Latest / Orthodontic Products Podcast / Navigating Clinical Autonomy in a Brand-Driven Era
Transcript
- Alison Werner (00:05) Hello and welcome to the Orthodontic Products podcast. I'm your host, Alison Werner. Orthodontics has never had more technology, more software or more branded treatment systems competing for clinicians' attention. From aligners and brackets to digital platforms and AI-driven workflows, today's marketplace promises efficiency, predictability and simplicity. But as orthodontics becomes increasingly brand-driven, an important question emerges. how do clinicians stay grounded in biology, biomechanics, and clinical judgment without becoming beholden to a single company's philosophy? On this episode, we explore how orthodontists can evaluate technology without outsourcing their thinking, balance innovation with skepticism, and ensure that the tools serve treatment goals, not the other way around. To unpack this conversation, I am joined by Dr. Mark Bronsky of Bronsky Orthodontics in New York City. He brings decades of experience across private practice and academic settings with a clinical foundation rooted in craniofacial care, growth and development, and long-term treatment stability. In this discussion, he shares his candid perspectives on brand influence, clinical autonomy, AI's emerging role in orthodontics, and what younger clinicians need to understand before tying their practice to any single system. Here's our conversation. Alison Werner (01:21) Well, Dr. Bronsky, thank you so much for joining me. I really appreciate you coming on to have a conversation about this topic. Mark Bronsky (01:28) Thanks for inviting me. It's great to be here. Alison Werner (01:30) Okay, so before we get started, can you tell our audience a little bit about how you came into orthodontics and then also your practice in New York? Mark Bronsky (01:38) Yes, ⁓ I was lucky enough to grow up the son of a ⁓ board certified orthodontist who practiced for 40 years in my beloved hometown of Binghamton, New York. I worked with my dad as a kid, fell in love with orthodontics and then pursued it straight out of college. I was lucky enough to go to the University of Alabama at Birmingham for dental school and then to the University of North Carolina at Chapel Hill for residency. ⁓ Came to New York in 1990. I worked for another practice for about 15 months and then went out on my own. ⁓ Always ⁓ working between the worlds of academics and private practice, ⁓ mostly in craniofacial ⁓ anomaly type of treatments at hospitals and also in private practice. Alison Werner (02:23) OK, well, then I think you're the perfect person to have this conversation with. And we had talked about before how orthodontics has become increasingly brand driven and whether we're talking about aligners or brackets or digital platforms. So I'm wondering, how do you think clinicians can kind of avoid becoming beholden to a single company? Mark Bronsky (02:45) It's a great question because I see practitioners that want to become beholden to a company because it seems to limit their choices and make their life at least allegedly easier. I think in order to not get seduced by companies presentation of ease and accuracy one has to always harken back to the true study of orthodontics and the biomechanics and the physiology and biology of what we're doing. to then assess how the newer methods or the presented methods actually work with respect to the reference standard of orthodontics, including growth modification as well as tooth movement. Alison Werner (03:30) Yeah. OK, so from your perspective, what do you think the risk is when a brand's philosophy starts to shape how orthodontists think about treatment rather than that biology or mechanics leading the way? Mark Bronsky (03:44) think it's very dangerous because the companies that develop and promote these products are very clever at advertising and they are so well capitalized in their ad campaigns that they try to put it out to the public that they are a better way to do things, which is most often not true. So as by way of example, ⁓ Align Technologies advertises at the Super Bowl. you know, and in so many different magazines and they say it's, you know, they use pejoratives for regular standard run-of-the-mill orthodontics. It's not ugly braces. It's much more comfortable. They don't tell you about attachments, elastic bands, and really aligners really only being about 75 % correction when you compare it to the reference standard of fixed orthodontic therapy. So... Alison Werner (04:25) with. Hmm. Yeah. Mark Bronsky (04:41) to really take a finer point to it, the companies are great at advertising ease and really falsely advertising the efficacy of these things. So one has to really look at the true efficacy of what they're doing and to force oneself not to fall in love with an easy cookbook fashion of treatment. Alison Werner (04:48) Mm-hmm. and Yeah. OK, so you've described technology as a tool, not the end goal. So how do you personally personally evaluate whether a product is