SmileDirectClub IPO

SmileDirectClub and it’s initial public offering is in the news. The numbers cited are astounding: revenue of $423.2 million in 2018; 700,000 customers since 2014; $945 million addressable market; $393 million in funding (Shen, 2019).

Legal and regulatory hurdles remain. SmileDirectClub is suing the state dental boards of Alabama and Georgia to remove the requirement that a licensed dentist be present for the 3D scan of the patient. Arkansas has a law, co-written by a state representative who is also a dentist, that requires in-person exams before a doctor can treat a patient remotely.  If the attorney general of that state takes action, expect a lobbying effort by SmileDirectClub (Mandelbaum, 2019).

The question remains: can you collect enough data to make a treatment decision (for example, start clear aligners or referral to a local orthodontist) remotely? If it’s really not possible, then more innovation is needed to make it so. Teledentistry provides a way to bring better oral health to under-served regions. The technology and infrastructure built to disrupt the orthodontic industry should have a side benefit.

Align Technology Inc.’s 17% stake is looking pretty good. What other disruptive startups have backing by industry leaders? Tell me about it in the comments!


Shen, Lucinda. Fortune (August, 16, 2019) Brace Yourself: SmileDirectClub Is the Latest Unicorn to File for an IPO Accessed August 23, 2019.

Mandelbaum, Robb. Bloomberg Businessweek (August, 22, 2019)  A Tooth-Straightening Startup Runs Into Resistance Accessed August 23, 2019.


Open Formats and Protocols in Dentistry

Open formats and protocols in dentistry first appeared in the 2000s. They grew from the need of dental laboratories to integrate equipment for digitizing study models, designing dental prosthesis,  and manufacturing those products. Many software systems are “walled gardens”, where everything inside the walls are manicured but there is no way to access other gardens.  Of course, outside the walls the landscape is *not* manicured, so a robust integration method is needed. The “gardens” in this case were the Dental CAD/CAM systems of the 1990s.

Dental laboratories pressed for open integrations so they could make effective outsourcing decisions about how to manufacture these products.  Dental CAD customers demanded ways to manufacture their products using the tools or partners they determined was best for their business. Performance tuning for specific equipment may still be needed, however the issue of connectivity between different vendor’s CAD and CAM is no longer an issue.

The same market forces that drove open formats and protocols between digital dentistry tools are now coming to bear on dental imaging and business software.  Some dentists are demanding it in the pages if Inside Dentistry:

Dentists should not be beholden to any company for the ability to access and use their data in the manner that they see fit. (Jablow, 2019)

Improving patient care while meeting the demands of the dental insurance industry will drive this move to open connectivity. For the patient that would be portability of dental records and image.   If market forces are expected to be efficient, then artificial barriers to patient choice need to be reduced.

The application of machine learning algorithms to dental imaging improve the accuracy of diagnosis, which could create demand for earlier interventions as well as reduce unnecessary ones [1].

Lastly, open formats and protocols will lower integration costs for the dentist [2]. Administrative costs are one of the largest drivers of dental (and overall healthcare) costs. In this way the dental industry will take a lead from dental lab owners in demanding  connectivity to improve patient outcomes.

How is open connectivity impacting your business? Tell me about it in the comments!


[1] Shah, Agam, AI Can Lead to Lower Dentist Bills, Wall Street Journal (July, 16, 2019) Accessed 2019-07-19

[2] Jablow, DMD, Martin, Digital Dentistry Data, Inside Dentistry (July 2019) Accessed 2019-07-19




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!


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.


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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