Digital Orthodontics

Ziman Orthodontics is skeptical of new technologies that focus more on marketing ploys than on actual, stable, high quality results. Insignia, for example, provides customized brackets and wires instead of standardized materials. Dr. David Sarver is an author of several orthodontic textbooks, an adjunct professor in Orthodontics at the University of North Carolina and Chapel Hill, and is in private practice in Alabama. He has "seen no data proving [Insignia] greatly reduces treatment time." Increased efficiency and speed of treatment are sometimes cited as being among the benefits of such digital technology. Dr. Sarver "lament[s] the recent emphasis on speed of treatment over quality" and while he has data in his office that does "reflect less average treatment time," he has "not really analyzed it statistically" and is therefore "reluctant to say that treatment time has been reduced." Dr. Sarver is selective in which case types are recommended for Insignia therapy, acknowledges its higher cost, and is generally supportive of its use as a marketing tool directed towards dentists and patients desiring an individualized rather than a "one size fits all" approach.

A randomized controlled study certainly could and should have been done in the past 13 years comparing Insignia and conventional therapy in similar case types by someone. When and if this occurs, even if either technique proves to be faster and/or better than conventional therapy, the issue of retention after the braces are removed remains. Relapsed teeth don't care how fast they were straightened or by which technique. This rationalizes our use of bonded lingual wires behind the upper and lower front six teeth for years after removal of the braces. See our long term results in the Gallery.

Why does this matter? In the current debate over high healthcare costs, a primary cost driver is new technology...not necessarily better technology. This distinction has been well studied, for example, with a robot assisted procedure for prostectomy and the conventional surgical procedure. Studies seem to conclude that in the hands of experienced surgeons, both procedures produce similar results but the former technique is considerably more costly. Since Medicare is the primary payor in these patients, we all end up assuming the higher cost without a better validated outcome in the 85% of patients who now demand the robotic technique and its costing us many millions of dollars more than necessary.

With reference to orthodontic techniques, I feel that new technology should be held to a comparative standard of proven outcomes and be shown to be superior and cost effective before widespread adoption. Trying new things is great...we do it with materials all the time in an incremental way. Changing entire techniques is a different proposition requiring, in my view, a much higher standard of proof beyond industry or media driven hoopla.