How staging and treatment preferences improve predictability in clear aligner treatment planning
- Jesper Hatt DDS
- 26. jun.
- 4 min læsning
Mastering macro-staging, micro-staging, and digital treatment preferences to achieve predictable aligner outcomes.
When planning clear aligner treatments, clinicians face two critical challenges:
How to stage the movements effectively
How to set up treatment preferences that guide the software and technicians
Both factors are central to predictability, efficiency, and long-term stability of treatment outcomes.
In this article, we combine recent insights on macro-staging and micro-staging with the practical approach of defining treatment preferences, as outlined in Mastering Aligner Orthodontics.
Introduction
Predictable outcomes in clear aligner therapy require more than simply moving teeth according to the initial setup. The key lies in understanding how movements are staged and how your treatment preferences guide the planning process.
In this post, we combine insights from recent literature on macro-staging and micro-staging with practical strategies from Mastering Aligner Orthodontics. You’ll learn how to coordinate these two systems to optimize your clear aligner treatment planning and avoid many common pitfalls.
Why staging matters in clear aligner treatment planning
Clear aligners apply forces very differently than fixed appliances. Because they move multiple teeth simultaneously, poorly staged movements can easily create:
Loss of tracking
Anchorage failures
Excessive refinements
Biological overload
That’s why staging - determining which teeth move and when - plays a crucial role.
The scientific literature (Martínez-Lozano et al., 2024) distinguishes between two types of staging:
Macro-staging: When entire groups of teeth move in relation to anchorage and space creation.
Micro-staging: How each individual tooth is programmed for complex, combined movements like rotation, tipping, intrusion, and extrusion.
But even perfect staging is not enough, unless it is supported by well-calibrated treatment preferences.
Treatment preferences: Your digital protocol for consistency
In Mastering Aligner Orthodontics, we define Treatment Preferences as your preset digital protocol, guiding the technicians and software to follow your planning philosophy consistently across all cases.
Your treatment preferences affect:
Movement velocities
Anchorage strategies
IPR timing
Posterior and anterior torque protocols
Expansion limits
Attachments and engager design
Bite ramps and occlusal management
Class II correction protocols
Let's see how each category connects directly with staging decisions:
1. Movement velocity and force control
Biological tooth movement averages ~1 mm per month. It is however worth noticing that there are considerable variations between the different teeth depending on root morfology and bone density.
Most aligner systems default to 0.3 mm per step, but preferences allow you to lower this for improved predictability.
Slower velocity reduces force levels, making micro-staging more biologically predictable and stable when combining complex movements.
2. Anchorage management and macro-staging
Sequential distalisation, differential anchorage, or segmental movements require clear anchorage rules.
Treatment preferences allow you to define these defaults systematically, ensuring technicians follow consistent anchorage staging logic.
3. IPR Timing: When space creation happens
Performing IPR too early increases round-tripping risks and long-term recession, especially in thin biotypes.
By delaying IPR (e.g. stage 3), you follow a macro-staging logic that allows space to open naturally first.
Preferences automate this safe timing across all cases.
4. Torque protocols and functional occlusion
Posterior torque (influencing the curve of Wilson) and anterior inclination influence long-term stability.
Treatment preferences allow you to predefine torque values that fit your occlusal philosophy.
This ensures consistent micro-staging of torque corrections.
5. Expansion rules: Balancing bone and stability
Expansion helps with early space creation, but must respect bone boundaries.
Treatment preferences limit expansion to safe levels, directly supporting safe macro-staging sequences.
6. Attachments and engagers: Controlled force application
Attachments must match the planned type of movement (rotation, translation, tipping).
Preferences let you predefine attachment shapes, sizes, and timing and can reduce your time spend on modifications.
This makes complex micro-staging more predictable and technician errors less likely.
7. Bite ramps and centric relation stability
Bite ramps disclude the posterior segments and may unintentionally influence mandibular positioning.
Treatment preferences allow you to define ramp timing, avoiding unintentional CR-MIP shifts mid-treatment. (Read more about CR-MIP considerations when treatment planning clear aligner cases here)
8. Class II corrections: Sequential vs. jump
Macro-staging heavily influences Class II correction strategy.
Preferences allow you to avoid software-generated unrealistic bite jumps in adults, and instead define sequential distalization protocols with proper anchorage.
Staging and preferences: Two sides of the same coin
✅ Macro-staging defines the treatment sequence
✅ Micro-staging controls complex combined movements
✅ Treatment Preferences standardise your planning philosophy
When these three systems work together, you gain maximum control, fewer revisions, and more predictable long-term outcomes.
Clinical Example
A case with significant crowding, CR-MIP discrepancy, and Class II molar relation:
Macro-staging: Sequential distalization, delayed IPR, posterior anchorage maintained.
Micro-staging: Intrusion then torque is staged before final rotation.
Treatment preferences: Low velocity, torque presets, late IPR, timed attachments.
✅ Result: Predictable tracking, minimal refinements, stable function, and excellent esthetics - even 5 years post-treatment.
Build Predictable Aligner Plans - One Step at a Time
Mastering Aligner Orthodontics gives you a complete framework for combining macro-staging, micro-staging, and fully customised treatment preferences.
Learn how to structure your aligner cases systematically, from safe force levels and anchorage control to torque, IPR timing, and attachments, across Invisalign, SureSmile, ClearCorrect, and Spark.
If you want to reduce refinements, minimise troubleshooting, and confidently handle even complex adult cases - this book is your guide.
Empower your practice and deliver the exceptional care your patients deserve.
FAQ
Q: What is macro-staging in clear aligner therapy?
A: Macro-staging refers to sequencing entire tooth groups based on anchorage needs and treatment goals, ensuring safe space creation and predictable movement.
Q: Why are treatment preferences important?
A: Treatment preferences create consistency across cases, helping technicians follow your clinical philosophy and avoid common planning errors.
Q: Can I apply the same preferences to all aligner systems?
A: Yes - while each platform has slight variations, the core principles described in Mastering Aligner Orthodontics apply across major aligner systems.
Final Thoughts
Staging and treatment preferences are not isolated topics. They work best when fully integrated into one coherent digital planning strategy. This is where predictable clear aligner therapy truly begins.
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Kind regards
Jesper Hatt DDS
P: +41 78 268 00 78
AlignerService
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