Tech Tip: Education and other resources for patients

Once you have a clear aligner candidate in front of you, educating them is the key to obtaining positive results in clear aligner therapy. Setting realistic expectations at the outset of treatment can help make the patient's experience smoother.

We have several resources for educating your patients on clear aligners. 

For patients wanting more information on clear aligners, we recommend the 3-minute video How Clear Aligners Work, which covers:

  • Clear aligners and their relation to traditional orthodontics
  • How the aligners are made
  • How the aligners straighten teeth
  • How the teeth move and change in relation to pressure
  • Importance of wearing the aligners 22 hours a day

How clear aligners work.png

We also offer a short Before and After video showing clear aligner results with various types of issues:

  • Crowded upper and lower arches
  • Overbites
  • Shifted midlines
  • Crossbites
  • Upper and lower arch spacing 

Patient reviews are also available here

Your patient may also find our aligner wear and care guide useful, covering:

  • Expected daily wear schedule
  • How to care for the aligners
  • Do's and donts on food, drink, storage, etc.

It's essential for each patient to read and sign the informed consent form before committing to treatment, which covers:

  • What clear aligners are and how they workInformed Consent.png
  • Potential risks of clear aligners in relation to
    • expected results
    • adverse reactions
    • potential dentition issues (black triangles, irritation of soft tissue, IPR, tooth sensitivity, etc)
    • potential relapse
    • additional costs.
  • What they are agreeing to in relation to treatment and results

For patients that need help with financing, we partner with beWell patient financing, providing:

  • higher approval percentages
  • a dedicated account manger
  • an easy application process
  • no "gotcha" interest rates or pre-payment penalties

Our ClearCorrect online store provides a few patient items for those interested, including:

OAP_New_1024x1024.jpg
  • OAP aligner cleaner
  • Outies (aligner removal tool)
  • Aligner cases 

If you have further suggestions or any feedback on the above, you can send us an email or provide feedback in the box below.

Until next time…

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Flex & Unlimited Q&A webinars

We've received a lot of great feedback and questions about the new Flex & Unlimited price options that we announced last week. 

We're offering two free live webinars on May 15 and May 19 to discuss the details of Flex & Unlimited and answer any questions you may have. If that interests you, you can register here.

These new options are currently in testing with select providers—we'll be making them available to all U.S. providers on June 1, 2017, and the rest of the world later this year.

You can find more details and FAQs at support.clearcorrect.com.

Or, if you still have questions, just email us at support@clearcorrect.com or give us a call at (888) 331-3323.

Tech Tip: Is your patient a good candidate?

One of the best ways to determine if your patient is a candidate for clear aligners is by determining if they will be compliant or not. If you suspect they will not be compliant, meaning if your patient cannot agree to wearing aligners for 22-hours a day, they are not likely a good candidate for clear aligner treatment and it’s more than likely that you and your patient will not get the desired results. 

As a new provider, some examples of good initial candidates for clear aligner treatment, in addition to committing to full compliance and wear: 

  • Minor anterior spaces or crowding
  • Ortho relapses
  • Single arch treatment with minor goals

mild treatment.jpg

With some experience and success under your belt, here are some sample moderate cases:

  • Moderate anterior spaces or crowding
  • Minor to moderate overjet and overbite correction
  • Class II and Class III cases 

moderate treatment.jpg

The following conditions could reduce the expectations of successful treatment with clear aligners and we do not recommend doctors treating them without a considerable degree of education and experience with clear aligner treatment:  

missing teeth.png

severe crowding.jpg

The presence of any of these conditions does not prohibit treatment with clear aligners, but the doctor must consider how their presence affects the patient’s candidacy as a good aligner patient.

Check out our Help Center which is filled with useful information on the topic of clear aligner treatment.

Until next time…

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Announcing new Flex & Unlimited pricing

We just introduced some awesome new options at the AAO Annual Session, and we can't wait to tell you about them: starting June 1, you'll be able to choose between Flex (simple, per-aligner pricing) or the new and improved Unlimited (one flat fee for five full years of aligners—and retainers).

With Flex, you get exactly what you need—no more, no less. We’re making it super easy and ridiculously affordable (up to 70% less than the other guys). Single-arch treatment just got a whole lot cheaper. Whether you need just a couple of aligners or dozens of steps, you can customize your treatment to meet your patients' needs without squeezing into pre-set pricing tiers.

