Talk:Clear aligners/Archive 1

Archive 1

Antitrust lawsuit

Not remotely in my field of interest, but the antitrust litigation ought to be mentioned in the history. See [1], [2] Tearlach 12:16, 24 August 2005 (UTC)

References

It seems that a lot of information was present, but none of it was refenced. I'm guessing the anonymous ip address that keeps working on this page is an employee of Align Tech, Inc and they know these things, but they still must be cited.

Also the less we can make it read like the brochure you pick up in the dentist's office the better. Jonnyct 00:34, 13 August 2006 (UTC)

I agree with Jonnyct...I'm sure the info is true, but can we make this sound less like an advertisement? "Some treatements as low as..." and things such as that. lemboy4 06:50, 3 December 2006 (UTC)

I've added a reference to a good review of the actual evidence about this system. Hopefully this will make the article sound less like an ad and not be taken away by the employees of the company --Vannin 01:56, 19 April 2007 (UTC)

Disadvantages

If there is an "Advantages" section, then a disadvantages section should be added to avoid the appearance of a commercial for Invisalign. Just my opinion. Wilsonbond 17:04, 19 October 2006 (UTC)

I'm not sure why there is so little discussion on the discussion pages, when some rather important edits are being made. I noticed that a section on sensitivities had been removed. I put this back in, because it seems rather important information. If there is a reason for taking this out, then I suggest that we discuss it here. --Vannin 02:38, 22 October 2007 (UTC)

time frame

I've removed the statement about a known time frame - this is contradicted by information from the invisalign review, [[3]] which states that only an estimate can be given as there are too many unknowns.--Vannin (talk) 22:49, 29 November 2007 (UTC)

randomized studies

I took out the statement about the rarity of controlled studies - as we now have two --Vannin (talk) 19:15, 28 January 2008 (UTC)

Advertising copy.

Again it looks as if someone has been through and tried to put advertising copy into the article. If the system is good it will stand on its own two feet and not need the big PR job. I've taken some of it out. I repeat that if it sounds too much like advertising there is a good chance that the article could be nominated for deletion. I see that an entire section has had no sources to it since August 2006, and really looks like it was put in by employees of the company. I will give it another week and then take that section out. --Vannin (talk) 02:35, 14 April 2008 (UTC)

done--Vannin (talk) 02:03, 21 April 2008 (UTC)

Tax deductibility

Medical expenses are only tax deductible if they are not cosmetic, though essentials for "normal" appearances, such as false teeth are allowed. All of these expenses are subject to a 7.5% AGI hurdle, so it's quite a much different case than mortgage interest expense deductibility, for example, and fairly misleading to say that these expenses are "deductible" in the same sense. For that reason I've struck the relevant line. fsiler (talk) 10:50, 29 June 2008 (UTC)

Visibility

In the article it is stated that although the braces are advertised as invisible, they are in fact not. I must disagree with that. I currently have braces for both arches, and I swear that nobody has been able to tell that I actually have them 24/7. Plus, if the claim of invisibility was factually untrue that would make the company vulnerable to false claims lawsuits. I do not want to start an edit war by correcting that, but I just wanted to point that out. —Preceding unsigned comment added by 151.56.182.198 (talk) 21:23, 20 January 2008 (UTC)

These aligners are not invisible. The look like transparent, custom-fit mouthguards. Then there's the "buttons" that may be needed. They are a ceramic buldge that is put on the face of a tooth to help the aligners grab the tooth. You could have few to many buttons per aligner. For instance, my upper aligner has only one button, but my lower aligner has six butttons. The buttons are easily noticable.--24.217.133.97 (talk) 22:45, 29 October 2008 (UTC)

Recent edits

Hello Phumber, thank-you for your recent contributions. In Wikipedia it is really important that statements be backed up by references. Can you add supporting references for your contributions? It is really important in this article because there is a risk that it will all sound like an advert and it really has to be neutral. Thanks, and you may want to discuss big additions on the talk page first.--Vannin (talk) 16:52, 29 November 2007 (UTC) P Humber and myself would love to carry out clinical trials for Align Tech, but without funding it is difficult to maintain a practice as well as a research facility. I have been doing Invisalign full time for about 6 years and have found only small problems with Invisalign: Rotations, patient compliance, Interproximal reduction etc. No system is perfect; look at metal braces...pain, extractions, gum problems, social stigma and relapse. In my experience I have used Invisalign for all types of maolocclusions, including anterior open bites with 12mm overjets etc. canine rotations are difficult, but with the new attachments it should work better. Patients need to decide on painful metal braces or painless Invisalign. The biggest disadvantage of Invisalign is the cowboy dentist...who carries out gross interproximal reduction between crowded front teeth and damages the teeth forever. This is probably the same problem with 6 month smiles. All orthodontic treatments should either involve extractions or movement of the posterior segments. Hence Invisalign is not a quick fix as some dentists think. Dr Raj Kumar —Preceding unsigned comment added by Doctor Raj Kumar (talk • contribs) 10:59, 22 April 2010 (UTC)

Costs

I notice that the UK price has been changed. Does anyone have a reference for this? Dentists in the UK seem to be giving a range of 3000 to 6000 pounds [[4]] so I'm wondering if the fee from invisalign should be 2800 pounds rather than dollars and whether there is any support for this?--Vannin (talk) 19:04, 29 November 2007 (UTC)

Well in London they currently cost £2000-3000 pounds. E.g. I got them for £2000 from Holborn Dental Practice. I guess the price has come down recently. Someone should probably updat the page to reflect this 155.198.65.29 (talk) 12:52, 6 March 2009 (UTC) Anterior crowding is usually due to posterior narrowing of the arch. There is rarely space to move the front teeth back to where they should be. So straightening the teeth should involve moving the back teeth if required. The cost of full Invisalign is over 1500 pounds for the dentist, so when a patient receives Invisalign for only 2000 pounds then the chances are that the patient is receiving Invisalign anterior/express etc. The retainers are probably not from Invisalign as they cost over 200 pounds. So it makes me wonder what is the patient getting? In USA Invisalign Anterior and express have been taken off the market. Invisalign full/complete is the way to go. If a dentist is so comfortable with stripping the crowded front teeththen ask them to explain how he/she will be able to create a straight cut between overlaping lower incisors. It is very difficult and usually leads to the loss of the corner of the tooth. I have been charging 3000-4000 pounds for over 6 years and that is all inclusive of full arch Invisalign, minimal interproximal stripping/ no stripping, 3 refinements and now 3 sets of retainers. Private orthodontics should encompass the whole mouth and normally takes about 12-15 months to treat. Only very mild cases will fall in the 2000 bracket, but patients are probably getting their front teeth stripped unnescassarily to create space. I have never had complaints from patients that i have stripped down their teeth. Dr Raj KumarDoctor Raj Kumar (talk) 11:21, 22 April 2010 (UTC)

Bias

Articles about products are particularly vulnerable to being deleted because they are not notable and are simply advertising. The advertising issue has been raised several times on this talk page. We have to be careful not to be totally over the top with biased presentations about this product and it is really important to stay neutral.--Vannin (talk) 15:46, 29 January 2008 (UTC) In my experience it is not about advertising. It is about choice. If a dentist can truly say that Invisalign can help many patients with a nearly invisible, removable system, then so be it. We can all get bogged down with what is the best. Porche or Ferrari? The word has to get out that there are some very experienced dentists out there that can orthdontially correct your smile without the pain of metal braces. It is always difficult to comment on a new product, so that is why after 6 years of use I can gladly say Invisalign works. Dr Raj KumarDoctor Raj Kumar (talk) 11:31, 22 April 2010 (UTC)

A non-sentence

I don't believe that the "sentence" below is a sentence. And if it were, it should be divided up for easier reading.

As with other forms of orthodontic treatments that incorporate a computerized plan with 3D imaging that allows the prospective patient to review the projected results, learn how long the treatment is likely to take, compare different plans, and make a more educated decision about whether or not to use Invisalign.

--Hordaland (talk) 23:17, 13 March 2014 (UTC)

Hordaland, I just found the exact same text on an orthodontist's website, which would seem to suggest it is copyrighted material. I am hesitant to provide a link to said website, as it would OUT the person that added the text as most likely being that orthodontist, but I think it is an easy delete/trim. (FYI, please note my COI disclosure above). CorporateM (Talk) 23:25, 13 March 2014 (UTC)

Introduction

I have a conflict of interest with Invisalign in that I'll be working with Align Technology and their PR agency to help improve the article following COI best practices. My approach is Bright Line(ish), whereby I may fix citations, grammar and spacing, but I will propose important changes on Talk. I will generally use Request Edit and/or only make edits with unambiguous support from non-conflicted editors.

I am currently getting smart on the topic by reading some of the source material, but thought I would introduce myself here and see if there are any editors with an interest in the page that may be interested in collaborating on it later on. Cheers! CorporateM (Talk) 20:58, 9 January 2014 (UTC)

Treatment process

I've helped prepare a Treatment process section intended to replace the current Treatment section at: User:CorporateM/Invisalign.

The proposed draft does not represent a radical change from the current text, but it has a stronger variety of sources, extensive copy-editing, a little more detail, and various corrections. The information about individual products (teen-line and express for example), I think will be better-placed in a different section, and some of the information in paragraph 2 I couldn't find in either of the sources. (I am not an expert, but I didn't think they used rubber bands). I didn't think the image of a blogger with her mouth open was really very informative, so I wanted to replace it with one of the 3D graphics of the patient's teeth that the sources talk a lot about.

