Dr. Colin Webb at his Invisalign®-only practice, Clearsmile
What is unique about your practice?
Launched in January 2017, Clearsmile is the first and only Invisalign®-only practice in the Charlotte area and one of very few across the country. I developed the idea for this practice while treating patients at my traditional orthodontic office. I was interested in doing something different that would expand our presence while creating an innovative orthodontic experience for patients that reflects where I believe the industry is heading.
From equipment to layout and especially inventory and staff, every aspect of this practice is designed to treat aligner cases in the most effective and efficient way. Compared to a traditional orthodontic office that employs around 8-15 employees in a 4,000- to 6,000-square-foot space with an open bay concept designed for teens, Clearsmile’s staff is efficiently lean, and the office is only 1,200 square feet. We’re doing around 10-12 consultations per day and seeing 40-50 patients per day with only two assistants.
How does your practice embody patient-centered care?
Patient-centered care is evolving in orthodontics, and it’s at the very heart of my treatment approach. My job as an orthodontist is to facilitate the treatment that the patient wants, not what I want. If a patient wants treatment to correct crowding, rotate a tooth, or eliminate plaque traps but doesn’t have the luxury of time, money, or tolerance to see it through to a 100% textbook finish, I’m willing to focus on his/her top concern. We provide a product and a service as orthodontists, so that means we have to focus equally on results and patient desires. As long as a patient is informed of potential consequences of an end-on molar relationship and chooses to forgo that perfection so that she can end treatment in time for her wedding day for instance, then I’m here to improve her smile and give her the confidence she desires as she walks down the aisle. I hope I would not be so arrogant to believe that, as an all-knowing orthodontist, those are my decisions to make. Patient-centered care, not doctor-centered care.
How has clear aligner therapy evolved?
As a Diamond Plus provider, I’ve seen how aligner technology has improved over the years — enabling us to treat cases that we would have never tried only a few years ago. We’re treating orthognathic surgery cases, deep bites, cross bites, open bites, underbites, impacted canines, and extraction cases with aligners now. What would you have thought 5 years ago if someone told you that?
Regardless of the case presentation, the key to achieving a quality clinical result with aligners is precise treatment planning — so with Invisalign, all of the power is in the ClinCheck®. It’s not as simple as scanning the patient and accepting the programmed movements that the Invisalign software or technicians suggest. The standard ClinCheck algorithm will not produce anywhere close to the results that I want. You, the doctor, must use your clinical training and use the CIinCheck software to provide a prescription for Invisalign to manufacture aligners to achieve your goals; treat them like a lab not a treatment planner. There are many initial ClinChecks where I’ll have to strip all of the suggested attachments, then resize, reshape, and reposition them on the teeth within the software. I also significantly modify the way that the aligners will move teeth. When working with aligners, it’s good to remember that if your virtual ClinCheck setup looks like a perfect smile, then your actual clinical results probably won’t. Overcorrection is your friend. Managing patient expectations from the initial consultation is also important. If you never have to reposition brackets in your braces cases, then you may not relate to this, but 90% of my aligner cases will have refinements just as 90% of my braces cases will need repositions (probably 100%). I inform my aligner patients that the aligner numbers are just to ensure they’re wearing them in the correct order and do not correspond to treatment time.
Top 5 favorites
3. iTero® Element™
4. Carriere® Motion Clear™
5. Brasseler USA® ET Flex™ IPR system
The iTero Scanner adds to the efficiency of Clearsmile’s digital workflow
What accelerated treatment options do you offer?
Many of our patients ask for AcceleDent® by name during the initial consult and prefer this noninvasive, accelerated option as opposed to micro-osteoperforations. AcceleDent is an FDA-cleared vibratory orthodontic device that employs SoftPulse Technology™ that has been shown through clinical trials to speed up tooth movement and reduce discomfort during treatment. These are significant benefits to patients who don’t want orthodontic treatment to interfere with their lifestyle, as well as patients who want to complete treatment prior to an important event, such as a wedding or graduation. I have yet to have a patient ask me if I could make his/her treatment longer.
Patients will no longer accept 24 months of orthodontic treatment, and that’s why it’s no longer the standard. We’re doing 5-day aligner changes in conjunction with AcceleDent and completing most simple relapse cases in 3 months, open bite/deep bite cases in 8-10 months, and surgical cases in 12-16 months.