serving your clinical judgment or is it quietly replacing it? Mark Bronsky (05:21) Great question and tough to directly answer, but I'll take it a little bit at a time here. I have made a habit of only buying technology when I can prove to myself through talking to other practitioners, going to the orthodontic meetings to see if in fact the quality of care can be improved by using a technology or if the patient experience can be improved by using a certain technology. or if it can help us streamline our systems to make the, not only the treatment go better and as expeditiously as possible, which is important to the patients and the doctors, but ⁓ to make sure that doing that, it's adding to the experience and the ultimate end result. Alison Werner (06:13) Okay. So do you see orthodontists sometimes outsourcing too much of their decision making to system software or prescribed workflows? And where do you think that line should be drawn? Mark Bronsky (06:27) Well, if I hear the word algorithm another time, I'm going to ⁓ bust a gut. But I will say that ⁓ the absolute fallacy of a computer algorithm replacing the judgment, the care, skill, and judgment of a doctor is where that fail happens. ⁓ It's probably like the no driver ⁓ cars for Uber. What do you hear about? You hear about the accidents. I find that when doctors that don't have orthodontic training or ones that do rely on algorithms for all different systems, bending wires, making aligners, where to put attachments, how to sequence wires, how to bend wires, when reliance on a computer model, AI or not, is where that fail happens in my opinion. Alison Werner (07:24) Hmm. Okay. So for doctors earlier in their careers, it can kind of be tempting to align closely with one brand for that simplicity or perceived success. What do you think they need to understand before making that kind of commitment? And since you are an academic and you're teaching, what do you talk to your residents about? Mark Bronsky (07:44) What I mainly try to stay and focus with is to ask the questions of the mechanics and the science and the clinical practice. How would you handle this problem? How can this technology help you get that done better or is it an inherent compromise? So when I'm speaking to the residents, it's not what's gonna make it easier, but what's gonna make it to where you wanna go. Always, I'm sure you've heard this a billion times in your research and development. of your theses here is begin with the end in mind. We know where we want to go with Allison's treatment. What's the best way to get there? Is the tool of aligners sure smile, whatever the product is, is it going to get you there better? Better than you can do manually with your own wits and thoughts. Alison Werner (08:36) Okay. How would you say orthodontists can stay open to innovation without buying into the idea that success clinically or financially depends on loyalty to a specific company or brand? Mark Bronsky (08:52) The companies and brands do their best to want to make you loyal by putting up very often these false benchmarks of, if you do X number of cases, you'll have to pay less for our service. But those goalposts are always moved. So I think it's easy to be seduced when one has the pressure of overhead, staffing, materials. Alison Werner (09:07) Mm. Mark Bronsky (09:20) to say, I'm just gonna put it all in that basket because I know what I get, I know what I can get out of it, and in fact, that's going to make my life easier, my bottom line bigger. And then one starts to believe those advertisements or those promises, but they're, at least in my experience, and I'm one guy, not a whole profession, those, you know. Alison Werner (09:24) Mm-hmm. Yeah. Mm-hmm. Yeah. Yeah. Mark Bronsky (09:46) I fully believe if it seems too good to be true, it is, and it always has been. Alison Werner (09:52) How do you manage in your practice that financial aspect of it of you do sometimes get those if you buy more, you get a discount or you save there. How do you balance the financial side of your practice with making choices based on not being beholden to one brand? How does that work for you personally? Mark Bronsky (10:18) Well, as I mentioned just briefly before, the promise of less cost with a loyalty to a brand is often a mirage. Those companies are hardwired to get their margins, and we are the backs upon which they get their margins. So it's usually a perceived and false ⁓ promise that if we stay with them, Alison Werner (10:25) Mm-hmm. Mm-hmm. Mm-hmm. Mm-hmm. Mark Bronsky (10:48) it's good for us. But more often, I would say almost all the time, it's better for the company and not so good for us. And it does kind of induce, you know, an application of our responsibilities of really making the decisions. I think the allure sometimes is I don't have to make so many decisions. And then if somebody doesn't work out, well, it was the computer. Well, it was the implementation of this. It was this technique or that technique. Alison Werner (10:55) Mm-hmm. Mark Bronsky (11:17) that we must not