As the field of orthodontics rapidly evolves, custom bracket and archwire systems are reshaping office efficiency, patient experience, and clinical outcomes. Once considered niche or experimental, these digital-first solutions are gaining traction as a viable and efficient alternative to traditional fixed appliances.
To explore this shift, Orthodontic Products spoke with Alexander Waldman, DMD, MMSc, of Waldman Orthodontics in Beverly Hills, CA; Kristen Knecht, DDS, MDS, of Knecht Orthodontics in Mont Bellevue, TX; David Richter, DMD, MS, of Richter Orthodontics in Greeley, CO; and Jared R. Gianquinto, DMD, MS, of Orthodontic Arts in Bakersfield, CA. In this roundtable Q&A, they share how custom fixed appliances are changing everything from clinical workflow to ROI, and why they believe this technology is here to stay.
Alexander Waldman, DMD, MS: Like other areas of technology, custom orthodontics has evolved slowly, then in leaps and bounds. The proliferation of digital scanning and adoption of digital workflows, especially in the area of braces, has opened our eyes to the value of digital orthodontics. Many people believed that analog braces would soon be completely replaced by digital braces due to the lack of a similar workflow for braces.
In reality, fixed appliances are just another area of orthodontics waiting to be disrupted by technology. Today, we are already seeing the benefits of digital orthodontics applied to fixed appliances in systems like LightForce, and we will continue to see growth in this area over the next decade as clinics realize the significant benefits in efficiency, workflow, and outcomes.
There has also been a significant shift in how many physicians (myself included) think about treatment options. Teen braces were very popular in the 2010s, and physicians were willing to pay high lab fees to create a better patient experience and more efficient treatment outcomes.
The harsh reality is that teens are not very compliant with braces, so the average teen brace case ends up taking more time, which reduces the patient experience and overall physician efficiency.
Digital custom braces are a great way to find that balance; we take the problem of non-compliant braces and combine it with digital efficiency to create a truly superior experience. I think this will drive widespread adoption of digital custom braces over the next decade.
Kristen Knecht, DDS, MD: Custom orthodontics has evolved significantly, moving beyond a one-size-fits-all treatment plan to a system that provides truly personalized treatment.
The biggest shift has been incorporating custom prescriptions, using precision-engineered brackets and optimized archwire sequencing to fully fill custom slots, provide us (the practitioner) with full torque expression, and let the brackets and archwires do all the work. The result is reduced treatment variability, less archwire bending, and more predictable treatment outcomes.
While early custom solutions focused on just one piece of the puzzle, custom bending wires or digital treatment plans, the latest advances offer a complete ecosystem designed to maximize clinical efficiency while maintaining full control of the machinery.
David Richter, DDS, MS: In my opinion, the custom orthodontic landscape has changed dramatically over the past five years. As orthodontists, we have been using technology from the 1970s and have struggled to provide quality care with systems that are very limited compared to today.
Jared R. Gianquinto, DMD, MSc: In the early days, the big players in fixed orthodontics did not see any need for customization. As customization took off, many companies doubled down on their efforts, making subtle changes to traditional systems, creating new branding, adding digital indirect bonding, and constantly exaggerating their efficiency to compete with the new players in the field. Now that truly customized systems have been in use for some time, more and more doctors are realizing that the efficiency gains are real and not just marketing gimmicks.
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