A lot goes into 10 years in business...

ClearCorrect began as a little family business in Dr. Pumphrey’s office to service his patients. Now, after 10 years, we have over 20,000 providers globally.

We didn't do it alone—we want to thank all our doctors who have been with us through thick and thin. It’s through your support that we’ve come this far and we’re proud to be on your team.

We made a little video to celebrate our journey and to take a look at what the next ten years may hold.

Happy holidays!

Case Study: Clear Aligner Therapy with ClearCorrect and CEREC

CEREC and ClearCorrect

Dr. Matthew Parker discusses how he pairs ClearCorrect and CEREC to improve his workflow and efficiency with clear aligners.

Continue on to Dental Products Report to learn more about Dr. Parker’s process and results.

 

Dr. Matthew ParkerDr. Matthew Parker loves dentistry. He is committed to providing the same level of care to each patient that he would to a member of his own family. He enjoys attending continuing education courses and is always looking for new ways to improve the quality of the dental work he provides.

Dr. Parker is a member of the American Dental Association, Arizona Dental Association, Academy of General Dentistry, International Congress of Oral Implantologists, American Association of Endodontists, and the Academy of Osseointegration. Dr. Parker is enthusiastic about technology and what those advances have done for dentistry. He continually seeks to stay abreast of the new topics in dentistry and is passionate about discussing the best treatment options for his patients.

Dr. Parker also serves as a mentor for cerecdoctors.com. In this role he helps educate other dentists about CEREC technology and its applications. Dr. Parker loves digital dentistry and is always excited to discuss this and learn with others.

Find out more about Dr. Parker and his practice at www.arizonafamilydental.com

We're doing the holiday giveaway, again!

     Santa’s coming early this year…                  
 

To celebrate and express our appreciation for all our great providers, we’ll be giving away some awesome prizes every weekday from November 21 through December 30.

Every weekday, we’ll be giving away a $100 Amazon gift card, selecting a provider randomly from all of the treatment setups that have been approved since the last gift card drawing.

Every Friday, we’ll also give away an even bigger prize, selecting a provider randomly from all of the treatment setups that have been approved since November 19, 2016.

Here’s the lineup of prizes:

We hope you enjoy the rest of 2016! Until next time…

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Void where prohibited by law. This contest is open only to registered ClearCorrect providers residing in the 50 United States and the District of Columbia who are 18 years of age or older at the time of entry. This promotion includes two categories of prizes:

  1. A random drawing for one of thirty $100 Amazon.com gift cards (value $100 each) will be held each weekday between November 21, 2016 and December 30, 2016. The winner for each of these drawings will be selected from the pool of all treatment setups for new Limited 6, Limited 12, and Unlimited cases that have been approved since the last gift card drawing. (For the first drawing on November 21, 2016, winners will be selected from the pool of all treatment setups for new Limited 6, Limited 12, and Unlimited cases that have been approved since November 19, 2016.)
  2. A random drawing for one of six grand prizes will be held each Friday between November 25, 2016 and December 31, 2016. The winner for each of these drawings will be selected from the pool of all treatment setups for new Limited 6, Limited 12, and Unlimited cases that have been approved since November 19, 2016. Grand prizes include: a YETI Tundra 250 Cooler (value $899.99); a GoPro HERO5 Black camera (value $499.99); an Apple Watch 2 - 38mm (value $1049); a 256 GB iPad Pro 12.9-inch with Wi-Fi (value $999); a 256 GB iPhone 7 Plus (value $969); and a Samsung 65" 4K UHD TV (value $1,399.99).

Potential winners will be notified by phone or e-mail. Recipient is responsible for any applicable taxes or fees. At ClearCorrect's discretion, prizes may be substituted for a gift card or alternate prize of similar value. No purchase necessary to win. Contact info@clearcorrect.com for details. Employees of ClearCorrect and their family members are ineligible for this promotion. By participating, contestant releases ClearCorrect, LLC and their directors, officers, employees and agents from any and all liability for any injury, death, loss, tax liability or damage of any kind arising from contestant’s participation in this contest, or resulting from contestant's acceptance, possession, use or misuse of the prize. Use your professional judgment. Submit and approve cases only for patients whom you believe are likely to benefit from clear aligner therapy.


