Clear aligner treatment has revolutionised orthodontic care, providing patients with a discreet and convenient option to straighten their teeth. As a dentist, it's crucial to ensure a smooth and effective treatment journey for your patients. Let's explore each of the steps and considerations to take during clear aligner treatment.
A. Pre-treatment Phase
Select your patient:
Determine the complexity of the patient and weigh that against your experience level.
To gain a deep understanding on the complexity of treatments and to learn how to treat particular conditions, read Diagnosis Type Treatment Guide. This guide grades treatments by complexity and by the orthodontic technique required, and grades by the expected experience required. The goal is to provide guidance on the efficacy of treatment for a particular condition and to aid providers select cases that best match their ability.
Submit the case:
Watch the guide on how to upload a new case or read How to submit a case in the Dr Portal.
Review the treatment plan and approve it for manufacture.
B. Treatment Phase
Treatment Start:
Once delivered, verify that the package is unopened and check the patient's name and aligner number.
Educate the patient about the treatment process, emphasising compliance and the importance of following the prescribed timeline.
Help the patient with the initial fitting, making sure they can both put them in and take them out safely: Read Guide to Inserting Aligners.
Placing Attachments:
If the prescription requires attachments, they are often placed on the first aligner fitting. Otherwise, arrange for an appointment to place attachments as per the prescription. These tooth-coloured, small composite ridges help aid in tooth movement.
Prepare the tooth surface by cleaning and etching then carefully place and bond attachments to the specific teeth indicated in the treatment plan, ensuring proper placement with the template included in the treatment plan. If you have not placed attachments before, consider joining a hands-on practical course. It covers attachments, IPR, bonded retention, and finishing restorative techniques.
Interproximal Reduction (IPR):
As part of the treatment plan, IPR may be necessary to create space for tooth movement. Assess the areas that require IPR and use the appropriate tools (strips, burs, or Swindle) to gently remove the amount of enamel directed by the prescription.
Follow strict guidelines to prevent excessive enamel reduction and ensure patient comfort.
Read the Guide to IPR.
Check-ups:
Schedule regular check-up appointments to monitor progress to ensure issues are addressed timely.
Assess the aligner fit, tooth movement, and overall treatment progress.
Check for any signs of poor compliance, such as evidence of aligner wear, oral hygiene concerns, or discomfort.
Some dentists only provide the patient enough aligners to wear until the next appointment to minimise the risk of aligners being lost and encourage compliance. If this step is taken, it is usually with younger, teenage patients.
Generally, check-ups are recommended every 4 to 8 weeks, depending on the treatment plan and patient's progress.
Usually, appointments will be more often early in the treatment plan, then extend depending on how well the patient is tracking.
Adjust the frequency as needed, ensuring regular monitoring of tooth movement, occlusion, and any areas that may require attention.
Patient's prescription compliance:
Remind patients to follow the prescribed consistent time of aligner wear per day, everyday.
Emphasise the need to maintain proper oral hygiene, including regular brushing, flossing, and cleaning the aligners.
Communicate the timeline clearly to the patient, and adjustments if compliance is not followed.
To understand the need for wear consistency, read: Biomechanics of Clear Aligners: How do clear aligners move teeth through the bone?
Order Revisions of the treatment plan:
In certain cases, revisions to the treatment plan may be required if unexpected challenges arise.
Factors such as delayed tooth movement, poor compliance, or insufficient treatment outcome should prompt a reassessment.
Collaborate with Proligner to order revised aligners to continue progressing towards the desired outcome.
Troubleshooting Issues:
Educate patients about possible issues, such as pain, discomfort, tracking issues, or aligner breakage.
Provide troubleshooting tips, including using aligner Chews, adjusting the fit with finger pressure, or using orthodontic wax for comfort.
Promptly address any concerns or issues to ensure patient satisfaction and treatment continuity.
Read the Troubleshooting Guide for:
Tracking Issues
Unintended or Residual Spacing
Tight Contacts
Aligners Don't Fit - Too Big or Too Small
Insufficient Space
Non-Compliant Patients & Tips for Keeping Your Patient on Track
Aligners Don’t Fit – Rocking (fits one side but not the other)
Aligners Don't Fit - Incisal Gaps
Insufficient Pressure
Maxillary Lateral Incisors Not Tracking
Bisphosphonates
Ibuprofen
Antihistamines
Poor Oral Hygiene
Attachment Fall Off
C. End Phase
Retainers:
Teeth have a natural tendency to shift back to their original positions, as the tissues surrounding them undergo a remodelling process after orthodontic treatment. Retainers play a crucial role in maintaining the achieved results by providing stability and preventing relapse.
Read The Key Role of Orthodontic Retainers in Post-Clear Aligner Treatment
Finishing:
After clear aligner treatment has completed it is a good opportunity to consider post alignment composite restoration to complete your patient’s orthodontic improvement journey.
Consider joining a Greater Curve course to learn about composite bonding, which is a cutting edge technique replacing dental crown to improve smiles, repair broken and decayed teeth.
Conclusion
Clear aligner treatment can yield excellent results when managed effectively. Dentists play a vital role in guiding patients throughout their treatment journey. By closely monitoring progress, facilitating regular check-ups, providing guidance, and addressing any issues, dentists can ensure a successful and satisfying outcome.
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