Impression of Smile Direct Club

I was 3D scanned at Smile Direct Club’s Boston location yesterday. They use a WeWork location at 745 Atlantic Ave.  I checked in on the 8th floor, waited for a bit, then down to their offices on the 2nd floor.


I had to reschedule it a few days ago, the online scheduler was super-easy to use. They had 4 rooms for impressions and one general office space. It was cramped but clean and orderly.

The SmileGuide described the entire process and explained all the contents of the box of aligners you receive. I asked a lot of questions, which the SmileGuide — who was a Certified Dental Assistant — happily answered. To be clear, the SmileShop is not a clinic and I am not a patient, just a customer. If I were to reference an HBR article, this company’s value stream is customer service.

Believe it or not, this was my first digital impression.  Imaging started with photos of my upper & lower arches and in occlusion.  Then onto the 3D scan. At this location, they used an iTero Element. — I once met the guy who came up with “iTero”. Before that, I met the guy who created the technology! —   I didn’t time the process, but it was over in minutes. There was no spittoon or bib. It was a not a dental office. The arch scans automatically processed on screen and then shown  in color.  I brought along a USB stick in the hopes of getting my scans, but no luck.  I will follow-up with the central office.

It made me grin to see Invisalign options on the scanner interface.  Align Technology might not like competition to Invisalign, but has to like the equipment sales. There are 6 locations in Massachusetts and it sounds like there are more to come.

I went in knowing the cost:  $1,850 up front, or a payment plan that totals $2,170 over 2 years. I did not commit.  I left with a *nice* canvas bag and an at-home tooth whitener system.  If you skip the trays, you may buy more of the tooth whitener goop.

I asked, but could not receive, a copy of my scans at that time.  There should be a way for customers to receive their scan data.  Mail the customer a USB stick, or e-mail a download link.

The rap on aligners is they don’t work for teenagers. The reason being: compliance.  A $3,500 discount over braces huge.  Can you ensure your child will wear them 22 hours a day?

The scanner! I think this was a v1 iTero Element. The software was top-notch. I watched the data collect onscreen.  Whoever figured out how to display the scan in-process should win an award. Oh snap, they did!

Have you been to a SmileShop? What do you think about at-home orthodontics? Tell me about it in the comments. Thanks!


Night Guard Market

Hello and welcome back from Chicago or where ever you spent February Break.  Since December, I have been working as a technology consultant to dental companies, which in practice means contract software development.  It’s good work, I hope to share more about it soon. Until then, I am conducting a night guard market survey.

One analysis puts the US market for sleeping bruxism at $211 million [1].  Price for night guards vary, but one made from a dental impression sells for $80-$170 on e-shops including Amazon. Dentists charge upwards of $500 for this product. One-eighth of the population suffers from sleeping bruxism [2]. A night guard does not cure sleeping bruxism, but it does reduce the effect of night grinding.

custom night guard
A 3d-printed, custom, night guard.

I’ve been seeing a lot of promoted content on Instagram from SmileDirectClub, Candid Co., and Bytes.  Why not night guards? I’ve found four companies selling night guards direct-to-consumers, one in the UK.  So far, I haven’t seen promoted content from these companies, but many of them use Google Ads.

Do consumers desire another option for a custom night guard? What is lacking in the current offerings?  To help answer these questions about the night guard market, please take the survey. I will share the results on March 15th.

What do you think will be the most desired improvement? Share your thoughts in the comments.

  1. Sleeping Bruxism Treatment Market Research Report –Global Forecast to 2023. Market Research Future. July, 2018. Accessed 2019-01-04.
  2. Bruxism. Wikipedia. 18 February 2019, at 19:23 (UTC). Accessed 2019-02-25.

high-volume custom designed manufacturing in the news

Check out this report from WCVB on the Atlantis concept from Dentsply Sirona Implants. Do you need to produce over 1,000 custom designed products a day?  Sign up or contact us to find out more.


Can you spare a few moments to take my survey?

Please take the survey titled “Metatooth Nightguard”. Your feedback is helpful! Thank you.


Medit i500

I spoke with a sales rep from CAD-Ray recently.  The stats on the i500 are impressive.  It’s certainly the lowest priced intraoral scanner that provides color. No monthly data fees or per scan fees, but there is a yearly support fee after the first year. Bring your own laptop. CAD-Ray bundles with exocad for a complete chairside scan & design solution.