Would appreciate any editor willing to spend some time to take a look. CorporateM (Talk) 19:53, 13 March 2014 (UTC)

Request edit (1)

For long-term reference and archiving, I've moved the discussion from the Talk page of the draft to the collapsed section below. The content has been reviewed by Hordaland and user:Anthonyhcole. Per WP:COI, I'd like to request an impartial editor move the draft at user:CorporateM/Invisalign into article-space as a replacement of the current Treatment section. CorporateM (Talk) 20:23, 23 March 2014 (UTC)

from User talk:CorporateM/Invisalign for reference/archives

Suggestions Comma in first sentence after Invisalign  Done Same paragraph, no comma needed (I think) after 'scanner'  Done, though I'm not actually 100% sure which is grammatically correct in 'movements are provided' - should be is, not are  Done in 'that connects the aligner to the tooth', connect seems the wrong word, as the appliance is easily removable  Done - it appears the source says they are "bonded" onto the teeth. I presumed they "latched" onto the aligner in some way, but it sounds they are just used to push off of the aligner. The source doesn't explicitly say how they work. --Hordaland (talk) 23:30, 13 March 2014 (UTC) Thanks Hordaland! CorporateM (Talk) 00:13, 14 March 2014 (UTC) Anthony "On average they are worn for 13.5 months." Does this mean each aligner is in place for 13.5 months, or does the whole aligning process, wth a succession of different aligners, take on average 13.5 months? Ah. That's made clear in the preceding sentence. Still, I'd be inclined to change this to "Each aligner is intended to be worn 20 hours a day for two-to-three weeks, and on average the aligning process takes 13.5 months." No big deal, though. --Anthonyhcole (talk · contribs · email) 07:40, 17 March 2014 (UTC)  Done Anthonyhcole I replaced it with "treatment period". An expert at Align felt "it depends" was the most accurate for number of aligners or treatment period, but these averages are prolific in the source material, so I felt they needed repeating here. CorporateM (Talk) 14:30, 17 March 2014 (UTC)

I've replaced the "Treatment" section with CM's "Treatment process".[5] --Anthonyhcole (talk · contribs · email) 02:26, 29 March 2014 (UTC)

Thanks Anthonyhcole! I was going to replace the image of the blogger with her mouth open with one of a 3D graphic of the patient's teeth in the software. A lot of the sources were talking about this specific graphic produced in the software and IMO the current image just looks the same way anybody does when they are in a dentist's chair. Is that ok or do you prefer the current image? CorporateM (Talk) 02:38, 29 March 2014 (UTC)

CorporateM: The 3D graphic would be much more relevant. The file name in your user space draft was File:Virtual teeth.png but it seems to be a dead link. --Anthonyhcole (talk · contribs · email) 09:55, 29 March 2014 (UTC)

GA preparation

I've prepared a "Comparison to wire braces" section at User:CorporateM/Invisalign that mostly summarizes the two review articles available in PubMed that are less than five years old. I'd like to propose this as a replacement for the current "Cost" and "Medical uses" sections (previously called Comparison to wire braces). I believe this addition will make the page ready for a "Good Article" nomination. There's also a couple misc items there.

If a disinterested editor has the time/interest to consider my work, I would be greatly appreciative of your time! Pinging user:TLSuda, user:Hordaland and user:Anthonyhcole, user:Doc James who have all participated in the article previously.

CorporateM (Talk) 04:33, 11 January 2015 (UTC)

I oppose the replacement of "As of 2005 it is unclear how well Invisalign work as they have not been well studied.[2] No further systematic reviews have been published between 2005 and 2014.[3]" Typically we discuss the evidence for something up front. The overall evidence is not clear as these have been poor studied and thus everything else is in light of that. Doc James (talk · contribs · email) 19:38, 13 January 2015 (UTC)

Additional issues include that the languages does not follow WP:MEDMOS. We use "person" rather than "patient" etc. Doc James (talk · contribs · email) 19:44, 13 January 2015 (UTC)

 Done "patients" swapped out for "people", "individuals" and "Invisalign users". Looking into the other item. CorporateM (Talk) 19:58, 13 January 2015 (UTC)

@user:Doc James: It looks like I put "The only randomized clinical trials in 2005 were inconclusive.[3]". I think this is more concise and better written. Just about every paper I've ever seen on anything usually says the subject has not been adequately studied by way of explaining why they are studying it, but if you feel there is not enough emphasis on this, we could add something like "The efficacy of Invisalign has not been adequately studied"? CorporateM (Talk) 20:08, 13 January 2015 (UTC)

We should write in simple English. Thus "it is unclear how well Invisalign work" is simplier than "the efficacy of Invisalign" Doc James (talk · contribs · email) 03:09, 20 January 2015 (UTC)

@User:Doc James How's this. CorporateM (Talk) 03:43, 20 January 2015 (UTC)

History

I've prepared a "History" and a "Background" section at user:CorporateM/Invisalign that I believe is neutral, well-sourced and an improvement to the page. History is usually one of the most important sections and is currently missing from the article entirely. Because I have a conflict of interest, I would like to defer the decision on whether it warrants inclusion and/or any necessary changes before it's ready for article-space to an independent, impartial editor. Your time is much appreciated in advance. Pinging user:Hordaland, who has shown an interest in the page and user:Anthonyhcole, who helped out previously and has an interest in medical topics. CorporateM (Talk) 13:54, 5 July 2014 (UTC)

As a bit of an update, in the process of discussion with user:John Broughton on the Talk page of the draft at User:CorporateM/Invisalign, the draft is now essentially a proposed replacement of the entire article, with the exception of the over-sized advantages/disadvantages section in the current article that is mostly synth/OR. This can be tacked onto the bottom of the Comparison of section or removed as most of it does not pass muster for medical claims. There is also a debate among orthodontists on the efficacy of Invisalign compared to wire braces and other information regarding medical claims that we'll still need to be sorted out and covered before it will be GA ready. CorporateM (Talk) 22:03, 15 July 2014 (UTC)

I've read through the original article and through the draft. The draft had many more reliable sources and fixed the issues of the original article. Although written by an editor with a declared COI, the article is not written like an advertisement. Instead we have a high-quality neutral article. Cheers, TLSuda (talk) 01:58, 22 July 2014 (UTC)

Agreed. DRosenbach ^{(Talk | Contribs)} 03:57, 21 January 2015 (UTC)

Request edit

I'd like to request:

• Replacing the "Cost" and "Medical uses" section with the "Comparison to wire braces" section located at User:CorporateM/Invisalign
• Replacing a sentence from the Lead with a summary of the medical literature (see specifics at User:CorporateM/Invisalign).
• A few other nick nacks I found in the academic sources (located at the same page).

I believe this should wrap it up and make the page ready for GAN. In case someone does pick up the Request Edit right away, I would like to ask that it wait at least a week to give DocJames a chance to make any edits to the drafted material. CorporateM (Talk) 03:32, 28 March 2015 (UTC)

No per the WP:MEDMOS we use the heading medical uses typically. Cost goes lower in the article. Doc James (talk · contribs · email) 07:08, 9 July 2015 (UTC)

I see that WP:MEDMOS includes medical uses as one of many "suggested headings", but I don't think it's the most appropriate header in this case. It would make sense for a plant, chemical or something else that may have other uses, but in this case it is a manufactured product with no other conceivable use besides a medical one, making it a bit of an awkard header. Almost all of the medical literature is about how it compares to other forms of braces and the general manual of style discourages small sections like the current Cost section. CorporateM (Talk) 07:17, 9 July 2015 (UTC)

We use that heading in hundreds of articles that have no use other than medical. Doc James (talk · contribs · email) 08:01, 9 July 2015 (UTC)

I'm sure you're familiar with WP:OTHERSTUFF and those articles may or may not have medical literature so focused on a specific topic. Also, the content currently under the Treatment Process header would make much more sense as the Medical Uses section than the way it is done now. I'm busy with other stuff right now, but I would suggest we use 3PO as a light-weight way to get a quick second opinion at some point. CorporateM (Talk) 16:22, 9 July 2015 (UTC)

Sure so we disagree. I am your second opinion as you are being paid for this work. Doc James (talk · contribs · email) 18:06, 9 July 2015 (UTC)

I won't do it, at least not right now, as i'm busy and just happened to glance at this before logging off, but i will say that i believe the Medical Uses heading is silly and quite out of place. As CorporateM says, it is not appropriate, for at least a couple of reasons ~ it implies there are other uses, which there aren't, and the section content itself also talks about studies and comfort in addition to uses ~ and OTHERSTUFF is quite rightly invoked. Doc James, don't you think you're being rather dismissive and unhelpful? Cheers, Lindsay^Hello 17:46, 18 July 2015 (UTC)

one could use the argument that "it implies there are other uses" to disqualify 99% of the times the "medical uses" heading is used. IMO that heading orients the reader to the fact that yes this is a medical device or medication.

