Orthodontic Products Podcast

Sherif Kandil, DDS, MSc Ortho, CEO and founder of K Line Europe, joins Alison Werner on the Orthodontic Products podcast to discuss ClearX aligners, integrating 4D technology, debuting at AAO Annual Session.

Key takeaways: 

Creators and Guests

Host
Alison Werner
Editor-in-Chief, Orthodontic Products

What is Orthodontic Products Podcast?

Introducing the "Orthodontic Products Podcast", a journey into the dynamic realm of orthodontic innovations. Each episode dives into fresh research, transformative technologies, and the methodologies redefining the field. Expert interviews seamlessly blend with in-depth analyses, offering listeners a comprehensive look into the ever-evolving world of orthodontics. This isn't just a podcast—it's a portal to the future of orthodontic practices and breakthroughs.

Alison Werner: Hello and welcome
to the Orthodontic Products

podcast. I'm your host Alison
Werner. Today's guest is Dr.

Sherif Kandil, the founder and
CEO of K Line. Europe, the

manufacturer that produces
ClearX aligners, an aligner

system that incorporates 4D
technology. ClearX aligners will

make their debut at AAO this
weekend. So this is a perfect

time to learn more about this
aligner company what this

aligner company brings to the
table, Dr. Kandil. Thanks for

joining me.

Dr Sherif Kandil: Thanks a lot
for hosting me, Alison.

Alison Werner: Great. So let's
dive in. Can you tell our

listeners a little bit about
your career and what led you to

founding this company and to get
into this aligner system?

Dr Sherif Kandil: Well, I mean,
it all started for me first

practicing dentistry of myself
back in Egypt in Cairo almost 12

years ago, where I first started
my practice and I I kind of like

exclusively focused on aligners
from day one. It was a very,

very new thing back then in the
Egyptian market. And I

transitioned from that to even
offering these aligners

according to also other doctors.
And then by time I started to

think okay, I think it's about
time to study orthodontics in in

Germany and move with the career
and everything towards to

Germany accordingly. So, I mean,
back then in Egypt, I had my own

orthos in my practices and had
also my orthos is in in the lab

who who did the treatment
planning. And then when I moved

to Germany, I finished my
orthodontic studies then decided

to establish K Line Europe. So
started to see them the world

from a totally different angle
as an orthodontic entrepreneur.

And from from one, there was
this mission to to redefine

orthodontics or innovation. So
this was like always, on my

mind, how could we improve
status quo and and go with the

evolution of orthodontics to the
next stage? And yeah, the thing

that caught me really heavily
was when I've seen once NASA,

having these articles, very
interesting articles about 4D

printing. And it was like very,
very new, almost think it was

back then in almost the year
2000, I think maybe 14, where

where I first saw it, and then
it kind of struck me wow, this

is such an amazing technology
that NASA did it before with

ortho the orthodontic world
through their innovative NiTi

wires that they introduced for
straight wires, and it's kind of

like changed orthodontics in the
1980s. And they did it again

through plastic this time. And
that's how the whole idea came

from and started to work on the
idea of 4D aligners.

Alison Werner: Okay, so can you
break down what this 4D

technology does for an aligner?
What incorporating? It does?

Dr Sherif Kandil: Yeah, so it's
certainly the idea of 4D first

of all is related to time, time
and, and shape shifting. So

that's the fourth dimension that
we refer to in 4D. Now, how do

we do that? It's some refers to
the manufacturing process

through which you pre-program an
object in a certain shape. And

then after you put in a certain
stimulus, it changes its shape

back to the pre-programmed one
that you had from the beginning.

So in other words, let's say in
the aligner world, what we do is

basically we pre pre-program and
aligner to have a temporary

memory and a permanent memory.
So it's like almost like there

are two steps of thermoforming
that are done that control these

two steps or control these two
shapes accordingly. There is one

shape that the patient wears,
which is the temporary shape,

and it fits perfectly on the
teeth. And then after one week

of wearing the patient, where
we're going to describe later,

boosts the aligner, which
stimulates the aligner or the

plastic polymer to change its
geometry to the permanent shape

of the thermoforming that was
done in the manufacturing

process. And that's how it it
moves from one shape to another,

whether in the manufacturing and
we reverse that when the

patients received the aligners
and they boost it at home.

