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The End of the D2C Era in Aligners? Strategic Lessons for the Dental Industry

The collapse of SmileDirectClub and the contraction of other D2C players mark more than the end of a hype cycle, they signal a strategic reset for the aligner industry.

 

At ConCom Dental, we’ve analyzed this shift closely. Behind the public headlines lies a more profound lesson:


Aligner therapy cannot be decoupled from clinical integrity, operational complexity, and long-term trust.


Here’s what we believe the industry should take away from the D2C fallout:


Perceived market size ≠ scalable business model

The demand for straighter teeth exists, but the D2C model overestimated how many consumers are willing to bypass in-person care, especially in the context of long treatments and real risks. Awareness does not equal conversion.


Clinical depth was sacrificed for speed and scale

D2C models thrived on simplification: faster, cheaper, "doctor-directed" care. But orthodontics isn’t a commodity. Misdiagnosis, refinement chaos, and poor outcomes created brand erosion, class action lawsuits, and regulatory attention.


CACs killed the economics

Digital-first brands faced rising customer acquisition costs and were unable to achieve real LTV through cross-selling or retention. Without the clinical stickiness of in-practice care, they were left with unsustainable margins.


Trust is local

Patients trust people, not platforms. The doctor–patient relationship drives adherence, satisfaction, and long-term growth through referrals and loyalty.

It can’t be replaced by TV ads, call centers, mobile apps, or even the most polished social media campaigns. Clinical trust is earned in-person, over time and it's this trust that turns treatments into outcomes, and patients into advocates.

 

Why long-term trust matters now more than ever

Trust isn’t just about warm feelings - it’s a structural necessity in aligner therapy:

• It sustains patients through multi-month treatments with biological variability

•  It absorbs clinical friction when things don’t go to plan

•  It powers referrals, repeat treatments, and long-term growth

•  And most importantly, it cannot be scaled without clinical infrastructure

 

So, what’s next?

The need for clinically grounded models is echoed by Dr. Werner Schupp in the Journal of Aligner Orthodontics (04/2024), titled “When economists think they can do orthodontics too”.  A timely reminder of the consequences when business ambitions overrule clinical fundamentals.

We believe the future of clear aligners lies in practice-centered, clinically integrated, tech-enabled ecosystems, not in bypassing care providers, but in empowering them. Not in mass-market shortcuts, but in clinical-grade, operationally flexible ecosystems.


Successful models will prioritize:

• Diagnostic quality over direct-to-cart simplicity

• Scalable workflows over marketing sprints

• Long-term patient value over one-time transactions

• Modular production models and hybrid clinical options

 

D2C providers in aligner orthodontics, where they still exist, must now make a strategic choice:

Adapt their business models to the clinical, regulatory, and ethical principles of dentistry and accept that this is not an endlessly scalable business case or leave the segment for good.

 

One notable exception is IMPRESS.

Founded in Barcelona in 2019, the company has prioritized clinical requirements and standards from the outset - building its model around in-person diagnostics, structured treatment supervision, and integrated care.

Utilizing advanced technology, IMPRESS ensures close orthodontic support throughout the treatment cycle, consistently prioritizing patient comfort and outcomes. The company is fully vertically integrated, managing every step from customer acquisition, treatment planning and execution in its own flagship clinics, to aligner manufacturing, treatment monitoring, and even post-treatment dental care via subscription models.

IMPRESS demonstrates that it is possible to modernize aligner delivery without compromising clinical integrity — and that scalable innovation must be rooted in trust, structure, and hands-on care.

At ConCom Dental, we work with aligner manufacturers, investors, and orthodontic practices to shape what comes after the D2C era and how to build models that are clinically credible, operationally viable, and economically sound.

Let’s talk if you're building for the next phase - not the last one.

 


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