But this just exemplifies what is wrong with paid editing. Paid editors often want minor changes and wish to redirect other community members towards what they are paid to "improve" They want to not follow guidelines so they can emphasize aspects of the topic that commercial interests want them to emphasis. Doc James (talk · contribs · email) 22:32, 18 July 2015 (UTC)

Just plain "uses" would make more sense than "medical uses". WhatamIdoing (talk) 15:44, 25 July 2015 (UTC)

Personally I think a "Uses" section is just as awkward as "Medical Uses". Invisalign has only one use and most of the medical literature is about how it compares to traditional braces. The original "Comparison of" header was fine and is a common section title when there is a lot of source material making comparisons. Anything about their efficacy, cost, aesthetics, etc. are in the context of compared to using other types of braces. I think this is true of most products that are an alternative to a more common approach. CorporateM (Talk) 17:57, 25 July 2015 (UTC)

Another possibility would be to rename the "Treatment process" section to something like "Medical application". Still awkward IMO (Treatment process is better), but more sensible than the way it is now. That's actually where it's use in medicine is described. CorporateM (Talk) 21:07, 25 July 2015 (UTC)

I'm not sure that devices or procedures that are normally done for cosmetic purposes are properly considered "medicine", even if it involves a person with a medical license. "Medical application" sounds too much like "Non-cosmetic uses" to be appropriate for any kind of orthodontic braces. WhatamIdoing (talk) 22:35, 25 July 2015 (UTC)

Happy with "Uses" Doc James (talk · contribs · email) 23:30, 25 July 2015 (UTC)

BTW if you see serious issues with content I am happy to help address them. Doc James (talk · contribs · email) 22:33, 18 July 2015 (UTC)

@WhatamIdoing: FYI - I noticed in your edit-summary you mentioned the section may need a re-write and I did take a crack at it here. I don't dabble much in medical articles, but based on the criteria Doc provided (review article, impact score above 1, less than five years old), there's literally only about 3 articles with a substantive amount of content about Invisalign that meet the criteria, so seemed pretty easy to just summarize 3 articles. I suspect Doc will have some opinions on it, but wanted to let you know it was there. CorporateM (Talk) 01:16, 26 July 2015 (UTC)

Because I have a COI, I am not allowed to edit in circumstances where there is no clear consensus, so I have started an RFC below in the hopes that a clear consensus will emerge. This should not be meant to indicate that this is a "big deal" or there is some heated argument a-foot, but I merely know of no better way to obtain a clearer consensus one way or another. I'll leave the Request Edit up, since most of the suggested edits in the Request Edit could be fulfilled without conflicting with the topic of the RFC. I'm also going to ping folks that previously participated in this discussion or the article to see if we can get some participants in the RFC that are familiar with the page: @WhatamIdoing:, @Doc James:, @LindsayH:, @John Broughton:, @TLSuda: CorporateM (Talk) 08:12, 30 July 2015 (UTC)

Setting the titles aside, there is other content in the request

We have been asked to view User:CorporateM/Invisalign to consider the changes there. If agreed, these may be performed separately form any discussion on section naming. CM asked me to look at the RFC (below) and the RE (this major section) to see if I was able to comment below and act here. I have commented below, and I do not feel competent to act on the other changes requested. Might knowledgable folk discuss those in this section, please? Fiddle Faddle 07:48, 6 August 2015 (UTC)

Lead

@Doc James: summarized the medical literature in the Lead thusly "As of 2005, it is unclear how well Invisalign work as they have not been well studied.[1] No further systematic reviews have been published between 2005 and 2014.[2]" This gives the article a "nobody knows if it works" tone that one would often find on alt-med articles. While it is technically well-sourced, this seems very far afield from an accurate, neutral representation of the total body of literature.

I suggest replacing it with something more like "Invisalign is probably effective for correcting mild to moderate overbites, underbites, crowding and spacing, but less effective than conventional braces for severe rotations, extrusions and closing extraction spaces. No recent, high-quality, random clinical trials have been published to verify how its effectiveness compares to conventional options"

It is very difficult to talk about what is "representative of the total body of literature" without an expert, so I'm going to see if we can get an expert from Wikiproject Dentistry to verify what the gist of the medical literature is. CorporateM (Talk) 22:38, 9 August 2015 (UTC)

Greetings -- head of the dental project here. Although I am a periodontist and do not personally use Invisalign, I sense that the overwhelming anecdotal evidence from tens of thousands (if not more) of clinical case results provide an adequate basis for stating that Invisalign is, indeed, effective. Unlike medicine, where, at least to some degree, people's lives hang in the balance based on the accumulated results of clinical data, and RCTs are rightfully and necessarily considered as not only the best but the only true endorsement for treatments, therapies, etc., in dentistry, we are not quite as rigorous. Sure, we have our controlled trials and even our meta-analyses, but there's certainly something to say about cumulative life experience even if uncontrolled and unblinded.

In summary, I don't think the qualifier "probably" is appropriate, and we can just go ahead with stating that it is, in fact, effective. But one ought to cite some form of even peer reviewed journal as to what it is effective for, and I cannot speak to this end, as a periodontist who knows nothing of how it is used. DRosenbach ^{(Talk | Contribs)} 03:13, 10 August 2015 (UTC)

The sentence reads "it is unclear how well Invisalign work" which gives the indication that they work but it is not known how much. Doc James (talk · contribs · email) 04:03, 10 August 2015 (UTC)

@DRosenbach: I took a fresh glance at the three review articles in PubMed that are less than five years old and all three seem to support something similar to the proposed article-text. However all three did also point out a need for additional randomized clinical trials to verify. I've revised the proposed text below, but added more doubtful language, rather than less. If you review the sources, I think you'll find this to be reasonable. I can also provide some specific excerpts from the sources if you like to show what I mean.

"Invisalign is probably effective for correcting mild to moderate overbites, underbites, crowding and spacing, but less effective than conventional braces for severe rotations, extrusions and closing extraction spaces. No recent, high-quality, randomized clinical trials have been published to verify how its effectiveness compares to conventional options"

References

The New York State Dental Journal leans more on the negative side, while the Dental Update piece leans more on the positive side, but both basically agree on the proposed text. The sources contain language like "compared to conventional braces" and whether "one intervention was superior to another"[6] or describes in what cases Invisalign can be "a valuable substitute for fixed appliances." The sources don't raise questions as to whether it's effective, but how its effectiveness compares to conventional braces.

References

CorporateM (Talk) 05:16, 10 August 2015 (UTC)

I think the best thing to do would be to obtain the position of an orthodontist. This is all really way too specific for anyone else to comment on. Just like an orthodontist cannot speak to the nitty-gritty details of dental implants, a periodontist cannot speak to the nitty-gritty details of orthodontics. DRosenbach ^{(Talk | Contribs)} 23:49, 10 August 2015 (UTC)

pardon me, but nobody gets to wield personal authority like that in WP. We can all read MEDRS sources and make judgements based on what they say.Jytdog (talk) 00:14, 11 August 2015 (UTC)

The best opinions are those of encyclopedia writers :-) And I believe we have a few around. Doc James (talk · contribs · email) 06:42, 11 August 2015 (UTC)

Section titles/article structure

Which is the superior article-structure and section titles?

(A) The original[7] format with "Treatment Process" and "Comparison to wire braces" sections

(B) The current[8] format with the Comparison section split up into "Uses" or "Medical Uses" and "Cost" and "Treatment Process" renamed to "Application"

The prior discussion on this topic is in the string above. Before the date marked as "Original" the section use to be called "Advantages and Disadvantages", which is another option very similar to the Comparison section. Also please note my COI disclosure. CorporateM (Talk) 07:50, 30 July 2015 (UTC)

• Comment As discussed above, "medical uses" is a common section title for plants, chemicals, etc., but this is a manufactured product with only one use, making the plurality of the section title awkward. Also, there are only three MEDRS-compliant articles in Pubmed that talk about Invisalign substantially and the biggest focus is how they compare to braces, not how they are used in medicine. Since Invisalign is an alternative to braces, it's only natural that comparing them to braces be a topic of substantial interest. CorporateM (Talk) 08:06, 30 July 2015 (UTC)

• Interesting. So this is a medical product applied by a dentist. User:CorporateM is being paid to "improve" the article in question. His version removes a couple of reviews from the lead of the article including this one from 2005 and this one from 2014
• Lets look at a similar article on Dental_implant. It was written by one of our dentist editors User:Ian Furst and begins with a "medical uses" section. This is as recommended by WP:MEDMOS. MEDMOS specifically states that this ordering is recommended for "drugs, treatments, and devices" Wikipedia:Manual_of_Style/Medicine-related_articles#Drugs.2C_treatments.2C_and_devices Doc James (talk · contribs · email) 09:46, 30 July 2015 (UTC)

The "Medical Uses" section on the Dental implant article makes more sense than the one here. It starts with "The primary use of dental implants are to support dental prosthetics". The section is about how it's used in medicine. In comparison, in this case the same title is used for what is more like a Reception section. The comparison would be more accurate if the "Treatment process"/"Application" section was named "Medical uses" because that is more similar to the example section provided. It's unfortunate that editors feel abusing a COI disclosure is the most appropriate way to win an argument. CorporateM (Talk) 16:41, 30 July 2015 (UTC)

The "uses" section here begins with "likely useful for tooth crowding of the front teeth that is of a moderate degree". This is what the device is used for thus I do not see what the issue is. This is also the layout of dozens of other similar articles. Doc James (talk · contribs · email) 07:05, 31 July 2015 (UTC)

