Tech Tip: Information on impressions

In case you missed it, in our last tech tip, we walked you through how to locate an occlusal view of your original PVS impression scans in the doctor's portal.

On that same topic, we recently did a survey to find out what questions you had about impressions and the most common question was:

I have difficulty getting the distal of the last molars. Do you have any suggestions on an easy way to capture these?

Posterior distortion of the most distal teeth in the arch is 3rd on the list of most common impression issues. It can be difficult to get a good impression since it's hard to see back there. There are a couple of ways to avoid this problem:

1. Make sure that you're using a correctly-sized tray. It should extend past the last tooth in the arch without touching the gums.

2. Before inserting the tray containing light body, add some light body directly to the occlusal and distal portion of the last tooth in the arch, ensuring that the last tooth is completely covered with impression material.

And in case you haven't seen these, we have an array of articles in our Help Center, covering various impression topics. Whatever your questions are, these articles likely have the answers:

We hope you found this information helpful! Keep an eye out for our upcoming article on some provider offered tips & tricks on taking impressions.

Until next time...

USPTO determines Align’s claims probably invalid

We got some great news from the USPTO!

But first, let me explain. No, there is too much. Let me sum up:

Last year, ClearCorrect petitioned for ex parte reexaminations , asking the United States Patent and Trademark Office (USPTO) to review several of Align’s patents.* These ex parte reexaminations are currently underway. So far, the USPTO has indicated agreement with ClearCorrect's position that all 75 claims of the patents in question are invalid.

Meanwhile, our legal team has also petitioned for an inter partes review of Align Technology’s patent #6,699,037 (’037) with the USPTO Patent Trial & Appeal Board. (Align has not accused ClearCorrect of infringing this patent, but it contains claims similar to those in other patents that Align has asserted against us.)

An inter partes review occurs between two parties, with the USPTO judges acting as examiners. This approach allowed ClearCorrect’s legal team to directly present key examples of “prior art” that predate Align’s in an effort to question ‘037’s patentability.

Phew! Here’s the “great news” part:

On May 23rd, 2016, the Patent Trial & Appeal Board accepted ClearCorrect’s petition and decided to institute a trial to reexamine key claims of the ’037 patent. The board determined that there is a “reasonable likelihood that ClearCorrect would prevail in showing that claims 1, 2, 9, and 10 of the ’037 patent are unpatentable.” (Over 70% of challenges accepted by the board result in cancellation of patent claims.)

Scott A. McKeown (a partner with the Washington, DC law firm Oblon, McClelland, Maier & Neustadt), who is leading our effort at the patent office, explains:

“We now have the board's feedback on our key ground of invalidity, which is presented in the inter partes review. We now know there is strong likelihood for a positive outcome for our pending reexamination proceedings. This is exactly what we hoped to accomplish when we filed the ’037 review.”

Cool! So what’s going on now?

We are still awaiting final decisions in the ex parte reexaminations. Ex parte reexaminations tend to take one to two years to resolve.Inter parte reviews can be faster—we expect a final decision in this case within a year. Align’s one remaining lawsuit against us isstill stayed as the ITC deliberates whether they want to try their appeal again with the Supreme Court.

The board’s decision to review this patent is the latest in a series of legal victories for ClearCorrect. It is also indicative of reasoning that should also apply to the remaining lawsuit with Align. There is little reason to think that Align’s claims will fare better outside of the USPTO, since the same or similar patents will be cited. Align’s chances for success are rapidly diminishing as their claims are repudiated at every turn.

High-five, Legal. You rock.

*U.S. patents 5,975,893; 6,217,325; 6,398,548; 6,626,666; 6,722,880; 7,125,248; 7,578,674; and 8,070,487.

Tech Tip: Notes from your Technician

You may have noticed notes from your technician regarding your treatment setup. These notes can be about the case type, your prescription or the quality of your impressions. These notes or comments do not always require a response.

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If you have a question or would like to respond to the note, you can click DISAPPROVE and there will be a field for you to enter your response.

When disapproving a treatment setup, providing your technician with the following information will give them a clear picture of the problem and what you want changed, resulting in a quick turnaround on your setup.

  1. Tell your technician what you don't like about the setup.
  2. Tell your technician what angle you are viewing the setup from.
  3. Give your technician simple instructions on how you would like any issues to be corrected.

