Host: Welcome to the inaugural episode of the Cruise Orthodontics podcast. I'm your host, Richie Guerzon and today we're talking to Dr. Cruz about the evolution of Invisalign.
Host: So what originally drew you in to specialize in orthodontics and specifically working with Invisalign?
Chula Vista Invisalign Specialist | Dr. Chris Cruz: I realized fairly early in dental school that orthodontics is a wonderful specialty. I mean, I think that you're generally speaking, when you think about visiting the dentist or visiting many different types of doctors for that matter, orthodontics is one of the few where the patients are genuinely excited to come and see you. Right? They have a motivated interest in coming to see you. And I know it sounds a little bit corny, but I genuinely believe that a smile says a lot about a person. And so for me to be able to play a role in that and really have a positive impact in their life is really gratifying.
And so, you know, another way of sort of thinking about it is that orthodontics is fun and it's rewarding. And so that's definitely what attracted me to it. And then as it pertains to Invisalign, it's definitely made it a lot easier or access for people that weren't necessarily interested in braces, but they still wanted to do something about their smile or about their bite. You know, Invisalign has made a big difference in allowing people to be able to do that in a more discreet way now.
Host: So how did Invisalign treatment and the technology look at the beginning of the last decade versus now?
Chula Vista Invisalign Specialist | Dr. Chris Cruz: That's a great question. You know, Invisalign, I have to give them kudos. They have done a really great job in consistently investing in themselves and investing in their technology. You know, when I first got started with Invisalign 20 years ago, any time you wanted to make adjustments as to how you wanted to move teeth for a particular patient, you'd have to literally type the instructions into a technician who would then make those changes.
And oftentimes it was a slow, laborious process because you type something in, they do that action, it come back to you, it would be quite right and so on and so on. Now, Invisalign has amazing software that gives the clinician total control on how to move the teeth. And so you can do things in real time to be able to get it exactly the way that you want without that lag of having to communicate with somebody.
They've also done a fabulous job in creating a really excellent material to be able to move the teeth, make it comfortable. And it took a lot of money and time to become up to come up with their sort of proprietary plastic material. They call it Smart Smarttrack. And then, you know, some of the other things as well is that in the last I'd say few years, there are some features that are actually built into the aligners.
One of them are called bite wraps. And so that allows you to be able to fix deep bites, which wasn't really feasible years ago. I was one of the challenges with Invisalign for patients that have a deep, overlapping bite in the front, there are these things called precision wings now. So when people have their upper front teeth, better to fast forward. The wings can help achieve that. And so, you know, if you look at where Invisalign started and where they are now, they have made massive progress in making sure that the results in the end are are excellent.
Host: I know it sounds like you're able to treat a lot of situations with Invisalign where normally you would have had to use traditional braces. Is that true?
Chula Vista Invisalign Specialist | Dr. Chris Cruz: That is absolutely true. You know, in the last few years in particular, some of that is based on what Invisalign has done with these features that I mentioned. And some of it has to do with things that we've done within our practice. You know, a good example of that, which we may talk about in a bit is something called a motion appliance.
And so we can actually get patients to wear this motion appliance, which is small and not all that noticeable, and attach rubber bands to it to get their bite corrected in the back. And so once that part's done, which usually takes a few months, then you're able to move on with the Invisalign. So, you know, it's not to say that Invisalign isn't able to do these things, but you can now do it much more efficiently if you add these auxiliary appliances in a discreet way to make sure that you're genuinely, you know, achieving a perfect result as far as the patient's bite's concerned.
Host: Dr. Cruz, can you tell us about any major milestones in the last ten years for Invisalign?
Chula Vista Invisalign Specialist | Dr. Chris Cruz: Yeah, sure. There have been a couple. One of them is the fact that we are able to now scan a patient's teeth with something called an itero scanner.
So the old school way of doing things, we used to have to take those goopy impressions of patient's teeth and it was definitely problem attic. You know, the impressions were really technique sensitive. Patients did not like having impressions taken and they also weren't all that accurate. So you can imagine that if you start with an impression that basically takes a mold of somebody's teeth and it's not a perfect replica, the aligners that are going to be made from that aren't going to fit ideally.
And so within the last, I'd say 5 to 10 years, many orthodontic offices have adopted these ITERO scanners, and they are highly accurate, I mean, even down to just a few microns. And so the other thing that, you know, patients love is it's comfortable. The impressions were not fun to take. And so now we're able to start off with Aligners that fit really, really accurately.
And so the idea of being able to track patient's tooth movement more consistently and accurately is a big is a big deal. And, you know, the idea of scanner is a big reason for that. The second thing is, you know, the attachments or what I call the bumps that we put on patient's teeth, you know, several years back, Invisalign created what are known as optimized attachments.
And so these attachments have been able to handle more complicated movements of teeth. When you look at what the attachments used to look like 15 or 20 years ago, they are now drastically different. You know, Invisalign hired some PhDs in mathematics to be able to come up with these attachments. And the way that I would think of it is that the Aligners are not able to hold on to the patient's teeth more snugly as a result of these attachments being on.
