A Hybrid Approach to Innovation
By A.J. Zak | Photography by Katherine Eve Photography
At the San Diego practice of Melanie Wang, DDS, orthodontic treatment that blends clear aligners with brackets means happier patients and happier parents.
Melanie Wang, DDS, vividly remembers the day she got her braces off at age 15, and the excitement for this milestone event. As the daughter of a dentist and as someone with a knack for math and science, the San Diego native knew even as a young girl that she wanted to go into the field of dentistry or a related specialty. Today, Wang has a thriving San Diego-area practice where she and her team of eight have more than 500 patients. In early March, she will open a second location nearby.
Wang’s success and that of her practice is driven by her deep passion for her work. She loves problem-solving and is always up for a challenge, whether it comes in the form of opening a practice fresh out of residency, overhauling her business at its 10-year mark, or figuring out a complex multi-disciplinary case. One example of her team’s innovative spirit is the practice’s increasing use of innovative hybrid treatments—combining both brackets and clear aligners—to align patients’ smiles.
On that day when Wang got her own braces off as a teenager, there was no fanfare, no celebration—the doctor simply gave her an uncomfortable retainer and sent her on her way, she says. So, years later, when she was deciding how to develop her own practice, she knew she wanted to prioritize a fun atmosphere and emphasize the importance of patient comfort. Her practice—Dr. Melanie Orthodontics—serves a wide range of patients. But Wang and her team have carved out something of a niche over the last few years for patients with special needs. That was no coincidence; it was just a few years ago that Wang’s oldest son was diagnosed on the autism spectrum.
“Because of what [my husband and I] deal with on a daily basis with our son, I have a deep connection with families of special needs patients. [These families] are, in my opinion, superhuman in a lot of ways,” she says. She and her staff work with patients to establish a rapport and trust, which is crucial in working with whatever issues a patient may have. “It’s about being patient and breaking little steps up,” Wang says. For instance, if a patient has intense anxiety about getting their first procedure done, the goal of their first visit might simply be to walk through the front door. “And maybe they’ll come in more frequently, but we get it done,” she says.
Wang is a graduate of the University of California at San Diego, where she studied biology and teaching before heading off to the University of California at Los Angeles School of Dentistry. She always thought orthodontics would be the most fun area to specialize in because of the way it requires innovative problem-solving. Her residency at St. Louis University in Missouri confirmed that notion. Getting to see the inner workings of practices during residency made her confident that orthodontics was the right path for her.
Wang appreciates the fact that orthodontics is about planning and requires a commitment to a long-term project. “You start with a challenge and you have this project in front of you, and you work really hard at it, and you get this great result that you think is awesome, but, in the meantime, it also changes the person in a deep and meaningful way,” she says.
Taking a Risk
Wang knew it was a big risk in 2007 when she opened her practice. She and her husband were young and just finding their footing after moving back to California, following the completion of her residency. They also had a small child. And, of course, not too much later, the Great Recession hit.
The couple took a leap, both opening their practices at the same time. “The practical thing to do—not the crazy thing that we did—would have been to find a job and just work there, get my feet wet for a while,” she says. “But I just felt like the opportunity of this location was too great to pass up.”
Wang also did her research prior to making the decision to go into business for herself. She talked to some California orthodontists before she moved back to her home state, and several of them told her they wished they had struck out on their own earlier instead of spending longer amounts of time in associate roles. So, Wang signed the lease for her practice within 2 weeks of finishing residency, and 10 months later she was open for business. Support from her family was a big help during that time; not only is her father a dentist but so is her husband, so she figured she would be able to get some referrals from both of them. She and her husband also lived with her parents during her practice’s infancy.
By the time her practice hit the 10-year mark in 2017, the office had become remarkably busy. Wang needed someone to help her manage the growth and all the stress that came along with it, so she hired orthodontic consultant Karen Moawad of Hummingbird Associates to help get things organized. That is just one of the moves Dr. Melanie Orthodontics has made in recent years to keep up with the pace of change within the industry. Each year, she sets a new goal. Recently, she brought her team up to speed with new ways to implement digital technology in their office. In 2018, the practice acquired its first 3D printer and began scanning and printing, making retainers in-house. The practice then graduated to the next level of 3D printing: producing in-house clear aligners for minor tooth movement. Most recently, the practice started 3D printing indirect bonding trays. It is time-consuming work, Wang says, but she feels the systems her team used then and now provide superior treatment for patients.
That commitment to providing superior treatment to patients also comes across in the treatment modalities Wang has incorporated into her practice. Wang is committed to offering her patients a comprehensive range of treatment options, and that includes hybrid treatment. Combining clear aligners (typically, on the upper arch) and braces (on the lower arch), hybrid treatment offers an aesthetic treatment option to patients who are not ideal candidates for full aligner treatment.