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The other type of note you might receive from your technician is usually a question on your prescription or materials before they can provide your treatment setup. In this situation, you will see the action item below, with the technician's notes and a field for you to reply.

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You may also receive emails (daily summary emails) notifying you that there is a note from your technician. You can click on the case in the email and it will ask you to log in to the doctor's portal where you will see the case and notes from the technician to reply.

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Viewing your original impression scans

The note from your technician may sometimes be about your impressions. If you would like to review your original impression scans, you can scroll down from the notification box and in the History section of the case, where you will see a title "Upper impression, lower impression received" along with the date it was receieved and an icon of the impression.

Each of the icons in the history can be clicked on, opened and viewed. (This is also how you can access your invoice, photos and the treatment prescription for the case.)

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We hope this information is useful to you when you're reviewing and approving your treatment setups!

Until next time...

Now offering new merchandise for taking photos

We’re happy to announce a new addition to our online store! Novus Dental Supplies' Full Arch Intraoral Mirror and a variety of cheek retractors.

These items are recommended for use when taking the photos required when submitting a case. You can pre-order these new items and save 10%. Enter promo code: PHOTO when ordering. The pre-order 10% off discount is for the new Novus Dental Supplies merchandise only and is only available until June 24th.

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Here is the selection of new photo merchandise you can choose from:

Full Arch Intraoral Mirror

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The Full Arch Intraoral Dental Mirror by Novus Dental is designed to provide the highest quality digital photo in dentistry. The mirror allows you to see a clear, accurate picture of both the maxillary and mandibular arch of your patient's mouth in two simple photos.

The most unique feature is the lightweight, easy to use design. While most dental mirrors only capture half of an arch in a single photo, the Full Arch Intraoral dental Mirror is sized appropriately to capture the full arch of the mouth, including the third molars, while sitting comfortably on the opposing arch.

The stainless steel base with double chrome plating provides a clear image while preventing breakage and discoloration during steam sterilization thus making the dental mirror significantly more durable than it's rhodium counterparts.

All the patented design features can be found in this Specification Sheet.

Instructions on use and cleaning the mirror can be found here.

We’re offering this product for $65.00 with an additional 10% off with the promo code.

Cheek Retractors - Mouth Widers and Cheek Retractors with Handles

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Whichever style you prefer, these cheek retractors are great for pulling back cheeks and lips when taking photos. The retractors are made of a polycarbonate plastic material and are fully autoclavable. It's recommended that they be cold sterilized between uses.

We're offering the retractors each in two different sizes, Adult and Pedo.

Each of the cheek retractors are $13.00 with an additional 10% off with the promo code.

These new merchandise items are being offered at these discounted prices for a limited time. Take advantage of these pre-order prices as they will only be available until June 24th.

Click to pre-order!

Estimated shipment - June 24th

Tech Tip: All about scanners

Making accurate dental impressions is easily the most essential part of submitting a case. There are many different options out there for capturing dental impressions, from traditional impressions to the wide variety of intraoral scanners available on the market today.

3-D technology has had a significant impact on dentistry in the last 20 years, and it is only expected to increase in the coming years. More and more doctors are moving over to intraoral scanners.

We thought that a tip covering intraoral scanning with ClearCorrect might be helpful, whether you already use an intraoral scanner or if you're considering one.

Intraoral scanners

A study from 2014 found that the use of intraoral scanners could significantly accelerate the work flow of making impressions.

Some benefits of using an intraoral scanner include:

  • More comfortable for patients than conventional impressions
  • Save costs on impression materials
  • No shipping hassles
  • Higher accuracy than traditional impressions
  • Fewer errors resulting in having to re-impress
  • Facilitates sending scans to ClearCorrect electronically, resulting in a faster turnaround

ClearCorrect accepts records from most intraoral scanners currently on the market.

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With the wide variety of intraoral scanners available, selecting the best intraoral scanner for you really comes down to your preferences. Some things you might want to consider when choosing a scanner:

  • Is the scanner portable?
  • Is the scanner light and easy to use?
  • Will the scanning experience be comfortable for patients?
  • Is there a cost for image export and storage?
  • Is the software for the scanner compatible with your practice management software?