If you're the type who prefers to "set it and forget it," you're going to love the changes we've made to Unlimited treatment. For one flat rate, you'll get five full years worry-free—including retention. Unlimited covers all aligners, revisions, and replacements for five years. Your case won't close before the five years are up, even if you order retainers or treatment goes slower than expected. Best of all, the new Unlimited treatment also includes multiple sets of retainers—up to two pairs every six months—at no extra cost during the five-year period.

You can choose to treat any case as Flex or Unlimited, regardless of length, when you approve the treatment setup. It's entirely your choice whether you want to prioritize lower upfront costs with Flex, or cover your bases for future revisions and retainers with Unlimited.

These new options are currently in testing with select providers—we'll be making them available to all U.S. providers on June 1, 2017, and the rest of the world later this year.

You can find more details and FAQs at support.clearcorrect.com.

We're also offering two free live webinars and Q&A sessions discussing the details of Flex & Unlimited on May 10 and May 15. If that interests you, you can register here.

If you still have questions, email us at support@clearcorrect.com or give us a call at (888) 331-3323.

Tech Tip: 2 basic principles for clear aligner treatment

Clear aligners have a lot of advantages over metal braces—most obviously, they're clear and they're removable. There is a tradeoff, though. Because they aren't attached to the teeth, some movements can be more difficult to acheive than they are with traditional braces.

properly fitting aligners.jpg

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For this reason, it’s important for you to know the limitations of clear aligners so that you can properly assess whether they can achieve the treatment outcomes that you and your patient desire. There are two key principles to keep in mind.

Principle 1: Teeth need space to move.

When you prescribe your case, you can plan to create space with extraction, arch expansion, or IPR, depending on how much space is required. However, despite prediction and planning, there may be some instances where insufficient space will still be an issue.

For example, when teeth crowd each other there may be tight contacts between them. Tight contacts between teeth are common and exist naturally due to the patient's dentition. The teeth are so crowded, they press up against each other, and literally put each other under pressure. You can try to relieve this pressure by creating space (for instance, by performing IPR).

If there's enough pressure, the surrounding teeth may just move in to fill the space you’ve created. If this happens, you may need to create more space than originally intended. If this is not caught and addressed, it can prevent treatment from going forward as planned because the rest of the movements no longer have sufficient space to straighten out. This can result in treatment going off track and the aligners no longer fitting.

Checking Compliance-1.pngYou can check for tight contacts by running floss between the teeth. If the floss has a hard time popping in and out, then you know that you have a tight contact. (If the floss pops in and out easily, then you have light to moderate contact.)

Conversely, you don't want too much space left between the teeth. Compliance Checkpoints can also help you to tell if the space you made is closing as planned.

Solutions for creating more space

TIP: Always track the amount of IPR being done. We offer an IPR tracking chart for this purpose.

Principle 2: Teeth need pressure to move.

Most teeth will move with a little bit of consistent pressure on them. However, some types of teeth, some movement, and some other factors are more prone to issues than others. These include:

Solutions for increasing pressure

Each of these solutions can increase pressure. The key is knowing when to apply each one.

engager illustration.png Engagers may be included in the treatment plan based on your prescription and/or the technician’s recommendation. Engager preferences and timing can be adjusted according to the needs of the patient—just let us know when submitting the case or in a revision.
Dimples can be created in office with dimple pliers. These are used to increase pressure to assist with difficult movements. They can also be used to increase the retention of an aligner when needed, such as with short clinical crowns.   dimple.jpg
extruding with aux.jpg   Buttons and elastics can be used to help with extrusions. See our technique for extruding with auxiliaries.
Buttons and elastics can also be used to help with rotations. See our technique for rotating with auxiliaries.   elastic in place.jpg

Overcorrection is when the technician stages the last few aligners with a little more pressure in the desired direction to ensure the teeth move into their final position. Overcorrection can be requested in your case submission form at the start of treatment, or in a revision.

Digital power chains can be used to close residual spacing, which can occur if too much IPR was done. Or some cases start with spacing, and you just want to ensure all spaces have closed.

General solutions

Here are some techniques that can assist with both insufficient space and insufficient pressure:

Backtracking is used to get the teeth back on track by having the patient wear an earlier aligner longer before advancing to the next step. You can get best results by requesting a fresh replacement. You can combine this with other solutions, like adding dimples, extruding with auxiliaries, IPR or hand stripping, all designed to get the teeth back on track without requiring a revision.