have done well, assuming that the technology is correct because it's the technology. Alison Werner (11:22) Right. OK. How in your practice have you kind of diversify the number of aligner brands you're working with or bracket brands you're working with? How does this look in your practice, this idea of not being, having the bracket or the aligner be the tool and not being beholden to a brand? Mark Bronsky (11:45) I have ⁓ been burned very many times, especially ⁓ with brands like Align, in that Align has such great and had for so many years such great ⁓ patents that if we tried out the frustration of working with the company that we wanted to try another brand, they had been suing other brands out of existence. And then if you were Alison Werner (11:48) you Mm-hmm. Mark Bronsky (12:15) if you had the audacity to try another product, they would punish you bitterly, which they have done. So with respect to aligners, I have consolidated all my aligner treatments to that company, not by choice, but by necessity. And they have advertised so well to what I was saying before, that people come in wanting Invisalign. And I have to say, for example, Alison Werner (12:21) Hmm. Hmm. Hmm. Yeah. Mark Bronsky (12:40) You know, there are other companies that make aligners. There's, you know, there's SureSmile, there was, you know, SmileDirect, there was, you know, all these different types. And some of them still do exist. But they really, they are in most cases inferior products, but Align itself, while it's had that 20 plus year head start from killing the competition, they have become an effective monopoly. Alison Werner (12:58) Mm-hmm. Mm-hmm. Hmm. Mark Bronsky (13:10) So I've had to, I've had to by force do this. Now with different types of arch wires, with different types of braces, with different types of indirect bonding, I have been able to test different companies to see who gives the best results. Number one, that's always the first. Who gives the best service and who gives the best cost per case and have to do that. That's again with, ⁓ Alison Werner (13:18) Mm-hmm. Mm-hmm. Yeah. Yeah. Hmm. Hmm. Mark Bronsky (13:38) with bracket companies, with arch wires and everything surrounding that, with the technology of radiography, the x-ray machines and that type of thing. ⁓ It has been sold and I think is a bill of goods that every orthodontist has to have a 3D CT x-ray unit in their offices. Otherwise, they're less of an orthodontist. And so there are a few different companies and Alison Werner (13:46) Yeah. Hmm. Mark Bronsky (14:07) and I have resisted that throughout my career, not because I'm a reactionary and I want to stay the way I've been, but because I can't in good conscience swallow that wave of advertising to justify a 40X radiation exposure to my patients. And especially being a father, I especially think of the kids on their crania. Alison Werner (14:30) Mm. Mm-hmm. Mm-hmm. Mm-hmm. Mark Bronsky (14:36) getting 40x the radiation so that we can use this Maserati of an x-ray machine, but it's really not what you want. And the images are inferior to a plain film digital machine. So that's another, I think, a solid example of the advertising trying to overwhelm us. And somehow, not so subtly saying, you're not standard of care because you're not buying our products. Alison Werner (14:43) Hmm. Hmm. time. Okay, okay. So what core principles of orthodontics do you think should never be negotiable no matter how compelling a brand messaging might be? Mark Bronsky (15:15) really final result. A lot of people will conveniently say, know, if kids come to you and they have a certain ⁓ dental facial, dental skeletal problem, well, I think just using Damon brackets can modify jaw bones. It's falling into the notion that jaw structural change and tooth movement are the same when they're absolutely not. You know, while some people will say that Alison Werner (15:41) Mm. Mark Bronsky (15:45) Well, it doesn't really do much good or change to expand maxilla Expand the maxilla or make a class two or class three ⁓ Change it really does so setting the foundations of the jaws the best you can and then really not starting fixed appliance or braces or aligners for that matter until somebody's in the beginning of the adolescent growth spurt those principles are just based on long-term longitudinal what's best for the patients for the long-term stability and health of their dentition and their mouth. So ⁓ different things come up where... ⁓ Alison Werner (16:18) No. Mark Bronsky (16:23) Benefits are attributed to a certain appliance type that just simply aren't true. So the basic skeletal growth and development principles as well as once you've gotten the skeletal foundations where they should be the best you can do based on the patient's genetics, only then do you proceed to the tooth movement portion. think keeping them separate to a degree or at least contiguous in there, you you do one and then the other, that's where I think compromise. Alison Werner (16:29) Hmm. Mm-hmm. Mm-hmm. Mm-hmm. Mark Bronsky (16:53) really