Comparison of cost efficiency between commercially manufactured and in-house aligners: a threshold analysis

To compare the cost efficiency of commercially manufactured and in-house aligner (IHA) workflows. A 30-item electronic survey was distributed to practicing US orthodontists to assess aligner usage and fabrication workflows. The survey was administered via SurveyMonkey, and 201 responses met the inclusion criteria and were included in the final analysis. For economic modeling, the variable production cost of IHA was estimated at approximately $40–$50 per aligner pair based on commonly reported manufacturing estimates and internal laboratory experience. Survey responses were used to estimate typical aligner quantities and laboratory costs. Capital equipment expenses required for establishing an IHA laboratory were incorporated into the economic model to identify cost-efficiency thresholds. Respondents reported that typical IHA cases involved approximately 5–15 aligner pairs, with laboratory build-out costs most commonly ranging from $2,500 to $10,000. When capital equipment and laboratory costs were incorporated into the model, IHA costs increased linearly with aligner quantity, whereas commercial aligner fees remained relatively fixed per case. Assuming a commercial aligner fee of $1,500 per case, commercially manufactured aligners became more cost-efficient once cases exceeded approximately 22–26 IHA pairs, corresponding to roughly 6 months of treatment. Cost efficiency between IHA and commercially manufactured aligners is primarily driven by anticipated aligner quantity and practice-specific economics rather than fabrication method alone. Identification of clinically relevant threshold points may assist orthodontists in selecting the most appropriate aligner production workflow.