Submitting a case to ClearCorrect with scanners

You can upload scan files from any intraoral scanner to ClearComm as long as the file is in STL format. (STL is an open, industry-standard file format that can be exported by most popular scanners.) Export your STL files from your scanner to your computer, and then upload those files just like your photos when you submit a case online, or on the case page after submitting.

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STL files are not necessary if your scanner has the option to select ClearCorrect as your dental lab and upload scans directly from the scanner. CEREC Connect and TRIOS currenty offer this option.

We provide instructions for some of the common scanners:

Model or impression scanners

We also accept scans from model or impression scanners like Motion View's Ortho Insight 3D Scanner. Whether you're using an intraoral scanner or a model or impression scanner, ClearCorrect works with your team to accept digital files enhancing productivity and quality.

Scanning tips

Here are a few tips for using scanners:

  • We strongly recommend that you visually inspect your STL files before you submit them to us. We recommend netfabb Studio Basic, which is available free for Windows, Mac, and Linux. Other STL viewing options include viewstl.com, MiniMagics and FreeCAD.
  • Some scanners output several files, but the only files we want are the upper and lower arches. The arches should be saved in separate files, with the arches oriented in occlusion.
  • Scan both arches, even if you're only treating or revising one of them. Recreating the occlusion based on one arch is prone to error. (This advice applies to PVS impressions as well.)
  • We prefer "closed shell" models, but "open shell" models are acceptable too.
  • To prevent aligners from flaring at the edges, always capture at least 3-5 millimeters of gum in the scan.
  • While bite registrations are no longer a requirement for submitting PVS impresions to ClearCorrect, this is still part of the workflow with some scanners. You can capture more accurate bite scans by including as much of the occlusion as your scanner allows.
  • We can't provide support for your scanner software, but if you have any other questions, as always, our knowledgeable support reps are here to help.

We hope you found this information useful!

Until next time…

Tech Tip: Case submission FAQs & tips from providers

In a recent survey, we asked some of our providers about any questions they might have on the topic of case submission, prescription and treatment setups. Below are some of the questions and answers. We hope you find this information helpful!

FAQ about case submission, prescription & treatment setups

Is ClearCorrect now 2 weeks for each aligner? I’m still using the 3 week method.

We did change our default wear schedule from 3 weeks to 2 weeks in 2015. At the same time, we also added the ability for you to choose your patient's wear schedule when you submit your case. With this change, you're able to request a 3-week, 2-week, or even 1-week wear schedule and you can dispense as many aligners as you see fit at each appointment. (This only applies to new cases--any cases that started on a 3-week schedule should still be on that schedule.) We recommend that most patients wear each set of aligners for at least two weeks. See our full article on aligner wear schedules.

Wear schedules can be viewed in the treatment setup and in the fine print on the treatment plan.

If a bite is no longer needed, how do we bypass this in CEREC Connect?

At this time, a bite scan is a requirement and part of the workflow when scanning with CEREC Connect. While we've made bite registrations optional, most doctors still like to take a bite scan to have as a record to compare to the bite that we provide in our treatment setup.

I understand that this system is only for anterior teeth. Is that correct?

No, ClearCorrect is an advanced system of clear aligner therapy that uses the latest digital technologies, design and clinical approaches to treat various types of malocclusion, ranging from simple to advanced extraction and surgical cases depending on the knowledge and expertise of the doctor.

What are the most common issues that cause a Limited 12 aligner case to be elevated to an Unlimited case?

When the ClearCorrect technician reads the case submission form, they try to follow all of the doctor's instructions taking into account the requested case type. However, if they can't follow both the treatment plan and case type instructions, they will prioritize the treatment plan instructions over the case type which can lead to upgrading the case to an Unlimited. If it's noted on the case submission form that the case type is a higher priority over the treatment plan, along with a note of which correction is allowed to be compromised for the case type, then our technician will follow those instructions instead of their normal protocol.

I’m not sure about the amount of trays to plan for. Maybe a guideline to selecting the right case type?

In 2015 we made a change where by default and at no charge to you, our technicians recommend a case type appropriate for the treatment you prescribe, which eliminates the need for you to choose the case type for your patient. However, if you have a preference, you can indicate it when you submit the case.

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Either way, the case type won’t be final until you approve a treatment setup and pay for the case.

If you want to choose your case type, we've prepared a simple chart to help you predict which treatment option might be best for your case:

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Can I ask for specific sizes or shapes of attachments for the setup?

