Keeping Up with the Rapid Changes That Are Reshaping Orthodontics

In today’s age of rapid technological advancement, it’s not uncommon for technologies to outpace their support structures. It’s the modern take on kids helping their parents setup their first computer. This rapid rate of technological evolution is reshaping our entire economy and not even orthodontics is immune from the march of technology.

At 18 years old, mainstream clear aligner therapy is a relatively new addition to the field of orthodontics. What most in the industry saw as a technique or system with a narrow application now makes up anywhere from 15% to 25% of orthodontic case starts. But here’s the catch: today’s graduating orthodontists, the group that should be the most tech-savvy, don’t get trained on the technology of moving teeth with plastic. That’s where today’s guest, Dr. Jonathan Nicozisis comes in.

A fellow New Jersey resident with offices in Princeton and West Windsor, Dr. Nicozisis is a member of the Invisalign® National Speaker’s Bureau and Clinical Research Network. But it’s his side project, the Aligner Intensive Fellowship that he founded with Dr. Mazyar Moshiri, that we’re going to explore today.

Like our own e-Commerce marketplace, Dr. Nicozisis has created a technologically disruptive education platform to address an unmet need in the profession. We sat down with Dr. Nicozisis, disruptor to disruptor, to discuss the Aligner Intensive Fellowship and the state of orthodontics as a whole.

MAO: Tell us Dr. Nicozisis, how did the Aligner Intensive Fellowship come into existence?

NICOZISIS: Well, you need a bit of background to understand where we are today. I graduated in the fall of 1999. Shortly thereafter I enrolled in and completed the first Invisalign registration course.

I took on just a few Invisalign cases at first. I had all the peaks and valleys that others did. It really was the Wild West and we were all figuring things out on our own. As the technology matured and my understanding grew, I started treating more and more cases with clear aligners. Clear aligner cases now account for just under 80% of my case starts each year.

As we’re all aware, Align has done a wonderful job with the Research & Development side of things as-well-as offering a robust array of educational programs. But there are still some unmet opportunities on the education side. Most doctors spend 2-3 years of a formal residency learning how to move teeth with fixed appliances. But their education gives them little if any exposure to moving teeth with plastic. To expect them to master moving teeth with plastic after completing a single introductory course is unrealistic. I decided I could help fill in the educational voids while creating a learning experience unlike anything before.

I have had the good fortune of being an official member of the Invisalign’s faculty since 2008. My first study club sponsored by Align was in Boston circa 2002 where I was advocating moving the ellipsoid from the middle of the cuspid crown to the mesial or distal halves to help create a longer lever arm aiding in creating a rotational force. Imagine how far we all have come! Since that time, I took it upon myself to dissect everything we take for granted with fixed appliances like the archwire interactions with bracket slots and how teeth move with fixed appliances, that sort of thing. After distilling it down to its most basic components, I then built it back up into CAD/CAM-odontics as I call it, or cartoon-odontics on the ClinCheck. The result is that I can recreate (or attempt to) the same force systems that we take for granted with fixed appliances.

That’s why we developed the Aligner Intensive Fellowship. We tell people to think of it as a live dynamic textbook with 12 chapters spread out over 17 weeks in a virtual classroom where you can ask live questions and receive answers from the comfort of your own home or office.

MAO: What’s really disruptive, at least in my opinion, is how you administer the course. Tell us how it works?

NICOZISIS: Our course is done via Facebook. It’s not a perfect platform, but it’s pretty solid and allows the most amount of flexibility when addressing people’s questions in real time. It’s a very easy medium for participants to work with.

We post video lessons, anywhere from 2 to 4 per week. When we post a video lesson, doctors are able to keep the video for themselves (they sign a non-disclosure agreement that they won’t share them) and review it. Following the video, doctors ask questions and we respond to them (usually within the hour). The course runs 17 weeks. It is truly comprehensive! From the basics of bonding attachments in under five minutes to mechanics with plastic to the positive business impact of incorporating more plastic in your practice.

MAO: Despite being on a public platform, your course isn’t public at all. It’s not even private. It’s a secret Facebook club. What does that mean?

NICOZISIS: With a private Facebook Group, anyone can see who’s a member and often what’s being posted, they just can’t participate. With a secret Facebook Group, it’s just that. You can’t see who’s a member or what’s being posted.

This helps protect the investment of the participating doctors as well as the privacy of the group without vendor influences. We find this leads to open and honest discussions, sharing experiences of what has worked well (or not) and why. After the course is done, the links to the videos expire, so it’s not getting leaked or pirated. It’s also incumbent upon the participant to download each video chapter. Unlike attending a course at a local Marriott or Westin where you get a little spiral notebook to scribble down your notes, those who take the course stay in the Facebook group in perpetuity; Thus you get to keep all the Q and A’s, and all the discussions, forever. So let’s say an anterior open bite case comes into your office, you can not only look at the video, but you can go back and search for the related FB thread covering that video for anterior open bite week. You can look and relook at the discussion as your notebook so to speak.

MAO: I find the comparison to our e-commerce platform to be fitting. It’s literally a technology driven way to meet the needs of the marketplace.

