The case for combination treatment

Dr. Eric Wu says that a combination of braces and clear aligners can balance patients’ wishes with treatment requirements. 

Dr. Eric Wu explains how to improve patient satisfaction and profitability

What is combination treatment?

Combination treatment is the use of two treatment modalities to achieve the best possible result in the shortest amount of time. Usually this means starting a patient in braces and then transitioning to clear aligners.

Why is combination treatment better?

Many prospective patients are interested in aligner-only therapy but often are not ideal candidates. When patients requiring extrusion, significant rotation, and/or posterior expansion present, here are your options:

  1. Inform patients that they’re not a candidate, and recommend braces.
  2. Attempt clear aligner treatment, anticipating a long case with multiple refinements.
  3. Propose < 6 months in braces followed by clear aligners.

By choosing option 3, you balance the patients’ wishes with the treatment requirements. The result is higher conversion rates, greater patient satisfaction, good clinical outcomes, and generally, shorter total treatment time. uSmile™ clear aligners are available on a pay-per-aligner basis with very rapid delivery from uLab Systems™, supporting the profitability and timing of these cases.

When to switch from fixed to clear aligners?

Start by planning any A/P corrections, significant expansion, extrusion, major torque, and significant rotations for the first, fixed phase of treatment. As soon as these major movements are accomplished, scan and transition the patient. Use aligners where they are undeniably superior — finishing, detailing, midline and tooth-size discrepancy management, and spacing correction.

Waiting until fixed appliances stall serves to only prolong treatment time and increase the total number of appointments.

How to price combination treatment?

You can offer combination treatment without modifying your fee scale. Pay-per-aligner lab fees — often just a few hundred dollars — are easily offset by the elimination of appointments.

In the competition between braces and clear aligners, is any one solution best? Read this CE, “A comparison of efficacy and efficiency of clear aligners versus braces post-COVID-19” by Dr. David Alpan and see what he thinks about evolving treatment plans. Subscribers can take the quiz and receive 2 CE credits!

Eric Wu, DMD, received his Doctor of Medicine in Dentistry from the University of Pennsylvania; his Advanced General Dentistry degree from UCLA; and his Orthodontic degree from the University of Pittsburgh. He is adjunct Faculty at the University of Nevada, Las Vegas (UNLV) and Roseman University Orthodontics. He practices at Wu Orthodontics in Palo Alto, California, and Redwood Shores Orthodontics in Redwood City, California. He is a published author, inventor, and frequent speaker. Dr. Wu is passionate about clear aligner therapy innovation and additive manufacturing/3D printing, and has treated more than 4,000 patients with aligners.


Disclosure: Dr. Eric Wu serves as a key opinion leader and advisor to uLab Systems.

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