SureSmile was developed by OraMetrix, a company founded in 1998 by Friedrich Riemeier and Dr Rohit Sachdeva. The company was launched globally in 1999 and sold to Dentsply Sirona in 2018.
Dentsply Sirona has spent some years integrating SureSmile's software into their, already extensive, digital portfolio. Since 2021, we have seen more and more dental practices - using Dentsply Sirona's Primescan - being introduced to the possibility of using SureSmile.
Sirona is known for German quality and thoroughness. Their products, software and digital workflows are generally extremely reliable.
About SureSmile
Measured by volume of aligners produced, SureSmile is a minor competitor to Invisalign. SureSmile has been known in the US for longer than in Europe. After the acquisition and integration into the Dentsply Sirona value chain, it is expected that SureSmile will become as well known as ClearCorrect from Straumann, Angel Aligners and possibly Spark from Ormco over the coming years. Especially among the existing Dentsply Sirona customers.
With Dentsply Sirona as the owner of SureSmile, the brand tries to add quality from the parent company. For many years, the company has cemented its position as a guarantee of quality in the market for dental equipment and digital workflows in particular. Dentsply Sirona is the world's largest manufacturer of equipment for dentists. It has one of the world's largest and most experienced digital development departments. It can therefore be expected that the SureSmile software and user interface will be further developed over the coming years.
Dentsply Sirona has observed the challenges ClearCorrect and Invisalign have faced in terms of production capacity and seem to have learned from their mistakes.
Unlike Invisalign, SureSmile is largely unknown to the general public.
The SureSmile USP (Unique selling proposition) is mainly their affiliation with Dentsply Sirona, the direct integration into Sirona's digital workflow and that SureSmile receives all IO scans in STL format.
In addition, SureSmile tries to market itself on the ability to complete clear aligner treatments in less time with the need for fewer additional aligners. This claim is based on a small study that found this relationship. We are not confident that the claim will hold up in a larger study. However, we acknowledge that fewer additional aligners are likely needed because SureSmile uses a more conservative protocol for tooth movements. More on this later.
As an additional feature, not so apparent in the marketing of SureSmile, the software allows you to work with both clear aligners and fixed braces. This can be quite an advantage for advanced treatments with tooth movements that can be very challenging with clear aligners.
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SureSmile Software:
The most important parameter for how easy an aligner system is to work with. Is unconditionally the software used in the treatment planning. SureSmile calls their treatment plan a setup, as does ClearCorrect, Spark and Angel Aligners (Presumably because Invisalign has copyright on the use of the word: "ClinCheck". In reality, it is exactly the same)
Invisalign sets the standard for clear aligners software. Based on the difference in first impressions, SureSmile's software looks a bit more old-fashioned and primitive than the corresponding Invisalign software. Upon review of the software, this proves to be the case as well.
The advantage of the SureSmile software is that it is an integral part of Sirona's entire digital workflow. If you have an IO scanner from Dentsply Sirona (such as a Primescan), it is extremely easy to upload all data directly via your normal workflow. It is easy and intuitive.
If your dental practice uses SureSmile, you don't have to worry about whether your scanner is certified by SureSmile or not - SureSmile accepts all IO scans in STL format. This means that all newer IO scanners on the market are capable of delivering digital images that can be used by SureSmile. THANK YOU SureSmile👍😊
As the only aligner manufacturers on the market (that we know of), SureSmile allows you to download the production-ready STL files for in-office production of aligners. This way you can produce your own aligners directly in the practice. Currently, this is not cost-effective, but once it becomes possible to print aligners directly (rather than the indirect technique used today), it will be an option that will put pressure on the production of aligners by the major aligners manufacturers.
Technical challenges
The SureSmile software is far more technically demanding when compared to the competing brands like Invisalign, Angel Aligners, Spark and ClearCorrect.
There are an extreme number of features that are not readily set up in an intuitive system. The many features in the software are really good to have access to. However, it would be nice if a little more thought was given to the workflow and user friendliness.