Not at this time. Engagers are an active area of research and development at ClearCorrect and elsewhere. Many variations of engager shapes have been proposed and discussed in literature and professional forums, but in practice, once the shape is thermoformed in the engager template, problems of adaptation and air gaps reduce the capability of many of these designs.

Without conclusive information and until the mentioned adaptation problems are resolved, ClearCorrect is happy to stick to the simple horizontal and vertical engagers that we've been using for the last ten years, which have proven sufficient to help with movements requiring an engager.

Fortunately, because of the way we trim our trays, our aligners are 2-4 times stronger than our competitors. This can reduce the need for engagers in many cases.

It looks like some overcorrection was built into the treatment setup. Is this correct?

Overcorrection is only added to the case per the doctor's instructions. Overcorrection can be requested at the beginning of a case when filling out the submission form, when submitting a revision or when reviewing/approving the treatment setup.

No bite turbo or bite ramps were offered, is this something that will be coming or is it even necessary with the greater gingival coverage that ClearCorrect has in their aligners?

Doctors can request lingual engagers to prevent full closure of the teeth. This is an advanced treatment technique, and should be monitored carefully. Whether a bite turbo and/or bite ramp is necessary would be determined on a case by case basis.

In cases with anterior interproximal reduction, how can I have a virtual power chain added to the end of the treatment sequence so that I have all the required aligners, including for the power chain, without having to request a revision?

When submitting the case, just ask for overcorrection with a digital power chain on the last two steps in order to get a virtual power chain without having to request a revision.

How do you determine which teeth will start the movement? (Or, phrased differently); How do you stage treatment?

We use protocols that have been developed by our Chief Technology Officer, orthodontist Dr. James Mah; ClearCorrect founder Dr. Willis J. Pumphrey; and our VP Products, Paul Dinh, CDT. These protocols are applied on a case-by-case basis by our technicians to help get the outcomes you prescribe for your patients.

Is there a process that I can tweak the final treatment setup myself?

Not at this time, though we are aware that doctors are interested in this functionality. The current process for adjusting your treatment setup is described below.

How do I make adjustments to a treatment setup?

If the model looks inaccurate, you want to move the teeth differently, or you want to cancel the case, click DISAPPROVE when viewing the treatment setup and let us know what you want to do. Our technicians will do their best to make any changes you request and upload a new version of the treatment setup for your approval within a few days.

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I have difficulty with viewing the setup. It isn’t real clear to see the final result. I kind of just go on faith that it is going to look good.

At the bottom left of the setup, you'll see a timeline representing every step of the case. The starting position of the teeth is shown at the left. Steps with checkup appointments are numbered on the timeline, and the final position of the teeth is represented on the right as a retainer.

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To navigate between steps, you can drag the slider, click on a step, click the Previous and Next arrows, or click Play to animate the treatment from beginning to end. You can click Previous at the beginning or Next at the end of treatment to quickly toggle between views before and after treatment.

Shortcuts are available for the most common views: Upper occlusal, Lower occlusal, Right, Front, and Left. You can also rotate the model to view the teeth from any angle by clicking and dragging.

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I sometimes need help in deciding on the treatment setup.

When approving a treatment setup, it's best to begin with the end in mind - consider the whole treatment and what are the goals for that particular patient. Also, when filling out the case submission form, the more information you give the better treatment setups you'll receive.

For more information, see our recommendations for how to evaluate the treatment setup in our Help Center article on this topic.

As a “bracket man” for years, I feel that the torque movements are hard to envision. Can some support evidence or outcomes be made available to give me more confidence?

We understand that being able to see some successful outcomes is helpful. We offer a number of different case studies covering a variety of scenarios from treatment of a Class II with crowding and a deep bite, to treating an anterior open bite with clear aligners. You can check out all of our case studies in our Help Center.

Provider tips & tricks

Some of our providers offered a few tips & tricks for submitting cases. Nothing here should be taken as official advice or recommendation from ClearCorrect or its employees. It’s up to you to use your professional judgement on what is best for you and your patients.

