How to reduce the environmental impact of clear aligner treatment

The importance of sustainability

The importance of sustainability has gained attention within dentistry over recent years. Orthodontics is no exception and as awareness about the environmental impact of healthcare practice grows, sustainable orthodontics has certainly emerged as an important area of interest. With the increasing demand for clear aligner treatment, there is also growing concern about the plastic burden of this treatment on the planet.

The delivery of orthodontic treatment, and specifically clear aligner treatment, has environmental consequences. As clinicians we need to think carefully about ways to mitigate the impact but it’s also important for manufacturers of aligners to play their part too.

Travel

We all know that travel is a major contributor to carbon emissions. Aligner treatment can involve multiple trips for very short appointments and so some clinicians are now routinely using virtual appointments for assessments, reviews and retainer checks. Remote monitoring of aligner therapy can potentially reduce the number of times a patient might need to travel to the surgery to assess their treatment progress.

Clear aligners are distributed to surgeries worldwide; this is also an important environmental consideration. Align Technology has recently opened additional manufacturing facilities and claim that this should help decrease carbon emitting activities from shipping products globally.

The use of intraoral scanners has many advantages not least removing the need to ship physical impressions from clinic to lab. Their use in aligner treatment is to be encouraged.

Actions to take:

• Consider using virtual appointments for assessments and retainer checks
• Use remote monitoring eg Dental Monitoring or Virtual Care
• Implement digital scanning in your practice

Materials

Single-use plastics (aligners, impression trays, retainers, scanner tips) are likely to have a high environmental impact and composites used to bond attachments release microparticles and harmful resin monomer components, including BPA (Bisphenol-A).

Using intraoral scanners saves thousands of tons of PVS impression material and plastic.

Since 2006, Align Technology has reduced the amount of polymer content used in aligners by 50% and reduced the amount of resin used in aligner moulding by 33% which is commendable but there is still much more that aligner manufacturers can do. There is growing concern about the excessive packaging used in the delivery of aligners.

As clinicians we have a responsibility to reduce aligner waste. One area where we can have some influence is by actively avoiding unnecessary refinements and overcorrections. At Aligner Intelligence we are able to advise you on methods to eliminate fabrication of unnecessary aligners for your patients and advise you of cases that aren’t best suited to aligners.

Actions to take:

• Implement digital scanning in your practice
• Avoid all unnecessary refinements and overcorrections

Energy

An important general area of consideration are the carbon emissions resulting from heating dental clinics. In addition, many high-energy appliances are used in the delivery of dentistry eg computers, sterilisation equipment and practice lighting.

Orthodontic clinics should adopt energy-efficient practices to reduce their carbon footprint. Investing in energy efficient appliances, such a LED lighting and energy-star rated equipment, will help reduce energy consumption. Creating paperless practices is to be encouraged. Letters to colleagues and patients should be emailed, electronic patient forms used and digital imaging used to reduce reliance on paper and chemicals.

Actions to take:

• Make your practice as energy-efficient as possible

Waste

Incineration of waste contributes to air pollution and plaster study models require specialist disposal to avoid the release of hazardous hydrogen sulphide gas.

Intra-oral scanning eliminates need to dispose of waste gypsum.

The polymers used in aligners are medical grade plastic and once the aligners have been worn by patients they cannot be recycled like household plastic.

Terracycle is an innovative recycling company that has become a world leader in recycling hard-to-recycle material but material from aligners can only be downcycled and not used for new aligner production. The aligners, flexible plastic packaging and cases are cleaned and melted into hard plastic. This is then remoulded to make new recycled products.

The scrap and waste generated by Invisalign aligner manufacturing does not go to landfill. In the Align facilities in Mexico and Poland, waste is used for energy recovery for third parties. In China, all waste is repurposed for reuse as floor tiles.

It is now possible to 3D print aligners directly in resin, without the need to 3D print a series of moulds first. Resin 3D printers are able to produce six to twelve aligners at once, greatly accelerating the process and at the same time reducing scrap and waste.

Actions to take:

• Make your practice as energy-efficient as possible
• Implement digital scanning in your practice
• Sign up to Terracycle to recycle plastic waste from aligners
• Find out how your aligner manufacturers manage scrap and waste

Conclusion

As the global focus on sustainability intensifies, sustainable orthodontics offers a vital opportunity to reduce the environmental impact of dental healthcare. By embracing eco-friendly materials, energy-efficient practices and digital advancements we, as clinicians, can make our contribution to a greener future while still providing optimal treatment outcomes for our patients.

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