For aligners to do their job as intended, it's important to wear them in order. Unfortunately, because aligners look so similar, it's not always easy to tell when they've been shuffled out of sequence. This can happen at the office, in the patient's possesion, or (though we do our best to prevent it) it's occasionally possible for them to be mixed up during packaging.

That's why last summer, we started laser–marking aligners. Of course, your first reference is going to be the step number printed on the aligner bag, but the laser markings provide a way to double–check that you're dispensing the correct aligners to your patient. Your patient can use them, too, to keep track for themselves. Here's what you'll be looking for:

The first section of the code represents the patient's ClearCorrect case number. This number is referenced on ClearComm, on the treatment plan, and in most emails from ClearCorrect.

The next section represents the step number. The example above shows a Phase Zero aligner. Usually, this will be in the form of a letter and number. For instance, step 4A (representing the first step of Phase 4) would be followed by 4B, 4C, 4D, and then 5A.

And the final section represents whether the aligner is for the upper (U) or lower (L) arch.

You'll also find matching codes on the bottom of each dental model.

Occasionally you may receive an unmarked aligner (for instance, engager templates are currently unmarked). In that situation, you can double–check aligners by comparing them to the dental models. We have some upgrades planned which should enable us to laser–mark 100% of aligners and engager templates soon.

If your patient does end up wearing aligners out of sequence, don't panic. It's usually not an insurmountable problem. Assuming that the aligners fit well and there aren't any complications, you can identify which step best corresponds to the current position of the patient's teeth and continue from there.

If you have any suggestions for how we can make things easier for you, please don't hesitate to let us know. Until next time…

We talked earlier this year about using Hilliard thermopliers to finish out a case and complete a difficult movement. Today, we'd like to share another great use for thermopliers.

Sometimes, aligners just don't want to stay down, especially in the posterior. This is often caused by a lack of adequate retention points. Aligners work best with bulbous teeth. Some teeth are just so short or straight-edged that the aligners don't have anything to grab onto.

Fortunately, there's an easy fix that doesn't require remaking the aligner or requesting a revision to add engagers. Simply heat up the pliers and make a dimple between two teeth on the facial and lingual sides of the aligner. You'll want to place the dimples down by the gumline, so they can tuck in between the bases of the teeth.

It's a quick and simple trick, but it can make a world of difference.

Now you can choose whether to submit your cases with traditional PVS impressions or go all-digital with intraoral scans. We've been testing this feature with our PREP group for a while, and now we're ready to open it up to the public.

Naturally, we won't restrict you to any particular brand or model—we'll accept scans from any intraoral scanner, as long as they're in STL format. (STL is an open, industry-standard file format that can be exported by most popular scanners.)

We've already tested scans from a wide range of scanners, including the 3M™ True Definition Scanner, 3Shape's TRIOS®, and even Align Technology's iTero™. Please do your research before you buy a new scanner, though. Confirm whether you'll be able to export STL files with your reseller or manufacturer. Some models may require a service or software upgrade to enable STL export functionality.

You'll download your STL files from your scanner to your computer, and upload them just like your photos when you submit a case online. When you do, we can start working on your case immediately instead of waiting for your impressions to arrive. We expect all-digital cases to get turned around days faster, with more accuracy.

If you don't have a scanner yet, don't worry. You can just keep doing what you're doing. We're happy to accept impressions as well.

Exporting tips

We strongly recommend that you visually inspect your STL files before you submit them to us. Our favorite STL viewing application is netfabb Studio Basic, which is available free for Windows, Mac, and Linux. Other options include MiniMagics and FreeCAD.

Some scanners output several files, but the only ones we need are the upper and lower arches. The arches should be saved in separate files, with the arches oriented in occlusion.

We prefer "closed shell" models, but "open shell" models are acceptable too.

When you scan a patient with an iTero scanner, choose the iCast or iRecord format. The Invisalign format will not permit you to export STL files.

We can't provide support for your scanner software, but if you've got any other questions, as always, your account rep is here to help.

