Welcome to The Golden Age of Orthodontics, the podcast that keeps orthodontists ahead of the curve in innovation and patient care. Join hosts Dr. Leon Klempner and Amy Epstein as they explore groundbreaking advancements shaping the future of orthodontics. In today’s episode, they welcome Dr. Neil Warshawsky, founder of Get It Straight Orthodontics, to discuss the transformative impact of direct 3D printing and digital workflows. Together, they delve into the revolutionary changes brought by this technology, from producing pre-polished clear aligners and nightguards to the role of teledentistry in enhancing patient care. The discussion highlights the environmental necessity of reducing waste through direct printing and recycling practices. There has never been a better time to be an orthodontist.

IN THIS EPISODE: 

• [5:20] Dr. Neil shares his background and contributions to orthodontics
• [7:11] Exploring the new wave of direct printing technology
• [17:06] Predictions for the future of aligners and direct printing versus thermoforming
• [24:33] The benefits of Ortho FX nighttime aligners
• [31:14] The role of teledentistry and the importance of patient comfort

KEY TAKEAWAYS: 

• Revolutionary 3D printing has transformed orthodontics by producing clear aligners and nightguards with pre-polished surfaces, streamlining the process and reducing waste compared to traditional thermoforming methods.
• The daily production of millions of non-recyclable aligner models highlights the need for sustainable practices, such as direct printing and recycling initiatives, to minimize environmental impact.
• Customization and patient-centered approaches in orthodontics are essential for achieving better outcomes. Leveraging innovative technology like teledentistry and custom-made appliances addresses diverse patient needs, including those with special requirements. Consistency and comfort are key factors for success with aligner therapy.

RESOURCE LINKS

People + Practice  - Website 

Leon - Email

Amy - Email

People + Practice - Email

Dr. Neal - Email

Dr. Neal - LinkedIn

Ep 68-Dr. Neil Warshawsky-Transcript

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Narrator: The future of orthodontics is evolving and changing every day. But although the way to achieve practice growth has changed, there's never been a better time to be an orthodontist. Let's get into the minds of industry leaders, forward thinking orthodontists. and technology insiders to learn how they see the future of the orthodontic specialty.

And now, welcome to the Golden Age of Orthodontics with the co founders of People and Practice, Dr. Leon Klempner and Amy Epstein.

Dr. Leon Klempner: Welcome to the Golden Age of Orthodontics. My name is Leon Klempner. Uh, if you don't know me, I've been around the industry for a while. Uh, after retiring from clinical practice, I began my next chapter helping orthodontists grow their practices.

How you doing, Amy?

Amy Epstein: I'm doing really well. Good to see you today. Happy New Year.

Dr. Leon Klempner: Happy new year.

Amy Epstein: Um, well, if you don't, if you, if you don't know my dad, you, um, probably have heard of him or you've seen him cause he's hard to miss if you're walking around. For example, the AIO, he's like about six foot four, um, silver haired guy.

Uh, I think that we can help. Together. And, um, turns out he was right. Um, so we've been working together since, and we have a dozen people that we work with across the U S to help orthodontists through all the different types of changes and phases and opportunities that, uh, are being presented in this ever changing industry.

And we're going to talk about one of those changes today, as my dad hinted at. Um, and that's why. We're really happy to have on our podcast today, Dr. Neil Warshawski and Neil. I'm going to call you Neil. Um, Neil is a, and I'm sure you know him because like my dad, uh, Neil is has been around. He's an excellent orthodontist, but he's also very involved in the industry.

Um, he's also runs the ortho department as the associate professor as an associate professor at the University of Illinois. focusing on craniofacial orthodontics. He is an active lecturer, a published author, um, and he's an advocate for direct 3d printing and digital workflows in modern orthodontics.

He's also a speaker for a lot of the companies that we see at the AIO and that we are learning about to see if they're a good fit. For our practices, um, Luxcreo, OrthoFX, ULA, Bria, Brias, Kail, Owen, Lightforce, you name it, he knows a lot. So, Neil, thank you so much for being with us today. We appreciate your time very much.

Amy Epstein: Oh, okay. Thank you.

Dr. Neil Warshawsky: But that's my alma mater. I went to school

Dr. Leon Klempner: there.

Amy Epstein: Okay, very good.

Dr. Leon Klempner: Well, I'm glad you're here, Neil. I've been trying to get you on the podcast for a while.

So it's finally come to fruition. So I do appreciate it. So as you know, as Amy mentioned before, um, at the AO meetings, you'll find me walking around and I'm, I'm always looking for what's new, what's, what's developing, you know, how I could leverage it with our, uh, Practices that we do all our marketing for.

