How T-Scan Saves Cases for Two Clear Aligner Dentists (Interview Inside)
The term “Return on Investment” is a layered phrase with several interpretations. Many of us often think of ROI in terms of economics, where implementing a new dental technology in your practice allows you to take on different or more complex cases, and become a new revenue source.
However, what may be more important than becoming an additional revenue source, is whether this piece of dental equipment can help you save cases.
Dentists always want to talk about ROI with different things, but it really comes down to how many cases you’ve saved because of a technology. That is really at the heart of what you do with T-Scan. You’re able to prevent failures, which is not only financially, but psychologically, hard to put a price on. It’s a big deal knowing that you prevented problems.
Dr. Ryan Oakley, FAGD, DDS
Dr. Ryan Oakley (FAGD, DDS) and Dr. Colin Lathrop (DDS) -- two key influencers with the American Academy of Clear Aligners (AACA) -- recently sat down with Tekscan’s Jen Cullen for an interview sharing how they use T-Scan as a critical tool in clear aligner therapy cases.
Drs. Oakley and Lathrop stressed the importance for dentists practicing clear aligner therapy to have a stronger understanding of the patient’s occlusion. For them, T-Scan has been instrumental in helping them verify recessions, abfractions, and other symptoms in the beginning, perform progress assessments, and address force outliers post-treatment. This has helped them limit extended treatment periods or patient relapses following clear aligner therapy.
We try to scan as much as possible with T-Scan to guide our treatment, and see if we ever have to make adjustments. Most users relying solely on articulating paper, a hundred-year-old-technology, are creating a lot more retreatments for themselves, or extended treatment times.
Dr. Colin Lathrop, DDS
This unscripted half-hour conversation share their thoughts and recommendations for using T-Scan in clear aligner therapy, touching upon the following topics:
- How having an understanding of occlusion can help guide a conversation with patients
- Recommendations for where and when to use T-Scan in clear aligner therapy treatment process
- How T-Scan combines with clear aligners to treat malocclusion
Watch the Complete Interview Here
Here is the full transcript:
Jen Cullen, Tekscan: Thanks so much for joining me on this call today guys. My name is Jen Cullen. I am the business development manager for Tekscan and I'm here with Dr. Ryan Oakley and Dr. Colin Lathrop. Tekscan polled our audiences and we ask them specifically what type of information related to T-Scan they would want to learn more about and one of the things that came up is clear aligner therapy and using T-Scan as part of that therapy and also traditional orthodontics as well. So I've got a number of questions and I figure who better get to get online than Colin and Ryan they are both members of the Academy of Clear Aligners and top Invisalign providers in their area and just amazing dentists in general and super cool guys. Let's start off. Just besides being some of the coolest guys in dentistry that I know um why don't you guys just tell us a little bit about yourselves.
Dr Colin Lathrop: Well I've been a T-Scan user for several years, general dentist. I have a very large practice in Katy, Texas scratch start 2013 all high-tech and we pretty much do just about everything and always looking to differentiate our practice and just provide better treatment services, quality, explanation, education, all those things for a patient base for our team, and for the doctors to come through and kind of see how we run things and that sort of stuff. So it works out really well and T-scan has been a great partner and a lot of high-end therapy as far as full mouth reconstruction all the way down to just basic simple aligner cases so you can't really go wrong with it.
Dr. Ryan Oakley: My name is Ryan Oakley. I'm a general dentist in the Houston area also.
Houston's a big place, so Colin and I are both sort of in Houston but were probably like an hour and 20 minutes away from each other. I've been a T-scan owner for a long time I and a T-scan aficionado for pushing a year now thanks to Colin, and you know, kind of similar practice size.
I'm part of a big group practice and once again also high-tech and trying to provide the best care for patients. T-scan is something where for me more than anything, the understanding of occlusion has been something that I've kind of chased for as long as I've been in dentistry, and really understanding how to use the T-scan has taken something for me that's always been sort of something I was always trying to learn and figure out and just could never quite understand is something. I am now exceedingly comfortable treating, providing, and explaining.
So, when it comes to occlusion T-Scan is kind of a silver bullet so to speak, as far as your understanding and then implementation and follow-through.
