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ClearX Aligners: 4D Technology and Sustainability · Orthodontic Products Podcast

• 0:04
  Alison Werner: Hello and welcome to the Orthodontic Products
• 0:06
  podcast. I'm your host Alison Werner. Today's guest is Dr.
• 0:09
  Sherif Kandil, the founder and CEO of K Line. Europe, the
• 0:12
  manufacturer that produces ClearX aligners, an aligner
• 0:15
  system that incorporates 4D technology. ClearX aligners will
• 0:19
  make their debut at AAO this weekend. So this is a perfect
• 0:22
  time to learn more about this aligner company what this
• 0:24
  aligner company brings to the table, Dr. Kandil. Thanks for
• 0:27
  joining me.
• 0:28
  Dr Sherif Kandil: Thanks a lot for hosting me, Alison.
• 0:30
  Alison Werner: Great. So let's dive in. Can you tell our
• 0:32
  listeners a little bit about your career and what led you to
• 0:36
  founding this company and to get into this aligner system?
• 0:40
  Dr Sherif Kandil: Well, I mean, it all started for me first
• 0:43
  practicing dentistry of myself back in Egypt in Cairo almost 12
• 0:49
  years ago, where I first started my practice and I I kind of like
• 0:52
  exclusively focused on aligners from day one. It was a very,
• 0:55
  very new thing back then in the Egyptian market. And I
• 1:01
  transitioned from that to even offering these aligners
• 1:04
  according to also other doctors. And then by time I started to
• 1:07
  think okay, I think it's about time to study orthodontics in in
• 1:12
  Germany and move with the career and everything towards to
• 1:17
  Germany accordingly. So, I mean, back then in Egypt, I had my own
• 1:21
  orthos in my practices and had also my orthos is in in the lab
• 1:28
  who who did the treatment planning. And then when I moved
• 1:32
  to Germany, I finished my orthodontic studies then decided
• 1:35
  to establish K Line Europe. So started to see them the world
• 1:39
  from a totally different angle as an orthodontic entrepreneur.
• 1:43
  And from from one, there was this mission to to redefine
• 1:50
  orthodontics or innovation. So this was like always, on my
• 1:54
  mind, how could we improve status quo and and go with the
• 2:01
  evolution of orthodontics to the next stage? And yeah, the thing
• 2:04
  that caught me really heavily was when I've seen once NASA,
• 2:10
  having these articles, very interesting articles about 4D
• 2:13
  printing. And it was like very, very new, almost think it was
• 2:17
  back then in almost the year 2000, I think maybe 14, where
• 2:25
  where I first saw it, and then it kind of struck me wow, this
• 2:29
  is such an amazing technology that NASA did it before with
• 2:33
  ortho the orthodontic world through their innovative NiTi
• 2:37
  wires that they introduced for straight wires, and it's kind of
• 2:39
  like changed orthodontics in the 1980s. And they did it again
• 2:44
  through plastic this time. And that's how the whole idea came
• 2:48
  from and started to work on the idea of 4D aligners.
• 2:52
  Alison Werner: Okay, so can you break down what this 4D
• 2:55
  technology does for an aligner? What incorporating? It does?
• 2:59
  Dr Sherif Kandil: Yeah, so it's certainly the idea of 4D first
• 3:02
  of all is related to time, time and, and shape shifting. So
• 3:06
  that's the fourth dimension that we refer to in 4D. Now, how do
• 3:10
  we do that? It's some refers to the manufacturing process
• 3:13
  through which you pre-program an object in a certain shape. And
• 3:17
  then after you put in a certain stimulus, it changes its shape
• 3:21
  back to the pre-programmed one that you had from the beginning.
• 3:24
  So in other words, let's say in the aligner world, what we do is
• 3:27
  basically we pre pre-program and aligner to have a temporary
• 3:32
  memory and a permanent memory. So it's like almost like there
• 3:35
  are two steps of thermoforming that are done that control these
• 3:39
  two steps or control these two shapes accordingly. There is one
• 3:43
  shape that the patient wears, which is the temporary shape,
• 3:45
  and it fits perfectly on the teeth. And then after one week
• 3:48
  of wearing the patient, where we're going to describe later,
• 3:51
  boosts the aligner, which stimulates the aligner or the
• 3:54
  plastic polymer to change its geometry to the permanent shape
• 4:00
  of the thermoforming that was done in the manufacturing
• 4:02
  process. And that's how it it moves from one shape to another,
• 4:07
  whether in the manufacturing and we reverse that when the
• 4:11
  patients received the aligners and they boost it at home.