  • "I usually let ClearCorrect dictate the course of action. I have had an extraction case that I had never done before and the ClearCorrect technician walked me through it and said that she had seen my other work and was sure that I could do this as well. It made me feel good."
  • "I look at my comprehensive diagnosis and go through in my head step-by-step what I need to correct the deficiencies."
  • "I like to avoid placing attachments at the initial stages, so that the patient can become accustomed to the appliances before making it tougher to remove them."
  • "I would recommend that all doctors finish with a digital power chain."
  • "I would overcorrect all rotations and ask for power chain to close any original spacing. My experience tells me that less engagers allow better fitting and tracking of aligners."
  • "I always leave 1mm of overjet between anteriors at completion to prevent a slight posterior open bite."

Thanks to all the providers who answered our survey!

Check out our Help Center for more helpful information on treating your patients with clear aligners.

Until next time...

Tech Tip: An in-depth look at impressions

Perhaps the most important aspect of submitting a case with ClearCorrect is making sure that you have clear, accurate intraoral scans or impressions. We thought we'd cover some of the basics on the topic of taking impressions, along with some new information that you may not know.

We love intraoral scans, but if you prefer taking PVS impressions, we happily accept them. We require both upper and lower impressions, even if you're only treating one arch. As we've mentioned recently, bite registrations are now optional.

You can use nearly any type of tray you like for your impressions except for metal trays. We don't return your impressions, so it's best to use disposable trays.

PVS or VPS materials work best for impressions. Polyether (Impregum) will work as long as the detail for the gum lines are there. In our experience, Sultan Genie™ VPS and Premium Dental VPS impression materials are easy to work with and deliver consistent results. If you prefer a different polyvinyl or polyether impression material, feel free to continue using what you're comfortable with. Alginate is not acceptable because it dries out and distorts.

A good impression looks like this:

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We recommend one-step impression methods for the best results, but we'll accept two-step impressions as well.

Make sure your trays are properly sized to fit all the teeth and surrounding gums. Because our aligners cover beyond the gingiva for improved retention, the importance for obtaining full and complete impressions cannot be overstated. Impressions that may have worked for other clear aligner companies, should not be assumed to work for our product (especially where the gingiva is not covered in the impression).

Our most common issue with impression distortions is material that hasn't fully set before being removed. There are a few simple things you can do to prevent this problem:

  • Set a timer and make sure to follow the directions for your material exactly
  • Discard the first inch of material that comes out of every new mixing tip
  • We recommend waiting an additional 60-90 seconds longer than instructed before removing the trays from the patient's mouth

Did you know that performing a cleaning before taking impressions, removes plaque which can make for better impressions and could reduce the amount of residual spacing at the end of treatment?

Any existing spaces or gaps that are filled with plaque can be properly caught in an impression if a cleaning is done before impressing. With the plaque removed, the spaces or gaps get accurately detailed in the impression and when the aligners are made, they can indent into those gaps and push out any plaque that develops during treatment. This process could reduce the amount of residual spacing at the end of treatment.

Help Center articles

Our help center has several helpful articles on the topic of impressions. Maybe they can be of use to you. Check out some of these great articles here:

We hope you found this information helpful! Don't miss our upcoming advanced training webinars on case submission, prescription & treatment setups or our advanced training series of webinars on various topics related to clear aligner treatment.

Until next time…

Now offering Reliance Orthodontics engager merchandise

We’re happy to announce a new addition to our online store! Reliance Orthodontics engager merchandise: Flow Tain flowable paste, L.C.R. composite paste, Assure Universal Bonding Resin and Assure PLUS All Surface Bonding Resin.

These items are recommended for use when placing engagers. You can pre-order these new items and save 10%. Enter promo code: RELIANCE when ordering. The pre-order 10% off discount is for the new Reliance Orthodontics merchandise only and is only available until May 26th.

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Here is the selection of new engager merchandise you can choose from:

Flow Tain

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Flow Tain is a flowable light cure composite used when filling engager voids. This material is very smooth when cured which will reduce wear and enhance patient comfort.  When cured, it has a low modulus of elasticity and is not as brittle as conventional composites. Even though Flow Tain is a flowable material, its time-dependent shear thinning properties prevent it from slumping for better control.

Using the 1.5g 19 gauge tips provided, this material is easily injected into lingual surfaces and across fiber splints.

We’re offering this great product for $15.00 with an additional 10% off with the promo code.

Flow Tain LV

Flow Tain LV is the same product as Flow Tain mentioned above, with a smaller 22 gauge tip.

We’re offering this great product for $15.00 with an additional 10% off with the promo code.