Dr. Colin Lathrop: You’re welcome, Ryan.
Dr. Ryan Oakley: [Laughs] Yes and the reason that I went from a T-Scan owner to a T-Scan user is because of Colin’s influence.
Jen Cullen: Thanks, Colin! We all appreciate it, the world is a better place. [laughter]
Dr. Ryan Oakley: I have to say, I owe him royalty checks for everything I do in dentistry now.
Dr. Colin Lathrop: I’ll take ‘em.
Jen Cullen: That obviously describes my next question is around how you first became interested in the technology. Maybe you can both kind of just touch on that quickly yeah.
Dr. Ryan Oakley: I'll do that first. I had heard about the T scan probably twelve years ago if not longer than that, from Bruce Baird of the Productive Dentist Academy. Bruce Baird has been a big proponent of the T-scan for as long as I can remember and would speak about in at the productivity workshop and they also typically had a T-Scan rep there at the productivity workshop sound. I had heard about it forever, and then I got it and I sort of dabbled with it. It spent most of its time in a drawer and I'd pull it out every once in a while or pull it out, try to get into it, and never really took off using it.
Jen Cullen: When you are not using it, it's hard to really see the value, right.
Dr. Ryan Oakley: I had gotten it out and I was trying to get trying to make it work and I'm hanging out with Colin, and Colin is the one who opened my eyes to the possibilities with it. And Colin's
the one that turned me on to Dr. Kerstein and Dr. Sutter and it was after doing training with Robert and Ben that things really took off with for me with it.
Jen Cullen: How about you Colin?
Dr. Colin Lathrop: I read about T-Scan way back when I was in Dental School, and my periodontist that I was referring to in Sugarland, which is maybe 40 minutes away, He had been using it for a long time. I always had the exposure to it knew about it, and after I opened my practice I really wanted to incorporate that and one of the CE programs that I had taken was at Arrowhead Lab out in Utah. Jim Downs teaches the full arch and occlusion courses out there and I had taken the full arch course and that's where I finally bought the T scan when I was there. And that was four, five years ago or something like that.
But I've known about it for a really long time and I just could not believe that more people didn't use it and a lot of people that I'd talk to you about it, they're like “oh, I don't need that you know really expensive marketing paper” and all this other stuff. And the more that I understand it the more than I'd used it, the more training that I've gotten the more cases that I have saved because of it I think, man, you know you people you'll spend $150,000 on a cone beam, $100,000 on a laser you know all this other stuff and you would use it T-Scan every day on everyday dentistry and it would make a bigger impact in what you are doing.
Whether you are doing a full arch or just a single MOD on a lower molar or something like that.
Jen Cullen: We appreciate that. I love the shoutouts to Dr. Bruce Baird and Dr. Jim Downs. I've worked with them both individually for a long time, as have a lot of people on our team, and they've just been super supportive and they provide such awesome education to dentists as well, so yeah I love that.
Dr. Ryan Oakley: Hey Jen, I think Colin hit on something really important there, this may be skipping to further questions but people always want to talk about ROI with different things and you know what, this and that. What Colin just said is how many cases he's saved using the T-Scan.
Jen Cullen: That’s a good way to say it.
Dr. Ryan Oakley: I'm not sure what kind of Dentrix report you can run this show that kind of stuff, but that really is at the heart of what you're able to do using the T-Scan. You are able to prevent failures and that is something not only financially but just psychologically, that is hard to put a price on. It's a big deal knowing that you've prevented problems.
Jen Cullen: Totally. All right so I'm going to shift gears just a little bit and jump into a couple of clinical questions. We get these questions pretty often and so I thought it was best to kind of have you guys run through - kind of give you a scenario.
So, let's say that a patient comes in and you identify that they have an occlusal issue. Tell me about how you're gonna go about communicating to them their problems or how you might introduce clear aligner therapy to them. What does that conversation kind of look like?
Dr. Colin Lathrop: I'll go first on this one, if you don't mind, Ryan. So a lot of times you know one of my hygienists will recognize that there's a malocclusion issue, abfraction sensitivity, cracked teeth, you know whatever. Whatever indication that we would use clear liners, whether it's in-house ortho-made aligners, or Invisalign as my usual number one go-to.
