Is advertising for clear aligner treatment truthful?
Clear aligners are now a significant component of contemporary orthodontic care. Recently, there has been an increasing amount of research into Clear Aligner Treatment. This reveals that they are indicated for treating mild to moderate orthodontic problems. In addition, there may be no other advantages other than better aesthetics than fixed appliances. Yet, the aligner companies make different claims for their treatments.
This situation has become more complicated with the advent of Direct-to-Consumer Orthodontics. A cursory review of the advertising reveals that these companies make many claims for this treatment.
But what claims are currently being made, and are they truthful? This was considered in this new study.
A team from Otago, New Zealand did this research. The Australasian Orthodontic Journal published the paper. It was great to see that this paper was open-access.
Clear aligners brands and marketing claims: An overview of available information on the web.
Cynthia Shi et al. Australian Orthodontic Journal 28:2: 2022.
What did they ask?
They did this study to:
“Investigate the existing and available CA brands and companies and assess their marketing claims”.
What did they do?
They did this study in several main stages. These were.
- An extensive search of internet search engines to identify as many clear aligner companies as possible.
- Identify interest in clear aligner treatment over time.
- Reviewed the website of each company in October 2020.
- Recorded the advertisting claims and looked for references to research on the websites.
What did they find?
They identified 75 clear aligner brands for inclusion in the study. Half of these were in the USA (37%) and China (14.7%). Most companies have globalised their products.
Most companies (78%) required patients to visit a qualified clinician for treatment. However, 21% of the companies operated a direct-to-consumer model.
They identified the main themes of the claims that were made. These included “improved aesthetics”, “increased comfort”, “improved length of treatment”, “superior materials”, and“treatment cost”.
Notably, only 4.5% of the advertising claims were supported by references on the websites. Furthermore, this was predominantly internal studies and experiments done within the company rather than peer-reviewed studies. Finally, the companies claimed that there were “multiple scientific studies”, but the study team could not find any.
In other words, there was no evidence to support these claims.
Their overall conclusions were:
“While companies made claims about their appliances, most did not provide supporting evidence. This could lead to public misconception. Furthermore, clinicians should be able to appraise the contents of claims and company advertisements”.
What did I think?
This was a concise, simple study that provided us with useful information. This is the first time there has been a systematic review of companies’ claims. As a result, this paper is important.
However, the authors drew attention to some areas for improvement. Firstly, they confined their search to English, Chinese and Korean sources. As a result, they could have missed some companies. Importantly, they did not attempt to contact the companies to obtain records of “data on file” references. I did not feel this was a problem, as the companies could easily have provided links to the data but chose not.
My interpretation of the study suggests that the most critical finding of this study was that the companies “made up” the claims they made. This is likely to be unethical, mainly because these are healthcare claims. However, one could argue that the salesforce does not have to work according to clinicians’ ethics. Nevertheless, these claims must be supported or refuted by the highly paid-KOLs who advise the companies. They do not seem to do this. We know who you are…..
So, we are still where we were many years ago and have not moved on much from “In the land of no evidence is the salesperson King?” Quite simply, we cannot trust most advertising on clear aligners.
Emeritus Professor of Orthodontics, University of Manchester, UK.
There are many companies that claim untruthful statistics but what I often see happening is practitioners (mostly general dentists) repeating or in some cases making up claims to get patients in the door. That is more concerning to me…
By using a manufacturers Plastic aligners the Orthodontist endorses and validates all claims made by the manufacturer.
Performance and results are never discussed by Orthos, except KOLs.
All the claims made by manufacturers are subjective in nature and anectdodal sound bites. Perfect for the media blitzes that target the un suspecting and trusting public.
At least a GP dentist can claim ignorance as a defense if asked about the topic.
Ignorance would not be a valid defense in court.
Hi Kevin, thanks for the article. Could you please note the Journal title has been changed for a few years from Australian Orthodontic Journal to the Australasian Orthodontic Journal which implies both Australia and New Zealand.
I have changed this, sorry it was a silly mistake!
