Why do my patient’s teeth still need movement at the end of treatment?

Question:

My patient has finished wearing their final aligner, but some of the teeth still aren't where we want them to be. What gives?

Answer:

First, make sure that your patient has been wearing their aligners for at least 22 hours a day. You can ask your patient, of course, and you can also verify wear by checking for occlusal scuffing and slight yellowing of the aligner material. Patient non-compliance is a common reason for teeth not tracking.

Even if the patient has been wearing the aligners regularly, it's very common for cases to require overcorrection to acheive ideal results.The final aligner should match the shape shown on the treatment setup—however, this doesn't always actually move the teeth into that position. It may be necessary to apply additional force by creating aligners with the teeth moved farther than you actually desire.

This is not unique to ClearCorrect. Age, sex, root length, bone levels, bone density, medications, and some systemic conditions can all affect the effectiveness of treatment. Studies show that orthodontists often fall short of their goals, especially for certain types of tooth movement. 

Overcorrection is especially likely to be needed for these types of movement:

  • Rotations (particularly single-rooted teeth whose roots have a circular cross-section)
  • Labial-lingual alignment (particularly of incisors)
  • Expansion
  • Extrusion (because the PDL tends to pull the tooth back into the socket)

If you know you're going to need overcorrection, you can request it upfront in your initial prescription. Just be sure to keep an eye on those teeth so they don't move too far. 

It's always safest to err on the side of caution—if you submit your case as Unlimited, additional phases won't add to your lab fee. When you submit a Limited 6 or Limited 12 case, you should be prepared for the possibility of purchasing an additional phase.

Make sure your patient is aware that there is no guarantee of acheiving results within a certain timeframe. Make sure they're aware that additional treatment may be required after the final step. (Some of this is covered in the required informed consent & agreement, but you'll probably also want to attach your own conditions regarding fees and outcomes.) It's better for everyone when you set realistic expectations at the beginning of the case.

Until next time…

A legal update… most likely more paperwork in store for the attorneys.

A recent decision made by the Federal Circuit Court of Appeals holds that the International Trade Commission did not follow their own internal procedures in the way it announced the ClearCorrect victory.

It was decided that the case would be returned to the ITC so that their findings can be decided in strict compliance with their own internal procedures.

In laymen's terms, Align still bears the burden of proving its case—that ClearCorrect is somehow Orthoclear reconstituted—and there is nothing in the court of appeals' decision contradicting the ITC staff's position that ClearCorrect is not Orthoclear.

Therefore, while the lawyers may need to file more papers to ensure that all of the ITC's internal procedures are followed, we're confident that the ITC's conclusion will remain the same.

ClearCorrect case study: Dr. Darren K. Miller

Check out the below case study written by ClearCorrect provider Dr. Darren K. Miller, DDS

Orthodontic case study: ClearCorrect treatment utilizing extraction of lower left central incisor

A 27-year-old female presented with a chief complaint of crowding on the upper and lower arches. Upon evaluation, it was noted that the patient had 2 mm and 4.5 mm of maxillary and mandibular arch length deficiency respectively, a missing lower left second bicuspid with primary tooth still present, small upper lateral incisors, cross-bite of the lower right canine, and lower midline shift to the right of 2 mm.

CLICK HERE TO READ MORE
 

Our terms & conditions, demystified

We'll just admit it upfront—terms & conditions are usually pretty dull affairs. They're full of legalese, and a lot of us just skip right past them.

However, our terms & conditions actually include a lot of helpful information. If you want to know what's included in a case, or what exactly our refund policy is, that's the place to look.

Our terms & conditions have changed a few times over the years (most recently last month). If you want to catch up on the changes, or if you never got through it in the first place, we've prepared this summary for you.

(It should go without saying, but this is just an overview of the terms as of today—if anything in this video conflicts with our current terms & conditions, the terms & conditions take precedence. And, really, you should read the real thing. It's not that bad!)

Until next time…

2014 Townie Choice Awards: Vote and WIN!

Voting for the 2014 Townie Choice Awards is now open!

Complete your 2014 Townie Choice Awards ballot by August 8, 2014 and you’ll be automatically entered to win a $250 Visa gift card, registration for Townie Meeting 2015, and your picture on the December 2014 issue of Dentaltown Magazine and $1,000!

Here are a few reasons ClearCorrect is on the ballot for two awards in the "Orthodontic" category:

  • VOTE NOW because ClearCorrect is manufactured in the USA.
  • VOTE NOW because ClearCorrect is the doctor-friendly alternative.
  • VOTE NOW because our cost is up to 30% less than the other guys.
  • VOTE NOW because treatment planning is flexible with phase-based delivery.
  • VOTE NOW because our doctor’s portal makes case managment simple.
  • VOTE NOW because our new and improved treatment setup is interactive and easy.
  • VOTE NOW because retainers are included with every case at no additional cost.
  • VOTE NOW because we have super service account reps.
  • VOTE NOW because we offer convenient online courses.
  • VOTE NOW because there is no course required for those with experience.
  • VOTE NOW because there are no yearly CE requirements.
  • VOTE NOW because there is no minimum number of case submissions required.

Please note, this ballot is open to dental professionals only, therefore Dentaltown requires you register with them before voting. If you aren't yet registered with Dentaltown, it's a snap to do so. Simply visit Dentaltown's registration page.

Changes to terms & conditions

We're making some changes to our terms & conditions, based on your feedback.

If you need more aligners than you originally paid for, you'll now purchase additional phases individually, instead of upgrading to a different treatment option. Even if a case is closed, you don't have to submit a new case—you can temporarily re-open the old case and purchase additional phases.