Alison Werner: Okay, so at a
you're going to be debuting the

ClearX aligner classic system.
Can you talk about what that

system brings to the table and
what orthodontists can expect

when they see this?

Dr Sherif Kandil: Sure. I mean
first of all, we are super

excited about this opportunity.
We have been since we started

since our debut in March 2023 in
Cologne, we started with almost

sole focus on the European
market, and now we are getting

for the first time into the US
market with this amazing

product. The AAO on our booth
where you were going to be like

almost all the time showing live
demos, live sessions showing

exactly how aligners change
their shape. So we're going to

be showing, you know a live how
an aligner before boosting looks

like. And then we're going to
place it inside the booster, and

then we take it out and then we
show the doctors how the aligner

feature of shapeshifting works.
Now then, this technology, it

brings so many things on the
table. And it's just the very

first step of so many other
steps that that will open the

gate towards internet of medical
things that is lacking, in my

opinion, in a lot in
orthodontics. Now let's start

with step by step. I mean,
currently, where do we stand, we

stand at a point where we are
harnessing to have two shapes.

And with that we decrease the
plastic waste and decrease the

number of aligners by half.
That's again, what I said is

just the first step, because we
have, we have already the proof

of concept of that it could even
decrease even to almost 75%. So

imagine all the aligner waste
that we have per per single day

that would shrink by 50%, if
everyone adopts the same

technology. Now, we're producing
almost like 1.2 million aligners

per single day, we're going to
talk about globally, everyone,

including align and all others,
all combined almost 1.2 million

aligners per day. That is
humongous amount of plastic that

is thrown in landfills at the
end or in the oceans. And we're

determined to decrease that. And
that's again, that's the very

first step towards later on
working on many steps that are

taking the path towards internet
of medical things where we start

to integrate more of like
biology, monitoring, lifestyle

into the treatments of the
patient to create a customized

treatment throughout the journey
of patients. I'll talk about

that in a bit. But for now, just
wanted to give you like an idea

in total, like what does it
bring right now on the table in

terms of advantage, and where it
should be going in the future.

And while it's going there in
the future, the the idea itself

of decreasing the plastic brings
other advantages as well with it

to the customer or the patient
in that in that sense. Where

first it increases the
compliance. So you're it's like

exactly you're having let's say
go or compare, let's say, a

diabetic patient without any
monitoring app or without any

monitoring gadgets. Same goes
for, for example, me trying to

you know, like, do sports every
single day or exercise every

single day without my
smartwatch, right. I mean, we

need gadgets, to I mean, as
humans, we need gadgets to

commit more to to give more, to
feel more responsible for

something but also to feel
rewarded. And that's exactly

what patients feel when they
start to boost their aligner and

they take it out, and they will
start to wear it and then they

feel immediately the difference.
It's like it feels like it's a

new aligner. So that's the kind
of like the reward that is that

is that kicks in for the
patients that they feel that

they're part of something. And
this something is rewarding as

well to them. And this increases
the compliance massively in an

orthodontic treatments. I mean,
we were doing a lot of research

on that comparing the compliance
of patients with standard

aligners and compares it to 4D
aligners, and the results are

staggering. I mean, it's, it's,
most of the patients were

reporting that they feel the
sense of responsibility, they

feel that they also part of
something big, where they're

working, or they're not just
only fixing their teeth and

getting beautiful smile, but
they're also part of something

that is eco friendly. And again,
they have their hands in it as

well. So it's also fun. Okay, so
yeah, that's mostly from

falling.

Alison Werner: Perfect. I know
we have a little bit of a lag.

No, the sustainability aspect I
find really interesting because

it is, because as I've talked to
you before about that you've

explained this to me before, so
I'll just kind of explain to our

readers, as I understand it.
With this, you know, one aligner

can get a patient through two
weeks because you're using that

booster. And we'll talk a little
bit more about that to

transition the aligner to that
second stage. So you're cutting

back, as you said, on the
aligner waste. So let's break

this down a little bit further.
From the treatment planning

stage, what can orthodontists,
what should orthodontist

experienced with that? Is it any
different from treating with a

traditional aligner?