• 4:15
  Alison Werner: Okay, so at a you're going to be debuting the
• 4:18
  ClearX aligner classic system. Can you talk about what that
• 4:24
  system brings to the table and what orthodontists can expect
• 4:29
  when they see this?
• 4:32
  Dr Sherif Kandil: Sure. I mean first of all, we are super
• 4:34
  excited about this opportunity. We have been since we started
• 4:40
  since our debut in March 2023 in Cologne, we started with almost
• 4:46
  sole focus on the European market, and now we are getting
• 4:49
  for the first time into the US market with this amazing
• 4:52
  product. The AAO on our booth where you were going to be like
• 4:57
  almost all the time showing live demos, live sessions showing
• 5:01
  exactly how aligners change their shape. So we're going to
• 5:03
  be showing, you know a live how an aligner before boosting looks
• 5:07
  like. And then we're going to place it inside the booster, and
• 5:11
  then we take it out and then we show the doctors how the aligner
• 5:17
  feature of shapeshifting works. Now then, this technology, it
• 5:23
  brings so many things on the table. And it's just the very
• 5:26
  first step of so many other steps that that will open the
• 5:30
  gate towards internet of medical things that is lacking, in my
• 5:34
  opinion, in a lot in orthodontics. Now let's start
• 5:36
  with step by step. I mean, currently, where do we stand, we
• 5:39
  stand at a point where we are harnessing to have two shapes.
• 5:44
  And with that we decrease the plastic waste and decrease the
• 5:47
  number of aligners by half. That's again, what I said is
• 5:50
  just the first step, because we have, we have already the proof
• 5:53
  of concept of that it could even decrease even to almost 75%. So
• 5:57
  imagine all the aligner waste that we have per per single day
• 6:01
  that would shrink by 50%, if everyone adopts the same
• 6:04
  technology. Now, we're producing almost like 1.2 million aligners
• 6:10
  per single day, we're going to talk about globally, everyone,
• 6:12
  including align and all others, all combined almost 1.2 million
• 6:17
  aligners per day. That is humongous amount of plastic that
• 6:20
  is thrown in landfills at the end or in the oceans. And we're
• 6:24
  determined to decrease that. And that's again, that's the very
• 6:28
  first step towards later on working on many steps that are
• 6:33
  taking the path towards internet of medical things where we start
• 6:36
  to integrate more of like biology, monitoring, lifestyle
• 6:41
  into the treatments of the patient to create a customized
• 6:44
  treatment throughout the journey of patients. I'll talk about
• 6:47
  that in a bit. But for now, just wanted to give you like an idea
• 6:51
  in total, like what does it bring right now on the table in
• 6:54
  terms of advantage, and where it should be going in the future.
• 6:59
  And while it's going there in the future, the the idea itself
• 7:05
  of decreasing the plastic brings other advantages as well with it
• 7:10
  to the customer or the patient in that in that sense. Where
• 7:15
  first it increases the compliance. So you're it's like
• 7:17
  exactly you're having let's say go or compare, let's say, a
• 7:21
  diabetic patient without any monitoring app or without any
• 7:24
  monitoring gadgets. Same goes for, for example, me trying to
• 7:28
  you know, like, do sports every single day or exercise every
• 7:31
  single day without my smartwatch, right. I mean, we
• 7:34
  need gadgets, to I mean, as humans, we need gadgets to
• 7:38
  commit more to to give more, to feel more responsible for
• 7:41
  something but also to feel rewarded. And that's exactly
• 7:44
  what patients feel when they start to boost their aligner and
• 7:47
  they take it out, and they will start to wear it and then they
• 7:49
  feel immediately the difference. It's like it feels like it's a
• 7:52
  new aligner. So that's the kind of like the reward that is that
• 7:55
  is that kicks in for the patients that they feel that
• 7:58
  they're part of something. And this something is rewarding as
• 8:01
  well to them. And this increases the compliance massively in an
• 8:06
  orthodontic treatments. I mean, we were doing a lot of research
• 8:09
  on that comparing the compliance of patients with standard
• 8:14
  aligners and compares it to 4D aligners, and the results are
• 8:16
  staggering. I mean, it's, it's, most of the patients were
• 8:21
  reporting that they feel the sense of responsibility, they
• 8:25
  feel that they also part of something big, where they're
• 8:28
  working, or they're not just only fixing their teeth and
• 8:31
  getting beautiful smile, but they're also part of something
• 8:33
  that is eco friendly. And again, they have their hands in it as
• 8:37
  well. So it's also fun. Okay, so yeah, that's mostly from
• 8:42
  falling.