The rumor mill has been spinning overtime, so let's make a few things clear:

• Align has not won any of their suits against us.
• We are still making aligners.
• Nothing has changed.

First, a quick recap. As you probably know, our good buddies at Align have a long history of suing their competitors. This doesn't usually work out that well for them—Align has had patent claims invalidated and they've paid out tens of millions of dollars in settlements.

But old habits die hard, and they've stuck to this strategy against us. In March 2011, Align sued us in California and Texas, and in March 2012, they filed two complaints with the ITC. These cases take a long time to play out: nothing significant has happened in the California case, and the Texas case is on hold. The first ITC complaint was decided in our favor this January.

This week, Administrative Law Judge (ALJ) Rogers issued his initial determination for the second ITC complaint. His opinion was that ClearCorrect did not violate Align's product claims, but Align's method claims were violated. Naturally, we disagree with that opinion. Regardless, here's what you need to know:

1. This is not the final ruling on the case. The ALJ's initial determination will be reviewed by the ITC before they make their final decision, scheduled for September 2013. Then that decision is likely to be appealed in the U.S. Court of Appeals for the Federal Circuit. The ultimate conclusion is probably still years away.
2. In the previous complaint, the ITC reversed this same judge's initial determination and ruled in our favor.
3. We don't have to do anything differently right now. There's no effect on our day-to-day operations until the ITC makes their final decision.
4. This initial determination has been incorrectly reported as "a ruling to block U.S. imports of a competing product by ClearCorrect." We make our aligners right here in Houston, Texas, so it's impossible for the ITC to block us from "importing" them. The only "imports" at stake in this case are digital files transmitted by diagnostic technicians in Pakistan. (We've argued that data transmissions shouldn't even be considered imports.)
5. Align's legal VP recently claimed to investors that if the ITC ruling went their way, "ClearCorrect will be excluded from the domestic market." That's simply not true. Even if the ITC rules completely in Align's favor, we can continue manufacturing and selling aligners in the U.S. The only thing the ruling will determine is how and where we can stage the treatment plans.

In short, don't panic. We're sticking around. We've just invested in scaling up our production capacity by 30%, and we've got a really cool announcement to share with you tomorrow. Until next time…

Update: Align put out a second press release shortly after this was posted, but nothing has changed. The "cease and desist orders" they refer to are just the ALJ's recommendations from his initial determination. As explained above, the ITC is not expected to make a decision until September. If the ITC does issue cease & desist orders, they will apply only to imported data—our ability to design, manufacture, and sell aligners in the U.S. is not at risk.

ClearCorrect's US operation remains unrestricted; Align Technology's litigious campaign remains unsuccessful

ClearCorrect, LLC announced today that it received notice of an initial determination in the patent infringement complaint filed by Align Technology, Inc. with the US International Trade Commission (ITC).

Align's complaint, filed in March 2012, alleged that ClearCorrect and ClearCorrect Pakistan (Private) Ltd. ("ClearCorrect Pakistan") infringed claims of seven Align patents and sought to have ClearCorrect excluded from the US market. Administrative Law Judge (ALJ) Rogers' initial determination presents his opinion that ClearCorrect did not infringe any of Align's product claims, but that Align's method claims (those claims concerning the way a certain process is performed) were infringed. The ALJ's opinion will be one of the factors that the ITC will take under consideration when making its final ruling, expected in September 2013. In Align's previous ITC complaint against ClearCorrect, the ITC decided to reverse ALJ Rogers' initial determination and found no wrongdoing by ClearCorrect.

"We view the preliminary ruling on the product claims as a big win and look forward to the Commission's review of the method claims," said Jarrett Pumphrey, ClearCorrect CEO. Indeed, the ITC's own staff attorneys have interpreted US patent law to mean that ClearCorrect does not infringe most of Align's method claims and ClearCorrect will present that interpretation when it asks the Commissioners to find no infringement of any of Align's patents. "We're hopeful the Commission will view the law as both we and their staff attorneys do," continued Pumphrey, "but even if the Commission upholds the Judge's recommendation in full, it won't have any material impact on our company or our ability to make aligners. That's what counts." In fact, ClearCorrect recently invested in increasing the production capacity of its US-based manufacturing facility by another 30%. "Business has been good lately," Pumphrey added, "and we're happy we can continue servicing our doctors who have all been so supportive."