 

Digital Bracket Removal

Did you know that ClearCorrect offers Digital Bracket Removal?

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Now you can easily transition your patients from traditional wires & brackets to clear aligners or retainers without risking relapse. Scan your patient's teeth--wires and all--and ClearCorrect's technicians will digitally erase the brackets from the 3D model.

Here are some doctor reviews of this feature:

"In the past, in order to get the most accurate clear retainers for our braces patients, impressions were made immediately after the brackes were removed, and retainers made that same day. The patients were excited to have the braces removed, but impressions are kind of a bummer for the patient and our team. Now, ClearCorrect allows us to scan with braces on, and have clear retainers ready for the patient's big day. They turned a busy and uncomfortable braces removal visit into the celebration it should be!" - Dr. Matthew Fortna

"Today I successfully used ClearCorrect's Digital Bracket Removal Process for my patient wearing metal braces. I was impressed how quickly I was able to issue her first 2 steps of aligners upon completing the digital removal of her braces.

Additionally, I was extremely happy about how accurate the aligners fit, and the patient was ecstatic to see how easy it is for her to complete her orthodontic treatment with ClearCorrect. This digital option allows my practice to offer better patient management, as it involves just one short 'scanning' visit prior to starting aligner treatment." - Dr. Jason Pireh, Smart Dental

Before & after digital bracket removal

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After

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Before

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After

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Before

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After

 

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Before

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After

How to request Digital Bracket Removal

Here's the process for digital bracket removal:

1. Take intraoral scans with brackets and wires in place

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We accept intraoral scans from most scanners currently on the market, inlcuding CEREC, TRIOS, 3M True Definition, Lythos, Carestream, and even iTero.

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2. In ClearComm, go to "Submit a case" or "Request a retainer"

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3. Send intraoral scans directly...

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or upload scans through our online portal

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4. Approve treatment setup (if applicable)

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5. Remove brackets and wires and deliver aligners or retainers

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We hope you find this feature useful!

Until next time...

Tech Tip: All about retainers & finishing cases

We sent out a survey asking doctors for their questions about retainers & finishing cases.

In this week's tip, we've consulted with our Clinical Advisor, Dr. Ken Fischer, to get answers to some of your questions. 

General questions about retainers

Can you offer guidance on the parameters for requesting additional aligners, chain, elastics, or fixed, full, or segmental braces?

Whenever treatment is not progressing as the doctor prescribed or intended, and after proper analysis discloses the reason it isn't, additional aligners or any of the other appropriate treatment auxiliaries may be called upon to re-orient treatment in the proper direction. The choice of which auxiliary to utilize is determined by the doctor according to what he/she feels would work best for the patient based upon the doctor's training and experience.

Treatment should be closely monitored at each appointment. If it seems that additional aligners are needed or treatment may need to be revised, you can use the treatment setupas a guide to help you diagnose what may have gone off track. For example, by comparing where the teeth are now to where they should be according to the treatment setup (based on the step the patient has advanced to), you will likely find where some of the planned tooth movements have not occurred. Whenever planned tooth movements have not occurred, it boils down to either not enough space for the tooth to move into or not enough pressure in the direction needed to move the tooth.

If you find that the teeth have incomplete movements (not extruded or rotated, etc.), check out our Help Center for some solutions based on your diagnosis of the issue:

Are the final retainers made differently than the aligners so they can sustain over time? For example, some patients say that their aligners feel more loose/stretch close to their 2nd week end mark, whereas the retainers are to be worn indefinitely after treatment. So, will this happen to the retainers as well?

ClearCorrect makes retainers from the same high-quality thermoplastic as its aligners. Ultimately, all thermoplastic materials will loosen with time. Occlusal forces, care by the patient, and the material chosen for the aligner or retainer can all affect how long they last. ClearCorrect provides the best material it can to sustain an optimum fit over time, but all thermoformed appliances will need to be replaced eventually. We recommend you switch out clear retainers for a new pair every 6 months.

I am new to clear aligners and am curious if the retainers fit similar to the active aligners.

Yes, just like the aligners for active tooth movement, retainers should initially have a snug fit that will eventually loosen over time.

Can a patient use the last aligner as a retainer?

Yes, as long as the aligner remains in good condition.

Questions about retainer wear

When is the best time to request retainers?