This modality has quickly become one of Dr. Melanie Orthodontics’ most popular treatment options. “It’s typically an agreeable compromise between the clear aligners that kids want and the [non-removable] braces their parents want for them,” says Wang.
Key to this modality is the right products.
Hybrid Treatment
Nine years ago, Wang began a customer relationship with 3M Oral Care. When she started her practice, she placed a large bracket order with another company, and soon ran into trouble. The brackets kept debonding. She, her staff, and her patients were frustrated. Despite trying multiple adhesives to solve the problem, the issue persisted. Then, a 3M rep came into the office and, hearing her complaints about the brackets she was using, brought in a 3M bonding expert to show her a technique utilizing 3M’s Transbond self-etching primer and adhesive to rectify the situation. Impressed with 3M’s customer support, the knowledge base of its staff, and the products, Wang switched to 3M brackets when the time came to place another bracket order. Eventually, she converted most of her orthodontic supplies over to the company’s products.
“The 3M metal brackets gave me better finishes than with what I was previously using,” Wang recalls. “When 3M came out with their Clarity Advanced clear brackets, I switched over to them and then became exclusively a 3M customer.”
Today, Wang relies on 3M Oral Care’s Clarity Advanced Ceramic Brackets in tandem with Clarity Aligners—part of the company’s aesthetic product line—when providing hybrid treatment to her patients. Wang first started using Clarity Advanced Ceramic Brackets about 9 years ago and Clarity Aligners soon after the product hit the market in 2018.
“When I heard [3M] were making their own aligners, I didn’t hesitate at all, because I really believe in their products,” Wang says.
The fact that both the products come from the same manufacturer goes a long way in making this treatment modality efficient. First, orthodontists using Clarity Aligners can order a single arch—and only pay for the arch they need, whether it’s upper or lower. Second, orthodontists can use a single software throughout the case—the 3M Oral Care Portal. The portal allows Wang to treatment plan her hybrid cases using both Clarity brackets and aligners and to order the aligners at any time, from anywhere. The HIPAA-compliant platform also gives orthodontists like Wang the flexibility to use the intraoral scanner of their choice and to turn the case over to 3M for final setup and manufacturing.
Wang admits there is a bit of a learning curve for orthodontists who are just starting to use combination treatment plans—especially when it comes to synchronizing the delivery of the aligners with the time frame for bonding brackets, she says. She requests an adjustment to the normal aligner treatment staging, so the schedule fits with adjustment intervals on the arch with brackets. For patients with very deep bites, she prefers metal brackets for the lower arch with a bumper tie from canine to canine. If a patient prefers to have clear brackets, she typically warns them that they might have significant bite mounds.
Based on her experience with her own patients, Wang predicts that hybrid treatments are bound to become more popular in practices everywhere.
Melanie Wang, DDS, shares a recent hybrid case…
A 43-year-old Caucasian female with no prior orthodontic treatment presented with mild-moderate recession, especially in the lower anterior region. Prior to starting her orthodontic treatment, the patient was referred for periodontal clearance.
Treatment was started July 11, 2019, using 3M Clarity Aligners on the upper arch and 3M Clarity Advanced Ceramic Brackets on the lower arch. Brackets were preferred because of the recession and slight potential of increased mobility of the lower incisors during orthodontic treatment. Progress photos were taken on February 14, 2020, show axillary teeth are tracking nicely with the first set of aligners, with patient currently on aligner #26. Photos also show mandibular teeth are almost completely leveled after 7 months of treatment.
Approaching the Future with Zeal
Wang’s commitment to clinical innovation is mirrored in her commitment to innovating her practice. With the opening of her new office, the busy mom of three is taking on a project she admits she never envisioned. “It’s scary,” she says. “I’m very debt-averse. And I think when I pictured the first 10 years of my practice, I was just trying to save money here and there wherever I can.”
But with the confidence that comes with a decade under your belt, Wang is approaching the future with a zeal to solidify the success of not one, but two offices now. A key component of that is the decision to ramp up her marketing, with a focus on ensuring the practice has consistent, ubiquitous branding—as she puts it, “I brand everything with my logo.” Also for that first decade, she only had four people on staff, but since investing in an expansion, bringing on new staff, and dialing in systems, the culture and stress level at the office has improved dramatically, she says.
All of that intentional work has made a huge difference for her team. Sharon Carlson, patient care coordinator at the practice, says Wang’s grace under pressure, and ability to meet challenges head on is a skill that her staff picked up as well.
“She rises to the occasion, stays grounded, nothing rattles her,” Carlson says. The culture at Dr. Melanie Orthodontics has even inspired a 17-year-old registered dental assistant on staff to become an orthodontist—“because he is determined to keep the band together,” Wang laughs.
That sort of dedication and growth is one of the things Wang loves the most about her work. “[What I am most proud of] are the things I personally helped my team achieve individually,” she says, “and just seeing all of them do something extraordinary.” OP
A.J. Zak is a freelance writer for Orthodontic Products.