Troubleshooting Clear Aligners – Top Tips
Clear Aligner treatments are a valuable and commonplace item in our modern clinical armoury. We might encounter barriers to fulfilling our patients expectations from treatment.
This article proposes some solutions to potential problems associated with clear aligner therapy.
1. Dental health
Prior to initiating clear aligners the dentition should be in a “good” condition and the patient free of primary dental disease. It is imperative that a full examination as well as clinically appropriate X-rays are taken to assess anything untoward including caries, periodontal disease, areas of pathology (eg. failing root canal treatments, root resorption or restorations). Manage any outstanding clinical issues accordingly and record your baseline findings.
2. Case selection
Understanding case selection is important when providing clear aligners. Every case is unique and should be reviewed prior to treatment initiation. Selecting the right case is experience-dependent and will vary from dentist to dentist. Inappropriate case selection can contribute to issues further down the line. Anterior 5 to 5 cases are often a good place to start. Knowledge on which cases to select will build over time, enabling more complex cases to be considered.
If you need support, ask an experienced colleague or visit our free accreditation course and case selection blog.
3. Patient expectations
To avoid disappointment, meet or exceed your patient’s expectations. All disappointment could be due to unmet expectations.
Understand your patients’ personality. Discuss their aims, objectives and the emotions underlying their reason for seeking treatment. Are their expectations realistic? Will you be able to meet them? If not, think about referring.
Clear aligners are just one tool in the orthodontic armoury
Not all tooth movements are predictable so anticipate results that may be hard to attain
Fully explain all stages of treatment including impact of attachments and IPR
Gain approval of the treatment plan and explain it is not a guaranteed outcome
Patient agrees to wear aligners 22 hours per day and to remove them when eating/drinking
4. Refinement risk
Tooth movements are unpredictable and perfection is subjective. No clear aligner system can guarantee teeth will move as planned and the potential for refinement should be discussed at the outset. Refinement is the option to correct slight discrepancies at the end of treatment and can be due to a variety of reasons including:
Teeth do not move as predicted
More complex cases have a higher rate of refinement
IPR may need to be reviewed or enhanced
Patient may not maintain good compliance