L.C.R.™ (Light Cure Retain) Composite paste

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L.C.R.™ is a flowable, light cure orthodontic paste-type composite, also used for filling engager voids. This 5gm syringe of highly filled light cure resin paste is great for when longevity and durability is required.

We’re offering this great product for $17.00 with an additional 10% off with the promo code.

Assure Universal Bonding Resin

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This bonding resin will increase adhesion to normal, atypical, dry or slightly contaminated enamel. This universal bonding agent bonds to metal restorations without additional primers. No drying or light curing required and it can be used with any light or chemical cure system. Assure Universal Bonding Resin is an Enhance Adhesion Booster and bonding resin in one step!

It will bond to the following surfaces without additional primers:

  • Fluorosed
  • Deciduous
  • Bleached or wet enamel
  • Dentin
  • Metal surfaces
  • Composite restorations

We’re offering this 2ml bottle for $33.00 with an additional 10% off with the promo code.

Assure PLUS All Surface Bonding Resin

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The difference between Assure and Assure PLUS is that if you're using Assure, you must use and apply a porcelain etch and porcelain conditioner first, before applying the Assure. There is no porcelain etch step if Assure PLUS is used.

Assure PLUS will increase adhesion to normal, atypical, dry or slightly contaminated enamel and zirconia and acrylic temps without additional primers. This universal bonding agent bonds to metal restorations and porcelain without hydrofluoric acid. It can be used with any light or chemical cure system.

Assure Plus All Surface Bonding Resin will bond to the following surfaces:

  • Fluorosed
  • Deciduous
  • Bleached or wet normal and atypical enamel
  • Dentin/Cementum
  • Gold, Amalgam, Stainless Steel
  • Composite restorations
  • Acrylic temporary/pontic teeth
  • Porcelain

We’re offering this 2ml bottle for $48.00 with an additional 10% off with the promo code.

These new engager items are being offered at these discounted prices for a limited time. Take advantage of these great pre-order prices as they will only be available until May 26th.

Click to pre-order!  

Estimated shipment - May 26th 

Providers talk engagers

In a recent survey, we asked some of our providers to share their tips & tricks for placing and removing engagers.

Nothing here should be taken as official advice or recommendation from ClearCorrect or its employees. It’s up to you to use your professional judgement on what is best for you and your patients.

As the clinician it is important for you to be aware of different approaches, so that you can customize treatment for each patient. By way of example, while it may be possible to place engagers all at once in one patient, it may be necessary to cut the engager template and place engagers separately for another patient. Another example is the availability of various composite resins. Some patients seem to have no problems with engagers made from flowable resins, and with others they can wear away and break down. In this situation, a filled resin or other more durable resin can be used. 

We wanted to pass on some of these responses in hope that you might find them useful in treating your patients.

Tips and tricks on engager materials/composite/flash

Doctors who preferred flowable composite said:

  • “I use only flowable composite to fill the engager templates. It is easier and fills the template without voids. I know you recommend a two fill system, but it doesn’t seem there is time to do that and still get a good fill. I have had good luck so far with my variation of your system.”
  • “When placing engagers, use a little drop of flowable to “wet” the inside of the well prior to injecting paste, then a dab of flowable to “wet” the interface of paste and tooth when going to mouth.”
  • “Flowable composite seems to work best versus packable products. Also, checking the bite after placing engagers can prevent some engagers from interfering with the bite and being dislodged. “
  • “A “thick” flowable resin like GC Universal Flo will work well, without need for two materials, thin flo and thick paste.”
  • “I use flowable composite first, then a filled resin when filling the template.”
  • “The combo of flowable composite placed on the etched, primed/bonding agent light cured teeth and heavier composite place in the lubed engager reservoir works predictably on seating and curing. The sandwich of light and heavy composite will leave some flash to remove.”

Doctors who preferred different composites & bonds said:

  • “Using a lower viscosity composite, but not flowable.”
  • “Blue phosphoric acid etch bonds better.”
  • “I use a packable composite and place the college plier’s tips in either embrasure, forcing the aligner into closer contact with the tooth.”
  • “Use cheek retractors, spot etch, bond and use Surefil flow, which has been my best result in placing engagers.”