Dr Sherif Kandil: Um, well, when
it comes to the treatment, let's

say complexities of cases or
malocclusions that can be

treated, there is no difference
at all, it's it's almost more or

less the same. When it comes to
the the setups for the doctors

will just realize that the
results that could be achieved

with any other aligner system is
achieved with half of the

aligners with ClearX. That's
basically the only difference

that they will see between,
let's say both setups of

treatment plans designed by
ClearX and any other standard

aligner system.

Alison Werner: Okay, great. So
then when the patient gets their

package, they're going to be
getting their aligners and then

a booster. So can you talk about
the patient experience? And then

exactly what that booster is you
kind of showed it there for a

second there and that it does
transition to the second form.

But how does it do it?

Dr Sherif Kandil: Absolutely,
I'll show it again. So, so the

patients when they receive their
box, it includes the booster,

the accessories, obviously, and
also, yeah, the aligners were,

where there was almost like a
place for let's say, almost like

four to five aligners that are,
let's say, aligner sets that the

doctor could give to the
patient. Now, the booster is a

very simple device, as you can
see here. And we designed the

boosting process in a very, very
simple way that anyone can do it

through which the patients will
be literally just placing the

aligners inside the booster,
they'll just boil water and pour

boiling water directly on the
aligner and just close the lid

for 10 minutes, take it out wear
the aligner once again, now what

do they experience when they
take the aligner out and wear

it, one is definitely they feel
like okay, it's like a new

aligner, it feels like a there
was some pressure on certain

areas where the teeth are moving
or should be are programmed to

move. That's one. Second is is
that there will be like a

refreshing for the mechanical
properties that would happen

also for all the other areas in
general the plastic through

which when you when you heat the
aligner to a certain

temperature, which is more of
the same temperature that is

required for the shape shifting
to happen, it starts to recover

also the original shape of the
areas that say especially at the

back teeth were because of the
grinding or the bruises and even

if the aligners are on the
aligners for like a whole week,

what happens is that the back
teeth, sometimes the aligners

start to just like move out a
little bit, you know, they start

to distance themselves slightly
from the teeth. Now when we

boost the aligner, the aligners
snap again, once again on the

teeth of the back. And that's
what the patients also reports

like, I feel like okay, in the
front, for example, there is

like sort of areas where I feel
that there's pressure, but I

also feel in the back that it
snaps more as if it's a new

aligner once again. Aligners are
almost disinfected, or, you

know, because I mean, you put
pour boiling water. So most of

the bacteria, I mean above 72
degrees are, are are dead. The

aligner comes out of the
booster, it's a hygienic clean

aligner, it's super fresh for
them, when they wear it, it

feels like it's new. And, and
they continue wearing it for

another week. And then they,
they change to the next aligner

and so on. So keep the keep
doing that throughout the whole

cycle. Now, the one thing that
makes the experience even more

exciting is that this is also
connected to the mobile app. So

the patient when they start the
treatment at the very start, at

the very beginning, there is a
mobile app, which is optional, I

mean, they could have it or they
could not depends on if they

want to have the full experience
or not. And through the mobile

app, I mean, they they will very
easily just scan a QR code that

is a customized QR code for that
particular patient generated

with every single case
manufactured. And when they scan

that code, the treatment details
will be uploaded automatically

or populate automatically inside
the app for that particular

patient so that they would see
exactly this calendar, when am I

starting, when is the next
boost, etc, etc. So it gives

kind of notifications or
reminders for the patient, but

also makes it a little bit of
you know, like a kind of a

gamification process that kind
of also incentivizes the patient

or gives the feeling of reward
throughout the whole treatment.

Alison Werner: Great. Can you
talk about because I'm sure

people are wondering what you
know, because you're using

boiling water and heat to change
the shape of the aligner, what's

to prevent, like a hot drink,
for example, changing the shape

of the aligner?

Dr Sherif Kandil: I mean, it
could happen. But in one case

where someone would be, let's
say drinking very, very hot

coffee and keep it in their
mouth for 10 minutes. That's

only maybe a scenario where that
would happen. But other than

that, it would never, it would
never boost with you know,

normal drinking or, you know,
normal normal lifestyle. Because

again, it was designed in a way
so that it needs temperatures

above 90 degrees, and would be
kept for a few minutes time,

ideally above five minutes, and
we say 10 minutes, and then you

have to take it out. So it's
highly, very, very highly

unlikely that it would happen
anywhere else except probably

through the boosting process.

