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Clear aligner death zone

When learning something new, you need to start slowly in order to pick up the pace later.

This applies to everything new.


Even when we think we have mastered a particular skill, there is almost always something new we can learn that can improve the quality or increase our efficiency. Unfortunately, this always requires us to slow down while we implement our new knowledge. This is also why many initiatives are never implemented.


a small child stands in front of a very long staircase and is about to take his first step upwards

Need for knowledge

When we teach dentists how to use clear aligners, it almost always comes as a surprise to the course participants how much new information needs to be implemented in the dental practice. This is also one of the reasons why so few dentists seriously implement clear aligner treatments in their clinics.


Unfortunately, clear aligners are like any other treatment. If you don't perform enough treatments regularly, you'll never master this type of treatment. Since there is a reason why it takes 3-4 years to become an orthodontist, there are also many dentists who never get around to treating enough patients with clear aligners.


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How many treatments should I do?

It is said that you need to perform 100+ implant procedures a year to be good at placing implants. If you don't perform the treatments regularly, you will slowly lose the skills, just like you will never become super good at performing them.


As with the implant treatments, you should perform about 100 clear aligner treatments a year. Otherwise, you'll never get a good grasp of the treatment and never get to master it.


I know that may sound like a lot of treatments.

But think about it.

If you love doing fillings, you probably do a lot of fillings and have become good at it.

If you don't love performing periodontal surgery, you probably don't perform many periodontal surgeries and as a consequence you will never become proficient at that type of treatment.


Respecting competences

The two examples above are treatments that are both within our normal areas of competence. When we talk about clear aligner treatments, the necessary competences are well beyond our normal area of competence. This means that we have to spend a lot of resources to get a basic understanding of orthodontic principles, biomechanics and biophysics.

In addition, the clinical management of ortho patients is somewhat different from our regular patients. So we have to implement a new workflow. In that workflow lies a lot of skills that we can use in all parts of our dental practice, but that very few clinicians implement. For example, the ability to take a series of clinical photos in 2 minutes without assistance, patient communication around complex treatments, patient conversations about financing relatively costly treatments, or the design of the entire patient experience as it has a huge impact on the patient's choice or refusal of treatment.

Golden star

Should you be an expert?

It is possible to start treating patients with clear aligners without being an expert in all areas from the beginning. It just requires that you have a reliable partner who is a dentist, or orthodontist with massive clinical clear aligner experience combined with extensive orthodontic knowledge (Orthodontists always have this) and an understanding of the differences between the way fixed appliances and clear aligners work (Here many orthodontists are still challenged).


I sometimes hear dentists refer to themselves as experienced users of clear aligners after they have performed 15-20 treatments. However, it is only after about 500 clear aligner treatments that one begins to have enough experience to perform a reasonably valid case selection. So beware of listening to colleagues who have not performed enough treatments.


Treatment planning support

You can buy a lot of help. Here it is important to know a little about what you are paying for. There are relatively many companies that provide so-called "treatment planning support" or "treatment planning services". Most companies in this category consist of technicians without a dental background who have worked for an aligner company. They may also be laboratory technicians who have dealt with clear aligners. What they all have in common is that they can be skilled at making the movements of an aligner treatment more predictable. But if the plan moves the teeth out of the bone or the teeth are going to cause problems with occlusion, airway or aesthetics after alignment, they have no predisposition to diagnose those problems. They just move the teeth more predictably.


So it takes a dentist with extensive knowledge of orthodontics or an orthodontist with knowledge of clear aligners, combined with good diagnostic data, to be able to put together a treatment plan that is realistic, biologically defensible and predictable.

So if you are seeking support, it is essential to secure these skills. Moreover, it is an advantage that you always have the same dentist/orthodontist to help you. Over time, as the aligner expert gets to know you-and your preferences-it will make your plans better and more likely to give you what you want.


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Death Zone

It is not easy to implement clear aligned treatments in practice so that patients receive good care. There are many elements that need to be managed inside and outside the practice.


Getting there requires a well designed action plan and a system to follow up on the plan to ensure that goals are met. This requires a lot of resources from the practice manager and from the whole team in the practice.


I once heard a foreign colleague describe the process as climbing Mount Everest. On the way up, there are a number of camps to reach. One of these camps is in the death zone. At this altitude the body slowly breaks down, so that over time you become so weak that you cannot survive.

To reach the top, you have to move from the death zone to the top. Not everyone makes it. There are many obstacles and many risks involved. But those who make it to the top achieve something special - to stand on top of the world and become part of a small elite that has overcome the same challenge.


If you plan your journey to clear aligner success carefully and get help from one or more experts, you may well get past the "clear aligner death zone" that 80% end up in and prevent them from achieving clear aligner success.


If you would like help implementing clear aligner treatments, like ClearCorrect, Invisalign, SureSmile or Spark in your clinic, please feel free to contact us.

Dentist Jesper Hatt in clinical clothes with dental loupes hanging on his chest

Many kind regards

Jesper Hatt DDS



Phone: +41 78 268 00 78


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