• 8:44
  Alison Werner: Perfect. I know we have a little bit of a lag.
• 8:47
  No, the sustainability aspect I find really interesting because
• 8:50
  it is, because as I've talked to you before about that you've
• 8:54
  explained this to me before, so I'll just kind of explain to our
• 8:56
  readers, as I understand it. With this, you know, one aligner
• 9:00
  can get a patient through two weeks because you're using that
• 9:03
  booster. And we'll talk a little bit more about that to
• 9:06
  transition the aligner to that second stage. So you're cutting
• 9:10
  back, as you said, on the aligner waste. So let's break
• 9:13
  this down a little bit further. From the treatment planning
• 9:17
  stage, what can orthodontists, what should orthodontist
• 9:21
  experienced with that? Is it any different from treating with a
• 9:24
  traditional aligner?
• 9:25
  Dr Sherif Kandil: Um, well, when it comes to the treatment, let's
• 9:27
  say complexities of cases or malocclusions that can be
• 9:30
  treated, there is no difference at all, it's it's almost more or
• 9:33
  less the same. When it comes to the the setups for the doctors
• 9:39
  will just realize that the results that could be achieved
• 9:43
  with any other aligner system is achieved with half of the
• 9:46
  aligners with ClearX. That's basically the only difference
• 9:49
  that they will see between, let's say both setups of
• 9:52
  treatment plans designed by ClearX and any other standard
• 9:55
  aligner system.
• 9:57
  Alison Werner: Okay, great. So then when the patient gets their
• 10:02
  package, they're going to be getting their aligners and then
• 10:06
  a booster. So can you talk about the patient experience? And then
• 10:10
  exactly what that booster is you kind of showed it there for a
• 10:12
  second there and that it does transition to the second form.
• 10:16
  But how does it do it?
• 10:20
  Dr Sherif Kandil: Absolutely, I'll show it again. So, so the
• 10:25
  patients when they receive their box, it includes the booster,
• 10:27
  the accessories, obviously, and also, yeah, the aligners were,
• 10:31
  where there was almost like a place for let's say, almost like
• 10:34
  four to five aligners that are, let's say, aligner sets that the
• 10:36
  doctor could give to the patient. Now, the booster is a
• 10:39
  very simple device, as you can see here. And we designed the
• 10:44
  boosting process in a very, very simple way that anyone can do it
• 10:48
  through which the patients will be literally just placing the
• 10:50
  aligners inside the booster, they'll just boil water and pour
• 10:53
  boiling water directly on the aligner and just close the lid
• 10:56
  for 10 minutes, take it out wear the aligner once again, now what
• 10:59
  do they experience when they take the aligner out and wear
• 11:01
  it, one is definitely they feel like okay, it's like a new
• 11:04
  aligner, it feels like a there was some pressure on certain
• 11:06
  areas where the teeth are moving or should be are programmed to
• 11:09
  move. That's one. Second is is that there will be like a
• 11:14
  refreshing for the mechanical properties that would happen
• 11:17
  also for all the other areas in general the plastic through
• 11:20
  which when you when you heat the aligner to a certain
• 11:23
  temperature, which is more of the same temperature that is
• 11:26
  required for the shape shifting to happen, it starts to recover
• 11:30
  also the original shape of the areas that say especially at the
• 11:33
  back teeth were because of the grinding or the bruises and even
• 11:37
  if the aligners are on the aligners for like a whole week,
• 11:40
  what happens is that the back teeth, sometimes the aligners
• 11:43