However, this is all "Comparison of" content: "...it is likely not as good as conventional braces. Additionally the teeth more often become misaligned again...Invisalign are probably more noticeable than lingual braces. They are, however, likely more comfortable." Being "more comfortable" is not a "medical use", it's a comparison, which is also a very common section name. It also creates a straggling Cost section that could be better integrated into a Comparison section. CorporateM (Talk) 08:38, 31 July 2015 (UTC)

Under medical uses we typically discuss comparative effectiveness yes. Doc James (talk · contribs · email) 10:17, 31 July 2015 (UTC)

• So CorporateM asked me to give my input on the RfC. The main issue I have with the structure is that the sections "Uses" and "Cost" are very short. If I were to do a GA review, that would give me pause, so something needs to be done about that. I'm not familiar with WP:MEDMOS and compliance with it isn't required for GA (or FA, I think, but I may be wrong), so I think serious consideration needs to be given to the combination of the two sections. And CorporateM and others have made a very strong point that invasalign was made with the express purpose of being a replacement for wire braces; that is how they are marketed, that is how people are familiar with them, so it is not unreasonable to have a section explicitly comparing them to wire braces. Since that is what "Uses" and "Cost" already do, why not combine them under that heading? Like WP:IAR says, if something, in this case WP:MEDMOS, is preventing us from improving the article, we should really consider ignoring it in this case. So I think, right now, that a "comparison" section makes more sense from a layman's perspective. Wugapodes (talk) 18:37, 3 August 2015 (UTC)
• I have no expertise in this area, so I must rely on WP:MEDMOS. I have no experience at all in medical articles. think what we might be discussing is the usage of the plural where there is only a singular deployment of the device. My view is thus that we go with MEDMOS but consider the singular in the section title.

For the reader, either way works, and works well. Fiddle Faddle 07:02, 6 August 2015 (UTC)

• Thanks User:Timtrent agree single it should be. Doc James (talk · contribs · email) 13:09, 7 August 2015 (UTC)

@Timtrent:@Doc James: Isn't it redundant to have one section called "Use" and another called "Application"? If one section is about how it's "used" and another section is about how it's "applied", I think that's basically the same thing. CorporateM (Talk) 17:30, 7 August 2015 (UTC)

@CorporateM: I am out of my depth here, so all I have is logic. "Use" is, or might be, how it is used, whereas "Application" is, or might be, how the device is applied in order to be used. It is a subtle distinction, I agree, like that between using and utilising a thing. Fiddle Faddle 21:15, 7 August 2015 (UTC)

It is similar to how we have one section for "causes" and one for "mechanisms". We have sections for what something is used for and the evidence for that use "medical uses" and a section for how that something does its work or is carried out "Technique or application or mechanism". Please read WP:MEDMOS Doc James (talk · contribs · email) 05:58, 8 August 2015 (UTC)

@Doc James: I'm not sure I understand why you feel WP:MEDMOS supports your point of view so strongly. "Medical uses" is just one of many "suggested" titles and I am not opposed to using that title for the section that is about how the product is used. Also, it says right at the top of WP:MEDSECTIONS that the suggested titles are "intended to help structure a new article or when an existing article requires a substantial rewrite. Changing an established article simply to fit these guidelines might not be welcomed by other editors." I feel like the discussion (including Lindsay's comment above, though it wasn't technically added to this RFC), is leaning against the current structure and we should be able to hammer something out that makes more sense. Or at least, that's my pep talk at 4 a.m., when I'm not thinking clearly ;-) CorporateM (Talk) 08:07, 8 August 2015 (UTC)

I have spent a fair bit of time arranging articles per our MOS and likely done this with a few thousand. I have had students tell me that having consistent formatting is useful. I know that it is useful as an editor. Doc James (talk · contribs · email) 08:22, 8 August 2015 (UTC)

One thing that might work for everyone is "Orthodontic use" with a sub-section on "Reception". This is less sensible in my view. "Comparison to" is a more exact description, but it may appeal to your desire to have fairly standardized section names and would make enough sense not to be severely problematic IMO. CorporateM (Talk) 15:53, 8 August 2015 (UTC)

"Dental use" would work. We need to keep the headings in easier to understand english. Doc James (talk · contribs · email) 16:50, 8 August 2015 (UTC)

 Done. Does that work for everyone? It's not the way I would have done it. I thought orthodontics was pretty plain English and more specific than dental too. But I think it's at least sensible enough not to be worthwhile to spend energy arguing over it. CorporateM (Talk) 17:17, 8 August 2015 (UTC)

I was saying changing the heading from "uses" to "dental uses" was fine. Sure we can add the application information as a subsection. Costs go lower in the article typically. Doc James (talk · contribs · email) 04:08, 9 August 2015 (UTC)

@Doc James: I don't feel you are editing in a manner that is representative of the discussion. @Wugapodes: agreed that a separate Cost section was awkward and would give him pause during a GA review. When your reasoning of citing MEDMOS was shot down, you simply came up with other reasons. @LindsayH: above also indicated concerns that you were being "dismissive and unhelpful". I think discussion has been leaning against your preferred article-structure, but you continue to insist on it anyway. This is especially frustrating because I cannot edit-war with you, which would normally lead to escalation to the Edit-Warring board, who would decide who is editing within consensus. Maybe there isn't an overwhelmingly clear consensus (there almost never is), but don't you think you are digging in your heals a bit here and preventing the article from meeting GA standards? CorporateM (Talk) 15:37, 9 August 2015 (UTC)

Per "preventing the article from meeting GA standards". If the article does not follow WP:MEDMOS it does not meet GA standards. Doc James (talk · contribs · email) 03:58, 10 August 2015 (UTC)

• I can think of no case where there has ever been any scrutiny to the section titles of any health related articles, and consequently, anyone supported anything other than the standard WP:MEDMOS articles. People have offered alternative orders, and maybe sometimes those have been implemented, but so far as I know, never with the backing of consensus and especially not the consensus of WikiProject Medicine. I can think of several options for going forward in this case -
  • Rearrange the article to match the section titles in Wikipedia:Manual_of_Style/Medicine-related_articles#Drugs.2C_treatments.2C_and_devices (least surprising way forward)
  • Do something different only for this article (an extraordinary action - community support unlikely)
  • Write an addendum to MEDMOS policy for why this is different - requires extraordinary insight and new ideas in a space where many new ideas have already been tested

Wikipedia is mostly developed by routinized processes and when articles are most routine they give the least pause on review. There is no way to use a new format without perpetually inviting question. Personally if I had content which did not fit the usual section titles then I most likely would force it to fit. Blue Rasberry (talk) 23:38, 9 August 2015 (UTC)

@Bluerasberry: To clarify, one version of the article-structure could be:

Dental use

Comparison to wire braces or Reception

Whereas another could be:

Dental use

Application

...

Cost

I would think MEDMOS would be supportive of either. For example, one topic of discussion is whether a separate Cost section is needed for such a small article, rather than consolidating it into a Comparison section. Costs are mostly discussed in comparison to traditional braces options and it's the primary shortcoming of using Invisalign compared to another product. Really small sections are generally discouraged. CorporateM (Talk) 02:57, 10 August 2015 (UTC)

Not sure what "Reception" means or what you are proposing. Why are you recommending "Dental Use" with caps for both terms? This is definately not supported by WP:MOS.Doc James (talk · contribs · email) 04:06, 10 August 2015 (UTC)

I would prefer "Comparison to wire braces"; such "Comparison to" sections are very common when there is a lot of source material that compares the product to alternatives, as is the case here. For years before I improved the article it use to be called "Advantages and disadvantages", which is also fine. The titlecaps was just a typo. CorporateM (Talk) 05:27, 10 August 2015 (UTC)

Much of the discussion of research / lack thereof is not a comparison to anything. Doc James (talk · contribs · email) 06:44, 11 August 2015 (UTC)

Lead copyediting

I noticed @Sunrise:'s edit-summary here, so I went ahead and added some annotations in an attempt to highlight some of the things I was referring to in the Lead. The sources have plenty of content to say specifically what is meant by "some cases". We have much more recent sources than 2005 to verify not enough research has been done. The "weight" tag was really just referring to those two sentences having a very similar meaning and being a good candidate for combining and copyediting (I couldn't find any better tags). I hope this helps. CorporateM (Talk) 04:20, 15 August 2015 (UTC)

I've started and will continue to do a little copy editing with out change in content meaning.(Littleolive oil (talk) 16:20, 15 August 2015 (UTC))

Strangeness

User:CorporateM Okay so you state the 2005 systematic review needs to be updated.[9] And than state the fact that no further systematic reviews have been done is undue weight? Doc James (talk · contribs · email) 16:41, 15 August 2015 (UTC)

In the post above this one I explained that I couldn't find a better tag to explain what I meant. I would appreciate it if you didn't remove my annotations as you did here, without discussion. This makes it very difficult to discuss the article. @Littleolive oil: has started doing some copyediting and the article looks better as a result. CorporateM (Talk) 17:55, 15 August 2015 (UTC)

That is the most recent systematic review. Thus it does not need updating. Your tagging is disruptive. Doc James (talk · contribs · email) 18:20, 15 August 2015 (UTC)

A systematic review is different than the other literature reviews that are more recent. Thus it is still notable. Are you able to provide a more recent systmatic review of this product? If you cannot do not tag the article again. Doc James (talk · contribs · email) 18:31, 15 August 2015 (UTC)

We do have this systematic review from 2013 which is excellent but it is much narrowing in scope [10] Doc James (talk · contribs · email) 19:08, 15 August 2015 (UTC)

The article is now protected, but Doc and I seem to be close to reaching agreement on some changes that could be submitted through an edit-request if needed. At the edit-warring board we discussed changing the following text:

"as of 2005 it was unclear how well Invisalign worked because it had not been well studied.[2] Between 2005 and 2014 no further systematic reviews had been published.[1]"

to something like:

"As of 2014, the last systematic review of Invisalign was in 2005."

