr. Deborah A.
    Flynn-Nyktas, DMD FAGD

  8. As a Prosthodontist, I was also shocked to receive this letter. How am I suppose to complete 10 cases by Dec 31? With only 24 weeks left in the year, that would mean that I need to COMPLETE 10 Invisalign Express cases, since all the other cases would take >12 trays. With the month it takes to impress and then go to Clin-Chek, this in reality only leaves it possible for a dentist to begin 10 cases this week and that they be less than 9 trays. Invisalign has set standards that are not attainable and doomed for failure. (After I have invested heavily in training, marketing, etc) Please contact me if you are in a similar situation and would like to join me in a collective response.

  9. I have been using AOA lab’s clear aligner called Simpli5. They do NOT require CE credits or case minimums (it is also less expensive). With its new requirements, Invisalign has lost my business indefinitely. I have spoken with a number of fellow GPs that share my same frustration. Luckily, Simpli5 has proven to be a more than adequate alternative, and I would whole heartedly recommend it to anyone not “meeting” the 10 case requirement.

  10. Academy creates tool for dental community to share reactions with Align Technology
    June 22, 2009

    CHICAGO--The Academy of General Dentistry has responded to member inquires regarding Align Technology's new "Proficiency Requirements for Invisalign."

    The AGD is concerned about these requirements and how they may adversely affect the practice of general dentistry.

    The AGD thinks the new requirements have two aspects the general dentistry community should note.

    The first aspect requires the completion of at least 10 Invisalign specific continuing education credits, and the second aspect requires the start of at least 10 Invisalign patient cases each year. Many AGD members voiced concerns regarding the second aspect.

    "The number of patient cases started each year may not fully be within the dentist's control for the following reasons," said Vincent Mayher, Jr., DMD, MAGD, immediate past president of the AGD.

    "First, especially in the present economy, a dentist cannot determine patient volume. Second, dentists are ethically obligated to treat their patients according to their needs and wants, not according to the requirements of a third party. Third, although many general dentists are highly proficient in Invisalign, orthodontists and large general dental practices will receive the bulk of patients seeking or needing Invisalign."

    According to Dr. Mayher, "We have spoken with Align executives and they have not provided anything to support the claim that the dentist who does nine patient cases is zero percent proficient while the dentist who gets the 10th patient walking through the door becomes one hundred percent proficient. In reality, one dentist may perform 12 cases poorly while another dentist may perform eight cases perfectly. However, with Align's requirements, there is no outcome or quality assessment."

    Due to these reasons, the AGD is investigating measures to address this concern with Align Technology. In addition, the AGD is investigating alternate educational pathways to aid general dentists in achieving or maintaining proficiency in orthodontic treatment.

    In response to its members' growing concerns, the AGD created a communications vehicle for its members, as well as nonmember general dentists, to use in sharing their reactions with Align Technology.

    The AGD invites members of the dental community to visit Academy of General Dentistry to send an e-mail to Align Technology's President and Chief Executive Officer, Thomas Prescott.

    The template letter can be edited and customized; however, the AGD is not responsible for any modified content to its template.

    For more information about the AGD, visit Academy of General Dentistry.

    To read more about the AGD, go to Academy of General Dentistry.

    To comment on this topic, go to PennWell Dental Community site.

  11. I also will be suffering the loss of my Invisalign Certification at the end of the year and I will no longer be able to submit new cases since I won’t reach the 10-case minimum requirement by December 31st 2009. My question is: Am I going to receive a refund for the costs involving my initial certification? These new requirements were not in effect at the time of my certification, so the acquired expense (actually, a very expensive course) where done without the knowledge that it would “expire” sometime soon if certain “requirements” were not met. If those requirements were in effect at the time of my certification, I probably would never taken the course taking in consideration the small amount of cases I would be submitting in the future. I am a Prosthodontist and I chose to submit few and very particular cases that needed minor teeth movement to accomplish my restorative goals. Have I known about these “minimum case requirements”, I would have never invested on such short-term expense. Is the Invisalign Company going to compensate dentists that invested and helped the development of their technology and are now suddenly being “lashed out” of the program?

  12. Invisalign is making a lot of dentists and orthodontists upset with their new requirements. I am considering switching to their new competitor, Clear Correct.

  13. I’m pleased to see that the word is out on Invisalign. I have no issue with what they do for minor tooth correction– to each his own – but find the power of their marketing has built an entire industry out of a concept that has been used for years. Our laboratory, NorthStar Orthodontics, was founded in 1975. At that time there were many doctors accomplishing essentially the same thing, not by resetting teeth, but by having us shave plaster off the cast or build up areas of a tooth before the bow and finger springs were added. It worked, cost just a few dollars more than a regular retainer, allowed for much more treatment flexibility, and required NO CONTRACTS or MINIMUM PURCHASES! Sure, our technicians have the ability to reset teeth and create clear pressure formed appliances (called Star Aligners) but we also maintain the tried and true methods of the past. There’s no need to be outstaged by brilliant advertising.

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  15. Interesting!
    Your post is pretty useful for the dental community. Thanks for taking the time and effort.

    Doylestown Dentist

  16. Awesome. Some professionals have learned about this through the required dentistry continuing education programs. It is really great that we have those kinds of requirements as they are great ways on updating us on new technologies or techniques in the dental clinic.

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