We have a very high demand in our practice for AcceleDent because patients view it as a worthwhile investment. Since we don’t mark up the AcceleDent price, the price of accelerated treatment is only costing patients an additional $50 per month on average. We don’t view AcceleDent as a moneymaker, but more as a time/cost saver and a tool to increase patient satisfaction. With AcceleDent, we’re reducing visits and reducing chair time, which allows us to increase our case starts and bottom line. I have also yet to have any patients ask if they could come into the office more frequently and have more chair time. During your next few aligner consults, ask patients if they would rather complete treatment in 8 months or 12 months. During aligner monitoring visits, ask if they want 8 or 16 aligners this time.
How has technology created efficiencies in your office?
Holding effectiveness constant, which means I’m doing everything I can to consistently produce quality clinical results, the big variable I have control over is efficiency. Efficiency is producing quality clinical results leaner and faster. This depends on office systems and workflow, and the beauty of the Clearsmile model is that everything fits into a digital workflow because Invisalign is a digital process. Everything from the iTero® scanner to the ClinCheck software and AcceleDent App, it all helps us become more efficient.
Patient using AcceleDent
How do you approach marketing?
Our patients are smart and motivated. The majority are educated young professionals, and they do so much research that they practically know everything about me, Invisalign, and AcceleDent before stepping foot in our office. Our marketing strategies reflect that. We frequently ask patients to submit Google reviews. We partner with local influencers, such as radio personalities and bloggers. We also do a lot of direct-to-patient marketing. Referrals are great, but we can’t expect many referrals because we’re offering a competing service.
The strongest aspect of our marketing is our superior track record. Many of the patients I see for consultations have been told by other doctors that their cases do not qualify for clear aligner therapy and are surprised to hear that I’m confident I can get them the results they’re looking for because I’ve treated a similar case. After showing a few before/after photos, they’re assured. My fees are also highly competitive because of our volume and the efficiencies we’ve achieved with this unique practice concept. Patients are getting a Diamond Plus Invisalign orthodontic specialist with tons of aligner experience at the price of a general dentist.
How are you able to maintain a good work/life balance?
Maintaining a good balance between work and family has always been important to me. We just had our first child, so it is more important now than ever. I believe you have to work hard and play hard, and that’s why I like to start early with my first patient at 7 a.m. and end early.
Another component of my balance is that I work with my family. Two days a week I’m at Clearsmile, and the other three days I’m at Webb Ortho with my dad who started the practice and still practices with me full time! My wife, Kelly, is a general dentist and practices 1 day a week at Clearsmile while I’m at Webb Ortho. While I treatment plan every case and program the ClinChecks, she is a lifesaver when it comes to other appointments. She sees monitoring appointments, bonds attachments for initial aligner and additional aligner deliveries, performs IPR, and really lightens my load for the days that I’m at Clearsmile. While we’re not physically in the office together, my wife and I enjoy the process of working on the same cases and discussing the amazing results we’re able to achieve together.
Who has inspired you?
I’m inspired by many people, but I’m really inspired by entrepreneurs and disruptors — Uber, Amazon, Tesla, and the like. These companies went against the norms and status quo. They found a way to be more efficient and do something better than how it was previously done. Innovation and an original thought inspire me.
What advice would you give to orthodontists?
My advice to orthodontists and especially to recent graduates is to practice forward thinking. In medicine we are treating diseases differently than we were just 5-10 years ago. Similarly, our responsibility is to learn, innovate, and adapt to the changing paradigms in orthodontics.
There are a lot of concerns about new treatment options that pose a threat to the traditional orthodontic business model such as direct-to-consumer, at-home aligner treatment. While I acknowledge the concerns of quality control, I also acknowledge that it is out of my control and believe that whatever is truly in the best interest of the patient will eventually prevail. I see this as an opportunity for orthodontists to focus on educating patients about the value of being treatment planned and frequently monitored by a hands-on orthodontist, in person. I explain to patients that I will see them throughout treatment not only to ensure that teeth are tracking according to the programmed movements, but also to monitor gingival and periodontal health. Several patients have asked me about the direct-to-consumer aligner option during consults. After explaining the difference on the most basic level, they immediately recognize the value and are ready to commence treatment at my practice. This is why I think we need to focus our energy on patient education and patient-centered care.