And so now, you know, when you go from start to finish with Invisalign, it's much more predictable because these attachments are very specific, depending on what type of tooth movement you're trying to do.
Host: Are there any other advancements in 3D imaging or the technology you want to talk about?
Chula Vista Invisalign Specialist | Dr. Chris Cruz: Sure. Yeah. I know that we were just mentioning the ITERO scanner. You know, one aspect to also think about with regards to that is that you now have been able to eliminate the idea of having to physically mail these impressions to Invisalign and then wait for the Aligners to be mailed to you.
Now we take the scan. It's highly accurate. We send it digitally immediately. And so what used to take weeks and weeks for the process of getting the aligners developed and shipped to the office has now been greatly reduced. So not only is it much more accurate and much more comfortable for the patient, but it also cuts down on the amount of time that we have to wait to actually receive the Aligners.
Host: Can you elaborate a little on the changes in materials and design? How is it changed patient outcomes?
Chula Vista Invisalign Specialist | Dr. Chris Cruz: Now we touched on it briefly, but this smarttrack material that Invisalign has created is is really pretty amazing. You know, one of the things that makes the material so great, it has the right amount of stiffness and the right amount of stretch.
So you know, you can imagine that if a clear aligner is too stiff, it's going to cause the patients to become really sore. And it's also going to be problematic as far as giving the teeth to actually track within the aligner. And then conversely, if you have aligners that are too stretchy, it's not going to provide enough force to be able to actually move the teeth.
And so you've got to find this perfect blend of being able to be stiff and stretchy at the same time, to be able to achieve all the goals that you're trying to achieve. And so this smarttrack material that Invisalign has come up with really is excellent at that.
Host: So as far as improving patient outcomes, is there anything unique that Cruz Orthodontics does with using Invisalign?
Chula Vista Invisalign Specialist | Dr. Chris Cruz: Yeah, there are a few things. I think one of them that's definitely worth highlighting is kind of our aligner protocol as far as how quickly you change them. You know, a lot of offices will have patients switching their aligners every two weeks, and within the last year or two we've started having our patients switch the Aligners every week.
What I do within the software at Invisalign is I have Invisalign actually slow the movement down so that we can then have our patients increase the rate that they go through the aligners. So now patients are able to wear each aligner for just one week and it has a few advantages. You know, one of them is that the teeth will track more directly because each aligners focusing on a smaller amount of movement and it's more comfortable for the patient and the other big one that we would get complaints about is that at the end of two weeks wearing the same aligner, the aligners get a little dingy, a little beaten up, they can stain, especially if you're drinking coffee or red wine. And so now this idea of being able to change your aligner every week is definitely made a lot of our patients happy because they get a nice new, fresh, clean aligner every week.
Host: So have you noticed any change in the demographics that use Invisalign in the last decade or so?
Chula Vista Invisalign Specialist | Dr. Chris Cruz: I have. What I will say is that more and more younger patients are using aligners and I'll be the first to admit I was actually quite hesitant to have some of our younger patients in Invisalign. My fear was compliance. Generally speaking, our teen patients are actually more compliant than our adult patients. That was no offense to teenagers, but there was a little bit of a surprise to me.
I also feel like we do a good job of sort of setting expectations with our patients early on that compliance with Aligners is key. You know, you're not wearing the Aligners, you're not going to end up getting that ideal result. So patient education is key. And yeah, we're definitely seeing more and more younger patients in Aligners.
Host: How would you say the effectiveness of Invisalign has changed from now versus a decade ago when you compare it to traditional braces?
Chula Vista Invisalign Specialist | Dr. Chris Cruz: Yeah, great question. You know, I continue to be impressed with how effective Invisalign can be with excellent compliance. Invisalign has actually become a wonderful tool and being able to resolve open bites. In fact, I recommend all of our patients that come in with open bites to do Invisalign over braces. So it's been really interesting to see kind of this evolution of how you can use Invisalign in ways to help you. That used to be really challenging when you're using fixed appliances like braces.
Host: So based on your experience, how has patient satisfaction evolved over time?
Chula Vista Invisalign Specialist | Dr. Chris Cruz: No, I was thinking about that the other day. It's funny you say that ten years ago. Our Invisalign patients really dislike having attachments placed on their teeth because they didn't like the way that they looked. And, you know, if you look at a lot of Invisalign marketing, it will show models with Invisalign on and it doesn't necessarily show the attachments.
But what I've noticed is that over the last decade or so, patients have actually become more and more open to the idea of these attachments. In fact, I feel like it's almost a status symbol or a badge of honor to have these attachments on and so that has definitely been something that's helped us tremendously. And Invisalign has done a really great job of making it sort of socially acceptable so that, you know, we're not having to fight our patients in explaining why these attachments need to be placed. It's definitely much more accepted now.
Host: Then the attachments changed or are they less noticeable now than they were ten years ago?
Chula Vista Invisalign Specialist | Dr. Chris Cruz: Now, that's a good question too, because we've actually purchased different shades of composite. And so for patients that have really white teeth, we've actually purchased some shades that will blend with the color of their teeth.