Note that I kept the original 2005 citation in there to supplement the 2014 source that refers to it.

I also noticed we didn't discuss the text "it is unclear how well it works". I think Doc may be getting this from the original 2005 source? If you read current sources, they will say that (while more research is needed to verify), Invisalign is considered effective for mild to moderate cases. But back in 2005, Invisalign was controversial and the product was not well-developed yet. Current sources describe the 2005 source as "inconclusive" but I find this to be an odd description, because it definitively showed that conventional braces produced far superior results. However, the product has changed a lot over the last ten years, in materials, process, training, computer support, etc.

I think we can work this out in the article body. "Recent articles say that it is good for mild to moderate cases.... but no high-quality randomized clinical trials have been done. The last systematic review in 2005 was inconclusive." That sort of thing. CorporateM (Talk) 22:02, 15 August 2015 (UTC)

How about "As of 2014, the last systematic review of Invisalign was in 2005.[4][1] This review concluded that it was unclear how well Invisalign works.[1]" Doc James (talk · contribs · email) 22:22, 15 August 2015 (UTC)

The issue we seem to have is you want to downplay the lack of evidence and up play expert opinion. We typically do it the other way around for medical topics. The evidence or lack thereof leads first. Than one can touch on expert opinion. Doc James (talk · contribs · email) 22:27, 15 August 2015 (UTC)

Just to be clear, I was making a general comment about how both current consensus among dentists, and the more historical assessment, could be combined in the article body. Re-reading my comment, I think I understand why Doc misunderstood my comment "I think we can work this out in the article body" to mean that I meant only in the article-body, but my intention was not to make any specific suggestion for the Lead. Basically everything after "I think Doc may be getting this from the original 2005 source?" was just me rambling. The main point was that we didn't discuss those few words and then I went on a rant about the general topic. Sometimes my comments are more like random ramblings, because they tend to just flow from my fingertips. My apologies for any confusion. CorporateM (Talk) 23:10, 15 August 2015 (UTC)

Maybe something like "As of 2014 the evidence for invisalign is poor. Some opinion supports its use for certain dental problems such as front teeth crowding." Doc James (talk · contribs · email) 23:39, 15 August 2015 (UTC)

Doc, I think the best way forward would be for both of us to wait a week or two to see if other editors choose to get involved. There is WP:NORUSH and a few editors like @Littleolive oil: have shown an interest in editing the page. There are only three MEDRS sources and as a basic dental device, the sources do not require a medical expert to understand. I had to look up what malocclusion meant (overbite/underbite). Nobody could participate in the discussion in a meaningful way without reading them and we need to give them time to do so (after the article is unlocked). Plus, I think we both have other stuff to do besides squabble here indefinitely ;-). So lets give some other editors a chance. CorporateM (Talk) 23:50, 15 August 2015 (UTC)

Citation 3

Hi All. Slimvirgin was able to find a link to the full-text of citation 3 here.

She said the source indicated the "lower front teeth relapse is a major issue" and "there is no high-quality evidence to show what is effective." I see it has a sub-section on Invisalign, but from my perspective the tone of the source was very different than she depicted.

Now that we have a link to the full text, it would be great to get more eyes on this source. Thanks. CorporateM (Talk) 03:12, 17 August 2015 (UTC)

I think "no high-quality evidence about efficacy [for lower front teeth relapse]" is a reasonable conclusion from the following quote: "The primary benefit of the Invisalign system is the superior aesthetic during treatment compared to metal brackets. Other advantages of the system include: the ability to remove aligners to eat, brush and floss, the superior comfort, and ease of use (Invisalign 2006). Based on case reports, this technique appears effective in treating mild malocclusions and is more visually appealing than conventional brackets." The advantages are described as related to aesthetics or convenience, and the implication is that there isn't any evidence on effectiveness beyond case reports. To address your comment on tone, it could certainly be used to source the other information as well, though my impression was that the issue being disputed was the effectiveness claims. Sunrise (talk) 04:26, 17 August 2015 (UTC)

At least from my perspective, I am not specifically focused on effectiveness claims. The aesthetics item for example is something I raised before and is basically the whole idea behind Invisalign, but is not currently mentioned. That was the purpose of this image that is now in the Cost section for some reason. Your depiction of effectiveness though is aligned with my understanding of it. Considering there are only a few sources, one way to proceed might be to discuss one source at-a-time and incorporate all relevant content from each. CorporateM (Talk) 05:25, 17 August 2015 (UTC)

There is also this article in the Journal of the Canadian Dental Association, 2007. I don't know whether that's too old. Sarah ^(talk) 06:01, 17 August 2015 (UTC)

WP:MEDDATE says to "Look for reviews published in the last five years or so". There are three Review articles in PubMed that are under five years old, so that's why I keep harping on three sources. If you're looking to make sure any limitations are included though, the New York Dental Journal is the most critical of the three and is from 2014. It also discusses the limitations and may be able to support very similar article-content using a more up-to-date source. CorporateM (Talk) 06:27, 17 August 2015 (UTC)

Rewrite

CorporateM, could you list here the issues that were removed from the previous version (March 2014, before the rewrite). It would be good to have an overview regarding what was added and removed, and to what extent position changes have affected the impression readers get. For example, the class-action suit over the quota requirement (ten prescriptions a year) seems a major issue, [11] but is no longer prominent. Sarah ^(talk) 20:52, 16 August 2015 (UTC)

It does have some significance. This is currently covered in the History section and judging by the text I must not have been able to find out how it resolved. In the original the majority of the Lead was focused on lawsuits and some of it was obviously written by someone involved or with a strong view. However, the current article probably swung too far in the opposite direction and could use more text on this.

As far as other changes, the original didn't have a History section or anything about the manufacturer, Align Technology. Per WP:ORGVANITY, Align Technology is primarily known for producing Invisalign, so I think it makes sense to combine the two subjects, rather than a separate article on the company. Nothing from the original Advantages and Disadvantages section was kept. It was filled with original synthesis where editors read one study about braces and another study on Invisalign and combined the two sources to create their own conclusions. I don't think the treatment section was changed significantly in tone, just in sources, completeness, etc.. Finally, the original Cost section was filled with OR and a primary source, which was replaced with sourced information. CorporateM (Talk) 22:59, 16 August 2015 (UTC)

Sarah, if you can give me a minute, I can look up sources on that class-action lawsuit for you and/or do anything else to help make sure it gets more coverage. It was way over-the-top undue and not NPOV originally, but I didn't notice that I marginalized it to such a great extent. CorporateM (Talk) 23:02, 16 August 2015 (UTC)

CM, did you find that material? It's not so much the lawsuit that matters, as the issue of dentists being required to prescribe a certain number a year. Sarah ^(talk) 21:28, 17 August 2015 (UTC)

Sorry, one more thing, I was looking at the original Advantages/Disadvantages section. A lot of it is junk sources (company website, some vendor), others are SYNTH and others are primary sources from a MEDRS perspective, but it does have a great summary of the 2005 report we've been discussing: "In a systematic review of the literature, published in the Journal of the American Dental Association in 2005,[17] Drs. Manual Lagravere and Carlos Flores-Mir were unable to draw strong conclusions about the effectiveness of the Invisalign system. They pointed to the need for randomized clinical trials.[17]"

This section was removed in its entirety, because so much of it is junk. But the Scientific Studies section, while not being properly sourced, is pretty similar to what a properly-sourced section would look like. CorporateM (Talk) 23:30, 16 August 2015 (UTC)

Noting here how the article changed:

• CorporateM posted on 9 January 2014 that he had been hired by a PR firm to work on the article. [12]
• This was the article on that date.
• CM began a rewrite, which was moved into the article in two edits: by Anthonyhcole on 29 March 2014 (requested here), and by TLSuda on 22 July 2014 (requested here). CM made some direct edits in January and August 2015. [13][14][15][16][17][18][19][20][21][22] Sarah ^(talk) 21:26, 17 August 2015 (UTC)

Provider status lawsuit

Hi All. Currently the article states the following under the History section:

"In 2009, Align Technology began to require that doctors prescribing Invisalign complete at least ten cases per year and ten hours of training in order to maintain their Invisalign provider status. In January 2010, 20,000 doctors had their certification suspended for not meeting the requirements, but a class action lawsuit regarding providers that paid for training under the original rules resulted in some certifications being re-instated.

The original article before my involvement had the following in the Lead:

"Align Technology is also defending a class action suit on behalf of dentists and orthodontists who were suddenly dropped as approved Invisalign providers because they failed to meet a never-before-mentioned quota requirement. After prescribing doctors paid thousands of dollars each for Invisalign training, Align Technology unilaterally implemented a requirement that every provider start at least 10 new cases a year. The doctors are seeking a refund of the training cost because the training has no utility except in the prescription of Invisalign products."