And so basically, I know you can show patients the data and all this other stuff, but that's like showing patients an x-ray. They're not a radiologist. You can't say “well there's your cavity right there you see it?” And they're like in their head, they don't want you talking about. So I try to break it down in really simple terms I try to talk to my patients as if they're a senior in high school. And that way I cover pretty much my whole patient base no matter who they are.
I'll talk to them about the balance of the bite. I'll say you know you're when you bite down, you're like ninety percent on your right side. If you walked around and put 90% of your weight on your right foot or your right knee you probably need a knee replacement not too long.
If you drove around and your tires were, you know, not aligned correctly and it was pulling you over into the wall of the freeway every time, you’d burn through tires every three or four months. It gets really expensive. It's the same thing on your bike.
I use those kind of two basic analogies because most people have either heard of someone or have a family member that's had a knee replacement. It sounds awful and expensive. Or, most people who are above driving age and own their own vehicle have replaced tires in their car, they don't really like doing that or want to do it again. And so that's helpful.
And the other thing is, now I had taken Robert and Ben's DTR training courses so I have them, patients, go through the excursive movements with a T-Scan. And I'm looking to see all of the posterior occlusion garbage that they have and I'm using that information, and I'm translating that into my little pea-brain and saying, “you know I bet you have headaches don't you?” They're like Yeah, I do”. “And your muscles over here are pretty sore aren't they?” and I'll palpate the muscles for them, “Yeah they are”.
I said, “Well, you know what the data is telling me is that your bike doesn't really fit well and that's causing these other symptoms of discomfort or pain or sensitivity or these other things that you have.” You know you can either spend a lot of money over the next 10, 15, 20 years fixing all your teeth - 40, 50, $60,000 and a full mouth reconstruction by the time you're 55 to 65. Or we can straighten the teeth and balance the bite, kinda like balancing your tires and aligning your tires so you're not having to replace them all the time and then they're your own teeth. I think that's a better smarter way to go. Especially at whatever the price is, you know for their case.
Because then they're thinking they're hearing 50, $60,000 in dental work, and then you come in at the bargain-basement price of fifteen hundred or whatever it is for a full course of Invisalign with retainers at the end. Then I do six to eight months after in Invisalign I will go back in with a T-Scan and I will check the occlusion, make adjustments as needed to try to keep them stable, to keep the case stable, and keep them comfortable. So that little spiel has done very well in converting, getting patients who we had talked to about orthodontics before more of cosmetic treatment and they're like “Yeah, I'm good I'm fine I'm married I got looking to impress anybody blah blah blah blah
Jen Cullen: I don’t need to spend that money on myself.
Dr. Colin Lathrop: Yeah, and especially it's really effective after you have put a crown on one of their teeth. I say “if you want to keep doing that it's cool I'll keep taking the money to fix those teeth but if you straighten them all, we won't have to really do that very much. It's a lot healthier way for you to keep your own teeth for a lifetime.
A lot of times right then there it's either after a breakage, they'll sign up for it, or during hygiene, we'll go through the balance issue and all that other stuff.
Jen Cullen: Ryan, you want to add to that?
Dr. Ryan Oakley: Yeah absolutely I mean it's hard to top. We could do like a recording just Colin’s communication stuff.
Jen Cullen: Yeah, I just got like 10 pearls right there!
Dr. Ryan Oakley: Every time I talk to Colin, I’m like, give me a piece of paper so I can write this stuff down.
I think the important takeaway from what Colin said, it comes back to what I do in practice also, is that in what he said he didn't have something that just magically makes something happen. He has a dialogue with the patient and meets them where they're at.
And the reason Colin can have a dialogue like he said is not because he has something cool, something cute to say or cool to say or some kind of verbiage. He can have a dialogue because he has an understanding of occlusion. He's able to look at the patient and he knows the cause and effect, and that allows him to have the proper kind of dialogue that's backed by his confidence and understanding because he knows what's going on.