On the topic of flash, doctors said:

  • “I find that if I leave a little flash they stay on better.”
  • “They key is high speed finishing off any flash or over extension of composite. Wearing an LED headlight with loops and air drying the tooth/engager composite junction shows excess flash the best. Always verify that the next corresponding aligners seat completely in the excess flash removal evaluation. I use yellow or red striped carbide finishing points (like a 7901 or 7102) to remove the flash. Remove some with a high speed and water spray, air dry, repeat until satisfied and remember less is more.”

Tips and tricks for attaching engagers

Doctors offered us a multitude of tips on technique, tools and even timing for placing engagers. Here’s what they had to say:

Doctor’s tips on engager placement techniques:

  • “Poke a small hole through the engager tray from the inside of the engager area to extrude excess air and composite material, then perform minor adjustment on the surface of the engager to smooth if necessary.”
  • “Make a pin-hole in incisal edge/cusp tip of template of each tooth getting an engager. Hydraulic pressure relief as seat filled template allows easier, more complete seating.”
  • “Using a very small bur the diameter of an adhesive tip (I use Flow Tain with disposable tip), drill a small hole in middle of engager on the template. Prep the tooth as recommended, place template on the teeth and then fill the engager bubble with adhesive through the hole. This ensures the correct amount every time.”
  • “For placing engagers, pre-load composite in wells, cover from light bonding procedures, then directly to mouth, less change for salivary contamination by pre-loading.”

Doctors tips for engager template removal:

  • “The composite tends to stick to the template tray unless you wipe with alcohol and then apply the Vaseline.”
  • “I cut up the engager template and only attach 2 at a time.”
  • I usually cut the template. I keep 3 teeth, the engager tooth and the 2 adjacent teeth on each side. That way it will be easier to remove the template once the engager is placed.”
  • “Trays definitely need modification prior to placing engagers. I separate the right & left sides, and remove the lingual portion of the tray just past the incisal edge. This way I can peel the tray off easily. I also place a light coat of Vaseline with a micro brush on the inside surface of the tray where the composite will go.”
  • “On the template for the engagers, I remove the aligner material on the gingival side just below each engager well, right up to the edge of it, either with a high speed hand piece or a hole punch. Removing the gingival area below the engager wells allows me to wipe away any excess composite material that extrudes out of the gingival side of the engager well. It also provides me a purchase point to be able to lift up the template off of each tooth that has an engager.”

Doctors tips on tools to use for engager placement:

  • “I do better with composite out of a fine needle syringe. It seems to be strong enough to hold up, but there is some excess flash that needs removing.”
  • “Attaching with Filtek Ultra resin worked so much better than anything else for me. Microetching first is a must.”
  • “Pumice and selective acid etching before regular bonding routine.”

Doctor’s tips on timing of engager placement:

  • “Attaching to rotated lower canines always presents a challenge because of the super-acute angles between the canine and the adjacent incisor. You should request to hold placement of those engagers until the last possible time during treatment.”
  • “Sometimes to ensure proper placement, I will have the patient wear the trays for one week and then come back and place the engagers.”

Tips and tricks for removing engagers

Based on our responses, doctors seem to favor burs and using a combination of burs, discs and polishers.

Doctors who preferred burs said:

  • “I find that the best FINAL tool is a small pointed low-fluted carbide bur.
  • “Use Braessler ET long multifluted burs to remove engagers and/or excess.”
  • “Use a diamond or carbine finishing bur, get close to the enamel, then use enhance polisher to remove residual resin. Does not harm the enamel.”
  • “I only use a finishing bur. It helps to dry the surface to see if any bond remains. If there’s bond/resin left, the surface will be dull.”
  • “Use a high speed composite finishing bur, dry, followed with a composite polisher.”
  • “I use older ET composite shaping burs as they are less likely to cut enamel.”
  • “12 fluted bur.”

Some doctors prefer a combination of tools:

  • “I use a band remover to remove engagers and then go to a fine diamond bur then carbide flame bur and polish the surface with something like a pogo.”
  • “I use a sandpaper disc and football Brasseler finishing bur to remove them.”
  • “I remove engagers with 1) medium diamond to very thin resin, then 2) carbide finishing bur to enamel resin layer, then 3) finishing/polishing discs, points and brush and last, 4) burnish fluoride.”
  • “To remove engagers, I use a diamond finishing bur to remove the bulk and then switch to a Softlex disc for the final removal.”
  • “I first use a scaler, then Soflex discs, dry to better visualize the borders of composite. I check with the side of an explorer to see if the composite abrades some metal or if is completely removed.”