The SureSmile software itself does not have an intuitive user interface, which we expect to be changed by Dentsply Sirona in the coming years. At present, new users can expect a relatively steep learning curve.
Based on experience from more than 30.000 treatment plans worked out on 6 different software platforms. All doctors at AlignerService spend twice the amount of time creating a realistic and predictable treatment plan in the SureSmile software, compared to any of the big competing software systems. This is really a shame as SureSmile has some of the most flexible and versatile possibilities.
Amongst the design features, the software allows the user to choose whether to have a "straight" or "scalloped" trimline. Which is great depending on the type of patient you are treating.
In addition it is possible to plan treatments with fixed braces with the SureSmile software.
Clear aligners and fixed braces each have advantages and disadvantages, depending on the tooth movements you wish to perform. Both types of treatment are based on the same orthodontic principles. So if you are able to plan and perform a clear aligner treatment, you should also be able to do the same with fixed braces. Having the option to do the same kind of backwards planning with fixed appliances as with clear aligners is really cool.
Since both clear aligners and fixed appliances should be considered orthodontic appliances, we see it as a huge advantage that you can choose to plan your treatment with one or the other type of appliance. Depending on what is ideal for the individual patient.
(In this blog post, we will not go into detail about the part of the SureSmile software that has to do with fixed braces.)
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Online portal
The SureSmile software is accessed via an online portal, just like any other clear aligner manufacturer.
Unfortunately, the SureSmile software runs extremely slowly. Load times do not yet seem to be taken into account as an important feature. Which means that photos are time-consuming to call up (in addition to not being appropriately located in relation to drawing up one's treatment plan and refining the setup). Each step in the processing sequence loads so slowly that one feels taken back to the days of the old ISDN modems. It makes it impossible to get a quick overview of the treatment sequence. We look forward to Dentsply Sirona moving their software to a faster server.
As with ClearCorrect, it is possible to see the amount of movement of each tooth for each step in the SureSmile treatment plan (movement chart = SUPERB fearture!⭐️).
This allows you to check whether the tooth movements are within your own preferences (and SureSmile protocols). If the movements deviate from the preferences, you can let SureSmile correct this until you achieve the desired result.
Unfortunately, this functionality is set up in a way that requires too much clicking back and forth in the very slow software. Meaning the workflow is slooooooooow!
As mentioned initially, SureSmile generally has a more conservative protocol for tooth movements with their clear aligners than their competitors. This results in more predictability in the planned tooth movements. Immediately, it may seem annoying that a treatment seems to take longer to complete with SureSmile than with another systems. But if fewer additional aligners are needed to achieve the desired treatment result, this will ultimately bring down the overall treatment time and reduce total chair time as well.
IPR challenges
It is possible to choose which attachments to use, where and when in the treatment. This is a great feature.
Unfortunately, the same is not possible with IPR. Here you are forced to choose between 2 different models.
Perform all IPR at the start of treatment. (There may be advantages, but they are few)
Let the SureSmile software distribute the IPR over the whole treatment. Without any possibility to influence the timing of IPR.
This lack of flexibility in treatment planning can be quite challenging in terms of planning an ideal treatment sequence. For example, it is not appropriate to perform IPR in 4 consecutive treatment steps. This leads to many unnecessary patient consultations that could be reduced to one. It is an inappropriate use of expensive chair time, and inconvenient for patients who usually want as few consultations as possible.
Similarly, it is super annoying when the software wants to perform IPR between teeth with a diastema, or between teeth that are in a strong crowding position (it makes it very difficult to achieve the precise amount of IPR that is planned).
In addition doing all IPR at the first step of treatment is rarely possible or a good idea. If at all possible. We prefer to wait performing IPR to the delivery of aligner no. 3. There are a lot of reasons for this, that we will cover in a different blogpost later.
Complimentary SureSmile case selection with no other obligations? It's easy and provides clinical confidence. Simply click the button bellow, fill out the form and receive step by step guidance.
