Should you hire an in-house orthodontist for your clear aligner cases?
Short answer: if most of your aligner patients are adults, an in-house orthodontist rarely pays off. Case selection gets slow, few referred cases come back to the general dentists, and the finished tooth position often doesn't fit the restorative plan. A dentist-led planning service that combines orthodontic and restorative knowledge is usually the better fit. If you treat many children with fixed appliances, hiring an orthodontist makes sense.
You've built a practice where more and more adult patients ask for clear aligners. You or your dentists want to say yes, but they can't judge the orthodontic risk of a case on their own. So the obvious move is to hire an orthodontist. We have watched large practices and DSOs do exactly that, in several countries, and most of them ended up with a setup that cost more and produced fewer aligner cases than before.
Why do practices hire an orthodontist for aligner cases?
The reason is sound. A general dentist can't risk-assess a normal orthodontic case. Biomechanics, the biological limits of tooth movement and orthodontic diagnostics are not part of general dental training. It takes a lot of training and experience from around 500-1000 cases before the task becomes a habit. Someone has to do case selection before treatment starts, and it has to happen fast. A patient who waits weeks for an answer loses the motivation to start.
An orthodontist has exactly the knowledge the general dentists lack. On paper, the problem is solved.
What goes wrong in practice?
The orthodontist gets their own patients
Orthodontists are expensive to have on the payroll, and rightly so. They have studied three to four years longer than a general dentist. A practice can't afford to let them wait for referrals, so they get their own patients. Most of those patients are treated with fixed appliances, some with clear aligners.
That changes the incentives. Their own patients secure the orthodontist's position, and treating usually pays better than planning cases for a colleague. Nobody has done anything wrong. The setup simply rewards the orthodontist for treating patients rather than for helping the general dentists treat them.
Few referred cases come back to the general dentist
In the setups we have seen, only around 5-10% of the patients sent for case selection end up being treated by the general dentists. The rest are judged unsuitable for them and end up being treated by the orthodontist instead.
For the general dentist, that is a loss-making routine. They spend time on records, referral letters and follow-up, and nine times out of ten nothing comes back. So they stop referring. The patient loses, and so does the practice.
Planning waits until the orthodontist's own work is done
With their own patients as the first priority, the orthodontist gets to colleagues' cases once their own work is finished. Case selection takes longer than it should, and treatment planning typically takes two to four weeks. The longest wait we have seen at one of our course participants was eight weeks. No patient stays motivated for that long.
The finished tooth position doesn't fit the restorative plan
Most general dentists have referred a patient to an orthodontist with clear instructions. Maybe with models mounted in an articulator, or a digital smile design showing the result they need for the restorative work afterwards. Then orthodontic treatment ends, and it is obvious the instructions were not followed. Before the crowns, veneers or implants can go in, the dentist now has a new set of problems to solve.
Both sides have a blind spot, and it comes from their training:
Orthodontists are experts in biomechanics, growth and fixed appliances. With training and experience they can become very good with clear aligners. But most know little about functional occlusion and restorative dentistry, and it shows in the tooth position they hand over for restorative work.
General dentists usually understand where the teeth need to be for stable function, and what the restorative options require. That makes them well suited to finish an orthodontic-restorative case, which almost every adult case is. What they lack is biomechanics, knowledge of the biological limits of orthodontics, and orthodontic diagnostics and treatment planning.
Hiring an orthodontist can move that gap inside your own practice, with a specialist salary attached.
What happened at a group with 300,000 patients
A few years ago, a large dental group asked us to train all of its general dentists in clear aligner treatment. The group had around 300,000 patients, so statistically the potential was enormous.
We built an internal certification for them. Every dentist went through several hands-on sessions, online modules and written tests, and their dental assistants were trained in the clinical workflows so they could support the dentists at the chair. After two years, every dentist was certified and keen to get started.
The start went well. The dentists found many patients with a clear indication for aligner treatment. At the same time, the group built an in-house team of orthodontists. They were to plan the cases for the general dentists and take over the cases judged unsuitable for general dentists to treat.
Some of the dentists used AlignerService in the beginning, until the orthodontic team was in place. After that, an internal policy said that only the group's own orthodontists could plan cases. Several dentists told head office that the new setup wasn't working for them. They had been used to fast turnaround, help with patient communication, plans that took functional occlusion and the final restorative work into account, co-planning with a colleague on equal terms, and a revision rate under 7%. The policy stayed in place.
Today, the group treats 20-40 aligner patients a year, out of 300,000 patients.
Nobody in that group lacked skill or motivation. The dentists were trained and ready, and the planning setup around them decided the outcome.
When does hiring an orthodontist make sense?
When your practice treats many children and wants to offer fixed appliances as the main treatment. Children belong with an orthodontist. General dentists don't know enough about growth, and we recommend that they refer these patients. The same goes for surgical cases.
What is the alternative for adult aligner patients?
For adult patients, the general dentist needs three things: a fast risk assessment before treatment, a treatment plan that combines orthodontic mechanics with restorative and functional goals, and clinical support through the whole treatment, including revisions. The dentist keeps the patient and the clinical responsibility.
That is what the AlignerService Risk Management System™ is built for. Every case starts with an Aligner Risk Check before any plan is made. It is free, without obligation, and you get the answer within 24 hours, Monday to Friday.
Our team consists only of orthodontists and dentists with different specialties. Technicians are not involved in diagnostics or planning. We chose that mix on purpose: the plan builds on orthodontic knowledge and is adjusted to the treating dentist's own treatment philosophy and restorative goals, instead of a standard orthodontic solution.
We built AlignerService the way we would have wanted it when we were still working at the chair. You pay per case. There is no contract that ties you to a monthly fee you never quite get to use.
What matters | In-house orthodontist | AlignerService |
Case selection | When the orthodontist's own schedule allows | Within 24 hours, Monday to Friday |
Treatment planning | Typically 2-4 weeks in the setups we have seen | From 4-6 hours to 7-14 days after we receive the data and the dentist's go-ahead, depending on the aligner system |
Who treats the patient | Often the orthodontist | The referring dentist |
Restorative goals in the plan | Often missing | Agreed with the treating dentist |
Cost model | A specialist salary, whether there are cases or not | Paid per case. No subscription, no monthly fee |
The same pattern holds across the 50,000+ cases and 2,500 clinics in 20 countries we have worked with.
Start with your next case
Not sure whether your next adult case is one you should treat yourself? Send it for a free Aligner Risk Check, and you'll know within 24 hours where the risk is.
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Kind regards
Jesper Hatt DDS
P: +41 78 268 00 78