The best time to order retainers is as soon as the doctor's objectives and patient's preferences are resolved to the satisfaction of both.

How long do patients wear retainers? At least 22 hours per day? At what point do they go to wearing only at night? How long after the completion of a case should they wear the aligners?

The term a patient will be required to wear their retainers is determined according to the retention protocol established by the doctor. When making this decision the doctor weighs the type of treatment provided, difficult movements accomplished, patient compliance, along with other factors. For more information on retainers & retention see the article on this topicin our Help Center.

How long should each retainer last with 22/7 wear?

How long a retainer survives is mostly dependent upon how the patient cares for their retainer, how often and hard they chew on the material, how well they clean it, how carefully they insert and remove it, etc. As mentioned earlier, we advise ordering a new retainer for your patient after about 6 months of wear.

Instructions for proper wear and care for ClearCorrect aligners can be found here.

Questions about fixed retainers

When would the use of permanent retainers be acknowledged?

Fixed retainers are effective at retaining teeth that have been significantly rotated during treatment and when the patient adamantly demands one. You may also want to consider fixed retainers for patients with the tongue thrust habit or for patients that are more inclined to relapse due to failure to wear their retainers.

Some of my patients request a lower fixed retainer. Do you provide this service? If you don't what is your recommendation to give this service to my patient?

Some doctors insert bonded, fixed lingual retainers as an in-office procedure. Some labs will fabricate the wire for you, but it still needs to be bonded in the office by the doctor or staff. We do not provide the material for this option at this time.

Is it necessary to use a fixed lingual retainer if the patient uses removable retainers?

No, not at all.

What should be used for a fixed lingual retainer?

The decision of what type of wire to use for the fixed retainer is made by the doctor based on their preference and experience. Some doctors prefer a single round wire, such as a .032, that is contoured to precisely fit the lingual of the aligned anterior teeth and then bonded on the ends directly to the cuspids. Some doctors use a "braided" or "twisted" wire applied to the lingual of selected teeth, but these wires must be bonded to each tooth.

I have difficulty with upper fixed retainers being placed in the occlusion and then needing to deal with no posterior contact. Do you have any suggestions?

Upper fixed retainers should not be used if they interfere with the bite and prevent posterior contact.

I have difficulty with patients who have midline diastema (spacing) between #8 & #9. I like to place a fixed lingual wire retainer 1x1 on 8-9. If I do this, then the final retainers from you do not fit. So, I end up making a retainer myself and do not use the one provided. Do you see any way around this?

As long as the patient wears the provided ClearCorrect retainer full-time, the diastema should not re-open. When the patient begins part-time wear, i.e., bedtime only, perhaps just placing a small dollop of adhesive between 8-9 will still allow the retainer to fit.

Questions about finishing cases

What are the criteria for a good finish?

The best evaluation of a "good finish" is when all of the doctor's and patient's goals or treatment expectations are met. There isn't another definition for a "good finish" that will apply to all treatment and all cases.

Sometimes near the end of cases, within the last one or two aligners, I notice a little lack of tracking. Maybe it is insufficient IPR or lack of patient compliance. I'm wondering if you have any other suggestions of what this could be. 

Lack of tracking can certainly be attributed to one or both of the 2 factors mentioned. The first thing to do is to have the patient wear the last aligners an extra week or 2. If they follow their instructions properly, a good fit should be re-established. If not, you have a few options:

  • You can request a reproduction of the last aligners (a new set will snap on again and may complete these last movements)
  • Check for tight contacts, address any found and extend the wear of the last aligners or request a reproduction of them
  • If slight rotations are still needed, you can add some dimples where applicable to the last step, with either the current aligner or a reproduction
  • At the outset of the case, you can request either overcorrection or a digital power chain which may help to prevent against needing a revision at the end of the case. (However, be advised that even when these adjustments are requested at the beginning of treatment, poor patient compliance and/or difficult movements may still result in the need for a revision.)
  • And, if you prefer, you can also do a revision
It seems like there will most probably be some open contacts based on the occlusion. How much correction is expected after the case is complete?

First, determine if the open contacts are in excess to what was approved in the original treatment setup. What you're trying to determine is: do the open contacts match the oclcusion that was approved in the treatment setup or are they there due to incomplete tracking during the treatment? Minor open contacts in the occlusion will most likely "settle" into contact if given the freedom to do so. This will require a Hawley-type retainer. If the open contacts are significant, a revision requesting a digital power chain can always be submitted to "tidy" everything up.

