Buyer Beware!

Unless you've been living under a rock, you've likely heard about the closure of SmileDirectClub, which was one of the largest direct-to-consumer (DTC) providers of clear aligner treatment. Although the closure shocked its patients, leaving many of them in the lurch midtreatment but still obligated to pay, it was perhaps less shocking to dentists, many of whom had been questioning the DTC clear aligner model from its inception. But what exactly happened to SmileDirectClub? In this month's cover story, Inside Dentistry explores some of the specifics and gives you the lowdown from providers who worked for and with SmileDirectClub as well as the opinions of orthodontists and industry professionals. Long before the closure, many dentists were already expressing concerns about the company's option for 100% remote treatment, which involved patients taking their own impressions and being exclusively monitored via teledentistry. This resulted in unsatisfactory results for many patients. However, as you'll learn in the article, as much as this flawed clinical model contributed to the company's demise, its business model, which was hemorrhaging cash in DTC marketing efforts, was likely as much or more of a factor.

The story of SmileDirectClub is a cautionary tale-not only for aligner companies but also for dentists. Let's say a patient who is beginning remote aligner treatment requires interproximal reduction, and a company you've partnered with asks you to do it. Remember, as soon as you touch the patient's teeth, you own the case. If the parts of the treatment that are outside of your control go sideways, and the patient decides to sue, will you still think doing the IPR for $200 was worth it? Only partner with aligner companies whose models are clinically sound.

I had one patient who pursued treatment with SmileDirectClub, and when his teeth weren't moving properly, I had to refer him to an orthodontist. The whole thing ended up costing him more money than if he had just gone to an orthodontist in the first place. When patients ask me about DTC aligners, I don't tell them expressly not to do it, but I warn them that they're taking their treatment into their own hands and that serious errors can occur. Also, it may potentially be cheaper, but because mistakes can end up costing more in the long run, it's ultimately a gamble.

Robert C. Margeas, DDS
Editor-in-Chief, Inside Dentistry
Private Practice, Des Moines, Iowa
Adjunct Professor
Department of Operative Dentistry
University of Iowa, Iowa City, Iowa
robert.margeas@broadcastmed.com