  start to just like move out a little bit, you know, they start
• 11:46
  to distance themselves slightly from the teeth. Now when we
• 11:49
  boost the aligner, the aligners snap again, once again on the
• 11:54
  teeth of the back. And that's what the patients also reports
• 11:56
  like, I feel like okay, in the front, for example, there is
• 11:58
  like sort of areas where I feel that there's pressure, but I
• 12:00
  also feel in the back that it snaps more as if it's a new
• 12:04
  aligner once again. Aligners are almost disinfected, or, you
• 12:09
  know, because I mean, you put pour boiling water. So most of
• 12:13
  the bacteria, I mean above 72 degrees are, are are dead. The
• 12:19
  aligner comes out of the booster, it's a hygienic clean
• 12:23
  aligner, it's super fresh for them, when they wear it, it
• 12:26
  feels like it's new. And, and they continue wearing it for
• 12:30
  another week. And then they, they change to the next aligner
• 12:33
  and so on. So keep the keep doing that throughout the whole
• 12:35
  cycle. Now, the one thing that makes the experience even more
• 12:39
  exciting is that this is also connected to the mobile app. So
• 12:43
  the patient when they start the treatment at the very start, at
• 12:45
  the very beginning, there is a mobile app, which is optional, I
• 12:48
  mean, they could have it or they could not depends on if they
• 12:51
  want to have the full experience or not. And through the mobile
• 12:54
  app, I mean, they they will very easily just scan a QR code that
• 12:58
  is a customized QR code for that particular patient generated
• 13:02
  with every single case manufactured. And when they scan
• 13:05
  that code, the treatment details will be uploaded automatically
• 13:09
  or populate automatically inside the app for that particular
• 13:12
  patient so that they would see exactly this calendar, when am I
• 13:16
  starting, when is the next boost, etc, etc. So it gives
• 13:20
  kind of notifications or reminders for the patient, but
• 13:22
  also makes it a little bit of you know, like a kind of a
• 13:25
  gamification process that kind of also incentivizes the patient
• 13:30
  or gives the feeling of reward throughout the whole treatment.
• 13:32
  Alison Werner: Great. Can you talk about because I'm sure
• 13:35
  people are wondering what you know, because you're using
• 13:37
  boiling water and heat to change the shape of the aligner, what's
• 13:42
  to prevent, like a hot drink, for example, changing the shape
• 13:46
  of the aligner?
• 13:47
  Dr Sherif Kandil: I mean, it could happen. But in one case
• 13:49
  where someone would be, let's say drinking very, very hot
• 13:53
  coffee and keep it in their mouth for 10 minutes. That's
• 13:57
  only maybe a scenario where that would happen. But other than
• 14:01
  that, it would never, it would never boost with you know,
• 14:05
  normal drinking or, you know, normal normal lifestyle. Because
• 14:09
  again, it was designed in a way so that it needs temperatures
• 14:12
  above 90 degrees, and would be kept for a few minutes time,
• 14:17
  ideally above five minutes, and we say 10 minutes, and then you
• 14:21
  have to take it out. So it's highly, very, very highly
• 14:24
  unlikely that it would happen anywhere else except probably
• 14:26
  through the boosting process.
• 14:28
  Alison Werner: Okay, great. So what else would you like doctors
• 14:32
  to know about treatment progression or, you know,
• 14:39
  outcomes for these cases and their use of this aligner
• 14:42
  system.
• 14:43
  Dr Sherif Kandil: So I think the doctor should look at it from
• 14:45
  several perspectives. So we're trying to accelerate the
• 14:51
  adoption of eco friendly solutions in the aligner market.
