Four orthodontists share how digital custom bracket systems are transforming their fixed appliance cases—from treatment planning to patient outcomes—and why they think it’s redefining the standard of care.
By Orthodontic Products Staff
As the orthodontic landscape rapidly evolves, custom bracket and wire systems are reshaping how practices approach treatment efficiency, patient experience, and clinical outcomes. Once considered niche or experimental, these digital-first solutions are now gaining traction as a viable, efficient alternative to traditional fixed appliances.
To explore this transformation, Orthodontic Products interviewed Alexander Waldman, DMD, MMSc, of Waldman Orthodontics in Beverly Hills, Calif; Kristen Knecht, DDS, MDS, of Knecht Orthodontics in Mont Belvieu, Tex; David Richter, DMD, MS, of Richter Orthodontics in Greeley, Colo; and Jared R. Gianquinto, DMD, MS, of Orthodontic Arts in Bakersfield, Calif. In this roundtable Q&A, they share how customized fixed appliances are changing everything from clinical workflows to ROI—and why they believe this technology is here to stay.
Orthodontic Products: How have you seen the landscape of custom orthodontics evolve in recent years, particularly in bracket and wire systems?
Alexander Waldman, DMD, MMSc: Like other areas of technology, custom orthodontics happened slowly, and then all at once. The proliferation of digital scanning and the adoption of digital workflows, particularly with aligners, taught us the value of digital orthodontics. The absence of a similar workflow for braces led many people to believe that analog braces would soon be completely replaced by digital aligners. In reality, fixed appliances were just another part of orthodontics waiting to be disrupted by technology. Now that we have seen the same advantages of digital orthodontics applied to the fixed appliance space in systems like LightForce, we will continue to see the growth of this area over the next decade as practices realize the significant advantages in terms of efficiency, workflows, and outcomes.
There has also been a significant change in how many doctors—myself included—are thinking about treatment options. Aligners for teens became very popular in the twenty-tens, and doctors were willing to pay the high lab bill to create better patient experiences and to have more efficient treatment outcomes. The hard truth is that teen compliance with aligners is not great, so the average teen aligner case ends up taking a lot more time, and that detracts from the patient experience and the overall efficiency for the doctor. Digital custom braces are a great way to find a happy medium; we get the non-compliance of braces and combine that with digital efficiency to create a truly great experience. I think this will drive a lot of adoption of digital, custom braces in the next decade.
Kristen Knecht, DDS, MDS: Custom orthodontics has evolved significantly, moving beyond the one-size-fits-all approach to systems that provide truly tailored treatment. The biggest shift has been the integration of custom prescriptions using precision-engineered brackets and optimized wire sequencing that fully fills the custom slot to give us (doctors) full torque expression, so the brackets and wires do all the work. The outcomes are reduced treatment variability, fewer wire bends, and more predictable outcomes.
While early custom solutions focused only on one piece of the puzzle, custom bent wires or digital treatment planning, the latest advancements offer a full ecosystem designed to maximize clinical efficiency while maintaining full control over mechanics.
David Richter, DMD, MS: The landscape of custom orthodontics in the past 5 years has been an absolute game changer, in my opinion. As orthodontists, we have been using technology from the 1970s and have struggled to provide excellent care with a system that’s very limited compared to what we have now.
Jared R. Gianquinto, DMD, MS: Early on, the big players in fixed orthodontics didn’t see any need for customization. As custom has started to gain traction, many of them have doubled down on new branding of slight changes to legacy systems, added digital indirect bonding, and continued to overstate efficiency to compete with the new players in the space. Now that true custom systems have been in use for a while, more doctors see that the efficiency gains are real, not just marketing.
OP: What key features in custom systems have had the greatest impact on your treatment planning, efficiency, and patient outcomes?
Waldman: I have used 3D printed brackets (LightForce) for all of my full fixed cases since 2020. It is important to realize that 3D printing is not just a novel way of fabricating the bracket, but rather a completely new conceptualization of braces treatment. The bracket is untethered from any preconceived notion of generic shape or prescription, and is digitally designed and printed de novo for every patient, based on their individual anatomical and tooth movement needs. When you combine the digital treatment planning experience and these 3D printed brackets with highly accurate 3D printed IDB trays, you get a profound level of overall accuracy which directly translates into treatment efficiency. Another recent advancement from LightForce that we are excited about is the introduction of integrated roots from CBCT data. One year into this feature, we are already seeing an even higher level of efficiency and accuracy in our cases, and an almost complete elimination of the need for bracket repositioning or wire bending.