This is going to be a game changer. So I remember this,

Amy Epstein: by the way, he came back to our booth and said, I found a game changer. And so I'm not making this up for your benefit, Neil, but, um, he did say that and we, um, you know, started doing some research.

Dr. Leon Klempner: Yeah. I mean, so, so, you know, tell us a little bit about how you got involved and just give us a, like a, a brief overview of, of.

How you use it and, and, and what your connection was.

Dr. Neil Warshawsky: Okay. So, uh, my background was I, one of the many KOL positions I've had over the last 30 years was I was the dense ply key opinion leader for a rain tree Essex. So I, um, spoke a lot about thermal forming. I mean, I could, I could spit out. Stats on plastic, uh, velocities of tooth movement, stuff like that.

And I'm, there's a key guy at Invisalign 1999. We were right at the beginning, we were using Invisalign, but you know, Anyone who uses clear aligners knows there's limits, right? And there's a lot of orthodontists out there that says they can do everything with a clear aligner. And I'm just suspicious of people when they say everything and always because there's always exceptions to a rule.

You know, and I believe in custom care, so I think using the same appliance to do something for everyone just doesn't make sense. So the problem now is the largest company in the world that makes clear liners by far is aligned technology that make a million aligners a day roughly. And they, in my mind, are a marketing company, right?

If that's really what they want, uh, there are just better products out there and I'm not saying bad or good. I'm not disparaging the product, but you know, they're, they're using a platform and technology that isn't really necessarily evolving, right? They're using thermal form technology. They're still using stereo lithography.

They're still, you know, still printing models and blowing stuff down. So one of the things that I learned along the way was, um, so I'm really into, Because of my craniofacial background, trying to functionally grow people. And I've been working on a project for about eight and a half years to. Build a class to corrector.

And I was talking to keep on Kim, who does a lot of the research at ST Louis University, and he runs a department there, and he really grounded me and kind of explained to me what it does and doesn't do well. And, you know, I learned the process of how it cures in a nitrogen environment and this and that.

And I started digging a little bit about looking for their patents. And what I realized is they, they weren't on the patents for direct print technology. It was a company called Lux Creo. I'm like, who are these guys? Right? So, so I did a little homework and, um, learned who they were. And I, so I called the head of sales.

Dylan was incredibly knowledgeable about this industry. Like he, more than anyone I'd ever met. So it was really, we had a fascinating talk and, and at the end of the day, he says, you know, we have a technology office in Chicago. If you ever want to go to Chicago. And I started laughing because, you know, it's like the technology office is two blocks from my daughter's apartment.

And I'm like, yeah, I actually know the building like, you know, so, so anyways, it was just a quick love story. I walked in. Um, it was like, you know, uh, yeah. A fat kid in a candy store. I just went berserk on these guys asking a million questions. And, and they just fed my passion and just let me learn. And it's been a fascinating love affair ever since.

Right? You have to be like, just ridiculous. It's something to get through school because it's such a long process. And, um, really a bunch of talented people. Very, very, very, very humble and just Uh, I was blown, blown away when I realized that they didn't create resin. They actually created an ecosystem and wrote all the patents and, and that's kind of where the direct print stuff for me really kind of started to change my practice.

And let me tell you, this is all new. It's all roughly about a year ago.

What, what exactly is it? It's, it's an ecosystem.

Dr. Neil Warshawsky: So, so this is a group of people. From all different backgrounds. And I mean like all different backgrounds. One guy is a material science guy from that. Design the skin on the 787 airplane. Um, they, um, created a system. So they built a printer. They created resins for different purposes, not just for orthodontics.

You know, they created, uh, resins. You know, they've, they've They've learned what's needed in dentistry and they've built their system to solve solutions. So they do make three resins that I use every single day. One is, uh, a Night guard resin. One is, uh, what we call DCA, which is direct clear aligner resin.

Yeah. And because they built the entire system together, right? And, you know, direct clear aligners are using, um, some called shape memory resin, which if you don't know your materials in this space is super weird compared to thermoforming plastic, because in thermoforming plastic, We heat the plastic to somewhere around 414 degrees for a set period of time, and then you blow it down using a positive pressure machine.

One of the issues is How do you polish it? Right? So it has to. So they pioneered digital printing, digital polishing while it's printing. So pieces come off the printer, polished. It's, it's like insane. Your night guards are already clear. When it comes off the printer, so, so their ability to reduce the amount of time to process something at the end is actually huge.