• 14:54
  And we do know and we have to be very transparent about this like
• 14:57
  so many doctors are not the most eco-friendly enthusiasts. But
• 15:03
  we're trying to raise that awareness. And we're also trying
• 15:05
  to like annex for the advantages that come through the ClearX
• 15:13
  with the eco-friendly part with other advantages related to the,
• 15:18
  the mechanical part and the biomechanics, as well as to the
• 15:21
  efficiency of the aligners. Because we use very high quality
• 15:26
  multi layered material as well, that comes with very, very
• 15:30
  amazing properties, in terms of anti-stain are pleased with the
• 15:37
  same quality before it's boosted. And we we've done all
• 15:42
  the studies to prove that as well. And to validate all these
• 15:46
  steps before the boosting after the boosting, how does the
• 15:49
  material react? How does it push the teeth? What are the, the the
• 15:53
  forces exerted on the teeth after the boosting all these
• 15:55
  things? So at this point of time, I think what I would tell
• 16:01
  doctors is that eco friendliness is certainly something that is,
• 16:06
  is about time that we start to take it more seriously in our
• 16:09
  practices, not just only for us, but also for our patients, it's
• 16:13
  something that they could actually be marketed also very,
• 16:15
  very efficiently in, in practice. And we see that
• 16:17
  throughout so many practice using clinics in Europe, where
• 16:20
  patients prefer to use a more eco friendly product with less
• 16:23
  plastic than another one that uses double the amount of
• 16:26
  plastic, right. And on the other hand, all the properties of the
• 16:30
  material that bring the the results of the treatment to in
• 16:36
  almost, I'd say 80 to 82% of the cases directly without
• 16:42
  refinements to the end result. That's a very, very profound
• 16:49
  statement yet all the data that we have prove that that our
• 16:53
  refinement rates are very, very low. And the the need for even
• 16:58
  mid course corrections is in the magnitude of almost 0.2 to 0.5%
• 17:05
  of our cases. So the teeth tracking is great. The the end
• 17:11
  results are very predictable. These are things that I think
• 17:15
  every orthodontist and dentist would love to always have from
• 17:18
  the very beginning to know that okay, I I trust to to reach this
• 17:22
  product I want to deliver to my patients, something that they
• 17:24
  would be proud of, but also what I would be proud of at the end
• 17:27
  to reach the results that I was promised or at least that was
• 17:30
  suggested to me all the treatment plans from the start.
• 17:33
  Alison Werner: Great. One of the other things that you will have,
• 17:36
  you'll have at a neighboring booth is K Line Europe's OEM
• 17:41
  services. And you'll be debuting that as well at AAP, and this is
• 17:45
  kind of the entry into the US market for this aspect of the
• 17:48
  company. Can you talk about what you're offering with these OEM
• 17:51
  services?
• 17:52
  Dr Sherif Kandil: So I mean, the OEM Service is, is a service
• 17:55
  where we prove we give access to a lighter innovation to to any
• 18:01
  aligner provider, whether it's a company, whether it is a DSO, or
• 18:07
  even a dental orthodontic lab, we have all the tools that we
• 18:11
  have, we have developed by ourselves or even made available
• 18:16
  and we offer that in just considered like an open buffet
• 18:19
  for any for any partner of ours, who could just take part of it
• 18:24
  or take the whole thing, whether it's treatment planning,
• 18:26
  aligners, having their own portal, having a mobile app, et
• 18:29
  cetera, et cetera. Now ClearX harmonizes with that really well
• 18:33
  or syncs really well with that as well, where we're currently
• 18:37
  working on providing also cobranding option for ClearX. So
• 18:41
  we're not limiting for for K Line, but rather, the goal is to
• 18:45
  make it available for everyone to use the same and also
• 18:47
  provided to to their doctors or the to their patients through a
• 18:54
  co-branding model that we that we're offering starting at the
• 18:58
  AAO.
• 19:00
  Alison Werner: Okay, great. And then do you will you have any in
• 19:04
  booth events or lectures coming up that our listeners can check
• 19:09
  out?
• 19:12
  Dr Sherif Kandil: Yeah, I mean, we have, we have a schedule for
• 19:15
  the events where I myself will be giving mini sessions, through
• 19:19
  which the sessions we're going to be showing live how the
• 19:23
  boosting process happens. And I always love to show the doctors
• 19:27
  how exactly the shape shifting happens right in front of their
• 19:31
  eyes, that it's like, you know, the immediate belief, wow, this
• 19:35
  thing is real, you know, it's not only looking good on videos,
• 19:39
  photos, but really they when they see it in front of them,
• 19:43
  then they start to also understand the full concept and
• 19:46
  the technology behind it. So yeah, I mean, we have the
• 19:50
  sessions where they include partial live demos as well as
• 19:53
  also a lot of updates about where we're this technology is
• 19:57
  going to and a little bit in depth into the technical part of
• 20:01
  the material and the patient journey.
• 20:03
  Alison Werner: Great. Well, Dr Kandil, thank you so much for
• 20:06
  taking the time to speak with me and I look forward to seeing you
• 20:10
  at AAO and for everybody to check out what's ClearX aligners
• 20:13
  are doing so thank you.
• 20:14
  Dr Sherif Kandil: My pleasure. Thanks a lot and see what they do.