When Nicole Clemente, DDS, completed her orthodontic residency in 2003 at Montefiore Medical Center, she entered a profession on the cusp of change. A single product, Invisalign clear aligners, from Align Technology Inc, was disrupting both orthodontic treatment and patient expectations about treatment.
Nicole, who joined the practice of her father Michael Clemente, DMD, after finishing her residency, was quick to follow his lead and embrace this new treatment modality. But little did they know how much this clear aligner system would shape the trajectory of how she and Clemente Orthodontics would practice.
To say orthodontics is the family business in the Clemente family is an understatement—three of Michael’s five children are in the field, with Nicole and daughter Marissa, DDS, who joined the practice 4 years after Nicole, working in the practice he started over 30 years ago. Nicole jokes, “He didn’t get everyone, just the girls.”
Both Nicole and Marissa had their first jobs in their father’s practice. While still in high school, Nicole got licensed as a Registered Dental Assistant so she would have a real feel for what an orthodontic career would entail. Following their residencies, it was only natural that the two returned to their father’s orthodontic practice to start their careers.
That was always the plan, Nicole says. “We always wanted to go in with our dad.”
When Nicole and Marissa joined their father’s practice, they were joining a practice that had a long history of treating with the latest products and treatment modalities. All three believed that Invisalign treatment was going to significantly shape the future of orthodontic treatment—and satisfy patient demand for an alternative to metal braces. Moreover, Michael, who had 20+ years in the field at the time, knew the practice he’d built would come out ahead of peers who resisted this disruptive force. Clemente Orthodontics dove in, with Nicole taking the lead on mastering the ClinChecks. She’s grateful that the three of them were on the same page from the beginning because Invisalign clear aligners have been key to this multi-generational practice’s growth in the years since.
From the start, Michael set the tone and pushed himself and his daughters to push the boundaries with Invisalign aligners, and what they learned was that it really worked—it did move teeth. What’s more, it could work for both younger and older patients.
“We jumped right into it. We treated some of the most complicated cases you could ever imagine. The fact that it worked well on a range of cases was amazing to us, because the patients that were coming in were demanding it. They wanted Invisalign aligners. They wanted to try it, and we really wanted to try it,” Nicole says.
One of those first cases was actually an extraction case on a teenager. The result, says Nicole, was beautiful. From there, the practice saw firsthand how Invisalign successfully treated open bite cases. That’s not to say there weren’t doubts. “With those early cases, we didn’t even know what Invisalign was capable of; we were pleasantly surprised, but it was tough. It was tough because it was a new modality and we were learning—and we told patients that. Those patients were totally accepting and willing to try,” Nicole recalls.
In the 16 years since the practice’s first foray into Invisalign treatment, the modality has become its focus. Today, 80% of Clemente Orthodontics’ patients are treated with Invisalign aligners. While that first generation of the Invisalign system was intended for adults, the practice wasn’t afraid to try it with teens. What’s more, they knew that Invisalign aligners could also be successfully used with even younger patients.
Prior to the launch of Invisalign First clear aligners in July 2018, Clemente Orthodontics had treated patients as young as 7 with Invisalign. But with Invisalign First treatment, the practice was able to offer a specialized product for this population. Invisalign First aligners are designed with features specifically for younger patients with mixed dentition—a mixture of primary/baby and permanent teeth. Designed to address a range of malocclusions common in Phase 1 early interceptive orthodontic treatment, Invisalign First aligners include SmartForce features such as optimized attachments designed for younger patients with shorter tooth crowns, allowing for improved predictability of tooth movements needed for developing the arch form; the application of SmartStage technology, which reportedly maximizes treatment efficiency by producing contacts and forces that support the tooth movement needed for arch form development specific to Phase 1 staging patterns; patented SmartTrack aligner material, designed to fit comfortably while applying gentle, constant force to the teeth; and improved and expanded Eruption Compensation features that make it possible to treat erupting or changing dentition.
Clemente Orthodontics has been using Invisalign First for a few months now, and Nicole lauds its effectiveness. “For cases where you have a single tooth cross bite in the anterior, Invisalign First just moved those teeth so efficiently and so comfortably. We had [another] case where the patient’s teeth were very spaced and flared. Normally I give a retainer for that, but retainers sometimes cause speech issues. Invisalign First is perfect for this. We just retracted those teeth and put them in a safe position. It was comfortable for the patient.
“The kids don’t mind wearing them because there’s nothing bulky in their mouth—and there are no metal braces.” What’s more, because they are removable, Nicole appreciates the continued opportunity to practice oral hygiene that clear aligners offer in this age bracket. “Kids at that age don’t brush well, so I hate putting fixed appliances on them,” she says.
Whether it’s adolescent or teen patients, there is a convenience factor that benefits not only the patients and parents, but also the practice. “We actually don’t have to see our patients as often as we do with braces. In our area, a lot of kids are very involved with sports and after school activities. They’re just busy. Parents love not having to come in every 6 weeks [which would be the typical appointment interval for a wire and brackets case]. Normally, we see our Invisalign First patients about every 8 weeks and our teen patients every 12 weeks,” says Nicole, adding that she appreciates the recent addition of mandibular advancement to Invisalign treatment, which she says makes treatment all the more efficient in non-adult patients.