But, you know, more so with direct printing, there is no model. So I'm a, I'm on the, on the ecology side of this. I think if you realize that a line technology produces a million models a day, you have to ask yourself, where did the million models a day go? Because they are not recycling them. They don't recycle their plastic.

Okay, they recycle 80 percent of their materials in their Memphis facility. So, and we'll, we'll talk about that.

Amy Epstein: You know, just a quick follow up on that question is, you know, before the show, we were talking a little bit about how you, you know, found Lux Crio, but you said it was out of necessity. Um, and so I want to ask you about that.

Dr. Neil Warshawsky: Okay. So, so if you ever hear, if you ever had the opportunity to meet like someone like Dwight Damon or someone who's like. Big in the industry, I think we all have one thing in common, which is we're all passionate about something, right? Some people, it's about golf. Some people, it's about working out. I love listening to orthopreneurs and ortho pearls because when they do their podcasts and you meet these guys or you listen to them.

And I'd wash my hands with Neutrogena soap. And to this day, when I smell Neutrogena soap, the hair on the back of my neck stands up because it's such a visceral effect for You know, I was very passionate, like going through school, like high school, college. I'm like, I'm gonna be an orthodontist. I never said I'm gonna be a dentist because I didn't really understand that.

And, uh, so I wrote a patent about eight years ago with a friend of mine who a lot of, you know, his name is Adam Schulhoff, who has created grin. I'm an advisor for grin as well. But, um, you know, so, uh, Adam and I, and another friend of ours, we wrote a class two patents and then, you know, Adam's. Project that grin took off.

So, you know, he's doing that. And our other buddy, he has a sleep apnea company. So he's in his, so I was left holding the bag on the class to think, but that was mostly my idea. And it's, it's been a project of mine that like, there's gotta be something better out there, right? Better than headgear that can grow people.

And, uh, so. When I realized I want to do it on an aligner, that's how I found Lux Creo because they're the only printer who can actually print what I'm trying to make. Okay,

Doctor benefits, time, cost efficiency. Um, but at the same time, there are companies that offer us the opportunity to shop out manufacturing of aligners as well. So how do you see the industry taking shape? Or is it like everyone's going to be buying ecosystem? Are we shopping it out? It was a hybrid.

What's uh,

Dr. Neil Warshawsky: no, I don't think everyone's going to buy it. So I think, you know, the first thing you have to be honest to yourself and you have to say is like. Do you want to do lab work? You know, I like doing lab work. You know, if it's not patient forward and I'm making stuff in the lab, you know, I, I, I find that kind of relaxing in a weird way.

And that's kind of one of those tough lessons I've kind of learned to accept that, you know, people don't always want a full correction. People want two teeth moved in their social six and, and they'll, they'll rave about you, you know? So it's like, so I think the concept that I tell people is under promise and over perform.

That's where direct print comes in because direct print oftentimes uses little to no attachments, right? That's a big deal when you have somebody who's like in their middle of their career and their vein and they don't want to be able to have a bunch of crap on their teeth, you know, and I'm sure we've all seen the case that, you know, someone walks in with a, with a removable product, they have 60 attachments on their teeth and I'm like, why didn't you just put braces on?

So depending on what your goal is, if you have a tooth that's being uncooperative, you know, oftentimes you'll see me like If I have a thermoforming case and something's not responding, I'll re scan it and I'll specifically put it in direct print at that point to finish whatever's just not happening with a thermoformed aligner.

It's interesting. They have different

And then we had. methyl methacrylate and all this type of stuff. So I'd be one that would want to farm this stuff out. So how does that work? If you have, who am I farming to? And, and how does that work? So we

Dr. Neil Warshawsky: are a mix of both, right? I, I still believe, you know, like I, like I told you up front at the beginning, I speak for ortho effects.

Um, and, um, it, you know, I, I believe That it's kind of like a kitchen, right? You know, there are some things you can do by heart and there's some things that take a little bit of time. And when I see a very involved, intricate case, I still think and and most importantly, when I when I'm pulling my patient and You know, questioning them, like, you know, what's your goals?

Um, because that's the only product out of about 100 companies on the market right now that says it doesn't have to be worn. Um, More than, you know, well, a minimum of 9 to 12 hours a day, you know, every other product is 22 hours a day, which is pretty much the speech we give everybody like, you know, take it off for meals, you know, brush your teeth, you know, if you're going out for an hour, you can leave it off, but otherwise get it back on right with ortho facts.