As mentioned, the SureSmile software is not immediately super intuitive to use. This becomes apparent when planning your treatment. This can be quite frustrating. There are an enormous amount of great features, they are just very time consuming to locate. No thought seems to have been given to workflows and ease of use. But rather getting all the good features incorporated. There is real potential for improvements in the software here.
We have previously written about how all aligner manufacturers are busy developing sophisticated and user-friendly software solutions. Indeed, in a few years, dental practices will be able to print aligners directly in the office. This will be faster and cheaper than the current technically demanding solutions offered by the aligner manufacturers. But it will requires great software to do this. SureSmile definitely has the potential to be one of the winners when this becomes possible. However they need to improve the speed of the software (Servers) and the user friendliness as well.
Technicians / Digitale designers:
Like Invisalign, ClearCorrect, Spark, Angel Align, Trioclear and everyone else, SureSmile uses dental designers (called technicians by the aligners manufacturers) who set up the teeth on the computer and generate an initial, virtual treatment sequence for this setup.
We've heard representatives from Dentsply Sirona claim that SureSmile's technicians are South American orthodontists. It is quite possible that SureSmile technicians have some sort of dental background. Unfortunately, this is not reflected in the setups we have seen. They look confusingly similar to the setups we see from all other manufacturers of clear aligners. Which in not that impressive and indicates that the technicians creating the virtual treatment plans have no dental background at all.
Since all setups need to be corrected anyway, it's a big advantage that SureSmile has 3D controls. This makes it very easy to communicate your wishes to SureSmile's technicians.
Corrections for staging (sequence of movements, anchoring, force and force distribution) are communicated and corrected easily and seamlessly. The only feature missing is the ability to dictate when and where to perform IPR. This, as previously described, is still not possible. Neither for the dentist nor for the technicians at SureSmile.
Only an initial proposal
Note that the digital designer is an employee of the aligner manufacturer who sets up the teeth in a position that the technician thinks they should be in after the treatment is completed. From here the technician follows a standard tooth movement protocol with the intention to reach the virtual goal. However no clear aligner manufacturer uses dentists or orthodontists for this critical task. It's a detail worth paying attention to as up to 95% of all virtual treatment plans need to be corrected to become realistic and predictable.
Many dentists mistakenly believe that the setup they receive from SureSmile is biologically sound, clinically realistic and based on a predictable treatment plan. This is very rarely the case (Which is true for ALL aligner manufacturers). Of all the setups we have seen, only about 5% do not need modifications. Either to get a realistic treatment plan or to achieve a biologically and clinically sound treatment.
It may seem excessive that 95% of all setups need modification. But let's look at the reasons.
SureSmile sets teeth according to American orthodontists' standards. These differ significantly from European and to some degree South American standards.
Like Invisalign, SureSmile often chooses to move the clinical crowns first, and then move the roots minimally. Any orthodontist would probably say that the order should be reversed: move the roots first, then the crowns. The reason for this discrepancy is that it is faster to move the crowns, but biologically inappropriate.
Most aligner manufacturers set the front teeth very steeply, as it is easier and looks good on a digital setup. The challenge is often that functional problems arise after treatment is complete. (Restricted envelope of function)
Neither AI nor technicians seem to understand the relationship between the different forces used in each patient's orthodontic treatment. We almost always see attachments placed inappropriately, incorrectly or in places where they have no relevance to the treatment outcome.
Furthermore, we almost always see movements that counteract each other, which certainly leads to a lack of tracking and the need for additional aligners.
Many setups and ClinChecks contain suggestions for inappropriate IPR.
Responsibility of the treatment
It is IMPORTANT to remember that it is ALWAYS the treating dentist who carries the full responsibility for the treatment with clear aligners. Thus, even if a setup looks great on the computer screen, the doctor always has to consider that treatment with clear aligners is no different from treatment with brackets and wires.
