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Reduce the need for additional aligners / revisions

Tips for effective clear aligner treatments

Clear aligner treatments such as Invisalign, ClearCorrect, SureSmile or Spark have revolutionized orthodontic treatments by offering a discreet, predictable and comfortable way to straighten teeth. While patients who have been correctly diagnosed, have an optimal treatment plan and optimized digital setup/ClinCheck and follow our recommendations typically receive a highly effective treatment, some patients may experience the need for additional aligners to achieve the desired results. In this blog post, we will explore some helpful tips to reduce the need for additional aligners and optimize clear aligner treatments.


The literature is flawed

In the literature, we seem to recognize a general misconception about orthodontic treatment with clear aligners. Until now, the general perception has been that the initial treatment plan, which is digitally designed and clinically transferred to the patient, should be the only treatment plan created during the entire treatment once, fully developed, when working with clear aligners. The challenge is that we cannot predict patient compliance or biology in advance. It is therefore naive to think that you can predict a complete orthodontic treatment 100% before treatment begins. It is therefore rarely possible to avoid additional aligners / revisions when performing orthodontic treatment with clear aligners.


two hands with clinical latex gloves give a thumbs up as a sign of success

When treating patients orthodontically with fixed appliances, a treatment plan has been developed prior to the start of treatment. This includes a clear vision of the final end result. The braces are placed on the patient, who is continuously monitored throughout the treatment. From time to time, the dentist can change the position of the brackets, change the type of wire (material, thickness, shape), bend the wire, add additional auxiliary appliances, etc. In this way, the treatment is continuously corrected so that the patient eventually ends up with the desired result. Transferred to clear aligner treatment, you could say these kind of corrections performed during treatment is the same as getting additional aligners / revisions.


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Need for a different perception

If we add the same mindset to the classic way of treating orthodontic patients with fixed appliances that we see described in the literature on clear aligner treatments. It would be equivalent to a patient being given a complete treatment plan with fixed braces and then having the braces fitted with a clear expectation that nothing needs to be corrected along the way!


Just like a classic treatment with fixed braces, a treatment with clear aligners must be thoroughly planned before the start of the treatment. In addition, it should be expected that all treatments requiring more than 20 aligners will need a correction of the treatment along the way. In other words, expect a need for additional aligners / revision.


While there are many similarities between classic bracket and wire treatment and clear aligner treatment, there is a big difference in the workflow. We will cover this in more detail in another blog post.


6 reasons why additional aligners / revisions are needed.

  1. The diagnostic material is inadequate (For example: photos that do not meet the golden standard and thus do not show everything we should be able to see. IO scans that are not performed according to protocol, inadequate X-rays)

  2. Diagnostics and treatment planning are not done correctly

  3. Insufficient control and optimization of the digital setup/ClinCheck

  4. Manufacturing defects of aligners (Extremely rare with major aligner manufacturers)

  5. Patient not using their aligners as prescribed (poor compliance)

  6. Patient biology

Below we take a closer look at some of the 6 reasons why additional aligners / revisions are needed:

  1. Accurate intraoral scans: Accurate impressions or digital scans of the patient's teeth are essential to achieve a precise fit and movement of the aligners. Make sure to thoroughly instruct the team members who will be performing the task in proper impression taking or digital scans. Only with an optimal digital representation of the jaws and teeth, it is possible to ensure that the aligners fit the patient's teeth optimally clinically and not just on the computer screen. This reduces the risk of fit issues and the need for further adjustments later on.

  2. Thorough diagnostics and treatment planning: A careful and thorough evaluation of the patient's teeth, bite, joints, muscles and functional occlusion is essential to develop an effective treatment plan. Through diagnostic tools such as good clinical photos, X-rays, intraoral scans or impressions, dentists can accurately assess where the teeth should ideally be positioned and thus where they should be moved - taking into account the patient's biology. By identifying any challenges upfront and developing a detailed treatment plan, you can minimize the need for additional aligners later in the treatment process. In particular, clinical photos should be of high quality and should meet the standard of care. Otherwise, it will not be possible to see all the necessary details when developing a treatment plan.

  3. Accurate and timely placement of attachments: Attachments or engagers are small buds of composite material that are placed on certain teeth to improve the grip of the aligners and guide the planned tooth movements. Accurate and timely placement of attachments according to the treatment plan is crucial. This ensures that teeth move as planned, reducing the need for additional aligners later in the process.

  4. Force distribution: Once the treatment plan is created, attachments or engagers are placed, the timing of the individual movements is checked and approved. The force distribution or speed of the planned movements should be checked. In orthodontics, the mantra should be: Slow down the speed for greater predictability and a shorter treatment time! It is often seen that aligner manufacturers' initial digital plans are too optimistic about the speed at which teeth are moved from aligner to aligner. This should be checked and corrected before an aligner treatment is approved and production of the aligners begins.

  5. Optimized changing of aligners: Correct aligner replacement is essential to achieve the desired results within the planned treatment time. Instruct the patient to change aligners at the specified time and to wear them for the recommended time period for a minimum of 22 hours a day. Consistent adherence to the aligner schedule contributes to more efficient tooth movement and reduces the need for additional aligners.

  6. Active engagement and communication with the patient: Motivate the patient to actively participate in the treatment process and comply with instructions and recommendations. Encourage the patient to report any discomfort or fit issues early so that any adjustments can be made quickly. By instructing the patient to look for potential aligner fit challenges themselves, many issues can be detected early and easily corrected, eliminating the need for a new treatment plan that requires additional aligners or revisions. Maintain open communication with the patient throughout the treatment process to ensure any challenges are addressed quickly and effectively.

  7. Patient biology Sometimes you just have to recognize that biology doesn't behave as expected. When this happens, the only thing to do is to first try to identify any reasons for the biology's unpredictability (has the patient been sick, are they taking any medication or supplements, etc.) Next, a new plan is drawn up and additional aligners are ordered.

Conclusion:

By following these tips, dentists can reduce the need for additional aligners and optimize clear aligner treatments like Invisalign, ClearCorrect, SureSmile or Spark. A thorough diagnosis and planning, accurate impressions or digital scans, correct aligner replacement, precise attachment placement, optimal sequence of tooth movement and force distribution, active engagement with the patient and patient biology are all crucial factors. By implementing a comprehensive and structured protocol for diagnostics, treatment planning, digital setup control, instruction and clinical control, you can achieve better and more efficient results while ensuring a satisfying treatment experience for your patients.


Always remember to consult with professionals and follow manufacturer guidelines to ensure safe and effective use of clear aligner systems.


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Dentist Jesper Hatt DDS

Kind regards

Jesper Hatt DDS



Phone: +41 78 268 0078



AlignerService helps dentists create realistic, safe and predictable treatment plans with clear aligners.

Currently, we support 1500 dental clinics in 16 different countries world wide.

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