@Slimvirgin: has expressed concern that this wasn't an improvement and/or that the lawsuit has been unreasonably marginalized and asked me to provide any additional sources that could be used to add more information. I searched Google, my library's online database and the in-depth sources I have like a 3-page entry in The International Directory of Company Histories and a book called "The Invisalign System". Besides blurbs, press releases, and trivial sources, I did dig up this piece in a niche publication that explains more prominently that there was also a cash settlement involved in addition to the change in rules. CorporateM (Talk) 23:38, 17 August 2015 (UTC)

Thank you for the sources, though I can't see the highbeam one. If the company still requires dentists to prescribe ten a year to maintain their status as providers, that shouldn't be in history, so the question is whether it is still a requirement. Sarah ^(talk) 00:59, 18 August 2015 (UTC)

Please use quote parameter

I would request editors attention be drawn to the |quote= parameter that can be used with citation templates (see Help:Citation_Style_1#Quote). Using quote you can directly quote the sentence or sentences that support a statement. This can save others a lot of time verifying that the sources actually support the statement. Currently the article uses no quote parameters at all. Jason Quinn (talk) 10:22, 17 August 2015 (UTC)

Agree it is a good idea. Doc James (talk · contribs · email) 16:38, 18 August 2015 (UTC)

Systematic review not summarised

Given the arguing over the lead, it is a bit strange that the systematic review is only cited there. The lead should be summarising the body of the text and it's difficult for me to judge whether the current wording is representative when the opinions of the systematic review aren't included in elsewhere. I will try to look at the reivew later on, but summarising it in the body should be the first priority rather than the lead. SmartSE (talk) 12:02, 16 August 2015 (UTC)

Agree. Was initially in the body and the lead as added here [23].

It was removed from the body in this edit [24] in July. Likely should be returned. Doc James (talk · contribs · email) 13:20, 16 August 2015 (UTC)

I agree. Also, more information can be added to the Dental Use section in general about quite a few topics. I was surprised this source was used to say that there was "no evidence" that Invisalign works. What the source actually says is that "there was no evidence from RCTs to show that one intervention was superior to another." In other words, they are all equally effective for managing relapse of the lower front teeth. It also mentions that Invisalign is more noticeable than lingual options, but not that it is less noticeable than conventional braces (the whole point of the product).

Regarding the lack of high-quality research, I think a couple/few sentences could be devoted to it in the body. The New York Dental Journal says "A look at the published research on the Invisalign technique reveals mixed results. The last systematic review was in 2005, and it yielded inconclusive results - another published review is overdue. Invisalign has been proven to resolve..." The Dental update piece says "Clinical studies with Invisalign therapy have begun to quantify treatment efficacy, but to date no randomized clinical trials have been undertaken."

The section needs some general expansion and other work. CorporateM (Talk) 16:55, 16 August 2015 (UTC)

How does no evidence equal "In other words, they are all equally effective for managing relapse of the lower front teeth." Doc James (talk · contribs · email) 21:02, 17 August 2015 (UTC)

• It doesn't, though it doesn't mean that the product doesn't work either. We'd have to be careful. With something like this I'd rewrite the sentence to be "A 2013 study found no evidence that Invasalign was superior to other interventions" or something similar. — Chris Woodrich (talk) 05:52, 18 August 2015 (UTC)

Yes, Chris Woodrich worded it better. There is no evidence that any treatment is better/worse than any other. That same sources says "Based on case reports, this technique appears effective in treating mild malocclusions and is more visually appealing than conventional brackets" CorporateM (Talk) 06:02, 18 August 2015 (UTC)

What it says is "A 2013 Cochrane review found no high-quality evidence with respect to the management of the recurrence of lower front teeth misalignment following prior treatment"[25] which is what we have right now. Doc James (talk · contribs · email) 15:52, 18 August 2015 (UTC)

• Although that is perfectly acceptable journal language, considering this is both a piece of medical technology and a consumer product, per MOS:JARGON I hope that we can simplify the language without making it inaccurate. The question to "does it work or not" should have an easier to parse answer, since that's what most members of the general public are probably looking for. — Chris Woodrich (talk) 02:00, 20 August 2015 (UTC)

There is no high quality evidence that it works. There is some low quality and thus tentative evidence that it is useful for a few dental issues. Doc James (talk · contribs · email) 05:32, 21 August 2015 (UTC)

Per WP:MEDMOS

I have moved the article to the generic term as per WP:MEDMOS and merged in the other brandname for this product.

Also updated with the 2014 systematic review. Doc James (talk · contribs · email) 05:26, 21 August 2015 (UTC)

Wondering if there was consensus for this move. I have only copyedited in a few places so have no strong feeling one way or the other, but others had been working consistently on the Invisalign article and may feel differently.(Littleolive oil (talk) 14:49, 21 August 2015 (UTC))

There is consensus to move brand names to the generic terms yes. There are a number of discussions such as [26].

Other examples include Cryolipolysis which is under the generic name not one of the brandnames Doc James (talk · contribs · email) 15:31, 21 August 2015 (UTC)

I meant consensus on this specific article. Might be concerning to have an article lifted out from under you when working on it. A notice might have been a good idea in hindsight, which is of course always 20/20 (Littleolive oil (talk) 17:13, 21 August 2015 (UTC))

Happy to start a RfC on this issue if people wish. Saw it as a fairly non controversial move. But yes others might see it otherwise I agree. Doc James (talk · contribs ·

email) 19:08, 21 August 2015 (UTC)

I doubt its a big deal to either undo the edit or to leave it as was per the editors working on the article. Is it? I copyedited and left so I would be fine either way.(Littleolive oil (talk) 19:14, 21 August 2015 (UTC))

It makes sense to use the generic name and deal with them in one article, particularly as one person developed two of the brands. Sarah ^(talk) 19:16, 21 August 2015 (UTC)

Sources

The lead ends with "By 2012, there had been two million Invisalign patients and most dentists and orthodontists in North America had been trained on the Invisalign system." This isn't sourced. Elsewhere in the article the partial sentence "which grew to two million by 2012" is sourced to "Align Technology, Inc. SWOT Analysis. (2013). 1-8" (which is used 11 times).

We need an independent source for this, or at least a more accessible one. There are 204,846 dentists in the US, according to this, so if most dentists and orthodontists in North America are providers, and if they're all required to prescribe Invisalign 10 times a year (or they were until recently), there would be more than two million patients. Perhaps a distinction is being drawn between dentists trained and dentists who are providers (or perhaps I've misunderstood something), but we need a better source regardless. Sarah ^(talk) 02:34, 20 August 2015 (UTC)

I've replaced this with the 2014 article from the New York State Dental Journal, which cites the company: "As of 2014, according to the company, 2.4 million patients around the world had been treated with Invisalign and 80,000 dentists had been trained how to use it." If the company offers more recent figures, we can update. Sarah ^(talk) 17:39, 20 August 2015 (UTC)

• This source – Align Technology, Inc. SWOT Analysis. (2013). 1-8. – is used 11 times, with no indication of how to find it or whether it's a primary source (I assume it is), so I'm going to remove anything sourced to it. Leaving this note in case there are objections. Sarah ^(talk) 20:09, 2 September 2015 (UTC)

• There are also news sources being used to support medical information, so I'll be removing those too, in case anyone wonders why. Sarah ^(talk) 23:02, 2 September 2015 (UTC)

SmileCareClub - Missing provider?

SmileCareClub - see https://smilecareclub.com/about. Anyone up for adding it? --Elvey^(t•c) 17:12, 31 October 2015 (UTC)

I summarize: SmileCareClub Invisible Aligner Therapy is FDA-approved* and intended to be a more efficient alternative to the competition in the invisible aligner market, for less than half the price. Jordan Katzman and Alex Fenkell cofounded the company. Someone willing to work this into the article?

• From their FAQ: "We are FDA-Approved as a Repackager/Relabeler. This means that we rebrand and repackage the FDA-approved invisible aligners from our partnering orthodontic lab. Our registration number is 3009498016."

--Elvey^(t•c) 17:12, 31 October 2015 (UTC)

I went ahead and added some pricing, and instead of joining the conversation here, Alex edit warred, reverting me. Lame. --Elvey^(t•c) 18:46, 31 October 2015 (UTC)

I removed the pricing information "Encyclopedic significance may be indicated if mainstream media sources (not just product reviews) provide commentary on these details instead of just passing mention. Prices and product availability can vary widely from place to place and over time."--Adam in MO Talk 10:01, 1 November 2015 (UTC)

Promotions

@Alexbrn + @Unbraceyourself: The ClearCaps material in this edit is far too promotional and will be removed (it's been reverted four times by three editors now). However, I see why Unbraceyourself believes that it's ok to drop adverts here because that has skilfully been done for another product. I don't have time to clean it up at the moment, but if it hasn't been fixed in a day or two I might remove the File:Woman wearing Invisalign.jpg spam magnet and any other undue text I can see, while doing the same for the new material. Thoughts? Johnuniq (talk) 10:32, 13 November 2015 (UTC)

Agree, there's way too much corporate noise in this article. It could do with a good trim. Alexbrn (talk) 11:49, 13 November 2015 (UTC)

I made some bold edits to remove the two company infoboxes which appear as if they were remnants from earlier attempts to make separate articles—they add no encyclopedic value here. I kept the image Woman wearing Invisalign but would be happy to see it go—it is far too decorative for an illustrative purpose, and I cannot see any reliable source identifying what it portrays. What is needed is an image with a source that can verify that what is displayed is typical for the device. Johnuniq (talk) 06:51, 14 November 2015 (UTC)