The notice of the initial determination did not include the recommended remedy. However, the worst-case scenario for ClearCorrect would simply be the exclusion of computer data prepared by ClearCorrect Pakistan. Because ClearCorrect manufactures its aligners in the US, there are no aligner imports for the ITC to block. Though only last month Align boasted "ClearCorrect [would] be excluded from the domestic market," the reality is ClearCorrect is still allowed to service its customers in the US and will continue to do so. The preliminary decision thus falls squarely in line with Align's other failed efforts to prevent competition through litigation. Align's highly-publicized case against Ormco Corporation resulted in the invalidation of Align's patent claims and a settlement that paid Ormco tens of millions of dollars, including 10% of Align's stock. Align's first ITC case against ClearCorrect resulted in complete victory for ClearCorrect. And now Align's second ITC case has failed to prevent ClearCorrect from competing in the US market.

"ClearCorrect fully intends to press the investigation further and ask the Commission to find that Align's patents are invalid because of the vast amount of prior art," said Mike Myers, ClearCorrect's legal counsel. "ClearCorrect has always held that orthodontists taught Align about clear aligners, not the other way around, and, if necessary, ClearCorrect will pursue its arguments all the way up to the Federal Circuit Court of Appeals, the same court that held Align's patents invalid in the Ormco case."

Notice Regarding Initial Determination on Violation of Section 337 and Recommended Determination on Remedy and Bond

We've talked before about how important it is to express your intentions clearly when you request a case revision. (See this previous tech tip for details.) Taking a few moments to double-check your revision form can save a lot of wasted time down the line.

Here's one issue that's tripped up a few doctors: they check the box requesting overcorrection of a tooth, but then provide conflicting instructions elsewhere on the form.

When you request overcorrection, this indicates to our technicians that you'd like to continue moving teeth in the same direction as originally planned -- just with a little extra pressure. If we got a form with conflicting instructions like this one, we'll have to guess which instruction to follow, and we won't always guess right.

If you don't want overcorrection, don't check a box in the tooth chart. Just list the teeth by number in your written instructions.

Dr. Mason Jones and his patient Connie Hansen recently sat down with us to discuss Connie's treatment, results, and overall ClearCorrect experience.  

Two years ago, we launched ClearComm at dr.clearcorrect.com. We started with treatment setups and added new features over time, like case tracking, online submission, documents & forms, a wiki, and an online store.

Today, we're launching our biggest update yet: a fresh new case view including the status and complete history of every case you've ever submitted to ClearCorrect.

Updated case list

The changes start with an updated case list. Your cases are now sorted into three groups for easy access:

• Action needed
• In progress
• Closed

This is what you'll see as soon as you log in. The action needed list shows all your cases that need your attention before they can continue. This includes treatment setups that are ready for viewing, cases on hold, incomplete submissions, and cases that are missing impressions or photos.

The in progress list includes all your other active cases. It shows the next scheduled phase (or lets you knwo it's time to request a final retainer). 

Finally, the closed list is an archive of all your completed and canceled cases. It's there when you need it, out of the way when you don't.

New case view

Here's where it gets really cool. Click any row in the case list to open the brand-new case view. This is a complete timeline of everything that's happened in each case, and what's coming up next.

Newer cases include clickable thumbnails of photos, x-rays, submission forms, treatment setups, and even your impressions.

This new case view is where you'll go to approve treatment setups:

And to resume or cancel incomplete online submissions:

If you need to send us materials, we'll let you know here:

And, when everything's on track, you'll be able to see the current status of the next upcoming phase:

As items at the top of the page get completed, they move into the history.

But wait -- there's more...

We've also re-organized the sidebar to prioritize access to the most important links. Logos, documents, and forms have been moved to the wiki, and we've added a link to troubleshooting tips.