What do I do if retainers are ordered, the case is closed and then the patient decides they want a revision too late?

Re-open the case, re-take impression/scans and submit a revision to comply with the patient's request. If there is an additional fee imposed by ClearCorrect, the doctor will need to decide whether or not to charge the patient.

How can I avoid revisions at the end of treatment by planning before or doing revisions mid-treatment?

Doing mid-treatment revisions does not always prevent the need for a revision at the end of treatment. Patient non-compliance can require an additional revision prior to delivering the retainers. Difficult tooth movements, such as extreme rotations, require careful monitoring and attention throughout the treatment in order to avoid end-of-treatment revisions. The best way to avoid end-of-treatment revisions is to require optimum compliance from the patient.

Another option is to request overcorrection or a digital power chain when first submitting the case.

I have difficulty getting teeth that were planned to erupt/extrude to do so.

Extrusion of fully erupted teeth is one of the more difficult tooth movements to successfully accomplish with clear aligners and requires the use of a horizontal engager. Whenever a tooth is expected to erupt or be extruded, always ensure that there is plenty of space to allow the eruption or extrusion to occur. For further help on extrusions, check our our article on Extruding with Auxiliaries.

I have difficulty closing open bites. Even with engagers, I am having difficulty closing an open bite on a lateral incisor. There is sufficient space (interproximal contacts are light between the lateral and its opposing dentition). Will it be necessary to remove the current engagers, re-scan and re-treat? Or, can I leave the engagers on, re-scan and re-treat? Or, should I give up and tell the patient I have done everything possible to close the space? 

First thing to make sure of is that there is no contact between the lateral and adjacent teeth. You can re-scan/re-impress, but you must remove the engager prior to re-scanning or re-impressing. Consider using the buttons and elastic technique as described in the article on this topic in the Help Center. This is an effective auxiliary technique for coaxing a stubborn lateral into place. For more information on open bites, check out the following articles:

I have difficulty sometimes with small rotations to finish a case which gets me stuck. Is there anything you can recommend for this circumstance?

The most common reason those lower incisors are the last to line up is usually because there is still a shortage of space for it to turn into. If this is the case, perform IPR, adding some dimples or submit for a revision. Alternatively, consider using a Hawley-type retainer or limited fixed braces to turn the tooth.

Finishing rotations is difficult. I asses if a little more IPR is needed, but it is a difficult/unpredictable movement for clear aligners I think, especially well-rooted teeth like canines. Would your fabricating internal "positives" to push on the rotated teeth line angles, help more than the engagers alone?

ClearCorrect does provide various vectors of pressure on rotated teeth to enhance effective rotation, however, the use of engagers is the best method for effecting rotations.

Tips & tricks

Some of our providers offered a few tips & tricks on the topic of retainers and finishing 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 judgment on what is best for you and your patients.

  • "I tell everyone that 'teeth have memory' and retainers are for life."
  • "Make the patient aware before they start treatment that they will be wearing them almost 24/7 for a year following completion."
  • "Use a fixed lingual wire with rotated or initially spaced teeth when possible before the retainers are made by your lab."
  • "I have found that scanning is superior to impressions in initial fit."
  • "I recommend retainer wear only while the patient is at home so that it doesn't get lost. At first, I suggest wearing it only while sleeping. If the retainer is tight, that means the patient needs to wear it more and then I suggest wearing it from after dinner until morning."
  • "I always tell the patient that at the end we will do some aesthetic contouring to get edges even, etc. It gives me the ability to smooth incisal edges and often round a line angle on any teeth that may have not fully rotated."
  • "I recommend thermoforming."

A big thank you to all the providers who answered our survey!

Check out our Help Center for more helpful information on clear aligner treatment.

Until next time...

Tech Tip: Types of retainers

There are a variety of retainers that can be used at the end of orthodontic treatment. The best type of retainer for your patient will depend on the type of treatment, any post-treatment corrections needed, and the patient's preference.

Retention protocols can vary from patient to patient and according to the type of retainer used. It's up to you to determine the best protocol for your patient. 

