Align Technology, the parent company of Invisalign is in some hot water. It is estimated that 80% of current providers will not offer Invisalign next year. Infringing on the doctor-patient relationship, Align technology instituted a quota system effective June 1, 2009. The quota requires a minimum number of cases be submitted each year to continue as an Invisalign provider. They spin it as "proficiency" but it is certainly a quota.
Proficiency would best be maintained with a qualitative standard rather than a quantitative benchmark. For example, weeding out providers whose treatment outcomes are fair or poor rather than good or great would be a proficient measure. Clearly their wording is just "spin."
Limitations
Invisalign doesn't work for everyone. My dad and I have successfully been using Invisalign to straighten teeth while being extremely picky in case selection. My mentor has a background in the movement of teeth because he placed traditional braces for 15 years. Knowing the limitations of clear removable aligners, we limit our cases to the most predictable. We consequently have very good treatment outcomes.
In spite of limitations, Align Technology recently instituted a quota system. Limitations of Invisalign have been reported in recent studies from the American Journal of Orthodontics-Dentofacial Orthopedics (Jan. 2009). The study reports "the mean accuracy of tooth movement with Invisalign was 41%." The most accurate movement had a success rate of 47.1% and the least accurate movement was 29.6%. Clearly there are limitations.
Dentists Act
Dentists from across the country have been voicing concerns to each other and previously established advocacy groups. The American Dental Association and the Academy of General Dentistry have voiced their concerns to Align technology. The president of the AGD stated:
"The Academy of General Dentistry is very concerned about the imposition of case requirements by Align Technology. We have received many letters from our members stating their concern that a corporate entity is imposing proficiency requirements and moreover a minimum number of patient case starts without the science to substantiate their actions. We as an advocacy and educational organization for the general dentist are in the process of expressing our concerns with Align Technology and are pursuing possible further action regarding Align’s standing as a PACE approved CE provider."
Investors act
Investors have also reacted. Since the quota policy was effected on June 1, 2009, (the peak) the stock has dropped.
I am not willing to use a treatment modality when it is not in the patient's best interest just to keep some large corporation happy.
Point #1: Aligns quota system is ridiculous.
The fabrication process of Invisalign's clear aligners is quite amazing.
Unfortunately, the entire process infringes a valid patent originally filed in 2003 by Ormco Corporation. A jury ruled on the matter in the U.S. District Court for the Central District of California in late June. Align was found liable and their punishment was to be determined at a future date.
ORMCO Acts
A huge hit (-10%) came yesterday when Align Tech, gave an update on litigation involving the previous mentioned patent infringement. Ormco is going for the jugular. On July 13, Ormco filed to essentially stop all of Align's revenue producing activities (doctor certification, case activations, etc).
It will be interesting to see how this plays out. Watch for news after August 3rd and August 17th.
OTHER options
Luckily, for patients and dentists, there are other options that can accomplish the same outcome. Take Clear Correct for example. The add is a bit cheasy.
However, they got a lot of attention from providers, including myself, with this:
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