puts the orthodontic profession at a disadvantage because a lot of times if it's done out of sequence or you don't read each patient's individual growth pattern as opposed to 12 year olds get this, 14 year olds get that, you really lost the plot. in a bell curve situation, the middle 50 % might get some good care but the outlying 50 % do not because you failed to do that individual due diligence for that individual patient. Alison Werner (16:58) Mm-hmm. Mm-hmm. Mm-hmm. Right. So if you would kind of take a step back and think about, know, what do you want or your colleagues or your peers or even some of the younger ones who are just getting started as they think about where they're going clinically, what do you want them to take away from this conversation? Mark Bronsky (17:38) What I would want the younger practitioners that are coming through to ask themselves is what kind of results do I want to get? How can I get to the best results so that I can create my reputation as an orthodontist in my given community based on solid functional health providing that for my patients and work back from there? There's no one solution. There's no one bracket company. There's no one software. know, Marshall, everything you can as a graduate or a young, younger practitioner, everybody's younger than me these days, to make sure that you know where you want to be and where you want your results to be. And then if you have had a residency that didn't teach that, there's plenty of education out there that you can get on your own. to make sure that you're gleaning everything you can and making your decisions based on not what somebody put into your head, but that you took the pains to study yourself and know and own what you want to do from your own creation. Alison Werner (18:46) Mm-hmm. Well, I'm going to ask a question that might be opening a can of worms, but where and probably should have asked it earlier. What are your thoughts on the role of AI? You talked a little bit about, you know, the algorithm before, but what are your thoughts on the role of AI in a lot of these technologies now? Mark Bronsky (19:10) I don't know that much about it, but I will tell you the little exposure that I've had, AI is a remarkable tool. Especially with diagnosis, I've seen a couple of my general dental colleagues using AI to diagnose caries. I think it's fantastic. I just haven't seen a lot in orthodontics yet. And I think could really, I think stuff's just gonna go away. Like a ⁓ cephalometric film is gonna be put up on the board and an AI program is gonna trace it for you. Alison Werner (19:25) Okay. Mark Bronsky (19:38) Right now we trace it point by point by point. That's going to save, like I said before, I like technology that saves time with no loss of accuracy and makes you a better diagnostician. I think AI will be able to tell you based on the cervical vertebrae where the patient is in growth and it'll do it faster than you can do it and more precise. You can also probably look at the root structures, measure the volume. That would be an indication to take a 3D CT to look at actual root volume. Alison Werner (19:40) Right. Mmm. Mm-hmm. Mark Bronsky (20:08) and give the practitioner a great idea of, ⁓ how much bone needs to be remodeled? What's the density of the bone? How long should it take to go from A to B to move five, six, seven millimeters? I think the sky's the limit with AI. just think that all the input into the AI system should be from years of study and longitudinal and bench and clinical research rather than Alison Werner (20:23) Alright. Mark Bronsky (20:37) the companies that are making the products that they want to sell loading up AI as their data in the AI database. Alison Werner (20:41) Mm-hmm. Yeah, yeah. OK, well, a lot of this conversation has been about kind of, some of the difficulty within the industry right now, but I'm kind of curious what excites you about the industry. Mark Bronsky (20:58) I always find the technological advances of making, like I was just saying, the diagnoses more accurate and less, you know, I grew up in the era where we're tracing the x-rays on acetate and we were handwriting charts ⁓ and being able to integrate what a periodontist does with their probings to make sure that our adult patients are healthy before we start. Working with an oral and maxillofacial surgeon before we as orthodontists set up Alison Werner (21:05) Mm-hmm. Mmm. Mark Bronsky (21:28) a case for an oral surgical procedure, being able to meld their data, our data, and our thoughts together and making it better for the patient outcome, less morbidity, better results. I'm super excited about what's going to be an integration of those things. It's already started. Alison Werner (21:47) Yeah. Yeah. Well, Dr. Bronsky, thank you so much for joining me to talk about this. I really enjoyed this conversation. Mark Bronsky (21:55) Thank you for having me. I hope it was helpful and I hope it's helpful to anybody that happens to take a watch. Alison Werner (21:57) You Yeah, definitely. Well, thank you again.