They're, they're the only animal in the whole industry that builds a tray differently. And it's interesting because they're the guys that started Invisalign, you know, all four of the owners are from Invisalign, you know, one was a finance person who ultimately ran the company. That's the call. Ren was the person who launched all the products.

In my mind, no two people have been more influential. Forward facing in my mind than those two people, block built what you call today. Um, the active plastic at Invisalign, which is a smart track. Um, he left Invisalign and what's company called Bay Materials. He created a reversed version of that, which is called F L X, which is by far the most popular plastic in the industry.

So, you know, uh, um, Spark from and Vista uses F L X. It's private labeled, you know, Great Lakes sells it as a private label. There's a lot of companies to use that material. And the reason being is it's really that good. You know, as as plastic goes, it's worth four bucks a sheet because it actually performs.

You know, there are a couple couple companies now that make their own stuff. You know, one of the newest ones to the market who's really been incredibly aggressive is angel liners, right? That's the one. Yeah. That's the number two company in the world right now behind Invisalign, but they're number one in China.

Uh, one of the sales guys is a good friend of mine who I know from 3M when we were doing clarity and it's just, they're growing like gangbusters because they're cheaper. And they are very focused on the consumer, meaning our, as the orthodontist, our experience. So, and they are just 100 percent automated.

If you see how they make stuff in their factories, it's insanely cool to watch. I mean, it's

Dr. Leon Klempner: crazy. I've heard a lot of positive things about their software. They're using a lot of AI. You know, they'll give you like, uh, CVM, you know, uh, a lot of, of interesting, uh, Uh, areas, uh, you know, landmarks on SF, you know, they'll deliver all of that.

That you could get the same result in half the time with this particular plastic. Okay, I don't get

And, um, you know, so it's, it's an honest study. It was retrospective. It's studied several hundred cases though. So, and that was a much bigger study versus his master's thesis. So he did the same thing 10 years earlier. And we all love Neil because he's just today. He's super humble. He's very positive and complimentary to [00:28:00] everybody in the industry.

And we need more people like him. I'm a big fan. So he's got a good name, too. So, uh, but, uh, You know, when you look at the first 10, 000 cases that came out of ortho effects, which were not nighttime, they were just their tetra material, which is their 22 hour where in their first 10, 000 cases that they finished documented 79 percent of the time the cases were completed with the original trays and a refinement.

I'm, I'm, I can't even talk to you. And I basically threw them out. Uh, I finished my project during COVID in 2022 and January 7th in 2023, they walked in my office and they're like, can you [00:29:00] talk to us now? And I'm like, I'll give you five minutes, which turned into an hour. They showed me what was going to become the nighttime material.

And I was very intrigued by the fact that the FDA actually certified this. That it could be warped for 9 to 12 hours, and they actually got the FDA certification. 100%. No material had ever done that. Now, the reason that it's so special is for three reasons. Okay. So the first, um, and Locke fan, the creator of the material is just a genius at resins.

Okay. He's got a. Bunch of patents, maybe like close to 500, not all in the ortho space. But if you look in the ortho space, he's the most accomplished. So Locke created something called an air shell. So the way their trays are built just in general, all he has four different resins, four different materials are all built the same way.

It's usually got polyethyl chloride on the outside, which is plastic. So it, um, Resist stain. And it's got like, uh, something flexible on the inside, like polyurethane. Okay, that's, that's how FLX is built. If you look at smart track, the polyurethane is on the outside, which is why it stains easier. Okay. So when, when you look at the, the technology with an air shell, first of all, the outside layer and the inside layer are incredibly thin.

So that inside layer is always going to fit well when you change from tray to tray to tray. It's the outside layers where the magic is. So with nighttime, the materials is incredibly flexible. It really fits almost over more than one stage. And it's because of its flexibility and the fact that the layers aren't bonded together.

So, if you look at the amount of force being applied to the teeth, Whether it's day one or day seven, it's aimed to be around 150 grams. Now, if you look at a typical aligner coming from a manufacturer, let's say Angel, Spark, Align, any of these big companies, Claire, you know, whoever, I don't care where you use it from, you can see forces up to 7, 800 grams.

And as a result of that, what you're seeing is. Teeth are moving, but they're really in my mind, more susceptible to relapse, right? Because all of a sudden you take this force off and then they're running for the fences, right? The teeth are all over the place. Cause you know, you took this heavy force off when you have this light force, it's kind of really not that heavy.