We recommend that you read the full document, but here are summaries of the main changes:

Product description

  • The terms passive aligners and active aligners are replaced with starter alignerstreatment aligners, and retentive aligners (a.k.a. retainers).

Treatment options

  • Once a treatment setup has been approved, cases cannot be upgraded or downgraded to another treatment option.

Open and closed cases

  • Cases no longer close after 365 days of inactivity.
  • Cases close when you request a retainer, or 90 days after the patient is projected to wear the final step, whichever comes first.
    • This deadline is based on the arrival date of the final phase + (the number of steps in that phase ✕ the wear schedule) + 90 days.
    • If you request a revision after the final phase is delivered, it will need to be fully processed before this deadline in order to keep the case open.
  • Any unused steps are forfeited when a case is closed.

Revisions

  • Revisions can now be requested to a phase up until it ships.
  • You should reschedule phase shipments as needed to stay in sync with your patient's wear schedule.
    • As a general rule, phases are rescheduled or placed on hold—not cases. A case with no scheduled phases cannot be placed on hold.
  • "Legacy cases" (Limited & Full) are no longer treated differently than newer cases. Additional phases are available for all case types, and no case type can be upgraded after the setup is approved.
  • There is no three-year "revision window." Revisions can be requested to any open case, regardless of age.

Case extensions

  • You can re-open closed cases and purchase additional phases for them.
  • No credit is applied for steps that were forfeited when the case was closed.
  • A retainer is not included with a case extension.

Restrictions

  • We removed the restrictions on re-opening closed cases.
  • We reserve the right to close any case five years after submission, regardless of any other policies in effect.

Cancellation and refunds

  • Refunds are available for standalone retainers or replacements only if you cancel the order before we receive all necessary records.

Shipment and delivery

  • You will receive starter aligners as soon as possible.
  • All other phases are scheduled to ship based on the wear schedule for the case.

These terms & conditions apply to all cases starting today, June 13.

As always, your feedback is welcome.

Introducing the Starter Kit

ClearCorrect Starter Kit

The first day of orthodontic treatment can come as a shock—it takes a while for most people to get used to pressure being applied to their teeth. That’s why ClearCorrect begins with starter aligners, designed to apply gentle pressure before ramping up movement in later steps.

We introduced starter aligners a few years ago as part of "Phase Zero." Now we’re expanding that concept into the new Starter Kit, shipping today at the start of every case.

Along with starter aligners, you’ll get:

  • a welcome letter for your patient with wear & care tips
  • a storage case
  • an OUTIE aligner removal tool
  • a sample of OAP Cleaner
  • and two Chewies to help seat the aligners.

Just pass everything on to your patient. If you want more of anything, it'll be available in our online store.

Starter Kit paperwork

We won’t ask you to approve the fit of the starter aligners on ClearComm anymore—we’ll just send the treatment setup as soon as it’s ready, and you'll be free to approve it right away.

Your patient should wear the starter aligners just like any other step, and (assuming you approve a treatment setup) Phase 1 will be scheduled to arrive when they're done.

If you do find a problem with the fit of the starter aligners, you can handle it like any other phase—request a revision on ClearComm and send in new impressions or scans. We'll now accept revisions right up until the ship date of each phase, so you can request a revision even if Phase 1 has already entered production.

The Starter Kit is now included with all new cases at no additional charge.

ClearCorrect case study: Dr. Jeremiah Danel

Check out the below case study written by ClearCorrect provider Dr. Jeremiah Danel, DDS:

How to Use Clear Aligner Therapy to Treat Severe Crowding

ITC grants ClearCorrect's motion to stay orders

As you may have heard, it was announced yesterday that the US International Trade Commission (ITC) stayed the cease and desist orders that were issued against us in the patent infringement action filed by Align Technology, Inc.

The ITC found that the equities of the case required that the status quo be maintained until the appeal is decided. As such, there will be no disruption to ClearCorrect's business operations during the appeal. 

The ITC’s ruling came shortly after the ITC was notified of recent developments in a case in Germany. In the German case, Align sued a competitor for patent infringement.  In that case, several of Align’s patents were recently found by the German court to be invalid.  One of the patents at issue in the German case is the European equivalent of one of the key patents at issue in Align’s action against ClearCorrect.

In summation, it's business as usual at ClearCorrect... and we look forward to continuing to service our providers.

New labels & improved paperwork

We've got a couple of cool changes to announce today.

Easier organization

First, we're making it easer to organize aligner boxes in your office. Starting this week, we'll be including a label inside each box with the patient's name and case information. Stick it on the side of the box, and you'll be able to identify all the phases on your shelf at a glance—no Sharpie required.

This label also includes a timeline, which might look a little different than what you're used to. That brings us to our second announcement: new treatment plans.

The new paperwork has a few benefits:

Simpler presentation

We used to fold the treatment plans in half, and we've been folding them in quarters ever since we shrank our packaging. Now we're taking advantage of that—the new treatment plans read like a booklet, with one page for each appointment's instructions.

We've removed all of the visual clutter and simplified our instructions. The results are clear and easy to read.

Accurate details

Despite the clean appearance, all the details you need are still there. Tooth charts represent the combined movement in both of the steps you dispense at each appointment. Missing teeth and untreated arches are removed from the chart. You can see all of the IPR, engagers, and Compliance Checkpoints planned for the case on the simplified timeline, which is now organized by steps instead of phases. (You got a sneak peek at a similar format on the new treatment setups).

Ready for anything

Perhaps most importantly, the new design is flexible enough to accommodate any new options we might want to add in the future. In fact, there's one improvement in particular that we plan to tell you more about very soon. Stay tuned…