Knecht: I chose the KLOwen Custom Digital Solution for my practice. The most impactful features for me are the custom prescription, precision slot-filling mechanics, optimized bracket positioning through digital indirect bonding, and efficient wire sequencing. The software is easy to use and I know what I approve in the digital setup is what I am going to see come to life. These elements eliminate the need for doctor-intensive appointments focused on excessive wire bending and mid-treatment repositioning, ultimately reducing appointments and improving consistency.
I really didn’t believe any custom solution could deliver the promises they make, but I’m a year and a half in with KLOwen as my only custom fixed-appliance system and I have more time than ever, the cases are finishing beautifully with minimal repos or wire bends, and my team and I are less stressed—all as revenue and starts continue to go up. Seems my skepticism was wrong—custom really works.
Richter: I’ve started over 1,300 cases and have found several key features in the custom system I use (KLOwen) that have significantly changed the patient finishes and the number of appointments necessary. In addition, these features have significantly reduced treatment times up to 40%. Mostly, it’s because we start with the end in mind and build a bracket system around our projected treatment outcome. When we do a digital setup, what you see is what you get, unlike aligner therapy, where you have to overcompensate teeth positions. The digital setup doesn’t look like what it will when the treatment is completed. Another significant point is that the wires almost completely fill the slot of the bracket with about 3° of slop. With conventional braces, we have up to 20° of slop in the bracket and when accounting for the adjacent teeth, that creates up to 40° of slop. So you have complete control over the first, second, and third orders. Treatment planning for the digital setup once it gets to you takes 5 minutes or less. Once submitted, it’s one-and-done. You don’t have to wait for them to send it back to you for approval; that’s your last step in the treatment planning process. With self-ligation and custom, we are able to leave the wires in for 12 weeks before the next appointment and let them fully express. Currently, I am in three sets of wires. The treatment outcomes are significantly better. With the conventional braces I used during most of my 30-year career, I would spend the last 6 to 9 months trying to regain the occlusion. With custom, we don’t have any repos—and we have only one to two detail appointments and then we’re finished.
Gianquinto: Digital treatment planning, custom torque, tighter bracket/wire tolerances, CBCT integration, self-ligating brackets and of course digital indirect bonding, which is listed last for a reason. While it’s a key part of custom, there are no significant changes in clinical outcomes or efficiencies—aside from saving some doctor time at the start appointment—from IDB alone.
OP: How has integrating custom orthodontic systems changed your clinical workflow, and do you see a strong return on investment compared to traditional systems?
Waldman: By adding a digital workflow for braces, in addition to aligners, our case submission and clinical start systems are the same for every patient in the practice—scan, digitally plan, and delegate the appliance placement. Just the introduction of digital indirect bonding alone has saved hundreds of hours of doctor time, improved the operations of the practice, and positively impacted quality of care.
The ROI on customized appliances is multifactorial: fewer appointments, reduced treatment times, enhanced patient satisfaction, and consistent high quality results. While there is increased cost of the customized appliance, once the appliance gets fully adopted in the practice and the clinical efficiencies are fully realized, there are savings in other areas, such as staff costs. So looking at net costs, it zeros out, and you gain all of the advantages of working with a customized appliance.
Sometimes an ROI can be non-financial, and I think that my biggest ROI is the improvement in the quality of care that we deliver. I have done an extensive case review on my former cases treated with generic appliances and compared those to my current case finishes with LightForce, and there is no question that I am much prouder of the work I am doing now with custom braces. While I am still the same practitioner, custom braces have elevated my treatment planning and case outcomes. That has been a big win for us and our patients, and has been worth the entire journey of learning a new digital system.
Knecht: KLOwen has changed my workflow by reducing the number of appointments by ensuring greater accuracy from the start. The improved bracket positioning and wire coordination means fewer finishing adjustments and less chair time overall, all while maintaining exceptional clinical outcomes.
