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Discussing the Evolution of Orthodontic Technology and SureSmile with Dr. Bill Crutchfield

Dr. William Crutchfield is the owner of Orthodontics By Crutchfield, a practice specializing in orthodontics. As an early adopter, he’s been involved in the clear aligner marketplace for close to two decades. He’s seen the market develop, evolve and mature over the past twenty years. We recently sat down with Dr. Crutchfield and spoke about his background, the evolution of clear aligner treatment and what he thinks about the SureSmile software platform. 

Thank you for carving out some time for us today. What’s your dental origin story?

We were a family of modest means growing up and visiting the dentist wasn’t a real priority for us. So unfortunately, my first visit to the dentist revealed three abscessed teeth, all of which needed to be removed. 

Fortunately, things got better. I think around the 8th grade, my now regular dentist asked me, “do you like science and working with your hands?” I told him I did and so he suggested that I should take a look at dentistry. 

As a result, I actually wound up working in his office. I was working construction at the time. So, I’d work construction up until 2:30 and then I’d go work with him from 3:30 to 5:30. 

From there I went to Virginia Tech as an undergrad and to the Medical College of Virginia, which is a part of VCU, for my DDS and my orthodontic residency. After graduation I launched my own practice, which I’ve been working at for 32 years and counting. 

Many orthodontists consider themselves tech-friendly. But it seems like you’re an early adopter even for the orthodontic crowd. Can you talk to us about your history with orthodontic technology?

Just by happenstance, the sales representative for the company I purchased braces from made the move to Invisalign® back in the 1990’s when they were just starting out. She was in her early twenties at the time. She told me this is going to be the hot new thing and it’s going to be a great product for you because you treat a lot of adults. So, I gave it a shot. In Northern Virginia I was one of the first ones to use Invisalign.

There were no digital impressions back then. We were taking the impressions with PVS material and patients had to keep the material in their mouth for several minutes. It was an uncomfortable process that yielded inaccurate results. For this and many other reasons, cases weren’t finishing correctly and few practices were getting the results they wanted. As you can guess, this was creating unhappy patients. 

So, I left Invisalign because it just wasn’t worth it. Eventually I came across the SureSmile® platform. This was before they were offering clear aligners. 

How did you adapt to the changing marketplace? 

In nature, survival of the fittest does not mean the biggest or the strongest is going to survive. Fittest is the one who can best adapt to change. It doesn’t matter if it’s evolution, business or orthodontics. Those who do not change with the times are going to go by the wayside. 

Practices, and orthodontists specifically, who don’t change will not survive. 

Look, I still think that the majority of cases can be best treated using wire technology. However, there are plenty of cases that can be treated, and treated well, with aligners. If patients are wanting clear aligners, and it doesn’t compromise the level of care I provide, then it’s on me to meet this market.

How do you balance the wants of the patient with your own clinical standards?

There’s a running joke in the profession that says “the Invisalign case is done when the patient says, ‘I can’t do this anymore, I’m done’”. Their product has gotten much better. But it’s not the best product out there. Some practices wear their struggles like a badge of honor. You hear them say, “I’ve got 20 Invisalign cases in review!” 

Well, that’s because you can’t get out of any of the cases. Doing revision after revision after revision is exhausting. It’s also not good business.

It costs the average orthodontic office $239 for every time they see a patient. So, if you look at your profit margin on a case that drags on forever, plus an unhappy patient because the length of time in treatment, it’s a very tight line to walk.

I only do SureSmile these days. I never have any trouble brand-switching patients. I don’t talk about Invisalign when I do so. I just tell them that there’s a newer, better product out there that I prefer. It lets me control their teeth better. We have consumers who have done their research. But they still look to me as the expert. 

As I’m sure you know, the SureSmile software has a reputation of being very comprehensive. Some wonder if it’s too in-depth. Do you consider the comprehensiveness to be a feature or a bug of the system? 

Think of it this way, a Porsche is a very robust car. But if you don’t know how to drive a stick shift, you’re going to have a problem realizing any of the potential. You can’t blame the car. SureSmile software is the same way. 

The treatment planning software for SureSmile is quite robust. The beautiful thing about it, compared to other aligner systems, is that you are in control if, and when you want to be. Most of the doctors I know want to be in control. But, that means you have to understand the process.

Yes, it does take some time to learn the SureSmile software. There’s just no getting around it. But it winds up giving you a great deal of control that other systems never offer you. Other companies just want you to take a scan and send the patient’s STL file and they will produce the treatment plan. 

What’s wrong with that?

Nothing. If you’re using SureSmile to create the movement, you just need to remember what makes aligners different. You need to understand that you’re going to have less root control than you would with wire technology. You need to know with a clear aligner that the tooth is going to tip a little bit, so you may need to do something to counteract that. You may need to tip it forward and then bring the root under. It all depends on the situation with the patient. There are a lot of different things you can do. But you need to know how to do them. 

Once you consider all of that, the world opens up to you. 

Any final thoughts to share on SureSmile?

The SureSmile software enables me as an orthodontist to be the best that I can be. They don’t tell me the way it should be done. They leave that up to me to define what success is, and they give me the tools to accomplish it. That’s something no other aligner platform can say.

Thank you for your time Dr. Crutchfield!