If any of you have seen the show “Dope Sick”, you’ll see the clear analogy to what these clear aligner companies are doing. To seek out profit, they invent claims, then train up their sales force to “educate” their doctor users who usually are too tired or lazy to follow up. So, they go along and indirectly give credibility to the company’s claims. Its a genius marketing/sales plan and works to the detriment of our patients and our profession. I really hope our leaders (AAO) will soon realize the error of their ways and stop accepting and supporting these companies without some proof of their claims. There is a legal hammer hovering over the AAO’s head, so that may never happen. The AAO is encouraging other companies to act in a similar manner.
Thanks Kevin. Would have liked to see a “control” – advertisements for fixed appliances, the claims made, and if any references are posted, whether the studies are “internal”, indirectly funded or “independent”. I like to use the same measuring stick where possible, and here it was.
*VV Some of my presentations are sponsored by Align Technology
I’ve been getting social media ads for various direct to consumer products, this week’s is ‘braceless teeth aligners’ which claim to ‘strengthen the palate’ (?) and prevent TMD, as well as straightening the teeth, all for just £38!
Of course the KOL for Invisalign will try to suggest that two wrongs do make a right. Hardly surprising.
In all honesty, I”m not really sure what claims aligner companies make, whether true or false.. More esthetic? Well, of course. More comfortable? Well, had both braces and aligners in my mouth. If one appliance needs to have wax given out to help with comfort and one doesn’t, that is pretty obviously more comfortable. Clear aligners were more comfortable in my mouth to me. Tooth soreness? I personally feel those are pretty close. You move a tooth, it’s gonna get sore. From a hygiene standpoint, it is an absolute no brainer. All we have to do is look at levels of decalcification of our patients at end of braces treatment compared to aligner treatments. Since Covid, my number of patients I have had to end treatment early on due to decalcification when in braces has sky rocketed. We use fluoride varnish at day of bonding, we use fluoride treatments regularly at visits, and we still struggle. I can say, it is extremely rare to see this in aligner patients. And yes, I treat any age with aligners, so I am comparing apples to apples. Less treatment time? I don’t agree with that, but in our practice, for similar cases (we treat any case with clear aligners if that is what the pastient desires) we are able to have less appointments, and less chair time for those cases. Overall treatment time seems similar to me. Like any treatment, patient compliance is a key (whether aligner wear or elastic wear) in determining treatment length. Aligners of course need overall more compliance, but I can say that over 25 years of practice, elastic wear is more of a headache than aligner wear. Superior materials. I think like any product/technology, as more companies enter the space, improvements will be made to the technology. Decreased cost. Well, obviously for the doctor, the materials cost increases. Align has talked for years about ‘Share of Chair’ to lower staff costs and doctor in office time. I feel you have to be at least over 55% aligner wear before that is ever noticed. So, for most practices, I don’t feel there is a reduction in cost. Most, actually, overhead increases. For the very high aligner practices, this is offset by staff costs, or lower leases for smaller offices, etc. Chris Bentson of Bentson/Copple consultants in the US has great data on this to back this up.
For patients, as always, the cost is based on what the practitioner charges. Whether that is right or wrong, I don’t feel this is the place to argue that. We will see second opinions that a doctor is offering the treatment or thousands less than the standard fee (at least the patient is saying that). I know what lab costs are, and either that doctor is using some product that probably is not very good, finishing to a very low standard, or essentially losing money on the case to gain a family. I don’t quite understand the cost argument other than for internal use for doctors to get to that lower staff overhead eventually that Chris Bentson has shown in his data
In regards to the AAO. I wouldn’t expect help there. In fact, it came out a few years ago that two members of the AAO council were on the Board of Advisors for Smile Direct Club. A very sad admission and one that showed that corruption can be found even at the highest levels of our profession that claim to be the ones to protect it.
Clear aligners are like any other treatment modality. For some it works very well. For some, it can be a struggle. It is a tool for moving teeth. Is it better than braces? For some clinicians, yes. For some clinicians, no.
My advice to doctors. Be as good a clinician with braces as you can. But also, be as good a clinician with clear aligners as you can because patients, especially adult patients, want that method of treatment for themselves over braces. So, develop your skills with clear aligners to the point that no matter what a patient would like for their treatment, you can delivery the same, high quality, excellent result with either modality. That, after all, is what we are supposed to do.
Aligner marketing and their KOLs put one in mind of something Sigmund Freud said to the effect that you don’t have to know what you’re talking about as long as your listener thinks you do.