I’m kind of a perfectionist, so it was really important to me that a custom solution deliver quality finishes, not just reduce chair time and number of office visits. Having a fully digital workflow with custom orthodontics for both braces and aligner cases has totally streamlined things in my practice. Every patient gets scanned, and every scan is a digital same-day start because we’ve redefined what ‘same day’ means. An end-to-end digital workflow with individualized treatment plans for every case is the only way I will work now.
Furthermore, my team is enabled with autonomy over patient appointments as they manage bondings and wire changes from start to finish. I’m only needed for a quick check at each appointment because the whole case is already planned out. This shift in workflow gives me more freedom to do my digital homework during clinic time, and it keeps the practice moving more efficiently throughout the day.
In terms of ROI, the reduced chair time, full portfolio of metal and clear custom options, and increased capacity for new patients more than offset any initial costs. I’ve saved an average of 4 appointments per patient since moving to KLOwen and extending my appointment intervals. Saving even two appointments made this a positive ROI for me. Since I started using KLOwen, my production is up over 50%, despite losing my lead assistant.
I recently extended my appointment intervals to 10 weeks to let the wires play out and further increase efficiency and ROI. Honestly, I wish I had started extending appointment intervals sooner as I’ve seen far more efficiency and an even better patient experience since doing so. The scalability of this system makes it a clear win from both a clinical and business perspective.
READ MORE: The Aligner Evolution: How Innovation is Reshaping Treatment
Richter: Integrating a custom system into my practice has completely changed my workflow. We were booked out 4 days a week, 8 weeks out, with 70 patients a day. Now, we’re booked out for 1 to 2 weeks and see 35 to 40 patients 4 days a week. I could easily change that to 3 days a week. The other significant benefit is your labor cost should go down by up to 50% if you plan it correctly. These days, the way the labor market is, we are less reliant on staffing and dealing with a larger staff.
Gianquinto: Going fully digital was a huge change in our office. The biggest obstacle we had to overcome was scanning every patient at the consult appointment. Fortunately, scanners have become faster and open-source options with reusable scan tips have brought the cost down significantly. Lab fees and material costs did not increase for us, as we were using a premium bracket system before. What we did see were holes in the schedule after the first year, which allowed us to grow the practice by 40% without any additional days or staff. When your practice goes from a 20 visit per patient model to a 10 visit model with better outcomes, everyone is happier.
OP: How are patient expectations and technological advancements, such as AI and 3D printing, influencing the shift toward more customized treatment?
Waldman: Patients are in instant gratification mode. The idea of being in braces for 2 to 3 years is simply not an option for most patients anymore. Digital, customized braces are a great solution because of the shorter treatment times engendered by more accurate digital planning and appliance placement. While I love aligners and they will continue to be in demand, if I have a patient who wants to be done in 12 months, I will put that patient into LightForce and eliminate any variables introduced by compliance. In general, there has been a swing of the pendulum back to teens requesting braces over aligners, and by providing a great digital braces solution, we have been able to meet their expectations for achieving a perfect result in the least time possible.
Knecht: Patients today expect options, precision, speed, and a tailored experience, and KLOwen aligns perfectly with those demands. Even clinical consultants are proclaiming this as the new norm: patients want individualized care with the same results and less time in office. Custom makes that possible.
AI-guided treatment planning and 3D-printed digital indirect bonding trays have elevated efficiency, allowing for optimal bracket placement at the start. The addition of the custom prescription and brackets means I have the right torque prescription to deliver the exact movements needed to achieve an ideal occlusion and aesthetic outcome.
The shift toward customization is not just a trend—it’s a necessity driven by patient demand for shorter treatment times and fewer in-office visits without compromising results.
Richter: I see a significant opportunity for AI to make this process even more efficient. The way the workflow happens with custom is that we scan the patient’s teeth and the computer generates a template which we 3D print. The braces are then put into the printed IDB tray, and bondings are significantly shorter, and our doctor time is 5 minutes or less. Most of that time is spent with the patient and parents describing the technology. The technology that people use to get this braces system is impressive because of the results that it delivers. It sets your practice apart from the other 95% of the other orthodontists in the country that aren’t using custom.