Longer wear schedules may help with patients that you suspect are non-compliant or need more time to achieve planned tooth movements.

Increasing patient compliance can be achieved with incentives according to what you want to offer. Here are some incentives used by doctors:

  • Educating the patient that by wearing their aligners 22 hours a day, they can avoid delays and added costs, and will be more likely to complete treatment within the expected time frame.
  • Explaining the alternative (traditional braces) if aligners are not worn 22 hours a day.
  • Using the treatment setup as an incentive to be compliant – reminding them of what their teeth could look like if they keep to their wear schedule.

Consequences

The consequences for not monitoring or addressing insufficient space and/or insufficient pressure can include:

We hope this article helps you to achieve your desired treatment outcomes. For further education on our techniques and solutions, visit our Help Center.

If you missed any of our previous tech tips, we post them regularly to our blog, which you can find here.

Until next time…

Tech tip: Methods for inserting aligners

When a patient tries on an active aligner for the first time, it's not going to exactly match the position of their teeth. (Obviously—that's how aligners work.)

Ideally, aligners should fit snugly at first, then loosen up over a couple of days as the teeth move into position. Sometimes, however, variables in patients' dentition or other factors such as flaring, inclining, or proclining teeth can cause discomfort for the patient or make the aligners difficult to insert.

If you have trouble inserting aligners, here are some techniques that you can try:

1. Front to back

Use this technique when the anterior teeth are excessively proclined (tipped forward) or excessively crowded.

  • Insert the aligner on the anterior teeth.
  • Then push the tray down over the posterior teeth.

2. Back to front

Use this technique when all of the teeth are relatively upright.

  • Insert the aligner on the posterior teeth first.
  • Then push the tray down over the anterior teeth.

3. Side to side

Use this technique when the posterior teeth are excessively inclined lingually.

  • Insert one side first, coming forward to insert the anterior teeth.
  • Then press down on the other side.
  • Cautiously, press the aligner on using the fingers; do not bite the aligners on with teeth.

4. Sectioning the aligners prior to insertion

Use this technique when there is excessive anterior proclination or excessive posterior inclination.

  • Cut the aligner in half along the midline.
  • Insert one side of the aligner fully into place, then insert the opposite side.
  • After a couple of stages, it probably will no longer be necessary to section the aligners prior to insertion.

5. Anterior then lingual or buccal

Use this technique when the teeth are flared either lingually or bucally.

  • Insert the aligner on the anterior teeth.
  • Then push the tray down on the side that is flared, for example, if the teeth are flared lingually, push the tray down on the lingual side. If flared bucally, push down on the buccal side. (If the aligners are inserted in the most difficult area first, the rest of the area should be easy to insert.)

When you get the aligners on, they should snap into place. If they don't, or if there is a small incisal gap, you can give the patient a couple of Chewies to bite on for a few days. These should help the aligners to fully seat.

For additional help with aligners not seating, we have a few articles that may be helpful to you:

We hope this information is helpful! Check out our Help Center which is filled with useful information on the topic of clear aligner treatment.

If you missed any of our previous tech tips, we keep them regularly posted to our blog, which you can find here.

Until next time…

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U.S. Patent Office to Reopen Align Patent Reexaminations

Good news, everyone!

We received notice from the U.S. Patent and Trademark Office (USPTO) that two of ex parte reexaminations that concluded in Align’s favor earlier this year have been ordered to reopen by the USPTO Director.

Last month, we published a press release about the USPTO’s Patent Trial and Appeal Board (PTAB) decision to cancel all of the challenged claims in Align’s U.S. Patent 6,699,037—a huge coup for Team ClearCorrect!

As anticipated, the PTAB’s decision helped bolster our efforts with our other Patent Office proceedings and we expect more reexaminations to reopen with favorable conclusions from the USPTO.

Can’t get enough of all this crazy patent stuff? Maybe you’re in a Fantasy Patent-Law League? Check out our blog post about our proceedings at the USPTO for more details and links to legal documents (oooh!).

Tech Tip: Troubleshooting engagers

While most of the time placing and removing engagers is a fairly simple process, it can sometimes be troublesome. We thought we’d offer up some of our “tricks of the trade” when it comes to troubleshooting the more common issues with engagers.

When engagers are not fitting in the aligner, aka “engagers are not tracking”

When an engager does not line up with the space created for it, it can cause discomfort or pain when inserting and removing the aligners. It can also delay the movements of the affected teeth.