@ Yankee Dental

I was on the lookout for value-priced intraoral scanners at Yankee Dental, but came up short.  The most attractively priced — that I saw, where was Medit? — is the Aadva(tm) IOS from GC America.  This scanner had the fewest restrictions as far as ongoing fees and data ownership. The resulting mesh is probably OK from a point density standpoint, but did not look great on the big display at the booth. The scanner is best applied to scanning quadrants for single-tooth restoration.  The software is rudimentary, although updates are on the way. The blue light wand is one of the smaller ones I have seen. No tip to replace.

The Carestream C3600 (w/o color) was the next afforable option.  Carestream also takes the attitude that the customer owns the data. No concerns about scan quality here.

3M was present at Yankee Dental, but I didn’t see the True Definition on display.

iTero, 3Shape TRIOS, Planmeca, CEREC.  These are the big four and command the highest price.  They all have monthly fees, some more (iTero) and some less (Planmeca). You get what you pay for and according to your philosophy.  Want total control? Planmeca.  Want to have Align Tech clean up your scanning work? iTero. Want the best looking scanner? 3Shape TRIOS. Want the absolute best in German engineering? CEREC.

All systems have some type of connectivity, where the scans can be sent to participating dental labs. 3Shape and Planmeca have ways of sending that do not require a fee from the dental lab.

While a traditional impression might cost up to $60 (materials and shipment to the lab), I am told the real return-on-investment is seen in patient comfort and reduced chair-time.  The anecdotes are also piling up regarding final fit of the devices designed from digital impression. (The anecdotes are that the fits are great.)


Small Business Determination (SBD)

If your business had less than $100 million in revenue last year, then you qualify to be a “small business” in the eyes of the FDA. Simply file Form 3602! You’ll need to re-apply for each new fiscal year.  The review period is 60 calendar days, so plan ahead.

The FDA provides detailed guidance for US and foreign businesses here.


Unboxing a Formlabs Form 2 bite splint

I received a sample bite splint from Formlabs today.  This was made on the Form 2 with their Dental LT Clear Resin.  The material is bio-compatible and suitable for Class IIa medical devices. It needs some finish work.


another direct to consumer clear orthodontic aligner

UPDATED 2019-01-16 As seen on their website, Candid Co is printing the dental model and vacuum forming the tray. The post has been updated to reflect this.

I was recently directed to Candid Co‘s promotional content on Instagram. Smile Direct Club has been doing this for a couple years now.  Both are trying to out-align Align Technology.

Here are a few other key figures from Candid Co’s website:

  • $95 for an at-home impression kit and treatment plan
  • $1,900 or $80/month if approved for financing
  • A free set of retainers

Smile Direct Club’s pricing is also transparent:

  • $79 for an at-home impression kit or free digital impression at a SmileShop
  • $1,850 single payment or $250 down and $80/month for 24 months ($2,170 total)
  • $99 per retainer (upper and lower)

What is Invisalign going for? It’s not so clear (ahem), but many websites report $3,500-$8,500.  I think Align Technology would argue that the added cost of being treated in-person by your orthodontist is worth it.

#3dprint #dental


Align Technology’s use of 3D printing

I recently came across this 2017 article by TJ McCue: 3D Printing Moves Align Technology Toward $1.3 Billion In Sales It contains information useful to understanding Align Technology’s business model.  Here’s what I found.

Treatment Efficiency

8 million aligners a year for 540,000 cases is 14.8 aligners per case. They also report a cumulative 327 million aligners to 4.5 million patients or 72.7 aligners per case. Not sure what to do about that, but I expect they used to make a lot more per case then they do now.

Average Sales Price

At the time, Align estimated a US market of 10 million orthodontic cases a year, with 60% or 6 million cases where aligner treatment is indicated. They claimed 9% of those for 540,000 cases.

Figuring $1.283 billion in sales of Invisalign for 540,000 cases is an ASP of $2,167.  I don’t think this number has changed since then.


The author claims to have seen 50 to 60 machines.  The 3D Systems’ Figure 4 starts at $25,000. Material cost per part should be low, say $5. They must have more capacity than the 8 million part demand.  Let’s say they are at 80% of total machine usage.  Can one Figure 4 print 30 trays an hour? There must of been more machines than the author saw!

Whatever the cost structure, Align Technology has eye-popping results.