And I think that's where I used to not be and where I am now. From, like he said, taking Ben and Roberts course and from using the T-Scan and understanding is, when you see the signs and symptoms of malocclusion in someone's mouth you know what it takes, you know what the consequences are you know what it takes to get them in a place of stability and then you're able to have the proper dialogue. From the patient's standpoint. Like Colin said, showing them a fancy graph or showing them this or that or the other, that isn't what moves a patient or shows confidence in you. It's the way that you're speaking about it and it's the way you're able to plain speak things simply and concisely. But you're not able to do that until you have that understanding of what's going on.
Jen Cullen: So if we take that a little bit further so the patient accepts the aligner treatment and, Colin you kind of touched on this a little bit but, I'd like to hear a little bit more about your protocol and for your aligner therapy, at what points during that process - I know Colin you said you're using it six to eight months post aligner therapy - Ryan we had talked about how you were doing a check mid aligner therapy, maybe you guys can just touch on that briefly. Where are the places where T-Scan would be used in that process?
Dr. Ryan Oakley: I'll go first on this one. So with any case, there is a beginning and a middle and an end, right. In the beginning, you may be using T-Scan to verify that the signs or what you're seeing on their teeth whether that's recession, abfractions, fracture lines on teeth, or their symptoms: muscle pain, cold sensitivity, etc., are occlusal-based. So you see visually with your eyes, and then T-Scan can confirm that they're having a long disclusion time or they're imbalanced on the right and left side or whatever, right. In the middle you may be just doing progress assessment, so you may be using the T-Scan to just verify as you're going through the process or midway or whatever you choose, or before you're going to either finish the Invisalign therapy or deband with ortho, though to make sure that you are getting where you want to be. Whether you needed then modify what you're doing or just be aware of what you're going to need to do as far as adjustments go once the case is finished. And then at the end to then finish the case right you've gotten to a certain place. You're never going to be perfect with regular orthodontics, you're never going to have a perfect bite after Invisalign.
I don't know if there's any studies on it, Colin, with Invisalign, but there are studies show that most class one patients treated with regular orthodontics, something like 70% of them are overloaded on their second molars. So they've shown that after orthodontic therapy, people have more force outliers than if they weren't treated orthodontically. So when it comes to finishing the case you're using it to just fine-tune what you did and actually have an occlusion that's balanced on the right and left side, doesn't have any force outliers, and that the patient has canine guidance. Colin does it six to eight months afterward. I think that six to eight months is a good general rule. I think it kind of comes down to when you are typically doing your retainer checks postoperatively – or when you finish a case.
If I have a patient that we did ortho on due to muscular TMD symptoms, I'm probably checking them on the T-Scan sooner than that. Colin, you may be doing that. If that was the purpose of it, I'm probably doing that immediately after we finish the case. But I don't know, does that answer the question?
Jen Cullen: Yeah, absolutely.
Dr. Ryan Oakley: Clean that up Colin.
Dr. Colin Lathrop: So, I'll take a T-Sscan before, either before we start their case or a delivery of their Invisalign case, we’ll take a T-Scan record that day. Some people just for data collection. I'm also taking T-Scan record immediately after we've delivered all the attachments and the aligners. So what we'll do is we'll take a baseline scan, aligners out, document everything, and then I had them put their aligners in I'll take another scan to see what the reduction in the overall forces is. You'll see on the force graph that it goes down. You can't clench as much especially with anterior bite ramps on these Invisalign trays. After the case is finished a lot of times when we put them in their final holding retainers I'll take another T-Scan measurement. I'm not doing any adjustments then, just to kind of see where they are and I'll compare where they started and then where they finished with the Invisalign therapy. I am I'm looking into taking STL scans of all the arches beforehand and an overlaying with all the T-Scan data. It's one of my projects to work on, I got more time now so I can get going on that. But yeah, you know if they're a regular patient there's no pain or there's no you know crazy things, then six or eight months later.