Moreover, appointments are just quicker for the practice’s eight-chair Ridgewood, NJ, location and six-chair New City, NY, location. “Since I know I set up my ClinCheck treatment plan extremely predictably, and the Invisalign system is a proactive method, as long as those aligners are fitting well, then I know that everything I programmed in is tracking. Braces, [on the other hand], are more of a reactive [system]. You put in a wire one month and then next month you have to see how the teeth reacted to that. Invisalign aligner appointments are much quicker than braces appointments because of that.”
And for the practice, this translates into a more efficient day for the three doctors and 40 staff members. “We’re not as packed during the day. There are fewer emergencies with Invisalign treatment. So we’re not getting those 4:30 in the afternoon emergencies that clog up the schedule. Our way of practicing has been so much nicer,” Nicole adds.
While orthodontists and parents may worry about compliance with younger patients, Nicole calls it a non-issue. “Kids are very, very adaptable. I mean, if you think about it, teeth are falling out; new teeth are coming in. Adults can’t really imagine that. So, when you give kids Invisalign aligners, they start wearing it and it actually feels strange to them not to wear it,” she says, adding that if they don’t, there’s always the threat of braces. “That’s a good motivator as well.”
For those few non-compliant Invisalign patients, the practice tends to persevere with the case. “I just feel Invisalign treatment is such a good way to move teeth, especially on young kids when they’re growing. It’s almost as if we’re catching the teeth into the right places.”
A key element of Clemente Orthodontics’ Invisalign workflow is the iTero digital intraoral scanner. The practice has iTero scanners in both of its offices to make sure they can scan patients at their initial consultation. This consultation often includes a simulation of what their results may look like after Invisalign treatment. The simulation, according to Nicole, can often make all the difference for patients who are on the fence. What’s more, Clemente Orthodontics makes sure to have a doctor come in and do that simulation. “Then they know the doctor is driving the case. I love Invisalign aligners, and I spend a lot of time setting up the treatment plan. To show the patient that the doctor is in charge, I think goes a long way,” she says.
One thing is certain: When Invisalign treatment is introduced into the clinical workflow, it changes how an orthodontist goes about the workday. Nicole notes how her schedule has changed drastically since she started her career. “Ten to 15 years ago, 90% of my time was spent on the clinic floor treating patients. Now, so much of my time is spent in front of a computer—about 50% of my day. I never thought going through residency that treating my patients would involve [so much time on a computer]. That’s been really interesting, and I’m still wrapping my brain around what’s happening. But as a mom of four kids, the fact that I can almost work from anywhere has been great for me. I never thought I’d be able to do that. It has totally changed my workday.”
As mentioned, about 80% of the practice’s patients are now treated with Invisalign aligners—of which, about 60% are teens and 40% are adults; but that overall percentage was closer to 60% in 2017. What led to such a significant jump in the practice’s percentage of Invisalign cases? According to Nicole, it all comes down to public awareness. Invisalign’s brand recognition is second to none in the orthodontic clear aligner space. As Nicole points out, the Invisalign brand is even part of kids’ vernacular. “Kids have it and they recognize [the brand]. In our area, they are going to get braces or Invisalign aligners. When one kid at the school gets Invisalign treatment, then every other kid [wants it,]” she says. What’s more, the brand’s national marketing campaign, including the Invisalign Doctor Locator, allows the practice to reach a wider audience. “More and more people are coming in asking for it. That’s an easier sell because they already know what it is,” Nicole says. “When we explain the difference between braces and Invisalign treatment, most patients say, ‘Well why would I ever choose braces?’”
While the practice still relies on tried-and-true marketing strategies, such as marketing to the community through team and organization sponsorships and word-of-mouth referrals based on exceptional customer service, they have also embraced social media marketing. And a component of this has been collateral marketing materials for Invisalign treatment. Ready-made Invisalign-branded Facebook and Instagram posts are especially helpful when the practice is too busy to come up with original content. All in all, Invisalign’s brand recognition and collateral marketing materials keep a steady stream of patients coming through the practice’s doors.
The Future Satellite
Invisalign treatment has been key to Clemente Orthodontics’ growth over the last 15+ years, and is likely to continue to play a significant role as the practice looks to the future. As part of the practice’s growth strategy, Clemente Orthodontics envisions an Invisalign-branded satellite. Currently Align Technology offers its Invisalign stores in 12 locations throughout the United States. These stores are located in high-traffic mall or outdoor shopping environments and offer participating doctors potential patient leads. Meanwhile in October 2018, Align Technology announced that it is piloting a doctor-owned Invisalign Experience program. This pilot will allow a doctor to use Invisalign branding with its own practice name—a concept that appeals to Clemente Orthodontics.
“I think the Invisalign stores can only help a practice—especially if they are very well versed in Invisalign treatment. They’re marketing for us. They’re sending patients directly to us. As long as that’s the model they continue on, we love that. And with the doctor-owned Invisalign Experience pilots, we’re definitely interested in that. Because we do so many Invisalign cases, it’s almost a no brainer to have a retail site just treating Invisalign patients. We would love that and that’s where we think we see ourselves in the future.”
The fact is, Michael, Nicole, and Marissa welcome how Invisalign treatment has disrupted the profession and shaped their family’s practice so far. And it looks like it will continue to do the same in the years to come. OP