Hi John and Alex, I think readers will appreciate an image of someone wearing an aligner. A closer crop (right) would be more useful, so they can see the aligner. It could be cropped even more to focus on the mouth. SarahSV ^(talk) 14:26, 14 November 2015 (UTC)

Forgot to ping: Alexbrn, Johnuniq. SarahSV ^(talk) 14:27, 14 November 2015 (UTC)

@SarahSV: Thanks, I put that in the article for a trial. I think it looks better. For a comparison, see the previous version and the current version. I also changed the caption since there is no good source concerning what the image shows, and there is no need for this article to pick a particular brand. Johnuniq (talk) 03:27, 15 November 2015 (UTC)

Hi John, that does look better, and making the caption generic is a good idea given the lack of an RS. SarahSV ^(talk) 04:37, 15 November 2015 (UTC)

Good stuff, SarahSV. Right after I urged Alexbrn to "Respect WP:DONTREVERT", he DISrespected it, with a revert that even removed information sourced to the New York Times, and the Times reference BAM! This shortcuts an attempt to provide some balance using the well at 'the grey lady' as an independent reliable source. I think the concern about spam magnets is adequately addressed by the in-line comment John recently added; there are only a handful of companies in this space, besides. What of my Cost section edits can we keep? --Elvey^(t•c) 08:07, 21 November 2015 (UTC)

Lots of poorly-sourced pricing information (spammy) and a single line "The New York Times" on its own, without even a full stop. What were you thinking? BTW, you don't get to insist that your edits can't be touched, especially ones like this! Alexbrn (talk) 08:34, 21 November 2015 (UTC)

Idiotic, ignorant comment not based in policy or reality. I certainly didn't insist my edits can't be touched. AGAIN: READ and Respect WP:DONTREVERT. See your mistake? You don't get to insist that you can edit war with impunity. If you don't shape up, I will find it difficult to interact with you further.--Elvey^(t•c) 08:53, 21 November 2015 (UTC)

You're quoting somebody's essay; WP:OWN is policy. I will revert crappy edits as it improves (or at least doesn't worsen) Wikipedia. Alexbrn (talk) 09:02, 21 November 2015 (UTC)

First things first. You're lying; I didn't insist my edits can't be touched. Stop saying I did. Please explain what's wrong with each of the sources you removed, one by one. I think the pricing on CrystalBraces is adequately sourced. Have you read the source article in full? --Elvey^(t•c) 09:05, 21 November 2015 (UTC) Hello? Alexbrn? --Elvey^(t•c) 10:15, 21 November 2015 (UTC)

Articles do not record prices unless there is some encyclopedic purpose—see WP:NOTCATALOG#5. Elvey's first edit introduced a lot of product details including pricing which approaches a how-to guide or price-comparison service for consumers. When reverted, Elvey's second edit was to tag-bomb the article. Tags are not intended for retribution. Johnuniq (talk) 09:19, 21 November 2015 (UTC)

I think the pricing on CrystalBraces is adequately sourced and the source makes clear the encyclopedic purpose is met. Have you read the source article in full, Johnuniq? It's MOSTLY ABOUT PRICING. The tags were all appropriate and not retribution at all. AGF. I don't claim my edit was perfect. I claim the total revert did not respect WP:DONTREVERT. Which, like WP:PRICES is an essay. WP:NOTCATALOG#5 isn't even a working link. And because iPhone pricing details!!! Must you insist that no collaboration whatsoever is possible?--Elvey^(t•c) 10:15, 21 November 2015 (UTC)

In what way is the link WP:NOTCATALOG#5 not working? Clicking it (if scripting is enabled in the browser, as is required for all shortcuts) goes to Wikipedia:What Wikipedia is not#Wikipedia is not a directory where item #5 says "An article should not include product pricing or availability information unless there is a source and a justified reason for the mention" and more. WP:NOTCATALOG is policy. The source is from blogs.nytimes.com which is from a great media outlet but is still a blog. The essence of the source is that people want a cheap way to straighten their teeth without the cost/hassle of a proper dental examination, and various options are available, some of which may damage teeth. The same thing could be said about a lot of products/procedures—it's unlikely that any Wikipedia article discusses the options and costs of getting a car serviced, for example.

May I suggest that making an edit without adding any tags, then adding three tags three hours after being reverted might look like irritation is being expressed, aka retribution. It's probably best to skip adding tags under conditions like that. I don't care if the article is tagged, but for the record such tags must be justified on this talk page, and Template:POV#When to remove says the POV tag may be removed because there no justification has been given, and the same principle applies to the other tags. Johnuniq (talk) 10:01, 22 November 2015 (UTC)

As the tag-bomber hasn't attempted to explain the reasoning behind the tags, I have removed them. If you care enough to tag the article then please justify the tags on the talk page. --Adam in MO Talk 12:11, 22 November 2015 (UTC)

SmileCareClub, ClearCaps and CrystalBraces & tags

All references to SmileCareClub and CrystalBraces, as well as any (references to sources of info on) the pros and cons of such systems have been excised from the article. This stuff should be covered. Hence the POV and related tags.--Elvey^(t•c) 19:01, 22 November 2015 (UTC)

Doubtful, in the absence of adequate depth of sourcing. And don't tag the article to hold it hostage until you get your way. Alexbrn (talk) 19:09, 22 November 2015 (UTC)

What's doubtful? I see you've re-removed the tags. Both systems do include a dental examination, IIRC. <sarcasm>But let's keep that and everything else about them, including their existence, secret. </> --Elvey^(t•c) 19:14, 22 November 2015 (UTC)

The need for inclusion of that stuff is doubtful. We should be digesting and relaying accepted knowledge: that which has been digested in the best sources, not scraping around for incidentals. Your sarcasm is another unhelpful contribution. Alexbrn (talk) 19:20, 22 November 2015 (UTC)

We should be NEUTRAL. I give up.--Elvey^(t•c) 19:22, 22 November 2015 (UTC)

Neutrality means accurately representing what the reliable sources say. Sometimes there really aren't two sides to a story. I think we have a clear community consensus on the tags. One editor for them and three against. It wouldn't be good for the editor who reintroduces them. --Adam in MO Talk 02:11, 23 November 2015 (UTC)

If an heretofore uninvolved user reintroduced, you would make good on your threat how and why, Adam in MO?--Elvey^(t•c) 01:53, 3 December 2015 (UTC)

Doc James, I believe that we routinely include all the brand names under which a given drug is sold in the article on the drug. (Right? Appropriate?) Wouldn't it be appropriate to include all the brand names under which a given medical device is sold in the article on the medical device too? --Elvey^(t•c) 02:29, 3 December 2015 (UTC) If it's true, as the article indicates, that "Align paid OrthoClear $20 million and OrthoClear agreed to end its operations", then eliminating the competition from this article would surely be worth a great deal of money.--Elvey^(t•c) 15:33, 4 December 2015 (UTC)

Litigation

There isn't even any mention of their names despite the litigation among them. You can't seriously claim there isn't adequate sourcing available documenting that litigation. Right?--Elvey^(t•c) 19:22, 22 November 2015 (UTC)

Sources? Alexbrn (talk) 19:25, 22 November 2015 (UTC)

The lawsuits themselves are sources, FS. Plus: RS mentioning SmileCareClub and CrystalBraces were given - in edits that were reverted. For ClearCaps in edits that you reverted. (example diff) Don't dissemble. For litigation specifically, http://investor.aligntech.com/releasedetail.cfm?ReleaseID=938030 (RS for this purpose WRT SmileCareClub) and/or http://money.cnn.com/news/newsfeeds/articles/marketwire/1233247.htm and/or http://www.fool.com/investing/general/2015/10/24/align-technology-inc-all-smiles-over-q3-results.aspx - and the latter notes that "some of Align's key patents expire in 2017"--Elvey^(t•c) 01:53, 3 December 2015 (UTC)

Primary sources then? Come back if/when there are secondaries to help establish due weight... Alexbrn (talk) 06:47, 3 December 2015 (UTC)

Wow, that's the height of dishonesty. I gave multiple secondary sources as well, and yet you claim that there are no secondaries to help establish due weight. How ostrich-like. How is that not an NPOV violation? Three of you insist the article not name any of these brands of clear aligners, despite plenty of coverage in reliable sources (Including all the ones you've collectively excised from the article). --Elvey^(t•c) 16:57, 3 December 2015 (UTC)

You said "The lawsuits themselves are sources". Those are primary. And no, "fool.com" isn't the sort of source which establishes weight. If there is some weighty secondary source that actually goes into some detail over this litigation, then please produce it. Alexbrn (talk) 17:23, 3 December 2015 (UTC)

Duh. As I said, I gave multiple secondary sources. The dishonesty continues; your claim that I gave none now rests on an attack on one of them. Also: on what basis do you claim fool.com" isn't the sort of source which establishes weight? Come back if/when you can honestly address the issue - including all the sources raised here and in-article. --Elvey^(t•c) 20:22, 3 December 2015 (UTC)

The investor.aligntech.com and money.cnn.com sources are both press releases. --McGeddon (talk) 20:47, 3 December 2015 (UTC)