Here’s one example of a typical retention protocol used by an experienced orthodontist:

  • Wear the last aligners for 2 months
  • Full-time wear of clear retainers or Hawley retainers for 2-6 months
  • Follow up with bed-time wear of removable retainers
  • Schedule 6-month "retainer check appointments" until doctor determines that they are no longer necessary 

Clear retainers

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Some things to consider when looking at clear retainers for retention:

  • Pro: Same discreet appearance and convenience as clear aligners
  • Pro: After ClearCorrect treatment, retainers can be created based on an existing step or on new scans or impressions
  • Pro: Multiple sets of retainers can be ordered at once to reduce costs
  • Pro: Clear retainers can also be made in-office by vacuum- or pressure-forming over a model of the teeth
  • Pro: The full coverage of the retainer provides maximum retention to prevent relapse
  • Pro: Pontics can replace missing teeth for optimum esthetics with clear retainers

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  • Con: Occlusal coverage may be a problem for some patients

Hawley retainers

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Some things to consider when looking at using Hawley retainers for retention:

  • Pro: Lack of occlusal coverage may be more comfortable for some patients

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  • Pro: Hawley retainers can effect minor tooth movements
  • Pro: There are unlimited design variations

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  • Con: An impression and model must be made of finished teeth to create the Hawley retainer
  • Con: Production of a Hawley retainer requires a lab procedure
  • Con: The bulky lingual material may be a problem for some patients
  • Con: Some patients may be opposed to the visible metal wire 

Fixed lingual retainers

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Some things to consider when looking at fixed lingual retainers for retention:

  • Pro: Fixed lingual retainers can either be fabricated in the office or at a lab 
  • Pro: Fixed lingual retainers are discreet because they can be placed on the lingual side of the teeth
  • Pro: Fixed lingual retainers are particularly good at retaining a tooth that has been rotated 
  • Pro: Fixed lingual retainers are good for patients with a large tongue or with the tongue thrust habit
  • Con: Fixed retainers may not be able to be placed behind the upper teeth if the lower teeth will occlude on them, causing wearing of the lower teeth, damage to the fixed retainer, or mandibular displacement
  • Con: Fixed lingual retainers may be inconvenient and cause hygiene issues for some patients due to the additional required step when flossing (threading the floss behind the retainer wire before wiping the floss between the teeth in the interproximal space)

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  • Con: De-bonding fixed lingual retainers may be a maintenance issue
  • Con: All teeth must be well-aligned

For further information on determining retainer type and wear schedules, see our article on Retainers & Retention.

We hope you found this information helpful! Our Help Center is filled with more information like this on the topic of clear aligner treatment. Check it out!

Until next time...

How to order retainers

As you know, orthodontic treatment doesn't end when the teeth are straight—most patients will require retainers.

ClearCorrect can create clear retainers based on PVS impressions, intraoral scans, or (if applicable) a previous step. Multiple sets of retainers can be ordered together at a discounted price.

There are three main situations in which you might want to order retainers:

  • Retainers for an open case
  • Retainers for a closed case
  • Retainers for a new patient who wasn't treated with ClearCorrect

Here's how to order retainers in each scenario:

How to order retainers for an open case

1. Find the case under the in progress tab on ClearComm.

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2. Click on the case to go to the case page.

3. Click the red REQUEST RETAINER button. As specified in the terms & conditions, the first set of retainers ordered for any open case is free, if it is based on a previous step and the case has never been closed. Note that ordering a retainer will close the case, so make sure you're satisfied with the treatment outcome first.

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How to order retainers for a closed case

1. Find the case under the closed tab on ClearComm.

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2. Click the case to go to the case page.

3. Click the red REQUEST RETAINER button.

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How to order retainers for a new patient

1. Click the Request a retainer link in the sidebar.

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2. Fill out the patient’s information and click “Submit.”

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3. You will be taken to the case page for the new patient. Use the green UPLOAD button to upload scans, or the green SHIP button to print a shipping label for impressions.

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We hope this information was helpful to you! Check out our Help Center which is filled with helpful articles on clear aligner treatment.

Until next time...

Tech Tip: Tongue thrust

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Tongue thrust (also called reverse swallow or immature swallow) is the common name of orofacial muscular imbalance, a human behavioral pattern in which the tongue actively protrudes through the anterior incisors during swallowing and speech due to a neuromuscular imbalance. This is what is considered by most professionals as a true tongue thrust.