Clear aligners and the associated software require as much orthodontic knowledge to safely and predictably complete treatment as treatment with fixed braces. Clear aligners are therefore a working tool in the hands of the treating dentist, equivalent to fixed orthodontic appliances.
Aligner material:
SureSmile uses Essix Ace plastic for their aligners.
In addition, in their portfolio of materials, they have the option to use Essix C+ Plastic for bruxers.
There seems to be a lot of research and development going on on aligner materials around the world. Therefore, we expect that new materials will be available in the future. Essix Ace is a relatively stiff material and can therefore be difficult to get on and off the teeth. Especially if there are undercuts or many attachments.
Trimline:
As described earlier, the SureSmile software allows the choice between a straight- or a scalloped trimline.
A straight trimline is more rigid, whereby the aligner does not lose as much force as with a scalloped trim line. It has the distinct advantage of requiring fewer attachments. Fewer attachments reduces the need for chair time during treatment (this is one of the reasons why direct to consumer companies prefer not to have attachments in their treatments and why they rarely achieve satisfactory results - from a clinical perspective).
A scalloped trimline is more flexible and therefore requires more attachments to achieve optimal transmission of the forces to the teeth. However, it may be advantageous to use a scalloped trimline if undercuts or a challenging insertion direction are detected. The greater flexibility makes it easier for the patient to get the aligners on and off the teeth.
The disadvantage of a straight trimline is that it is more difficult for patients to take their aligners on and off. In addition, it can be a challenge when adjusting patients with gingival retractions. In these cases, undercuts will often make it very difficult (read: "almost impossible") to get the aligners on and off.
A further disadvantage of a straight trimline is that there is a risk of uncomfortable zones of pressure on the gingiva. Especially in the treatment stages, where movements are planned that may press the aligner against the gums.
In conclusion it is a great feature, that SureSmile allows the doctor to choose the best solution from case to case.
Attachments:
If a SureSmile patient loses an attachment, it can be replaced using the aligner that the patient is wearing at that stage of treatment. This is a huge advantage over Invisalign, where a template has to be ordered as attachments in Invisalign have a slightly different size in the template than in the aligner.
In this way, the SureSmile clinic saves chair time, minimising potential patient dissatisfaction and the costs associated with increased chair time consumption.
Attachment loss occurs almost exclusively when deviating from a standard bonding protocol. Even on ceramic surfaces, it is possible to bond attachments so that they do not fall off. It just requires that the proper protocol is followed accurately.
If you do not have a protocol for bonding attachments, you can download our free start-up guide here.
Retainers:
SureSmile uses Essix PLUS Plastic as standard for their retainers. It is a well-known material that is widely used in orthodontics for the well-known Essix retainers.
In addition, it is possible to order retainers in the material: Essix C+ Plastic. The material is specially designed for aligners and retainers for bruxists.
As with Invisalign, retainers are not included in the SureSmile treatment and must be ordered separately.
IO scan:
As long as your scanner can export STL files, you can work with SureSmile in your practice. There is no requirement for a specific scanner and as far as we are aware, scanners do not need to be approved by SureSmile.
If you have a Primescan, you can get the SureSmile software module installed, which makes it easy to export the right files to the SureSmile online software module. From here you can choose to create your treatment plan yourself, or let a TPS provider like Alignerservice.com save you the time by optimising your setup for you. Freeing up char time, that can be used for more profitable procedures.
The ability to use any IO scan in STL format is a huge advantage over Invisalign, who seem to want to exclude all scanners other than their own, despite the fact that other scanners on the market provide IO scans of higher quality than Invisalign's own iTero scanner.
Impressions:
It is not possible to send conventional impressions to SureSmile.
Receiving SureSmile aligners.
SureSmile markets itself to dentists as an alternative to Invisalign.
The materials provided to patients are useful. It comes in a package that can be handed out to the patient. But it's a far from the same tasteful experience you get with Invisalign.