And the sources raised in-article? E.g. http://well.blogs.nytimes.com/2015/02/01/a-trip-to-the-mail-box-not-the-orthodontist/? That particular sub-sub site alone, well.blogs.nytimes.com, is used in 24 articles, including several medical articles. For the record, does anyone dispute that we have adequate sources to show that it's verifiable that these are brands under which clear aligners are sold? I think not, but I'm checking just to be sure. IMO anyone who disputes this is insane. All these attacks on the sources as being inadequate are clearly wrong per Wikipedia:Perennial_proposals#Define_reliable_sources. WP:UNDUE is about viewpoints. If it's a "viewpoint" that these are brands under which clear aligners are sold, then let's be serious. No one is disputing that viewpoint; it's the dominant viewpoint. --Elvey^(t•c) 03:37, 4 December 2015 (UTC)

Things might work better if the drama level were toned down. The florid language guarantees that very few will want to investigate the associated points, and if the matter ever reaches a noticeboard, third parties will similarly jump to conclusions about which side should be supported. Johnuniq (talk) 05:51, 4 December 2015 (UTC)

Johnuniq - It appears you referring to something in my last comment. Can you suggest a rephrase? --Elvey^(t•c) 14:48, 4 December 2015 (UTC)

@Elvey: The brand names may be verifiable, but they weren't verifiable in your recent edit. Text needs to have WP:INTEGRITY. Personally, I am not convinced that adding a roll call of brand names to this article adds any encyclopedic value. Alexbrn (talk) 12:58, 4 December 2015 (UTC)

Kudos for not denying that the brand names are verifiable. Yet, you just reverted my last revision with the edit summary "rv. unsourced / fails WP:V". The edit summary of my last revision is "Per discussion on talk. No one has disputed that they are sold under these brand names. It's wp:verifiable that they are. If anyone claims to dispute this, such claims will evidence incompetency or dishonesty." So you are saying you'd revert even with the sources that made it verifiable as you see it put in inline citations. 1)Yes? So you've shifted from arguing that the issue is sources, to that it is a WEIGHT issue to that it's plain unencylopedic, with no reference to policy; see WP:Just unencyclopedic. 2)What is encyclopedic about the mentions of (Align's?) ClinCheck and Treat programs in the article? The selective removal of the brands I added while leaving these in smells fishy. Please explain. --Elvey^(t•c) 15:07, 4 December 2015 (UTC)

Try understanding my comment. (unsigned comment by Alexbrn ) 15:43, 4 December 2015 (UTC)

Please answer the 2 marked questions I asked. I do. That's not responsive, IMO. Editors are expected to ... be responsive to good-faith questions. Unencyclopedic is synonymous with "I want it.deleted".--Elvey^(t•c) 15:56, 4 December 2015 (UTC)

I asked for opinions at WT:WikiProject Medicine#Including brand names. My major concern is having a procedure to reject spam and promotional editing, and when I searched a couple of weeks ago there were quite a lot of independent mentions of two major brands, and very little of others. A minor isse is WP:NOTCATALOG and WP:DUE which suggest that listing all brands is not desirable. Johnuniq (talk) 05:43, 5 December 2015 (UTC)

Note

Talk archives got left behind when the page moved. fixed it. Jytdog (talk) 08:15, 1 September 2016 (UTC)

Brands

The lede says there are at least five different brands, but the article only mentions three: ClearCorrect, Invisalign, and Orthoclear. I added them to clarify the reason for the redirects. This article [[27]], while not a reliable source, lists several others, in alphabetical order: 5 Align; Angel Align; AOA; ASO; Essix ACE; Five-Star Bioliner; Red, White & Blue; Simpli5; and Smart Moves. Timtempleton (talk) 00:53, 31 May 2017 (UTC)

Limitations

This page would be improved if it contained information of potential weakness or limitations of the treatment. TMorata (talk) 15:39, 6 October 2017 (UTC)

Agree Doc James (talk · contribs · email) 22:39, 6 October 2017 (UTC)

Text

Have shortened "There are about 27 products available. Among the most complex and comprehensive systems are those provided by Invisalign (the most common) and ClearCorrect"

To "There are about 27 products available including ClearCorrect and Invisalign." in the lead as the later is more concise and less promotional. Doc James (talk · contribs · email) 11:18, 11 February 2018 (UTC)

Conflicted source

This source is by a single author, Tony Weir who is a "Platinum level Invisalign provider"[28]

Also works for the company in question per[29]

The journal provides no COI statement which is concerning aswell. Doc James (talk · contribs · email) 11:22, 11 February 2018 (UTC)

• It is not our place to champion the underdog. Also, are you disputing his facts and what he says? I suspect it is becoming difficult to find many authors that do not use Invisalign and would therefore not have conflicts of interest. --Robert.Allen (talk) 20:53, 11 February 2018 (UTC)
  • He does not just use the product he is on a board of the company... Doc James (talk · contribs · email) 08:23, 12 February 2018 (UTC)

Reversions distorting the meaning of the lead

User:Doc James has twice reverted edits which make the language closer to what the sources actually say. I feel this results in some distortion of the meaning of the originals.

• For instance, he puts ClearAlign first in the list of manufacturers, saying that putting Invisalign first is 'undue weight'. However, Weir (2017) puts Invisalign first and ClearAlign second in his longer (non-alphabetical) list of complex and comprehensive brands. As he tells us, Invisalign remains by far the leader in the marketplace with more than 3 million patients, while ClearAlign trails significantly with about 80,000 patients. Putting Invisalign first actually reflects 'due weight'.
• Weir (2017) counts about 27 brand names and classifies these under the headings:
  • Minor tooth movement (MTM) with limited clinical applicability
  • Direct to Consumer Alternatives
  • Make Your Own Aligners
  • Complex, Comprehensive Systems

I feel it is important to note that Invisalign and ClearAlign stand out from most of these other products and can be characterized as complex and comprehensive. Weir (2017) quotes Robert Keim, editor of the Journal of Clinical Orthodontics, as saying that Invisalign offers patients "a viable alternative to fixed braces” and that “today practically any malocclusion can be successfully treated using this or similar technologies”.

• Doc James says "Aligners have changed, making assessment of effectiveness difficult." However, software affecting computer-aided design of treatment protocols has also been changed. Also, the speed of the changes is one of the important parameters that helps to make clinical studies outdated before they are published. To say "Clear aligner therapy has undergone rapid technological change" is more accurate.
• Rossini et al (2014) say "The quality level of the studies was not sufficient to draw any evidence-based conclusions", while Doc James says: "A 2014 systematic review concluded that evidence was of insufficient quality to determine effectiveness." This may give the reader the impression that results with clear aligners were not good enough to provide clear evidence, rather than that the design of the studies was poor. It is more accurate to say "A 2014 systematic review concluded that the published clinical studies at that time were of insufficient quality to provide evidence-based proof of the effectiveness of these therapies". Weir (2017) makes a similar point and goes further:

It has been noted that published studies which compare fixed appliances with CAT are subject to numerous flaws, including poor methodology (63% of studies had a high risk of bias), absence of control groups, proper blinding procedures or sample randomisation procedures. Sample sizes were generally small and similar criticisms could be fairly directed at published studies on CAT in general.

--Robert.Allen (talk) 20:13, 11 February 2018 (UTC)

• IMO it is perfectly appropriate to list the product alphabetically.
• The Weir source has concerns. Providing further comments on which are complex is undue weight in the lead IMO.
• "The quality level of the studies was not sufficient to draw any evidence-based conclusions" means the same as "A 2014 systematic review concluded that evidence was of insufficient quality to determine effectiveness."
• By the way what is your relation to the product in question? Doc James (talk · contribs · email) 08:29, 12 February 2018 (UTC)

Disambiguation problem

Semiconductor manufacturers used some sort of "contact aligner" which is some sort of "copier" or similar for making the masks. Yet it links to this article on orthodontics. 68.67.254.133 (talk) 20:02, 24 January 2022 (UTC)

More Up To Date Info About Effectiveness

This article cites a paper from 2014 for information on effectiveness. However the assessment of inconclusive appears to contradict some more recent papers. Such as the 2021 paper cited in the orthodontics page. The wiki article states that “There was a lot of controversy about the effectiveness of Invisalign, but with years of advancements, Invisalign's results can now be closely compared to traditional braces but with a lot more freedom and faster results.” 76.175.1.167 (talk) 00:53, 11 October 2022 (UTC)

Copyright problem removed

Prior content in this article duplicated one or more previously published sources. The material was copied from: https://www.milltowndental.com/blog/invisalign-vs-braces-pros-and-cons/. Copied or closely paraphrased material has been rewritten or removed and must not be restored, unless it is duly released under a compatible license. (For more information, please see "using copyrighted works from others" if you are not the copyright holder of this material, or "donating copyrighted materials" if you are.)

For legal reasons, we cannot accept copyrighted text or images borrowed from other web sites or published material; such additions will be deleted. Contributors may use copyrighted publications as a source of information, and, if allowed under fair use, may copy sentences and phrases, provided they are included in quotation marks and referenced properly. The material may also be rewritten, provided it does not infringe on the copyright of the original or plagiarize from that source. Therefore, such paraphrased portions must provide their source. Please see our guideline on non-free text for how to properly implement limited quotations of copyrighted text. Wikipedia takes copyright violations very seriously, and persistent violators will be blocked from editing. While we appreciate contributions, we must require all contributors to understand and comply with these policies. Thank you. Racer C77 (talk) 17:44, 1 February 2023 (UTC)

First affected version appears to be 1032015673 Racer C77 (talk) 17:44, 1 February 2023 (UTC)