In this situation you don’t want to force the aligner into place over the misaligned engager – this can do more harm than good by moving the tooth in unwanted ways.

Try the following options:

  • Remove the engager that's not fitting in the aligner, and use the previous aligner as a template to place a new engager on that same tooth.
  • Check for tight contacts that may be preventing movement and if you find any, follow instructions given for breaking tight contacts.
  • Inspect the engager for excessive bulk and/or flash. The excess material can cause the aligner to lift away from the tooth making the aligner less effective and may lead to tracking issues.
  • Try backtracking with the previous aligner, the teeth may just need more time to make the needed movement.
  • Though the engager will still apply pressure to the tooth and work towards completing that difficult movement, there may be a slight gap in the aligner because that tooth will be moving a little behind schedule. (In the meantime, Chewies may help close those gaps and help your patient feel more comfortable.)
  • If the aligner fits everywhere else, remove the engager that isn't fitting into the aligner and continue with treatment. That particular tooth probably will not move as scheduled on the treatment plan, but the movement can be completed later with a refinement at the end of treatment using auxiliaries or dimples.
  • If all else fails, remove the engagers from all of the teeth, take new upper and lower impressions, and request a case revision. This may delay treatment, but it will allow us to tweak the treatment plan for that particular tooth.

When engagers fall off

The most common cause for why an engager might fall off when removing the aligner, is that the composite is not fully adhering to the tooth. Bond failures are usually technique related and by doing each step well, the cumulative error in the chain of failure is reduced.

Common conditions related to engagers falling off (it could also be a combination of these issues):

  • Plaque might prevent the etch from working
  • The tooth could be a restoration (Try to avoid bonding engagers on restored teeth whenever possible. Advances in tooth-colored restorative materials have brought forward materials that do not etch, even with fluoric acid and are tremendously resistant to sand-blasting.)
  • Lubricant used on the engager template could have accidentally smeared on the tooth
  • Compressed air that is used to dry the tooth is contaminated with oil or water
  • Using too much primer
  • Excess moisture or saliva
  • Inadequate light curing (All light cure units wear down with time resulting in reduced curing intensity. Refer to your manufacturer's guidelines for proper care and maintenance to maintain performance.)

Try the following:

  • When plaque prevents the etch from working, using a pumice will remove the plaque properly.
  • If the tooth is a restoration, use a special etch for porcelain from your dental supplier. (Note: This does not always work.) Here is an article on bonding systems that may help you in choosing a bonding agent.
  • If lubricant from the template is accidentally smearing on the tooth, lift the template off of the tooth during insertion. Or, if possible, use the previous aligner to install the engager without using lubricant. The composite won't adhere to used aligners as much as it will to new templates.
  • Compressed air used to dry the tooth is contaminated with oil. This is the most common problem with compressed air and is hard to correct in the system.  Make sure to service and maintain your compressors to ensure clean, dry air. Try drying the tooth with a low-heat blow dryer that can be bought at a dental suppler. 
  • Using too much primer will weaken the bond between the engager and the tooth. Primers are meant to work in thin layers. A blast of compressed air for 3-5 seconds can help thin out the layer of primer. Refer to the manufacturer's guidelines before attempting this for the first time.
  • Intraoral retractors and saliva evacuation systems can help reduce excess moisture or saliva and will increase the integrity of your bonds.

Broken engager templates

Engager template can sometimes break due to a lack of lubricant in the engager void and surrounding area.

What to do?

If the engager template breaks, we’ll be happy to replace it. You may call and place the order with us, or fortunately, there is a quick and easy alternative that keeps your patient in active treatment.

Instead of waiting for a replacement template, you can use the current step as the engager template. Since it has been worn, the composite should easily release from the engager void.

Or, if you don’t have the current step, you can have your patient wear the new set of aligners without the engagers. Schedule your patient to come back for another appointment two weeks later, then use the worn-out aligners as an engager template for the next step.

We hope this tip helps you with any potential issues you might have with placing engagers. Check out our Help Center which is filled with useful information on the topic of clear aligner treatment.

If you missed any of our previous tech tips, we keep them regularly posted to our blog, which you can find here.

Until next time…

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Tech Tip: Engagers - how to remove

The engager  is made up of dental composite material, so a good general guideline for EngagerIMG14.pngremoving engagers, would be to use the same methods that you would use to remove composite from the tooth.