Otherwise, if they are a pain patient like what Ryan was talking about, TMD symptoms, then I will T-Scan them when we're finished. I will do a DTR style adjustment and put them in their final holding retainer as I'll see them three months later, I'll see them six months later. And then after that, what we're doing now is we're taking T-Scan and records a year, eighteen months after, and comparing those with the original data for those cases that we were consistent with taking them on. So we're still getting consistent with you know our protocol for aligner therapy with Invisalign scanning, T-scan scanning, all of that stuff together so that we can get a really good protocol and be very consistent. So that then I can you know kind of comb through all of that data and then share that with some other people. Or even maybe publish some of this stuff in the future. But we try to scan them as much as possible, especially to help guide our treatment to see, do we need to make more changes or not.
Jen Cullen: That helps a ton. So for people that aren't using T-Scan now, what is maybe - point out one or two things that T-Scan gives you during that aligner therapy that you don't get if you're not using the technology.
Dr. Colin Lathrop: You know, anterior contacts. That's the biggest use of the T-Scan during active aligner therapy or even fixed ortho therapy. So everything looks great and then they take all the buttons off they put them in retainers and all that sort of stuff and then two or three weeks later the patient comes in and they've got a space somewhere, in the front on the upper. They're like oh, man, I guess I'll have to do a refinement and scan y and put you in Invisalign all over again. And then you do that again and then you finish. Two or three months later they come back in and it's more spacing that occurs later on. Because, yes you can check your anterior contacts with marking paper if it will show up. But it will not give you the direction of force when they're going into the excursive movements. So most people are checking on a regular MI bite, they don't see contacts there and they're like this is great, let's put them in retainers. But what happens is - if you don't check them in the excursive movements - you're not going to see that those cuspids are pushing that lateral out. Or you're overloading something to where you're creating a diastema, but just during normal chewing function and that's for the relapses especially in the anterior will come from.
That's the biggest thing because most users that are not using a T-Scan and they're relying solely on a hundred-year-old technology with marking paper, you know, they're missing out on - that they're creating a lot more retreatment for themselves they're creating extended treatment times for their patients. And let's be honest, if you've done enough ortho work though, or long-term treatment of people, patients, develop dental fatigue. They just get tired of it. They don't want to do it anymore. They're like, you know what, I don't care. I've got a space, it's fine. And then they moved, and two or three years later, they forgot that conversation. They forgot their fatigue. And then their new dentist is like, we got a space here. They say, well I did Invisalign. And the new dentist says, “Oh you had a bad dentist he didn't an awful case for you. You should sue him”. Or some garbage like that.
Jen Cullen: And that’s obviously not the case.
Dr. Colin Lathrop: Right, exactly. So using the technology that way, it's been way better.
Jen Cullen: Yeah, I love that perspective.
Dr. Ryan Oakley: I think that one of the biggest things for me is, there's a lot of talk about treating malocclusion with Invisalign right - most people have had their Invisalign rep come give a Lunch and Learn to their hygienists about evaluating malocclusion and talking to patients about treating malocclusion. And, what you don't know without using a T-Scan is that just lining the teeth up doesn't necessarily fix it malocclusion. And it doesn't necessarily - it could even make the situation worse as far as the signs and symptoms - as far as the signs that it's generating.
And so, when you line the teeth up - and a lot of times we do expansion into premolar area which leads to more of a tipping in the premolar area - that actually brings the lingual cusp of the upper premolars into more of a contact than they should be. And so when you align teeth a lot of times you are creating more of a group function than they might have even had in the beginning. And so you talk to a patient about their signs and symptoms, and about how you're going to treat their malocclusion with orthodontics or Invisalign, and you don't necessarily treat the problem. You just line up teeth more and you might even create more of a group function issue through your therapy.
Understanding occlusion and using a T-Scan to verify your results and then make adjustments allows you to kind of put your money where your mouth is if you are speaking to patients about malocclusion in the chair.
Jen Cullen: Yeah, I love that perspective. I think that's exactly what people are interested in hearing, too. What is it that's it's doing to solve a problem of some sort. Before I let you guys go, just one last question. For the benefit of all the doctors that are going to be listening to this.
What's just one pearl that you could leave the audience with for the doctors listening?. And it doesn't have to be T-scan related. I'm not all about T-Scan. We can veer from that if we need to.
