Your 20% refinement rate needs a receipt
- Sherif Kandil
- 6 hours ago
- 6 min read
Dr. Sherif Kandil on why the refinement number most aligner manufacturers and labs quote doesn't survive scrutiny, and what it's really costing them.
Ask ten aligner companies for their refinement rate, and you'll hear the same answer ten times: "around 20%." Remarkable consensus, considering almost nobody can show the math behind it. The number rests on two measurement errors, blending every level of case complexity into one figure and counting cases that haven't finished treatment.
Correct for both and the real rate lands far higher than anything quoted in a sales meeting. And since every refinement means producing, planning, and shipping a case you were only paid for once, the gap between the story and the number comes straight out of margin.
The receipt, detailed
One blended rate across simple and complex cases. Two different measurements wearing the same number.
Open cases counted as if they were finished. They haven't had time to need a refinement yet, which is not the same as not needing one.
The published figure: roughly 70% of completed cases required at least one refinement (2,937 treatments, 2024). The industry's 20% isn't a different result. It's a different calculator.
Every point of hidden refinement rate is a real cost. It belongs on the P&L, not just in the chart.
Why is almost every refinement rate wrong?
Because it is quoted as a single number, and a single number cannot describe what refinements actually are.
I hear it constantly from manufacturers and labs: "our refinement rate is about 20%." Always about 20%. Never 24.7%, and never with the methodology attached. I don't think anyone is being dishonest. I think most people genuinely don't know how to calculate the number properly, and 20% has been repeated long enough to sound like data.
Once you look at how the figure is built, it falls apart in two places: what it lumps together, and when it's measured. Get either wrong and the number you are quoting, to your clients, to your board, to yourself, is a confident, specific, useless fiction.
What is wrong with a single, blended rate?
It compares apples to oranges and calls the result a benchmark.
A refinement rate on simple cases and one on complex cases are not the same measurement. Mild crowding on a straightforward arch will always refine at a fraction of the rate of a severe, multi-plane correction. So when a lab benchmarks its "20%" against a leading brand's published figure without matching the category of case complexity, it is borrowing confidence from someone else's marketing department. Simple against simple. Complex against complex. Anything else is noise.
And it isn't only an external problem. Your own internal average is misleading if you cannot say what share of your treated cases are simple, moderate, or complex. Without that breakdown, your "company refinement rate" is a blended number that conceals the mix driving it. Two labs can both report 20% and be running completely different businesses. At least one of them doesn't know it.
Why does timing wreck the number?
Because most companies measure the race before anyone has crossed the finish line.
This is the part almost nobody gets right. To calculate an accurate refinement rate, you have to go back in time. You need a pool of cases whose expected treatment duration has fully elapsed, cases that are confirmed closed. If you pull from open or ongoing treatments, you contaminate the data, because a case that hasn't reached its endpoint hasn't yet had the chance to need a refinement.
Measure a cohort still mid-treatment and your rate will always look flattering, right up until those cases mature and the refinements arrive with the punctuality of a tax deadline. The number wasn't good. It was early.
"You're measuring a race before anyone crossed the finish line." - Dr. Sherif Kandil, CEO, K Line Europe
What do the real numbers look like?
Much higher than the industry quotes, and the gap is mostly measurement.
The published evidence is sobering. A 2024 study of 2,937 aligner treatments across 188 orthodontists found that 70.31% of cases required at least one refinement. Among orthodontists with more than 20 years of experience, the figure reached 82.3%.
Read that again: the most experienced clinicians reported the highest rates, most likely because experience means taking on harder cases and tracking outcomes honestly. Twenty years in practice, it seems, cures you of optimistic bookkeeping. Set that against the comfortable "around 20%" the industry repeats, and the size of the gap tells you it is not a clinical difference. It is a measurement difference.
Why should manufacturers and labs care most?
Because for you, a refinement is not a clinical event. It is a line item.
For a clinician, a refinement is more chair time and another round of scheduling. For a manufacturer or a lab, it is additional production, additional treatment-planning resources, additional shipping and support, on a case you have already been paid for once. Every point of hidden refinement rate is margin leaving the building without a receipt.
That is why this number cannot live only on the clinical side of the house. If you run a private-label or OEM aligner operation and you cannot state your true, complexity-segmented, closed-case refinement rate, you do not fully know your own cost of goods. You know a rumor about it.
"Your refinement rate is not just a clinical metric. It is a cost structure." - Dr. Sherif Kandil, CEO, K Line Europe
So what do you actually do about it?
Measure it honestly, then engineer it down.
Two steps.
First, fix the measurement: only count confirmed-closed cases whose treatment window has fully elapsed, and segment the rate by case complexity so simple and complex are never blended.
That alone gives you a number you can trust, even if it ruins a few slides. Then engineer against it. A refinement rate is not fixed. It is the output of material performance, treatment-planning quality, staging, and how well the appliance holds its force over time, and every one of those is improvable.
The manufacturers who win the next five years will be the ones who stop guessing this number and start building the workflow to bring it down.
FAQ
Is a 20% refinement rate good or bad?
On its own, neither, because the question is unanswerable without context. 20% on mostly simple cases may be poor; 20% on complex cases would be excellent. The rate only means something alongside the case-complexity mix.
Why does measuring open cases distort the rate?
An ongoing case hasn't reached the point where a refinement is typically decided. Including it counts a "no refinement" that simply hasn't happened yet, dragging the reported rate artificially low until those cases close.
What does the research actually say?
A 2024 survey of 188 orthodontists covering 2,937 treatments found roughly 70% of cases needed at least one refinement, rising above 80% for the most experienced clinicians.
Why does this matter more for a lab than a clinic?
Because the lab absorbs the production and planning cost of every refinement on a case it has already delivered. It is a direct hit to cost of goods, not just to a schedule.
Can you actually lower a refinement rate?
Yes. It reflects material behavior, planning quality, and staging, all of which can be improved. It is an engineering target, not a fixed cost of doing business.
What is the first step to fixing our number?
Rebuild it from confirmed-closed cases only, segmented by complexity. If you can't produce that breakdown today, that is the finding, and the place to start.
The bottom line
A refinement rate quoted without a complexity breakdown, or measured before cases have closed, is a number without a receipt. It feels like insight and behaves like guesswork.
The published data says the real figure is far higher than the industry admits, and for anyone manufacturing aligners, that gap is money. Measure it properly, and you can finally manage it.
Keep guessing, and you will keep paying for it, one "successful" case at a time.
Want a number that survives an audit?
If you would rather know your real refinement rate than keep quoting a comfortable one, that is a conversation we enjoy. K Line manufactures private-label aligners, and we treat refinements as an engineering problem: measured on closed cases, segmented by complexity, and worked on deliberately.
We focus on:
Treatment planning and staging built to prevent refinements, not just absorb them. | Material and manufacturing consistency, so the appliance delivers the force the plan assumed. | Transparent case data, so you see your rate by complexity instead of guessing at a blend. |
Bring us the number you quote today and how it was calculated. We'll help you replace it with one you can defend.
Schedule a call or talk to us via WhatsApp.
Dr. Sherif Kandil is CEO of K Line Europe and an orthodontist. Source: National Library of Medicine, PMC12101830 (2024), survey of 188 orthodontists across 2,937 aligner treatments.
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