And so we've started to customize now the color of the attachments. I wouldn't say that the size or shape of the attachments have changed all that much, but I think that it's important for the office to customize it so that it blends with the teeth of the individual patient.
Host: Yeah, I think that extra step makes a big difference to someone.
Chula Vista Invisalign Specialist | Dr. Chris Cruz: Yeah.
Host: So what have been some of the biggest challenges Invisalign treatment and how has the technology helped with that?
Chula Vista Invisalign Specialist | Dr. Chris Cruz: I think the one that's not discussed all that often, but it's sort of the elephant in the room always is compliance. And so I know we've touched on it a little bit, but you know, if the aligners aren't worn 18 to 20 hours per day every single day, you can't expect to get in ideal results.
One of the things that we've recently done tests to help with this is we've adopted something called dental monitoring. So this allows our patients to attach a device called a scan box to their phone. And so they're actually able to scan their teeth once a week and then it comes to my computer so I can evaluate the progress and how well they're tracking.
And I'll be honest with you, it's been it's been a game changer in also improving compliance, which wasn't my primary focus in using this dental monitoring. But, you know, rather than seeing patients every 8 to 10 weeks, patients now know that I get to see how they're tracking every single week. And the software helps us catch things like the aligner fit in a way that even the human eye can have a tough time doing.
That's how sensitive the software is. And I've noticed that our patients actually enjoy or appreciate the fact that we're taking a look every week because it holds them accountable. I think we all like to have somebody that holds us accountable. And so, you know, I've been surprised that I'm the only one in my community that's using this dental monitoring because I think that it's going to be a really big benefit in improving this compliance. That's that's one of the things that you're always striving to improve on with Invisalign.
Host: So how do you think Invisalign has adapted to treat more complex cases over time?
Chula Vista Invisalign Specialist | Dr. Chris Cruz: It's it's a good question. It's a combination of what Invisalign has done and it's also partly what we have done in our office.
And, you know, a couple of examples of what Invisalign has done, which we briefly mentioned, are things like precision wings or also bite wraps. They're actually built into the aligners themselves, and they've really helped with treating patients with large overbite or with deep bites in a way that wasn't really feasible to do even just four or five years ago.
And so what would happen is that you have to continue to do these revisions with Invisalign and keep trying to resolve the issue, and it would extend treatment time. And so these new features now really been effective in achieving the proper result and doing it in a timely fashion. And then, you know, some of the things that we've done in our office are using something like the motion appliance, for example.
And so for the first few months of treatment, our patients attached these elastics or rubber bands to this motion appliance. And what it does is it corrects their bite on their back teeth. And that's sort of the foundation of what you're trying to resolve generally speaking, when you're doing orthodontic treatment. And so if you don't get the back teeth set in the proper position first, everything else is very difficult to then fall into place.
So by us in our office using this motion appliance for three or four months in the beginning of treatment and getting those back teeth set has really made a world of difference. And then being able to then go into something like Invisalign, not forcing our adult patients to have braces on and still achieving a really nice result.
Host: So in your opinion, what are the next frontiers for Invisalign Technology?
Chula Vista Invisalign Specialist | Dr. Chris Cruz: I you know, that's a great question. I was actually talking to one of our sales reps recently and I asked him that same exact question of, Hey, what's what's on the frontier? What are we looking forward to?
And his answer was a bit cryptic, to be honest with you. And he had a coy smile on his face. But he did say that within the next year there will be some major news dropping. But that's all he would give me. I'm not sure if it has to do with them incorporating AI into their product, but it's anybody's guess at this point. But something should be coming here in the near future.
Host: Dr. Cruz, so what advice would you give new orthodontist thinking about specializing in Invisalign treatments?
Chula Vista Invisalign Specialist | Dr. Chris Cruz: That's a good question. I would say embrace it as soon as you can. Based on my experience, it was tough to get a lot of Invisalign cases under your belt while you're in residency. And so once you're out, I think that's the opportunity early on in your career to really try and educate yourself on it.
You know, the ideal situation would be to have a great mentor, to show you the ropes and improve the learning curve. And I was lucky enough to have that with with having a mentor. So, yeah, sooner the better in adopting this because, you know, it's obvious that it's not going away. In fact, Invisalign continues to take more and more market share away from fixed appliances like braces.
Host: So how do you think Invisalign will shape the future of orthodontic care?
Chula Vista Invisalign Specialist | Dr. Chris Cruz: I, I think that the natural path for Invisalign is just going to continue to focus on making it more accessible to everyone with every type of bite. You know, the line between braces and Invisalign as far as which one is better is definitely become blurred.
And I expect that to continue. And you're going to see younger patients, even as young as eight or nine years old, wearing aligners as opposed to braces. And so, yeah, this idea of it being just generally more accessible to everybody.
Host: Well, Dr. Cruz, thanks for your time. I'm glad we got this first episode under our belt. It's going to really help a lot of people and we're looking forward to hearing from you again.
Chula Vista Invisalign Specialist | Dr. Chris Cruz: Yeah, my pleasure. That was fun.