NICOZISIS: Yes, very much so. People all around the world are reaping the benefits of our Aligner Intensive Fellowship via this platform. The beauty of it is that you are getting the real-world experience, stuff from the school of hard knocks, that’s not otherwise available. You’ve got myself and Dr. Moshiri in addition to eight guest lecturers who all have their own niche in aligner therapy, sharing their wisdom and experiences. We have had just over 800 doctors in total taking the first three courses. Like your e-commerce platform offering efficiencies and conveniences, one of the best attributes about the course is that people not only do not have to travel and close their offices, but they can review the videos and content at their own pace on their own time!

MAO: You are employed by Invisalign as a lecturer. Yet the Aligner Intensive Fellowship seems to go out of its way to not mention Invisalign.

NICOZISIS: To be more accurate, I am not an employee of Align, rather I suppose I am an independent contractor that is signed on as a guest lecturer. Getting on to your point, we are intentionally independent from Invisalign because we recognize that there are additional platforms coming onto the landscape. A perfect example is another technological disruption—3D printing. We’ve had doctors complete the course that have then stopped doing Invisalign altogether. They now do everything in house, incorporating the principles and biomechanics we have taught them in moving teeth with customized plastic. Only now, they print and fabricate their aligners right there in the office.

In fact, we are having two of these doctors present their protocols, the logistics of their in-office systems when it comes to 3D printing as a part of the course. So while Invisalign is the leader, and will likely continue to be so for the foreseeable future, there are other bubbles percolating.

If someone wants to take the time and move teeth on their own, process models and keep everything straight and labeled and package stuff, have at it. It’s not for me, but there are people doing it successfully and well. That’s why we’re independent of Align Technology, Inc.

MAO: Now I have to ask, not all doctors view these kinds of technological interruptions favorably. A couple of decades ago it was Invisalign, and now it’s Smile Direct Club. What do you…

NICOZISIS: Let me stop you right there. To me, it’s the best time to be an orthodontist. I feel like in five years, Smile Direct Club will be looked back upon as the best thing that could have happened to our industry. Look, at the end of the day, it’s only going raise awareness of people’s jacked up teeth. We already have three million people receiving orthodontic treatment annually. So tell me, why can’t that number be 4 million? That would mean an extra million people…I can’t help but imagine quite a few of them might trickle into one of my two offices. I have already experienced people starting treatment with me to correct their less than satisfactory results with DIY approaches or that looked into DIY aligners and decided they wanted to do it properly under direct doctor supervision. I believe this trend will continue to the benefit of all orthodontists.

Yes, there is consolidation going on. But I grew up in the retail business with my father and he taught me how to evolve, how to grow, how to ebb, how to flow, how to stay relevant, how to stay current. If an orthodontist can’t survive and stay relevant then it’s on them. There are people out there who will always demand a proper and/or premium level of care.

At the end of the day, you need to evolve. Any business is a good business if you do enough of it. A rising tide lifts all boats.

MAO: As a small business owner, we don’t get to pick and choose what trends we want to respond to. Adaptation is survival.

NICOZISIS: Absolutely. Unless someone has joined the ranks of a DSO, orthodontists are small business owners. Private practices may complain that they’re uncomfortable with the direction in which orthodontics is moving. Personally, what makes me uncomfortable is that our educational infrastructure and our residencies are not teaching orthodontists how to move teeth with plastic. It’s not coming, it’s here and it will pass us by if we are not careful.

The beauty of dentistry—and why private equity is so in love with dentistry right now—is that there’s little reimbursement issues. Look at it this way, over the past 30 years, the cost of braces has roughly doubled. Growing up in Lancaster, PA my braces in 1986 cost $3200. In 2018, in Princeton, NJ it’s mid $6k. In the overall healthcare space, you get a doubling of prices every few years. As long as insurance companies and the government stay out of dentistry trying to manage prices, we are going to continue to see a wonderful increase in dentistry. When government, insurance companies or even corporations try to dictate fees for services, that’s a slippery slope. I totally understand people’s concern for this especially when it is hard to not be looked upon as a commodity. But that’s where the human element comes into play; My interaction with my patients, my community, my referring offices, etc. is what will continue to set me and any of my orthodontic colleagues in private practice apart from these threatening influences of consolidation.

But as I said at the onset, we’ve got doctors coming out of their orthodontic education with half a million dollars in student debt and they are being thrust into a marketplace where 15% to 25% of the cases involve aligner therapy…and they don’t know what they’re doing. That’s not just bad for them, that’s bad for the profession as a whole. We are empowering the doctors, giving them knowledge, insight and confidence to expand their usage of aligners in an efficient, effective and convenient way.

The tagline for our course is “together we will accomplish something greater.” This is our effort to get our orthodontic colleagues on board, get their head on straight and teach them how to move teeth with plastic, regardless of what aligner system they will be using.

MAO: One last question…two questions actually. How can doctors find out more about the Aligner Intensive Fellowship and how does one get a head of hair like that?

NICOZISIS: Ha! Well, they can follow this link or just Google Aligner Intensive Fellowship. As for my coiffure, I was just born with it. My partner Dr. Mazyar Moshiri sports the clean-shaven look and I’ve got the windswept mop so much like our course when it comes to moving teeth with plastic, we’ve got all the bases covered!

MAO: Thank you for your time Dr. Nicozisis.

Note: The next Aligner Intensive Fellowship course starts April 30, 2018. Registration is now open. Click to learn more and to register today.

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