Alison Werner: Okay, great. So
what else would you like doctors

to know about treatment
progression or, you know,

outcomes for these cases and
their use of this aligner

system.

Dr Sherif Kandil: So I think the
doctor should look at it from

several perspectives. So we're
trying to accelerate the

adoption of eco friendly
solutions in the aligner market.

And we do know and we have to be
very transparent about this like

so many doctors are not the most
eco-friendly enthusiasts. But

we're trying to raise that
awareness. And we're also trying

to like annex for the advantages
that come through the ClearX

with the eco-friendly part with
other advantages related to the,

the mechanical part and the
biomechanics, as well as to the

efficiency of the aligners.
Because we use very high quality

multi layered material as well,
that comes with very, very

amazing properties, in terms of
anti-stain are pleased with the

same quality before it's
boosted. And we we've done all

the studies to prove that as
well. And to validate all these

steps before the boosting after
the boosting, how does the

material react? How does it push
the teeth? What are the, the the

forces exerted on the teeth
after the boosting all these

things? So at this point of
time, I think what I would tell

doctors is that eco friendliness
is certainly something that is,

is about time that we start to
take it more seriously in our

practices, not just only for us,
but also for our patients, it's

something that they could
actually be marketed also very,

very efficiently in, in
practice. And we see that

throughout so many practice
using clinics in Europe, where

patients prefer to use a more
eco friendly product with less

plastic than another one that
uses double the amount of

plastic, right. And on the other
hand, all the properties of the

material that bring the the
results of the treatment to in

almost, I'd say 80 to 82% of the
cases directly without

refinements to the end result.
That's a very, very profound

statement yet all the data that
we have prove that that our

refinement rates are very, very
low. And the the need for even

mid course corrections is in the
magnitude of almost 0.2 to 0.5%

of our cases. So the teeth
tracking is great. The the end

results are very predictable.
These are things that I think

every orthodontist and dentist
would love to always have from

the very beginning to know that
okay, I I trust to to reach this

product I want to deliver to my
patients, something that they

would be proud of, but also what
I would be proud of at the end

to reach the results that I was
promised or at least that was

suggested to me all the
treatment plans from the start.

Alison Werner: Great. One of the
other things that you will have,

you'll have at a neighboring
booth is K Line Europe's OEM

services. And you'll be debuting
that as well at AAP, and this is

kind of the entry into the US
market for this aspect of the

company. Can you talk about what
you're offering with these OEM

services?

Dr Sherif Kandil: So I mean, the
OEM Service is, is a service

where we prove we give access to
a lighter innovation to to any

aligner provider, whether it's a
company, whether it is a DSO, or

even a dental orthodontic lab,
we have all the tools that we

have, we have developed by
ourselves or even made available

and we offer that in just
considered like an open buffet

for any for any partner of ours,
who could just take part of it

or take the whole thing, whether
it's treatment planning,

aligners, having their own
portal, having a mobile app, et

cetera, et cetera. Now ClearX
harmonizes with that really well

or syncs really well with that
as well, where we're currently

working on providing also
cobranding option for ClearX. So

we're not limiting for for K
Line, but rather, the goal is to

make it available for everyone
to use the same and also

provided to to their doctors or
the to their patients through a

co-branding model that we that
we're offering starting at the

AAO.

Alison Werner: Okay, great. And
then do you will you have any in

booth events or lectures coming
up that our listeners can check

out?

Dr Sherif Kandil: Yeah, I mean,
we have, we have a schedule for

the events where I myself will
be giving mini sessions, through

which the sessions we're going
to be showing live how the

boosting process happens. And I
always love to show the doctors

how exactly the shape shifting
happens right in front of their

eyes, that it's like, you know,
the immediate belief, wow, this

thing is real, you know, it's
not only looking good on videos,

photos, but really they when
they see it in front of them,

then they start to also
understand the full concept and

the technology behind it. So
yeah, I mean, we have the

sessions where they include
partial live demos as well as

also a lot of updates about
where we're this technology is

going to and a little bit in
depth into the technical part of

the material and the patient journey.

Alison Werner: Great. Well, Dr
Kandil, thank you so much for

taking the time to speak with me
and I look forward to seeing you

at AAO and for everybody to
check out what's ClearX aligners

are doing so thank you.

Dr Sherif Kandil: My pleasure.
Thanks a lot and see what they do.