Are Orthodontists Better at Invisalign®? A Survey of General Dentists and Orthodontists Says. . .

Picture from Best et al. General Dentists were more confident in treating this case, but also less likely, in general, to use Class II elastics with Invisalign®.

BY TATE H. JACKSON AND WILLIAM V. GIERIE

STUDY SYNOPSIS
A study in the Angle Orthodontist has surveyed 1,000 General Dentists and 1,000 Orthodontists – drawn from a list of Invisalign® providers on the company’s website. Those surveyed were asked to rate their confidence using Invisalign® to treat six different cases for which intra-oral photographs were provided: a Deep Bite case, a Posterior Crossbite case, a Anterior Open Bite case, Mild Crowding case, a Severe Crowding case, and a Class II case. Additionally, both Orthodontists and General Dentists were asked about their various treatment planning (e.g. time spent with ClinChecks) and mechanics (e.g. use of Class II elastics or auxiliaries) tendencies with Invisalign®. Finally, demographic and training information, as well as experience in treating cases with Invisalign® was reported.

Overall, both Orthodontists and General Dentists were relatively confident in treating the four cases presented with Invisalign®. Interestingly, General Dentists were significantly more confident when it came to more complex cases: deep bite, severe crowding, and Class II. Orthodontists reported higher confidence in treating mild crowding than General Dentists.
 
Orthodontists were significantly more likely to spend more time reviewing ClinCheck set-ups and were more likely to use refinements and elastics as a part of treatment. Not surprisingly, Orthodontists reported more training and experience using Invisalign® and were more likely than General Dentists to tell patients that their malocclusion was too complex for Invisalign®.

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Dr. William V. Gierie

WHAT THE PROFESSORS THINK
This article provides some data for practicing Orthodontists that might be of great use in discussing with patients why orthodontic care is specialized treatment – not just the appliance used to straighten teeth.
 
The use of a specific case records in conjunction with confidence ratings, and not just a survey self-report, gives these data some greater credibility. The use of intra-oral photographs alone had good rationale, since it provided a realistic version of the information that a General Dentist might consider when planning an Invisalign® case. The structure of the survey, asking respondents to give demographic and training information after completing the confidence ratings is helpful since it aids in avoiding bias when reporting confidence.

The fact that the response rate to the survey is not clearly reported is an unfortunate shortcoming of the study – one that, if clarified, would significantly improve the reliability of the results.
 
There are two pieces of information from this study that are most interesting and clinically relevant:

1. General Dentists reported a higher level of confidence in treating more complex cases but also reported using auxiliaries less often. For example, General Dentists used Class II elastics less often than Orthodontists but reported a higher confidence in treating the Class II case. Together, these results suggest a lack of expertise for General Dentists.
2. Orthodontists were more likely to have more training, to have treated more Invisalign® cases overall and in the past 12 months, to spend more time adjusting ClinCheck set-ups, and to use more refinements than General Dentists. All of these points suggest that Orthodontists not only might have more training and experience, but also that they might put more effort in to achieving a more ideal final result.

Article Reviewed: Best et al. Treatment management between orthodontist and general practitioners performing clear aligner therapy. Angle Orthodontist. Online Early Nov 2016.

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