Dr. Ryan Oakley: I’ll give my favorite non-T-Scan and T-Scan pearl. Number one pearl that I could recommend anybody is to make post-up calls or text to your patients that you treat. Anybody that you numb up.
I used to make phone calls. I mean, I’ve been making them for, gosh, pushing 20 years now. I think it's one of the most powerful relationship builders and practice builders. So often you'll hear people say, I had a guy that was like 90, and he's like “I've been going to doctors my whole life and you're the first person that ever called to check on me.” Do follow-up calls with your patients.
I used to do calls. I decided to do an experiment. I would call, let's say I had ten people to call - maybe one person would pick up, maybe one person would call back and like leave me a voicemail. But when I see the patients they don't tell me they appreciated the call. I started texting patients. It takes way less time. I usually hear back from like 90% of them saying thank you, I really appreciate you checking up on me.
Make follow-up calls, it's very, very important.
Jen Cullen: You can add to it and you could say make follow-up calls so they have to come in and get their T-Scan done and then it’s a T-Scan pearl.
Dr. Ryan Oakley: With T-Scan, it kind of goes back to what Colin said, he said in the beginning – so many of our failures are from our misinterpretation of occlusal issues. You will save yourself so much headache and heartache if you are able to properly address occlusal issues that a lot of times we caused.
Jen Cullen: Great. That’s, awesome. Colin?
Dr. Colin Lathrop: I will start with a T-Scan pearl. T-Scan all of your implant crowns. Several times over. Because there's nothing that's going to show you more as far as force issues - and if you T-Scan your patient before you screw in or submit your crown get your baseline and then add your implant crown and see what has changed as far as your disclusion time, or your force direction, your balance - any of those things. So take a baseline and then load your implant crown and then scan them again, and then adjust your implant crown until you get back to your previous scan data.
Jen Cullen: We might need to do a whole other conversation on implant stuff.
Dr. Colin Lathrop: Hey, that's easy. As far as non-dental or non T-Scan pearl, but general dental pearl, you know you got to figure out - and again I'm gonna go back to Jim Downs on this one - big, change in my practice when I started thinking about and expressing in simple terms to all of our patients, consistently, so that my team can hear the same message over and over and for my patients to hear the same message over and over, as I would tell people “I don't want to drill in your teeth if I don't have to”. Of course, they don't want you to do that in here either. And so that opens up a lot more treatment as far as ortho or all these other things. But the reason I tell them that, is, I say, “Listen, I'm trying to figure out what is the best plan for years so when you're 90, 95, 100, 105 whatever age you are when you expire you're still going to have as many of your own teeth as possible and they're going to look good and function really well.”
Developing a true lifetime plan for patients is far better for them, for your ethics, and all these other things, than just looking at what can you drill on today to get payment out of a patient as quickly as possible. You know that's sort of stuff. Because, if you think comprehensively and shoot for that, then that's gonna open up way more dentistry over a longer period of time and it's better for your patients. And they're gonna feel that you're doing it in their best interests.
And you want to talk about driving referrals - when patients have an overwhelming amount of trust in you they know that you're looking out for them - you're investing in all this technology and all these you know CE courses and all this other stuff to provide the best things for them. Then they're gonna refer more and more and more people to you because they've already had either, other dentists that are trying to get their money out of the pocket quickly or you know, with all the corporate dental offices that are coming in, you know there's just a big changing wave of how we look at dentistry.
And then the results of all this pandemic stuff, you know how that's going to change private practice. But nothing changes how you feel about a patient and what you recommend to them. And that will pay the biggest dividends.
Jen Cullen: I love that, awesome. Thank you both so much we really appreciate it. I love chatting with you guys and just seeing your faces right, we have to have this face to face interaction more so yeah thank you again and for everybody that's watching stay tuned we'll have more interviews coming and yeah we appreciate your time hope everybody stays safe and healthy
Dr. Ryan Oakley: Awesome Jen, thanks for having us. I feel like I got more out of this listening to Colin than anybody just being on here.
Jen Cullen: Great. Me too, both of you, I just I love it's really great.
Dr. Colin Lathrop: I love teeth and I'm missing them right now so you know whatever we can do to help! [Laughter]