At some point, clear aligner setups start behaving… oddly
- Jesper Hatt DDS
- 12 minutes ago
- 3 min read
The moment you stop just approving - and start noticing
There’s a moment most aligner clinicians remember.
Not in the beginning.Not in the first 20 cases.
But somewhere later.
You open a digital setup.
And instead of just approving it, you pause.
Something doesn’t feel right.
One tooth rotates in a way that shouldn’t be possible.
Another one slides as if its neighbor isn’t there.
Contacts appear… then quietly disappear.
You can’t immediately explain it.
But you know one thing:
This is not how teeth behave in the mouth.
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At first, you think it’s the obvious stuff
Most of us start by spotting the problems in the anterior region.
That’s where they’re easiest to see.
Incisors rotating too freely. Canines behaving like single units in empty space. Movements that look elegant - and fail clinically.
So we correct them.
We tweak staging.
We adjust attachments.
We add safety margins.
And for a while, that works.
Why clear aligner setups start behaving in unexpected ways
After a few hundred cases, something changes.
You start noticing the same strange behavior in the posterior segments.
Premolars drifting.
Molars translating as if anchorage is theoretical.
And that’s when the frustration really kicks in.
Because now it’s not “one weird tooth”.
It’s a pattern.
The uncomfortable realization
Eventually, many of us reach the same conclusion - quietly.
This isn’t about poor compliance. It’s not even primarily about biomechanics.
It’s about how the teeth are defined digitally in the first place.
Tooth segmentation.
Before any aligner planning happens, the software has to decide where one tooth ends and the next begins.
And in the approximal areas?
It doesn’t know.
It estimates.
Smoothens.
Assumes.
Fills in what the scan doesn’t clearly show.
And once that geometry is even slightly wrong, everything built on top of it starts behaving strangely.
Why this becomes exhausting - not educational
Understanding segmentation issues is intellectually interesting.
But clinically?
It’s exhausting.
Because now you’re not just planning treatment. You’re reverse-engineering someone else’s assumptions.
You find yourself:
Replaying animations
Guessing what the software thinks the tooth looks like
Correcting movements that “should have worked”
And all of this takes time.
Time that doesn’t improve patient care.
Time that doesn’t grow the clinic.
Time that simply disappears.
The hidden cost: uncertainty
There’s another problem that’s harder to quantify.
When segmentation is clearly off, you lose confidence in the plan.
Not dramatically.
Just enough to wonder:
Will this track?
Will I need refinements?
Am I compensating - or overcompensating?
That uncertainty is what slowly erodes predictability.
What many experienced clinicians eventually accept
Most of us don’t become better aligner clinicians by trusting the software more.
We get better by questioning it earlier.
By assuming:
Approximals are less reliable than they look
“Perfect” movements are rarely perfect
Attachments need to support reality — not animations
Clear aligner treatment becomes predictable not when the setup looks flawless,but when it has been interpreted.
A deeper dive (if this resonates)
If you’d like to explore this topic further - from digital setup logic to biomechanics and clinical decision-making - you’ll find practical, step-by-step guidance in our book, Mastering Aligner Orthodontics.
It’s written for clinicians who’ve already discovered that the real challenge isn’t starting with aligners - it’s making them behave predictably.
Why AlignerService exists
These frustrations are exactly why we built AlignerService.
Not because clinicians lack skill or insight - but because decoding segmentation errors shouldn’t be part of your daily workload.
We help bridge the gap between digital design and clinical reality,so setups behave more like teeth - and less like mathematical models.
Final thought
If you’ve ever looked at a setup and thought:
“This shouldn’t move like that.”
You’re not wrong.
And you’re definitely not alone.
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Kind regards
Jesper Hatt DDS
P: +41 78 268 00 78
AlignerService
We are dentists helping dentists create realistic, safe and predictable treatment plans with clear aligners.
Currently more than1500 dental practices in 19 different countries use our service on a regular basis. We offer expert guidance in the following clear aligner systems: Invisalign, SureSmile, ClearCorrect, TrioClear, Angel Aligners and Spark.
AlignerService is a preferred partner of ClearCorrect and TrioClear.
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