And some doctors prefer other tools:

  • “Remove with a white stone and high speed hand piece.”
  • “Use a high speed dry (no water so you can see the difference between the composite and the tooth structure, then use composite polishers to finish.”
  • “I use a fine diamond for gross reduction and finish with Dentsply enhance.”
  • “Use G-Bond provided by ClearCorrect, red stripe (fine) bur to remove 90%, then usually I’m able to flake off with a scaler. Not fun but it works without damaging the enamel.”
  • “Dura white stone high speed ulta dent polishing brush.”
  • “I like to remove the final layer of composite with a Brownie point, at a reduced speed.”

Doctor’s tips on engager removal techniques:

  • “I like to polish after removing engagers to make sure all is smooth.”
  • “You can always shave down engager slightly if too difficult to remove aligner initially.”
  • “Have patience in removing. Using a porcelain polishing diamond wheel works very well. When the resin is very thin a scalpel can be used or a rubber resin polisher will help remove resin without removing enamel.”
  • “Use a fluoride treatment after removal.”

Tips and tricks for lubricating

Doctors offered us several different tips for lubricating the engager template before installing, helping with template removal.

  • “Lubricate the template with Vaseline.”
  • “Apply mineral oil to the aligner beforehand so engagers don’t come off in the tray.”
  • “Make sure template is thoroughly coated with a separator and pull template away facially not incisal after curing.”
  • “Your seating video is spot on. The key is to lube the engager housing with either a dab of Vaseline or separating liquid (Sure Sep by Belle de St. Claire lab products).”
  • “We coat the template with Pam cooking spray before bonding the engagers. It makes it easier to remove the template. With multiple engagers the bonding material would sometimes fracture during template removal before using the releasing agent.”
  • “I find that the template needs to be wiped with alcohol before using Vaseline. My guess is that there is some type of oxygen inhibiting layer that the composite sticks to.”
  • “I spray the inside of the aligner with a light mist of non-stick cooking spray and then air blow it out of the engager well, not allowing any to pool up but still leaving a thin amount of separating medium. The separating medium in the template helps prevent the composite from bonding to the template and also aids in disengaging the template from the teeth which minimizes the engagers popping off.”

General tips and tricks regarding engagers

From installation techniques and engager modification to patient preparation, here are some general tips offered from providers.

  • “The engagers are pretty sharp to the lip so I always polish them a bit.”
  • “ Have the patient wear the engager stent/tray for at least a week before placing the engager.”
  • “I do one quadrant at a time. Usually there’s an area on the tray that serves as the best point for removal. You may want to consider adding something similar to a removal button on PFMs.
  • “Important to place pressure on the template from buccal and lingual. This ensures the engager is not too thick.”
  • “Magnification is a must.”
  • “Keep area clean and dry. Etch the enamel very thoroughly. Fill template and push the material into each attachment to adapt it well.”
  • “I make sure to abrade the enamel slightly with air abrasion or diamond and then etch. I fill with composite slightly below level, then place a dot of flowable composite to fill the last bit so it is level before placing in the mouth.”
  • “I always round them just a little after I place them. They seem to work fine and it makes the trays easier to insert and remove. I know that could cause some trouble at some point, but so far it has not.”
  • “I do them one at a time so I can press the engager matrix hard against the tooth with the back of the tips of a cotton forceps.”
  • “You should overbuild the engager and reapply material if it does not look accurate.”
  • “Sometimes we like to modify the tray and enlarge the engager to act as a hook and use the engager with elastics/rubber bands to help super erupt a tooth.”
  • “We prefer longer treatment without engagers than shorter treatment with engagers. We also prefer to have engagers removed at the earliest possible step instead of waiting until treatment completion.”
  • “I try to always prepare people for engagers: “You’ll have a big, tooth-colored blob on these three teeth…etc. This way they don’t freak out: “You told me I could take them out but I can’t take this blob out!”

Thanks to all of the providers who answered our survey!

Check out our Help Center for more helpful information on treating your patients with clear aligners and don't miss our upcoming advanced training webinar Case submission, prescription & treatment setups or our advanced training series of webinars on various topics related to clear aligner treatment.

Until next time…

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