If you run into trouble, now your account rep's name & contact information is inculded right in the sidebar. Please don't hesitate to call or email us.

And if you're thinking this new case view would be a great place to add features like online case revisions, phase scheduling, and retainer requests, well, let's just say you're not alone.

Have fun checking out the new features, and be sure to let us know what you think. Until next time...

The appointment when your patient receives Phase Zero and views the treatment setup is often the most anticipated appointment. This is your patient's first experience with aligners, and they are usually anxious to start treatment and see results. If you help your patient view Phase Zero as an opportunity to get used to treatment, they will be mroe compliant with your instructions and confident in their progress.

This week, we're providing answers to questions that your patients might ask about Phase Zero.

What does Phase Zero do?

Phase Zero is a set of passive aligners that helps you get used to treatment while your active aligners are being planned and manufactured. During this time, you'll get used to cleaning your aligners, get lots of practive applying and removing them, and start to adjust to any "lisp" or foreign feeling they cause. After wearing Phase Zero, you should be comfortable wearing aligners.

Will Phase Zero move my teeth?

No. Phase Zero aligners aren't designed to move the teeth. They're passive -- just like a retainer. They help your teeth stay in the position they were in when your doctor took your impressions, so that your first active set of aligners will fit and you can start treatment right away.

Phase Zero is really uncomfortable. Is there something wrong?

It's not unusual to feel a little bit of pressure or discomfort when snapping in the Phase Zero aligners for the first time -- especially if you're never had orthodontic treatment. However, this doesn't necessarily mean that there's a problem. As long as the aligner fully seats over your teeth, you're good to go.

To help ease the discomfort and pressure of a new aligner, try soaking them in warm water or biting down on some Chewies.

What happens next?

If Phase Zero fits well, your doctor can approve the treatment setup, and ClearCorrect can start planning & manufacturing phase 1. If Phase Zero doesn't fit, your doctor will probably want to take new impressions and send them in.

Have you run into any other questions during Phase Zero fitting appointments? Let us know how you answer them in the comments.

Earlier this year, we announced the availability of case evaluations + treatment setups for $95. We created this option to give "on the fence" patients a way to visualize their results without committing to treatment. (Free case evaluations are also available without setups, for those times when you're just not sure which treatment option to choose.)

This week, we'll walk you through this new service and show you how it works!

Submit evaluation on ClearComm

To submit a case evaluation with a treatment setup, select "Evaluation + Setup" on the Submit a case page on ClearComm. You'll enter in all the necessary information about your patient, as if you were starting any other case.

The fee for a case evaluation plus setup is $95, $50 of which will be applied to your lab fee if you decide to start treatment.

Receive case evaluation

You will receive a case evaluation by email within 5 business days. It will include the estimated difficulty of the case, whether or not engagers will be needed, and a recommended treatment option.

After this evaluation is completed and sent to you, our technicians start work on your treatment setup. The treatment setup will be based on the instructions you provided when you submitted the case.

Approve treatment setup and upgrade case

Within 5 business days of receiving your evaluation, you'll receive an email invitation to view the treatment setup on ClearComm.

If you'd like to modify the setup, disapprove it in ClearComm and let us know what you'd like to change. A revised setup should be ready within 5 business days.

If everything looks good, simply approve the treatment setup in ClearComm. Then, call or email your account rep to upgrade the case to the recommended treatment option. You'll be charged the standard lab fee (minus $50). 

Phase Zero ships

Now here's where things are slightly different than what you're used to.

After you upgrade the case, you will get Phase Zero, but because the treatment setup is already approved, you don't have to go online to approve Phase Zero as well. Phase 1 will automatically ship about 15 days after Phase Zero, unless you request otherwise.

We're excited to offer this new service, and hope that it will be a helpful tool to inform your patients about their clear aligner options. We'd love to hear your feedback!

To submit a case evaluation (with or without a setup), or to begin a Limited 6, Limited 12 or Unlimited case right away, log on to ClearComm.