When the tongue passively protrudes between the anterior teeth while the tongue is at rest (as in the case of an overly–large tongue), this is a postural phenomenon, or a pseudo-thrust.

Doctors treating patients with large anterior spacing and extreme proclination should consider the size of the tongue or the tongue thrusting habit prior to commencing treatment.

Causes

Some factors that can contribute to tongue thrusting include:

  • A neuromuscular imbalance
  • An enlarged tongue
  • Thumb sucking
  • Large tonsils
  • Hereditary factors

What to do?

When considering the correction for an anterior openbite, it is imperative to determine the actual etiology, i.e. is it an environmental result of a large tongue, or a result of a hyperactive tongue thrusting against those teeth?

Proper identification and correction of an anterior openbite problem will greatly increase the long–term success of the treatment and the stability of the retention. While referral to a speech therapist may help with a neuromuscular imbalance, correction of the environment or openbite to allow the large tongue to properly occupy the oral cavity without it applying excessive labial pressure against the teeth can be sufficient without the help of a therapist.

Possible correction of an openbite can include clear aligners, ‘reverse-curve’ archwires, vertical elastics, or orthognathic surgery, depending upon the severity of the problem. A long-term retention protocol may be advised to increase stability of the correction.

We hope you found this information useful! If you're interested in more like this, check out our Help Center.

Until next time...

(Photo credit: Pacific West Dental Group)

Tech tip: anterior open bite with clear aligners

The following information is for reference when specifically dealing with dentoalveolar tooth movements with clear aligners and excludes all medical, functional, developmental and skeletal causes for open bites.

An anterior open bite is generally defined as a condition where the upper & lower posterior teeth are touching when the patient bites down, but the anterior teeth are not in occlusion.

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An open bite can occur during transition from primary to permanent dentition, and is considered to be a temporary stage of normal dentoalveolar growth and development.

Causes

Anterior open bite, like most other malocclusions, can either be hereditary or have environmental causes and are usually a combination of both.

Some of the more common environmental causes are:

  • Thumb, finger or pacifier sucking
  • Abnormal tongue function (such as tongue thrusting) or large tongue that occupies the space between the teeth
  • Trauma or pathology to one or both condyles
  • Neurologic disturbances, iatrogenic factors, e.g. extruding molars during treatment
  • Airway pathology

Some conditions, such as TMJ degeneration, can manifest as an open bite. Factors like onset and disease progression can also come into play. Along with this, other factors such as habits, mode of respiration, tongue size, smile display are all considerations—each of these a complex topic in itself.

Open bite & clear aligners

If an anterior open bite is present before, during, or after treatment with clear aligners, a comprehensive evaluation must be completed in order to properly determine the reason for the openbite, whether it is due to a dental, skeletal, muscular, or other etiology; only then can the appropriate course of treatment be applied.

Some dental open bites can be corrected with clear aligner treatment, pending examination and diagnosis to determine eitology of the open bite. When you submit your case, be sure you provide your technician with your treatment details for how you plan to correct the anterior open bite in the "Additional instructions" section. 

We hope you found this information helpful. Find more information like this in our Help Center.

Until next time…

Tech Tip: Basic principles for difficult movements

Rotations, extrusions and intrusions are some of the more difficult movements to achieve with clear aligners. Here are some basic principles to observe when attempting to rotate, extrude or intrude a tooth during clear aligner treatment.

Intrusions & extrusions

1. A tooth that’s not upright will not extrude or intrude easily.

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2. Place a horizontal engager and tilt it upright first.

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3. Make sure there is adequate interproximal space; use IPR where appropriate to make space and prevent collisions.

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4. Then extrude or intrude slowly.

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Extrusion

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Intrusion

5. If an extrusion doesn't work, try button & elastic auxiliaries.

Rotations

1. A tooth without space won't rotate.

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2. Give it adequate space to move/rotate without restriction by adjacent teeth.

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3. Then place an engageron the tooth to be rotated and rotate it.

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4. If you're having trouble with rotations, see our article on troubleshooting rotations.

We hope you found this information helpful. Want more information like this on the topic of clear aligner treatment? Check out our Help Center which is filled with useful information.

Until next time...