Gianquinto: Consumers demand Amazon-like convenience with just about everything these days, whether it’s realistic or not. Custom treatment with remote monitoring and 3D printing can get us pretty close to that. We can offer customized appointment intervals, excellent communication and visual records for patient support, quick turnarounds for retainer and aligner replacements, and custom appliance fabrication without additional visits. I would venture to say that none of this would be possible or, at the very least, remotely practical in an analog practice.
OP: What advice would you give to an orthodontist considering a transition to custom bracket and wire systems?
Waldman: Go all in. Not only is this the best way to learn the system, train your staff, and make sure all of your patients benefit from the technology, but it is also the way to unlock the efficiency of the system that is really hard to perceive when you are only using it for part of the practice. Some doctors are hesitant to pay for custom appliances, but the efficiencies that are gained will ultimately lower the overhead in other parts of the practice, such as staffing. It does take a few years, but you come out on the other side of that equation with no net increase in overhead, and with happier staff, patients, and doctor. You have also future proofed your practice and made it competitive in the world of digital orthodontics.
Knecht: Look for a custom digital system that offers both metal and ceramic options for you and your patients, that enhances efficiency without compromising control, and that delivers a cost-positive ROI. The best custom digital solutions give you flexibility in mechanics, simplify bonding, and reduce wire adjustments while keeping you at the center of treatment decisions. Avoid custom systems that don’t give you all the options you need to have a single solution for your fixed appliance cases. Efficiency comes from a less-is-more approach, so boutique products that can only do aesthetic cases, or that don’t have a full portfolio to choose from, will add one more thing to your tech stack instead of streamlining your digital workflow. A great solution reduces noise and empowers you as the doctor to design every case in one system.
Richter: My advice to any orthodontist considering transitioning to custom braces is to start with at least 6 to 10 patients a month. You have to do this enough to get a feel for it. If you dabble, you will fail. Your team generally doesn’t like change, but if it makes your lives easier, then they’re all in. But if you’re only doing a few cases, it’s more frustrating for them and you.
Gianquinto: Clinical efficiency is the greatest advantage of custom. But if you’re not changing your scheduling protocols or mechanics to adapt to the new systems, or not starting a vast majority of new cases with whatever you choose, you won’t see meaningful change in your practice. Change is difficult. It’s a good idea to try out a few cases to see how it works, and if you like what you see, pick a transition date, go all-in, and work through the learning curve. There are excellent training, mentorship, and online forums to help. None of that existed 5 years ago, and it’s only getting better. Also, custom systems don’t do everything for you. You still need to plan, execute, and monitor your mechanics.
OP: Where do you see custom orthodontics heading in the next 5 to 10 years, and what innovations excite you most?
Waldman: While I don’t think analog appliances will completely disappear in the next 5 to 10 years, we will see custom braces become the standard of care. Regarding specific innovations, we will continue to see new products emerge from both existing and new companies, which will slowly but surely convert every last piece of analog and generic orthodontics to digital and custom, whether that be brackets, wires, auxiliaries, or other appliances. Technology is additive, and the flywheel effect of digital innovation will spawn other clinical modalities that we can only dream of now. In addition, AI will play an important role in treatment planning, and when we layer in the potential of biotechnology to advance the fundamental process of tooth movement, it is clear that our profession’s best times are still ahead of us.
Knecht: The future is about even greater efficiency and precision. Expect continued advancements in AI-driven case planning, more streamlined in-office digital workflows, and further optimization of bracket and wire interactions.
Custom digital systems will continue to evolve toward greater ease of use and integration, making them the standard of care driven by doctors, their teams and their patients, rather than an optional upgrade. The most exciting innovations will be those that empower orthodontists to deliver faster, more predictable results while maintaining full control over treatment mechanics.
Forward thinking doctors will choose solutions that help gain clinical efficiency and reduce doctor intensive labor as much as possible, because well-designed treatment is fundamentally different from what we learned in residency: It’s proactive, not reactive. That’s where real change with full custom treatment is happening in orthodontics.
Richter: I see custom braces as the standard of care in the next 5 to 10 years. It’s a digital workflow and technology that actually works, and it works very well. There are so many benefits to everybody involved: shorter treatment times, fewer appointments, and much better finishes.
Gianquinto: I believe that the “early majority” part of the adoption curve for custom appliances will start to happen in the next 5 to 10 years, and some of us “early adopters” won’t seem so crazy anymore! OP
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