What you find out is when you take the tray off and you put the tray back on, there's not a lot of difference to the tooth, right? We're not, we're not overstressing the tooth. So that's my. Belief of why nighttime is working for me, right? But nighttime is their only material where they say if you don't wear full time, um, it'll still work and I have to say, you know, 150 or more cases in.

You know, I don't want to do refinement. I just don't believe in it. I believe in being forward facing on the patient. And when things don't look good, then I want to, I want to get you. And whether it's a smart STL or a real scan, I want to, I want to refine it, rebuild it. If you will build forward, as I say on the fly, right?

So, so one of the things I will say, so I believe what makes the most sense. Today is I think teledentistry should be used with all clear aligner systems. Okay, because you know, when people tell me, well, patients come and I can see what's going on, you know, I'm going to call bunk on that. Okay, your eye is not as good of a scanner as a scanner, right?

The camera is phenomenal, right? You can see really well. I just need to see if you're in the ballpark or not, right? And depending on how far you're off, that determines whether I want to scan you and build you forward or not. So I think it's really just clever, right? When, you know, and my entire practice is custom made products.

So, like, I have to say, like, my biggest problem today is I don't have enough employees. I can't find them, let alone hire them. So, you know, using custom made appliances and teledentistry has really helped me manage, especially clear aligners, right? And a lot of times, I just tell patients, like, wear it an extra week.

You should be better. And a lot of times, that's all it is. Because not everybody is the same. So the same thing with this nighttime material. They say 9 to 12 hours. I don't tell people that. I tell people nine to 12 contiguous hours is the minimum of what you need, right? And I want you to wear it more than that.

I'm like, well, different products. That's all, you know, and, and the, the thing about it is, is this is the only company out of the hundred companies making aligners that does it this way. So they're very disruptive. Again, they have a deep, deep knowledge set of. Of what's, you know, what's the industry about?

And, you know, and even if it like is close, but not perfect, you know, I can always then say, okay, come on in. I can scan you and I can, I can build you to retainers and deliver them in the same day because I've got both the Lux Creo system and thermal for me at my fingertips. And we're, I'm a huge you lab user.

So it's like, That's just my thought

Uh, do you, do you use that in a way that you know,

Dr. Neil Warshawsky: it's, it's interesting. I don't like, I don't like to back myself in the corner and tell people like you can wear for 12 hours a day. I wait till I talk to them and I, I. Uh, I say, tell me your handcuffs, tell me what I can't do. And when time is a factor, that's when I pull that out of my bag and surprise them.

Right. Cause it's always, it's always nicer to. Offer them more than they expect in return, right? Other than promise, you know, for the stars and then fall short and then look like, you know, you're just not that good. You're like everybody else. You just promise, promise, promise, and you fall short. So, but I, I make, I make people own it a little bit.

So, especially when someone is sensitive or I have someone with sensory integration issues, like I see a lot of special needs things. Adults and kids, and it does very well for that.

Amy Epstein: So listen, it sounds like we need to have you back and dive into some of the topics we talked about today to go even deeper.

But in the meantime, if we have questions for you, if our audience has questions for you, how might they best reach you?

Dr. Neil Warshawsky: Oh, that's easy. Um, you can always email me. It's my email. Super easy. It's dr neil. D. R. N. E. I. L. Just like, just like my scrub at get it straight dot com. Um, you can always come and see me like I'm, I'm, uh, in the near future.

So,

Dr. Leon Klempner: you know,

Dr. Neil Warshawsky: and you can reach out to me through any number of the social media options out there. It's like I'm on all that as well.

Amy Epstein: Well, appreciate that. Well, thank you again for joining us today. We appreciate it. We'll see you at the AIO. I'm sure. Um, and in the meantime, happy and healthy new year to you and your family.

Dr. Neil Warshawsky: Thank you. You as well. Neil.

com.

Dr. Leon Klempner: I want to thank everybody for watching and listening. And, uh, if you have any marketing questions, uh, you can shoot me an email at Leon at. PPLpractice. com. I want to take this opportunity also to welcome K. L. Owen and Grin as our new sponsors. Uh, we talked about, uh, customized appliances, um, and some, uh, monitoring, remote monitoring for aligners today.

So, uh, if you're looking for, uh, a special deal, uh, go to our website at, uh, PPLpractice. com and go to our partner page. Um, And I want to leave you with what I've left you with every podcast for the last four years, which is my strong feeling and belief that it's never been a better time to be an orthodontist.

Narrator: Thank you for tuning in to The Golden Age of Orthodontics. Subscribe now on Apple Podcasts, Spotify, or visit our website at thegoldenageoforthodontics. com for direct links to both the audio and video versions of this episode.