Parts needed

  • Highspeed handpiece with water irrigation
  • White stone or multi-fluted composite finishing burs
  • Fine diamond burs
  • Ceramic bracket remover pliers (optional)

Instructions

Here are five different methods for removing engagers:

  • Use a high speed handpiece with water irrigation and a multi-fluted composite finishing burr to grind off the composite. Most efficient method
  • Start with a diamond or a more aggressive burr to remove the bulk of the composite (be careful to not damage the enamel) and then finish off with a multi-fluted finishing burr or a stone.
  • Use your customary technique for polishing the enamel surface of the tooth.
  • Use a series of diamond burs ranging from coarse to fine. Most expensive method
  • Use "ceramic bracket remover pliers" and white stone polishing burs, both found in almost all orthodontic supply catalogs. Least effective method

Checking if all the composite has been removed

A common technique is to drag a metal tipped instrument such as a scaler or an explorer over the tooth. Composite resin will be revealed as the material picks up marks from the metal instrument. This is a good practice not only for ensuring all the composite material is removed but also to prevent enamel damage, particularly when using diamond burs.

Alternatively, a lead pencil may be used to mark the composite. This technique works beautifully to better visualize small composite fragments left on the tooth. 

Check out our Help Center which is filled with useful information on the topic of clear aligner treatment.

If you missed any of our previous tech tips, we keep them regularly posted to our blog, which you can find here.

Until next time…

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Tech Tip: Best practices for engagers

Engagers (a.k.a. "attachments" or "buttons") are composite shapes added to the teeth to 
engage the aligner and assist with movements. They act like small handles for moving teeth. Engagers are often recommended when treating patients with clear aligners.

There are a number of important things to keep in mind when you need to place engagers.

Know before you go

  • ClearCorrect's technicians will recommend a number and location of engagers, but you can always override those recommendations.
  • Engager preferences are always at the discretion of the clinician and it’s up to you to make any necessary changes.
  • Let us know your preferences in the Engagers, Avoid engagers on these teeth, and Additional instructions sections of the case submission form, when you submit your case.

Staff preparation 

  • engager best practices-2.pngReview the treatment plan sent with the case or the treamtnet setup to see if engager placement is recommended at this appointment.
  • If yes, confirm that the patient or parent has signed an informed consent form.
  • Prepare instrumentation as required by doctor. 
  • Identify locations for engagers on treatment plan.

Placing engagers

Fully describe engagers to the patient (and the parent if patient is a minor) before placing them.

Discuss possible negative side effects, including:

  • Tissue awareness
  • Diminished esthetics
  • Possible debonding – not an emergency
  • Always get signed consent before placement.

Prepare the teeth 

  • Use lip retractors.
  • Consider using air abrasion with 50 micron aluminum oxide.
  • Acid etch only the area beneath the engager.
  • Thoroughly rinse off the acid etch.
  • Use warm air to dry the teeth.

engager best practices 2.pngPrepare the templates & place engagers

  • Trim the template(s) if desired.
  • Put a light, thin coat of petroleum jelly, Pam, or mineral oil inside the engager bubble or void .
  • Use an explorer to put a hole in the engager bubble for composite extrusion.
  • Fill the engager bubble about 2/3 full with paste composite.
  • Fill last 1/3 with flowable composite.

engager best practices 3.pngFinish engagers

  • Apply bonding agent to the etched & dry tooth.
  • Place the template on the teeth and light cure.
  • Remove the template and any composite flash.
  • Check the fit of the new aligner.

Document placement of all engagers

  • You can use the treatment plan enclosed with every case.
  • Note the date of placement next to the engager graphic on the treatment plan.
  • Alternatively, note step, date and location in the patient’s chart.

Removing engagers

Engagers can be removed at the patient’s demand, but be sure to inform them that the aligners may not move the teeth as well as expected without them.

Use the same methodology as one would for removing composite restorations or orthodontic bracket adhesive:

  • White stone finishing burs (will not cut enamel)
  • Multi-fluted composite finishing burs (will cut enamel)

Following these best practices can help make the task of placing engagers quick and easy. We hope this information helps you place engagers more effectively. Check out our Help Center which is filled with useful information on the topic of clear aligner treatment.

If you missed any of our previous tech tips, we keep them regularly posted to our blog, which you can find here.

Until next time…

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