Personally, I'm not a big fan of their tray storage boxes. They work fine, but seem clunky and old-fashioned. Kind of like denture boxes. In my opinion, it doesn't speak optimally to patients who want nice white teeth. But I suppose SureSmile is aware of this and is working on improving their product packaging.
Certification:
A great advantage of SureSmile is that they are more at eye level with the dentists. They acknowledge that they are providing a product that moves teeth according to the dentist's preferences, equal to brackets and wires. Therefore, no certification is required to work with SureSmile (unlike Invisalign).
Any dentist who wishes to work with SureSmile can access the SureSmile platform. This simply requires contacting the local sales representative for Dentsply Sirona. Dentsply Sirona charges a minor fee to open a SureSmile account. This fee is deducted from the price of a SureSmile treatment. A sales representative will come and help the clinic get started with the workflow.
You should be aware that no clear aligner manufacturer offers orthodontic training. It is the responsibility of the individual dentist to build up the necessary knowledge to perform orthodontic treatments. Whether this is done with clear aligners or fixed braces.
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Price:
SureSmile costs about the same as Invisalign.
However, clinics with a Primescan receive a 25% discount on SureSmile treatments.
At this time, SureSmile is not on par with Invisalign.
Their prices reflect the fact that there are very few alternatives for practices that have an intraoral scanner of a brand that has not been approved by Invisalign.
Despite the fact that SureSmile does not currently meet the same standards as Invisalign, it is relatively clear that they intend to make an effort to reach the same level, but with a much greater flexibility in terms of choice of scanners and choice of treatment (aligners or fixed appliance - and probably a combined solution in the future).
If you can accept the current shortcomings and equip yourself with a few years of patience, SureSmile is very likely to reach the same level as Invisalign. They are, after all, owned by the world's largest dental company.
With Dentsply Sirona's experience and reputation for delivering first-class products, it's hard to imagine SureSmile remaining a second choice of clear aligners.
Like all other manufacturers of clear aligners, you can choose from various possible treatment packages. In reality, however, it usually only makes sense to work with a complete case.
Complete case:
3 years treatment incl. refinement and replacement of lost aligners.
No cancellation fee.
Retainers not included
Select case:
Payment per setup and per aligner.
Retainers not included
We see no limitations in the treatments possible with SureSmile compared to Invisalign. As long as you know your orthodontic principles, what you are doing and why, there is no difference in what treatments you can perform with the different systems.
However, one should be aware of the challenges that may arise from the inability to schedule IPR.
Discounts:
As with SureSmile's competitors, discounts are available for practices purchasing a large amount of treatments.
However, compared to Invisalign, it is more unclear exactly what is required to advance in a discount program. Discounts are agreed with the local sales representatives from Dentsply Sirona.
Customer service
Customer service at SureSmile is usually fast and good.
Dentsply Sirona spends a lot of resources every year training their customer service to help dentists in the best possible way.
Clinical support
SureSmile is in the process of building clinical support in the various countries in Europe. The support is likely to provide the same kind of assistance as the other aligner manufacturers. That is, help in using the SureSmile software and the workflow within it. As well as the clinical challenges that may arise during the course of a treatment. It is expected that the clinical support will be instructed not to assist in the development of treatment plans, as SureSmile would then risk incurring liability for the treatment with their aligners.
If you want help creating realistic, safe and predictable treatment plans, contact Helle@alignerservice.com. We help you select the best clear aligner cases. In consultation with the responsible dentist, we design the treatment plan and optimize the clinical setup so that the treatment proceeds as predictably as possible, reducing chair time and the need for additional aligners.
Questions:
Should you have any questions or require assistance with one or more clear aligner cases, please do not hesitate to contact us. AlignerService helps dentists and orthodontists in 15 different countries develop and optimise clear aligner treatment plans, independent of the aligner brand, making treatments more predictable, less time-consuming, biologically safe and clinically realistic.
Many kind regards
Clear aligner expert
Helle Hatt DDS
P: +41 79 174 30 03
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